Portsmouth sits on the banks of the Ohio River, a gateway to West Virginia and Kentucky that was once a manufacturing hub but has since long faded. In the 2000s, the town earned widespread attention as an epicenter of the opioid crisis that ravaged America.
Today, Portsmouth, which anchors Scioto County, is the state’s epicenter for opioid treatment — and many who live there aren’t happy about it.
That trajectory explains why recovery homes, a type of transitional housing for people receiving addiction treatment, are a top-of-mind issue for many local officials.
In interviews, community leaders said that recovery homes – partly driven by unscrupulous financial speculation — have proliferated in residential neighborhoods, frustrating residents and straining the area’s housing supply.
State numbers show that Scioto County, despite having just around 72,000 residents, has the fourth-highest number of recovery home facilities of any county in Ohio. Scioto trails only Cuyahoga, Franklin and Montgomery counties, which contain three of the state’s largest cities: Cleveland, Columbus and Dayton.
At the same time, the recovery business has become intertwined with Portsmouth’s economy. This means addiction services are now a part of the community’s fabric, for better or worse, which is an increasingly common dynamic in Appalachia.
“Portsmouth, Ohio, used to be the shoe capital of the world,” said state Rep. Justin Pizzulli, a Portsmouth Republican who earlier this year introduced a bill in Columbus to tighten regulations of recovery homes. “And instead of finding some industry, now we’re the recovery capital of the world. That’s not what we’re going for.”
Pizzulli’s bill would regulate recovery homes in a manner similar to nursing homes by requiring them to get a state license state license that’s granted following a review to see if the housing is needed. This would be a change from the current system, through which private industry affiliated groups certify providers as following their standards.
The bill has failed to advance in the face of opposition of addiction recovery advocates, including providers, who say it would having a chilling effect on the industry and stifle the state’s recovery efforts.
Portsmouth: The recovery capital of Ohio?
Recovery homes, or sober-living facilities, provide transitional, communal housing to people who are in addiction recovery. People who live in these homes are required to follow house rules, which include remaining sober.
The facilities often are converted single-family houses, typically with one person assigned to live there per bedroom, although they can be larger. Better-funded providers sometimes build or operate large, apartment-style buildings.
More comprehensive recovery housing includes on-site staff that provide support and enforce house rules. These types of facilities have proliferated in Portsmouth and the surrounding area because they are more likely to offer affiliated services, such as outpatient addiction treatment, job training and group therapy, which is eligible for reimbursement from Medicaid and private insurers.
Sue Shultz, director of the Alcohol, Drug Addiction and Mental Health Services Board of Adams, Lawrence and Scioto counties, and others interviewed for this story said Portsmouth started to see more recovery homes pop up around five years ago.
But Shultz was reluctant to issue blanket criticisms of the industry, given the need it serves in Scioto County, which, in 2023, ranked by far the highest in the state in drug overdoses.
“Do we have a lot in our area? Yes we do,” Shultz said. “Do we need all of them? Maybe not. However, the ones that we do have, quite a few, are excellent providers, and we are so happy they’re within our area.”
After a new state law took effect in January, officials in the area got their first idea of how exactly many new recovery homes have rooted themselves in the county. The law, backed by Pizzuli’s predecessor, for the first time required recovery home operators to register with the state or an industry group as a condition of operating and receiving referrals within the state.
The data collected show Scioto County has about one recovery bed for every 86 residents — roughly 13 times the state average.
‘One of the most frustrating things I dealt with’
Joey Sandlin ran for Portsmouth City Council in 2021 in part to try to curtail what he called the “exponential” growth of recovery homes in neighborhoods.
In an interview, he said recovery home operators have bought up many of the area’s low- to medium-priced houses, contributing to a shortage of rentals and entry-level homes.
On a warm night, Sandlin said, blocks in Portsmouth that feature multiple group homes might have six to eight young men smoking on porches.
“It does create an atmosphere where you can’t let your children run in the streets. It’s a safety issue,” Sandlin said.
Officials interviewed also expressed concern that poorly maintained recovery homes are overcrowded or – as detailed in an oft-repeated story from several years ago – lack basic essentials such as running water.
