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Meet Janina Kean, addiction specialist

Islanders have been hearing a lot in the news lately about the opioid crisis in the country, the state of Massachusetts, and locally as well. Many feel helpless in the face of substance use disorder, both those who use, and their families. But for the last year or so, thanks to the efforts of Nantucket’s Behavioral Health Task Force, and now the Alliance for Substance Abuse Prevention (ASAP), help is at hand, in the form of education. Education is a powerful tool in this battle, and no one knows this better than Janina Kean.

Janina, a Psychiatric Nurse Practitioner, with an MS in Nursing from Yale, has presented her Family Awareness Program eleven times so far on Nantucket, free of charge. She’s no stranger to recovery, as the former director of an acclaimed inpatient residential rehab facility in Connecticut, the world’s first to use Twelve Steps principles. She revamped the program by integrating the Twelve Steps with state of the art medical treatment, including the latest in addiction medicine, addressing both the neurobiology of addiction, and co-occurring disorders. Additionally, she is open about being a person in long-term recovery, for over 35 consecutive years. This is just an abbreviated version of her bio; her experience, credentials, and dedication are unmatched, and well recognized in the field. A warm, energetic, and engaging professional, Janina “gets it,” and connects with others like a benign lightning bolt.

These days, she has her lens focused on Nantucket. Her workshops have been well attended, with many participants returning to subsequent programs for more information. Relationships have been formed. It’s obvious that Janina cares. She says that the program has not only established itself as a touchstone for islanders in great distress, but in addition, has generated great momentum on Nantucket.

“I was waiting for an elevator while watching a man lovingly rub an infant’s back as the child touched the man’s face,” said Janina. “Because of the child’s size, I commented that this baby must be only ‘15 minutes old’.  We laughed and he replied, ‘You’re Janina, right?’ He proceeded to tell me that both he and his mother attended my first Family Awareness Program on Nantucket. He told me his name and reminded me that his mother had called me after the program asking for a plan on how to help him. I remembered her phone call. He then informed me that because of this program, he now has seven months of sobriety and he has his baby. He went on further to thank me for the Family Program that helped save him, and his family’s life.”

Janina said that a culture exists on the island that is filled with shame and embarrassment around behavioral health issues, compounded by the lack of ongoing education programs, which could teach the community about substance/behavioral health disorders, as well as prevent further development of these disorders.

“Substance use disorder is considered the major health care problem here, yet there are no formal programs to address this adequately,” said Janina. “To compound this, the culture supports drinking and it has become normalized.

 “Patients appear in the emergency department needing detox, and are then referred to a facility off island for treatment,” she continued. “No formal continuity of care exists: one that starts with the emergency department, then to the off-island facility, then back to the island for transitional care, and finally, formal long term medical/maintenance care.”

 Janina noted that there is a harm reduction program for opiates, Dr. Lepore’s Suboxone clinic, but a lack of adequate funding has thus far prevented him from hiring a therapist for his patients, a key component to recovery. She warned that Nantucket needs to move beyond harm reduction as a response, because research shows that it can actually spread the problem through diversion, without addressing the root causes of substance use disorder.

She said that islanders who suffer from other behavioral health problems go from crisis to therapy appointments, because there are no partial hospital programs, and no intensive outpatient programs. The housing crisis is a contributing factor for this population, the stress of which is not supportive of their psychosocial platform, resulting in an exacerbation their behavioral health/substance abuse problems.

Last year, ASAP brought consultant Dr. Jeffrey Rodman to Nantucket, to conduct interviews, gather data, and formulate a report on the risk factors that effect the community’s youth. Janina presented his results at a recent public forum. In addition, she did some intensive research of her own last summer, interviewing over 20 members of the Behavioral Health Task Force, as well as town officials, medical staff, and people with long term involvement in the public schools. I asked her what she learned.

