Dimetrius Flint lay in an ambulance in front of his mother’s house. Sirens violently wailed through his semiconscious haze. Fresh out of Wake County Detention Center and days away from entering a court-ordered justice intervention program, he had slipped back into old habits, but this time it had almost killed him. Today, Dimetrius sits in a crowded cafeteria, laughing with old friends over burgers with Swiss cheese and mushrooms. A department manager, mentor, and community leader— he is one of many successes within Durham’s Triangle Residential Options for Substance Abusers, better known as TROSA. TROSA’s model—two years of residential treatment, run largely by graduates and funded by the businesses residents work in—suggests that recovery depends less on clinical intervention than on time, structure, and a community that resists treating addiction as a moral failure. Established in 1994, TROSA is a residential recovery program that is free for all enrolled participants and largely self-funded through its own businesses. Its founder, Kevin McDonald, had struggled with addiction himself; after what he described as a life-changing experience in a therapeutic community, he set out to build a program that could transform others the way he had been transformed. Participants commit to two years and to working in what TROSA calls “community assignments”: the businesses the organization owns, among them a moving company, a lawn care service, thrift and frame stores, and seasonal tree lots. According to TROSA’s 2024-2025 impact report, those businesses generated 36% of the organization’s funding, with government sources accounting for 33%, individuals and foundations for 18%, in-kind donations for 12%, and other sources for 1%. That model lets TROSA accept harder cases than most programs will, which is how it earned its reputation as the “last chance place,” and how Elisha and, later, Dimetrius ended up there.
Durham has suffered from a drug problem since the 1960s, when rising heroin and amphetamine use drove up arrests here as in cities across the country. The long public response left the community with a concentration of addiction counselors, psychiatrists, and researchers— clustered around the universities of the Research Triangle. Despite this thriving infrastructure, a second wave emerged. Driven by fentanyl and deepened by the isolation of the pandemic, Durham County’s opioid death rate rose roughly 172% between the 2016–2020 average of 12.5 deaths per 100,000 residents and 2021, when it reached 34, according to the Durham County / Healthy Durham opioid epidemic report. (Deaths have fallen sharply since: statewide they dropped 34% between 2023 and 2024, from 4,4442 to 2,934, North Carolina’s first decline since 2019, with opioid-specific deaths down nearly 40 %, according to the state Department of Health and Human Services.) Many credit the isolation and stress associated with 2016–2021 as catalysts behind the dramatic increase in drug addiction and overdose. Amongst many attempts at various methods and services, one treatment program has emerged as an unlikely model for recovery. TROSA is more than a rehabilitation center. Despite the vast number of alternative solutions and services for addiction, TROSA continues to stand out as a model of treatment for the future.
For many residents, TROSA becomes a community, a workplace, and often a vital second chance at recovery. For many, it becomes a second family. That was certainly true for Elisha McLawhorne, who explained during our interview, “The thing is that I had always been in search of something like this, you know, because I did come from a dysfunctional, broken family. And so that’s what TROSA is to me now. It’s like a family.”
Elisha found drugs as a young, susceptible teenager. Throughout her childhood, she watched her mother suffer from a substance use disorder and ended up similarly turning to drugs to “escape from reality.” Alcohol and marijuana became intertwined with her formative teenage years. However, she never viewed her habits as problematic. She dulled and softened her reality, but still managed to follow the accepted picket-fence structure of life. She got married and had kids. However, her newfound responsibility of motherhood pushed her further into addictive substances. She found herself grasping for a way to escape from some of the pressure and duties of her new role. While the demands of parenting deepened her spiral, her love for her kids and desire to be a good mom were what motivated her to find a solution: “By that point, I was already physically and emotionally addicted to opiates; I just continued to use, and it became an issue, you know, affecting my parenting.” She tried outpatient program after outpatient program, but nothing brought the lasting change she needed, just quick fixes that led to eventual relapse. She heard about TROSA’s long-term structure and guiding principles. It was a different kind of program. She thought this could be the one, the one to work. “It wasn’t just about stopping using substances. It was more about built-in core beliefs and values.”