Sandlin denied community stigma is fueling the backlash. He said that, if anything, Portsmouth residents are more sympathetic to addiction because so many people there have a close friend or family member who’s died of an overdose.
The city tried to respond by imposing zoning restrictions, including passing a full moratorium a few years ago. But officials concede that their restrictions are toothless, since federal law forbids communities from restricting medical care.
“We had any number of centers come to our town and open up and so forth, and there’s really nothing we can do,” said Sandlin, who left office last month. “It was one of the most frustrating things that I dealt with during my time on council.”
The big business of recovery in Portsmouth
Recovery housing proliferated in the Portsmouth area after Ohio expanded eligibility for Medicaid, the government healthcare program for the poor and disabled, about a decade ago.
Today, about 39% of Scioto County’s residents are enrolled in Medicaid — the second highest rate in the state — making it easy for providers to find billable patients in the area.
The environment has helped a prominent local provider, The Counseling Center, grow from a relatively small organization to a major part of the local economy.
Aaron Wagner, the organization’s COO, said The Counseling Center today employs roughly 600 people in five counties. It has a budget of around $50 million, about 90% of which comes from Medicaid reimbursements.
The center’s growth also has carried symbolic weight. The organization recently bought Portsmouth’s historic shoelace factory to redevelop it into a state-of-the-art “recovery campus.”
But the availability of Medicaid funding also has attracted providers who view recovery homes as an easy way to make a quick buck, Wagner said.
While recovery homes can’t bill Medicaid directly, they’re commonly operated by drug treatment providers who can bill Medicaid for their services while offering housing as a separate service to their clients.
Wagner said his organization, which is a nonprofit and generally well-regarded by local officials, provides high-quality services. It pivoted away from offering recovery housing in single-family homes, opting instead to build large apartment-style buildings, which he said are safer for residents.
But more profit-driven operators find ways to cut corners by not properly staffing their recovery homes or by skirting regulations, Wagner said. These “bad actors” promote community stigma, he said.
“It’d be easier for you to become a clinical provider and make money than it would be for you to open a Chipotle,” Wagner said. “And that is a shame, right?”
Pizzulli said there’s word-of-mouth hype in his community about buying houses and turning them into recovery homes, kind of like how people might talk about getting rich by day-trading stocks.
“I work at the railroad and guys are talking with other guys to buy houses up to use recovery to make money on the side,” Pizzuli said.
Pizzulli said he believes some providers are billing for more services than they’re capable of providing.
“It’s Medicaid farming. That’s what it is,” Pizzulli said.
Recovery homes and homelessness
There is a widespread view within the Portsmouth area that recovery homes contribute to the area’s rising levels of homelessness.
Here’s how some officials and residents believe it affects the problem.
Recovery centers in Portsmouth attract patients from outside the area, sometimes through court systems, which often requires defendants to attend drug treatment as a condition of sentencing. Portsmouth has a larger supply of housing, leading to a stream of referrals, according to local officials.
This makes the area a magnet for people with addiction problems, some of whom fail treatment and therefore are forced out of homes, leaving them with nowhere to go.
“It’s caused the homeless population to grow exponentially. Just a number of folks who sign up and for whatever reason don’t stay in, and then they get left here, basically, so to speak,” said Sandlin, the former Portsmouth council member who is a real estate agent.
It’s hard to measure how widespread this scenario might be, in part because neither the Ohio Supreme Court nor the local courts keep track of how often people facing drug charges are transferred from one county to another.
The Counseling Center has studied the issue, Wagner said. Eighty percent of the organization’s patients are local, he said. For those who come from out of town, TCC transports them back to their home community if they leave treatment. And when the organization has polled the local homeless population, it found no one who said they ended up in Portsmouth after being brought for treatment, Wagner said.
But Maureen Cogodon, director of Scioto County’s only homeless shelter, said people regularly show up at her center’s doors after failing drug treatment. Some are from out of town, while others have burned bridges with local family members or friends.
