NaloxBox at WIN Recovery Providing Needed Resource

WIN Recovery, a certified opioid treatment facility operated by Hamilton Center Inc., saw evidence of a community need being met in the first month with the self-service “NaloxBox” added to the outside of its Terre Haute location (located at 86 Wabash Court, just west of the Vigo County Courthouse).  This box distributes naloxone (also known as Narcan) for free to consumers, family members, or anyone from the public on a no questions asked basis. During April, dosages were distributed at a rate of more than one per day – with 31 in all.

Naloxone is a medication approved by the Food and Drug Administration that is effective in preventing death by rapidly reversing the effects of an overdose from opioids, and doses distributed through the WIN Recovery NaloxBox are administered via nasal spray.

Mark Collins, Chief Clinical Officer for Hamilton Center, admits he and his staff had no idea how much usage the NaloxBox would get in its first month.

“What we do know is that we want to give as many individuals the capability of having Naloxone at their disposal as humanly possible because Naloxone prevents overdose deaths,” he said. “What we’re trying to promote is harm reduction. Most importantly, we want to keep individuals alive, and Naloxone keeps individuals alive.”

Collins termed the volume of dosages distributed as “incredibly beneficial to our community” with hopes of that number increasing as more people are aware of the program.

“Having 31 doses in the first month shows that there’s a need within the community, and hopefully this will continue to decrease the overdose deaths in our communities, which is the ultimate goal” Collins said. “We will continue to advocate for the use of Naloxone within our communities.”

The box was provided by Overdose Lifeline, a non-profit organization which has fought the opioid addiction problem since 2014. Designated HCI/WIN Recovery staff will monitor the box, track its usage, and order free replacement kits as needed from Overdose Lifeline’s Indianapolis office.

State and federal funding has been utilized to cover the cost of the program, with support also coming from the Indiana Division of Mental Health and Addiction.

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Hamilton Center, Inc. is a regional health system in Central and West Central Indiana with corporate offices located in Terre Haute, IN.  Services are provided to children, adults, and families, with specialized programs for expectant mothers, infants, and people who may be struggling with stress, life changes, or relationship issues, as well as more serious problems such as depression, anxiety disorders, and serious mental illnesses.

WIN Recovery Installs NaloxBox to Help Treat Opioid Overdose

According to overdoselifeline.org, opioid overdose is the leading cause of death in the United States among adults 50 years old and younger.

WIN Recovery, a certified opioid treatment facility operated by Hamilton Center, Inc., has added another tool in its fight to battle this growing problem by establishing a “NaloxBox” at its Terre Haute location (located at 86 Wabash Court, just west of the Vigo County Courthouse). This box will distribute naloxone (also known as Narcan) for free to consumers, family members, or anyone from the public on a no questions asked basis.

Naloxone is a medication approved by the Food and Drug Administration that is effective in preventing death by rapidly reversing the effects of an overdose from opioids, and doses distributed through the WIN Recovery NaloxBox will be administered via nasal spray.

The box was provided by Overdose Lifeline, a non-profit organization which has fought the opioid addiction problem since 2014. Designated HCI/WIN Recovery staff will monitor the box, track its usage, and order free replacement kits as needed from Overdose Lifeline’s Indianapolis office. State and federal funding has been utilized to cover the cost of the program, with support also coming from the Indiana Division of Mental Health and Addiction.

“The NaloxBox mission is to improve the capacity of bystander rescuers to save the lives of victims of opioid overdose with overdose response tools, including naloxone,” Overdose Lifeline states on its website.

Natasha Newcomb, WIN Recovery’s deputy chief of addiction and substance abuse services, is pleased to add this naloxone distribution method to its many ways of assisting those in need.

“We know and understand that when somebody has addiction problems, they can’t always just quit,” Newcomb said. “They may want to quit, they may have tried, and they may have struggled – but sometimes they just can’t stop. Narcan is a way for them to help save their life or the life of somebody they love.”

Newcomb emphasized that the person getting the Narcan from the Naloxbox may not be the person experiencing addiction.

“It may be for their brother, their sister, their girlfriend, or their child,” she said. “It’s important to recognize that that while the box is there for people who are using substances, it is also there for people who have a loved one they are trying to save.”

Statistics from the Centers for Disease Control and Prevention show that Vigo County had 179 patients admitted into emergency departments for treatment for overdoses, while 24 fatal cases were recorded.

Newcomb acknowledged someone using drugs might not to want to seek help from law enforcement or a hospital due to potential legal repercussions.

“Historically in our society, and even today, if somebody called the police because they were overdosing there’s a chance that after they were taken care of at the hospital they’d be taken to jail,” she said. “If somebody is overdosing, then they obviously have paraphernalia there, or they have substances on them because they’ve been using. People are hesitant to contact the police or go to the emergency room for the same reason. The Naloxbox removes that step.”

Newcomb noted that if someone is at a point where they think they’re going to overdose, they need to seek medical attention whether they have access to Narcan or not.

One particularly vulnerable segment of society who could benefit from the Naloxbox consists of people who have been released from incarceration.

“Individuals who return to the community after being incarcerated are 129 times more likely to suffer an overdose than the general population,” according to Overdose Lifeline. “The NaloxBox provides easy, stigma-free access to lifesaving medication – completely free of charge.”

Newcomb added that there is no limit to the number of dosages someone can receive from the Naloxbox, although hoarding is unlikely since the product has no street value. She said in some circumstances people may need to get multiple applications.

