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Volusia-Flagler moms struggle to find assistance while recovering from opioids

News-Journal - 11/16/2019

Expecting mothers share a similar set of goals: set up the nursery; buy baby clothes; stock up on as many diapers as possible; make sure everything in the house is ready for their little one's arrival.

But for 35-year-old recovering addict Kristin Howard, whose sixth child is due at the end of November, her main goal is getting her life back together after years of opioid addiction.

"Everything bad that could have come with my addiction came with it," Howard said from the couch in her living room of her temporary home in Bunnell, packing boxes strewn around her. "It had such control over me. It was so horrible that it didn't matter what I had to do or what I had to get to feel better."

For recovering mothers like Howard, the challenges associated with getting clean -- such as finding stable housing, getting a job and, in many cases, regaining custody of their children -- can prove nearly insurmountable without the proper help. But local social service programs are falling short of offering the extensive support these mothers need.

Support local in-depth journalism like this. SUBSCRIBE HERE.Programs that do exist within Volusia and Flagler counties that have long waiting lists and rules against medication-assisted treatment are additional obstacles for mothers who are trying to stay in recovery for their children.

The lack of services makes it more difficult for mothers to stay clean, resulting in a high number of babies born addicted to opioids. Volusia and Flagler counties reported three times as many opioid-addicted babies than the state average, according to the most recent data collected in 2014 by the Florida Department of Health.

Since 2016, Volusia County also has seen a 34% increase in the number of opioid-related deaths, according to the Sheriff's Office. The county reported 165 overdose deaths in 2018. As of October of this year, 103 people died of opioid overdoses.

[READ MORE: Halifax Health is one of 27 Florida hospitals suing opioid manufactuers]

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Howard has been clean of opioids since late 2018, but she has not been able to get housing on her own. She ended up moving into her mother's home. Now, they are on the verge of eviction after her mother's house went into foreclosure and was sold at auction in October. They are trying to find a new home, a grave challenge with Howard's criminal history and no proof of income other than her mother's disability checks.

Since her addiction began in 2012 -- when she was prescribed opioids for injuries from a car accident -- Howard has been arrested 15 times on charges ranging from theft to possession of illegal substances. She lost custody of her five other children and she has been in and out of more rehabilitation centers and outpatient treatments than she can count.

She's been homeless, crashing on the couches of friends when she could. A few times she wasn't so lucky and ended up on the street. She also spent time as a prostitute, sleeping with men she barely knew.

"I would exchange favors to stay there because I had nowhere else to go," she said, her eyes watering. "I was unemployable because I was using, so I was always sick or I didn't look good. I wasn't showered and just my frame of mind wasn't there to work."

Once mothers like Howard have a criminal record, landlords are less likely to rent them an apartment. Those landlords who are willing to rent require a lot more money up front to offset the risk. But recovering addicts seldom have extra cash. If they are working, it's often in low-paying service jobs. No one else will hire them because they often have felony convictions.

Beyond housing, there are transportation, food and clothing needs that all require money that mothers who are recovering addicts almost always do not have.

Nowhere to turn

But finding stable and affordable housing is the biggest issue, according to Dr. Pamela Carbiener, a gynecologist for Halifax OBGYN in Daytona Beach. Carbiener is one of a few doctors in the area who provide medical care to expecting mothers who are struggling with addiction or recovery.

"The common denominator for failure is if they don't have a stable place to live," Carbiener said. "We can throw all the other things at them, all the money in the world, but if they don't have a place to live, they're not going to succeed."

To make it even more difficult, there are few programs in Volusia County that will even accept pregnant mothers, especially those who don't have a job. Dixie Morgese, executive director of Healthy Start Coalition of Flagler and Volusia Counties, said for mothers in those situations, there's nowhere for them to go.

"The options are extremely limited," Morgese said, explaining that many organizations see pregnant women as a liability. "The county has some programs, but they are not sufficient to handle the volume that we see."