“From my perspective, just based on the number of clients that are being rejected from recovery centers, I am seeing that as an influx,” Cogodon said. “I know people are saying that’s not true, but from my perspective, they knock on my door. I’m seeing what they’re not seeing, I guess.”
Cogodon said a recent two-year survey found the homeless shelter saw 488 different people.
“The number of the unhoused in Scioto County has increased exponentially,” Cogodon said. “It’s been hard to watch.”
Complaints allege unsafe, unsanitary conditions
One provider in Scioto County helps illustrate how quickly some recovery home operators have expanded and how local and state officials have struggled to regulate them.
Earlier this summer, state and local mental health officials conducted an unannounced drop-in at Step Wellness, a Portsmouth provider that offers both outpatient addiction treatment and recovery housing.
The company has a sparse online presence but describes itself in one social media graphic as “the first step to recovery.”
Several complaints written by residents at Step Wellness facilities, which Signal obtained through a public records request, apparently prompted the investigation. In one complaint, filed on June 25, a resident described living in a house with an active roach and mouse infestation.
“I’m doing my best to heal, but these conditions are disturbing and unsanitary,” the resident wrote. “I’m concerned about my safety, my health and the risk to other residents. This facility is funded by Medicaid and I do not believe these living conditions meet the standards required for housing and care.”
In another complaint filed the following day, someone who said they were staying in a Step Wellness home on a 90-day court order made myriad allegations. These included that the house had a broken front porch and contained animals that had urinated and defecated on the floor of the house.
“Respectfully place me in a different facility, would need the court to approve or immediate release,” the resident wrote.
In a complaint filed on May 13, a resident in part alleged that the Step Wellness home where they were staying lacked smoke alarms and fire extinguishers and was “very dirty” and had cockroaches inside.
It’s not clear whether the complaints referred to the same house or different ones, since the documents that the state provided were redacted. It’s also not clear whether they were all written by the same resident or by multiple residents.
But officials with the Ohio Department of Mental Health and Addiction Services, accompanied by officials from the local mental health board, conducted unannounced inspections on July 1.
The OHMAS and local ADAMHS board officials visited several Step Wellness recovery homes that day, according to a description local officials provided to Pizzuli, who shared the information with Signal.
In one home, officials found a Step Wellness employee conducting a group therapy meeting with 12 people. The house was covered with dog feces and urine. They observed the five-bedroom house appeared to have more than five people living in it. And a state official was struck by a door leading to the house’s third floor after it fell off the hinges.
Several other houses had mice infestations. One had bed bugs.
County property records show how quickly Step Wellness’ parent company, AYG Properties, has expanded in the past few years. The company has spent $1.1 million since September 2023 buying 26 properties in Scioto County.
Some of those properties aren’t yet active recovery homes, but many are, officials said.
State records show that AYG Properties is owned by Cynthia Mild, who accompanied officials on some of the property walkthroughs, according to the information Pizzuli provided.
Before getting a state counseling license, Mild was a real-estate investor. She was convicted of a federal crime for making false statements 2014, after prosecutors said she lied on her mortgage applications when she bought six homes.
Mild didn’t return several messages seeking comment for this story. Local ADAMHS board officials said they just accompanied state officials on the inspections and haven’t heard anything since the visits.
The Ohio Department of Mental Health and Addiction Services wouldn’t grant Signal a phone interview to discuss Step Wellness, the inspections or any potential enforcement efforts. In a statement, an agency spokesperson described how, under state law, private industry affiliated groups are responsible for certifying providers, making them eligible to operate in the first place.
Pizzulli said the situation illustrates the challenges with enforcing registration requirements.
He said the local agencies that are tasked with inspecting providers all are underfunded, while state and local prosecutors have other priorities.
“Long story short, there’s a bureaucracy in Columbus,” Pizzulli said.
The story was updated to correct the spelling of Justin Pizzulli’s last name on a second and third reference. It also was corrected to correct Aaron Wagner’s title, the spelling of Sue Shultz’s last name, and three counties which are served by the Alcohol, Drug Addiction and Mental Health Services Board of Adams, Lawrence and Scioto counties