“Dr. Rodman’s report outlined what was obvious as I explored the mental health issues on Nantucket,” she said. “Primarily the island was setting the foundation for the next generation of those who will suffer from substance abuse. What I found provocative was the following statement in his executive summary:

‘As an island that survives, to a great extent, off of a four-month tourist season highlighted by continuous summer beach parties, there is a real feeling that the community, without the promotion of alcohol and the tolerance of the related consequences...would cease to be Nantucket. Given this dependency, a culture of shame exists, a culture that subtly communicates that “we are not going to talk about this” pervasive, multi-generational use and abuse of alcohol, marijuana, and now prescription pills and heroin, by which everyone has been intimately touched.’

“It makes sense that there would be a “culture of shame” under these circumstances,” she said,  “and hence most islanders will make believe there is no problem, as a defense to deal with this shame.”

Shame is what Janina lists first as the biggest barriers to seeking treatment, along with the need for anonymity, and too few experts in substance use disorder, partially due to the exorbitant costs of island living, which prevents highly trained clinicians from moving here.

Janina explained the need for evidence-based treatment: the adherence to psychological approaches and techniques that are based on scientific evidence, a treatment protocol she successfully integrated at the facility in Connecticut.

“When treating any disease, if one does not engage in evidence based treatment, more than likely the outcome will not be an improvement in their medical condition,” she said. “Evidence based treatment for addiction comprises of medical treatment for the addicted brain; identifying and treating co-occurring disorders; educating the individual on how to manage a chronic disease; family participation in their loved one’s care, as well as their own; and that length of treatment matches severity of illness.”

As far as short-term goals to address behavioral health and substance abuse on Nantucket, Janina would like to see partnerships amongst island providers, and increased staffing. She would also like to continue educating the community, through the Family Awareness Program.

“If we can obtain the funding we should continue with the momentum generated by the Family Awareness Program, providing it to the community on a monthly basis,” she said. “It should also be presented to target audiences such as police, first responders, schoolteachers, ethnic-communities and other special interest groups for examples. I have done a luncheon series for the nurses at Cottage Hospital.”

For long-term solutions, Janina cites Martha’s Vineyard as an example, with more programs in place, and The Vineyard House, a transitional sober housing complex, consisting of a building for men, a building for women, and a building with common space, offices, and a conference room. She would like to see similar resources on Nantucket, along with a Behavioral Health Center, designed to not only contain office space for individual therapists, but to also include provisions for a partial hospital program, and intensive outpatient programs to provide care for mental health and substance use disorders.

“It should contain provisions for a large, comfortable, beautiful room that can be used as a drop-in center. Also the center should include an amphitheater, used to educate the community,” Janina said. “Those who are new in recovery or have come back to the island from inpatient treatment elsewhere, can reside in transitional housing, and attended the new behavioral health center, where they receive care in the partial hospital program, intensive outpatient program or from an individual therapist depending on their behavioral health needs.”

Whether all of this remains a wish list, or evolves into a plan, with results, is up to the residents of Nantucket. In the meantime, ASAP and Janina want to continue to build the foundation needed to bring these resources into fruition: education on what is needed to strengthen the health of the community. Education and awareness are the cornerstones of this foundation.

The next two-day Family Awareness Program will be held Friday, March 10, from 4-8 p.m. (snacks provided), and Saturday, March 11, from 9 a.m. to 2 p.m. (light lunch provided), at the Nantucket Community School, 56 Centre Street. The program is free of charge; pre-register online by visiting www.nantucketcommunityschool.org, or contact Sheryll Reichwein: 508.228.7285, reichweins@nps.k12.ma.us. If you have any questions, please get in touch with Holly McGowan of ASAP, hollymcgowan@comcast.net.

And last, but not least, ASAP needs support to keep this program going. If you would like to help, send a check, made out to the Alliance for Substance Abuse Prevention, Inc., to ASAP, PO Box 2102, Nantucket, Ma 02584. Donations are tax deductible.