Regional Trends in Overdose Deaths Reveal Multiple Opioid Epidemics, According to New Study

The United States is suffering from several different simultaneous opioid epidemics, rather than just a single crisis, according to an academic study of deaths caused by drug overdoses.

David Peters, an associate professor of sociology at Iowa State University, co-authored the study, which appeared in the academic journal Rural Sociology. Peters and his co-authors conducted a county-level analysis of death certificates from across the country that noted opioid overdoses as the cause of death. The study found regional differences in the kind of opioids that cause the most overdose deaths, and these differences should lead to policymakers considering varying strategies to address the epidemics, Peters said.

“Our results show that it’s more helpful to think of the problem as several epidemics occurring at the same time rather than just one,” Peters said. “And they occur in different regions of the country, so there’s no single policy response that’s going to address all of these epidemics. There needs to be multiple sets of policies to address these distinct challenges.”

Multiple epidemics

The study describes three different opioid epidemics in the United States, as well as a syndemic, or a single population experiencing more than one epidemic:

— A prescription drug epidemic persists in rural southern states where access to opioids centers on local pharmacies. Overdose deaths linked to pharmaceuticals peaked nationwide in 2013 and have fallen in the years since. However, some rural counties continue to struggle with prescription drugs, according to the study.
— A heroin epidemic has taken root in states out west and in the Midwest, especially in urban areas near major interstates that experience heavy drug trafficking. The study found overdose deaths related to heroin clustered along two major corridors, one linking El Paso to Denver and another linking Texas and Chicago. Peters said those findings correspond with known routes used by cartels smuggling heroin into the United States from Mexico.
— An epidemic of synthetic opioids, such as fentanyl, has grown as a major concern in urban centers in the northeastern United States. Often these synthetic drugs are mixed with heroin or cocaine and made to resemble prescription medications. These counterfeit street mixes are highly potent and deadly.
— A syndemic involving multiple simultaneous opioid epidemics exists in counties where the opioid crisis first erupted, particularly in mid-size cities in Kentucky, Ohio and West Virginia that have experienced steep job losses in manufacturing and mining.

Peters said roughly a quarter of all counties in the United States fall into one of the epidemic categories noted in the study.

The study was funded by a grant from the U.S. Department of Agriculture’s National Institute of Food and Agriculture. The data used in the study came from the Centers for Disease Control and Prevention.

How to Support Someone Going Through Heroin Detox

Going through heroin detox can be a grueling experience. Before the individual enters a heroin detox treatment program, they have already started going through some horrible withdrawal symptoms. By the time they are ready to enter a treatment program, their body has endured a tremendous amount of strain and pain, and their psyche has taken a toil making them very vulnerable to relapse if not cared for appropriately.

Not only is their detox treatment vital; so too is the support from their loved ones, and this can be challenging especially for those who don’t understand what heroin is, what it does, and what heroin detox treatments consist of. If you have a loved one who is fighting for his or her life by trying to get off drugs and enter a heroin detox program, you can best support them by understanding what they are going through. Some basic education will help you be a great support system, and help your loved one get back onto a path of normalcy and healthy living.

What does Heroin do to the Human Body?

The impact heroin has on the human body depends on how much is injected, where the drug binds in the body (or brain), how long it sticks, how strong it is, the rate of speed it takes to bind, and what happens afterward. When heroin is used it clings to certain receptors in the brain called mu-opioids. Once it affixes, it activates these receptors causing a massive sensation of pleasure.

The human brain contains naturally produced chemicals called neurotransmitters that fuse receptors that regulate hormone-release and pain. This all takes place in “the reward center” of the brain, where dopamine is released. When natural dopamine is mixed with external opioids like heroin, that high a person experiences is amplified by massive proportions. According to the National Institute on Drug Abuse, the greatest increase in heroin use is seen in young people aged 18-25. Unfortunately, many young adults can see themselves as invincible and don’t consider the various consequences heroin can have on their health, their life, or on their mortality. When a person takes heroin, their breathing and heart rate slows down–in some cases to the point it can be life-threatening.