Each month, an average of 10 women who are pregnant or have an infant seek help from the Healthy Start Coalition, a nonprofit that helps unite people with resources in the community. But unless those women have jobs, there's not much the coalition can do.

"If they are pregnant and they don't have a job there are next to zero resources for them," Morgese said. "They can't get housing because they don't have an income and employers in the services or hospitality industry won't hire them."

Carbiener said unreliable funding to local, state and national organizations -- which comes from grants and donations -- that help recovering mothers, makes it even harder for them to stay in recovery. Those organizations include the Salvation Army, Stewart Marchman Act and the Rapid Re-Housing program -- a national program that provides money to organizations to help homeless residents fund stable housing.

"Some of them (programs) have grants, some of them get federal and state dollars," Carbiener said. "But far too often that money is too little too late; not consistent and not enough."

Karin Flositz is the chief executive officer for Community Partnership for Children in Volusia County, a nonprofit that builds a system of care between state and local organizations. She said there is always a need for funding, but another issue organizations face is how to use the money in the best way possible. The lack of a cohesive system makes it challenging for recovering mothers to get the multiple resources they may need.

"The systems are not interconnected in the way that they need to be," she said. "There isn't a one-stop-shop for all of those things moms in recovery need."

Another hindrance is many programs won't accept mothers who are on medication-assisted treatment like Suboxone, a prescription medication used to treat opioid-dependent adults that is safe for pregnant mothers. Although it helps addicts like Howard stay straight, the medication does not help them rebuild what they've lost during their addiction.

Carbiener, who often recommends Suboxone for her patients, said the unwillingness of programs to give aid to patients on that medication only adds to the high percentage of relapses in Volusia and Flagler counties.

"In this community, abstinence-based recovery has a 90% relapse rate," Carbiener said. "If you're using medication-assisted therapy, it's still 30%, which is still too high, but it's not as high."

Getting clean for her child

In 2013, Helena Girouard found out she was pregnant. It was the same day she planned to become a prostitute.

But she got sick while getting ready to attend her first "gig." Her friend, who was going with her, made her take a pregnancy test. And it was positive.

"I was never a prostitute but I 100% tried to, that was where my next step was and there was literally that pregnancy test standing in my way," said Girouard, now 35. "I'm really grateful that my friend (who was a prostitute) cared enough for me to be like, 'Listen, this isn't the life for you.'"

Girouard, made the tough choice to get clean of opioids while she was pregnant -- not just to get assistance through local programs, but to make sure her daughter wouldn't suffer from neonatal abstinence syndrome, also know as NAS. Many babies exposed to opioids during pregnancy become addicted in the womb and have to undergo withdrawal.

"I said to myself, 'I don't want to be on anything; I don't want my baby to have to detox,' " she said on a recent day from her office in Daytona Beach. "If it makes me want to die, how is my baby going to handle it? So I said I'm going to do it myself so my baby doesn't have to."

According to the Florida Department of Health, for every 10,000 live births in Volusia County, 182 suffer through NAS. In Flagler County that number is 228 per 10,000 births, well above the state average of 65.

Some of the most common side effects of NAS -- which mimic those of an adult opioid detox -- include trouble sleeping; irritability; difficulty eating and gaining weight; excessive crying; difficult to soothe; sensitivity to noise and touch; twitching or seizures; diarrhea; vomiting; and periods of not breathing.

With Carbiener's help, Girouard's recovery from a 12-year addiction included a short stay in the hospital during her detoxification. She gave birth to a healthy baby girl, and has remained drug-free.

She credits her sobriety, and her life now -- which includes a kindergartner, her own apartment, an upcoming college degree and a fellowship with the Early Learning Coalition in Volusia County -- to her daughter.

But despite her accomplishments, it has been a long and sometimes difficult journey. Girouard struggled to get her own apartment and re-enroll in college. Banks wouldn't let her open a checking account. She had to jump through hoops to get an internship for her degree.

