First Step Services, LLC: Substance Use Center Adapted Quickly to COVID

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“We have seen opioid use skyrocket as well as other forms of substance use since COVID began in March 2020,” said Henry Tarkington, founder of First Step Services, a mental health and substance use treatment clinic in Raleigh and Cary.

“The pandemic has had a huge impact on us as a whole, but on women in particular,” Tarkington adds. “We are seeing more DWIs, substance use, and drinking problems among women.”

When First Step Services was first launched in 2001, 70% of clients were men; today, Tarkington estimates that 50% of his clients are now women.

Over the last 20 years, Tarkington estimates his clinics have treated over 20,000 clients and some of his clinicians have been with the company for over a decade.

All that experience has been vital during COVID. “We had to pivot quickly from in-person counseling to online telehealth services during COVID. We had to learn how to tell what the person was experiencing in Asheville while we are in Raleigh. You can’t see the body language. We can’t smell alcohol on their breath or marijuana smoke on them. But our staff has learned what to look for. If they see a client who is typically quiet, and then they are talking and interrupting in the next session, something’s changed. Sudden behavior changes may indicate a possible resumption of drug or alcohol use.”

Another byproduct of COVID has been the spike in divorce and child custody cases in family law. “We get referrals from family lawyers who think their client may have a substance use issue. So, we do an evaluation and get a diagnosis and a recommendation to send it to the attorneys. When we’re working with the clients, we try to help them realize ‘OK, you are mad at each other, you’re going through a divorce or tough custody issues, but substance use is not the solution.’”


Henry Tarkington once needed counseling himself after a rash of DWI arrests in the ’70s and ’80s almost landed him in jail. He has been in recovery since 1987. He founded First Step in 2001. First Step provides outpatient services as part of a DWI sentence and to people who have or think they may have a substance use problem. “We treat everyone from airplane pilots and lawyers to the guy working in a factory,” said Tarkington. “We provide substance use disorder intensive outpatient treatment, early intervention counseling and education groups, individual, group, and family counseling to supporting people returning home from inpatient, residential, and hospital programs.”


“One of the things that has changed over the last 20 years is how clients are labeled,” explained Tarkington. “When I started, people were referred to as drug addicts or alcoholics. Now, we would refer to that same person as someone with a substance use disorder. This shift has been important, as we do not want to label the people we work with in a derogatory manner. In changing the language, we’ve shifted the focus away from assigning stigmatizing labels to treating each person as the individual they are.”

Bob Friedman

Robert "Bob" Friedman is the publisher of Attorney at Law Magazine North Carolina Triangle. He contributes articles and interviews to each issue.

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