Charmin Gabbard cares deeply about people struggling with addiction because it’s a struggle she can relate to.
In her 20s, Gabbard had three DUIs in five years. Two of those violations resulted in prison sentences. She was eager to turn her life around.
But when she was released from prison in 2015, she’d been banned from driving due to her prior DUIs. And she lived five miles outside of Connersville, a rural town in eastern Indiana. When she wanted to attend recovery meetings, or even run errands, she had to hitch a ride from a family member. Or she’d run.
“And then after a little bit of time, I bought a bicycle,” Gabbard, 48, said. “It was like one hundred and some dollars — best investment ever.”
Gabbard eventually moved into town, but had to find jobs that were close enough to walk to. Gabbard has two children, and when her youngest son started middle school she had to move closer to the school so that he could participate in sports and other activities. She had to move again when he started high school.
On top of her children’s schedules, Gabbard had her own commitments: probation appointments, visits with mental health providers, and meetings to sign up for insurance and get other social services. Gabbard said transportation is a huge barrier for many with a history of substance use. Not being able to get yourself where you need to go makes staying in recovery difficult.
“Without having that ability to get to that appointment, then you got that fear of – I just violated. Or I miss an appointment with my children, I've let them down,” Gabbard said. “So that cycle of guilt and shame and regret and feelings of failure, and then all of those things that you've ever thought are right there, right in the front. And so it's easier to give up.”
The notion that lack of transportation can affect a person’s ability to access health care has caught the attention of policymakers in recent years. A 2017 federal survey found 4 percent of people under age 65 enrolled in Medicaid reported delaying medical care because they lacked transportation. The findings led at least 35 states to try to address the problem by covering ride-sharing services for medical appointments.
Dr. Paul Joudrey is a primary care physician and addiction medicine specialist at the University of Pittsburgh. He said lack of transportation for all of life’s needs intersect and can affect someone’s recovery.
“When people talk about transportation, it's not just transportation to health services, but it's transportation to all of the important things in their life,” he said. “Getting to their jobs, getting child care, going to the grocery store.”
Those on the frontlines of Indiana’s addiction crisis are taking steps in this direction.
Free rides for all aspects of life in recovery
A few years ago, Indiana zeroed in on addressing the transportation needs of people in recovery from addiction and launched a partnership with Lyft to provide free rides to people to and from addiction treatment and recovery programs.
The Indiana Recovery Network – a statewide collaboration of recovery organizations – expanded on the state’s efforts to provide free rides to people in recovery through Lyft. The program is available to anyone actively engaged with one of Indiana Recovery Network’s 20 regional recovery hubs. Rides are free for anything as long as it relates to the four pillars of recovery: home, health, community and purpose.
“It can be to and from employment, school … things like that,” said Heather Rodriguez, who leads the network. “Even if, you know, somebody needs to get the kiddos to day care on their way to an appointment or employment.”
Rodriguez says so far, more than 300 people have taken advantage of the free rides – and many say they appreciate the service.
It’s too soon to know whether ride-sharing programs increase the likelihood of a person to access treatment or remain in recovery. But studies on barriers to recovery suggest transportation issues can prevent access to medication assisted treatment. Joudrey at the University of Pittsburgh researches access to methadone, a drug used to treat opioid use disorder.
Joudrey said methadone can only be prescribed at opioid treatment programs. But he said there aren’t enough clinics. In Indiana, the Family and Social Services Administration oversees 23 clinics, which is fewer than what the federal Substance Abuse and Mental Health Services Administration reports for Indiana's neighboring states. According to SAMHSA, Illinois has 89, Kentucky has 31, Michigan has 50, and Ohio has 112.
And for some, opioid treatment programs are hard to get to.
“Particularly in rural communities, transportation is very frequently brought up as a challenge,” Joudrey said.
In a 2019 study, Joudrey analyzed the drive times to opioid treatment programs in Indiana, Kentucky, Ohio, Virginia and West Virginia. The study found that drive times to the nearest opioid treatment program from rural counties were greater than from urban counties.
Joudrey said the lack of clinics, combined with transportation barriers and policies surrounding methadone prescriptions, can make it hard for someone in a rural county to access the medication.
“They would have to try to find the nearest methadone clinic, which often may be an hour or more away,” he said. “They would have to either not work because they have to drive an hour there and an hour back six days a week in order to get that medication administered in person for the first 90 days of treatment, which means everything else in life is kind of put aside to just be able to get into treatment.”
Joudrey said for these reasons, some people in rural communities might not stick with medication assisted treatment.
“They'll try, but they won't last very long in treatment because the barriers will eventually cause them to throw in the towel,” he said. “And that's unfortunate.”
Finding creative solutions for rural areas
Gabbard, who lives in rural Indiana, now runs Connection Cafe, one of the Indiana Recovery Network’s regional recovery hubs. It’s a place where people in recovery from substance use disorders can gather for support groups or just hang out. They serve hot meals throughout the week, provide clean clothes for those in need and even have a shower.
“We are just a come-as-you-are community, and our biggest strength is loving people,” Gabbard said. “We're not faith based, we're not 12-Step. We are just an open community.”
Gabbard said she loves Indiana Recovery Network’s Lyft program. There’s just one problem: There aren’t many Lyft drivers in her area.
“So it's a great program, and I cannot say enough about it,” Gabbard said. “But with most of my counties, it don't apply.”
Having a bicycle made a huge difference in Gabbard’s ability to get around town. Last year, she learned the city of Connersville auctions off bikes that have been found and scraps the ones that don’t sell. She had an idea to repurpose those bikes.
She asked the city if she could have them, and they said yes.
Gabbard keeps the bikes at Connection Cafe. If a bike is in need of repair, she’ll fix it up before giving it away. Ten people have taken her up on her offer for a bike, and she’s excited to help more. She said the people she has helped have been grateful.
“Just to see the joy and as their recovery pathway starts picking up, and then you start seeing their potential. It's just amazing,” Gabbard said,
Free bikes and rides can’t solve the problem entirely. Better public transportation in rural communities would help. And researchers say policy changes – that lead to more treatment centers, closer to home, and easier to access – will make the biggest impact.