Content warning: This story contains mention of addiction, drug use and overdose. Recovery from addiction is possible. For help, please call the confidential referral hotline, 1-800-622-HELP, or view options on campus through University Health Services.

Around the end of 2017, a few volunteer board members banded together to form what would eventually become the Wisconsin Association of Sober Housing. At the time of its founding, WASH’s work was focused on housing quality standards for people in recovery from addiction.

In 2021, WASH hired Thomas Vonck as the project director through a three-year research grant. As project director, Vonck is responsible for certifying recovery residences, studying outcomes and implementing measures to improve those outcomes. The research project aspect of this work is done through community-based participatory research — collaboration between researchers and community members to generate more equitable findings, according to the National Institute of Health.

“It’s slow going, but it’s really strengthening a recovery ecosystem in the state,” Vonck said.

In addition to serving as WASH’s project director, Vonck is a person in long-term recovery. In September 2018, he spent three and a half months in residential treatment in Ann Arbor, Michigan, before moving into a recovery house for seven months.

Vonck said a fundamental aspect of his recovery journey was coming into contact with others who were also in recovery. While he is not a fan of the “disease model,” he described recovery as “contagious.” Vonck does not attribute his recovery to the physical space or the proximity to recovery meetings, but the interaction between those resources in addition to the people he was living with.

Vonck’s passion lies in strengthening these kinds of connections at all levels of the recovery process.

“I think that there’s a strong need for scientific evidence, because funding is typically tied to evidence-based practices,” Vonck said. “But there’s also so much you can do in the absence of actual financial capital, just by connecting people to each other and to show people that we don’t recover alone — why would we provide peer recovery services alone?”

As a project director and person in long-term recovery, Vonck is not alone. Wisconsin’s growing recovery network is helping people access the resources they need. Despite remaining challenges, stakeholders from a variety of backgrounds — people in recovery, doctors and public health officials — are working to build a network around supporting recovery and saving lives.

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Contextualizing addiction

The American Society of Addiction Medicine defines addiction as “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment and an individual’s life experiences.” This definition, updated in October 2019, focuses on addiction as a public health issue — and on the efficacy of treatment and recovery.

Also inherent in this definition is the idea that individuals have different risk levels of developing an addiction on the basis of a variety of complex factors. Based on this understanding, prevention methods that were used in the past are now being scrutinized more closely.

Julia Olsen is a substance use prevention and harm reduction supervisor for Public Health of Madison and Dane County. Harm reduction is an evidence-based approach that involves engaging with people who use drugs to reduce the risks of legal or illegal behavior, according to the National Institutes of Health.

Olsen said a summary report from the United States General Accounting Office demonstrates past prevention methods — “Just Say No” in the 1980’s and D.A.R.E. in the 1990’s — simply did not work to stop drug use in American youth.

According to Olsen, the Nixon Administration’s War on Drugs and the 1986 Anti-Drug Abuse Act criminalized addiction by implementing higher penalties for certain drugs, thereby creating major racial inequities that persist today. In a 1994 interview with Harper’s Magazine’s Dan Baum, former Nixon domestic policy chief John Ehrlichman admitted these policies were about disrupting Black communities. Lasting implicit biases in law enforcement lead to higher arrest rates and harsher punishments for people of color in drug offenses, according to the Gateway Foundation.

Now, experts on addiction are reckoning with the failures of past decades and confronting new challenges in drug use prevention as a result of a changing landscape for Generation Z.

E-cigarettes have changed the addiction landscape for young people, according to Dr. Megan Piper, a director of research at the University of Wisconsin’s Center for Tobacco Research and Intervention. Piper said the relative recency of e-cigarettes and a lack of longitudinal studies make the long-term consequences of vaping unclear.

“There are some data that suggest vaping really does cause problems with the pulmonary system,” Piper said. “The other piece that we do know happens is that when you are vaping, you’re putting nicotine into your brain, and when you do that, it changes the structure of your brain. You have more nicotine receptors that your brain grows so that it can handle all the nicotine … that’s where dependence comes into play.”

Early versions of e-cigarettes were not very good at delivering nicotine until Juul entered the market in 2015, according to Piper. Juul developed a nicotine salt product that was marketed to adolescents through social media advertising and fruit or dessert flavor offerings that appealed to younger audiences. Novelty encouraged minors to try the product, while the high nicotine content kept them hooked, Piper said.

