Brandywine Counseling and Community Services (BCCS) has been around for 35 years. Its roots are in the Christiana Care Hospital System and was started as a result of Christiana deciding it didn’t want to provide outpatient opioid drug and alcohol treatment services. BCCS began with a specialty service: opioid addiction treatment as behavioral health counseling combined with the opiate-replacement medication methadone.
Dr. Lynn Morrison joined Brandywine Counseling in 1991, when it had just one location and about 35 staff members and 400 clients. The organization’s mission began expanding with the arrival of the HIV and AIDS crisis. BCCS introduced an Indigenous Outreach street model where they asked people in recovery to go to places where others were using drugs to either try to get them into treatment or provide preventive education services. She left for a few years early in her career before returning and took on greater responsibilities until 2009, when she became CEO.
The organization today provides Recovery With Care to individuals and families touched by mental health, substance abuse, HIV, and what it describes as “multiple occurring diagnoses and their related challenges.” BCCS is Delaware’s No. 1 source of substance abuse treatment and prevention services, with four locations in Wilmington, Milford, and Newark as well as mobile services. The organization now has 175 staff members and more than 2,000 clients.
Dr. Morrison has what most would call a BHAG (Big, Hairy, Audacious Goal): Eradicate opioid addiction in Delaware within her lifetime. Her plan includes:
- Stop self-destructive behaviors.
- Go to where the clients are, physically and mentally.
- Push back on the marketing tactics of drug dealers (which includes some pharmaceutical companies).
- Educate communities.
She sat down with DBT Editor Peter Osborne to discuss the frustrations — and high points — of her job and what it’s going to take to achieve that goal. This interview has been edited for length and clarity.
You've been here pretty much your entire career. What brought you here and what keeps you here?
I was a typical social worker-type person who just wanted to help people. Brandywine was the first organization to really give me the opportunity to do counseling, and honestly, I fell in love. The people that work here are the best in the field and the clients that we serve are kind of the underdogs, and for whatever reason that really spoke to me. I also started to see a lot of myself and family members in the faces of the individuals I was treating. That really helped me understand myself in a different way. It made me want to go back to school so I eventually got my master's and Ph.D. in hopes that I could increase my impact.
Do you ever get to a point where the problem just seems too big?
When I get frustrated, I go and talk with the clients. That reminds me why I'm doing what I'm doing. I get frustrated by the stigma associated with addiction and how that impacts my ability to help people. If you’re advocating for someone with cancer and they pass away, no one looks at that as a failure. They lost their battle with cancer. If it happens with one of our clients, we say he lost his battle with depression or addiction. No one judges the cancer, but we sometimes see a judgmental backlash when someone overdoses or commits suicide related to their mental health diagnosis.
Do you feel like you're making a dent?
I do. I feel like we're helping keep people alive. I can only imagine how bad the overdose epidemic in Delaware would be if we weren't around. That's really what I think about, how many people that we've actually been able to help and save.
Where was the point in your life when you realized you could make a difference?
Early on, I had a client who had been struggling for a long time. She got into recovery, restarted her life and left. Eventually, she had a baby whose middle name is my name. She said it was because I helped her obtain recovery. And I think that's when it really hit me. Then another client repeated a phrase that I used in a counseling session that I didn't think twice about. That reminded me that words matter, people matter, relationships matter, and if you're helping people, you're making a difference.
You've set a pretty audacious goal, of eradicating opioid addiction in your lifetime. How’s that going? Do you ever think about ratcheting it back a bit?
I believe that once you ratchet back a goal, then you ratchet back your objectives and your intervention. If you keep striving for the ultimate, more things become possible than they would have been otherwise.
We're getting Narcan (the opioid antagonist drug that can treat narcotic overdoses) into more hands than ever before — around 757 individuals so far this year — through street outreach and the continued community programming. We have tested 2,366 individuals for HIV, and roughly the same number for Hepatitis C.
