“When I first got here, I talked to some clients who said they could never go back to Cherokee because they can’t live here, because everybody they know uses and they feel like it’s not a place that’s safe for them to be,” said Doug Trantham, director of behavioral health for the Cherokee Indian Hospital Authority. “I would like people to say Cherokee is the place to be if you want to live a healthy life.”
The Recovery Center, which sits behind the Bureau of Indian Affairs office where the credit union used to be, offers a range of services for people who need help battling an addiction. Peer support specialists — people who are practicing recovery after dealing with behavioral health issues — offer counsel. An employment specialist is available to help people in recovery find work. A full schedule of classes offers emotional support, life skills, cultural connections and yoga, among other resources.
“What we see ourselves doing everyday is helping people get restarted, get back on track, get a new start,” Trantham said.
Since opening on Dec. 1, 2015, the Recovery Center has been nothing if not well used. Dozens of people pass through its doors every day with 29 people attending 178 classes in the first three months.
Trantham and the rest of his division are excited about its impact, but the center is far from the only change coming to the way the Eastern Band of Cherokee Indians handles substance abuse issues.
Attacking the issue
In June 2015, Tribal Council approved a 15-point plan to combat substance abuse from prevention to rehabilitation, allotting $16 million for facilities and $2.2 million annually for operations.
“We have the resources to address it is really why it’s at the forefront now,” said Lynn Harlan, public relations officer for the hospital and a tribal member. “Before it was like, we don’t want to talk about a problem we can’t address.”
As casino profits have rolled in and the tribe has become more able to make and fund its own decisions, Harlan explained, the Cherokee people have addressed their most pressing needs one by one. High diabetes rates and the landing of a state grant led to a push to build community gyms. An opportunity came up for property to accommodate a new school system, so that came next. An $18 million grant from the U.S. Department of Justice paved the way for construction of a new justice center and jail.
Now, with drug abuse prevalent and the effects bolstering crime rates and leading young adults to early graves, the time has come to combat the issue head-on. It’s made frequent appearance in Tribal Council chambers in recent months, and programs are ramping up to attack it from a health standpoint.
But substance abuse is not a Cherokee-specific problem, Harlan emphasized.
“Our problems aren’t any more significant than other communities,” Harlan said. “It’s just that we, unlike many governments, are able to address issues that affect us personally.”
No good data exists on use and abuse rates on the Qualla Boundary, so it’s impossible to compare prevalence on and off tribal land. But Trantham agrees that substance abuse, especially prescription opiates and heroin, are issues across Western North Carolina and in the nation as a whole.
“Opiates have really exploded all across the country, and it’s really the case here,” he said.
Of 14,700 enrolled members, about 11,000 have been patients at the hospital. In 2012, 1,530 of those 11,000 patients received a diagnosis related to substance abuse. That’s roughly 14 percent of hospital patients or 10 percent of enrolled members.
Rates are high elsewhere in the region. Every year, about 15 people in Haywood County die from prescription drug overdose, a rate several times higher than deaths from automobile accidents. In Jackson County, 72,000 prescriptions for abuse-prone drugs were written for 22,000 people in 2014.
The goal for Cherokee’s program, called Analenisgi Behavioral Health, is to attack the causes of those numbers on the boundary and turn addicts into healthy and productive members of society. That’s a multi-faceted goal with a lot going on surrounding it.
“Literally, we could water board you with information,” Trantham said.
Perhaps, but the summary of Analenisgi is in the name itself. Analenisgi means “they are beginning” in the Cherokee language. The name was chosen carefully by a group of Cherokee speakers to underscore the program’s purpose.
“A lot of what we’re doing here is we are helping people begin again,” Trantham said.
Implementing the plan
The tribe has the beginning and the end of that cycle mostly in place. The Recovery Center is there to help people who need outpatient help and encouragement to stay sober. And people in need of intensive detox can go to the hospital for care as the drugs leave their system. But the resources to bridge those two extremes are still in progress.