“You can’t abuse Narcan or get high from it,” she said. “People can take as many as they need. It may be that that one person takes four doses, but that person may live in a household with three other people who abuse opioids, and they may need one for each person in their household. Maybe they’re going to keep them handy because three of their friends have overdosed in the past week.”

“That’s the reality of what some of these people are seeing and living with.”

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Hamilton Center, Inc. is a regional behavioral health system in Central and West Central Indiana with corporate offices located in Terre Haute, IN.  Services are provided to children, adults, and families, with specialized programs for expectant mothers, infants, and people who may be struggling with stress, life changes, or relationship issues, as well as more serious problems such as depression, anxiety disorders, and serious mental illnesses.

Hamilton Center Receives LCC Grant for Addictions Treatment

Matrix Scholarships, Materials, and Equipment

Hamilton Center, Inc. has been awarded a grant from the Owen County Local Coordinating Council (LCC) and the Owen County Drug Free You & Me initiative that will fund addictions treatment scholarships for 12-15 individuals, as well as training for 2 staff members in Relapse Prevention. Through certification of The Matrix Model, Hamilton Center provides an Intensive Outpatient Program (IOP) which runs three times a week. The programming uses technology to deliver and enhance treatment through presentations, programming videos, and Motivational Interviewing. In 2018, Hamilton Center was designated as the first certified site for The Matrix Model in the state of Indiana, achieving a three-year Certification with Excellence.

The Matrix scholarships will remove the financial barrier to addictions treatments. Hamilton Center has state-certified navigators who can help those who are in need of services complete a health insurance application to obtain insurance that would potentially cover all their health care needs. “This process can take weeks, if not months, to complete and often presents an overwhelming financial barrier in seeking treatment,” said Cindy Rotman, Program Manager, Hamilton Center, Inc., Owen County. “Support from the Owen County LCC Drug Free Community Fund will help offset costs of Matrix programming, allowing consumers to receive the treatment they need in a timely manner, which can be crucial in the process of recovery from addiction,” added Mrs. Rotman.

Hamilton Center, Inc. is a regional behavioral health system in Central and West Central Indiana with corporate offices located in Terre Haute, IN. Services are provided to children, youth and adults, with specialized programs for expectant mothers, infants, and people who may be struggling with stress, life changes, or relationship issues as well as more serious problems such as depression, anxiety disorders, and serious mental illnesses.

For information on Hamilton Center Services call (800) 742-0787.

WIN Recovery, Hendricks – Now Open

Hamilton Center, Inc.’s Certified Opioid Treatment Program to serve adults with opioid use disorder

October 26, 2020 Plainfield, IN- Hamilton Center, Inc., an Indiana community mental health center, is now accepting patients at its newest opioid treatment program (OTP) facility, WIN Recovery, located at 401 Plainfield Commons Dr., Plainfield, IN.  This clinic is the third clinic opened by Hamilton Center.  Other clinics are located in Terre Haute and Vincennes.

The clinic will provide comprehensive treatment for adults 18 years of age and older who are struggling with addiction to heroin or other opioids such as prescription pain medication. The program provides daily medication (Methadone) coupled with individual and group therapy and case management services to treat each individual’s unique needs.

The office will be open from 6:00 am – 2:30 pm. New patients are welcome to walk in without an appointment between 6:00 a.m. – 12:00 pm or can call toll free 833-232-0215 or 317-268-2941 to make an appointment. The clinic is open 7 days a week including weekend and holidays.

Methadone is a medication administered daily under monitored, controlled conditions. It has been utilized for years with a great deal of research determining its safety and effectiveness. Once patients begin taking methadone at appropriate levels, withdrawal is avoided, cravings are minimized and physical and mental stabilization occurs. “That is when the real recovery begins,” said Jessica Nevill, LMHC, WIN Recovery’s Clinical Director. 

Hamilton Center, Inc. secured a license from the State of Indiana to open the Hendricks county opioid treatment program in November 2018. The $500,000 construction/renovation project concluded this month. The facility is nearly 6,000 square feet, includes nearly 1300 square foot of waiting area and six bathrooms. The clinical area offers six medication-dosing stations, separate drug screening rooms, one medical examination room, 14 offices and two group-counseling rooms. Black and white photography of local landmarks adorn the walls, which were secured through assistance from the Knox County Public Library and Terre Haute photographer Wayne Jordan.

In 2018, 70 percent of all drug overdoses involved an opioid. In that same year, there were 65.8 opioid prescriptions per 100 persons, 14.4 more prescriptions per 100 persons than the national average of 51.4.

“Unfortunately Indiana residents have been greatly impacted by the opioid epidemic, certainly more so than many other states,” said Melvin L Burks, CEO of Hamilton Center, Inc. and Program Sponsor of WIN Recovery. “We are truly privileged to partner with the State in their goal of establishing one of these programs within an hour’s drive any person in our state.”

“This facility is not only providing treatment to individuals with opioid use disorder, but is also offering education to the community and combatting the many stigmas associated with opioid use disorder,” said DJ Rhodes, Chief of Opioid Treatment at Hamilton Center Inc.  “At WIN Recovery we believe that Opioid Use Disorder is a disease; treatment works and recovery is possible,” he added.

Hamilton Center, Inc. is a regional behavioral health system in Central and West Central Indiana. The organization provides service regionally to 12,000 clients annually.  For additional information on Hamilton Center Inc., call 800-742-0787. For additional information on WIN Recovery, call (833) 232-0215 or visit winrecovery.org.