What Makes Heroin So Addictive?

Heroin is a very addictive opiate because it actually changes the neurochemical activity in the brain which alters the state of one’s sensation and overall feeling while creating profound degrees of physical dependence and tolerance. Opiates cause pleasure by targeting various regions of the brain and nervous system–giving instant pleasure, both physically and emotionally, on tap. An opioid like heroin alters activity in the limbic system–a part of the brain that controls emotion. Pile this on top of the fact it blocks pain signals being delivered through the spinal cord, and one experiences a state of pleasure that becomes instantly addictive.

Your Loved One’s Behavior is Still Obnoxious after Heroin Use

Supporting a loved one going through heroin detox can be challenging, as much of their bad, obnoxious behavior can still be present. Here are some things to keep in mind: repeated use of heroin causes long-term imbalances that are very difficult to reverse because of the brain’s physiology and physical structure changes.

According to a study on white matter impairment in chronic heroin dependence, W. Li and others discovered that the brain’s white matter deteriorates due to heroin use, and that one’s decision-making abilities, the capacity to regulate behavior, and how one responds to stress is affected. Therefore, if your loved one is having massive mood-swings, says inappropriate things, and acts irrationally, know that the aftermath of this drug has simply dug its talons this deep into the user, and now it is up to a heroin detox treatment to gently and lovingly reverse as much damage done as possible by bringing the person back to their normal self.

Give Support by Finding a Heroin Detox Treatment Program

One way you can support your loved one going through heroin detox treatment is to do some research in looking for the best programs available. You simply can’t lock someone in a room and slide food and water through a window, as movies like ‘Trainspotting’ would like you to think. Coming off heroin can be life-threatening and extremely painful, which is why finding the best heroin detox program is vital to your loved one’s ability to have a happy and healthy future.

Heroin detoxification treatment centers use specific drugs to shorten the timespan of opiate withdrawal syndrome. Even with these drugs, patients still experience various degrees of pain, and the road to recovery is still harsh and often hard for loved ones to witness. When looking for various heroin detox treatment centers, here are some questions worth asking:

  • What accreditations does the facility hold?
  • Are medical resources immediately available?
  • Is there a pre-admission evaluation focused on protocol?
  • What are the safety standards and guidelines?
  • Are there multiple detox options to accommodate a variety of patients?
  • How long is the inpatient care program?
  • What is the post-detox recovery care?
  • What procedures are used to make the detox more humane?

By investigating programs and learning more about why they are successful, you can be of tremendous support to your loved one by helping him or her get on the best path to a full recovery.

More Ways to Support Someone through Heroin Detox

Love and ongoing support is crucial to recovery. Here are some ways in which you can show your loving support through their journey to a bright, promising future:

Write a Letter – Writing a letter to someone expressing your love and support is good therapy for you, and it is an ideal thing for the patient to have because they can look at it whenever they need some additional motivation to get them through hard times. If the person has wronged you, avoid being judgemental or calling them out in the letter. There will be a time to confront them, but when they are focused on detoxing is not the ideal moment. Once the detox treatment is complete and the person enters the next phase of recovery, you could write a second letter praising them for making it through the detox, and then confront them on the pain they caused. This way they can deal with the reality of what they did in the next step of their treatment plan which often involves coming to terms with the past.

Build Confidence – Be their cheerleader. Let them know how you have always admired them, acknowledge what they are going through must be very difficult, and let them know you recognize their bravery for undertaking the journey. Saying things like, “I am proud of you for embarking this huge step” and “I respect you for wanting to get clean and be the best version of you” will help empower and drive the person to keep up the good work.

Trophy – A trophy is given to someone to acknowledge and honor them for being victorious. You don’t have to go out and get an actual trophy; instead, create your own “trophy concept” by giving the person a special gift as a way to honor them for being victorious thus far in their recovery. For example, if the person loves to write you could get them a fancy pen with an engraved message on it, and a leather-bound journal. Tell them the pen is their trophy for completing phase one of a very challenging task, and the journal is their platform for writing reflections, celebrating the little victories they experience every day, and writing down their game plan and goals for a fruitful future.

