Treating addiction, in and out of jail
- Published: September 26, 2019
This is the final article in a series looking at the proposed expansion of the Greene County Jail, and the economic, social and human issues surrounding incarceration in the county.
• Read the first, second, third and fourth articles in this series.
Between the ages of 16 and 24, Zachary Good abused heroin.
“During that time, I pretty much destroyed my life,” Good, who grew up in Brookville, said in an interview with the News this spring.
Living on the streets of Dayton, sleeping under bridges, panhandling and eating out of trashcans, he cycled in and out of treatment programs — and jail.
“I didn’t have any felonies. But I committed a lot of petty thefts in order to use,” he said.
Then his life took a positive turn.
Facing six months of jail time in Greene County for a misdemeanor, the courts gave Good the option of treatment in lieu of jail. He took the offer — not so much to get clean, but because “I didn’t want to sit in jail for six months,” he said.
Good was referred to Christopher House, a 16-bed residential facility for men with alcohol and/or substance use disorders run by TCN Behavioral Health Services in Xenia. But first, he spent two months in the county’s medium-security Adult Detention Center, or ADC, waiting for an open treatment bed.
“It was two months, but it seemed like a year,” he said.
When he was transferred to Christopher House, something happened that he still, four years later, can’t fully explain.
“As soon as I got there, I had a mindshift,” he said.
“It’s the best treatment center I’ve ever been to,” he added.
Two months later, in the summer of 2015, Good completed the program and opted to transfer into two different transitional living facilities for the next 16 months. Then he moved out on his own.
Today, he lives in Centerville and works as a tattoo artist, finally putting to use his artistic talents. Good previously studied art for three years as a student at Miami University, before his addiction took over.
He looks back at his incarceration in Greene County as difficult, but useful.
“My life was so caught up in drugs. It was a really painful way to live,” he said. “Going to jail, you get a break from it. … I think I finally got in touch with how insane it was — eating out of trashcans, panhandling on the highways, having people around me dying.”
Jail can serve as a “reality check” for some addicts, according to Amy Pulver, director of the Hope Spot, a drop-in recovery center and advocacy organization in Xenia that sees about 150 clients in recovery each week.
“The majority of our clients have experience with the county jail. I hear some pretty good things,” she said. “Some of them credit being locked up with saving their lives.”
In this final article in the News’ series on the proposed expansion of Greene County Jail, we look at how drug addiction impacts those in jail, and how the county criminal justice system is responding to the challenges of substance use. And we probe how proposed plans for the new jail could affect drug treatment options in the county.
Opioids and jail
County jails are on the front lines of the nationwide opioid crisis, according to an April 24, 2019, NPR report.
“America’s county jails are struggling to adjust to an opioid health crisis that has turned many of the jails into their area’s largest drug treatment centers,” the report states.
Ohio is ground zero of that crisis. In 2017, it had the second highest rate in the nation of opioid overdose deaths.
County jails across the state are struggling to keep up, according to Buckeye State Sheriffs’ Association Executive Director Robert Cornwell in an interview with the News this spring.
“Jails don’t have the time and facilities to dedicate to long-term treatment,” he said.
Around the state, opioid use is driving increases in the numbers of women in jail, Cornwell added. This is true in Greene County, where around 30% of inmates are women, about double the national average for jails.
Broadening beyond opioids, drug and alcohol addiction is prevalent among people held in jail.
Nationwide, about two-thirds of sentenced jail inmates met medical criteria for drug dependence or abuse, according to a 2017 U.S. Bureau of Justice Statistics report using 2007–2009 survey data, the most recent available.
By contrast, 5% of the total general population met those same criteria.
In Greene County Jail, the rates of substance use and addiction could be higher than the national figure. About 80% of those booked into the local jail experience symptoms of alcohol and/or drug withdrawal, according to a recent estimate by Jail Commander Major Kirk Keller.
“Many may not be that bad, but we do have some severe cases of withdrawal,” he said.
And drugs themselves were rife within Greene County Jail until about two years ago.
“We had drugs all over our facility. We had four overdoses around the same time four years ago,” Major Keller said.
Then two years ago, the jail had its first in-custody overdose death. An inmate who had ingested drugs around the time of his arrest died a few hours after entering the jail. The county purchased and installed a body scanner the next month. Inmates are now scanned by the airport security-like scanner before being booked into jail.
“I take my job of caring for inmates very seriously,” he said.
Major Keller believes that the scanner has dramatically cut down on drug activity in jail. The scanner is detecting fewer instances of people entering jail with stashed or ingested drugs, an indicator that the device is acting as a deterrent, he said.
The jail does not, however, carry Narcan, the brand name for Naloxone, a medication that blocks the effects of opioids and nationwide has saved tens of thousands of people from opioid overdose deaths.