WIN Recovery, Hendricks County Ribbon Cutting

Hamilton Center, Inc.’s Certified Opioid Treatment Program to serve adults with opioid use disorder

October 16, 2020 Plainfield, IN- Hamilton Center, Inc., an Indiana community mental health center, announced the opening of its newest certified opioid treatment program, WIN Recovery at 401 Plainfield Commons Dr., Plainfield, IN.  This clinic is the third clinic opened by Hamilton Center.  Other clinics are located in Terre Haute and Vincennes. 

The Hendricks county clinic is awaiting Drug Enforcement Administration (DEA) certification which is estimated to occur early next week. Once secured the office will be open for patients.

Hamilton Center Inc. secured a license from the State of Indiana to open the Hendricks county opioid treatment program in November, 2018. The $500,000 construction/renovation project concluded this month.   The facility is nearly 6,000 square feet, includes nearly 1300 square foot of waiting area and six bathrooms. The clinical area offers six medication-dosing stations, separate drug screening rooms, one medical examination room, 14 offices and two group counseling rooms. Black and white photography of local landmarks adorn the walls, which were secured through assistance from the Knox County Public Library and Terre Haute photographer Wayne Jordan.

The clinic will provide comprehensive treatment for adults 18 years of age and older who are struggling with addiction to heroin or other opioids such as prescription pain medication. The program provides daily medication (Methadone) coupled with individual and group therapy and case management services to treat each individual’s unique needs.

 “We are privileged to serve the Hendricks county community and those communities in the surrounding area,” said Melvin L Burks, CEO of Hamilton Center, Inc. “Our facility offers a professional environment where those struggling with opioid addictions can seek help and receive safe, effective treatment.”

“Governor Eric Holcomb and I thank Hamilton Center, Inc. for helping us move closer to our goal of placing an opioid treatment program within an hour’s drive of every Hoosier,” said Douglas Huntsinger, Indiana Executive Director for Drug Prevention, Treatment and Enforcement. “As Hoosiers work to recover from this disease, it is extremely important that we continue to expand access to the full continuum of care for substance use disorder in Indiana, including access to medication for opioid use disorder.”

The office will be open from 6:00 am – 2:30 pm.  New patients are welcome to walk in without an appointment between 6:00 a.m. – 10:30 a.m. or can call toll free 833-232-0215 or 317-268-2941 to make an appointment. The clinic is open 7 days a week including weekend and holidays.

Methadone is a medication administered daily under monitored, controlled conditions. It has been utilized for years with a great deal of research determining its safety and effectiveness. Once patients begin taking methadone at appropriate levels, withdrawal is avoided, cravings are minimized and physical and mental stabilization occurs. “That is when the real recovery begins,” said Jessica Nevill, LMHC, WIN Recovery’s Clinical Director. 

“The combination of medication and behavioral health interventions is the most effective in combating this disease,” said DJ Rhodes, Chief of Opioid Treatment at Hamilton Center Inc.  “Opioid Use Disorder is a disease; treatment works and recovery is absolutely possible,” he added.

Hamilton Center, Inc. is a regional behavioral health system in Central and West Central Indiana. The organization provides service regionally to 13,000 clients annually.  For additional information on Hamilton Center Inc., call 800-742-0787. For additional information on WIN Recovery call (833) 232-0215 or visit www.winrecovery.org.

Hamilton Center Adapts to Meet Needs of Community, Those in Crisis

Focuses on coordination of care for those with mental illness.

Hamilton Center, Inc. was established as a community mental health center in 1971, and as such has been providing quality behavioral health, wellness and human development services to central and west central Indiana. The organization’s vision is to advance excellence in behavioral health services through compassion, customer responsiveness, innovation, and flexibility.

“Both our mission and our vision have always been guiding principles for our organization but took on a new light this past year, both in response to the needs of our consumers and to the needs of our community in the wake of COVID-19,” said Melvin L Burks, CEO of Hamilton Center, Inc. “Mental health has been placed at the forefront of the social conversation around wellness, especially since the beginning of social distancing guidelines and practices.”

In fiscal year 2020 the organization served over 12,300 individuals across its traditional 10-county service area, which expanded to 11 counties in May 2020 with the addition of Knox County’s WIN Recovery, a state certified opioid treatment program. Of those individuals served by the organization, 42 percent live in Vigo County and 79 percent of those served had incomes of less than $8,000 per year. “Hamilton Center serves some of the most vulnerable Hoosiers”, said Burks.  “We are grateful to our community partners, grantors and others for their support.” He said. 

In addition, last fiscal year, the organization delivered 264,548 outpatient visits, 5,246 inpatient days and 13,679 residential days.

Coordination of Care

In moments of crisis, no one should have to navigate the complex web of the healthcare system alone. To assist the community, individuals, and families with these issues Hamilton Center has focused efforts around coordination of care, specifically for those struggling with mental illness.

“This is a powerful goal to aspire towards, however, the resources and coordination required to make this possible for those in crisis can present a seemingly insurmountable challenge for many,” said Burks.

In response to barriers to treatment of mental and physical health conditions, the organization has made efforts to not only increase access to services but to also establish coordination of comprehensive holistic care for individuals and families.

In June 2020, the organization was awarded a two year $3.75 million grant through the Certified Community Behavioral Health Center (CCBHC) Expansion Grant from the Substance Abuse and Mental Health Services Administration (SAMHSA). The grant is a part of the center’s broader strategic plan to acquire the CCBHC designation and has three primary components.

