We take a trip to Sullivan County, New York, with the researchers behind the Rockefeller Institute’s long-term study of the opioid epidemic to hear from the people on the front lines of the crisis.

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Stories from Sullivan


  • Transcript

    Transcript was generated using AI software and may contain errors.

    Kyle Adams 00:02

    Welcome to Policy Outsider from the Rockefeller Institute of Government. Today, we’re at Dynamite Youth Center in Sullivan County, New York, following two of our researchers as they continue with our long-term study of the opioid crisis in this rural community. And we’re meeting this band.

    Billy 00:24

    My name is Billy. I’m 25 years old. I play guitar and I sing.

    Joe 00:29

    My name is Joe. I’m 21. I play a little bit of everything, just bounce around where they need me.

    James Murano 00:35

    James Murano, I play guitar and vocals.

    Austin 00:38

    What’s going on? I’m Austin. I’m 26. I work here at Dynamite and I’m part of the band. I jump on as many instruments as I can play because I love playing music.

    Rush 00:47

    What’s up, my name is Rush. I am 25 years old. I also work here at Dynamite Youth Center and I am a drummer and a guitarist, also I play the bass sometimes too. We are the Dynamite Youth Collective.

    Kyle Adams 01:44

    I’m Kyle Adams, communications director at the Rockefeller Institute. For the next 30 minutes or so we’re tagging along with two of the researchers behind our Stories from Sullivan project, which aims to understand and portray how the opioid epidemic really plays out on the ground in rural communities like this. So far, they’ve interviewed more than 100 people on the frontlines of the crisis over more than a year of research. We’re publishing their reports in real time rather than waiting for a final product at the end, so that you can learn as we learn. You can read the series at rockinst.org or follow on social media with the hashtag StoriesfromSullivan. Today, we’re giving you a peek behind the research to get a sense of the kinds of interactions and conversations that our researchers have when they come down here. And to give you a chance to hear directly from some of the people at the heart of the opioid crisis.

    Patricia Strach 03:04

    My name is Patti Strach. I’m the director for policy and research at the Rockefeller Institute of Government.

    Katie Zuber 03:09

    My name is Katie Zuber. I’m the assistant director for policy and research at the Rockefeller Institute.

    Patricia Strach 03:14

    We are in Salzburg, New York in Sullivan County. We are here talking to the folks at the Dynamite Youth Center about their program. We’ve toured the facility here and we’ve talked to the members here. We’ve gotten to hear their voice about what it is they do, how their day looks, and why this particular program looks the way it does, which is different from many programs. It’s a longer-term program. It focuses only on youth 18 to 25. It is a very structured program. It gives the members a lot of skills. They have a lot of responsibilities that they earn and they take on here.

    Katie Zuber 03:56

    We know what the statistics are. The statistics don’t look good. But we want to get a sense of what local communities are experiencing, how they’re addressing this particular crisis, and what they really need to respond. The best way to do that is to speak to the people on the frontlines who face down this crisis every day.

    Patricia Strach 04:17

    We’ve talked to everyone who touches this issue. So health officials. We’ve talked to the policy officials. We’ve talked to the elected officials. We’ve talked to doctors and to nurses. We’ve talked to treatment providers, attorneys, district attorneys, law enforcement, the sheriff.

    Katie Zuber 04:37

    Today was really special though, because we got a chance to talk to some of the people who benefit from these programs, not just the people who are in these programs in addition to the people who run these programs, and that provided some really unique perspective.

    Patricia Strach 04:51

    We talk about the opioid crisis in the very general terms but people on the ground face very real and very particular problems in terms of staffing, in terms of funding, in terms of the kind of resources that they get from the state. Its hard work and people who are doing it are very dedicated. But at a certain point, it makes it harder to do a good job when the problem is getting bigger and they have more and more people using drugs and the resources that are available aren’t growing at the same rate.

