The Healing Place is not a treatment center
Years of work by New Hanover County to deliver the “very best evidence-based treatment program” culminated in the recent opening of The Healing Place. Now, the facility says it is recovery housing, not a treatment center, despite advertising itself as the latter (and despite New Hanover County and others referring to its services as treatment). Officials call the distinction ‘semantics,’ but it could mean the difference in millions of dollars in opioid settlement funding — and the health outcomes of hundreds, even thousands, of people seeking help for addiction.
In the early days of 2019, The Healing Place was in trouble, and the heavy hitters came out to save the day.
The county had been working for years to take a big swing at the region’s substance-abuse problem, specifically an opioid crisis that was one of the worst in the nation. While the county was funding other addiction services, it envisioned a flagship project: a 200-bed facility, built in partnership with Trilium, the quasi-governmental agency that handles funding for substance abuse and behavioral health for much of Eastern North Carolina.
Trillium identified The Healing Place of Kentucky, a peer-led non-medical facility based on the 12-step model, as the blueprint.
The planned location was land located in Wilmington that Trillium was willing to donate to the project, but that meant the county needed a special-use permit from the city. And over the course of several protracted city council meetings, the county faced unexpectedly significant opposition. Major concerns included the lack of security and possible safety issues at a Healing Place ‘sister location,’ called Healing Transitions, in Raleigh.
Some concerns also came from NIMBY-ism or unfair stereotypes about people dealing with substance abuse issues. In an interview at the time, County Manager Chris Coudriet said he was incensed by the “lack of compassion” people showed for their neighbors who were struggling with addiction.
Coudriet went before the city more than once to lobby for The Healing Place, describing the seriousness of the opioid crisis and the shortage of existing options — specifically the lack of a long-term residential facility.
Coudriet told the City Council that The Healing Place would be “the very best evidence-based treatment program,” that Trillium could provide. He said it would help people overcome addiction “through non-medical detoxification, through residential alcohol and drug services, and, importantly, transitional living.”
The proposed facility would get plenty of different definitions. Over the course of hours and hours of sworn testimony between August 2018 and February 2019, when the permit was finally approved, The Healing Place was referred to as a detox facility, a treatment center, recovery housing, a long-term residential facility, and transitional housing.
Further muddying the water, Trillium Executive Vice President Cindy Ehlers repeatedly told city council that Wilmington-based non-profit Coastal Horizons, a top local provider of medication-assisted treatment (MAT), would operate The Healing Place. While The Healing Place’s Kentucky and Raleigh locations were abstinence-based, Coastal Horizons and its longtime director Margaret Weller-Stargell were passionately dedicated to MAT services like methadone and Buprenorphine.
Ehler’s promises, Coastal Horizons’ good reputation in the community, and Coudriet’s patient explanations eventually won over city council. At the time, it was assumed by many that Coastal Horizons would oversee MAT treatment at The Healing Place — including Wilmington Mayor Bill Saffo, who would later voice concerns after Trillium pushed Coastal Horizons out of the project.
In the summer of 2020, Trillium reneged on Ehlers’ sworn testimony and threatened to pull the land donation unless the county dropped plans to partner with Coastal Horizons and instead went with a spinoff of The Healing Place of Kentucky – and an abstinence-only model that would not allow MAT at the facility.
[Editor’s note: Trillium has ignored repeated requests for comment on this issue.]
The Healing Place has defended this model as being not just effective but cost-effective, free to the client with an operating cost of just $35 per day. But it’s worth noting that the dedication to abstinence extended to clients receiving MAT off-campus, which would not impact The Healing Place’s per diem operating costs.
In fact, it was only in August of 2022, after being confronted with pointed guidelines from the U.S. Department of Justice indicating that the facility would be in violation of the Americans with Disabilities Act if it turned MAT patients away, that The Healing Place relented on its ban. The facility was determined to remain abstinence based but would allow MAT patients on campus.
Below: Letter from The Healing Place to New Hanover County. Story continues below.
For many, including those dealing with substance abuse issues, there was understandable confusion when it came to what The Healing Place was and what services it would offer when it opened.
There are many lay definitions of “treatment.” For some, it’s weening off opioids using methadone or Suboxone combined with talk therapy, for others it’s a faith-based 12-step program, or talk-based therapy, or a trip to Mexico for a sweaty, hallucinatory ayahuasca purge. Or some combination of the above.
In short, the term is sometimes used loosely. But the State of North Carolina was about to define it more specifically.
As the county’s new facility broke ground and construction got underway, North Carolina Attorney General Josh Stein was closing in on a series of settlements with opioid manufacturers and distributors — litigation that promised to bring billions of dollars to the state.
The opioid settlement funds came with detailed guidelines on how the money could be used. That includes very specific language about what “evidence-based treatment,” meant.