As one component of the grant, Hamilton Center will establish a 24-hr mobile crisis unit. This service will work alongside local authorities to deliver crisis services to those most in need as well as assist them in accessing services during their most vulnerable times. One of the goals of the program is to relieve some of the mental health crisis demands on local authorities and ERs. “We want to connect individuals to the most appropriate services to maximize care and recovery,” said Mark Collin, Chief Clinical Officer. “In the case of a mental health crisis, crisis management and behavioral health services are the most appropriate services.”

Last month, the mobile crisis unit began delivering services in Terre Haute, and will continue to scale gradually, with the ultimate goal of reaching an additional 475 children and adults in the next two years.

Another component is the implementation of the Assertive Community Treatment (ACT) model. This model of treatment, an evidence-based approach, will establish an intensive team of health professionals with a primary focus on collaboratively assisting people with serious mental illnesses in becoming independent and integrating into the community.

Additionally, the grant will enhance Hamilton Center ‘s capacity to offer mental health and primary health screenings for both children and adults. Through this integrated system of care, individuals can begin to address their issues in a holistic way, promoting higher rates of recovery and, most importantly, wellness.

“We are committed to excellence in care coordination, and we welcome additional conversations with leaders and partners committed to helping our team continue to improve along the way,” said Burks.

Integrating primary and behavioral health

Grace Clinic Health Professional now open

Removing barriers to treatment is another key component in addressing the health needs of a community. Grace Clinic Health Professional, the organization’s primary health care clinic, is now serving consumers at two locations – one at Vigo County located at 622 8th Avenue in Terre Haute, IN and the other at 239 Hillsdale Avenue, Suite A in Greencastle, IN. In August, the clinic was designated as a Federally Quality Health Center (FQHC) Look-alike by the Human Resources & Services Administration (HRSA). This designation allows the organization opportunities to develop and implement services required to meet the full qualifications for designation as a Federally Qualified Health Center. Together FQHCs and FQHC Look-alikes work to ensure health care for the Nation’s underserved communities and vulnerable populations through service provision to all. No one is turned away regardless of ability to pay.

Hamilton Center for years had recognized that very often those who were seeking intensive mental health or substance abuse services lacked primary care. This was due to lack of financial resources, access, transportation, or their mental illness being an obstacle for seeking other health services. At times these individuals would end up in less than appropriate levels of care such as emergency rooms.

Grace Clinic addresses these issues by providing holistic patient care, to men, women, and children who are underserved, underinsured, or without the ability to pay for quality healthcare. Experts agree that the body and mind are connected, so it is not uncommon for one’s mental health to effect other parts of the body and vice versa. Grace Clinic works to improve the overall health of patients by ensuring preventative care and early detection and management of chronic health diseases. In addition to primary care, the clinic also offers some behavioral health services and has the ability to refer to Hamilton Center for more intensive mental health and substance abuse services.

In fiscal year 2020, Hamilton Center/Grace Clinic provided 3,489 primary care visits.

Telehealth Services

Another component of the organization’s strategic plan is a continued expansion of telehealth services. Telehealth services is the use of video conferencing, electronic monitoring, and teleconferencing to deliver health services. Telehealth has exploded in the health care field. In fact, in 2017, 76 percent of all hospitals had established a telehealth system.

Limited access to health care has been a primary focus of both federal and state governments. Currently, Hamilton Center serves ten counties with behavioral health services and nine of those are considered mental health professional shortage areas (MHPSA) by HRSA. Telehealth services can be a valuable tool in those areas by perhaps having a therapist from an urban areas deliver services by telehealth to a consumer in rural Indiana where therapists are scarce.

And then came the coronavirus and social distancing guidelines which took telehealth services at Hamilton Center to new heights. From March, 2020 to the present, it is the preferred means of delivering outpatient behavioral health and substance abuse services. The organization has the majority of staff working from home who connect with clients electronically each day.  

“Telehealth has always been a valuable tool utilized by our organization, specifically in addressing the mental health needs of rural communities,” said Burks. “When COVID-19 hit, and social distancing became the way of life, our entire organization adapted to those demands quickly and efficiency.”

In fiscal year 2020, 24% of services delivered at Hamilton Center were by telehealth.

Connecting to the Community

Diversity Walk on Wheels and We Live events continue

On Saturday, August 22 the Diversity Walk-On-Wheels, pulled out of Fairbanks Park with over 120 cars parading across town to Indiana State’s Memorial Football Stadium. While at the stadium, Burks along with other dignitaries, delivered a presentation on diversity, inclusion and equity in the community, while also addressing the many Social Justice movements sweeping the country.

“The Diversity Walk was created to bring a diverse group of people together to break down barriers, build relationships and show what is possible when a community is welcoming to all,” said Burks. “Our goal was to offer individuals the opportunity to show their support for social justice in a positive and safe way.”

On Friday August 21, Hamilton Center and event sponsors, First Farmers Bank & Trust and Children’s Bureau, Inc., worked with community partners to deliver over $6,000 in schools supplies to both Benjamin Franklin and Deming Elementary Schools. Over 700 individual bags of supplies were delivered to the school for them to distribute to their student body. In addition, each school received $500 in additional support for the school year.

“On behalf of our entire organization, our board of directors and myself – from the bottom of my heart – I thank everyone for their efforts in making these events happen,” said Burks. “I consider the collaboration it took to execute these events in such complex circumstances, to be a testament to our commitment to each other.”