    Katie Zuber 05:26

    It’s a very complex, complicated problem. It’s not isolated to the criminal justice and public health systems. When you’re talking about the opioid epidemic, you’re talking about the foster care system, you’re talking about schools, you’re talking about education, you’re talking about families. We talk about that in context of the spillover effects. Understanding the intricacies of the problem and how it affects all of these other aspects beyond just what you would think of as being a criminal justice problem or a public health problem. It’s much bigger than that.

    Patricia Strach 05:56

    It’s hard sometimes for people to get the treatment that may be available, that they have barriers that policymakers and health officials need to work on. One is access to services, making sure that services are open and available. That includes insurance restrictions that limits the length of stay for how long someone might be able to go into treatment.

    Katie Zuber 06:21

    The questions about, beyond just individual treatment, what government should be doing and how we can actually fix the system itself and what we need to change about the system and how it operates. We talk a lot about how this is a disease. We need to start treating it like a disease and government itself needs to reorient itself and start thinking about how we move from an acute system of care to understanding and treating this as a chronic condition.

    Patricia Strach 06:53

    There’s inequities within the system. The same kind of job gets paid a lot more in one environment versus another. There’s staffing shortages. There’s real issues that policymakers can address. We hear lots of things from folks on the frontlines about stuff that they should just take away. Not just we need more, whatever it is we need, but we need things to be taken away, particularly regulations that may not be effective and may actually hamper people’s ability to get better.

    Katie Zuber 07:25

    A week ago, we heard about smoking regulations. There’s a harm reduction approach at this particular place, and if someone is using heroin, and they come in for treatment, and then they relapse and use heroin again, they are allowed to stay but if they are caught smoking on the premises, then they’re kicked out of the program.

    Kyle Adams 07:48

    Just smoking cigarettes?

    Katie Zuber 07:50

    Smoking cigarettes.

    Patricia Strach 07:51

    The big picture it seems to be these rules and regulations are made in pieces and that nobody sits in puts them all together and say what the effect on communities, on facilities that are providing treatment, and on the people who are trying to get better?

    Kyle Adams 08:49

    Let’s start with introductions.

    William Fusco 08:51

    Bill Fusco, executive director, Dynamic Youth Community/Dynamite Youth Center.

    Karen Carlini 08:58

    Karen Carlini, associate director of the Dynamic Youth Community.

    William Fusco 09:01

    We started our residential program in Sullivan County in Fallsburg, New York in 1973. We are the oldest program exclusively for adolescents and young adults in long-term residents in the state of New York. From our very beginning, that’s all we ever dealt with was young people and their problems with drugs and taking drugs and trying to work with them and really getting them to a better place. We’re at it almost 50 years now. I mean, in those years, there’s been a lot of experience that we’ve had that have led to, for us, some real basic knowledge of what goes on for young people and how they get involved with drugs and how they can get uninvolved with drugs and do better for themselves. But certainly all that time that we’ve spent doing this, we’ve seen patterns that don’t change no matter what the drug of choice is.

    Karen Carlini 10:10

    We have in this program room for 86. That’s our capacity, 86 kids. In Brooklyn, we have 16 beds in a community residence, and our outpatient fluctuates anywhere from the day program like 50, in the night program, it’s about 20 to 25, at any given time. It’s probably important to say that the program is a continuum. Everyone starts at this level of care in the intensive residential program. That’s because they meet the criteria for this level of care. If they don’t need this level, we refer them somewhere else. They start here and then eventually, they have the opportunity to stay here for as long as a year, sometimes a little longer. Lately, we’ve had some challenges with beds not being available for the next level. But then they transfer to our outpatient program, where they can attend daily, five days a week, they step down into three days, and finally to two nights and one night. That process happens over a period of a couple of years. What they’re able to do in that time is through every transition, whether it’s getting a job, getting back with their family, getting their own apartment, being independent, relationships, education, all of the things that for young people present challenges in and of themselves. Never mind, if you had an opioid addiction. Those are challenges for anybody and having support is helpful. Putting other layers on top of this, where you had years of addiction, and you’re just beginning at maybe age 23 or 24, and you’re in school in college with 20 and 21 year olds whose idea of a good time is to go drinking all night and funneling and smoking weed, and now, how am I going to do this? We’re there to provide that kind of support on a continued basis until they’re finally ready to go out on their own. And they do. They become independent. They do okay.