Emphasize Self-Care – In many cases people going through certain phases of heroin detox treatment will be so haunted by the pain they caused loved ones that they don’t focus on themselves. Let your loved one know that self-care is crucial to a full recovery. Let them know that putting themselves first is not at all selfish, but healthy and necessary to their recovery. Let them know you are there to give support, but they need to support themselves at the same time.

Supporting a loved one going through heroin detox treatment means you also need to support yourself. If you aren’t getting enough sleep, eating right, or taking care of your own needs, you won’t be at full strength to be a strong pillar of support. Also, if you are worn down your loved one will likely notice, and enhanced guilt on their part may surface thus slowing down their recovery.

Compassion, forgiveness, and understanding–these are the tenants of supporting a loved one going through heroin withdrawal, and these core components can also be used to help you get through the emotional rollercoaster of watching from the sidelines.

Bipartisan Task Force Hosts Discussion on Effects of the Opioid Epidemic on the Child Welfare System

The Congressional Caucus on Foster Youth and the Bipartisan Heroin Task Force teamed up to host a dinner highlighting the effects that the opioid epidemic has had on the country’s child welfare system. This epidemic has impacted countless lives throughout the country and has already had a specifically insidious impact on children.

“The opioid crisis is devastating families and our already over-burdened child welfare system,” said Rep. Karen Bass, Co-chair of the Congressional Caucus on Foster Youth. “We have learned so much from the crack cocaine epidemic and how it affected those in the child welfare system. Now, we have to apply those lessons to the epidemic at hand. Last night’s bipartisan dinner was a step in that direction and I look forward to working with my colleagues in both caucuses that participated tonight on this incredibly important issue.”

More than 20 Members of Congress from the two caucuses came together Tuesday night to work with experts — individuals who grew up in the child welfare system and individuals who have dedicated their life’s work to children in the child welfare system — to identify tangible ways Congress could assist the overflowing child welfare system and also take meaningful action in bringing this epidemic to an end.

“I was pleased to join my colleagues last night at a bipartisan dinner that addressed our country’s opioid epidemic,” said Rep. Marino, Co-chair of the Congressional Caucus on Foster Youth. “This epidemic has affected countless children in the foster care system and it is up to Congress to come together to find a solution to end this horrible tragedy in our nation. I look forward to having more productive discussions on this issue and will continue to work tirelessly with Congress to ensure that our children are protected from this crisis.”

Ideas presented ranged from reforming law enforcement’s ability to respond to on-scene overdoses, to overhauling relapse protocol in court orders, to creating an entire cabinet position to address the issue of drug epidemics in our country. Experts and Members were quick to caution that there will be no one quick fix to this expansive issue, but agreed that conversations like the one held last night will bring us closer to a better future for these communities affected by this epidemic.

“The opioid epidemic has had a devastating impact on communities in New Hampshire and across the country,” said Congresswoman Kuster, the founder and co-chair of the Bipartisan Heroin Task Force. “That impact has been acutely felt by families and children who so often bear the brunt of substance use disorder. I’m pleased that the Bipartisan Heroin Task Force and the Congressional Caucus on Foster Youth have come together for this constructive conversation about how we can better support children as we take on the opioid crisis.”

“The opioid epidemic continues to destroy communities and families across my home state of New Jersey and throughout our nation,” said Republican Chairman of the Bipartisan Heroin Task Force, Congressman MacArthur. “More and more children are ending up in foster care because of this crisis and straining our already burdened child welfare system.  I’ll continue to work with my colleagues on the Bipartisan Heroin Task Force and the Congressional Caucus on Foster Youth to combat the opioid crisis and help children impacted by it.”

The dinner featured three panelists, all of whom have been directly impacted by the child welfare system, addiction or both. Linda Watts serves as the Acting Commissioner for the West Virginia Department of Health and Human Resources and provided detailed analysis regarding her work at both an administrative level as well as in the field.

