The once-abandoned hotel on the outskirts of Hastings buzzed with activity this summer.  

Maintenance staff lugged donated furniture into rooms, patients met for group therapy and clinicians rushed to train nurses for the new detox center.

All the while, referrals, inquiries and pleas flooded into Tara Schroeder’s email inbox for a spot at Revive Inc. At any given moment, on any given day, 50 requests await her.

Within the first month after transforming this Motel 6 into an inpatient treatment center, Revive had filled every bed. 

It doesn’t matter how many emails Schroeder, vice president of clinical operations, opens, how many people they get in the door, she says. The messages just keep coming.

At first glance, it may appear that small-town Nebraska doesn’t have a drug problem. 

Western Nebraska has some of the state’s lowest overdose rates. Some counties haven’t reported a single drug death in decades.

But those numbers are flawed. The state has long undercounted drug deaths, say state officials, experts and a Flatwater Free Press analysis of Centers for Disease Control data showing that Nebraska’s nonfatal overdose rate and its death rate simply don’t match up.

By failing to acknowledge the size of the problem, we’re failing to address it, researchers and treatment workers say — sending few resources to more rural Nebraska counties to combat substance abuse.  

“It’s a literal desert from Lincoln to Denver,” said Revive CEO Kristine Kasperbauer. “There are very few, sporadic options for treatment.”

Nebraska has only 12 inpatient treatment centers outside of Omaha and Lincoln, according to a Flatwater Free Press analysis of federal data. Five of those are in Norfolk.

Only four of those 12 treatment centers offer a place to detox. Revive and a smaller center in O'Neill are the only two outside of eastern Nebraska. They’re located in the center of the state, more than 300 miles from its western edge.

Revive’s staff has watched the need for substance abuse treatment grow even as available money shrinks — federal and state cuts mean less money for the Hastings treatment center.

And Nebraska’s undercounting likely hurts Revive, too. Overdose fatality data is often used to allocate both state and federal funding. Undercounting drug deaths can widen the gap between what a community needs and what it receives.

“The need never ends,” Kasperbauer said. “We’re glad to be able to do what we can, but it’s not enough.”

The treatment desert

In the year before Derrek Cocchiarella died, he started asking for help.

"Mom, I need to get clean,” his mother Linette Cocchiarella remembers him saying. “I need you to help me out here, I need to go to detox."

She started calling around. A treatment center in Lincoln had a bed but couldn’t take a patient from outside the county. Another treatment center in Grand Island, closer to their home, told them Derrek would have to detox on his own for five days first.

“It was just like one wall after another,” Linette said.

Derrek detoxed at home, then was sent more than 100 miles away to Norfolk for treatment, where he spent the final months of his life before overdosing at the family home north of Hastings.

His sister Lindsey Lyons became a substance abuse counselor at Revive, working to fill the gaps her brother fell through.

Many of the existing detox options turn away people who use opioids, Lyons said, as well as people who have expressed suicidal thoughts. Revive takes those people.

There’s not much choice, Revive leaders say: Their new detox center is the closest one available for most western Nebraska residents. 

“And those are some big cities out there, like Scottsbluff and North Platte,” Lyons said. “We get so many referrals from those particular towns, and that’s still six hours away. It’s awful.”

Butler County Attorney Julie Reiter sees those gaps firsthand as she works with problem-solving courts, an alternative program for nonviolent drug-related offenders, in four east-central Nebraska counties.

Case workers help people look for a bed, Reiter said, but there are no sober living houses, treatment centers or intensive outpatient providers in Butler County. To get into a sober living program, residents must leave their community.

“There's a shortage, and we've known that there's a shortage for as long as I can remember,” Reiter said.

Almost all of Nebraska’s counties score among the weakest in the country for accessibility of recovery resources, said Michael Meit, director of East Tennessee State University’s Center for Rural Health and Research, which studies recovery ecosystems.

Sixty-two counties, mostly in central and western Nebraska, have no substance abuse treatment facilities and no hospitals or clinics that provide outpatient substance abuse care, according to a Flatwater Free Press analysis.

Residents of Cherry County, for example, need to travel more than 60 miles on average to receive medications like methadone or suboxone from the nearest provider, according to Meit’s study. 

Even people from Omaha and Council Bluffs, metro areas with more treatment options, seek care from Hastings’ Revive. Jails and other treatment centers have started to refer patients.

People undergoing substance abuse treatment in Nebraska often are shuffled among hospitals and detox facilities, short-term inpatient treatment centers and longer-term options like sober living houses — many of which are nowhere near the patients' homes, Kasperbauer said.

Each move means starting over, having to retell traumatic events and connect with new providers. It isn’t an effective way to recover, said Jake Shaddy, who runs a sober living facility in Omaha. He sees patients build a great foundation at treatment facilities in Omaha.  

