Out of the Shadows, Part 3 | Skiing town, drinking problem: Steamboat’s party culture makes it hard to get, stay sober

With this support in place Ray decided The Foundry Steamboat Springs — the only inpatient treatment and recovery facility in Routt County — would be his next step. It took him six weeks to get in, sifting through various insurance issues and red tape.

“I was lucky. I had a lot of smart, caring and loving people around me,” Ray said. “My parents and my friends and my coworkers and my former employer. They helped me get into treatment, and I worked really hard myself to get into treatment.”

Ray was in The Foundry’s inpatient treatment program for about 35 days. When he got out, he went back to where his family lives in Indiana.

“I didn’t know what I would do when I got back here to Steamboat, because I just didn’t feel like the ski town could…” Ray said, trailing off. “I think I needed some time away.”

Drinking town, skiing problem

There is a saying in Steamboat that it is a drinking town with a skiing problem — and it isn’t entirely unique to the ski town.

Pittsburgh, Pennsylvania, is joked about as a drinking town with a football problem and Madison, Wisconsin, is known as a drinking town with a college problem. These are often said in jest, but many say there is a deeper truth behind the seemingly innocuous, unofficial catch phrase.

“There’s always an element of truth to that kind of joke, that there’s pretty significant issues with everything from addiction to mental health to suicidality,” said Dr. Mike Barnes, chief clinical officer at The Foundry. “All of that is usually pretty significant in the Mountain West, … but the ski towns certainly have their share of that struggle.”

Mountain towns like Steamboat have unique factors that contribute to addiction, and it starts with the culture. Being a transient town, where people often stay a matter of months and work in the service industry, Steamboat can be a tough place to get sober or stay sober.

“There is just a high pressure to drink and to party, because it is what people move here for,” said Sarah Coleman, a wellness and recovery coach at The Foundry. “When I first moved here, that’s just what everyone did, you know. You skied, you waited tables and you party.”

There is no denying that alcohol is a crucial part of the local economy, bringing in over $1 million in sales tax revenue to the city of Steamboat from liquor stores alone in 2020.

Many people come to the Yampa Valley to enjoy this atmosphere and have no problem with the prevalence of alcohol. But this culture of drinking also normalizes certain behaviors that are certainly not normal, such as drinking an entire liter or even a whole handle of liquor in one day.

In Northwest Colorado, the most prevalent job is in food service or preparation, according to the U.S. Bureau of Labor Statistics. Experts say these jobs, which often have a culture of drinking, can make it almost impossible for those dealing with addiction to stay sober. For people like Ray, leaving town is the best option.

Coleman said she believes a lot of ski towns have a similar culture that can be difficult to break out of.

“It is just a habit — you ski, you drink, you ski, you drink,” Coleman said.

Because it is so ingrained in the local culture, Coleman said she believes alcohol, drug addiction and substance use disorders get overlooked. When The Foundry started six years ago, Coleman recalls people questioning the need for such a facility, not seeing addiction as a problem that really hampers the community.

“Look at all the events you go to in Steamboat. It is always like, ‘have a shot, have a beer, oh, we have a bloody Mary bar,’” Coleman said. “Everything kind of centers around that active lifestyle but drinking culture.”

It is more than just the bar scene on Lincoln Avenue that can be difficult for people dealing with addiction to handle, but also the very recreation that draws thousands to the Yampa Valley each year.

“We’re often taught in our culture that play and recreation is associated with intoxication,” said Amy Goodwin, a licensed professional counselor and behavioral health counselor at the UCHealth Behavioral Health Clinic in Steamboat. “The true meaning of the word party is really about pure expression and pure joy and is not supposed to be about intoxication.”

America’s drinking culture

Americans like to drink. Almost 86% of Americans over the age of 18 say they have drank in their lifetime, with about 55% saying they have had a drink in the past month, according to the 2019 National Survey on Drug Use and Health.

There are American cultural stereotypes about moms and wine time, pairing a football game with beer and using a drink as a form of liquid courage. There are many jokes about drinking like someone not being able to hold their liquor, or the common phrase, “beer before liquor, never been sicker.”

Like the saying about Steamboat, these are meant to add humor to a relatable situation and build camaraderie.

“It is funny and humorous until it is really not,” said Dr. Patrick Fehling, an addiction psychiatrist at the UCHealth Center for Dependency, Addiction and Rehabilitation on the Front Range. 

