EPC's Special Sauce

While helping the people of Albuquerque is all well and good, we very much hope to help other communities to adopt some or all aspects of our inebriate (and community) rehabilitation model. Drug and alcohol addiction, emergency department overcrowding, psychiatric illness and general isolation are not problems familiar only to Albuquerque. We've learned much in our first few years.

EPC was created in phases because our initial ideas seemed so distant and out of reach. To divide and conquer we named these phases: outreach, detox center, community center, housing, gym and alternative energies. Today each of these phases are growing together to create one harmonious rehabilitative campus.

Whether you and your community would like climb under our nonprofit umbrella, or if you want to start from scratch, the following points are the EPC "special sauce,"; mixed with a little philosophy and non-evidence-based dogma. For those of you who want greater detail, read on through the separate phases as well.

EPC's Special Sauce

Volunteers are critical. No rehabilitative system is perfect. But through weekly meetings, the systems created can be continuously refined and improved to meet the needs of the target audience and the community. Lose the volunteers, and you're just another processing plant. By blending newly sober individuals with people who have never suffered from addictions, the rehabilitative opportunities explode for everyone.
A detox center adjacent to a community center is an incredibly potent relationship. It doesn't matter who runs what, whether it be governments, nonprofits, individuals or corporations. The bottom line is that everyone with an addiction related problem has somewhere to go. If someone presents to EPC intoxicated, they are escorted to MATS. Once discharged from MATS, newly sober individuals have EPC as a safe environment to help them establish sober friendships.
While it is nice to have a little separation between the centers, it wouldn't be crazy for both to be part of the same physical structure. However, division between the two helps to shelter newly sober individuals from any whiff of alcohol or other triggers for use.
Basic medical services for inebriates (still in development within MATS), offers immense societal bang for buck by decompressing emergency departments. Even if not a single person cared for within MATS stays sober, by shifting inebriate care from emergency departments to MATS, the general public still benefits through an improved emergency medical system.
Creative opportunities are rare in today's litigious society. Sure, it's easy to offer arts and crafts, but to offer opportunities to actually teach arts and crafts, or to weld, or repair a computer, or teach yoga, or establish a 12 step meeting, or climb an 18 foot wall or participate in developing a rehab program.. that's quite rare. Creativity, contribution to society and the sense of accomplishment are at the core of recovery at EPC. It's impossible to force creativity, but proper infrastructure can certainly be built enabling it to exist.
One size does not fit all in addiction rehab. Some people benefit from deep discussion about past harms. AA, NA, psychoanalysis, counseling, etc. all serve this purpose. Other people need distraction… "All that talk about heroin makes me want to shoot up." Others need spirituality. Others need a tall rock face to climb and conquer. EPC strives to offer any and every hook aimed at facilitating sobriety. Addictions are complex and reasons for use are as many and varied as there are addicts. Some want the high. Others want to feel normal. Others don't want to feel. Others want to forget. Sobriety can't be forced on anyone. But infrastructure and wholesome environments can be created to help people find their way back to healthy lives.
Addiction is more than an individual problem. It's a mirror on society. It is very easy to get lost today with urban sprawl, limited healthcare access, car dependency, splintered families. Reinventing and reviving "community" is necessary for any rehab that hopes to have real impact. NIMBY (not in my backyard) suggests an attitude that addiction problems should be swept elsewhere. But done right, a rehab center can help revive a community.
Lastly… on a public policy note mixed with a little physics… Incarcerating people for drug use in absence of other crime is an amplifier. Using methamphetamine as an example, meth users find themselves in jail making friends with other meth users. With all the time in the world, they learn to cook better meth. Once released their employability has plummeted and their closest friends are now addicts. Great… Back to physics, a good rehab is a damped oscillator. People who arrive swinging from extreme highs to lows, should walk out with sober friendships, new skills, improved employability and stability.

Phases

Phase 1: Outreach

Outreach commenced on March 10th, 2004, thanks to a generous donation of a recreational vehicle by the United Blood Services. In 2004 and much of 2005 we visited various shelters and parks distributing donated clothing to homeless individuals, and we conducted a needs assessment survey to guide the development of our future services. In September 2005 the vehicle was sold. However, outreach still continues to some extent through distribution of donated clothing and other items to individuals in need.

Phase 2: Detox Center

In February 2004, EPC volunteers searched high and low for a headquarters. We eventually set our sights on an abandoned hospital formerly known as Charter. However, the asking price was $4.5 million. Far from reach, we looked for other options. Fortunately, we discovered that John Dantis of Bernalillo County was also looking at Charter in order to relocate the County's existing Sobering Services Center which offered social model detox. After months of negotiations, Bernalillo County purchased the hospital for $2.5 million in July 2004. After a year of renovations, on October 21, 2005, MATS (Metropolitan Assessment and Treatment Services) opened its doors offering social model detox services with 40-50 beds. EPC volunteers assisted Mr. Dantis and the County by gathering neighborhood support, by developing and coordinating a medical advisory board, by developing EMS transport protocols, by assisting with policies and procedures, by providing input related to building renovation, by helping to develop transitional housing and through legislative lobbying. Assuring MATS success remains one of EPC's primary objectives.