    Kyle Adams 12:11

    You mentioned earlier, the various cycles of drug use that you’ve been seeing over the past 50 years, how does the opioid epidemic compare to those previous cycles?

    Karen Carlini 12:24

    Um, well, the worst, I’ll say that right off the bat, it comes with so many challenges, the level of addiction just in terms of what happens scientifically or biologically to the brain is different than what we’ve seen with other drugs. That in and of itself makes the challenge even greater. The supply and demand makes the challenge even greater. I mean, it’s so available, the normalizing of opioids in terms of legal use and prescribed use, it made what was a very dangerous drug, it normalized it because doctors were prescribing it for pain. People would be more comfortable, it sounds right. It sounds like the right thing to do and then created this problem. That’s very different than what we saw during the crack epidemic. People were very clear, the lines were very clear, crack is bad. Cocaine is bad. Street drugs are bad. Drug dealers are bad. You could tell, they look bad. The drug dealer could be wearing a white coat, you can’t tell, you can’t recognize the problem all the time. That for us is really what makes it so bad and so much of a challenge and just very difficult.

    Patricia Strach 13:42

    We went on a tour earlier. Can you talk a little bit about the things that we saw? We saw a band, and a gym, and classrooms, and greenhouses.

    Katie Zuber 13:52

    Butterfly garden.

    Patricia Strach 13:53

    Running courses.

    William Fusco 13:56

    Well, it’s a program for youth. There’s all kinds of things. I guess a basic philosophy is you’ve taken drugs out of your life and what’s going to replace that? What’s going, to use an old fashioned term, to turn you on? What’s going to make you feel good today? What can you replace it with? People discover things or go back to things that they used to do, whether it be they never ran a marathon in their life, but gee, I want to try to do that. They’ll practice every day in the morning, running and everything like that. Of course, a few drop out. But actually five or six of them just finished running a 26 mile marathon. They are proud of that like you can’t believe because what an accomplishment. It truly is. People that used to be musicians or in a band or wanted to be in it, they’ll work and at nighttime, they’ll work with each other and put a band together. We try to get them some performances and some recovery things that are going on around New York State. They just eat it up. Again, it gives something for them to do. We have a greenhouse that we built about four or five years ago. We’ve wound up with some young people who never thought that they would like doing that. But all of a sudden, when they started doing it felt like wow, this is something that I really enjoy doing and it gives me a little something that I feel good about. I guess we tried to seek those things out along with the membership on what kinds of things on a positive and constructive way that they can go to. In Brooklyn, we have video-editing that we do a lot more than we do up here, but people who are involved with those kinds of things, some of them wind up going to school for that and things like that. None of its Medicaid reimbursable. But it really is a key factor to how people actually wind up gaining recovery is when they can actually see an alternative that for them makes sense.

    Karen Carlini 16:13

    I think it’s important to say just for the purposes of people who don’t know who we are, we’re certified and funded by the Office of Alcoholism and Substance Abuse Services. It’s a certified organization that knows what they’re doing. There’s counseling services that go on as group counseling and individual counseling. There’s educational services that happen that are provided by the New York City Department of Education even though we’re up here. There’s all sorts of certified activities that help but if we try to do that by itself and just have group counseling sessions and individual counseling sessions, the kids or people this age, it would never work. Most of what we’ve learned, Billy and I both have been, Billy from the very beginning started with Dynamite. I came soon after that.

    William Fusco 17:00

    In 1970.

