Collectively, the five nonprofits that compose Recovery Link – a coalition of addiction treatment providers in Hamilton County – have served this community for more than 250 years.
To assess the current state of the addiction and recovery services sector, we gathered the heads of these organizations, which work together to improve access to substance abuse treatment programs here by influencing policy, practices and funding for those services. They are:
- Josh Arnold, Talbert House
- J.B. Boothe, NorthStar Behavioral Health (formerly Crossroads Center)
- Morgan Gibson, The First Step Home Inc.
- Lisa Mertz, Addiction Services Council
- Patti Webb, Center for Addiction Treatment
During their tenures in the sector – Webb’s is the longest at 28 years; Arnold’s is close behind at 27 – these leaders have seen significant shifts in the approach to treating addiction.
Individualized care that considers the whole person
Arnold: We as providers are doing a better job … trying to serve the whole person. It’s not just, come (to us) for substance abuse, and go somewhere else for mental health, and go somewhere else for primary care. We’re trying to serve all the needs that individual has, or at least connect them and be facilitating that.
Gibson: The individualization of treatment has significantly changed. … We’ve gotten to a point where we can very much individualize what someone’s treatment services look like – whether it’s only individual services, or if you add group services; if you have a residential setting versus an outpatient setting; going home immediately after withdrawal management or detox services.
Boothe: No two people are alike when it comes to their recovery path. Certain things will work for one person that will absolutely not work for the next.
Webb: (It’s) seeing the bigger picture: There is no hope if the person overdoses and is no longer here. So what can we do to keep them alive one more day so that hope is still there?
Arnold: The need is not just an individual service. It’s often working with the family or other things that are affecting the individual because substance abuse and addiction completely can tear apart a family … it affects the relationships and the children and the school and the housing and work. … We’re serving the whole person, and potentially the family network that is being damaged by substances.
Gibson: We’re all trying to provide this continuum of care to make sure we have people who can be successful, because at the end of the day, that’s what we want for our clients – to live happy and successful lives without us.
Peer supporters
Arnold: I really like the changes that have happened in the peer recovery space in our field. We have adopted more peer recovery coaches, individuals with lived experience to help walk alongside folks with substance abuse issues.
Mertz: I think it allows for people in recovery to feel hope that they can pursue a meaningful career path in the field, which I don’t think was possible before. A lot of that is also related to expungement law changes for drug possession and related charges over the past 10 years.
Outpatient treatments
Gibson: One of the major shifts that I’ve seen in the last 15 years is a shift from primary residential treatment into more of an outpatient setting … that mainly took place since the opioid epidemic of ’16 to ’17.
Funding increases
Arnold: There’s been more emphasis in the last 12 years since the opioid epidemic hit (that) shifted some grant dollars and funding into this space.
Speaking of the opioid epidemic, addressing it has been a great success story in this sector. But that doesn’t equate to a decrease in addictions overall.
Arnold: We’ve done an incredible job from 2017, (when we had) 590 overdose deaths in Hamilton County, to last year, when we had 194 – still too many. So we’ve made incredible progress in the overdose deaths, but addiction’s still there.
As approaches to treatments have evolved, so, too, has the perception of addiction.
Arnold: I think stigma’s changed quite a bit, for the better. Everyone knows someone who’s been affected or impacted by someone with an addiction issue, whether it’s opioids or alcoholism or whatever it may be. … More people are accessing treatment (and) people are talking about it.
Mertz: The overarching theme of change has been public acceptance that substance use disorders are a disease and that they are treatable; that treatment must be prioritized for these individuals; and that recovery is possible.
But even with more awareness and acceptance surrounding addiction, misunderstandings still persist.
Arnold: I think the biggest misunderstanding with stigma is folks think that substance abuse is a character flaw, and it’s not. It’s brain disease. … It’s not because someone doesn’t want to be well and take care of their family. It’s because the grips of addiction are pretty darn severe.
Boothe: Another one is that anyone who has a substance abuse disorder doesn’t work. Our medication assisted treatment program for methadone opens at 6 a.m. because many of our patients come to dose before they go to work.
