Young adults with substance use disorders in Texas will now have an easier path to recovery housing services thanks to vouchers funded by a $3.4 million grant awarded to Be Well Texas, a UT Health San Antonio program.

The 3-year grant from the Texas Health and Human Services Commission will be used to subsidize part of the cost of level 2 and 3 recovery housing services from 16 providers operating 44 homes around the state, including four homes in San Antonio. Those 44 homes contain beds for 440 individuals dealing with substance use disorders.

The recovery levels are established by the National Alliance for Recovery Houses, a nonprofit, where level 1 is the lowest level of care and level 4 is the highest.

Richard Hamner, the program manager of recovery support services for Be Well Texas, explained what level 2 and 3 recovery homes do.

“[Level 2 recovery homes] need managers that are there 24/7,” Hamner said. “Recovery support services have to be available. Level 3, they also have to provide life skill development — life skill classes — they have to have counseling available outside of peer support and recovery support, and generally they’re connected to an intensive outpatient treatment program.”

He added that recovery housing is worth subsidizing because of its proven efficacy in supporting the recovery process, including multiple studies by DePaul University of Oxford Houses, one major sober-living provider.

They found that individuals who stayed in Oxford homes were more likely to have higher incomes, lower incarceration rates, and lower substance use rates compared with those who did not use recovery housing services.

But for Hamner, the proof goes beyond research.

“I stayed in Oxford House for three years, and had I not gotten married, I probably would’ve stayed another year or two,” Hamner said. “That was over 15 years ago now. Where I was at one time, I was in Austin under a bridge.”

He said he’d also served time in prison for a drug-related felony conviction and had a warrant out for his arrest.

A picture of a lamp post on the grounds of UT Health San Antonio with UT Health San Antonio banners on the sides of it.
UT Health San Antonio grounds.

“So yeah, a lot to overcome, and sober living, recovery housing, played a big part in that,” Hamner said.

Besides a home manager and recovery support services, Hamner said a big part of the success of recovery homes is the personal responsibility that comes with them. Residents have their own chores and roles in the house, and they act to support and hold one another accountable to those tasks with the knowledge of the shared struggle they all face.

In addition to the four homes in San Antonio, three of which are for men and one of which is for women, there are 12 homes in the Houston area, 11 in the Dallas-Fort Worth area, four in Austin, and a few homes each in Lubbock, El Paso, and Midland that will be available for subsidized living.

The voucher will pay for three to four months all on its own, but residents can provide a portion of the rent themselves to stretch out their time. They can also apply for a new voucher when they run out if funding is still available.

Hamner said the level 3 housing vouchers are worth $6,800 and the level 2 housing vouchers are worth $4,500. Rent varies from house to house, but goes up as the level of care does, ranging from around $800 to $1,500 per month.

The goal is that over time, individuals will move from higher care and higher rent level 3 or 4 homes down to lower care and lower rent homes at level 1 or 2 as their recovery process goes on. At level 1 Oxford Houses, rent can run around $500 or $600 per month, making it affordable for long-term stays.

“We’re subsidizing the higher level of care, and then as they’re working then they can kind of support themselves,” Hamner said. “At the same time, now they’re able to develop those life skills — saving and budgeting, and doing those types of things, now they’re really setting themselves up to be successful.”

Though Hamner said the initial idea behind the grant was to stand up new homes, it ended up being more cost effective to plug into the pre-existing recovery housing provider field and pay for those providers to get nationally certified so they could subsidize stays in their locations.

For more information about the recovery housing subsidies, contact Be Well Texas at 888-852-3935.

Be Well Texas is UT Health San Antonio’s substance use disorder program. It is funded by Texas Health and Human Services, and it supports patients around the state.

But officials at Be Well Texas argue their approach to addiction recovery goes beyond medication and 12-step programs. They said their holistic approach means more paths to recovery.

Dr. Tara Wright, the senior director of Be Well Texas, explained the philosophy behind their approach.

“We really try to look at it from a more holistic perspective, of what does this patient need?” Wright said. “That’s why there’s case management in our clinic to figure out what do they need — do they need food vouchers, is there legal assistance, is there housing insecurity issues that are occurring? What are the problems that individual is facing? Because all of that contributes to the substance use disorder.”

The virtual and in-person clinic services are free for low-income Texans, but Wright and others realized that paying for the services wasn’t the only barrier between patients and treatment. Another huge issue was transportation.

So, in late December, Be Well Texas finalized a deal with Lyft Healthcare to offer free rides for patients to get to the San Antonio clinic, and to labs and pharmacies around the state.

When a patient needs to make a clinic appointment or get to labs or a pharmacy, they will call their case manager at Be Well Texas and provide them with a pick up and drop off location. Then, support staff will arrange the ride and provide the patient with a window of time that works for them. All the patient has to do is get to the right location, get in the car, and they’re on their way to critical services.

Richard Hamner, Be Well Texas’ program manager of recovery support services, said when he was dealing with the worst of his substance use disorders, having free access to transportation would have been a lifeline.

“I still had a warrant out for my arrest, I had to take care of those issues, I didn’t have a driver’s license, didn’t have a vehicle, couldn’t get around,” Hamner said. “I also had legal challenges and other things that came with that — so I had appointments to make, I had to meet with parole officers, I had classes to attend, not to mention outpatient [care]. I needed mental health services at the time, with the bipolar and depressive disorders that I also had. Had I had Lyft, that would have made making those appointments quite a bit easier.”

A poster inside the Be Well Texas clinic. It reads: "Providing statewide access to high-quality, evidence-based substance use disorder treatment that's grounded in compassion, built on science and improved by technology."
A poster inside the Be Well Texas clinic.

