This article is part of Scroll’s Second Chances series. Second Chances highlights the unique experiences and potential of individuals who have overcome addiction, substance abuse and/or incarceration, as well as the programs and people that supported their journey.

Zero. According to the Substance Abuse and Mental Health Services Administration, that’s the number of substance use facilities, mental health care providers or opioid treatment programs within 50 miles of Arco, Idaho.

Arco, a small town with the fame of being the first city lit by nuclear power, appears even smaller against the backdrop of the Lost River Mountain Range.

The 2020 census shows Arco is home to 879 individuals. 488 housing units make up the town‘s sum total of housing options.

Lost Rivers Medical Center is a type of legally mandated hospital called a Critical Access Hospital. Each has a max of 25 beds, and Lost Rivers is the sole medical provider for two counties, Butte and Custer, according to the hospital’s website.

What each of these facts have in common is that each disproportionately affects those with substance use disorders.

Limited access to medical appointments, increased stigma and minimal housing options — all characteristics of rural areas — contribute to increased difficulty for those facing substance abuse disorder or recent release from incarceration.

Distance

A similar picture appears in rural towns throughout southeastern Idaho.

The closest facilities to Custer are in Challis, over 55 miles away. Malta’s nearest are 20 miles out in Declo, and individuals in Ashton must find their way to St. Anthony for care.

10 to 15 miles away might not seem far for individuals to drive to a neighboring town for health care facilities, but those returning from rehab or recent incarceration are less likely to have a vehicle or current license.

And oftentimes the scope and quality of care provided at those distant facilities is limited.

“Generally rural areas tend to prescribe opioids at a higher rate, and not only … for veterans specifically. Rural areas prescribed 30% more opioids per capita …” said Joshua Tibbits, an economics professor at BYU-Idaho currently working on a study investigating the relationship between a Veterans Health Administration policy inadvertently raising suicide rates for veterans in rural areas.

Tibbits describes research showing rural areas have a higher rate of not just general opioid prescriptions, but long-term opioid prescriptions — the type of opioid use much more likely to result in addiction, overdose or suicide.

Tibbits explains higher-ranked medical schools correlate with lower opioid prescriptions, possibly indicating that the training received at those schools instructs doctors to be warier of prescribing opioids than doctors graduating from lower-ranked schools.

In spite of these negative conditions, there are significant bright spots for southeastern Idaho substance use disorder recovery.

In December 2023, the state of Idaho relaunched its naloxone distribution program, according to the Idaho Department of Health and Welfare. Naloxone is a medication that almost instantly reverses the effects of an overdose, according to the FDA.

Naloxone works by attaching to opioid receptors, blocking and reversing their effects, according to the CDC. An overdose tells the victim‘s lungs to stop working, and the opioid antagonist, Naloxone, tells them to start working again.

“It’s just so effective, it saves lives,” Alison Wiens, a nurse who works at Southeastern Idaho Public Health offices in Arco, American Falls and Pocatello, said.

Naloxone is a nasal spray that can be easily administered by anyone. Naloxone recently became available over the counter, making it widely available to the public. The downside is that insurance stopped covering the $45 cost per dose.

Arco has a median household salary of $35,585. The national average is $67,521, nearly double Arco’s. To counter the decreased financial availability of the drug, Southeastern Idaho Public Health employees applied for and received a grant covering the cost of the drug and have begun distributing Naloxone to the public at offices throughout Public Health District 6 for free.

Idaho’s Good Samaritan Law offers legal protection for those offering assistance in an emergency, expanding individuals’ ability to act in good faith quickly without fearing repercussions.

Naloxone is a great, and often lifesaving, first step in an emergency, but further medication is often a vital component for recovery from a substance use disorder.

This is where buprenorphine steps in.

“Buprenorphine works by activating the same brain receptors that more powerful opioids target. However, the effects are weaker, helping addicts wean themselves off other substances like heroin and fentanyl,” an article by U.S. News said.

Suboxone, a name-brand prescription drug consisting of a combination of Buprenorphine and Naloxone, is available at all District 6 public health centers, according to Wiens.

Physical resources aren’t the only steps necessary on the path to recovery, however, the social scheme brings its unique problems as well.

Stigma

“You have to cut ties with all of them that are using,” said Chelsea Sabin, “You have to. There’s no way you can continue those friendships and be around them and say you’re not going to use again.”

Sabin tried meth for the first time when she was 21, and it wasn’t until she was in her 30s when she began using daily.