There are many people who do just fine while occasionally using drugs or consuming alcohol, Fehling said, but there are others who do not.

The party side of the equation — the people who can drink or use drugs without a problem — normalizes this behavior, which can make it more difficult for people to understand their own problem with alcohol or drugs.

For many, drinking isn’t just having one drink, as nationwide about a quarter of people reported binge drinking in the last month, which equates to five drinks in one sitting for men and four drinks for women. While Colorado is actually below the national average with about 18% of people reporting binge drinking, according to the Centers for Disease Control and Prevention, it is more common in Routt County than the state as a whole.

About 22% of county residents reported binge drinking in the last month, according to community level estimates from the Colorado Department of Public Health and Environment, last updated in 2019. That means about 4,400 adults over the age of 18 in the county binge drink.

Heavy drinking, which is defined by having more than 15 drinks in a week for men, or eight or more drinks in a week for women, is also higher in Routt County at almost 14% — more than double the state average.

People don’t just drink at higher rates in Routt County as alcohol is actually a contributing factor to death at higher rates, too. Since 2000, Routt County’s rate of alcohol-related deaths, 15.1 deaths per 100,000 people, is higher than all but two counties in Northwest Colorado and higher than the state’s rate of 14.7 deaths.

Since 2000, 73 Routt County residents have died an alcohol-related death, according to CDPHE death data. On average, each one of these deaths cuts 29 years off a person’s life, according to the CDC.

Over the last two decades, Routt County residents have collectively lost more than 2,100 years worth of time with their loved ones who died too soon because of alcohol.

Addiction is a medical issue

Substance use disorder is a medical condition that is reimbursed by insurance and treated through a multidisciplinary approach, Fehling said.

Treatment often involves someone like Fehling, various levels of counselors and therapists, a heavy amount of nursing support as well as social workers, chaplins, family therapists and sometimes even workplace and housing support.

“This is very important to approach it using this whole chronic disease frame work, not different from the way we would approach very severe diabetes,” Fehling said. “It is a mental health thing and it is a physical health thing.”

There are chemical elements to addiction that can be seen on lab tests. Things like heart disease, liver failure, cardiac disease, overdoses, infections, HIV and Hepatitis C can all stem from addiction. But there are also well-documented neurological changes that can happen as a result of ongoing substance use.

“Ongoing substance use actually will impair the brain and make it harder for the person to say ‘no,’” Fehling said. “They have this very vicious cycle that there is part of their brain that desperately loves and craves the drug, and they have lost some of their impulse control to make good choices.”

Fehling said there are five main symptoms of addiction: building up a tolerance and having withdrawal symptoms; losing control around a substance and continuing to drink or use drugs amidst a decline in one’s life; and significant cravings for the substance.

“You really spend a lot of mental energy and almost an obsessive energy around your drinking, when there is no alcohol in your system,” Fehling said. “Basically, you are drinking, or you are obsessing about your drinking.”

People who are genetically predisposed to addiction are more likely to see several of these symptoms earlier in life, but for others it can be more of a linear progression, slowly developing one symptom after another. Fehling said the latter is whom society often labels as a “functioning alcoholic.”

Other people will add symptoms as they step up their substance use, often sparked by some sort of stressor or trauma.

Fehling said it is typical for him to treat someone who is routinely drinking a fifth of alcohol in a day, which is 16 drinks. He added that it isn’t uncommon for someone to be drinking entire handles in a day, which is 39 drinks.

“This is not partying. This isn’t people who like to let loose after work. This is compulsive use of substances,” Fehling said. “This speaks to how this is so life-threatening for people.”

While addiction can lead to mental health issues and vice versa, Fehling said conditions like severe alcoholism seem to be more of a cause of severe depression and severe dysfunction than it is caused by depression. But addiction can exist alone as well, without another co-occurring mental health condition.

“Stable people with good families and good jobs who are happy develop strong addictions too,” Fehling said. “Sometimes it is caused by stress, sometimes it is caused by no great reason at all other than tolerance and beer is amazing to the point that people can progress to alcoholism.”

Someone doesn’t need to have a dark story to develop an addiction to drugs and alcohol either, Fehling said, though that can be a risk factor.

There is also a strong genetic component to addiction, and this is seen most often in people who have a strong history of alcoholism or drug abuse in their family. To explore this, Fehling said he will ask patients if they ever feel like they drink differently, and are more hardcore, than the rest of their friends.

