The following story was written and reported by Taylor Hartman for The Utah Investigative Journalism Project in partnership with The Spectrum.
Addiction touches every corner of Utah, altering the lives of families in both rural areas and cities, prompting a need for recovery resources, treatment and hope. With alcohol and drug abuse —especially opioids — on the rise, it would seem logical that the availability of help would increase dramatically to fill a vital need. But in some of Utah’s hardest-hit counties, data shows that the number of operating treatment centers has changed very little or stayed the same. In areas of Southern Utah, rehab “deserts” have kept individuals struggling with addiction in limbo, without access to the help they need to heal.
Sheryl Moore is a former methamphetamine addict from Arizona who began living in Kanab after she was pulled over and arrested for drug possession. When she was released from jail, Moore fell in love with the quiet, beautiful town, and was able to stay sober for several months. She got a job, and things were looking up.
“I just fell in love with Kanab, and I thought ‘why not just stay here?’” Moore said. “It was sort of a second chance for me to get away from my old life. Start new.”
One day, despite the progress she made, Moore said she relapsed and used marijuana. As a result, she was taken to jail for violating her probation and was placed in drug court. Despite a doctor saying she would have responded well to outpatient treatment following her relapse, Moore said there were no such services available, and she was forced to wait for an inpatient bed to open up in St. George.
“In Kanab, they don’t have much of anything for people who need treatment,” Moore said. “I had to wait in a cell for two months before I could go to Desert Haven in St. George. I didn’t see my husband for four and a half months, and I lost my job. All because there wasn’t help in Kanab for me.”
Michael Cain, clinical director for Southwest Behavioral Health Center, said there is a huge need for more accessible and affordable treatment centers in Southwest Utah. Although the area’s most populous counties have numerous treatment centers, most are privately operated, expensive, and don’t take Medicaid.
“We absolutely need more affordable treatment,” Cain said. “We do have private entities down here but most of them are unwilling to take lower rates. We definitely have the need.”
In a data request submitted to the Utah Department of Human Services, the number of licensed treatment providers in Southern Utah’s counties changed very little, despite a spike in substance abuse as opioid use and overdose deaths soared. In Carbon County, the number of treatment centers available decreased from 10 to four from 2014 to 2019. In Emery County, the number of treatment centers went from four to one in the same period, and Kane County saw an increase from two to five available.
Overdosed and under-treated
The Department of Human Services said these numbers only reflect the number of licenses given in those counties and don’t explicitly reflect the number of people who are served, but when it comes to public substance abuse treatment providers in Southern Utah, current providers are few and far between. Four Corners Community Behavioral Health, located in Price and Moab, is meant to serve Carbon, Emery and Grand County, but does not have inpatient treatment. The Southwest Behavioral Health Center has five locations in Beaver, Garfield, Iron, Kane and Washington Counties, but staff said the centers are strained and overfull.
According to the Utah Department of Health, those three counties in Southern Utah have significantly higher rates of opioid overdoses when compared to the rest of Utah. In a report published in March of this year, the health department stated that in Carbon and Emery counties, the overdose death rate between 2014 and 2016 was 47.7 per 100,000 people, compared to the state average of 17.4 per 100,000. Kane County followed close behind, with approximately 30 overdose deaths per 100,000 people.
These high overdose numbers prompted Carbon County to declare an “Opioid Overdose Crisis” in September of last year. And in St. George, a roundtable was held between concerned citizens and Washington County officials in an attempt to get a handle on the large number of overdoses that occur in the area each month.
Cain says that in Kane County there is a higher demand for treatment than is currently available. The county has a drug court that is busy and full and there is a Southwest Behavioral Health Center located in the area, but the services offered don’t provide help to everyone who needs it.
“We are not meeting all of the demand in Kane County. We are actually looking to add some more provider resources in our area ourselves,” Cain said.
But as treatment providers wait to add more resources to rehab deserts, people are failing to get the help they desperately need.
“Since I’ve been out of treatment and in drug court I’ve seen probably eight women who had to go to treatment in St. George or Cedar City who got kicked out because it’s so far away and they can’t handle it,” Moore said. “That’s devastating to them, and not fair at all.”
Funding for treatment
Across the board, an issue Cain sees in public substance abuse treatment is funding. He says that in general, there are fewer professionals willing to work in his treatment centers because the pay isn’t competitive with privately-owned facilities.
“In Iron County, I’ve had a position open for months that I’ve been unable to find a therapist to fill,” Cain said. “Part of the reason is that our pay scale is lower than others because our funding is so limited. Our challenge is getting more funding.”
But when a lack of funding in rehab deserts forces people to travel far away from their homes for treatment, the help they receive may not be conducive to their recovery and may not help build a strong support system when they return home.
Evan Done, community outreach and empowerment coordinator with Utah Support Advocates for Recovery Awareness (USARA), says that local inpatient treatment within a community is more effective for people suffering from an addiction.
