A proposed sober living facility in Door County would provide more options and increased flexibility for addiction treatment and lead to better outcomes in recovery, according to county Health and Human Services leaders.

It also would save the county money while acting as a critical resource for building an addiction recovery community, an increasing need as Door County grapples with an alarming rise in cases of meth addiction within the past few years.

Under the proposal, the county would spend a portion of the almost $5.4 million it is allocated under the American Rescue Plan, a 2021 federal Covid relief law, to purchase a building or buildings to house the facility. The facility then would be run by a third-party organization, with no ongoing costs for the county aside from building maintenance.

The county has not set a specific amount it would spend on the purchase. County Health and Human Services Director Joe Krebsbach said April 12 at a county finance committee meeting that he has been looking at properties in the $400,000 to $800,000 range.

The funding would come from the $1.2 million in Covid relief funding that the County Board in February informally allotted to Health and Human Services. That total also is intended to cover a separate proposal to bolster child care. The County Board also set aside $500,000 in reserve funds from the Covid relief money for projects that exceed initial cost estimates.

A sober living facility, also known as transitional living, is a supportive place for people to live while in treatment for or recovering from addiction. Door County has not had such a facility since the Sturgeon Bay nonprofit Kimberley House closed in 2015 due to funding issues.

Krebsbach said in an interview that the Covid relief money presents a unique chance to address that.

“It’s kind of a once-in-a-lifetime shot,” he said.

Rising case numbers

Door County has had long-standing challenges with alcohol dependency, and to a lesser extent other substances. In the past few years, the county has seen a wave of more acute addiction cases, driven by meth addiction but usually combined with multiple other substances such as alcohol and fentanyl, said Donna Altepeter, the Health and Human Services department’s behavioral health division manager.

In these cases, people affected are less able to function in society and need more intensive and longer treatment.

“Meth in particular is so unbelievably affordable and so hard to treat,” Altepeter said. “We have better success with other things like alcohol, but meth, people just keep going back to. It’s probably the most treatment-resistant drug I’ve ever laid eyes on. People just can’t get away from it.”

Meth can do a similar amount of damage to someone’s brain in months as alcohol does in five to 10 years, Krebsbach said.

Krebsbach estimated that in 2018 and 2019, the county treated 10 cases each year of addiction to meth or opiates. In 2020 and 2021, he said, that number roughly doubled to about 20 cases each year.

“What I’m concerned about is that as meth use goes up, or that as heroin and meth use go up, we’re going to see a large proportion of (people struggling with addiction) coming in for treatment,” Krebsbach said. “Those particular drugs are harder to use and function than alcohol and marijuana.”

The county sees people who are deeply struggling with addiction, Altepeter said.

“When we assess a client and we ask the question, ‘Have you tried to quit?,’ there isn’t a client who doesn’t say yes,” she said. “Their back’s to the wall when they finally come.”

Better treatment options

The sober living facility would both reduce the need to send people struggling with addiction to residential treatment facilities and allow for a smoother transition back home for people who do go to residential treatment, said Krebsbach, Altepeter and Cori McFarlane, the Health and Human Services department’s deputy director.

Residential treatment is the most intensive addiction treatment option. It consists of living in a treatment facility while receiving treatment in that facility, usually for 28 to 30 days.

There are no residential treatment facilities in Door County, and the county most often sends people to facilities in Kiel, Rhinelander or Manitowoc, Altepeter said.

A big part of the county’s decision-making process when initially assessing how to treat each person is related to whether the person’s living environment would be conducive to recovery, Altepeter said.

“If they need a high level of intervention and they have a safe living situation, that looks different than if they have a high level of need and don’t have a safe living situation,” she said.

In cases in which the person does not have a safe living situation, Altepeter said, the county usually ends up sending that person to a residential treatment facility, even if the county doesn’t otherwise think that level of treatment is the best option.

Receiving treatment only in a completely separate environment and community, without a smooth transition back home, also can make the treatment less effective, Altepeter said.

