When Avalon Dugan got out of treatment for drug and alcohol abuse, she had a choice: head back to the mainstream high school where she spent her freshman year or enroll in a tiny high school on the campus of the rehabilitation facility.

Dugan choose the school for kids in recovery — a decision she says has helped her stay sober for over a year.

Hope Academy, a charter school that has been operating out of Fairbanks Addiction Treatment Center in Lawrence Township for ten years, offers services for teens grappling with addiction along with typical classes like math, English and art.

Dugan initially struggled with relapse after she got out of rehab but Hope Academy’s  close-knit community and regular drug testing made it difficult for her to hide her drug use from her parents and teachers, she said.

“Teachers at larger schools don’t really see one kid out of like 300 walking through a hallway,” Dugan said. “There’s a lot of people in recovery that work here, so they … pick up on things because they were there are one point.”

Hope Academy is among about 30 recovery high schools around the country that offer a unique approach to helping students stay sober and graduate from high school but, as the programs mature, they’re finding that many students are enrolling earlier in their recovery processes. That has put pressure on the schools to offer more support to students.

In Indiana, Hope officials say the problem is insurance companies are offering less coverage for rehab for kids addicted to opioids as opposed to alcohol, since detoxing from opioids isn’t considered life-threatening.

When Hope opened in 2006, it largely served students who had abused alcohol or marijuana — and typically had been in treatment more than 30 days before enrolling in Hope. But as more kids use opioids like heroin and oxycodone, even students with access to healthcare are less likely to get the kind of long-term treatment they used to, said Rachelle Gardner, the school’s chief operating officer.

“We may have students that come to us with a week or so of inpatient treatment,” Gardner said. “They’re just starting to get clean.”

The first Hope students had been through treatment at Fairbanks, and they were well into the recovery process, Gardner said. That helped build a foundation for the kind of supportive culture the school is based on, and for the first few years, most students came to them after long-term treatment.

But the landscape has changed: students now are coming to the school after brief stints in recovery programs — or no treatment at all, Gardner said. These teens need more support and they can struggle to integrate into the school culture.

“That’s a different student then we had five years ago,” she said.

Located on the second floor of a Fairbanks building, Hope has just eight classrooms and seven teachers. Enrollment fluctuates, with students joining and leaving the school throughout the year, but it usually hovers around 35 teens.

Andy Finch, a Vanderbilt University researcher who is leading the first large-scale study into recovery school outcomes, says many of the recovery schools around the country are also serving new, more challenging students because they are intentionally targeting more diverse students.

“When you look at recovery high schools historically,” Finch said, “they are not very diverse racially and ethnically and really not all that diverse economically.”

Hope is a free, publicly-funded charter school, but many recovery schools are private schools that charge tuition. The teens served by recovery schools in the past tended to be relatively privileged, with access to substance abuse treatment, Finch said. But that is changing as some schools have actively tried to open their services up to needier kids including those with limited or no health insurance.

“Recovery high schools are having to face the fact that not everybody has access to treatment,” he said.

At Hope, incorporating teens who are new to recovery can be a strain on committed students who’ve been at the school for months or years, Gardner said.

“They’re still living in the old mindset of an addiction kind of culture,” she said. “You lie, you cheat — those kinds of values.”

About five years ago, Hope leaders decided they needed a place to help new students, or students who had relapsed, acclimate to the school. That’s why they created the STARR room, a therapeutic setting where students spend their morning catching up on academic work and their afternoons doing art and discussing recovery with school staff.

Usually teens spend about three weeks in the STARR room before integrating into traditional classes, but with an increasing population of high-needs students, the school is considering expanding the services or extending the time students spend there before joining the rest of their peers, she said.

The first recovery high school opened in 1979, Finch said. But there hasn’t been much rigorous research into how well the programs work compared to traditional schools. In fact, Hope is at the forefront of site-based research, he said.

A study of Hope’s program from 2014 found that when students stop using drugs, their academic outcomes improve, said Mary Jo Rattermann, an educational consultant. Hope students who don’t relapse actually show more growth than similar peers at mainstream high schools.

Rattermann initially evaluated Hope for the Mayor’s Office of Education Innovation, which charters the school. When that contract ended, she continued to study the school, first through a contract paid for by Hope and now as part of a national project funded by the Association of Recovery High Schools, she said.

“What Hope Academy is doing is nationally acknowledged as a very successful model,” Rattermann said. “This is a school and it’s about academics, and it’s about being a high school kid as much as you can give that to them.”

The per student cost at Hope is about $23,000. The school receives more than half that amount from the state, including the per student funding every charter school receives and a special grant for support services. The rest of the school’s funding comes Fairbanks, grants and philanthropy, Gardner said.

Part of the reason the bill is so high is because the school is committed to having teachers for every subject rather than online learning, said Gardner. The school can serve as many as 60 students without increasing the number of teachers, she said. Since only about 35 students are currently attending, Hope could push down per-student costs by increasing the number of teens enrolled.

Gardner is certain that more students in the region could benefit from recovery high school, but there’s a stigma to attending a school for teens with substance abuse problems and some families simply don’t know about Hope, she said.

“I tell new schools,” Gardner said, “if I would’ve done anything different, I would’ve put a lot more money in marketing.”

Hope won’t work for every teen. Some students drop out or leave for more intensive treatment. When teens continue to use drugs and alcohol, they are sometimes suspended or expelled.

In fact, Dugan herself was briefly expelled from Hope. In her second year at the school, she had fallen deeper into addiction, going from using alcohol and marijuana to injecting heroin. It got so bad in the spring, that she was expelled from the school. But she continued to come back for tutoring and regular drug tests.

It was her drug tests that changed everything for Dugan.

For months, she had managed to clean up enough for her heroin use to slip under the radar, Dugan said. But on a spring day in 2014, she made a mistake and her drug test came back positive for opioids.

When Dugan’s mother walked in to her room to tell her the test result, Dugan could see the pain and resignation in her face.

“I just didn’t lie to her,” she said. “I just said, ‘yeah, I’m still using.’ ”

And that was the end, Dugan said. She stopped using drugs that day and she’s been clean ever since.

When she came back to Hope that fall, she was totally changed, said principal Linda Gagyi.

“We had kind of a contract,” she said. “She did amazing. … She was truly committed to recovery.”