“What we know is that when someone has a substance use disorder, the whole family is impacted,” Done Said. “Oftentimes, just taking that person with substance use disorder and putting them through treatment alone doesn’t address the entirety of the issue. The whole family needs to be engaged in some level in that person’s care or treatment.”
In response to the growing opioid crisis in all areas of Utah, the state legislature and the federal government poured new funding into multiple facets of overdose prevention including education campaigns, outreach programs and drug enforcement funding. From 2017 to 2018, the total amount of funding used to try and stop the opioid overdose epidemic in Utah more than doubled, going from $5.2 million to $10.5 million.
So why, in counties where substance abuse is rampant and officials are overwhelmed, are there not more affordable treatment options available? The answer may be in how the funding, both state and federal, is distributed. In more populous areas of Utah, public funds set aside for treatment programs are able to go to multiple different providers, creating a market where there are more options to choose from. In smaller areas of the state, Done says that publicly available funds are spread out less, making the options fewer for people in need.
“Salt Lake County’s publicly funded treatment services are fairly diversified because county funds go through multiple providers,” Done said. “In other counties across the state, it works a little differently, and the publicly funded dollars go to the local mental health authority there. That really dictates where people are able to access care.”
In the last year, Done said in response to a need for substance abuse help in Southern Utah, the federal Substance Abuse and Mental Health Services Administration (SAMSHA) stepped in and gave grant dollars to organizations to help build communities of recovery. As a result, USARA opened an office at the end of September in Price. But that office does not include treatment.
“The kind of services USARA provides are different than clinical treatment services. We’re peer recovery support services. While we can assist people in finding treatment, we are not a replacement for treatment services,” Done said.
When public funds are distributed to one mental health provider for several counties, the choices for affordable treatment are oftentimes limited to what that provider offers. For treatment professionals who are on the front lines in Southeastern Utah, the problem of getting people to participate in the programs they offer is multi-faceted.
Small town stigma
Kara Cunningham, the clinical director for Four Corners Behavioral Health in Price, says that their facility always has openings. In her opinion, there is a disconnect between those who are suffering from addiction and the treatment that exists in their own backyard, possibly because of the culture of a small town or less populous area. Everyone knows each other, so if someone goes to get treatment, it may become public, which is not ideal in a society that frowns on substance abuse and addiction.
“The really sad thing is that there’s such a stigma around substance abuse and mental illness that people don’t like to come here because they feel like it labels them,” Cunningham said.
Because of that stigma and the fact that Price is such a tight-knit community, Cunningham points out that her office of Four Corners Behavioral Health usually has the availability to take new clients. She says that even though there is an issue with substance abuse in her area, that may not always translate to people wanting to get help.
“We don’t have a waiting list,” Cunningham said. “We would never close our doors on anyone.”
When it comes to inpatient treatment availability in Carbon County, Cunningham disagrees with the commonly held professional view that seeking help within a person’s community to have familial support is necessary and ideal. She points out that there’s a “revolving door” in Carbon County, causing many addicts to go right back to places and people who are triggering when they get out of treatment or jail, prompting a relapse.
“What do people do when they go to jail in Carbon County? When they get out, they go right to their playgrounds,” Cunningham said. “So getting people out of playgrounds and away from Carbon County, I think helps them.”
Cunningham does agree with her peers on one thing: Inpatient treatment, no matter where it is located in Utah, is expensive, and many people aren’t able to afford it. Though the Four Corners Behavioral Health doesn’t have its own inpatient, there are grants available that can help people get into treatment somewhere else in Utah.
“A couple of our grants give us money to send people to rehab, and we’ve done that a lot,” Cunningham said.
Still, those grants don’t cover everyone who gets out of jail and needs treatment or needs something more structured than what Four Corners Behavioral Health offers. When asked about how easy it is for Southern Utah residents to find treatment in other parts of Utah, Cunningham said it can be difficult.
“With Medicaid expansion, some rehabs take it up north,” Cunningham said, “but it’s really hard to get into rehab up there.”
With additional federal help, and with Utah’s eyes on the opioid crisis in rural counties, there is hope for those struggling with substance use disorder in underserved areas. But the issue of funding and the stigma of addiction runs deep and may take a long time to overhaul. As communities continue to be affected by substance abuse, there is an urgency for a solution that may not be readily available. For people who are struggling and can’t find treatment they can afford or get to, it may seem like there’s an insurmountable wall to climb in order to get sober.
Cunningham says that even with limited resources, her staff tries its hardest to get people into treatment, and won’t turn anyone down. So for those struggling in rural southern counties, the first step can be to ask for help, whether that be from a parent, spouse, or professional. Only when someone is willing can a support team find the treatment that is available.
“If you’re struggling with addiction or mental illness, I don’t care where you are,” Cunningham said. “Please, just ask for help.”
If you or a loved one is suffering from substance abuse or other mental health issues, assistance is available for you 24/7. Find resources and treatment in your area by visiting the Utah Department of Human Services, or Utah Support Advocates for Recovery Awareness.