For inmates at the Butler County Prison, therapy — which is required as part of the jail’s medication-assisted treatment program — begins by learning to regulate your emotions.

“Living in this impulsive … brain so long, we’re really teaching them how the brain works, and how it connects to the body,” said Alyssa Vorel, clinical supervisor with the Ellen O’Brien Gaiser Center.

“We want to disrupt the cycle of trauma for the next generation and for their children,” she said. “A lot of these individuals have children, and they want to be better for their children and their families.”

For the past two years, therapy has been a critical component of the Butler County Prison’s medication-assisted treatment program that provides medication to inmates struggling with substance use disorder.

In therapy, Vorel said she addresses trauma and decision making, as well as how to navigate high-risk situations inmates will face upon release.

First, Vorel said, inmates learn how to cope with daily stressors, and how to practice grounding techniques.

“We get creative with them,” Vorel said. “They don’t have access to resources like we do; they can’t just go outside and take a walk.”

Inmates can practice other mindfulness techniques, like journaling, meditation and deep breathing.

“We work with them on how to manage their own emotional states,” she said. “What are some things you can do when you become frustrated, angry or when your cellmate is not someone you would ever connect with in life, but you have to live with in prison?

“In turn, these are skills they can take with them when they are released. We all have stressors in life. We teach them things you can start building in here and can carry out into the world.”

The second piece of therapy, which is trauma-informed and operates from a cognitive-behavioral model, can help with assertive communication, healthy boundaries, mental health concerns, depression and anxiety symptoms, trauma, stress management and goal setting.

For many, substance use is a way to cope with trauma, Vorel said. Trauma is layered, and can stem from childhood, or from experiences later on in life.

Addiction is, in itself, traumatizing, she said.

“With therapy inside jail, we recognize it’s a tough environment, and we have them for an hour,” she said. “I feel we get to be a little bit of light in a world that is very dark for them. When they walk away from us, they have to put their masks back on to stay safe.”

“You have to honor that because, I’m not the one that’s incarcerated,” Vorel said. “They have to be able to survive what they’re going through.”

Within the jail’s MAT program, therapy is required at minimum once a month, but Vorel said most participants choose to meet with a therapist weekly.

When it comes to addiction, experts stress that medication that treats withdrawal symptoms and curbs cravings for different kinds of drug addiction, including opioid use disorder, is not enough to ensure successful recovery, and that therapy should be part of the process.

“Taking medication as prescribed is just one tiny piece of (recovery,)” Vorel said. “The behaviors that come along with addiction are really what we have to look at.”

“(Addiction) is evidence that someone has really been living in a nervous system that’s overactive,” Vorel said. “All behaviors become a means to survive, and reversing that takes time. So, it can’t just be medicine … if I just take medication every day that doesn’t change the obsessive compulsive part of me that drives me to use substances.”

To qualify for the jail’s medication-assisted treatment program participants are required to have an existing prescription prior to being incarcerated and test positive for medication by urine analysis to prove consistent use.

About 5 to 10% of inmates at the Butler County Prison take part in its MAT program, said Matt Clayton, reintegration coordinator, but numbers fluctuate and vary as people are released from jail, and others are detained.

The jail’s MAT program contracts PrimeCare Medical, a private health care company, to administer the medication. In September 2022, the jail contracted the Gaiser center to provide therapy for inmates receiving medication. The three organizations work in conjunction with each other, meeting weekly to discuss the MAT program and any issues surrounding it.

Prior to the program’s implementation, inmates in active addiction would go into withdrawal in the prison. While withdrawal differs from substance to substance, the symptoms, which can range from nausea, hallucinations, vomiting and fever, are not only painful, but can sometimes be lethal.

Withdrawal from xylazine, which is an animal tranquilizer and is increasingly mixed with other drugs without drug users’ knowledge, can put people at risk of cardiac arrest, said clinical pharmacist Bill Lynch.

MAT treats withdrawal symptoms.

It also reduces recidivism and overdoses, Clayton said.

“I think where you’re going to see the benefit of (MAT) is when (inmates) are released,” he said. “A lot of times we were seeing people go back to jail, and they would go right back to their addiction. (MAT) is something that helps.”

“We don’t want recidivism or overdoses,” Vorel said. “People who are leaving (jail) face the highest risk of overdosing.”

By working with the Gaiser center, Clayton said, the jail is bridging the gap between medication and treatment.

“I think the anxiety of addiction is something that affects them in here,” Clayton said. “When they have that support, that just makes their transition a lot easier.”

Once a person enters the jail’s MAT program, they are connected with a case manager at the Gaiser center.

Staff will assess which form of medication is the best fit for them and will offer one-on-one counseling, as well as schedule an aftercare plan for their release.

Outside of therapy, Gaiser staff meets with inmates to discuss how the medication is working and any side effects, said medical director Dr. C. Thomas Brophy.

To receive medication, Clayton said inmates are taken to the building’s medical department, usually in the mornings.

The dosage frequency varies based on the medication. Subutex, or buprenorphine, treats opioid withdrawal and is taken once a day. Sublocade, which is another form of buprenorphine, is administered as a monthly shot.

Being a monthly shot, Sublocade eliminates any possibility of diversion, Clayton said, which can be a challenge when some inmates sell their dose.

“Obviously, that’s against the rules,” Clayton said.

This happens rarely, but when it happens, the inmate refuses the medication so many times or breaks the rules, they can be removed from the medication.

“It’s very straightforward, with the medication,” he said. “Our fight, as far as the jail goes, is just making sure we don’t let it become a contraband issue.”

“MAT a great tool gearing people toward success,” he later continued. “It’s just a program that’s very easy to be manipulated or taken advantage of, also, which you’re going to find across society. Anything you have out there for people, people have the capability to use or abuse, but this is designed to help people. So you help the people that you can.”