Jeremy Hiltz, seen at his Middle Street office, is founder and CEO of Recovery Connections of Maine in Lewiston. He likens the opioid epidemic to generational trauma, and says to focus only on the drugs is shortsighted.  Andree Kehn/Sun Journal

Generational trauma and the cycle of addiction is something that deeply concerns Jeremy Hiltz, the founder and CEO of Recovery Connections of Maine, located in Lewiston.

The opioid crisis is getting “worse and worse and worse,” he said. But to focus only on the drugs — the opioids — alone is shortsighted “when what we’re really dealing with is a trauma epidemic. This is generational trauma that is spreading the substance use issue.”

Hiltz was adopted and he said the feeling that his biological parents abandoned him “never left me.” To deal with the pain of that trauma, he turned to drugs.

While incarcerated at Maine Correctional Center about 15 years ago, he went through a recovery program. As he was working to transition back into the community, he realized that he could “use my past to help me, like as an advantage rather than a barrier,” and became a licensed alcohol and drug counselor, eventually opening RCOM.

When someone new comes through the doors, Hiltz said they start with the ACES — Adverse Childhood Experiences — survey. The average score of people in their program indicates a “severe level of trauma.”

Without taking care of families, Hiltz said, “the cycle will just continue,” and Maine won’t find the solutions that will end the opioid crisis.

TRAUMA-INFORMED RECOVERY

Gordon Smith, who serves as Gov. Janet Mills’ director of Opioid Response, said prevention and harm reduction — two key pillars in Maine’s opioid response strategic action plan — start with the family unit.

“One of the initiatives that you’ve got to do if you’re really going to help people is you need to identify the people that are at the highest risk for substance use disorders and mental illness,” he said. “And in the substance use world that very much involves parents that are using, grandparents. There may be intergenerational drug use.”

Genetics play a role but so do the social determinants of health, like poverty and access to health care, which is why primary prevention efforts are so important, Smith said.

“People are going to use drugs, they always have. But if we can improve health care, social determinants of health, get kids the help they need,” in places like school-based clinics, it could interrupt the generational grasp on families that addiction often takes.

Low-barrier access to treatment and community, especially peer support, is crucial for helping individuals with substance use disorder find a treatment and recovery plan.

“I think, right now, our biggest, best resource in the, I guess, in this healing process, our best resource is people with lived experience or allies,” said Hiltz, from RCOM.

Peer recovery coaches “are going to be the most impactful” in helping people get into recovery, he said.

AT THE CROSSROADS

Maine’s child welfare system, as detailed in a series of investigations from the Office of Program Evaluation and Government Accountability, the national firm Casey Family Programs, the Maine Child Welfare Ombudsman, among other independent groups, is under immense stress as its internal operations — chronically underfunded and understaffed — have been slow, or lack the resources to respond to the growing demand for services created by external crises, like the opioid epidemic.

The reports from OPEGA, Casey Family Programs and others say that these pressures create systemic issues that sometimes leave a child in an unsafe home.

Twenty-five children died in 2021 who either had previous contact with OCFS, whose death OCFS found related to abuse or neglect, or who the Office of the Chief Medical Examiner ruled a homicide. It was the highest one-year death total since OCFS began record-keeping in 2007.

“What really is bothering me and is increasingly bothering me is that some things just don’t change,” Sen. Bill Diamond, D-Windham, told the Sun Journal in March.

Diamond, a former secretary of state and longtime advocate for reforming Maine’s child welfare system, said he’s been pushing for changes within the Department of Health and Human Services since the death of 5-year-old Logan Marr in 2001. Her foster parent, Sally Schofield, was convicted of manslaughter the following year.

“And we’ve heard in the last three years, that the child welfare ombudsman keeps reporting in her annual reports, that the department does not make good decisions when they place kids, in terms of placing (them) in a safe environment.”

OCFS is tied up in the “bureaucratic goal” of reunifying children with their parents or family members, which sometimes keeps children in an unsafe environment, Diamond said. OCFS is statutorily required to place children with a family member whenever possible.

Caseworkers are also often ill-prepared to respond to issues beyond assessing the immediate risk of a child, like providing resources to a parent with substance use disorder and lack the resources or time to follow-up with families beyond the initial assessment.

Tiana Warriner gets ready Saturday morning with her daughter, Sophia, 9, in their home in Auburn. Andree Kehn/Sun Journal

That can leave parents like Tiana Warriner, a 28-year-old mother of two, and Nikole Powell, a 33-year old mother of three, unsure of where to turn for help once they’ve come into contact with Child Protective Services.

Warriner and Powell, both of whom are now in recovery for substance use disorder, said that when OCFS placed their children in the custody of family members, OCFS told them to stop using drugs and alcohol in order to regain custody, but offered no resources for how to do that.

“You hear all the time, like ‘just stop.’ When we went through our (OCFS) case, that’s what they said. They’re like, ‘You just need to stop,’” Warriner said.

Powell, who is currently incarcerated on drug charges at the Southern Maine Women’s Reentry Center, also heard the same — get rid of the drugs and alcohol and you can have your kids back, she said.

Diamond said that he hears stories like Warriner’s and Powell’s all of the time.

Nikole Powell waits March 16 in the hallway of the Southern Maine Women’s Reentry Center to make a Zoom call to her son. Residents of the program are allowed five outfits of their own once they have made it through a 30 day period. Until that time they wear the prison garb, as shown on the two women walking. Andree Kehn/Sun Journal

“I’ve heard that time and again, and hopefully there’s going to be a change,” where support for parents, including treatment and recovery resources for substance use disorder, became common practice for OCFS, he said.

It’s overly simple — and potentially dangerous for the child — to tell a parent to get off the drugs, wait a couple of months and then return the child to their home without much assurance that the issue at hand — substance use disorder — has been properly addressed, Diamond said.

“The missing piece is dealing with the drug problem,” he said. “Again, we’re in the position of checking off the box.”

In response to questions regarding the issues raised by Diamond, and experiences of the two mothers, DHHS spokesperson Jackie Farwell said in a statement to the Sun Journal on behalf of DHHS Commissioner Jeanne Lambrew and OCFS Director Todd Landry that the department recognizes “the need for additional SUD recovery resources and continues to work to improve the availability of services.”

Farwell pointed to a number of initiatives from the department, as well as the governor’s office, to address the child welfare system’s clash with the opioid crisis. Among them are increased staffing, new support programs for parents and children with various needs and safety concerns within the household, and a parent mentor program that would match parents currently going through an OCFS case with a parent with previous OCFS experience.

Warriner and Powell both wonder how things would have played out differently for them if some of the current initiatives in place had been around when they were going through the child welfare system.

“At that point in time, I feel like had I known about (Narcotics Anonymous) and like, DHHS had been like, ‘these are here for you,’ instead of just taking my kids and placing them somewhere and just saying, ‘well, get all this stuff out of your house and stop drinking and we’ll give them back’ and just waiting a couple of weeks,” Powell said, “I feel like things would have been a little different.”

Warriner wishes she had peer support.

“It’s the exact reason why I got into recovery,” she said.

In her case, it wasn’t even a professional who helped her, but rather, “it was a girl who saw me struggling and said, ‘Hey, let me help you.’ Someone who had been there who actually cares and isn’t looking down on you.”

The project was produced in partnership with the USC Annenberg Center for Health Journalism through its 2021 Data Fellowship program.