Narcan is readily available from the Xenia Fire Department, according to Keller. The fire department is located 0.2 miles away from the jail, a drive time of one minute.
The jail was regularly using Narcan four to five years ago, but hasn’t used the medication in over a year, Keller said.
The jail has so far opted not to buy its own Narcan because the fire department supply is available to the facility without the expense of an in-house purchase, he said.
“We have the resource available to us. It would be more expensive to have a supply available [in the jail],” he said.
But some in the county have been working to get Narcan into the jail, according to the Hope Spot’s Pulver.
Treating addiction in jail
A snapshot of the treatment services provided within Greene County Jail suggests a small percentage of inmates with addiction currently receive some form of treatment while in jail.
Two main services are available: counseling, including cognitive behavioral therapy and AA and NA meetings; and medication-assisted treatment, or MAT, which is used to prevent relapses.
While the jail does not have its own MAT program, it assists with four different MAT programs run through TCN and the courts, according to Major Keller in a recent email to the News.
Keller estimated that at least 70 to 75 inmates a year take part in a MAT program. This represents around 2% of the total number of people admitted into Greene County Jail last year.
Regarding therapy, about 12% of inmates receive cognitive behavioral therapy and/or attend an AA or NA meeting, Keller said. Lack of space limits the number that can take part, he added.
That 12% includes men and women who take part in an intensive in-jail residential treatment program called Greene Leaf. Begun in 2002 for men and 2006 for women, Greene Leaf provides cognitive behavioral therapy, job skills and other programming to help inmates overcome addiction and rebuild their lives outside of jail.
About 130 to 150 men and women take part in Greene Leaf each year. Participants are referred by the county’s probation department and screened for participation by program staff.
All participants have substance use issues, as well as other life challenges in addition to their criminal charges, according to Becki Robinson, who’s been a Greene Leaf counselor in the women’s program for over three years.
“They have an underlying substance use issue, but how that comes out in their charges just depends,” she explained. Charges such as OVI, drug possession, disorderly conduct, check forgery and shoplifting are common, she added.
Greene Leaf accepts women convicted of misdemeanors, as well as those convicted of felonies. Depending on the charge and depth of help needed, participants stay in the program anywhere from 90 days to six months.
And the women frequently come from difficult family situations, where family members used drugs, and where the women experienced domestic violence, sexual abuse and other traumas as children and adults.
“A large portion of the ladies have dealt with abuse and a lack of support in their lives,” Robinson said.
Widely praised by county mental health leaders, Greene Leaf is currently undergoing its first-ever formal evaluation, according to Dr. Greta Mayer, CEO of the Mental Health and Recovery Board, or MHRB, of Clark, Greene and Madison Counties. MHRB is one of the program’s funders.
“We’re trying to determine outcomes, and how the program can better align with best practices in criminal justice and mental health,” she said in a recent interview with the News.
Greene Leaf in action
This reporter saw the women’s program in action on a recent Friday.
Thirteen women sat in a circle discussing books. They could have been a women’s book group — except for the fact that they were in jail uniforms, and confined within Greene County Jail.
Leading the discussion was Yellow Springs resident Jonathan Platt, who runs a nonprofit called Story Chain that aims to connect men and women in local jails to their children through literacy. Participants in Story Chain select and read children’s books aloud, which are recorded on MP3 players and distributed to their children in collaboration with local libraries.
Story Chain has worked with 107 inmates in Greene, Clark and Montgomery counties over the past four years, according to Platt.
In the jails, Platt’s role is part theater coach, part book group leader, part cheerleader and part funny-man.
“Do you have your Yoda voice yet?” he asked one woman, who was describing her love of the book “The Strange Case of Origami Yoda.”
“What’s the meaning of life?” Platt teased the women as she held up a Yoda finger puppet she’d created.
Without missing a beat, she replied, “Life? Meaning you must find.”
Her “Yoda voice” was pitch perfect.
And that was just the prelude to more than an hour of vocal exercises, reading aloud, book discussions and laughter.
Ranging in age from 18 to 60-plus, many of the women are mothers, some with custody of their children, some without.
Building and rebuilding connections with children and other family members is what Story Chain tries to do, according to Platt. He sees the program piggybacking on the work being done at Greene Leaf to help women heal and grow.
Asked what he would want people unfamiliar with jail to understand about the experience, he offered a perhaps surprising answer.
“Jail can be a place of joy, a place of real change,” he said.
A place of change?
That said, those battling addiction face steep odds, in jail and out.
“Once you have addiction, the statistics aren’t great for overcoming it,” Fairborn Municipal Court Judge Beth Cappelli observed in a recent interview with the News.
Four years ago, Judge Cappelli founded Greene County’s first — and so far only — state-certified drug court, which provides intensive supervision and drug treatment to certain misdemeanor offenders in lieu of normal probation or jail time.
