PROVIDENCE – There was much ado about something at the monthly meeting the Overdose Prevention and Intervention Task Force on March 8, with the release of the first statewide standards in the nation for treating overdose and opioid use in hospitals and emergency settings.

The new standards were driven in large part by the passage in 2016 by the R.I. General Assembly of the Alexander C. Perry and Brandon Goldner Law, which mandated comprehensive discharge planning by hospitals and emergency departments. Perry and Goldner both had visited emergency departments because of substance use disorder issues prior to their fatal overdoses.

The law reflected the anguish of prominent parents whose sons had died despite their frequent visits to hospital emergency rooms – Goldner was the son of Barbara and Brian Goldner, the CEO of Hasbro, and Perry was the son of former R.I. Senator Rhoda Perry.

There was also a presentation from Brandon Marshall, assistant professor of Epidemiology at the School of Public Health at Brown University, announcing that the website, preventoverdoseri.org, would soon be updated to provide more comprehensive data regarding the use of Narcan, in particular the use of Narcan tied to overdose data from specific towns and cities in Rhode Island.

Marshall also acknowledged that the current toll of 329 overdose deaths in Rhode Island for 2016 far exceeded the initial projections when Gov. Gina Raimondo’s action plan was first introduced in May of 2016, with the goal of reducing overdose deaths by one-third by 2018. The explanation for the rise in overdose deaths was attributed to the increasing presence of fentanyl in the illicit drug stream.

Beyond a clinical approach
As much as the task force has been diligent in its strategic approach to addressing the epidemic in overdose deaths in Rhode Island, much of the work has focused on clinical interventions to save lives: medication assisted treatment; the distribution of Narcan to emergency responders and police; the development of new protocols and standards for emergency departments at hospitals; and the development of a clinical model for peer recovery coaches at emergency rooms.

The demand for treatment and recovery services, not surprisingly, has also been increasing dramatically, in parallel with the ongoing epidemic.

As reported by WPRI’s Ted Nesi in his discussion of Care New England’s deteriorating financial situation: “One relative bright spot on Care New England’s balance sheet is Butler, a psychiatric hospital in Providence, which cut its operating loss during the last three months of the year by more than half, to $1.1 million. Joseph Iannoni, Care New England’s chief financial officer, said demand for treatment for behavioral health and substance abuse issues has been ‘off the charts.’”

What’s missing from the discussion?
What have not been yet addressed in a substantive public conversation – or in the strategic approach – are the recent demographic findings of sociologist Shannon Monnat, who looked at the combined death totals for drugs, alcohol and suicide from 2010-2014.

Monnat found that Rhode Island had the highest percentage of young white adults, at 59.8 percent, who died from those causes. In turn, Monnat has suggested that the dramatic increases in deaths can be correlated with economic distress and emotional despair. [See link to ConvergenceRI story below.]

Translated, if we are not going to arrest our way out of this problem, or “Narcan” our way out of this problem, as Monnat has suggested, what kinds of different strategies can be implemented?

Theater as therapeutic intervention
At its 2016 board and medical staff retreat, South County Health President and CEO Lou Giancola set an ambitious agenda around mental and behavior health delivery and the role of providers in the prevention and treatment of substance abuse.

Over lunch, there was a performance of “Four Legs To Stand On,” a short play by the group, Creating Outreach About Drug Addiction Support Together, or COAAST, to use community-engagement practices to create an ongoing dialogue about addiction, loss and recovery.

The characters in the play presented dialogues based upon the actual stories of parents and their children in recovery, and the disconnect that occurred between what was said, what was unsaid, and what was heard.

The performance of “Four Legs To Stand On” seemed to cut through much of the discussion around priorities and address the underlying issues involved, according to numerous attendees at the retreat.

Wilderness
In the promotional description of Wilderness, a new multimedia documentary theatre piece by En Garde Arts, the production explores “that place of darkness where a gulf separates children and parents,” attempting to find answers to the question, from both the parents and the young adults perspective: “how do we persevere when we feel most alone in the world?”

