ON THE FRONT LINES OF CHICAGO’S OPIOID FIGHT
Addiction counselors struggle in the trenches where it’s tough to tell victory from defeat
The van was coming for Richard Rivera, but it was taking a long time. He waited inside the entrance of Saint Anthony Hospital where he had spent the past three days getting off heroin. His next stop: a sober- living facility.
As his addiction counselor, DeValle Williams, kept a silent watch, the 49- year- old Rivera griped about the people who found him a bed 22 miles away, complete with meals, job training and gym access.
“They couldn’t find me a place closer?” he grumbled.
Would Rivera get in the van, Williams wondered, or would he walk away?
Long before President Donald Trump declared the opioid crisis a national emergency and pledged to “overcome addiction in America,” Williams was fighting in the trenches, where it’s tough to tell victory from defeat. More than 64,000 died of drug overdoses last year in the U. S., most from opioids.
At 41, he’s been a counselor for two decades, the last few years helping people with drug addiction. Now he runs a new program that works to get hospital patients struggling with opioids directly into treatment.
Similar programs, called “warm handoffs,” have been shown by early research to decrease the chance of relapse. Funding comes from last year’s 21st Century Cures Act, which sets aside $ 1 billion to tackle the deadliest drug crisis in U. S. history.
Williams and others on the front lines see the Cures money as a glint of hope, but they know addiction is a powerful adversary.
Those who seek help at Saint Anthony are hard cases. They come with arrest records, broken relationships and mental health problems. Openair drug markets flourish mere blocks from the small Catholic hospital, a 119- year- old pillar of Chicago’s working- class, gang- ravaged Southwest Side.
Rivera arrived here on a Saturday sick from heroin withdrawal. He got hooked on heroin two years ago when a friend asked him to help sell it. “I started little by little,” he recalled. “Three days later, I’m a junkie.”
His public health insurance would cover three days in the hospital’s new medical detox unit on the sixth floor. Rivera would receive methadone to ease his nausea, cramps and shaking legs. And he would meet with Williams.
“My job is to read people,” Williams said.
Part of a three- person team, Williams sees any patient who will talk with him. He and his colleagues coach, listen and attempt to match people with addiction treatment in the community. They track patients after they leave the hospital, offering treatment to those who’ve said no in the past and following the progress of patients in recovery.
The work is challenging. Even as a team member found housing for Rivera, Williams took a call from downstairs: A middle- aged woman, a former patient, was in the hospital’s clinic, tearfully begging for another chance. Williams went down to speak with her.
Minutes later, he worked the phones. This was tricky. The woman had burned bridges by walking out of treatment. Williams pounded the table as he talked to a treatment center that didn’t want to see her again. “This is me groveling,” he said. “This is me begging. I need that bed. … What do I have to do?”
“It’s all about not giving up” on patients, Williams said. “Take all their excuses away.”
The next day, in Room 636, Rivera put on jeans and a baseball jacket, getting ready to leave. First, he had to meet with Alexander Hannah, a case manager from an insurance company with a state contract to keep Medicaid costs down.
Rivera was just one of Hannah’s caseload of 102 of the most expensive patients. He made calls to change Rivera’s approved pharmacy to one within walking distance of the facility where he would be living. He gave Rivera the name of the closest hospital, and told him that he should be able to find work nearby.
Hannah and Rivera exchanged a fist bump. It was time to head downstairs. The van was coming.
“I’m not feeling good today,” Rivera said in the lobby. “I’m getting chest pains.”
Williams watched as Rivera walked into the hospital emergency room instead of through the front door. Then he watched him slip away. Rivera would be seen hours later jaywalking across a busy street and disappearing into an alley. In the days to come, his cellphone went unanswered.
Williams was undeterred. “It’s just part of the job,” Williams said in the elevator as he headed back to the sixth floor, where four other heroin users were trying to change their lives.
“I used to go home and cry,” Williams said. “I’ve spent many days crying, cursing and yelling.”
He learned, though, not to judge progress by a single day. People with cold feet, people who relapse, sometimes return to treatment. Like the woman who showed up pleading for another chance — she was now in treatment.
“IT’S ALL ABOUT NOT GIVING UP. TAKE ALL THEIR EXCUSES AWAY.” DEVALLE WILLIAMS, addiction counselor, on treating patients