Dr. Nicole Schramm-Sapyta, the Associate Director of the Duke Institute for Brain Sciences and a leading expert in Neuroscience and mental health studies, described the incarcerated population as “the ones that seem to get trapped” in the cycle of addiction. Dimetrius was one such case. After finding drugs as a pre-teen, Dimetrius’s mother sent him to live with his father; however, this only escalated Dimetrius’s drug use, as his father similarly suffered from a substance use disorder. Dimetrius eventually ended up behind bars, and it was in the Wake County Jail that he first heard of TROSA. At first, he was not so much invested in recovery as in what TROSA could do for his case: the program operates as a diversion option—an alternative to prosecution meant to address the root causes of crime. Dimetrius received a judge’s approval for a reduced sentence, conditional on his enrollment in TROSA. Between his release and entering TROSA, Dimetrius overdosed. Lying in the ambulance is where it all hit him. He realized he may really need help.
Upon arrival at TROSA, participants begin their “admissions process.” As the program is focused on holistic healing and emerging as a contributing member of society, participants describe being shocked at how different TROSA was compared to their “typical rehab experience.” Instead, they are made to feel welcome right away. Employees, roughly 70% of whom are in recovery themselves, most of them TROSA graduates, go to great lengths to make the transition as smooth as possible. Dimetrius remarked how it was really the smallest details that made him feel valued on his first day: “When I was brought here, the admission specialist offered me a meal that was being served at lunch, and it was this amazing meal. It was like burgers with Swiss cheese and mushrooms, and French fries; I was like, wow, I was really surprised by it.” He noted being “overwhelmed at how friendly everyone was” and that they were eager to listen to his story. Because so much of the rehabilitation process is tainted by judgment and external pressure, TROSA makes a point to eradicate the idea of moral failure from the very first day.
After the initial orientation, the residents begin the “internship” phase. This is the most structured portion of TROSA’s progression. Residents follow a strict daily schedule including wake-up times, morning meetings, work, meals, and counseling sessions. This rigid structure has proved very beneficial for the residents. Dr. Schramm-Sapyta commented that “the best antidote for addiction is a life filled with meaning and purpose (…) to keep your mind off those cravings for the drug, and in that time of staying busy, then people can begin to heal.” As the residents progress through the program, they are gradually given more freedom, such as additional spare time, the ability to leave “campus,” and the ability to talk to loved ones. Residents are also given additional responsibilities, including more involved roles in community assignments and mentorship roles for newer residents. It’s these mentorship roles that build up the network that TROSA is so known for.
The mentorship program at TROSA enables a relatable approach to treatment. Residents are guided by people who went through the program themselves. They too walked the halls of TROSA and faced the uphill path of recovery. Dimetrius remarked how this leveled playing field really helped him open up and embrace the recovery journey: “There’s no prestigious status,” he said. They want to emphasize how much they can relate and experience and have similar situations to you”. Because of this equality and understanding, the residents find it easier to be honest about their struggles and why they turned to drugs. In the way they share their stories, it is easy to see how they have been taught not to define themselves by past mistakes or missteps.
There is a clear sense of strength and resolve, fueled by the connections fostered at TROSA. Within this resolve also comes a sense of shared responsibility that motivates the participants to stay clean. For Dimetrius, it was this sense of duty to his peers that motivated him the most. “You made a promise to yourself, but also remembering you’re kind of part of a bigger community, and what you do can affect others as well. Trying to keep the community the best it can be.” This commitment to improving the community does not just fall within the participants or employees, but extends throughout the leadership hierarchy at TROSA.