Arnold: Also, relapses are part of the recovery journey. I often hear folks say … “They went through treatment, and they relapsed, so the treatment didn’t work.” It’s not the way it works. On average, an individual relapses seven times. So to think that go once to an outpatient or to a residential center and get services and you’re going to be cured, that’s not the trajectory.
And with as far as addiction treatment has come, these CEOs are concerned about the impacts of rapid policy changes and funding cuts at the local, state and federal levels on the care they’ll be able to provide going forward.
Boothe: The majority of the individuals we see depend on assistance through Medicaid, through state funding.
Arnold: It’s estimated in Ohio that over 300,000 individuals will lose Medicaid coverage next year when they pull back the Medicaid expansion. That, plus other changes with the ACA requirements and healthcare coverage (and) the shift of potential grant dollars away from substance abuse, is a big concern for all of our organizations.
Boothe: As we look at the Medicaid restrictions and the people who will potentially be kicked off of the Medicaid expansion … they’re going to have less access to primary care if they don’t have coverage, which is just going to exacerbate their existing medical conditions. … So when they do end up on our doorstep, they’re going to be more medically fragile. Then that’s going to increase the cost to take care of them and increase our need for higher-level staffing … I see from these cuts just a snowball effect of people becoming more and more medically complex, in addition to their substance use disorder as well as their mental health issues, which is just going to continue to drive the cost of care.
Mertz: If you lose your Medicaid and you can’t get your prescription that we gave to you, you get very, very, very ill and go into withdrawal. … We know when people are cut off of medication-assisted treatment abruptly, they have a seven-time increased risk of overdose death. So, throughout the state of Ohio, anybody that is abruptly cut off Medicaid and is taking medication-assisted treatments is at very high risk of death, and I don’t think people are aware of how serious that is.
Gibson: One of the major concerns also is HUD funding and being able to maintain our permanent support of housing units. It is a critical thing for our clients to be able to have a step in their process where they can have low-income housing before they enter market rent … because return to use is so high if you don’t have somewhere to live.
Boothe: I’ve never seen anything like this in my 40 years in healthcare, where changes are made so rapidly and without the right people at the table.
Any losses of funding will also exacerbate preexisting workforce challenges.
Arnold: The funding has, over the years, driven what for a long time was our number one issue: workforce challenges. Those two go hand in hand: When you don’t fund the services, then you’re not able to get the quality staff for the amount of care that you need.
Webb: The reimbursement over the years has not kept up with the cost of maintaining our workforce and having the right credentialed people in place to take care of the patients, to match their needs. The cost of living, everything is going up, and in fact, we’re getting cuts back from money that never kept up for years. … Our patients are a higher acuity than they have ever been and need so much more skilled attention. And yet, we don’t have the dollars to keep up with that need.
Mertz: It’s disheartening at times. When I started in my role, there was a lot of support behind our efforts. … It felt like I could, for the first time in a long time, see a result: Reduced overdose deaths, increased access to care, improved outcomes. I was seeing it with my own eyes. And now, well, there’s just uncertainty.
The organizations are already seeing the implications of funding challenges.
Mertz: We’re at the point now where the cuts are real cuts: They’re cut to access, people and services. There’s no more fat to cut. …
We will have to provide fewer services. We don’t have a workforce to support them. … We save as many lives as we can and provide the best care we can under those circumstances, which we will do. That being said, it sucks.
At the same time, policy changes aimed at reducing fraud – specifically, prior authorization requirements – are increasing the agencies’ administrative burden while hindering their ability to provide same-day care.
Mertz: When you used to be able to get in today, you won’t be able to, because we’ve got to get approval for you to be seen. And people will die, because they will go back outside and they will overdose because we couldn’t bring them in.
Gibson: We were at a point when we had such good access to care that between the five of us, if we got a call, we could get someone in that day, no issue. Between all of us, we made it happen.
That care not only helps the individual who’s battling addiction; it also has ripple effects.
Webb: Addiction affects the entire community.