* * *

Hamilton Center, Inc. is a regional behavioral health system in Central and West Central Indiana headquartered in Terre Haute Services include specialized programs for expectant mothers, infants, and people with drug and alcohol problems. Counseling services are provided for people who may be struggling with stress, life changes, or relationship issues as well as more serious problems such as depression, anxiety disorders, and serious mental illnesses.

Opioid Use Disorder and the Many Paths to Recovery

By:  Jessica Nevill, LMHC, Clinical Director, WIN Recovery

Opioid use has been the focus of a great deal of national attention recently, with good reason. According to the National Behavioral Council, Americans consume 80% of the opioid prescriptions given worldwide. According to the Centers for Disease Control and Prevention, an average of 41 people die each day in the United States from overdoses on prescription pain killers. As a result, America is now in an opioid crisis. There is a growing number of individuals dying daily from overdose as well as increased criminal activity and increased HIV/AIDS rates.

Opioids have been prescribed in the United States to help individuals who are experiencing pain. These medications are effective at blocking the pain and providing relief. This is done by impacting the “reward pathway” which allows the person using the opioid to experience pleasure and an overall state of well-being. However, when used repeatedly over long periods of time, the person can build a tolerance to the medication which does not allow them to experience the same levels of well-being that they experienced before. This results in individuals taking more and more of the medication to get the same desired results.

So how does this result in an opioid crisis? When individuals need more and more medication to reach desired amounts of relief, they often use medication faster than prescribed. This results in their bodies becoming dependent, and can lead individuals to seek alternative ways of acquiring pain medicine. The Substance Abuse and Mental Health Services Administration (SAMHSA) has reported that over half of individuals who abused pain killers received them for free or from a relative. Once these individuals are no longer willing or able to provide this medication, individuals often turn to alternative methods such as buying medication illegally or beginning the use of heroin which is also an opioid. Once individuals begin using illegal methods to maintain an opioid dependence they are then at higher risks for HIV and AIDS, incarceration, separation from family, and loss of employment.

Opioid Treatment Programs (OTPs) are working to tackle the opioid crisis by providing individuals with medication such as methadone, buprenorphine, and naltrexone to help them discontinue the use of illicit substances. Methadone activates the same parts of the brain as other opioids. Buprenorphine activates the same parts of the brain, but without the rewarding effects. Naltrexone blocks the part of the brain that opioids activate and removes rewarding effects. Research shows that methadone and buprenorphine, when prescribed by a physician and closely monitored, are the most effective treatment methods for opioid use disorder.  Methadone is considered the “gold standard” of treatment, especially for pregnant woman who are addicted to opioids. This, along with behavioral health services such as individual and group counseling, help individuals gain the skills needed to maintain success in their lives.

WIN Recovery is a State licensed opioid treatment program located in Terre Haute and Vincennes Indiana.  The office provides comprehensive treatment to adults 18 years of age and older suffering from opioid use disorder.  Through medication assisted treatment and behavioral health services individuals are able to Regain Something Lost to addiction. The facility is open 7 days a week, and walk-in assessments are available from 6 a.m. to 10:30 a.m., Monday through Friday. Fees are based on the provision of service, with Medicaid accepted and no referral necessary.

For more information, call (833) 232-0215, visit our location at 1433 Willow St, Vincennes, IN, or go to www.winrecovery.org.

WIN Recovery: Regain Something Lost

Hamilton Center, Inc., based in Terre Haute, IN, and serving multiple counties throughout central and west central Indiana, is committed to supporting the State of Indiana in responding to the opioid crisis which has been growing in recent years. As a community mental health center, Hamilton Center, Inc. has been treating individuals with substance use disorders and a variety of other behavioral health issues for over 49 years.

WIN Recovery is the first Opioid Treatment Program (OTP) of its kind certified by the State of Indiana in Knox County.  The clinic will provide daily Methadone administration and behavioral health counseling and case management to provide comprehensive medication assisted substance abuse treatment

I. The problem:

  • Substance abuse costs our nation over $740 billion annually
  • Opioid overdose continues to be a major public health problem in the United States.  There were 67,367 lethal drug overdoses in 2018 – most were opioid related. 
  • Drug overdose is the leading cause of accidental death in the United States.  Over the past several years, Indiana has seen a record number of heroin overdose deaths.
  • The rate of opioid-related emergency department visits to Indiana hospitals increased 32% between 2009 – 2014
  • Indiana suffered 1,211 deaths from drug overdoses in 2019 (18.7 per 100,000)
  • In Vigo County, 10 deaths were attributed to opioid overdose in 2019. 

II. Who is at risk?

  • Individuals using heroin are not the only individuals at risk.  Anyone who uses opioids for long-term management of chronic cancer or non-cancer pain is at risk for opioid overdose, as are persons who use heroin.  Those who use prescription pain killers are 40x more likely to develop an addiction to heroin.  Nearly all addicted individuals believe at the outset that they can stop using drugs on their own and most try to stop without treatment.  Because of the drug-induced changes in brain functioning, many individuals have behavioral consequences, even long after they may have stopped using drugs, including continued impulsiveness to use drugs despite consequences.