Back in 2019, Couedriet had used the same language — “I want to emphasize this: ‘evidence-based,’” he said. But he clearly meant something very different.
At the time, Coudriet was apparently referring to The Healing Place’s self-reported 70% success rate.
“Early on in my meetings with Trillium, The Healing Place of Louisville and Healing Transitions in Raleigh, the program was often referenced by the experts as an evidence-based peer model program. Trillium, as the LME-MCO in our region, is a top expert on substance use disorders and has often cited the success rate of the program that you mention,” Coudriet told WHQR this week.
That success rate statistic is based on a phone call to former clients one year after graduating from the program. It’s a metric that ignores the long-term difficulties of remaining sober and the remarkable number of people who relapse years, even decades, after recovery.
The county compares this to national recovery rates, which it claims “vary from 30 to 50%” — despite the acknowledgment of Marla Highbaugh, The Healing Place’s chief mission advancement officer, who told WHQR in a 2021 interview that, “there is no national average. There is no national tracking.”
That was Coudriet’s “evidence-based.” He noted that The Healing Place itself has other definitions of “evidence-based.”
“The Healing Place itself outlines the program as having components of behavior modification, cognitive behavioral therapy, and motivational interviewing through the foundation of a 12-step program — all of which are evidence-based practices,” Courdiet said.
None of that is what Attorney General Josh Stein meant when he said “evidence-based.” Stein meant MAT.
As Stein said publicly last Spring, “it's not only the gold standard, it is the standard of care, the addiction doctors of this country say that MAT is the standard of care. And so if you are funding opioid programs that don't offer MAT, they're not meeting the basic standard and [are] certainly not evidence-based.”
Stein was clear: if you offered ‘treatment’ that wasn’t MAT, it wasn’t evidence-based — and if it wasn’t evidence-based, you couldn’t use opioid settlement money to fund it.
Follow the (opioid settlement) money
The Healing Place had sparingly referred to itself as offering treatment in promotional language online, but the term was used more freely by the county and county commissioners — who seemed to take notice of Stein’s guidelines and didn’t direct a single dollar to The Healing Place as it came up with a plan on how to spend its $20-million share of the opioid settlement. [Editor's note: The county notes that commissioners approved the funding plan for The Healing Place prior to the opioid settlement, and "were not ever considering THP for opioid funding in this initial phase of their spending plan."]
But other counties did, or are considering doing so.
In January, Columbus County approved just shy of $290,000 from its 2022-2023 opioid settlement funds to ‘reserve’ 10-12 beds at The Healing Place, which the county described in a press release as an “evidence-based Peer-run residential treatment model.” The county also set up a confidential hotline, according to The News Reporter. [When called, a hotline receptionist confirmed several times that The Healing Place offered “treatment,” but declined to say what kind until an evaluation interview had been conducted.]
Earlier this month, Brunswick County appropriated up to $198,000 for the rest of the 2023 fiscal year to ‘reserve’ up to 20 beds — 10 for men, 10 for women – at The Healing Place, which the county referred to as both a “ 'treatment facility' and a “residential” and “detox facility.”
In response to questions from WHQR, the county clarified its definition.
“Brunswick County leadership is aware that this facility is a social detoxification and recovery treatment program and not a medical detox treatment facility. It was not the County’s intent to refer to The Healing Place as a medical detox treatment facility, although we can see how it could be interpreted that way,” a spokesperson for the county said, adding that the county wanted to represent the full scope of The Healing Place’s “unique” program and mission.
And the county clearly supports that mission, already estimating it could allocate $481,000 in funding to The Healing Place for the 2024 fiscal year. According to the county, “opportunities to fund a portion of the program cost with Opioid Settlement funding is currently being reviewed by staff.”
These appropriations seemed potentially misleading or confusing for two reasons.
First, the term ‘reserved,’ which has been used by several counties. The Healing Place is “first come, first serve,” according to Director of Development Megan Alicia Weber-Youssefi, regardless of investments from surrounding counties. The beds aren’t reserved like a hotel room – instead, it’s a contract for potential services. So if Brunswick or Columbus counties (or one of their non-profit partners) wants to send a resident to The Healing Place, and there is availability, then The Healing Place will bill the county a per-diem rate up to the amount of the contract. [Onslow County, which is also ‘reserving,’ beds, discussed this earlier this month.]
Even without a contract like this, in theory, a Brunswick County resident could drive across the river to Wilmington and check themselves in, for free, if there was an available bed. But even with the contract in place, no beds can be ‘held,’ and no one is skipping the line. Instead, what the contracts allow is for local governments to support The Healing Place, according to Executive Director Brian Mingia.
“Without funding, this program wouldn't exist. And we're going to be working with any number of counties in eastern North Carolina,” Mingia told WHQR.
This leads to the second issue: Given Josh Stein’s clear statements, how can opioid settlement money distributed to Columbus County – and potentially Brunswick and other counties – then go to a treatment center that is adamantly abstinence based?