Gibson: The care that (we’re) providing and stabilization that we’re providing is really what feeds the system as a whole – for getting people back to their families; for getting people back to their jobs; for getting people back to school. It feeds the economy in a way that if we’re not doing that, it really does increase cost to everything.
Mertz: Yes, they go to jail, they steal things, and they go to the ER – the three most expensive things you can do.
Boothe: If you incarcerate someone for a year, it costs over $40,000 to take care of them. If we can bring them onto our unit for a 30-day stay, the cost of their residential stay, and possibly getting them back to work or back to being able to self-sustain, is $10,000 to $12,000.
Arnold: They’re giving back in their taxes, contributing to society. They’re keeping their family together, as opposed to just being a cost.
Funding is also critical to help these organizations go beyond survival mode and keep up with emerging trends, including increases in alcohol misuse and problem gambling.
Arnold: The evolution of the “substance of choice,” if you will, continues to evolve and change, and it has shifted away from the opioids. … We have to really stay on the cutting edge of what are all these things and what is the withdrawal; what’s the reaction that a body has physiologically to them?
When we opened (an engagement center serving withdrawal management services seven years ago) … it was predominantly opioids, and now the majority is alcohol abuse.
Mertz: We are seeing, and there’s lots and lots of research and studies coming out now, that alcohol use disorder is spiking, and it’s spiking quickly. We have a staff member embedded at University Hospital’s emergency department; it has experienced a 33 percent increase in alcohol-related ER visits since 2024. We have an after-hours mobile engagement team that takes 24/7 calls and responds in person to take people to treatment that we’ve been operating since 2021. It used to be about 60 percent opioids for the issues that the callers had. Now, the number one call is alcohol, followed by crack, followed by meth, followed by opioids.
Webb: It’s another thing that’s normalized in society. You know, drinking is cool; it’s okay. You look at it differently than somebody using opiates or meth. It’s the same thing with problem gambling.
Despite their “normalization,” these addictions can have dire consequences.
Arnold: Really the most deadly drug is alcohol. More people die from alcoholism than opioids.
Webb: With gambling, it’s something that they can hide and they do hide very well because of the shame and the guilt. And it can financially devastate a person very, very fast … I know that the statistics of suicide tied to gambling are incredible.
Mertz: People don’t realize – it’s not the substance; it’s not the gambling addiction. It’s a brain disease. So people with the brain disease will choose a substance or behavior to be addicted to absent treatment. And they’ve just found one they perceive will not kill them as quickly, or at all.
Arnold: I think we need to continue to invest in the research around medication-assisted treatment. … Because it’s a brain disease, we have to address the chemical makeup of the brain.
Their past success – built on collaboration between not only these agencies, but also with the Hamilton County Mental Health and Recovery Services Board, the justice system and other community partners – offers a reason for hope going forward.
Arnold: There’s obviously a lot of headwinds we’re facing, but the collaboration amongst us as organizations and the progress in the access to care … that’s what gives me hope. There’s not enough of us, but there are some incredible organizations (and) incredible staff who’ve dedicated their lives to helping others.
Webb: Ohio was hit hard with the addiction crisis, and I saw how Ohio acted. It forced us to collaborate, to join together as a community, to be innovative, to figure out how to solve the problem. So I have faith; we’re all in it together.
Mertz: What we are seeing, to some degree, is the philanthropic organizations are attempting to step up and stop-gap in the interim. That’s so important for us.
The reality is there will be cuts to our services. There will be limits, so people will have reduced access to care – probably at least quantity, likely quantity over the next couple of years, But we don’t give up, right? And we have support; we really do. We have support of a lot of people – bipartisan support, too – in this space.
And the “miracles” they see keep the CEOs keep going.
Arnold: I get folks reaching out, saying, “your staff helped save my son, my daughter” … so that’s what keeps me going.
Boothe: Same thing for us. Mission moments are huge for us. It keeps not only me, but all of our staff going when we can hear someone say, “You saved my life.”
Webb: Absolutely. It’s the miracles.
Discover more from Movers & Makers
Subscribe to get the latest posts sent to your email.