Social model detox was the initial service offered. But eventually, Turquoise Lodge was added to the MATS mix, which is a New Mexico State run agency offering full medical model detox. While the existence of both models under the same roof is fantastic for individuals seeking sobriety, the service which stands to offer the greatest societal impact remains in development, namely "medically monitored" detox. Both medical and social model detox require inebriates to be ambulatory and to accept or request detox services. For the individual, this service is critical. However, this does very little to decompress emergency departments or jails, because staggering or barely conscious inebriates who can barely recall their names continue to find themselves strapped to beds in emergency departments. By expanding care for inebriates to the time period "between their last drink and their first steps," all local emergency departments can be decompressed.

Inebriates are routinely delivered to emergency departments for medical "clearance." Once deemed stable, they essentially sleep until sober. Sobering may require 12 to 24 hours. Treatment for withdrawals is achieved more rapidly but still often requires hours to stabilize. In the meantime, many other patients sit anxiously awaiting emergency department bed availability. Many in the waiting room actually leave without being seen due to the prolonged waits. Care for these people within MATS, and perhaps expanding care to include simple laceration repair or abscess drainage, could offer immense savings to local emergency departments.

While the addition of basic emergency medical services to MATS may seem relatively simple to accomplish, it has been the most challenging step to achieve in 5 years. Luckily John Dantis, as well as the EMS and medical communities continue to forge ahead and such services seem around the corner.

Phase 3: Community Center

While assisting the MATS team to gather neighborhood support, one neighbor offered to sell his 11,000 sq. ft. building to EPC. The timing was right, the price was right and the seller helped to finance the purchase. Since closing on the purchase in May 2004 we have been working to develop our community center, located directly across the street from MATS.

This center provides our volunteers an opportunity to be creative, along with a wholesome social environment for the general public and for graduates of MATS. Our community center officially opened on October 29, 2005. Opportunities to assist with the development of this center remain endless.

Although not part of the original plan, we are finding our community center to be more and more critical in the rehabilitative process. Many detox centers exist. And in fact, it is relatively simple to help someone to get sober. A sandwich, a quiet bed and a kind word remain cutting edge detox care. But without aftercare services, the newly sober often seek the comfort of their old environments and friendships, often leading straight back to their old habits and addictions. Our community center offers the newly sober a chance to establish new wholesome relationships and to learn new skills.

Art, yoga, meditation classes take place within the center. People interested in computers, landscaping, exercise, bike repair also utilize the space, along with numerous 12 step and prayer groups, and even the local neighborhood association.

In short, MATS helps people to get sober, EPC helps them to stay sober.

Phase 4: Housing

On February 29, 2008, we held our opening ceremony for the Waterman Power House. In August 2004, Sam met a general contractor named Ted Waterman at a meeting aimed at solving Albuquerque's homelessness problem. After touring the EPC and MATS sites, Mr. Waterman donated 20 military housing units to EPC and 48 units to Bernalillo County to help create transitional housing. Additional assistance came via the McCune Charitable Foundations of Santa Fe and Pittsburgh as well as the Daniels Fund and the LaFarge Corporation. And throughout 2007 EPC volunteers slaved away to create our 20 unit structure.

The housing program called Endorphin Power University saw its first enrollees in December 2007. Each day our residents (aka guests or students) participate in 4 "electives", namely fitness, education, fellowship, and community service. We consider these the 4 pillars of our housing program.

All rehab programs fall somewhere on a wide spectrum… everything from jail to total freedom. Endorphin Power University is aimed at people who want help, but don't need continuous monitoring and containment. The primary goals in the 9 month program is to help each of our residents to achieve gainful employment, housing (preferably within the EPC neighborhood), and stable sober friendships. Refinement of the program is continuous with input from volunteers, staff and residents, and the Endorphin community as a whole continues to gather strength and stability.

In addition to the Waterman Power House, Bernalillo County is also adding another 82 beds to the transitional housing mix, which is slated for completion by early 2009. In January 2005, EPC hired a lobbyist named Ed Mazel to seek financial support from NM state government to support such construction. As a result, $865,000 in capital outlay was allocated to Bernalillo County for the project. Bernalillo County hired Mr. Mazel in January 2006 resulting in an additional $850,000 in capital outlay. Since that time the project has doubled in size and budget and now stands to become New Mexico's largest transitional housing complex.

Many thanks to Bernalillo County, to Ted Waterman, and our financiers for making housing a high priority.