University Health Services data from 2019 revealed about 21% of incoming UW students reported vaping in the prior two weeks — a 33% increase since 2017 and a 486% increase since 2016. Vaping is incredibly common on college campuses, and with little research on vaping cessation, there are not many evidence-based treatment options to choose from.

In fact, there is a singular study that demonstrates the success of an evidence-based treatment to help people quit vaping, according to Piper. “This is Quitting” is a text-based program from the Truth Initiative that has worked with over 600,000 youth and young adults in their journeys to quit vaping, according to their website.

“They’re doing their best to market and get this information out there,” Piper said. “When people do want to quit vaping — if they’re not able to just put the vape down because of dependence or other issues — they [Truth Initiative] have got other ways to support them being able to quit successfully.”

While nicotine use continues to rise, so does the use of other substances. As usage for drugs like opioids, benzodiazepines and stimulants increases, rising overdose deaths present an added danger to addiction in Wisconsin.

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Drugs and overdose

According to the Drug Overdose Deaths in Dane County 2022 Annual Report, drug overdose deaths in the county have been steadily increasing since 2000, particularly those related to synthetic opioids.

“Fentanyl is the drug supply now,” Olsen said. “Anyone who is using drugs, whether you do it regularly or you’re an occasional user … you should probably be prepared that there is more than likely fentanyl in that.”

Notably, the overdose rate among Black people was more than three times the rate among white people from 2018 to 2020, with a rate that has sharply increased in the last 10 years, according to the annual report.

“There is an urgent need to better understand and address the worsening racial inequities in drug overdose deaths,” the annual report said. “The rapid increase in drug overdose death rates among Black people in Dane County is related to long-standing inequities experienced by Black people, including higher rates of policing and incarceration as well as policies across sectors that negatively impact wellness and the ability of Black people to thrive.”

Additionally, the highest rates of drug overdose in Dane County are in the 35-44 age group, Olsen said. Olsen said while younger people don’t make up as much of the overdose deaths, patterns of use often begin around college.

But there are some notable distinctions between young people and other generations regarding drug use and overdose, according to Dr. Ritu Bhatnagar, an addiction psychiatrist and the associate director of psychiatric services at University Health Services.

Centers for Disease Control mortality data shows counterfeit pill use in overdose deaths doubled from July 2019 to December 2021. Compared to deaths without counterfeit pill use, people who died from counterfeit pill use were younger, more often Hispanic or Latino and more often had a history of prescription drug misuse and drug use by smoking.

More generally, Bhatnagar said young people are more likely to have attitudes that downplay the risks of substances because of their developmental stage that lends to a sense of invulnerability. Marijuana and tobacco lobbyists have also effectively marketed to young people, resulting in a decreased perception of harm over the last five years, according to Bhatnagar.

The creators of products like Juul not only altered after the e-cigarette to create a more addictive nicotine substance, but they modeled after the marketing strategy of Big Tobacco to reach American youth in advertising, according to Piper.

“What you will learn from the tobacco industry is how to market to adolescents,” Piper said. “And they [creators of Juul] did it hard and heavy. You could see all the different ads, all the different social media influencers that were all talking about Juul … so there was lots of marketing work as well as change to the product itself.”

Bhatnagar also said social media has changed the way people experience peer pressure, which requires a whole new level of resilience to resist. More broadly, social media has impacted the way adolescents develop social relationships, according to the Clinical Child and Family Psychology Review.

Social media use can have adverse impacts on youth mental health, as time online limits the amount of time people can devote to in-person interactions. But since social media offers important cultural context, not using social media can also be isolating, Bhatnagar said.

Isolation is a major concern when it comes to drug use and misuse prevention. In fact, Bhatnagar said the number one protective behavior families can do to reduce the risk of their child developing a substance use disorder is having dinner together.

“You’re sitting around talking about things and having that connection,” Bhatnagar said. “There’s one quote that resonates with a lot of people I work with: ‘Addiction is the opposite of connection.’”

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Rally for Recovery

In the spirit of building connection, Wisconsin Voices for Recovery hosts an annual Rally for Recovery at the Wisconsin State Capitol. The event hosts a variety of speakers, provides educational resources, offers community building opportunities and honors those who have been lost to overdose. The 2023 event was held Saturday, Sept. 9.

At the rally, Lt. Gov. Sara Rodriguez presented a proclamation from the Governor’s Office, declaring September 2023 as Recovery Month. As part of a wider effort to make 2023 the Year of Mental Health, the Evers administration is working to invest in substance misuse recovery and affordable healthcare, including mental health and behavioral healthcare, according to Rodriguez.