Angelique Salizan is a former foster youth who is currently serving as a legislative correspondent in United States Senator Sherrod Brown’s D.C. office and a part-time consultant for the Capacity Building Center for States, an initiative of the Children’s Bureau. China Krys Darrington has been a trainer for the Ohio Child Welfare Training Program since 2010 and a provider of Recovery Support Services through XIX Recovery Support Services since 2007.

Drug Overdose Epidemic in America

Every 25 seconds someone is arrested for drug related activities in America. According to an FBI crime report, police make more arrests every year for drug abuse violations than for any other reported crime.

Surpassing the number of both violent crimes and property offenses, David White, a Texas criminal defense lawyer reports that over 1 million people were incarcerated in 2015 for drug possession and abuse. Although drug activity continues to remain the single most common cause for arrest, the numbers have actually been dropping over the last decade. However, illicit drug abuse is showing no signs of slowing down.

Drug Users in America

In 2013, 2.8 million Americans became ‘new’ drug users which is equivalent to almost 7,800 people per day experimenting with drugs for the first time. The National Institute on Drug Abuse (NIDA), reports that the highest percentage of first time drug users are among 18-20 year olds with more than half of users beginning with Marijuana, but the study does not investigate alcohol use in the conclusions made.

The U.S. has officials focused its attention on opioid overdose. With 47,000 reports of drug induced fatalities in 2014, 61 percent of these were driven by opioids – originally prescription painkillers that have evolved into heroin. The drug has taken icons such as Elvis Presley, Prince, and Chris Farley. While sending people in and out of the legal system and to rehab facilities, it has quickly destroyed the lives of thousands. As fatality rates from excessive drug use have more than doubled since 2000, it’s safe to say that America is suffering a deep rooted drug crisis.

The police of East Liverpool, Ohio, recently took it upon themselves to show the non drug using public just how serious the side effects of heroin are. In September of 2016, the city released a graphic photo to Facebook showing a couple overdosing on what they believe to be heroin. The photos show the two incapacitated in the front seat of an SUV while a 4-year-old child sat trapped in the back.

The police responded to the backlash of the photos commenting, We are well aware that some may be offended by these images and for that we are truly sorry, but it is time that the non drug using public sees what we are now dealing with on a daily basis. The poison known as heroin has taken a strong grip on many communities not just ours…”

The Effects of Heroin

Heroin can be used in many different forms – it can be injection, inhaled, snorted and smoked. All four methods deliver the drug to the brain at a rapid rate, contributing to the high risk for addiction.

Shortly after the drug enters the brain, enzymes convert heroin into morphine while simultaneously binding it to opioid receptors. The binding of the two then triggers an intense sensation of both pain relief and euphoria – an intense feeling that the body cannot produce on its own.

Also intensified when heroin hits the brain is dopamine production, an otherwise natural response to rewards such as eating food. Heroin is estimated to produce an amount 10 times the normal level.

Heroin abusers risk losing their long-term memory, their ability to make decisions, as well as the ability to control one’s own social behavior. Due to the high potential for abuse and addiction, heroin is considered to be among the most dangerous drugs.

James Fata, a recovering addict comments to the Guardian, Id like to say its getting better because I see at least things are being brought to the surface and theres an advocacy movement, but on a numbers level, its getting worse. On the amount of deaths I see, its getting worse. The amount of heroin use Im seeing, its getting worse.

Experts warn that Fata is correct, the overdose epidemic in America hasn’t peaked yet. The most critical component to prevent the abuse of painkillers and illegal drugs is by really educating our youth on the dangers of the addiction. The NIDA has plans to advance awareness, prevention, and treatment in primary care practices, including the diagnosis of prescription drug abuse. To learn more about drug addiction and how you can help visit heroin.net.