“What we know about learning and learning new behaviors, it works better, it’s more effective if it’s done ‘in vivo’ (in real-world situations) and in the situations where you’re going to use them,” she said. “The evidence doesn’t support learning in one environment and then transplanting that into another environment.”

“Often what we see is that the move back here is where things fall apart.”

Donna Altepeter, Behavioral Health Manager, Door County Health and Human Services

For people struggling with addiction who may not need residential treatment, Altepeter said, the sober living facility would provide a safe and supportive place to live while they receive intensive outpatient treatment from the county—all while remaining in their home community.

In cases in which residential treatment is a person’s best option for initial treatment, the sober living facility would provide a smoother transition back home and reduce the likelihood of relapse, Altepeter said.

Right now, a person moving out of residential treatment is faced with a difficult choice: either a jarring transition back to their previous living situation (or not being able to find another place to live in Door County), or spending an additional several months away from home in a sober living facility elsewhere.

“Often what we see is that the move back here is where things fall apart,” Altepeter said.

Transitioning right back home after residential treatment can lead someone to relapse, Krebsbach said, because it comes with the possibility of returning to difficult relationships with family members or being around friends who also use substances. Those triggers are removed when someone is receiving residential treatment in another community.

“You learn those skills (in treatment), but now you come back and you’re dealing with a whole new level of stress,” Krebsbach said.

Living in a sober living facility elsewhere after residential treatment also is not feasible for most people, Krebsbach said, because it means being away from home and family and being out of work for several additional months.

The only people who do usually choose that option are participants in the Door County Treatment Court for whom living in a sober living facility is a recommended part of their Treatment Court participation, Krebsbach said. The Treatment Court is offered as an alternative to prison time to people who are severely struggling with addiction, he said. (Disclosure: Knock board member Stephen Seyfer is on the Treatment Court’s steering committee and has written letters to the County Board in favor of the sober living facility proposal.)

Living in a sober living facility elsewhere also means people recovering from addiction are disconnected from the county’s treatment staff, who act as primary support people, Krebsbach said.

The Door County-based sober living facility would provide the county more treatment options, including in cases in which a client relapses, Krebsbach said.

“Recovery is not a linear process,” he said. “It’s an up or down road.”

“There’s so many variables in it that we just need as much flexibility in the process as we can get,” he added.

Lowering costs

From the county’s perspective, a sober living facility would mean more flexibility in finding the best treatment and recovery options for people struggling with addiction. It also would mean lower costs—in effect, a smarter allocation of resources leading to better outcomes.

The county has meetings with clients entering treatment about their ability to pay for it, Krebsbach said. If a client can’t afford the cost of treatment, the county covers the cost up front, and the client signs a contract agreeing to pay it back.

Clients paying the county back for those costs can be a slow process, Krebsbach said. Most clients make regular payments, but the county can end up paying for much of the cost of residential treatment over the long term.

More successful treatment can make it more likely that a client is able to pay the county back, Krebsbach said, because of the effects addiction can have on someone’s ability to earn a living.

The average cost of a 30-day residential treatment program is $6,000, based on the county’s contracts with residential treatment providers for 2022, Krebsbach said.

Historically, Krebsbach said, residential treatment or its equivalent was done in hospitals, and health insurance companies covered it. Today, it is provided by nonprofit organizations, and health insurance companies do not cover it.

Health insurance companies usually do cover intensive outpatient treatment provided by the county, Krebsbach said, and the county has a sliding fee scale for clients whose insurance does not cover it. That treatment typically involves three group therapy sessions per week and one individual therapy session per week.

“Our chances of being successful—and not just us, the client—are so limited without that sober living option.”

Donna Altepeter, Behavioral Health Manager, Door County Health and Human Services

As of mid-2021, the state-run BadgerCare Plus insurance for low-income residents has started covering the treatment part of the cost of certified residential treatment facilities for the first 28 to 30 days, Krebsbach said. It does not cover the cost of room and board at those facilities or any “steps down” in treatment after the initial residential treatment, such as a sober living facility.

