Story written by Jordan Meier.
COLUMBIA — Stefie Sylvanog grew up surrounded by addiction.
Her mother was addicted to K2 and other drugs. Her stepfather was addicted to alcohol. She grew up without a lot of money.
“Addictions around here are easy to come by and hard to break,” said Sylvanog, 29, as she smoked a cigarette outside the women’s shelter where she lives.
Sitting at a picnic table outside St. Francis House, Sylvanog, who uses the name professionally for her photography business, said she is clean now except for the cigarettes, but she used to be addicted to the prescription drug Adderall.
According to the U.S. Department of Health and Human Services, one out of 10 Americans making less than $20,000 a year struggle with addiction. For many, the lack of money correlates to a lack of access to affordable treatment, which can create a barrier to overcoming addiction.
As she lights her fifth cigarette, Sylvanog tells the story of her addiction. When she was younger, doctors had her take extremely high doses of Adderall to control her ADHD. They started out giving her normal doses of the medication, but when her body stopped responding to it, the doctors just kept increasing the dosage. At one point she said she was taking 650 mg of the medication a day. According to the Food and Drug Administration, a normal dose of Adderall for children is 30 mg.
“250 mg in the morning, 150 mg in the afternoon, and 250 at night. You do the math,” she said.
When Sylvanog first tried to get off the medication, she went through major withdrawls and only lasted one week before she was forced by her father and grandparents to start taking it again, she said.
“Do I blame them? Yes. They couldn’t see that I was a child who didn’t need this s— in my system,” she said.
After moving in with her mom, Sylvanog said she continued to struggle with the addiction for years and even overdosed a few times.
“I was crying out for help and people were seeing it, but they didn’t know what to do,” she said.
Sylvanog said the only reason she was eventually able to get the treatment she needed was because she was under 18 and qualified for Medicaid. After signing up for Medicaid, Sylvanog went to a doctor and started getting off the pills. Once she was off Adderall, she went to a Boys and Girls home where she got therapy to work through some of the trauma she had experienced as a child.
“They saved my life,” Sylvanog said of her time at the Boys and Girls home.
If she were to need addiction treatment now, however, she would have a difficult time paying for it. Medicaid primarily covers adults with disabilities and low-income children and their parents in Missouri. She can’t afford private insurance.
Missouri does provide funding for treatment centers statewide, so patients without private insurance can get help. The majority of that funding historically has come from Medicaid. However, last year the Missouri Department of Mental Health added a new program called PR+, or Primary Recovery Plus.
“PR+ programs were largely modeled after the CSTAR General Population Programs but do not have some of the services available in CSTAR. It offers a full continuum of services within multiple levels of care to assist individuals without Medicaid coverage,” said Debra Walker from the state’s department of mental health.
Comprehensive Substance Treatment and Rehabilitation (CSTAR) is the state’s Medicaid substance abuse treatment program.
Despite this, experts interviewed for this article as well as those in the state’s department of mental health agreed that treatment is still hard to come by for people without insurance.
“There are usually more individuals needing treatment than treatment providers can serve,” Walker said.
“The services are effective, there just isn’t enough of them,” said Denis McCarthy, a MU psychology professor specializing in alcohol addiction.
To Sylvanog, the solution is simple.
“Make treatment more available to those who need it and want it. That’s the key, people who want it,” she said. “Give people means to end the cycle.”
In Sylvanog’s experience, the closest thing a person without medical insurance gets to treatment is when he or she overdoses on drugs and goes to the hospital. Then the person can get clean and sober for a few days before being sent back out onto the streets.
“(The hospital) gives fare for a cab service and that’s about it. They have 4-5 days of sobriety and then they are back out on the streets doing the same s—,” Sylvanog said.
Americans who make more than $20,000 per year are less likely to be addicted to drugs or alcohol — about 7 percent of people with higher incomes are addicted to drugs compared to the 10 percent of people in the lowest income bracket, according to the U.S. Department of Health and Human Services.
But people aren’t more likely to be addicted simply because they’re poor, Walker said.
“There is a correlation between household income and substance-use disorders. This is a complex relationship and a correlation does not mean that one causes another,” said Walker, adding that transportation can also be a challenge for people who don’t live close to treatment centers.
Even though portions of people in poverty do struggle with addiction, many of them want to get help, they just don’t know how to get it, said Sylvanog.
Central Missouri Community Action is working to solve that problem in Columbia. As part of the community outreach agency’s efforts to alleviate poverty in mid-Missouri, the organization helps people find treatment for addictions if they need it.
“People (in poverty) want more,” said Angela Hirsch, the agency’s community services director. “It’s simply an issue of not knowing how to get there.”