III. Medication Assisted Treatment (MAT):

  • Medication-Assisted Treatment (MAT) is opioid addiction treatment that includes medication administration such as Methadone coupled with other behavioral health services such as individual and group counseling, case management and other support services as appropriate. 
  • Medication is prescribed and administered under monitored, controlled conditions and is safe and effective for treatment for opioid addictions when used as directed.
  • Methadone treatment provides patients with medication, health, social and rehabilitation services that relieve withdrawal symptoms, reduce cravings and allow normalization of the body’s function. 
  • Methadone has been used for over 50 years world-wide and is the gold standard of opioid treatment as it is most effective and least expensive.
  • Methadone represents a community return on investment as the average cost of treatment is $5,500 annually compared to $25,000 annually for incarceration.
  • Methadone treatment programs are associated with a decrease in criminality, promotion of patient employability and education and connects patients with other medical and mental health care. In addition, the relationship between intravenous drug use, needle sharing, hepatitis and HIV/AIDS exposure is well documented. Methadone treatment is the most effective intervention for reducing the spread of HIV/AIDS and hepatitis – consistent with strong public health initiatives.

IV. WIN Recovery:

  • Hamilton Center, Inc., Vigo County, opened its first clinic in Terre Haute in May 2018.  In November 2018 the organization received a second license from the State of Indiana to establish a clinic in Knox County.   
  • WIN Recovery Knox County is currently open and accepting patients 18 years of age or older.
  • The program is certified by the State of Indiana, SAMHSA and accredited as appropriate. 
  • In addition to medication assisted treatment, services will include individual and group counseling, case management and other behavioral support services as appropriate.
  • Hamilton Center, Inc. is partnering with Sagamore Medical Recovery Services, LLC which was formed in 2016 by Christian A. Shaw, MD, PhD and his partners.  Dr. Shaw is a leader in the field and has worked to develop the most successful, innovative and respected methadone based opioid treatment program in New Mexico.  Sagamore is providing the medical component of the clinic; Hamilton Center is providing the behavioral healthcare which will include individual therapy, group therapy and case management.
  • Hamilton Center is working with several community partners to integrate services within the Knox County community. This includes collaborating with the community mental health center, the hospital and physican practices, criminal justice, law enforcement amoung others.
  • The office is open from 6:00 am – 2:30 pm with new patients being seen from 6:00 am – 10:30 am.  The clinic is open everyday including holidays and weekend.

For additional information call 833-232-0215 or 812-494-2215.  Appointments can be made, however walk ins are welcome.

History and Effectiveness of Methadone Maintenance Treatment

Methadone treatment provides the patient who is opioid dependent with medication, health, social, and rehabilitation services that relieve withdrawal symptoms, reduce physiological cravings, and allow normalization of the body’s functions. Methadone treatment has been available for over 30 years and has been confirmed effective for opioid dependence in numerous scientific studies.

Moreover, in 1997, the U.S. Department of Health and Human Services’ National Institutes of Health (NIH) Consensus Panel found the following concerning methadone treatment: “Of the various treatments available, methadone maintenance treatment, combined with attention to medical, psychiatric and socioeconomic issues, as well as drug counseling, has the highest probability of being effective.”

Methadone treatment programs are staffed by professionals with medical, clinical, and administrative expertise. Patients receive medication from a health professional. Patients routinely meet with a primary counselor (social worker, caseworker, or certified substance abuse counselor), attend clinic groups, and access medical and social services.

Methadone’s effectiveness, and the absence of any serious, long-term side effects from using it, have been demonstrated in numerous studies conducted over the past 30 years. Among the most commonly cited outcomes are:

  • Consumption of all illicit drugs declines to less than 40 percent of pretreatment levels during the first year and eventually reaches 15 percent of pre-treatment levels for patients who remain in treatment 2 years or more.
  • Crime is reduced substantially: For example, in the most detailed study of treatment outcomes to date, during the first 4 months of treatment, crime decreased from 237 crime days per year per 100 addicted persons during an average year of their addiction to 69 crime days per year per 100 patients, a reduction of more than 70 percent. This number declined further to only 14.5 crime days per year for patients in treatment 6 years or more.
  • Fewer individuals become infected with HIV: A study by Metzger, et al, 1993, showed that over a 3-year period, 5 percent of patients in methadone treatment became HIV positive (over and above those already positive at admission), while among a cohort of out-of-treatment addicts in the same neighborhood, 26 percent became HIV-positive (over and above those already positive at baseline).
  • Individual functioning improves, as evidenced in improved family and other social relation­ ships, increased employment, improved parenting, etc., according to the Substance Abuse and Mental Health Services Administrations Center for Substance Abuse Treatment, 1994, and Lowinson, et al, 1992.

Source: U.S. Department of Health and Human Services, Medication Assisted Treatment for the 21st Century