    Karen Carlini 17:00

    I came a few years after that. In all that time we spent, we watched the kids, we listened to what they say. One of the biggest reasons we got this program up here is because the kids in the outpatient in Brooklyn were saying we need to get away from our neighborhoods. We want to get away, it’s too hard. It’s too hard to be around people in places and things and whatnot. We raised the money and they helped and everybody contributed. It was a very new organization. Over the years, the program has evolved to something based on what the young people say works for them. Today, I listen to everything they said, because it helped me to know we’re doing some things right. And maybe some things we can do differently, but I listened. We listened to everything they said. I think that they feel that.

    William Fusco 17:50

    Again, those are the services that don’t get any funding. Since they don’t get any funding, we do them anyway. But on some hand, a lot of that falls by the wayside. It’s not considered to be important that we find that to be integral. We also do counseling services a lot. We do all the usual things that are in a rehab. We know that those services are essential as well.

    Karen Carlini 18:24

    We work really hard. We try to raise money for some of the extracurricular activities that we do. We’re an OASAS-funded service, some state aid that helps, as well. I think the frustration is in the lack of understanding on the value of this work. It isn’t the funding, not the funding. We do say because there’s so much pressure on us to increase the services that are billable, so that we can increase revenue and take the burden off the state in terms of the state aid. Okay, we get that. Nobody is going to argue with that’s a good idea. But then we talk about, well, we don’t give people what they need, what is it going to cost in the long run? We get that, but not everybody gets the long run. That’s frustrating to us. But the bigger part with these other activities is when they look and say and it’ll be like, that’s why I interrupted Bill because I wanted people to understand that there’s a lot happening. It’s really very comprehensive services. But also as essential as that group therapy session is that greenhouse was somebody or the band or the softball teams that we have. The softball teams, I mean, those kids have the highest retention of any other group in the program. This is over a 25 year period, they have the highest retention of anybody, the kids on the soccer team, and the kids in the band, any of these kids that are involved in these kinds of projects are the kids that do that. Same with family participation, the kids whose parents come and get involved, it’s been documented. We held a study many years ago that proves if the parents come, it helps. There’s all sorts of things we know, because we’ve seen it. We know it because we’ve seen it. We’ve witnessed it. We’ve seen people that have been in the program 30 years ago, and now, you’d never know that they went through treatment or had any sort of problem. They’re living their life like anybody else.

    William Fusco 20:27

    We do have some of the highest retention in the state. Now, this 28 day program since may say they have higher retention, but it’s higher retention because he didn’t really spend much time there. For a year program, we run somewhere, and it varies, but somewhere between 50 and 65 percent.

    Karen Carlini 20:48

    We’re probably over 55. Now, we’ve been as high as 72.

    William Fusco 20:54

    They spend one year in treatment…

    Karen Carlini 20:59

    Transitions. We attribute the lower retention, again, to more choices, too many options. I can go to an outpatient and I don’t have to make this commitment. This is a big commitment. If you could talk to probably any kid here, they would tell you, when they first came here, they didn’t really want to be here. A few will say even today, they surrendered, they walked in, they were ready. So that happens as well. But it takes a while for them to really want this. But once they want it, it works.

    Katie Zuber 21:32

    Talking to these individuals, especially a young group, somebody said to us, there’s a lot of adults talking. I think it’s really important to think about how our response is not going to be a blanket response that works across all age groups across all demographics. It’s really important for voices to be heard. I mean, to hear the young woman who said, “I was the youngest person in every program that I went to and nobody got me.” When we are talking about what our response needs to be or what government should be doing, we need to really take into account that not everybody is the same and not the same thing is going to work for everybody. If you really want to understand what people need, you have to have a conversation with them.

    Allan Constantinofski 22:17

    My name is Allan Constantinofski. I’m 21 years old. Been here 11 months now. And to describe myself as a person, I will say I’m very outgoing and kindhearted. I pull in the younger members, look out for younger members, which are our support network in here and my peers. I make sure they get the ins and outs of the program. So pretty much just looking out for people.

    Amod Zeus 23:00

    My name is Amod Zeus. I’m 25 years old, I’ve been here for about eight months now. I’m very laid back but stern person at the same time. Just like Allan said, I pull in all the other members in the same way that I was pulled in, by applying positive pressure and showing them what we do in this house. This is our house, so we take care of it.

