December 5, 2019

A Decade on the Front Lines of the Opiate Epidemic

Christopher Hindbaugh took over Addiction Treatment Services when the nonprofit was at a critical point.
By Patrick Sullivan | Nov. 23, 2019

Christopher Hindbaugh didn’t know what he was getting into when he took over as executive director of Addiction Treatment Services in 2009. The Traverse City-based nonprofit — which had been providing substance abuse services to the community for 30 years — was in deep financial trouble. As it struggled to stay afloat, a deluge of another sort threatened: a culture-shifting opiate epidemic.

In the decade since Hindbaugh’s arrival, the organization has had to adapt and rapidly evolve in the face of opiate addiction. During that time, ATS’s annual budget has grown from $1.9 million to $5.2 million. They now serve around 3,000 clients each year, two or three times more than a decade ago.

Northern Express sat down with Hindbaugh to talk about the whirlwind of the past decade and how ATS has found its footing while staying true to its mission to treat drug addiction as the complex problem that it is.

Northern Express: How did you end up as the leader of ATS? Did you always plan to work in substance abuse treatment?

Christopher Hindbaugh: My background is in mental health, really, since the age of 19. I got my first job in a psych hospital as a tech, just as a college job, and then just never left. I was actually wanting to do journalism. My first major was broadcast journalism. But I worked in mental health for 17 years and was in different administrative roles. And then coming here was as much about moving North as a lifestyle. I wanted to work in a behavioral health field, but I wasn’t necessarily looking to work in addiction, because I don’t have that background. But there’s a lot of parallels, similar systems, similar funding structures. There’s no romantic story about how I ended up here.

Express: When you took this place over, did you know going in what you were up against?

Hindbaugh: No. It was this perfect storm of an agency that was really months away from going out of existence. We’d lost a quarter-million dollars the year before, on a $1.9 million budget, so that was far from sustainable. We had very little in the bank. We could barely make payroll. But I didn’t have a good sense of that coming in, because I think the board didn’t have a good sense of it, and so within my first month I realized this organization was in big trouble. I did contemplate not continuing, but I felt kind of a moral obligation to give it a go.

Express: And then just as you grapple with that, here comes the opiate crisis … 

Hindbaugh: Right — the perfect storm. The other piece of it was then, as we see the opiate epidemic rise up, we’re just not prepared for it. My first concern was how are we going to survive? That’s where my head was that first year: How are we going to exist to help address what we were starting to see? But even then, we didn’t know where this was headed. We didn’t have the data. We didn’t have the resources. 

Express: How did you become aware that there was this big problem out there, that this was something different than we’d seen before?

Hindbaugh: We first heard about it in 2010. We kept hearing more and more about folks becoming addicted to prescriptions — that really predated the heroin use. So, it was really around prescribing practices. And now [in 2010] we’re having people show up addicted to pain meds. That’s really how it first showed up for us.

Express: That’s how it showed up in society, I think. 

Hindbaugh: Exactly. And we seemed to be a click or two behind. We were hearing about it at national conferences. As I was learning this field, I was doing everything I could to consume information, and there was all this information around the start of this epidemic happening. The biggest shift for us was when we started seeing people that had no addiction history that were middle-class, middle-income, educated folks that showed up in our treatment center, when this system was really built as a safety net for people that are coming through the criminal justice system, or who have lost everything and are on Medicaid. The system wasn’t equipped to handle that new demographic.

Express: How do you think you handled it?

Hindbaugh: The first thing we had to do was to look at the science and the research to see what interventions make sense, when our whole history had been sort of closed-door, 12-step-oriented talk therapy. And the data really pointed to having evidence-based, peer-reviewed curriculum. That was way outside the norm for community-based small nonprofits. We couldn’t afford curriculum. So, we had to professionalize both our staff and the type of intervention we were doing. And we also had to shore up our financial sustainability. I mean, our entire leadership changed in 2010. It really had to. We needed to have more accountability to the people we served.

Express: How would you grade yourself then? How well do you think you adapted to this new reality?

Hindbaugh: I think it took us a number of years to do some internal reflection, because it was a philosophical shift, and once we got there, I think we’ve done amazingly with the resources that we have. We’re still underfunded. The field, in general, lacks adequate research. But for what we have at our disposal, we’ve done an amazing job of meeting the people’s needs. When we switched our philosophy from keeping you clean to helping you live healthily, it changed everything for us. It changed how we operate from our core. We changed our mission statement to meet that. We recruited staff and board members that understood that strategy. It took us out from under the shadows. It gave us pride, as opposed to just dealing with the stereotypes that we wait for people to become. That’s one of the flaws of this field — is we wait for people to become the stereotype that we assume an addict is, and then we’re here for them. So, our philosophy is about keeping people healthy and keeping people out of our system.

