The Wahkiakum County Eagle - Established as The Skamokawa Eagle in 1891

Part One of a conversation with Pam Hongel, the lead counselor in a local substance use disorder program

By Diana Zimmerman

A Substance Use Disorder Program at Wahkiakum Health and Human Services is typically visited voluntarily or through referral.

According to Pam Hongel, the lead counselor at the program, people show up voluntarily when they realize they need help and aren’t sure what to do, or maybe have had help before and want to get back into treatment. And there are other less willing participants who are referred to the program by district court, superior court, the sheriff’s office, the Department of Corrections, or federal probation.

Regardless of how they get there, they generally have one thing in common. They either have a dependence or addiction to a substance or they are abusing a substance to a point that they’ve become uncomfortable with how much they are drinking or smoking, typically marijuana, or taking pills or medications they’ve been given for pain.

Maybe they aren’t dependent yet, Hongel said, but it’s not serving them well.

“Bad things are starting to happen,” she added. “It’s affecting your grades at school, it’s affecting your attendance, it’s affecting your work, it’s affecting your family, and it’s affecting your health.”

Recognizing the abuse becomes the time to stop, before it becomes a dependence.

According to Hongel, it’s not just physical addiction. It is holistic. A mental addiction to the substance, an emotional addiction, and a social addiction, and at the SUD program, they are looking at all the aspects, not just the physical part of the person. Regardless of where people find themselves, in abuse or full blown addiction, the program, counselors, and staff are there to help.

It all begins with a lengthy assessment, which is called a Substance Use Disorder Assessment or a Drug and Alcohol Assessment and generally takes two hours or more. Hongel or one of her colleagues want to make sure they have all the information they need to determine appropriate care for a person they are seeing.

Once the assessment is completed, the clinicians consider that and the information provided by the courts or police reports and drivers abstracts, if it is a referral.

“Oftentimes people come in and they are really nervous,” Hongel said. “They are scared. When you ask them all these questions, it’s so much. The collateral information helps us best determine what is the real issue here. We need to decide is this person dependent? Are they addicted? Or is this an abuse situation where we can guide them in getting the help that they need, but they don’t assess it as medically needful.”

From there, decisions are made about whether a patient might need something like intensive outpatient care, which is four times a week, nine hours a week for two to three months, or outpatient care, which might be one to three times a week, up to six hours a week.

A urinalysis is also conducted, to determine what, if anything, is actually being used.

Later, a counselor will sit down with the patient to discuss a treatment plan.

“They will let us know to the best of their ability what they need, what they want to learn, and what they find themselves struggling in, so the counselor can help guide them in group settings,” Hongel said.

They receive individual therapy and there are four groups that meet each week. The treatment plan determines which group or groups are appropriate for each person. They include a process group, a DBT (dialectical behavioral therapy) group, an MRT (moral reclamation therapy) group, and a relapse prevention group.

Treatment plans are reviewed monthly and every three months the counselor will reassess. Is treatment going well? What is working? What isn’t working? Should they downgrade the treatment or change it?

“It’s very progressive,” Hongel said. “It starts out high and the goal is to wean them down, and when they are ready to graduate, the best to our ability, we’re not perfect, nobody is, they at least have the skills enough to be able to stay sober and prevent them from relapsing on substances again, There’s no guarantees on that, because people do relapse, even after they are done with treatment.”

“We expect that sometimes,” she added. “Even when they are in care with us, we will have people that relapse during their treatment course. The craving for substances is so strong sometimes, and the triggers are so intense that they don’t have enough skills yet to help them resist the cravings and the urges to use.”

"It’s what they know, it’s where they go,” she said. “We expect it early on in recovery.”

Stress can set it off, and sometimes it’s returning to the same social circle.

If it does happen during treatment, counselors and staff will call and send out letters, or contact probation if the patient is involved in probation.

“We’ll do everything we can to reengage them,” Hongel said. “Sometimes that doesn’t happen.”

But when clients complete the program and are discharged, everyone celebrates.

“For those who have completed treatment, the goal is, is the disease in remission? If yes, they have to do things every single day in their recovery that they keep that in remission,” she said. "Recovery is an ongoing daily process. Treatment is only a small piece. It’s what you do when you leave here.”