This summer, the tribe hopes to have a halfway house for men in recovery up and running in Whittier, just off the U.S. 74 exit for Cherokee. They’ve purchased the property and secured a Conditional Use Permit from Jackson County. Now they’re just waiting on contractors to return bids to renovate the 1960s brick structure. The 4,400-square-foot home would house eight men as they work on life skills and reach the stability they’ll need to safely reintegrate to the community.
While living there, Trantham said, the men will stay busy with work or volunteering or treatment, but they’ll be safe while doing so.
“A lot of our folks do not have a place to live here in Cherokee that is safe for them — safe from the standpoint of being free of triggers,” Trantham said.
Plans are in the works for a similar facility for women, designed to accommodate their children as well. But that project will take a little longer. The folks at Analenisgi have their eyes on the property that used to house the Cherokee Children’s Home, behind the Ginger Lynn Welch Complex. The location is perfect, within walking distance of the library, a coffee shop, two daycares, a recreation center and multiple playgrounds. That’s basically ideal for mothers who may or may not have access to a car.
“It’s close to a lot of things, but when you’re there it feels very residential,” said Kristi Case, recovery services manager for Analenisgi.
The construction, however, is problematic. The existing buildings are old and probably not worth the cost of renovation. Currently Analenisgi is investigating the cost of building a new facility. It’s hard to say exactly when that project might be finished.
The flagship of the Analanisgi program, however, will be the Snowbird Recovery Center, a facility that now exists only on paper. Accounting for $13.5 million of the $16 million Tribal Council promised for facilities, the center would accommodate both men and women in need of intensive rehabilitation.
The Snowbird Recovery Center would offer everything from medical services to family engagement to connection to Cherokee culture, a one-of-its kind facility using the same environmentally themed design principles as the new hospital.
“There’s not anything like this facility,” Trantham said. “There won’t be anything like it in North Carolina, certainly not west of Asheville.”
Located in economically struggling Graham County, another boon of the new treatment center will be the jobs it will provide to the area, Harlan said. A staff of 10 to 15 will be required to run it.
“Everything on the news about Graham County is jobs leaving, so the Snowbird center is a huge opportunity,” she said.
The center is expected to open sometime in 2017, with the timeline largely depending on permitting. The land itself is trust land owned by the Eastern Band, but access will require building a road through land managed by the U.S. Forest Service.
Connecting mind and body
Though the planned continuum of care progresses from hospital detox to the rehabilitation center to the halfway house to continued contact with the Recovery Center, not every person will follow that same path. Not everyone will need to. And not everyone who is touched by the ramped-up behavioral health efforts will actually be seeking out help.
For example, the Analenisgi program includes a fulltime therapist who works in the jail, treating a population that’s often overlooked but includes high proportions of people with behavioral and mental health issues. The program addresses prevention, too, working in Cherokee Central Schools. And the integrated care model at the new hospital is also being put to work to combat the stigma that can come with seeking help for mental and behavioral health.
The new hospital is organized into “integrated care teams,” teams of medical professionals representing a diversity of specialties. The idea is that they collaborate and share responsibility for each patient in an effort to address the whole person. The teams include a psychologist.
“No one knows whether you’re getting your blood pressure medicine or having a mental health checkup,” explained Harlan.
“It very much normalizes behavioral health,” Trantham said.
The connection will get even stronger down the road when the hospital completes its plan to renovate space for the behavioral health program in the old hospital building, now empty.
“That’s basically saying there isn’t some great separation between the mind and the body,” Trantham said. “Everything is connected.”
That’s a mantra that Harlan is happy to repeat.
“This is a project that is a step in taking care of our community, and there will be another issue that comes up that we address next,” Harlan said. “This will help us have more healthy individuals to work toward what the tribe believes is important, and that’s keeping us strong as a culture and keeping us strong as a nation.”
Cherokee people looking for help with substance abuse issues can find it at the Analenisgi Recovery Center, which is always open to walk-ins. The center provides an extensive range of services, including therapy, employment services and a full schedule of classes to assist with recovery.
The center is located on 375 Sequoyah Trail behind the Bureau of Indian Affairs office and open weekdays from 7:45 a.m. to 4:30 p.m. 828.497.9163 ext. 7550.