Express: At the same time, though, I know you work closely with the court system, and the court system doesn’t have the same philosophy, specifically when it comes to medically assisted treatment. How much of a challenge is that?

Hindbaugh: Our goals are not always in line with the court or the jail system. We’re really trying to talk about rehabilitating someone’s health and wellness. Those systems, rightfully so, are concerned about public safety. Sometimes there’s an alignment there, and sometimes there isn’t. So, the more we become a healthcare facility, the more tension shows up. That said, we have a really good working relationship. We still support the specialty courts. We wish some of their practices could more follow the lead of the healthcare community.

Express: Recently ATS stopped providing daily drug testing for the court. Why did you make that decision?

Hindbaugh: For a lot of years, it felt like having drug testing was an unnecessary connection to the court system that really undermined our desire to meet people’s healthcare needs. It no longer really met mission for us. So when we had an opportunity to create a community health center, that didn’t fit anymore. We let the courts know that that was the case, and I think that they’ve figured it out since. 

Express: What do you mean, “It doesn’t fit with the mission”?

Hindbaugh: In its nature, sending somebody for drug testing is punitive. For us, that’s not anywhere near our mission, so it no longer made sense to continue drug testing, because our mission is more about health and wellness. The one reason we kept doing drug testing for as long as we did was because we could do it in a community center where we had other offerings, so if folks were going to be sentenced with drug testing, at least they could walk past services that would be of benefit to them. Eventually, when we went to our new facility, we just couldn’t reconcile that anymore. We’re trying very hard to have a different kind of relationship with folks who are struggling.

Express: You’ve said that drug testing was a losing proposition financially. Why is that?

Hindbaugh: To do it right and maintain the chain of custody and look at it as essentially a medical service, it has overhead that, on our best months, was break even, but we mostly lost money on that. We also refused to raise prices. In the entire time, in the last 10 years, we only raised the prices one time; because it just didn’t feel right to do that on the backs of folks that were putting bags of change in front of us. They had no choice. And we had no choice, because if they didn’t have the money, then we had to report them, then they could do a retainer in jail. The whole scenario just didn’t feel right. 

Express: The Porch, which you call the community center, moved this year from Eighth Street to your small campus on Garfield Road. And while the former Porch is now the retail location of City Bike Shop, in an ironic twist, a marijuana dispensary for a while had an option on that building. What do you think about the coming of medical marijuana and now recreational marijuana in Michigan?

Hindbaugh: We don’t see people very often come in for our services where marijuana is their primary drug of concern. It might be part of their mix, but nobody’s breaking and entering, nobody’s entering the criminal justice system — especially now that it’s legalized — to the extent that they are with other drugs. I don’t want to say it’s not a concern, but for us at this agency, we tend to serve folks that have higher needs and are pretty deep into their addiction, and so marijuana just doesn’t play a big role that. When we look at the data nationally, what we see is, if there’s any place we should be concerned, it should be stopping or delaying [marijuana] use for our young people. We know that there is arrested development that happens if you use marijuana in your developmental years. That data is very clear. 

Express: I notice that you refer The Porch as a community center. What do you mean by that? 

Hindbaugh: We’ve created a place that anybody in the community can walk into and have access to information, access to same-day assessment, access to social activities, [like Monday Night Football sober viewing get-togethers], prevention activities, after-care activities and, most progressively, compared to other facilities in the state, there is a whole medical facility there. We’re now able to actually manage people’s primary care. Again, as we think about our philosophy of health and wellness, how could we not have that piece connected to what we do? So, for us, it’s really about expanding the public health strategy, so we can add both prevention and healthcare services. We’ve added P.I.E.R. coaches. [The P.I.E.R. is ATS’ medically assisted detox treatment center.] We’ve added case management.

 

Express: How difficult has it been over the years to work on the front lines of the opiate epidemic? It must have been heartbreaking at times. 

Hindbaugh: The irony of the opiate epidemic is that when you look at the last 30 years, addiction rates have not increased. It’s just that this particular addiction to opiates has a fatal outcome more than any other drug before its time. And so, the heartbreak has been the number of families that we’ve had to console, the number of families that I’ve had to sit in these chairs and talk about funeral arrangements with. Historically, that was not the case to this degree. We’re losing friends and neighbors. That’s the heartbreaking part. It also really adds a layer of obligation to put everything we have at it. From the federal government all the way down to organizations like ours, we really haven’t prioritized taking addiction seriously. The opiate epidemic has really highlighted that we have something fundamentally challenged in our society.

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