“To just say that this is chalked up to high school or college partying, it can be more complex than that, and that speaks to some of the genetic elements that people have,” Fehling said.

Sober but not changed

Ray’s health was in bad shape when he moved to Indiana following treatment. He had to get teeth pulled and have sinus surgery, some of the physical effects of his addiction. But he was also making progress.

He did 30 days straight of yoga, which helped with his anxiety. He went to 90 12-step meetings in 90 days, which helped with his mental health. He also got to spend a lot of time with family.

After four months, he knew it was time to come back to the Yampa Valley. He immediately jumped into another yoga program and went to 12-step meetings. But he was still trying to do many of the same activities he did before he left. He was still sober, but he hadn’t changed everything.

“I was hanging around at parties where people were still partying. I would like to go to happy hour — all that stuff,” Ray said. “I tried to go to concerts. Back in Indianapolis, it was easy, but here it was harder because I knew everybody and they knew me as fun, drunk Chris.”

At a gathering in Boulder, with people partying all around him, Ray thought he was drinking water. The bottle had been dosed with GHB, a colorless liquid designer drug more often known as the “date-rate drug.” There was maybe two or three ounces of the drug, unbeknownst to Ray, in the water bottle, which he said is a lot.

Ray was 10 months sober then, in October 2019. He overdosed that night.

His heart stopped. The doctors said all the indicators showed he was all but dead. His parents came to Denver with their son on life support to preserve his organs for donation. They bought a casket. A friend that helped him get sober drove to Denver from Steamboat.

Together they went to see Ray, pull him off life support, and say goodbye.

“Somehow I woke up,” Ray said. “It was a miracle.”

Ray said they didn’t resuscitate him. Doctors who treated him and saw the signs of death in his body would see him in the hospital halls and ask what was happening. They thought he was dead.

“When I got out, I was like, I guess I have got to change now,” Ray said.

How treatment is changing

Experts say the biggest barrier to getting treatment is the person admitting they need help.

“The thing people say about addiction is it’s the only disease that tells you, you don’t have it,” Barnes said.

Barnes said about half of people with a mental heath issue will also have issues with substance abuse. This has led treatment that is co-occurring, meaning it focuses on addiction and the mental health issues that stem from it or are contributing to it.

“It is kind of like universal precautions. There is a possibility for any client to come in with post traumatic stress disorder, developmental trauma, depression,” Barnes said.

Fehling said there is more accountability in treatment than there used to be. Treatment centers often had been run by for profit entitles, were partially regulated and mainly staffed by people in recovery who wanted to give back.

But treatment has quickly progressed beyond that, Fehling said, with it now being approached as a lethal health problem and not just a social problem.

Medication-assisted treatment has gotten better too, Fehling said, with there being several newer and more effective medications, such as the opioid addiction treatment buprenorphine, which can prevent relapses and has significantly reduced deaths among opioid users.

Psychology has changed too, Goodwin said. While iconic names like Sigmund Freud were mainly guessing, now there is strong scientific evidence to back up various treatments.

“It was more of a guess, and now, it is really more of a science,” Goodwin said.

Access is a mixed bag

Access to treatment in Steamboat and the broader Yampa Valley is a mixed bag. While those supporting people with addiction believe services may be better than ever before, there are still not enough resources to meet the need.

“I think it is definitely getting better,” said Erik Plate, a recovery team supervisor with the Health Partnership. “But it is one of those things that we could always do better.”

Barnes said he thinks there are a lot of really good private practitioners in Steamboat and that Mind Springs Health, one of two providers in Northwest Colorado that take Medicaid, does a good job with the communities it serves.

Still, with a town the size of Steamboat, Barnes said there should be more services. For example, the area only has one part-time psychiatrist who lives and works in the community, along with only a few psychiatric nurse practitioners.

Barnes said he has tried to entice a few psychiatrists he knows to move to Steamboat and start a practice, thinking one could be set up rather quickly, but so far they have all balked at the idea, fearing there isn’t enough need to make the business sustainable.

“The numbers just aren’t big enough for a lot of physicians,” Barnes said. “But the need is dramatic.”

Sober living is one area Plate said needs to be improved. There are only two such programs in the county, both with a religious affiliation. There is ongoing work to bring sober living to Craig through Providence Recovery, which currently offers intensive outpatient programs as well as medication-assisted treatment.