That BadgerCare Plus coverage will help for people who are eligible for BadgerCare Plus, Krebsbach said, but there still are many clients who earn too much to qualify for BadgerCare Plus but who nevertheless can’t afford the cost of residential treatment up front.

The county also recently received a grant from the state that will cover the cost of room and board for anyone who goes to a residential treatment facility for opiate addiction in 2022, Krebsbach said.

For clients who don’t need residential treatment, rent at the sober living facility—which might be $400 or so per month—would cost a lot less than residential treatment, even if a client lived there for several months while receiving outpatient treatment from the county.

That also would represent a major cost savings for the county in cases in which it covers costs for a client up front, Krebsbach said.

Living in a Door County-based sober living facility also would increase the likelihood that someone recovering from addiction could start or continue a job and be able to afford rent at the facility.

Krebsbach and Altepeter said the flexibility in treatment that the sober living facility would enable is more important to the county than the cost savings.

“It’s much less about are we going to save money and much more about having more options that could be therapeutically appropriate for a client,” Altepeter said. “Our chances of being successful—and not just us, the client—are so limited without that sober living option.”

Building a recovery community

In using the federal funding to purchase a building or buildings to house the facility, the county also would help allow such a facility to open by reducing the startup costs for any organization that would run it.

The facility would be organized by an outside organization and would be peer-run, with people further along in recovery serving as resources for those just starting out.

Those support people, called peer specialists, would be trained and paid by the organization running the facility, Krebsbach said. They would not live at the facility but would check in regularly to provide support. They also would be in charge of drug screenings at the facility and be available on call for people who are struggling.

The facility also would provide a structure for residents, Krebsabch said.

“Typically a resident there, the most senior resident is usually kind of in charge of the day to day, but then there are rules tied to it—chore lists that everybody does,” he said. “It’s an environment where people are taking care of themselves but there’s structure set up.”

The idea, Krebsbach said, is that once the first group of residents transitions successfully out of the sober living facility, some of them would become peer specialists, with that cycle continuing into the future.

The county’s treatment staff might have their regular check-ins with patients at the facility, and they would be closely connected with the peer specialists.

“It’s really about putting a team around these individuals (clients) to give them extra support,” Krebsbach said.

The county hopes the facility can be a foundation for building a recovery community in Door County, something that does not exist in a robust way now.

Altepeter said a recovery community consists of both formal resources, such as treatment facilities and meetings of Alcoholics Anonymous and Narcotics Anonymous, and informal resources, such as support networks of people recovering from addiction, that develop from those formal structures. Door County has relatively few of either, which results in a higher likelihood of relapse, she said.

“It’s really about putting a team around these individuals (clients) to give them extra support.”

Joe Krebsbach, Director, Door County Health and Human Services

“There isn’t a central place where people say, ‘We’re recovered and we’re dedicated to this,’” Altepeter said. “Our clients feel that.”

Door County has few meetings of Alcoholics Anonymous or Narcotics Anonymous, Altepeter said, and existing meetings and the social infrastructure they create have been disrupted by the Covid-19 pandemic.

Some clients have shifted to attending online meetings that include people from around the world, she said, but a lot of clients don’t find online meetings as helpful as in-person ones. Other clients drive to Green Bay to attend meetings.

“The whole idea of meetings here is very touch and go,” Altepeter said.

Altepeter said many clients also feel there are no options available in Door County for sponsors in addiction recovery.

The sober living facility could fill those voids, Altepeter said, both by serving as a meeting place and by creating connections between people recovering from addiction.

“Recovery will beget recovery,” she said. “People will feel like, I know where I can go where I’m safe in Door County.”

The county’s goal is to create the sort of full-fledged support network throughout Door County for people recovering from addiction that can snowball, leading to better outcomes, a lower likelihood of relapse and a healthier relationship with substance use community-wide.

“I think about how much I love Door County, and I am seeing an underbelly that a lot of people don’t see,” Altepeter said. “I don’t want to ignore that, or something’s going to happen to our county that we don’t want to see. And we’re not going to like it.”

“This is an issue for everyone to get behind,” she added.