TROSA reports serving 802 residents in fiscal year 2024-2025, 98 of whom completed the full two-year program. TROSA leaders told KFF Health News in 2022 that roughly a quarter of participants would complete the program. A two-year residential commitment is far longer than most treatment programs ask, and the completion rate reflects that length rather than a single year’s cohort. The organization runs on a staff of nearly 80, a ratio that makes peer mentorship a practical necessity. Residents stay far longer than the national norm: the median stay in long-term residential treatment nationwide was 41 days in 2019, according to federal treatment data, against a reported median of 142 days at TROSA. Among graduates surveyed a year out, TROSA says 99% reported remaining sober and 96% were employed or had stayed on as senior residents, figures the organization collects itself and that have not been independently audited. The success of TROSA is also reflected in the number of participants who remain deeply involved in the program after graduation. Both Dimetrius and Elisha have gone on to assume full-time roles within the organization, dedicating their careers to helping others access the same support that transformed their own lives. This sustained commitment suggests that TROSA offers more than a pathway to recovery from substance use disorder. It fosters a sense of purpose, belonging, and connection powerful enough to inspire those ~70% of graduates to stay and give back. After 17 years at TROSA for Elisha and 5 years for Dimetrius, they still feel the same sense of purpose and connection they felt on their first days: “Having people care about you, and then you care about people, it just, it makes all the difference in the world.”
With so many treatment options available, why has such an unconventional, holistic approach proven so successful? The program’s efficacy centers on TROSA’s removal of arguably the biggest obstacle to recovery: the judgment that surrounds it. Elijah Bazemore, a 33-year veteran of the Durham Sheriff’s Office, believes that negative perception remains one of the greatest barriers to effective drug policy. As he explained, “There’s so much stigma around substance use and mental illness that it almost prevents us from moving forward.” Recovery often carries intense pressure from the outside world. Individuals are judged for their past mistakes and their perceived failures. So much scrutiny can drive people back toward the very habits they are trying to escape. Even the language surrounding substance use disorder can reinforce that shame. Terms like “addict” and “addiction” dominate media coverage and policy debates, which is why many experts now favor person-centered language such as “substance use disorder.” The shift is more than semantic; it reflects an effort to humanize people rather than define them by their struggles. For many people, seeking treatment comes on what Bazemore calls “their worst possible day.” These individuals are often seeking help only after hitting their lowest points. Successful recovery means being “the best part of somebody’s worst possible day,” and encouraging people to seek help rather than putting them down. TROSA operates under this same principle.
TROSA’s President and CEO, Keith Artin, holds the organization to the standard it sets for its residents. “We’re asking them to work on being a better person, achieving a better version of themselves,” he said. “TROSA as an organization is always looking at itself and thinking, ‘how can we get better and how can we serve people better?’.”
That self-examination has been tested. Residents work roughly two years in TROSA-owned businesses without wages, in a program many enter as a reentry model and that some residents, like Dimetrius, enter under court order. Residents work roughly two years in TROSA-owned businesses without wages (and are not permitted to keep tips) in a program that markets itself to judges and probation officers as a reentry model, and that some residents, like Dimetrius, enter under court order. A 2020 national investigation identified roughly 300 facilities in 44 states requiring unpaid labor from participants. When KFF Health News examined TROSA’s state funding in 2022, one former participant said the program was “taking advantage of people at their low points in life.” Artin’s answer then was that TROSA is not an employer but a therapeutic community, that policies guard against exploitation, and that “the work-based element is essential to recovery. We’re teaching people how to live.”
While treatment at TROSA does not shy away from the harsh realities of what the participants have struggled with, they also take every chance to celebrate small milestones. From work promotions and birthday celebrations to graduation ceremonies, members of TROSA are always lifted throughout their recovery any time they plateau. In fact, Dimetrius believes he’s celebrated someone’s birthday nearly every day he’s been at TROSA. This emphasis on recognizing accomplishment, combined with the mutual understanding and motivation among those involved, works to flip the negative perception surrounding recovery. In turn, it strengthens the program’s success, as participants know they are supported instead of shamed.
As Elisha noted, substance use disorder “can affect anybody, no matter where you come from.” There is no single profile for who becomes trapped in destructive patterns. TROSA’s success suggests that recovery cannot be reduced to detoxification or abstinence alone. People battling substance use disorders need structure, accountability, support, dignity, and a community that lifts them and believes they can become something more. In Durham, TROSA has shown that when treatment offers not just sobriety, but also belonging, people do more than recover. As in the cases of Dimetrius and Elisha, they continue to give back by returning to help others do the same.