But getting access to sober living remains a challenge for many, as most of the programs are either in Denver or Grand Junction. Furthermore, most sober living programs are expensive and are generally not covered by insurance.

“It’s one of those things that’s always kind of out of reach for people leaving treatment, because it’s just expensive, and insurance won’t cover it,” Plate said.

Plate said sober living gives people leaving treatment another layer of support and a greater chance of staying in recovery.

There is also no designated inpatient location for people to go in Routt County if they are experiencing a mental health crisis. Absent a proper receiving facility, a lot of times people in need end up in the emergency room where the staff does what they can but most patients have to uproot their lives to go to Grand Junction or the Front Range, Barnes said.

“It would be really better from a care perspective if we had a treatment location in the Yampa Valley,” Barnes said.

If someone has insurance, Barnes said he thinks the services locally that specialize in substance abuse and addiction are actually close to meeting the need. There are several private practitioners, those looking to get sober can go to a place like The Foundry, and insurance opens up more options to go elsewhere.

“For people that don’t have those resources, we’re not very close to meeting those needs,” Barnes said. “We get far more calls then we can take because of insurance or lack of insurance.”

Barriers to accessing help

It is difficult to increase addiction treatment services in rural parts of Colorado like Routt County.

Before starting The Foundry, founder Scott Borden said an effort to build a nonprofit treatment facility stalled because it simply was not sustainable.

“At the lower rates, you really need to operate on volume, so in these smaller towns (like Steamboat), often what you will find is the more cost-prohibitive, private pay facilities,” Borden said.

In larger areas, like Denver and Grand Junction, there are a lot of support groups and services are more accessible, Borden said. That is why people from the Yampa Valley are often sent to these places when adequate treatment is not available locally.

Part of the problem, Borden said, is that much of the issues are out of sight, out of mind. When The Foundry opened, Borden said he was surprised to see how many local people came there for treatment.

“I think that once there is a solution, it starts getting talked about more,” Borden said. “If you don’t have a solution to something, you don’t like to constantly be telling yourself that there’s a problem.”

But sometimes when that solution is offered, such as building a new treatment facility, communities push back, Barnes said. He often testifies when treatment centers are going through the municipal approval process. In these situations, people worry that a treatment center will bring more people with addiction to their community, which neglects the need that is already there.

“Well, what about the 5,000 people that live in your town?” Barnes recalled saying in his testimony. “Most of them aren’t getting treatment.”

Another barrier to increasing services are the same economics that have restaurants struggling to fill open positions. The cost of living makes it hard for people to move here, and The Health Partnership Executive Director Stephanie Monahan said her staff sees that throughout the health care world, with physical and mental health providers being hard to come by.

“The cost of real estate is harder, which makes it hard to get providers and staff and all of the things that go into supporting those services,” Monahan said. “It is a challenge, and I think our access to affordable housing here makes it even harder.”

Connecting people to treatment

As a recovery team supervisor for The Health Partnership, Plate serves as a Swiss Army knife for people who are either in recovery already, are looking to find recovery services or people who are “sober curious,” meaning they are not necessarily sober, but are interested in exploring a sober lifestyle.

Plate and others at The Health Partnership coordinate various substance use services such as medication-assisted treatment and counseling.

“We usually like to look at it like an orchestra and we are the conductor, playing all those different instruments and bringing them together,” Monahan said.

Monahan said their organization tries to focus on the social determinates of health, which encompass issues like transportation and affordable housing but also include how strong the sense of community is.

“Part of trying to step out of the world of substance use disorder and be clean, be sober, can be extremely isolating because your friends, your peers, perhaps family members could all still be in that world,” Monahan said.

Part of treatment for some is seeing a counselor to talk through the issues they are dealing with, which lands some people on Goodwin’s couch. She has been a counselor for more than 20 years and she said none of her patients are the same.

She tries to help patients think about how their decisions, relationships, traumas and even their thinking has contributed to their addiction and how all of that is impacting their physical and mental health.

“A lot of people have an instinct about the connection between the two, they need just need a place where they can process it for themselves,” Goodwin said. “A place where they can talk about what are the different things that are going on in their life, making sense of if it might be a variable in their depression or in their physical condition they have like an addiction.”

She also talks with patients about how their substance use is impacting their health overall, and generally, not for the good.

“There is a big difference between using medication to improve functioning and using medications that are then impacting our health,” Goodwin said. “I really try to help patients differentiate between that within their own substance use.”