To wake up, she used. To go to work, she used. To function, she used.

“It was probably 3 weeks, and I knew I was hooked. It was really fast, like, it kind of blew my mind how fast it just went almost before I knew it,” Sabin said.

By this point, she had several children and was living with her physically and emotionally abusive boyfriend, who was also a drug dealer.

After a fight with her boyfriend, Sabin packed her bags and asked him to take her to the Crisis Center in Idaho Falls, right next to the Center for Hope recovery center. Driving there, she changed her mind and begged him to turn around, but this time his anger worked in her favor, and he kept driving, still upset from the fight earlier.

“He dropped me off at the Crisis Center, so I stood outside at Fred Meyer until 9 p.m. at night, and decided, well, I guess I’m going to walk in there because I don’t know where to go … so it was probably the best thing (that) ever happened to me,” Sabin said.

Sabin before (left) and after (right) recovery. Photo credit: Chelsea Sabin

A police officer sat at the front desk and greeted Sabin when she walked in. He asked her if she had anything in her backpack and said if she did to put it in the black bin sitting nearby. Sabin didn’t and he said, “We ask no questions, but if we find it on you later on down the road while you’re here then we’re going to have problems.”

Sabin remained in rehab for three months and got the entire cost of her stay covered through Idaho Behavioral Psychology Associates.

She did outpatient classes for two years on entangling relationships, guilt and shame and dialectical behavioral therapy.

Sabin has been clean for six and a half years.

Sabin explained how those with a substance use disorder often have an underlying diagnosis that triggers the addiction, such as depression, anxiety or even obsessive-compulsive disorder.

Sabin said that removing the people who enabled her addiction was one of her biggest obstacles.

Research by the National Library of Medicine shows that stigma is worse in areas with lower population density. Instances such as an individual’s absence while in rehab are more likely to be noticed by community members, making it more difficult to remove oneself from social circles in tight-knit communities.

“You can’t be around those kind of people when you’re trying to stay clean.” Sabin said, “Another thing is, if you’re able to move out of the town, if you have any opportunity to move in with a family member that’s not in that area, you know, try. Try to get as far away from that as possible.”

This highlights an especially poignant issue for individuals recently out of rehab or incarceration: Housing.

Housing

“They go through this program. And it was an amazing program to go through. And we learn so much when you’re in there,” said Amy Mickelsen, “But the problem is that when it’s over, it’s over, and it’s done, and you’re back out on the street just like that.”

At 40 years old, Mickelsen had been through several divorces which left her alienated from her children, with only troubles from her ex-husband to fill their space.

Mickelsen, a licensed Idaho realtor and home builder, went from never having tried alcohol before to downing an entire bottle of tequila in a day.

“I was in and out of the hospital with seizures and blood transfusions, and you know, my life turning upside down and losing just complete, like, my world really went upside down after that. I thought it was bad before, you know, just being sad about the situation of going through hard times. I really went through a hard time by turning to substance abuse to try to kill pain.” Mickelsen said.

Mickelsen, licensed Idaho relator and builder. Photo credit: Amy Mickelsen

Mickelsen’s parents came to her home one day, found her, and took her to St. Luke’s hospital where she stayed for nine days, having major seizures and detoxing through blood transfusions.

After Mickelsen was released from the hospital, she checked into Moonlight Mountain Recovery.

Mickelsen found her situation was not like most of the other women she was living with in rehab. She was not there by a court order, she did not have a history of substance use disorder or a criminal record, but the biggest difference between her and other individuals in recovery was what they were going to do after rehab.

Mickelsen is a business owner. When she got out of rehab she was returning to a house and a job.

“But there’s these women, they didn’t have the resources… as soon as rehab was done, they were shoved out the door and scrambling to figure out where to go and where to live and what to do and many were homeless,” Mickelsen said.

Without a paycheck and a car, Mickelsen explains the gap in the recovery cycle that makes it very easy for individuals to relapse.

“As a State, we’re paying $17,000 a month for them to go back into rehab for a couple of months per person. And so we’re really not doing what we need to manage the funds that are going for these people correctly and getting the resources that they need. That transition has not been ironed out correctly.”

Mickelsen is currently working on a proposal to the Idaho state legislature to allocate more funding to assist in the transition by helping individuals leaving rehab find employment and safe and sober housing.

To locate resources available for substance use disorders visit FindTreatment.gov.