She started the court in response to local impacts of the opioid epidemic.
“We just had so many opioid-addicted people who were dying,” she said.
Statewide, the height of the opioid epidemic was 2017. While more recent statistics suggest the trend may be moderating somewhat, opioid addiction is still a huge problem in our area, according to Cappelli.
“We’re still seeing the trend,” she said.
The Fairborn Municipal Drug Court was originally targeted to people with opioid addiction, but has been broadened to serve those with any drug or alcohol dependency.
About two-thirds of Ohio’s 88 counties have at least one drug court, and Gov. Mike DeWine has pledged to expand that number substantially.
Not all drug courts are alike. The Fairborn court focuses on the “highest risk” cases — people for whom normal probation hasn’t worked in the past, according to Cappelli.
“They’ve reached the point where they’re ready to try something new,” she said.
Under normal probation, offenders are required to check in with their probation officer and meet other requirements ordered by the court. Courts use probation as an alternative to jail time for some lower-risk offenders.
By contrast, the supervision provided by drug courts is much more intensive, and drug treatment and testing is mandatory. Most drug court clients receive medication-assisted treatment, or MAT, together with behavioral therapy and other supports. Each client has a treatment team, and the judge is heavily involved in monitoring clients’ progress. Jail time might be used when offenders fail to meet requirements.
But the program is structured around realistic expectations, according to Cappelli.
“At the beginning we’re just trying to get them to show up, to get to programs. Later on, the emphasis is on staying clean,” she said.
Fairborn’s drug court is small, serving just 10 to 15 clients a year. But the results so far are encouraging, according to Cappelli.
“We have some really great success stories,” she said. “People who haven’t been clean since they were 12 years old are living lives of quality.”
Impact of new jail plan
Despite such successes, much remains to be done to address the overlap between addiction and incarceration in the county.
When Greene County Commissioners began public discussions of the proposed new jail this spring, addressing drug abuse and reducing what are termed “frequent fliers,” those who cycle in and out of jail, were two topics of focus.
“The biggest problem is the drug issue,” Commissioner Bob Glaser said at a town hall meeting in Yellow Springs in March.
“We need to take a holistic approach to reduce the number of folks in our jail,” Commissioner Tom Koogler added.
The proposed plan for the new jail calls for converting one existing jail facility, the ADC, into a drug treatment and rehabilitation facility operated by a third party. Such a facility could provide an alternative to jail time, county officials have said. Details on that facility have yet to be fleshed out, however.
County mental health leaders have had preliminary conversations with jail officials regarding the proposed new treatment facility, according to Mayer, of the Mental Health and Recovery Board.
“We’re looking at what has been done in other settings, and what would be possible here,” she said.
Involving the relevant stakeholders, finding funding and developing a workable plan are still to come.
“We have a lot of work to do,” she said.
Also still to be determined is how that facility would affect the county’s total jail population. Given the high rates of drug-involved inmates in the county, having a new drug treatment option could decrease the need for regular jail beds.
“Drug rehab has a major role in reducing the jail population,” Commissioner Koogler commented in a work session last March discussing plans for the new jail.
Yet that point may have been lost in subsequent discussions, as the county has stated its plans to seek voter approval in March 2020 for a county sales tax increase to pay for a new 500-bed jail — 30% larger than its existing facilities.
Responding to a recent question from the News, Greene County Sheriff Gene Fischer wrote in an email that expanded jail capacity and a new treatment center are both needed to address crime and addiction in Greene County.
“I certainly do not want a 500-bed jail just to fill it up,” he wrote. “I am looking at a facility we can move people around within to help in cleaning and programming as well as having something which will last.”
The impact of the proposed new drug rehabilitation center is unknown, he emphasized. The center “would be third-party operated and while we would hope for a very successful program, I cannot predict the successes a rehab option would bring,” he wrote.
Asked by the News whether she believed the county needed a larger jail as well as a new treatment center, Mayer said the question was “hard to answer.”
“I believe we need to increase capacity for treatment and alternatives to jail,” she said. “And we need to use whatever space we have available in the best possible way.”
Addiction issues go well beyond the criminal justice system, and need to be addressed collaboratively, she added.
Toward that end, a newly invigorated Greene County Drug-Free Coalition, made up of mental health providers and others, is stepping up its planning and programming efforts, she said. Several community partners came up with funding to hire a coalition director last March to increase the coalition’s reach and impact.
“All parts of the community are involved in this,” she said. “The more we can do at the community level in terms of prevention and keeping people out of jail, the better.”
The News will report on further developments regarding the proposed rebuild/expansion of Greene County Jail as they occur. A planned county sales tax increase to fund the project could appear on the ballot as early as presidential primary day, March 17, 2020.