    Kyle Adams 23:24

    If you weren’t talking to me right now, what would you be doing?

    Allan Constantinofski 23:50

    Right now, I’d be in the gym. Because honestly, when I came here, came here very skinny, maybe 120 pounds soaking wet. It’s like I couldn’t look myself in the mirror, so I’ll be in the gym right now. Like getting my physical appearance up there because I’ve been here 11 months. I feel like within groups I like talking to my support network, which are my peers. I feel like next step is to make myself feel good about myself.

    Amod Zeus 24:22

    What I would do is basically what I was just doing, I was hanging out with a member who just walked in about four or five days ago and doesn’t know if this place is the right place for him. Just by assuring him that everybody went through those same feelings. Me, myself, I also went through many of those feelings, just speaking to have gotten back to him tell him that eight months fly by real quick but as long as you’re doing the right thing always work on yourself little by little.

    Kyle Adams 24:50

    Have you been in other programs before this?

    Allan Constantinofski 24:53

    Yes, I have been in about four detoxes and two programs, which were out of state. Put me on a lot of meds, talking about like full pages of meds. Everything you could think of Seroquel, Remeron, Gabapentin, Zoloft, Suboxone and to be honest, I’ll get a little bit deep right now, that’s the first time in that program I tried to attempt suicide. I’ve been in the psych ward. Went straight from that program for about two and a half weeks in the psych ward, and then they took me back. Then I got medically discharged for that. I was on suicide watch, things like that. But after that I came to this program and it kind of changed me because I argued with them about the meds and stuff like that. Sooner or later, I was off all my medications and now it’s like I wish that happened sooner that I came to this program. I’m very grateful for this place.

    Amod Zeus 25:53

    This will be my third program as well. I was in one program down in Brooklyn and one in Florida, both attempts weren’t even real times. They were both just mandations. Trying to beat cases, making sure I didn’t go to jail at those times. But ever since I did get incarcerated and just came over here and not mandate and voluntarily now taking it seriously. I didn’t really think I had a problem for many years because it wasn’t up to opiate, heroin, or crack just yet. But now it is. Before it was just marijuana, alcohol, Xanax. But two programs, this being my third, and two incarcerations later, now I know that it will lead to that. Little by little, every little step leads to either heroin or crack or anything in between. Nothing’s better or worse than the other, but it will come down to it and thank God it didn’t come down to it. Come down to Dynamite because I would have overdosed and passed away.

    Allan Constantinofski 26:58

    Which is funny you say that, because I remember, you ever heard of Oxycontin, right? That was my next step after Xanax. I caught seizures off Xanax before and talking about millions of tons of hospital procedures on Xanax. Then I found Oxycontin and I’m smoking. After that, all I remember is how much money I’m using on these pills. That’s how I found heroin, which it’s not really heroin. Where I’m from, Brooklyn, it’s all fentanyl. That’s literally what I was doing, fentanyl. Then I started shooting it. After that, it was off to the races.

    Amod Zeus 27:36

    That’s where we used some $25 little pills at $30 a case and then you’re just sick. Sick of paying so much money rather go and chase like the cheaper, like not quality, but the lower value drug. But nowadays, it’s not heroin anymore. It’s mostly fentanyl. That’s how it leads to most of us. A relief from Xanax to blues, which are Oxycontin, and then it will go straight to dope because instead of paying $30 for one pill and your time was get so high, you just jump onto heroin. Heroin where we’re from, it’s like $40 a bundle. That whole bundle will last you a day in which that one pill lasts you maybe an hour.

    Allan Constantinofski 28:18

    Things they come out with now, I don’t feel like they really look into it about what an addict mentality is. We don’t care, when we’re using nothing matters to us, nothing at all. Whether you know, this could kill you or not, we just want that five to 10 minutes of high.

    Kyle Adams 28:40

    At this point in the program, how do you feel you’ve changed looking back at the people you were just describing?