And it's still not over. Her 11 arrests during her 12 years of addiction -- which include failure to appear in court, possession and theft -- still haunt her.

"It didn't matter how much money I had because they kept running my background," she said. "Even as a volunteer in Human Services, they run a background. It was a fight for sure."

Doing what she can

Carbiener helps patients like Howard and Girouard get the services they need so they won't relapse and put their children at risk. While these mothers make up about 25% of her practice, Carbiener said what she does to help them takes up about 80% of her time.

"There's times when we've been buying groceries and taking them to an apartment complex that we have several women in, going in on the weekends and bringing them furniture others have given away," she said one recent day in between taking a call from a mother about to lose her home. "I have paid first, last and deposit for many women over the last 10 years because they can't get it anywhere else."

Carbiener might soon be doing the same for Howard. The people who have purchased the home she and her mother occupy have been coming by and asking when they will be out. It's a matter of time until an eviction notice is taped to their door.

"I'm trying to get my 3-year-old back and I want to keep this baby," Howard said while rubbing her swollen stomach. "But I need a home to do that. I don't want this baby taken away, too."

This will be the first holiday season in years that Howard will be spending with family members. But she's still working on gaining back the trust of her friends and family. She still doesn't have custody or contact with most of her children. She only sees her youngest son once a week for an hour during a supervised visit.

"I just want people to trust me and not look at me as a criminal, junkie drug addict," she said. "It's an internal, like emotional thing I'm going through. My oldest daughter ran away because she doesn't want anything to do with me."

She recalls one of her worst nights during addiction, when she'd been kicked out of a house at gunpoint with nowhere to go.

"All I had was two big pink Rubbermaid tubs with clothes and I'm dragging them down the street with nowhere to go," Howard said. "I'm at a point where I just want to be wherever I'm supposed to be. I don't want to go through that again, not knowing where I'm going to be each night."

Carbiener's motivation as a physician and person is that she doesn't want to see children with neonatal abstinence syndrome, or who are homeless with no food or safety.

"Knowing there's people out there, sleeping in their cars with their babies is not acceptable, if they are even lucky enough to have a car," Carbiener said. "Not knowing if they are putting needles in their arms while they're pregnant or have a newborn in the backseat dying. I just can't not do it."

Nicole Desimone of Palm Coast is facing the same challenges since getting sober two years ago: getting a home; finding a job that pays enough to cover her bills; and, recently, a long legal battle to regain custody of her two youngest children, who now live with her. She can't even open an account with Florida Power & Light because of how many times she failed to pay the bills during her addiction, which started in 2010 after she was prescribed opioids for injuries sustained during a motorcycle accident.

Her battle isn't over yet.

She has a broken foot, which she suffered while playing with her oldest son's dog. It requires surgery and nine months of recovery time, something she doesn't know how she'll afford while supporting two of her four children. So for now she has foregone surgery, and limps around the house with her bruised foot taped up. She's also worried about dealing with the pain without opioids. She currently works mornings at a Dunkin' Donuts and waits tables at another Palm Coast restaurant at night.

Her only saving grace is the friend who graciously opened her home to Desimone after she relapsed just days after leaving Project WARM, a residential behavioral health-care program for mothers in Bunnell.

Due to her relapse, the state took her then 5-month-old daughter, Kelon, and made it even more difficult to get her 3-year-old son back.

"I slept in that chair for a year because I couldn't sleep without my children and I was having panic attacks," she said, pointing to a recliner in the middle of her friend's living room. "But I cleaned myself up immediately and I got them both back after a year."

Now, she is doing everything she can to stay afloat. She has been clean for more than a year.

"It's 1,000 times better. Listen, I might struggle with money and I might not know how I'm going to make a bill happen or I might be rushing from this place to that job to daycare, but I have my kids," she said with tears in her eyes as she held her daughter. "I wouldn't trade this for anything in the entire world."

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