Bhatnagar, who also serves as the principal investigator for Wisconsin Voices for Recovery, spoke about the medical perspective of substance use and recovery at the rally. According to Bhatnagar, the medical establishment is working to address addiction as a health issue, rather than as a moral failing.

Amid a culture of stigma and other barriers, Bhatnagar said people experiencing substance use disorders must be met with treatment when they are ready to receive it. Harm reduction can help with this, as it prevents people from turning down life-saving treatments by accepting them for wherever they are in their recovery process and not leaving them there, according to Bhatnagar.

“We need an approach that provides a bridge to treatment, not a pipeline to prison,” Bhatnagar said. “We are not going to arrest our way out of this.”

Data from the Dane County Narcotics Task Force reported 286 drug charges in 2016, compared to 326 drug charges in 2022. Despite the increase in charges related to drug delivery and possession, the drug overdose rate in the county has only increased, according to the drug overdose deaths annual report.

The fear of law enforcement can prevent people calling for help in dangerous, potentially life-threatening situations, Bhatnagar said. UW’s Medical Amnesty Through Responsible Actions program offers legal protections for students in these kinds of situations. But off-campus, amnesty is not guaranteed.

Addressing these issues, however, takes coordination between community and policy, according to Vonck.

“It’s really important for us that service providers don’t feel like they are providing services alone,” Vonck said at the rally. “So we work to build a stronger community, a stronger recovery ecosystem.”

There is a growing ecosystem of support in Dane County offering recovery resources. For example, PHMDC’s Syringe Services Program has two locations in Madison. The program offers free services such as sharps disposal boxes, fentanyl test strip kits, Narcan, safer use supplies and educational resources.

Olsen said SSPs also serve as critical touch points for people using drugs to access other kinds of health services, such as sexual wellness or wound care. People who are using drugs and use SSPs are five times more likely to enter a treatment program than people who do not use SSPs, according to the CDC.

“We’re trying to create a nonjudgmental space for people who use drugs to be as healthy and safe as they can be,” Olsen said. “We’re trying to work on policy changes that don’t criminalize addiction and don’t stigmatize people and hinder them in their recovery.”

Peer recovery is another important aspect of recovery in Dane County. Safe Communities is a nonprofit coalition of over 350 organizations who work to improve health and public safety in Dane County. One of their programs offers recovery coaching, which is guidance from people who either have personal experience in long-term recovery from addiction or mental health issues or have loved ones who have been affected by addiction or mental health issues.

Lily Sultze has been a recovery coach at Safe Communities since early 2023 and is also a person in long-term recovery. Since becoming sober June 24, 2018 through a 12-step program, Sultze has come to appreciate the harm reduction aspects of peer recovery coaching.

“Recovery coaching is something that I hold super close to my heart,” Sultze said. “I think that it’s super important to give folks out there the opportunity to have someone support them who understands what they’re going through.”

In her day-to-day work life, Sultze interacts with several of her peers in recovery — sending text messages, answering phone calls and visiting treatment centers — to offer companionship and help connect them to the resources they need.

Sultze also works with the Addiction Resource Team, a grant-funded initiative through the Madison Police Department that sends a multidisciplinary team to check in on individuals who have recently suffered drug poisoning to offer resources and support. Sultze said harm reduction tactics that promote engagement help make sure people who need resources feel supported, even if they do not feel ready to enter a 12-step program.

“When I was able to get the help that I needed, it was solely because people were there reaching out for me and there to help me when I needed it,” Sultze said.

Though there are many resources available, Sultze said a lack of education, capacity and resources can create barriers that prevent institutions from being as effective as they could be.

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Barriers to resources

The current state of Wisconsin’s Good Samaritan Law presents one of these barriers. In 2017, the law was amended to offer immunity from arrest or criminal prosecution for witnesses of overdoses who call 911, also known as aiders, and for individuals who receive aid during an overdose, or aided individuals.

These protections were sunsetted in August 2020, leaving aided individuals without criminal immunity. A 2021 study from the International Journal of Drug Policy revealed extensive Good Samaritan Laws — those that included immunity for aiders and aided individuals, not only from charges or prosecution but also from arrest — were associated with lower rates of overdose deaths.

Though there is room for improvement on the policy level, Olsen said she’s been surprised how supportive policy makers and people in the community have been of implementing harm reduction programs. While it takes a lot of education in some spaces, Olsen said, evidence-based harm reduction treatments work.