If her patients are ready for treatment, one place she may recommend to people is The Foundry, which opened in 2015. It was the first inpatient treatment facility in the county, though it only accepts men. It has five levels of treatment including detox, 12 residential care beds, eight partial hospitalization beds, intensive outpatient care and more general outpatient care.

Borden believes his greatest life achievement is his own acknowledgment of addiction and his recovery. Steamboat was where Borden was able to find lasting recovery and The Foundry is his effort to give back to the community that has helped him.

Many of The Foundry’s patients are local. Borden estimates between 30% and 40% of patients are from Routt and Moffat counties. Overall, they see between 100 and 140 people a year.

“Really it varies, but I like to think that if you called and there wasn’t a bed available, there would be within a week,” Borden said. “It is so important that when someone finally seeks help, that they get help then because it takes so much for somebody to finally be ready to ask for help that you want to be able to handle them immediately,”

If they don’t have space or The Foundry may not be a good fit, Borden said they draw on relationships around the country to get people into the right facility.

“If all the treatment centers would really operate collaboratively … everybody would be plenty busy and the level of care, the outcomes would be better,” Borden said.

There are treatment facilities that focus on things like pain management for people whose addiction stems from abusing prescription painkillers like opioids. Others are faith-based, using religious teachings and community to help people through recovery.

The Foundry is a trauma-integrated facility, which means it specializes in treating the underlying trauma that substance abuse is often a product of, which is where the relationship to mental health comes in.

But trauma is often misunderstood and can come in many forms, Borden said. It can be direct trauma from ones own experience or it can be trauma transferred from a family member or friend.

A unique thing about The Foundry is that it is an in-network provider, meaning it is most likely covered by insurance. Borden said they offer services that are generally only available in a private-pay experience, and the ratios between clients and staff are smaller with patients getting much more personalized care.

While it accepts insurance, The Foundry does not accept Medicaid. There are only two providers in the county that accept the government-assisted care — Mind Springs and Northwest Colorado Health.

“If you are looking for a residential treatment facility in Routt County, no, there are not a ton of choices,” Borden said. “If you call (The Foundry), you will have access to any number of facilities across the nation, but in this area, it is an underserved are.”

Because access can be so difficult, Monahan said The Health Partnership tries to promote a variety of options for its clients, trying to find them the best available treatment.

“A faith-based program is going to be great for some; a (12-step program) is going to be great for other people,” Monahan said. “The most important thing we can do is support choice.”

Resetting the culture

While partying and drinking is part of Steamboat’s culture, people like Ray are trying to change that.

Ray, who is now a peer recovery specialist with The Health Partnership, said he feels he can connect with clients on a different level than those who aren’t in recovery.

“I know what it is like to be depressed and sleep 16 hours a day. I know what it is like to not answer the phone when your job is calling or your parents are calling,” Ray said. “That is where I find value and where it helps me, because I am reminded of how far I’ve come and how far I want to go.”

Ray has been integral in building Clean and Sober Steamboat, which holds sober events for people in recovery or those who are sober curious. Plate said the Clean and Sober events in Steamboat and Craig have become a big part of The Health Partnership’s outreach.

“They see that there is a free, sober event, they come to it, they have fun, they realize, ‘Oh there is fun in sobriety,’” Plate said.

Ray also participates in The Phoenix, a national program that centers sobriety around being active.

“Their philosophy is coming together through fitness, an activity or something that is hard to do,” said Ronni Waneka, owner of Steamboat Strength and Conditioning who started the local Phoenix group. “Then you accomplish it and realize you have this inner strength.”

Waneka is not in recovery but has had several people in her life deal with addiction. She led the classes for a while, but now people in recovery lead most classes. The group meets three times a week for a CrossFit workout where they talk about their addiction and their lives in recovery.

Longtime local Hillary Ackerman got sober in 2013. She became part of the strong 12-step community in Steamboat and, eventually, heard about The Phoenix.

While finding a 12-step program locally isn’t hard, Ackerman said being sober was intimidating because of how much of her life involved going to bars and drinking. But she feels like there have been vast improvements in the sober community in Steamboat in the last couple years.

Ray said The Health Partnership is working to grow the sober events by hiring two more peer support specialists, with one of them being bilingual.

“We want to grow the events into something that is just part of Steamboat,” Ray said. “We want to be visible and we want to break down the stigma of what it looks like to be in recovery.”