They come from different walks of life, but they all have one thing in common: The people being treated at Judy Retterath Withdrawal Management Center in Plymouth have consumed high amounts of intoxicants, and they need help safely getting the substances out of their systems.
“When people come to see us they’re usually blowing some kind of numbers,” explained Jessica Sprenger, the center’s program director. (For the uninitiated, “blowing numbers,” means that a breathalyzer test discovered that the person’s blood alcohol concentration is over the legal limit.)
Until earlier this month, and for the last 40 years, the program Sprenger runs was known as Mission Detox Center, and its clientele tended to be people who had abused alcohol and needed a medically monitored place to dry out.
“Last year, 86 percent of our clients’ main drug of choice or use was alcohol,” she said.
The facility is well known and respected in the community — clients simply call the place “detox” — and for many years, people with alcohol dependency have turned to it for help when they’ve been on a bender. Family or friends often bring loved ones in, or sometimes clients admit themselves. Local police and hospitals also regularly transport inebriated people to the facility.
“The other day, there was an incident in Scott County where a client was walking across the middle of the street,” Sprenger said. “Thank God a police officer saved them before they got hit by a car.” The officer brought the person to Retterath, she explained: “They put an emergency hold on them for 48 to 72 hours. That way, we had time to help them recover.”
On June 14, Mission Detox held an event to mark the renaming of the program in honor of Judy Retterath, a longtime night nurse at the facility and former program director. The name change reflects a shift in the program’s offerings: While the program made its name as a place for people withdrawing from alcohol; starting next year, the facility will also offer medically monitored withdrawal management services for opioid users.
The process of treating clients for opioid withdrawal requires higher levels of medical supervision for longer periods of time, Sprenger explained, and new staff will be hired and adjustments made to accommodate the anticipated shift in clientele.
This expansion of withdrawal management services to programs like Retterath is part of the comprehensive substance use disorder (SUD) reform package passed by the Minnesota Legislature in 2017, explained Claire Wilson, Minnesota Department of Human Services (DHS) deputy commissioner: “Before, detox services had been primarily county funded, which did limit access.” Now, Wilson explained, these programs are funded by Medicaid and Medicare.
With the new funding streams came the incentive for more SUD programs like Retterath to expand their offerings to include withdrawal management services for opioid users, Wilson said.
“Making it more available and incenting providers to provide these services was part of a larger effort to include these programs in a continuum-of-care model,” she explained. In the past, Wilson said, “Because detox programs weren’t always connected to a treatment provider, people would cycle in and out. In some cases, it would become kind of a ‘drop-off’ situation that could, for some people, perpetuate a cycle of abuse.”
Leaders at Retterath decided to expand their withdrawal management offerings because they saw an acute need for these services in their community, said Jim Steinhagen, CEO of Missions Inc., the nonprofit that runs the Retterath Center.
“I think every care provider has a responsibility to make an effort in the best possible way to meet the demands of the community that it resides in,” Steinhagen said. “In our community, we’ve seen the increase in opioid use and the devastation and the consequences that use brings. We have the ability within this program to provide those services without a significant amount of change to our current footprint, so we decided to step up and make that happen.”
Opioid addiction, Sprenger added, is “a huge issue in the community. This year, from May 27 to June 8, there were 175 overdoses in Minnesota. Seventeen of those overdoses were fatal. It’s a big deal.”
The hope is that expanded withdrawal management services will help bridge the gap for individuals who don’t have anywhere else to turn to treat their addiction, Steinhagen said. Most treatment centers have long wait lists, and many do not offer withdrawal management services. People with the disease of addiction can turn to programs like Judy Retterath to safely get the drug out of their systems before transferring to an addiction treatment provider.
“What moving to withdrawal management will do is broaden our capacity to serve more people and more addictions,” Steinhagen said. “We’ll continue to provide detox services like we are doing now, but we will also have the ability to provide advanced levels of care to individuals who need that level of care. For many people, we can help bridge the gap.”
What happens in Detox
Judy Retterath Withdrawal Management Center doesn’t have a fancy entrance. In fact, even though there’s a shiny new sign with the facility’s new name posted outside the door, the low, nondescript brick building is still a little hard to find.
Once you locate the door, there’s no walking right in — it’s a locked facility, where clients are confined inside during the length of their stay. From the inside, the building feels surprisingly small for a place with beds for as many as 21 adults. There’s a community room, with a reception desk, a medium-sized television, a sprawling table, and a small rolling cart near one wall, where three times a day, meals are delivered, family style, for clients and staff to fill their plates.