One of these harm reduction tactics is the use of naloxone. Narcan is a brand of naloxone nasal spray that can counteract the effects of an overdose by blocking opioid receptors in the brain, according to the National Institutes of Health. University Health Services recently installed 13 additional naloxone boxes across the UW campus to increase access. Students are encouraged to take boxes whether or not it’s an emergency, which helps distribute overdose supplies and reduce stigma.

“There’s still an enormous stigma around recovery,” Vonck. “I’m really privileged to be able to say ‘I am recovering’ out loud.”

People are experiencing addiction in every community, Vonck said, but NIMBYism fuels misconceptions that recovery centers draw people who use drugs to those neighborhoods, when in reality, they benefit people who already exist and are seeking treatment.

While there are lots of available resources, connecting people to them in a timely manner is another challenge, according to Bhatnagar. In implementation research projects, Bhatnagar found 45% of the people who died from an overdose in 2020 had a visit to an emergency department in the year preceding their death, according to the Drug Overdose Deaths in Dane County 2022 Annual Report. Bhatnagar said these were missed opportunities for treatment.

Connecting with the people in particular age groups is something Olsen said PHMDC is still working on. The 25-34 age group is most difficult to reach, since they no longer rely on university resources and are transitioning to a period of real independence and stress as adults, according to Olsen.

PHMDC issues overdose spike alerts, which Olsen said are a relatively discreet harm reduction tactic to warn people about potentially unsafe drug supplies in the area. PHMDC has partners such as Safe Communities which are working to bring drug use prevention and suicide prevention programs to local high school students, and OutReach LGBTQ+ Community Center which offers support services to a variety of age groups.

But Vonck identified a disconnect between these state and private organizations as a barrier to recovery. WASH has collaborated with the Department of Health Services, Vonck said, but the state has no legislation mandating certification for recovery housing, which could be limiting their ability to offer support.

For example, WASH advocated for inclusion in a piece of legislation related to the registration of recovery residences. The association proposed including an oversight body to ensure accountability for residences on the registry, but the final piece of legislation created a self-reporting system, which Vonck said is problematic.

Vonck said WASH still frequently interacts with people at DHS to share resources and collaborate on projects, such as a training program for UW–Whitewater’s Center for Inclusive Transition, Education and Employment.

“When we do come together to share our expertise … it’s really great,” Vonck said.

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Fortifying a strong recovery network

Despite the challenges of disjointed resources, various organizations, agencies, experts and individuals in Wisconsin are making a connection between the integration of resources and positive recovery outcomes.

“I think for now the main thing is just letting people know they’re not alone,” Bhatnagar said. “UW does a decent job, but it’s a huge place — 55,000 students — it’s easy to feel lost. If that is what somebody is feeling right now, I would really encourage them to reach out.”

Olsen said part of PHMDC’s ongoing work plan is to bolster its long relationship with UHS and UW. This means putting out more information about the state of the overdose epidemic and familiarizing students about the wide variety of resources that are available in Dane County.

At the Rally for Recovery, Bhatnagar listed the kinds of efforts that give her hope for the future of recovery. Peer recovery programs offer a social recovery experience. Harm reduction tactics keep people alive long enough to seek further treatment. And collaboration between the state and other entities better ensures people in recovery are met with support — wherever they are in the recovery process.

“There are people out there that will listen no matter what,” Sultze said. “I think that’s the most important thing — in any circumstance, there’s somebody there who cares.”

Recovery resources:

Hotlines:

• National Overdose Prevention Lifeline: 1-800-484-3731

• Safe Communities 24/7 Recovery Hotline: 608-228-1278

• University Health Services 24-hour crisis intervention: 608-265-5600

• Wisconsin Addiction Recovery Hotline: 211

Additional recovery resources:

• Badger Recovery, a program for students in or considering recovery from substance use: [email protected]

• Behavioral Health Resource Center of Dane County for treatment and recovery resources: 608-267-2244

• Connections Counseling: 608-233-2100, connectionscounseling.com

• End Overdose online Opioid Overdose Response Training: endoverdose.net/professional-training

• Other campus recovery resources: alcoholanddruginfo.students.wisc.edu/resources

• Safe Communities: 608-441-3060, safercommunity.net

• Tellurian Behavioral Health: 608-222-7311, tellurian.org

• Truth Initiative: truthinitiative.org