Michaela Howe, 33, of the Fort Berthold Indian Reservation, a U.S. Army veteran, started drinking when she was 10 years old — after her three brothers died in front of her. Howe blamed herself, as she was the oldest of six children.

When she returned home after eight years in the military, she developed postpartum depression and her drinking worsened.

Aaron Fowler, 37, an associate pastor at Lighthouse Church in Fargo, grew up in Las Vegas, and there, in 2008, he was charged with possession of methamphetamine. A judge gave him a second chance, sentencing him to treatment instead of prison.

Joe Fay, 29, of Cando, used to get high on any type of drug, starting at a young age. He's well known in his hometown of Bismarck, but not for the right reasons. Fay said he thought he was a drug addict when he was sentenced to a year in prison in 2013, but, when he got out, he was "10 times worse."

There are many different faces of addiction, which is often coupled with a mental illness. To help people struggling with substance use disorders, treatment providers are increasingly looking to peer specialists to share their unique stories of recovery and, in turn, help others dealing with addiction.

In a conference room of a hotel in Bismarck on Thursday, dozens of people from across North Dakota were being trained to become certified peer specialists, including Howe, Fowler and Fay. The weeklong training program is funded through the Free Through Recovery Program, which was created by the state's justice reinvestment initiative that allocated $7 million for recovery services, including peer support.

"It hurts to see people leave treatment, and they have no support," said Fay, who completed treatment two years ago and works for the Heartview Foundation in Cando. "I'm here to get the help to people who need it, where they can get it."

Peer specialists use their experiences of recovery from an addiction or mental illness, and, through formal training, are able to support others in a behavioral health setting.

In recent years, there has been a sharp increase in the use of peer support services within treatment settings to assist in recovery. Recent research shows peer support can significantly reduce relapse.

"Their role is to connect people with resources in the community," said Ike Powell, director of training for Georgia-based Appalachian Consulting Group Inc., which is hosting the training in Bismarck.

Medicaid approved billing for peer support services in Georgia in 1999, and, in 2001, the first training was held there, Powell said. In 2007, such services were recognized by Medicaid in every state.

The group in Bismarck this week will undergo 40 hours of training before they take a test to become certified. Currently, North Dakota does not have a certification process for peer specialists.

"This group here is really at the cutting edge of bringing this to North Dakota," said Jean Dukarski, director of operations for Appalachian Consulting Group Inc.

Stories of addiction

Howe, an enrolled member of the Three Affiliated Tribes and a mother of three, grew up in what she described as a "traditional family," with an established culture and structure. Her father, however, struggled with alcoholism.

Howe joined the military at age 18 because her father told her the military was "no place for a woman."

"I was going to prove him wrong," said Howe, who carriers photos of her and her dad in their military uniforms, as well as a photo of her grandfather in his uniform.

Howe, who was an alcoholic for 22 years, was also diagnosed with PTSD, depression and anxiety — disorders which intensified after returning home from overseas.

"I really struggled with my beliefs, my tradition, what I saw over there and what I signed up for," she said. "You go home and it eats at you, and it just turns ugly."

In 2012, she divorced and, shortly after, she fell into a depression after losing her grandfather, as well. After spending a few months in jail, she landed at the Bismarck Transition Center. There, a representative from the Three Affiliated Tribes Warriors of the 21st Century Re-entry Program reached out to her and got her into treatment through a Veterans Affairs clinic in Bismarck.

Howe said she aims to get certified as a peer specialist and take that expertise back to her community, where she can focus on helping other veterans.

"This is awesome. This is what I've been asking about for years," she said.

Continued training

Pam Sagness, director of the behavioral health division for the North Dakota Department of Human Services, said more training will be held later this year. Those being trained this week will teach others to become peer specialists.

Those who complete the training will work for the Free Through Recovery program, which launched on Thursday. Other local health care providers and treatment centers also will be able to hire the peer specialists. 

For more information on peer support services and Free Through Recovery, visit behavioralhealth.dhs.nd.gov/addiction/free-through-recovery.

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(Reach Blair Emerson at 701-250-8251 or Blair.Emerson@bismarcktribune.com)