He said that when he was dealing with all of these issues 15 years ago, he had to rely on public transportation. It was a critical tool but it wasn’t adequate for his needs. He added that it remains inadequate for the needs of many dealing with substance use disorders. So he had to make hard choices about what parts of his life to tend to and which parts to neglect.

“When I have to make all of these different appointments, I’m probably going to either no-show or not make some of those appointments. And then I just have to prioritize what’s most important. Generally, medication, making those appointments, were low on the priority list. They were most important for me physically, but not legally.”

Claudia Draper, a practice manager at Be Well Texas, said about 40 people around the state utilized the free Lyft Healthcare services to get to appointments, pharmacies, and labs.

She explained that the initial contract with Lyft Healthcare is a year-long, with the likelihood of renewal.

Be Well Texas is also starting to subsidize recovery housing for 18- to 25 year olds dealing with substance use disorders, finding ways to get people connected to internet services, and working with people in prison so that they can be on a path to recovery by the time they get out.

Wright said part of the reason for all of these services is that the need for substance use disorder treatment is so great in Texas — and it’s only increasing.

“Since the year prior to the pandemic [to] the year after, we saw almost a 79% increase in overdoses in the state,” she said. “So it is a huge need in our state alone, so in San Antonio it’s just the same.”

A picture of the UT Health San Antonio Campus. Light poles with banners of the UT Health San Antonio logo and name in orange and grey are placed in the grass along a sidewalk that leads to a school building.
The UT Health San Antonio campus.

She said Be Well Texas has grown to try to accommodate that need, going from nine employees four years ago to more than 90. With that growth, and a new clinic which is in use but has not yet had its grand opening, Wright said they’re able to accomplish more.

“This space means the world to us because what it means is we’re able to come together and do things like problem solve for our patients and ensure that we’re collaborating with all of our experts and program managers like Richard [Hamner] to come up with creative solutions to barriers our patients hit,” she explained.

One of those creative solutions is Be Well Texas’ peer to peer support services, inspired by Hamner’s own experience as someone in long-term recovery from substance use disorders.

“I was what they called a 'serial relapser.' I was in and out of all kinds of treatment programs — residential, outpatient, you name it, and none of those were really successful,” he explained.

He said it required engaging with multiple different types of programs, including faith-based counseling, a men’s accountability group and a 12-step support group before he really saw results. That’s what made him realize that no one method to recovery will work for all people, and in fact, many people will need numerous different methods simultaneously in order to make progress.

“Whether it be mental health treatment, substance use treatment, whether it be some kind of job training, GED, whatever that is that we can help connect them for," he said, "we’re there, and we can do those things.”

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Texas Public Radio is supported by contributors to the Bioscience and Medicine News Desk including UT Health San Antonio and Dr. Johnny and Joni Reyna, supporting prostate cancer research and early detection to save lives.

Be Well Texas, UT Health San Antonio’s substance use disorder response program, will use a $2 million federal grant to expand opioid use disorder treatment in rural Texas counties.

Many rural counties in Texas have opioid use rates that are two to three times higher than urban counties, according to data analyzed by the Washington Post. That’s coupled with what Bee Courtois says is a real lack of resources to handle opioid addiction.

Courtois is the program manager of Be Well Texas and the director of the grant project.

“Texas has had a significant issue with opioid use, and in particular rural counties,” she said. “And again, that just goes back to the issue of lack of resources in those rural communities.”

Courtois said Be Well Texas essentially acts as a funnel to get funds to opioid treatment efforts around Texas by partnering with local organizations. The funds for this grant will be devoted to the 178 federally-designated rural counties.

“This grant will allow us the opportunity to work on building a responsive behavioral health care delivery system with a focus on reducing the morbidity and mortality of opioid use disorder among rural Texas residents,” she said.

The grant will fund telehealth, in-person treatment, and recovery support services for those suffering from opioid use disorder.

Courtois said opioid use disorder is a growing problem in Texas, and especially rural counties, partly driven by the availability of heroin and the rise in the use of fentanyl — sometimes by accident.

“You, at times, have individuals that are not aware that something may be laced with fentanyl,” she said.

Recently, Gov. Greg Abbott signaled he supported decriminalizing fentanyl testing strips, which can be used to test drugs to see if they have fentanyl in them. He was previously against decriminalizing the test strips.

Courtois said one way Be Well Texas has tried to support those dealing with addiction is by providing housing.

“We recently set up some recovery housing for individuals with a substance use disorder who are in need of housing and are engaged in treatment,” she said.

This effort is focused on the 18 to 25 age group, which she says was identified as the age group most in need of this kind of support.

According to UT Health, Be Well Texas already supports 10,000 adults every year, but now they’ll be able to reach people who have struggled to access health care.

“The biggest challenge is access to care, transportation, and funding — these residents not having the financial means to access care,” Courtois said.

She said one method they’re using to remove that barrier is Be Well Texas’ telehealth clinic, which they can utilize to reach people who may not be able to take the time to drive to the nearest in-person clinic.

Courtois added that destigmatizing opioid use disorder would be a major step in tackling the crisis.

“It is a chronic disease, similar to high blood pressure [or] diabetes, however, it is not seen in the same light,” she said. “And because there is so much stigma and bias, it compounds the challenge for individuals that are dealing with this to seek help because of fear of that very stigma.”

Texas Public Radio is supported by contributors to the Bioscience and Medicine News Desk including UT Health San Antonio and Dr. Johnny and Joni Reyna, supporting prostate cancer research and early detection to save lives.