So, what does success look like in 2020?
Zero individuals losing their life to the diseases of addiction. We're trying to reach some hard-to-reach places, especially downstate in Kent and Sussex counties. I’m sure you’ve heard from other businesses that the transportation downstate makes it challenging for people to get to work, let alone get to treatment. So, we’ve extended our COPE (Community Outreach and Prevention Education) services by providing mobile treatment. We're going to start bringing counseling and medication to folks in their neighborhoods through a mobile van. In addition, we will increase prevention efforts, especially around e-cigarette vaping. We’ve been doing that already, but now that it's hit the national news, communities have more interest in learning about its impacts. Right now, society is starting to understand how dangerous it is. It's so frustrating that the marketing targeted young folks. I mean it really is true. When you think about the opioid epidemic, they were telling the doctors that Oxycontin was safe to be prescribed would not get addicted if taken as prescribed. Marketing for e-cigarettes focused on it being safer than smoking cigarettes.
Additional program service offerings will focus on primary care integration: family planning, Hepatitis C treatment, and tobacco cessation programming. Those things were implemented in 2019, but we won't see outcomes until 2020. HIV testing will continue to get a lot of attention in specific populations. Delaware has successfully started lowering its HIV rate, so you're starting to see the funding shift away from it now, but Hepatitis C is an epidemic. We have higher Hepatitis C positives in the state of Delaware than we do HIV.
Has the amount of support you’ve been getting in recent years significantly higher than previous years, just because this is becoming a bigger workplace issue? (Long pause) No, not necessarily. It's shifted around. We haven't gotten an increase in our rates from some of our health-care provider contractors for years. Some of the organizations have worked with us to renegotiate … and others have not. As far as other major corporations showing their support for addiction treatment, addiction's not sexy enough. It's very hard to compete with the children's hospital, cancer … for limited resources.
Are there industries that seem to be more interested than others?
We have seen some renewed interest by the construction industry, which understands correlation between alcohol and other drug use by individuals who work in that industry, and also from the food- service industry. Those two industries are trying to help their workforces.
How do you make it sexier?
One individual at a time. Things rarely matter to people until it hits home. So now that more folks have family members with addictions, they are more interested, even if they don’t necessarily want to admit that out loud.
Tell me how you work with the state and local governments.
Pretty closely, I would say. We get a lot of our funding from the state. They've been making some significant changes and supporting the efforts of the providers in trying to reach people. They're also trying to do a lot with reducing the stigma of addiction, getting more physicians involved and educated about addiction, and about treating people with addictions issues in their offices. Long-term treatment providers are often left to operationalize the ideas, so it's really important that the providers be at the table during all the conversations, and they've started including BCCS more and more. Legislatures are also including providers and advocacy groups when they craft and pass legislation.
What keeps you awake at night?
Having the income needed to continue our services that save lives and prevent addiction. And reimbursement rates. It’s getting harder and harder to compete in the health-care system with the reimbursement rates that behavioral health providers get. I'll give you an example: One of my supervisors is leaving to go work as a care manager for one of the commercial health-care providers and will make 38% more than I'm able to pay him for direct service and supervision to clients. That tells me something is significantly wrong when an insurance company can pay their employees 38% more than a direct service provider who's a recipient of insurance funds.
Are we better off in Delaware than some of our neighboring states?
We are better off in the sense that we can get all the significant players to the table — one table in one place — and strategize and come up with some really solid ways to address the problem so we can move faster than some of the other states. We’ve been late in other areas, like getting Narcan into the hands of first responders, but the recent state grant will help with making this life-saving tool more available.
What is helping you get traction?
The middle class deciding to speak up about the children that they're losing. The number of people dying from their disease has certainly gotten worse but I hesitate to think that addiction is any worse than before; it's just now more people are talking about it than they were before due to the number of deaths. More people are accessing treatment.