Heroine vs. Methadone vs. Suboxone

TOPICHEROINMETHADONEBUPRENORPHINE (Suboxone)
Onset of actionA few seconds30 minutes30-40 minutes
Duration of action4-6 hours24-36 hoursAbout 24-48 hours
Route of administrationInjection, snorting, smokingOralSublingual
Frequency of administrationSeveral times a dayDaily or more frequently as neededEvery day or every other day
Effective doseEver increasingBlocking dose usually 80-120mg2-32mg
ToleranceIncreasing toleranceTolerance is stableTolerance is stable
Euphoric effectsEuphoria for up to 2 hoursNo euphoria when stabilizedNo euphoria when stabilized
Overdose potentialHigh and increasingRare (potential is mixed with other depressants)Very rare
Overall safetyPotentially lethalVery safeOverall good. Suboxone injection will cause serious withdrawal symptoms in dependent person. Not recommended for pregnancy and caution with liver disease
WithdrawalWithin 3-4 hours after last doseWithin 24-36 hours after last doseWithin 36-48 hours after last dose
CravingRecurringEliminated with adequate doseCraving may not be totally eliminated due to ceiling effect
Pregnancy/NursingGrave risk for mother and fetusSafe during pregnancyNot indicated/study underway
Experience of pain and emotionsBluntedNormal and full range of emotionsNormal pain but opioid analgesics may not be effective – may need to switch to methadone. Full range of emotions
MoodConstant mood swingsNormalNormal
Reaction time and intellectual functioningImpairedReaction time normal. Intellectual functioning unimpaired on stable doseReaction time presumed to be normal like methadone. FDA cautions driving/operating machinery in the beginning of treatment
HIV & Hepatitis C transmissionHigh rate with needle use and unprotected sexReduced/eliminatedReduced/eliminated
Immune system for HIV positive personsRapid progression to AIDSProgression slowedProgression presumed same as methadone – data not available
Immune/endocrine system functioningImpairedNormalized during treatmentPresumed normalized. Data not available
Stress ResponseSuppressedNormalized during treatmentNormalized during treatment
Criminal activityHigh levelReduced/eliminatedReduced/eliminated
Community impactDestructing impact. High crime, high death rate, transmission of diseaseContributed to public safety, low mortality, increased healthContributed to public safety, low mortality, increased health
Reproduced from 2003 Medication Assisted Treatment for the 21st Century: Community Education Kit, SAMHSA

Frequently Asked Questions

Does methadone treatment impair mental function?

Methadone treatment has no adverse effects on intelligence, mental capability or employability. Methadone treated patients are comparable to non-patients in reaction time, in ability to learn, focus and make complex judgements. Methadone treated patients do well in a wide array of vocational endeavors, including professional positions, service occupations and skilled, technical and support jobs.

How is success in methadone and other pharmacotherapy treatments defined?

The primary goals are to help addicts cease heroin use and lead more stable, productive lives. But, as knowledge about heroin addiction and effective treatment practices has grown, so too have the objectives of most methadone treatment programs, which also aim to:

  • Decrease criminality and reduce the numbers of substance abusers entering the criminal justice system.
  • Assist patients in addressing multiple substance abuse (including crack/cocaine addiction and alcoholism).
  • Assure treatment for general health matters, especially those related to drug use, such as HIV/ AIDS, tuberculosis and hepatitis
  • Promote patient employability and educational development.
  • Identify and treat mental health problems and alleviate homelessness, family substance abuse and child and family dysfunction.

Why do drug-addicted persons keep using drugs?

Nearly all addicted individuals believe at the outset that they can stop using drugs on their own and most try to stop without treatment. Although some people are successful, many attempts result in failure to achieve long-term abstinence. Research has shown that long-term drug abuse results in changes in the brain that persist long after a person stops using drugs. These drug-induced changes in brain function can have many behavioral consequences including an inability to exert control over the impulse to use drugs despite adverse consequences – the defining characteristic of addiction.

How effective is drug addiction treatment?

In addition to stopping drug abuse, the goal of treatment is to return people to productive functioning in the family, workplace, and community. According to research that tracks individuals in treatment over extended periods, most people who get into and remain in treatment stop using drugs, decrease their criminal activity, and improve their occupational, social, and psychological functioning. For example, methadone treatment has been shown to increase participation in behavioral therapy and decrease both drug use and criminal behavior. However, individual treatment outcomes depend on the extent and nature of the patient’s problems, the appropriateness of treatment, and related services used to address those problems and the quality of interaction between the patient and his or her treatment providers.

How long does drug addiction treatment usually last?

Individuals progress through drug addiction treatment at various rates, so there is no predetermined length of treatment. However, research has shown unequivocally that good outcomes are contingent on adequate treatment length. Generally, for residential or outpatient treatment, participation for less than 90 days is of limited effectiveness, and treatment lasting significantly longer is recommended for maintaining positive outcomes. For methadone maintenance, 12 months is considered the minimum and some opioid addicted individuals continue to benefit from methadone maintenance for many years.

How do other mental disorders coexisting with drug addiction affect drug addiction treatment?

Drug addiction is a disease of the brain that frequently occurs with other mental disorders. In fact, as many as 6 in 10 people with an illicit substance use disorder also suffer from another mental illness; and rates are similar for users of licit drugs-i.e., tobacco and alcohol. For these individuals, one condition becomes more difficult to treat successfully as an additional condition is intertwined.

Is the use of a medication like methadone simply replacing one drug addiction with another?

No – as used in maintenance treatment, methadone is not a heroin/opioid substitute. It is prescribed or administered under monitored, controlled conditions and is safe and effective for treating opioid addiction when used as directed.

Source: NIDA, “Principles of Drug Addiction Treatment”

WIN Recovery, Knox County Now Open

Hamilton Center Inc.’s Certified Opioid Treatment Program to serve adults with opioid use disorder

June 1, 2020 Vincennes IN- Hamilton Center, Inc., a certified Indiana community mental health center, announced the opening of its newest certified opioid treatment program, WIN Recovery at 1433 Willow St., Vincennes, IN.  This clinic is one of two opioid treatment programs operated by Hamilton Center Inc. with a third scheduled to open in the fall in Hendricks county.

The office is open from 6:00 am – 2:30 pm.  New patients are welcome to walk in without an appointment between 6:00 a.m. – 10:30 a.m. or can call toll free 833-232-0215 or 812-494-2215 to make an appointment. The clinic is open 7 days a week including weekend and holidays.

