Health

HE A LTH • Summer 2019 11 communication. It presents a positive public face of recovery. "When you walk in, you don't know who in the restaurant serving you or sitting in the restaurant is in recovery," he said. "Just because they have a substance abuse issue doesn't mean they're any less charming or less capable." Beyond helping people succeed in recovery, Castiel said local officials and health providers are working to address the social issues creating fertile ground for substance abuse. That means things like Source: Massachusetts Executive Office of Health and Human Services Opioid-related overdose deaths PHOTOS/EDD COTE can allow people to think about getting a job, taking care of their family, as opposed to getting their next fix." HealthAlliance has formed partnerships in the surrounding communities. Like health institutions and campaigns in Worcester, the partnerships are helping make the overdose reversal drug naloxone, or Narcan, widely available. HealthAlliance is working with recovery coaches, people who have been through addiction themselves and can help others like them. Helping people in recovery succeed One longstanding institution demonstrating how people in recovery can help each other is Café Reyes, a restaurant and catering company on Shrewsbury Street that Castiel helped create before going to work for the city. The café employs men who have gone through treatment at the Hector Reyes House, which serves Latino men in recovery. "A lot of them have been incarcerated, and for a lot of them they have not had jobs," said Dr. Aaron Mendel, who is the executive director of the organization, as well as a UMass physician and Castiel's husband. Mendel said the business allows the men to learn both specific jobs skills and soft skills like workplace helping people leaving jail or prison to get jobs and housing, and supporting public school students who have experienced trauma and high levels of stress. But those efforts won't have immediate results in stopping overdoses. Meanwhile, healthcare officials are seeing a continuing rise in the prevalence of the powerful synthetic opioid fentanyl. Castiel said dealers are now mixing the substance not just into other opioids like heroin but in drugs like cocaine and marijuana too. To really get a grip on the overdose problem, Castiel said, it's crucial for providers to become allies to people with addiction. She said only 20% of people with substance-use disorders seek help. Others are often worried about being punished as criminals for their drug use or stigmatized by healthcare systems. "For a long time, people with addiction and mental health problems have been marginalized," Castiel said. "You can go into places and be treated horribly, and people will not go back." Tsinteris said medical approaches are gradually shifting, becoming less judgmental and more focused on maintaining provider-patient relationships and helping drug users to keep themselves as safe as possible. "It's helped simplify things, helped people be honest," she said. "They don't have to lie and hide it if they relapse." '10 '11 '12 '13 '14 '15 '16 '17 Worcester County Massachusetts 0 50 100 150 200 250 300 0 500 1,000 1,500 2,000 2,500 '18 '10 '11 '12 '13 '14 '15 '16 '17 '18 283 2,033 Fernando Ayala (left) and Eleuterio Vargas work the kitchen at Cafe Reyes, which serves Cuban food. H

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