The executive producer and co-writer of the show is Anne Hamburger, who used her own experiences with her son as the backdrop. The show features seven actors, with six playing the roles of the young adults engaged in wilderness therapy, with images and video of real parents [with their permission] shown on screens as a backdrop to the stage.

As Hamburger makes very clear, the production is not about wilderness therapy. Wilderness is the setting; the show is about the relationship between parents and their teenage children.

Hamburger spent a year and a half documenting and recording the stories of the young adults and their parents. The show, the promotional materials say, “speaks to the our collective search for connection and hope, as families survive the extraordinary pressures and complexities that accompany coming of age in 21st century America.”

Hamburger is clear that the story is not about wilderness therapy, but rather, the recognition that, as she described in a recent interview, “Looking at yourself in the mirror and recognizing that my child needs more help than I can provide.”

Wilderness does not use her son’s story in the production. But there is a character in Wilderness known only as Mom. As described in a story in The New York Times, Hamburger wrote the role, and the voice sounded a lot like hers.

“Mom’s son has locked himself away in his room, and she is beside herself, fearing the worst. Filled with self-doubt, feeling like a failure as a mother, she wrestles with how to do the right thing for her son,” according to The New York Times story.

Much of the original work of En Garde Arts, founded by Hamburger in 1985, has been focused on creating dramas using outdoor spaces in New York City to stage the production. In the production of Wilderness, the outdoor wilderness setting of the high desert in Arizona is used as a backdrop of the internal drama that is being played out. As the promotional materials describe the contrast: “The show veers from familiar domestic confines to the harshness of the world outdoors.”

Again, as the promotional materials describe the context: “In Wilderness, adolescents stand at the brink of emotional chaos, lost in social stigma, insecurity, aggression and anger. Parents risk losing their children forever. Thoughts race. Emotions fire. Isolation intensifies.”

Wilderness is now on tour; the next performance is at Penn State University on March 15.

Hamburger said that she would be more than willing to stage the drama in Rhode Island, working in cooperation with a theater such as Trinity, if financial sponsors can be found to support it.

“A play can be a play, a theatrical experience, with an honesty about mental health issues with teens,” Hamburger told ConvergenceRI. “People might come to see it that would never go to a community discussion.”

Here is a brief ConvergenceRI interview with Anne Hamburger, the founder of En Garde Arts and the executive producer and co-writer of Wilderness.

ConvergenceRI: How would you describe the origins of Wilderness?
HAMBURGER: It is a story that began with my own experiences, about my teen-age son who spiraled off the rails and entered wilderness therapy.

I then spent a year and half recording interviews on Skype, to create the documentary drama.

The piece, on stage, has one actor playing the mom, and six different actors playing the young adults. [The parents, show on multi-media screens as a backdrop behind the stage, are all actual parents, who agreed to be recorded.]

We also worked with a bunch of different child psychiatrists and institutes.

We are using theater to produce a nuanced drama.

ConvergenceRI: You are on tour now? Would you be willing to come to Providence?
HAMBURGER: We’re happy to go anywhere and to create partnerships. We are going to Penn State because they hosted our previous show, [Basetrack Live, in 2014, a documentary theater piece about returning combat veterans], which was very successful.

ConvergenceRI: How do you see the stresses playing out for young adults?
HAMBURGER: The emotional issues are interconnected. It is a combination of things: easy access to drugs, the ubiquitous of technology. It’s also about the way that schools deal with children who learn differently. Kids are made to feel stupid, and they feel like they will be made fun of if they to get extra help.

It is also about online bullying, with the way that something private can become public.

ConvergenceRI: Wilderness grew out of your own personal story. What happened?
HAMBURGER: I have twins. My son went from bad to worse. We couldn’t reach him at all. He was very depressed. We were extremely concerned about what might happen.

We were at the end of options with therapists and tutors. We decided to try wilderness therapy. [My son] is one of the success stories. He is now doing very well.

A play can be a play, a theatrical experience, with honesty about mental health issues with teens. People might come to see it that would never go to a community discussion.