The facility, which is 5032 square feet, includes three medication dosing stations, separate drug screening rooms, physical examination room, and rooms for individual and group counseling.   Black and white photography of local landmarks adorn the walls which were secured through assistance from the Knox County Public Library and Terre Haute photographer Wayne Jordan.   

In November, 2018 Hamilton Center received a license to open the Knox county program.  The clinic will provide comprehensive treatment for adults 18 years of age and older who are struggling with addiction to heroin or other opioids such as prescription pain medication.  The program provides daily medication (Methadone) coupled with individual and group therapy and case management services to treat each individual’s unique needs.

Whether opioids are prescribed by a physician or acquired illegally, with continued use and misuse, they can cause serious changes to the brain and body.  People often hesitate to begin the recovery process due to fear of the physical symptoms associated with withdrawal, or because they doubt recovery is even possible.

Methadone is a medication administered daily under monitored, controlled conditions. It has been utilized for years with a great deal of research determining its safety and effectiveness. Once patients begin taking methadone at appropriate levels, withdrawal is avoided, cravings are minimized and physical and mental stabilization occurs. “That is when the real recovery begins,” said Jessica Nevill, LMHC, WIN Recovery’s Clinical Director. 

“The combination of medication and behavioral health interventions is the most effective in combating this disease,” said DJ Rhodes, Chief of Opioid Treatment at Hamilton Center Inc.  “Opioid Use Disorder is a disease; treatment works and recovery is absolutely possible,” he added.

“We are so grateful to the Knox county community for welcoming this clinic to the area”, said Melvin L. Burks, CEO of Hamilton Center Inc.  “There is a solid understanding of the benefits of medication assisted treatment and because of that many people in this community will benefit,” he added.  

Hamilton Center, Inc. is a regional behavioral health system in Central and West Central Indiana. The organization provides service regionally to 13,000 clients annually.  For additional information on Hamilton Center Inc., call 800-742-0787. For additional information on WIN Recovery call (833) 232-0215.

To learn more please visit www.winrecovery.org.

Social Work Month in March spotlights the positive impact of social workers over generations

This year’s theme is “Social Workers: Generations Strong”

Terre Haute, IN – The National Association of Social Workers – Indiana Chapter (NASW-IN) was joined by the Indiana State University Department of Social Work, Hamilton Center, Inc., and several community organizations to celebrate Social Work Month in March by recognizing individuals and organizations for contributions to their communities in the field of social work. The event took place at the College of Health and Human Services, Thursday, March 12, 2020, and featured presentations from local educators and leaders of the field, as well as the announcement of the “NASW-IN Region 9 2020 Social Worker of the Year”, Ms. Emily Owens, MSW, LCSW, Executive Director of Clinical Services at Hamilton Center, Inc. Region 9 of NASW-IN includes Parke, Vermillion, Putnam, Vigo, Clay, Owen, Sullivan, and Greene Counties.

With the beginning of a new decade, the theme for 2020 is “Social Workers: Generations Strong”, which highlights the way social workers from every generation – from the Silent Generation to Generation Z – are shaping our society for the better. There are more than 700,000 social workers across the nation – with more than 9,500 licensed social workers in Indiana – working each day to meet people where they are and help them live to their fullest potential.

Emily Owens, MSW, LCSW, draws experience from working in the human services arena for over twenty years and in the community mental health field for over fifteen years. She began working at Hamilton Center, Inc., in November, 2004, as a Wraparound Specialist and later had several promotions which lead her to her current role of Executive Director of Clinical Services. She oversees Hamilton Center’s Child and Adolescent Services in Vigo County as well as several outpatient satellite offices. Her clinical interests include children and families with complex behavioral health needs as well as adults with mental illness and substance use disorders.

“During Social Work Month, NASW Indiana Chapter makes time to acknowledge and celebrate Social Workers at our regional events, celebrating the profession’s accomplishments, discussing our challenges, and supporting each other,” Executive Director Beryl Cohen said.  “We also present Regional Social Worker of the Year awards at most of our events.  This award recognizes and honors a current member of the association who exemplifies the best of the profession’s values and achievements through specific accomplishments.”

“Social workers have been doing heroic work for generations,” said Ms. Owens. “The impact of those contributions are the foundation on which social workers, like myself and closest colleagues, work today. I value the generations to come that will continue the important work in the field,” she added.

Social work is a profession with expansive borders, and one of the fastest growing professions in the United States. According to the Bureau of Labor Statistics, the number of people employed in social work to grow by 11 percent over the next decade. Even though social workers are found everywhere in our society – for example centers for veterans, mental health and health care facilities, corporations, and local, state and federal government offices – there is a critical shortage of social workers in places like schools, where the profession is needed to help young people deal with complex issues such as trauma, poverty and the impact of our nation’s opioid addiction crisis.

“As we enter a new decade, it is a great time to look back at the tremendous contributions social workers have made to improve the quality of life for individuals, families and communities on both the local and national level,” Cohen said.  “It is also time to recognize that there is a new generation of social workers coming to the fore who are already making a positive mark on our society.”

Hamilton Center, Inc. is a private, not-for-profit regional health system that employs 45 people with social work degrees in central and west central Indiana, many of which are licensed clinical social workers. Social workers play a critical role in the organization’s efforts in building hope and changing lives. Serving individuals from birth through older adulthood, Hamilton Center provides the highest quality of behavioral health services through individualized treatment plans, trauma informed care, and evidence-based practices.

For more information, contact 812-231-8323 or visit www.hamiltoncenter.org.