Simple. The Healing Place isn’t a treatment center, apparently.
"It’s about semantics, right?"
In an interview, WHQR asked Mingia and Weber-Youssefi, “do you consider yourself to be a treatment facility or recovery housing facility or detox or all of the above in certain ways?”
After some discussion, Mingia interjected, saying, “I think it's about semantics, right? So if you look at the two different services, two of the main services that we provide, our detox service is more of a clinical model, they're going to receive a clinical assessment, there's a health and physical that goes on there, that borderlines on most people's definition of what a treatment program would be. Our long-term residential program is a non-clinical program. And that is probably more like recovery housing.”
After the interview, Weber-Youssefi sent an email to add further clarification that read in part, “you asked if we are considered ‘treatment or recovery housing’ and I can’t remember but if I said treatment, that was inaccurate. We are non-medical; so between the two, we would more be considered recovery housing. Again, it’s the semantics. We are a residential recovery program. We are not a treatment center. But we are also not transitional housing [bold for emphasis in the original email].”
It’s worth noting that, in addition to rejecting the label of ‘treatment center,’ the email also dispels the idea that The Healing Place is transitional housing – a service Coudriet had identified as an important part of the project back in 2019 when he spoke to city council.
So, does the terminology really matter? Or was it, as Mingia suggested, ‘semantics’?
It turns out, it does matter. Because while Attorney General Josh Stein spoke frequently and directly about how treatment centers that didn’t offer MAT weren’t eligible for opioid settlement funding, he said much less about other facilities and services that are eligible for that money [detailed in this FAQ from the Attorney General’s office].
And one of those, according to the North Carolina Department of Justice, is recovery housing, which is how The Healing Place now identifies. Recovery housing is eligible for settlement money — with the important caveat that the facility must not exclude clients who are receiving MAT off-campus, terms to which The Healing Place recently agreed.
It’s a subtle, even semantic difference, for some. But it also clears the way for The Healing Place to receive millions in opioid settlement funding.
Pender County, for example, is set to receive $7.8 million in total settlement funding, parceled out in annual installments through 2038. If the county continued to spend $290,000 of that annually it would be over $4 million in opioid settlement money for The Healing Place, money the facility would not be eligible for as an abstinence-based treatment facility. Brunswick County is exploring whether it can spend similar funds on the facility – and other counties could follow suit.
Despite Stein’s emphatic public statements, NCDOJ said it’s not getting into policing local governments’ decisions about how to use opioid money if it could plausibly fall under one of the categories allowed by the settlement guidelines. WHQR solicited comment from Stein about this, but he did not provide any; a spokesperson for his office directed WHQR to several parts of the settlement guideline FAQ, and eventually issued a statement.
“NC DOJ is not going to come along after the fact and tell the local government that the program or service that qualifies for funding is ‘really’ something else – whether that something else is ‘treatment’ or a different activity. If the program or service qualifies as recovery support services or recovery housing support, it does not matter that it might also be characterized by some people as something else,” according to an NCDOJ spokesperson.
But that doesn’t mean everyone agrees with the decision – or that’s just semantics.
Treatment Vs. Recovery
For his part, County Manager Chris Coudriet was unconcerned with ferreting out the “clinical differences” between the words “treatment” and “recovery” when asked for his thoughts on how the terminology used to refer to The Healing Place had changed and whether the public understood the difference.
In a statement provided through a county spokesperson, he called The Healing Place “an evidence-based, long-term, peer-led residential treatment facility,” and said it’s unnecessary to separate treatment from recovery if they go “hand in hand.”
“I think it’s understandable that some may refer to it as treatment, recovery, and housing — and use one or all of those words. Co-location of treatment and recovery are not mutually exclusive in my opinion,” he wrote.
But leading experts don’t agree. Coastal Horizons President and CEO Margaret Weller-Stargell defined treatment as “professional intervention in managing a substance use disorder.” She added that medications are often used in the process, and that MAT is the “gold standard of care” for treatment of opioid addiction.
On the other hand, she defined “recovery” as a process that often begins with treatment, but is a lifelong process of change involving personal growth, health, wellness, and the attempt to live a productive and self-directed life.
Weller-Stargell also reiterated her past concerns about The Healing Place’s unwillingness to provide MAT, including that clients at the facility might not receive lifesaving treatment if they need medications that weren’t available.
In a follow-up email, she added, “no, this is NOT just a matter of semantics!”
[Editor’s note: WHQR emailed Rob Zapple and Jonathan Barfield, Jr. to ask for their perspectives on this story, as the only two sitting county commissioners who were in office during the process of planning and approving The Healing Place. Neither responded. Additionally, as a disclosure notice, in addition to serving on the Trillium board, Zapple is also a member of the WHQR board of directors, which has no role in editorial decisions.]