The building has four shared bedrooms, three set aside for men and one that can hold up to six women. Some of the beds are made neatly or left messy, with bunched-up blankets and pillows, but in other rooms beds stand empty, with slick, bare mattresses ready for the next visitor. There are also a few shared offices in the building, for nurses, counseling and support staff, and a small private office for Sprenger. One windowed room by the front door is a ventilated space reserved for smokers. On the day I visited, a two youngish men were smoking cigarettes in the room, perched on the edge of hard, institutional chairs.
The place is clean but lived-in and showing its age. Staff is warm and professional, chatting easily with clients. During my visit, an ambulance pulled up, siren off but lights flashing, and delivered a new client. Inside, a police officer chatted familiarly with front desk staff.
The facility, while definitely not the Ritz-Carlton, is also not the chaotic, depressing scene I imagined. It felt, in a way, like a small-town medical clinic.
Wilson, for her part, said it’s not unusual for people to have preconceived ideas about what a withdrawal management center will look and feel like.
“Most people aren’t even aware of what detox actually is,” she said. “They have this weird nightmare vision from the movies of what it’s like to go through detox or withdrawal. But the process is actually quite medicalized now. It’s like any other health care service.”
The average stay for people who come voluntarily to Judy Retterath Withdrawal Management Center for alcohol consumption is between 48 and 72 hours, Sprenger said.
During a client’s stay, she explained, medical staff will monitor them, “for several different things.” Because alcohol withdrawal can cause serious health risks, staff determines whether clients have a history of seizures or other major medical issues. Those with a seizure history are immediately started on Librium, a benzodiazepine used to treat anxiety disorders or alcohol withdrawal.
“We do see people who have seizures,” Sprenger said. “Once, on a client’s fourth day here, as she was leaving, everyone thought she was fine. She was within her vitals. But she had a seizure right before she walked out the door. That’s why it’s important that we’re here and keeping an eye on clients.”
Clients cannot leave the facility until they are officially discharged. “A nurse determines whether they are medically stable to discharge or not, depending on protocols that our consulting physician has written,” Sprenger said. “Say if someone isn’t within the range of certain vital signs, then our nurse wouldn’t be able to discharge. She could place a medical hold on them, and they would be here for 72 hours.”
Many clients come into the facility acting belligerent or defiant, Sprenger said, but after they get rest, food and medications that help reduce withdrawal symptoms, staff members usually see a notable change in attitude.
“On the second day they are usually feeling better, eating better.” A happier mood presents an opportunity to make plans for the future, she added: “On the third day, the day of their day of discharge, they meet with our chemical dependency addiction counselors to do an individualized treatment plan. During that time they’ll decide if they are going to go into a treatment program, if they just need an AA sponsor of if AA meetings would help them.”
Helping people take the first step on the long road to recovery is the name of the game at Retterath. It’s been the focus of its founding organization since the beginning.
“Missions Inc. started in 1895,” Steinhagen said. “It just amazes me that an organization has that kind of legacy behind it. The numbers of people we’ve touched and helped has to be in the tens of thousands at least. In the years to come, we hope to help many thousands more.”
What change brings
While Sprenger’s program admits a few clients struggling with opioid addiction — some 6 percent of the patient census — the program, as it is structured now, is not well suited to help them through withdrawal.
“We give comfort meds that might alleviate some of the stomach pain they might have and some of their anxiety,” Sprenger said, “but it doesn’t do near as much as what Suboxone would do.” Until the program officially becomes licensed to administer Suboxone, it does not make sense to send people in active opioid withdrawal to her program.
“It usually takes 10 to 14 days to come out of opioid withdrawal and during that time the Suboxone really alleviates those symptoms. Hospitals are aware that we don’t administer Suboxone yet, so they don’t even deliver those patients to us.”
When Retterath is approved to offer medically supervised Suboxone withdrawal services, administrators expect the number of people using the program will likely rise. At the moment, there is room for more clients, Sprenger said. “We have 21 beds available right now. Generally our census is around 18 beds.”
This year Retterath made it through the state review process for withdrawal management licensing. The next step is to apply for specially designated licensing. Once the new designation is achieved, Sprenger said, “We will be better able to partner with hospitals in our community to bring people struggling with opioid withdrawal in here. They won’t be taking up hospital beds, which will then be open for others who need them.”