Phase 5: Exercise

Studies show that exercise benefits many medical and psychiatric conditions. The following excerpt, taken from an article written in DukeMed magazine by Richard Merritt on 9/21/2000, refers to the effect of exercise on depression:

Last year, the Duke researchers reported on their study of 156 older patients diagnosed with major depression which, to their surprise, found that after 16 weeks, patients who exercised showed statistically significant and comparable improvement relative to those who took anti-depression medication, or those who took the medication and exercised.

The new study, which followed the same participants for an additional six months, found that patients who continued to exercise after completing the initial trial were much less likely to see their depression return than the other patients. Only 8 percent of patients in the exercise group had their depression return, while 38 percent of the drug-only group and 31 percent of the exercise-plus-drug group relapsed.

"The important conclusion is that the effectiveness of exercise seems to persist over time, and that patients who respond well to exercise and maintain their exercise have a much smaller risk of relapsing," said lead researcher, Duke psychologist James Blumenthal, who published the results of his team's study in the October issue of the journal Psychosomatic Medicine.

The research was supported by grants from the National Institutes of Health (NIH). The Duke researchers are now using a new $3 million NIH grant to better understand the subtle factors that may explain the positive effects of exercise in a new trial that begins enrolling patients this month.

"We found that there was an inverse relationship between exercise and the risk of relapsing - the more one exercised, the less likely one would see their depressive symptoms return," Blumenthal explained. "For each 50-minute increment of exercise, there was an accompanying 50 percent reduction in relapse risk.

"Findings from these studies indicate that a modest exercise program is an effective and robust treatment for patients with major depression," he continued. "And if these motivated patients continue with their exercise, they have a much better chance of not seeing their depression return."

Researchers were surprised that the group of patients who took the medication and exercised did not respond as well as those who only exercised.

"We had assumed that exercise and medication together would have had an additive effect, but this turned out not to be the case," Blumenthal said. "While we don't know the reasons for this, some of the participants were disappointed when they found out they were randomized to the exercise and medication group. To some extent, this 'anti-medication' sentiment may have played a role by making patients less excited or enthused about their combined exercise and medication program."

He suggested that exercise may be beneficial because patients are actually taking an active role in trying to get better.

"Simply taking a pill is very passive," he said. "Patients who exercised may have felt a greater sense of mastery over their condition and gained a greater sense of accomplishment. They may have felt more self-confident and competent because they were able to do it themselves, and attributed their improvement to their ability to exercise."

Once patients start feeling better, they tend to exercise more, which makes them feel even better, Blumenthal said.

Other studies exist supporting the effects of exercise therapy on anxiety, addiction, psychosis, bipolar disorder and chronic fatigue syndrome.

A study from the journal, Psychopharmacology, in June 2002, demonstrated that the withdrawal-induced anxiety in alcoholism could be due to beta-endorphin deficiency. Based on this study it seems that alcohol also indirectly drives down a body's endorphins. Opiates such as heroin and methadone, are exogenous opiates which also drive down the body's endogenous opiate (endorphin) stores. Thus, it makes sense that replacement of these endorphins through exercise is a therapeutic treatment for opiate or alcohol addiction and withdrawal.

Patients are occasionally advised to exercise by their doctors. But the advice usually stops there because few doctors have a gym in their pocket. Statements are sometimes made about walking 30 minutes 3 times a week. But our perspective at EPC is that these minor bits of advice are too few and far between. We believe that exercise should be part of one's daily routine. Sweating is good, and reaching that "pumped" feeling is better. Thus our name.

Our exercise center now exists thanks to a $20,000 grant from United Way as well as Mike Hayes of the Home Fitness Warehouse, who has continued to donate numerous pieces of equipment as well as flooring to our gym. Seeing people emerge from the gym with flushed smiling faces is one of the most uplifting sites at EPC.

Phase 6: Human power

The exhilaration and cleansing process of producing endorphins through exercise is important for rehabilitation. However, we feel that people may be even more inspired and motivated to exercise knowing their efforts are contributing to something useful beyond themselves. To provide this sense of accomplishment and to capture an educational moment here and there as well, we have linked some of our exercise machines to generators. This part of the company has miles to go. But currently we have 3 exercycles that generate electricity.

We know full well that exercise equipment can not produce all the power needed to run the center, but that is not the point. The emotional reward each individual gains by knowing they are accomplishing something positive is a goal in itself.

While EPC took a little flack for this idea in it's early years ("Hey buddy, Can you Spare a Treadmill"… News of the Weird… Cowchip award… etc.), we are happy to say that other gyms in California and overseas have taken the idea to new heights.

By adding various additional sources of energy such as wind and solar power, we hope eventually to turn EPC into Albuquerque's flagship for alternative energies as well as a center for recovery.