    Allan Constantinofski 28:48

    Honestly, at this point in treatment, I feel like very good about myself. When I go home for home visits, my family’s very proud of me, because I have a wife and kids. I can actually spend time with my son that I actually remember. I could be there for him. I can take him places and not go to cop spots with him. My wife is very proud of me because she was an addict four years ago too. She has a recovery right now, four years clean. Now, we’re getting a relationship back together. I feel great about myself. I never pictured myself looking in the mirror now from 11 months ago. It’s crazy, the change. The thought processes in state right now and as we said the little things in this program is what makes me the person I am today. Changes your whole thought process.

    Amod Zeus 29:49

    I wake up and I just I’m happy to look at myself straight in the mirror. Before for years, while I was using real heavy and stuff, I would just wake up and I’d make sure I’d had some type of substance, whether it was Xanax or blue, a joint or blunt, anything, even cigarettes. I was addicted to just waking up and making myself feel like some type of high. So right now, I love waking up, I love looking at myself. I love going through my days knowing that I’m not addicted to any type of substance anymore, even cigarettes. I’ve changed a lot. I’ve changed a lot from being in here for eight months. I’m one with my emotions in which I can identify why I’m feeling anyway. I have this thought process of reset. With drugs I would have never had and now without them, I can actually identify why I’m feeling instead of not feeling and just taking more and more substances just to stop me from feeling anything and have me thinking about happiness is heroin, or happiness is Oxycontin, or I have to smoke weed to be happy. I wake up, I go to sleep with the constant laughs. My stomach hurts from the laughs that I have with these guys over there. I have had the best laughs of my life in just eight months. Now I think I could have been doing this for the past 12 or 13 years, I would have a great life. But I wanted to stop myself by going through that long time. I went through that time that I should’ve never walked through. Now, eight months later, I finally have rekindled a relationship and it’s not fully there yet, but I’ve rekindled a relationship with myself and my family. It took me over 10 years just to burn that bridge between me and them.

    Allan Constantinofski 31:52

    I feel like this kind of brings you back to peace. You got nature all around you. You got a lake upon whatever you would like to call it.

    Amod Zeus 32:01

    It took one person’s playground and was that you’re finally found like a little kid, but in a man or woman’s body. You have that thought process in which that you’re over. I’m 25. He’s in his 20s. We’re grown. But for years, we never thought of ourselves as kids. You find your inner self, you find peace, tranquility, and wish that you could hang out and see a sunset for the first time in years without actually thinking about getting high. I’ve sat down and just looked at the moon. I’ve seen stars that I’ve never seen. I’ve never seen stars ever in my life. I’m used to going to sleep with city buses, trains vibrating my room, and people cursing each other right outside my window. Over here is nothing but peace and tranquility. You find your inner self. Just being over here, seeing the nature, seeing the trees, smelling the fresh air is beautiful. I came into this program thinking if I don’t get it at this point, I’m going to go back out there and die. Most of my friends that I grew up with are dead. If they’re lucky, they’re incarcerated. If they’re lucky. From all the BS that’s out there right now, all the cut stuff, all the fentynal, I’m lucky I didn’t die when I overdosed a couple of times. Since I came into this program, I thought about me not dying, I didn’t want to have that option of it’s either me or this drug. That’s how I looked at it. I looked at it like it’s either I defeat this thing, defeat this demon that I’ve been fighting for so long. Now it’s finally time for me just to get it right.

    Kyle Adams 34:20

    To read the full Stories from Sullivan series, visit our website rockinst.org. We’ve published 13 parts so far examining things like how rural geography exacerbates the opioid crisis, the disconnect between people on the frontlines and their state and federal lawmakers, the effects on the foster care system, problems with the deaths of despair narrative, and so much more. It’s a must read, if you want to begin to understand this complex problem. We’ll be back next month with another episode of Policy Outsider. Thanks for listening.

Policy Outsider

Policy Outsider” from the Rockefeller Institute of Government takes you outside the halls of power to understand how decisions of law and policy shape our everyday lives.

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