“But once they have the option to go back home, who wouldn't want to go back home?” Shaddy said. “They go back to their families … and once they get back, they lose everything they've just built.”

Shaddy now works with Revive to ease patients’ transitions back into the central parts of the state. He usually has six or eight clients waiting to get into a treatment center. Some wait months for a bed to open.

When a person decides to seek treatment, Schroeder said, they’re often in crisis, and Revive needs to get them through the door quickly. 

“If they reach out for help,” Schroeder said, “it is a matter of life or death.”

Not a problem out there

People are dying of drugs in Hastings, Revive’s leader says. They just aren’t being counted.

Kasperbauer said she personally knows of four people who likely overdosed in the past year. She learned how they died by word of mouth.

Adams County, home to Hastings, had 21 reported drug-induced deaths over a five-year period. Some years, it has reported only one or two deaths. Revive’s clinicians say those numbers don’t match what they’re seeing.

Schroeder said she knew of at least three apparent suicides within a two-week period that may have been overdoses. Her clients all have multiple friends who have died of drugs.

“It’s an outright tragedy for Nebraska to say overdose isn’t an issue here,” Schroeder said.

From 2019 to 2023, 25 different rural Nebraska counties reported no drug-related deaths at all, a Flatwater Free Press analysis found. 

Those apparently low overdose numbers across rural Nebraska influence policy discussions in Lincoln and fuel the perception that drugs aren’t a problem in rural Nebraska, said Lyons, the Revive counselor whose brother died of an overdose.

Nebraska receives federal funding to reimburse counties for toxicology tests that coroners order for suspected overdose deaths. The point of this funding: improve data quality.

But the 11 counties in the Nebraska Panhandle’s behavioral health region didn’t request a single toxicology test reimbursement in 2023 or 2024. Dundy and Loup counties haven’t even created accounts needed to access the program, according to state records.

Eat the bills

As Revive cleared trash, tore out carpets and filled in the Motel 6 pool to build a new treatment center in Hastings, legislators convened in Lincoln and approved a budget that cut $15 million in behavioral health funding.

That decision “dealt a huge blow” to Revive as it worked to open the new detox center, said Kasperbauer, its CEO, and trickled down to those working to combat drug overdoses across the state.

Region 3 in central Nebraska lost almost $3 million, which impacted work “drastically,” Kasperbauer said.

Revive itself operates with little support from the state’s Department of Health and Human Services. It has no contract with the Division of Behavioral Health for its new detox program, no funding for its long-term treatment programs and limited funding for short-term treatment.

When Kasperbauer joined in 2023, the organization’s top priority was adding detox and inpatient treatment. Revive raised $2 million by spring 2024, she said, mostly from local donors and funding from Region 3, to buy the hotel. 

Revive was at full capacity for inpatient beds within the first month.

Often, the treatment center starts providing services to patients while enrolling them for Medicaid, hoping to get reimbursed after the paperwork goes through.

If a patient is denied Medicaid coverage, Revive sends them a bill. But that’s not always possible — for example, if a patient is homeless.

“We’ve had to eat quite a lot of our bills,” Kasperbauer said.

When treatment programs aren’t available, Kasperbauer said, more people end up in emergency rooms, courts or jail — costing more in the long run. 

Before Revive opened its own detox facility this summer, Kasperbauer said, many Hastings-area residents struggling with substance abuse landed in the ER at the local hospital and filled beds in the psychiatric department.

“It’s so frustrating for the state to not recognize the need for resources when people are working so diligently out here,” Kasperbauer said.

Meit’s Center for Rural Health and Research identified nine state-level policies that support substance use disorder prevention and treatment. 

Nebraska, he said, has only two in place: a Good Samaritan law that protects people who call for help when someone is overdosing and a policy requiring certain substance use disorder providers to help patients access treatments like methadone. 

But Nebraska doesn’t require private insurers to cover that medication, Meit’s study found. The state’s Medicaid plan also does not include behavioral health support for patients undergoing medication-assisted treatment.

Medicaid expansion enabled some states to reduce overdoses, Meit said. But recent federal cuts will slow that progress and make substance abuse treatment less available, he said.

Other incoming federal cuts worry Revive leaders who say that COVID increased their communities’ needs tenfold and hasn’t decreased.

As its budget is squeezed tighter, Revive keeps working toward expansion. The nonprofit is hoping to renovate more of the abandoned hotel and grow its capacity.

Because the patients keep coming — from every corner of the state. Patients from 19 to 72 years old, patients of every gender and race, from all walks of life.

The staff of Revive, many personally touched by addiction and overdose loss, know that for those patients, their work is a matter of living or dying.

“Addiction is not prejudiced. Addiction doesn’t care what you look like or what you believe,” Kasperbauer said. “There’s a lot of pain and shame that comes with it, but we’re all affected by it.”

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