You've written that people with substance-abuse challenges are also dealing with mental-health issues. When you think about treatment, which do you need to deal with first?
Both. When I started at Brandywine, I had a client who had major depression, anxiety and she was a heroin addict. We had a psychologist on staff who made that diagnosis, and they said we needed to connect her to mental health. But when I called, they said she needed six months of abstinence before they would see her. When I responded that she couldn’t get six months of abstinence because of her condition, they said to call us back when she had six months of abstinence. Today, I have a psychiatrist on staff and a psychiatric nurse practitioner on staff. My counselors now are educated on how to provide mental-health counseling in addition to the substance-use counseling so they can be treated at the same time.
Why do you have two locations within a block or two of each other in Wilmington?
Because we're needed in the sense that this location is the only medication addiction treatment center that offers methadone maintenance medication in this whole city of Wilmington. And so this building is serving that population primarily. The need for treatment in Wilmington is bigger than our Wilmington locations. And if you're the only treatment facility in the city of Wilmington, how do you expect me not to be busy?
Do you ever think about going into low-income neighborhoods like Riverside?
The stigma associated with addiction is everywhere, in every neighborhood. When you think of revitalization, you don't think of drug and alcohol treatment, behavioral health treatment. That’s why we also partner with the efforts of local business and community organizations to help those in need of services.
But I would think that the Riverside neighborhood probably has a lot of people who need your services, and it’s not easy to get here from there.
Is this another thing that maybe keeps you awake is whether there's other places you could be?
Absolutely. Finding other places to be, to be able to make us more accessible to folks.
What emotion do you feel when you hear about the various overdose deaths that have hit the state of late?
Deeply saddened, I think is the first one, frustration that I can't do more to stop that from happening. Those are the top two.
Yes. I start off being sad and then it moves to anger. The anger drives me to say things that might get me in trouble or pick up the phone and push the envelope, because if I don't, who will?
Do you look at the stories to see if they're … Ours?
Absolutely. I usually know before it hits the paper, because the client network is pretty good. When I say “ours,” let me define that. The occasions when it has been a former client, few were in treatment at the time of the overdose. Since we knew them when they were in treatment at one point in time, I'll always consider them mine, even if they're not actively in treatment. Statistically speaking, you're 50% more likely to stay alive if you're connected to treatment.
What's one thing that businesses and business owners can do to help address the problem in terms of supporting your organization or the problem holistically?
From a financial perspective, we need more COPE medical health services vehicles out on the street, because when we talk about Brandywine going to where the problem is, we’re talking about leaving our brick-and-mortar locations. We're always looking for capital to help expand. We have a lot of land at our Newark location where we could grow and still maintain our relationships with our neighbors because we’re not in a residential area.
When I think about how companies can help, I think they can help reduce the stigma, by supporting any educational efforts about addiction as a disease. People suffering from addiction need help the same as someone suffering from cancer or diabetes. And statistically speaking, our client compliance rates in treatment are the same as somebody who's getting treated for high blood pressure.
Getting treatment is so important. It’s everything. People who are in treatment are less likely to commit crimes. They're more likely to be employed and make a positive contribution to their communities. The real help is needed in reducing the stigma of addiction because it impacts treatment retention. We need individuals struggling with addiction to seek treatment and not feel ashamed to tell their friends and family. We need them to have the freedom and confidence to ask for help on days when they might need extra support. And that support could just be a positive comment.
Are you counseling your clients to try to do that?
Yes, we're partnering with the University of Delaware to study the most effective ways to communicate to your family members that you have an addiction. The study aims to determine the best way to share this information. So yes, we constantly are working with folks on building up their support network and coping mechanisms to manage stigma related to their disease.
Is there anything we want to add here for people to contact you if they need help or want to learn more?
If anyone needs help with recovery from their addiction or that of a loved one, or just has questions about BCCS and our programs, they should call us at (302) 656-2348 or visit our website at brandywinecounseling.com.