Steinhagen explained that Missions, Inc. administrators have determined that the Retterath facility will set aside 10 of 21 available beds for people needing assistance in opioid withdrawal management.
“Depending on the demand for these services, we may have the ability to flex upward,” he said. “We can occupy adjacent space on our campus. We’d have to take beds away from other programs to do that, but it would be a decision we would have to make at that time.”
Sprenger anticipates that the transition to withdrawal management services will draw larger numbers of clients to her program. “I think that once people learn that we can serve clients with opioid withdrawal we will be getting much more busy. I’m actually a little bit worried about that, but I know we can handle whatever comes our way.”
Retterath’s transition from a traditional detox program to a withdrawal management center is part of a larger plan to get more Minnesotans off opioids and into residential treatment programs, Wilson said. She said that the transition might include a few bumps as staff adjusts to a new client base that requires longer stays and more intense medical supervision, but the end result could help everyone.
“The hope is that they will be able to help more people make the transition to residential treatment programs — and that some treatment programs will add withdrawal management programs where clients can stay and transfer into treatment,” she said.
Sprenger believes that her staff is prepared to make the switch and welcome more clients struggling with opioid withdrawal.
“I think it is going to change the dynamic,” she said. “These new clients are going to be coming in and they are going to be sicker. We are going to have to hire new staff for that and prepare existing staff.” But in many ways, the dynamic with clients will resemble the treatment routine that’s already been established, she added: “It might be one or two days before the Suboxone kicks in and then they will be feeling better.”
The switch to withdrawal management will require work and adjustment on the part of Retterath staff, Steinhagen admitted, but the end result will be positive. The shift is in line with the program’s mission and it’s something that needs to be done to continue serving the needs of the community.
“What we know is that in the last 40 years the demand for the service have changed as illicit drug use has become more problematic in our communities,” Steinhagen said. “We have to diversify our ability to respond to other types of drug withdrawal.”
‘I’ve seen change with my own eyes’
Sprenger said that Retterath and Missions Inc. has a reputation among clients as a place where staff members treat everyone with respect and courtesy.
“We’ve been called the ‘Cadillac of the Detox Centers,’” she laughed. “The other day a client said to me, ‘You’re not the Cadillac of Detox, you’re the Rolls Royce of Detox.’” This luxury designation does not describe the well-worn facilities, she explained, but rather, “It’s about how people are treated when they come here. I get feedback all the time about how great our nurses and staff are, about how kindly they treat our clients.”
This “no-shame, no-blame approach” has served the program’s clients well, Sprenger said. Addiction is a chronic disease, and her staff treats it that way. When clients come back again and again, staff consider the relapse as part of the disease’s progression, and they do their best to help clients take the next step required to turn their lives around. “When some of our clients come through over and over again in a year we do our best to get them into treatment,” Sprenger said, “but ultimately it is up to them when they are ready to go in. For the ones that are released and drink again and come back here, they know that we are here to serve them and help them get better. It is not our job to point fingers.”
Steinhagen wholeheartedly supports this approach. “A number of the people that are in detox have a long history of relapse,” he said. “They have been treated and have had multiple detox visits and are still struggling to maintain long-term sobriety. Our approach is to continue to work with these individuals and continue to help give them a chance to reach their best opportunities as people.”
The revolving door of clients can seem depressing, but Sprenger recalls many instances where people have been able to overcome their addiction with her program’s help. “I’ve seen change with my own eyes,” she said. “I’ve been part of seeing families develop relationships and seeing clients achieve recovery. It’s sad that they have to be at their worst when they get help, but at least they know when they are at their worst that they are not being judged. We support them fully and we’ll get them the help they need.”
Every Retterath admission is viewed as a success, Steinhagen added. “It is the person realizing that they need help for their chronic disease. There is always the possibility that they will get the help they need starting with us. We never know what the outcome will be, but we always hold out the hope that it will be positive. Our long-term employees have a level of passion and commitment to our clients that’s really very admirable.”
Commitment and passion comes easy to Sprenger, who said that she thinks of her work at Retterath as something she’s meant to do, and she’s committed to doing it for as long as she can.
“I really believe that’s what life is all about,” Sprenger said. “I’ve had a very difficult life myself, and I finally figured out that it’s almost been a gift given to me so that I can relate to others and lift them up. That gift of relatability can go a long way. I don’t look at it as coming into work. I look at it as my purpose in life and as giving back.”