Dope Sick With Mouths To Feed: The Struggles of American Women in Active Addiction

For certain subsections of society, it happens so often that its occurrence becomes commonplace such as the realities for those of us who live surrounded by the effects of active addiction and alcoholism. Like a soldier who served in Iraq or Afghanistan or a teenager who grew up in the heart of West Baltimore or East St. Louis, it is all but impossible for an addict to make it more that a couple of months without a family member, friend or acquaintance dying on them. In 2011, 41,340 Americans died of drug overdoses. That’s 113 deaths a day—a mortality rate that is higher than the rates for homicides, suicides and traffic accidents and one which is 400% greater today than it was in 1990. This surge in the national overdose rate can be attributed to many factors, but there is little doubt that the sea of prescription drugs that have flooded the market over the past 20 years are at the root of the problem.

One unintended consequence in this rising tide of prescription opiates and benzodiazepines is that women have suffered increases in opioid addiction and overdose deaths at a significantly higher clip than their male counterparts. Women, who have traditionally been seen as a low-risk group for drug-related deaths, have been gaining ground in recent years, nearly cutting the ratio of male to female overdose deaths in half thanks largely to a fivefold growth in prescription painkiller deaths among women in the millennium’s inaugural decade. This trend is problematic for a number of reasons, none more so than the fact that we’re still largely in the dark in our understanding of the differences in opiate abuse based on gender and are inconsistent—if not ineffective—at screening addicts and modifying treatment plans in ways that reflect those differences. How else can we explain the fact that admissions of women to substance abuse treatment have only inched forward a few percentage points over the last decade while overdose death rates and prescription opiate overdose hospital admissions have skyrocketed to unprecedented heights?

The cruel and pernicious irony in the deaths of the young is that the old and the living are made to bear the burden of their foreshortened lives. For the deceased, all of the suffering they endured and the sadness they felt at the prospect of forfeiting the bulk of their life’s balance ends up being little more than existential window dressing. Once the weariness, fever and fret of their existence fades away, the only people effected by circumstances of their passing are those they left behind.

The earth does not give preferential treatment to post-mortem youth and beauty, just as the hereafter shows no deference to the unripened soul. Death is final for the dead. To them it is as eternal as it is immutable; a thing devoid of ticking clocks and swirling moons and rotations of a sun whose rays will never again warm their unwrinkled flesh. Death is little more than a bondsman—a thing that could care less if it found you with a needle in your arm or plaque in your lungs so long as it gets its due. No, it is we the living who are held hostage by the deaths of the fecund and the fledgling members of our little worlds.

We sit and we think of the life they might have had—the life they should have had. We ask ourselves an unrelenting stream of what if’s and how come’s, meticulously analyzing the moments before their passing with the unspoken and unacknowledged believe that if we could just tie up all of the loose ends and unanswered questions surrounding their deaths, we could somehow save them. That we could bring them back whole and as they were—as if it had never happened.

American women have seen a fivefold increase in Rx drug abuse without a corresponding rise in access to treatment (Clarence Williams/Los Angeles Times)

A few weeks ago, I found out that a young woman in recovery in my hometown of Cincinnati—we’ll call her Laura—had died of a heroin overdose. I didn’t know her personally but the recovery community in the Queen City is small enough that I knew plenty of folks that did. From what they told me, Laura’s death followed an all too familiar script of those who struggle with opiate addiction, which is as follows: First, the addict rips and runs until they hit their “bottom” or get in trouble with the law/family/significant other, at which point they head to treatment and/or transitional living to get their mind and body right so they can take another crack at sobriety.

Once the fog lifts and they have their bearings again, they get immersed in 12-step programs, make a new network of sober friends and start beginning to pick up the pieces of the life they’ve left themselves. Pretty soon, things start turning around and they start getting used to sobriety. They start thinking about the future again—about getting a better job, going to college, getting their kids back. A semblance of normalcy and calm comes over their lives for the first time in what feels like forever. Then, for reasons often not even known to them, they go back out. After such a lengthy sabbatical from using, their bodies have temporarily lost most of the tolerance they gained over the years and they overestimate how much junk their body can handle. After that the next steps are often the morgue and a burial plot.

Most of what I’ve heard concerning the immediate circumstances of Laura’s death fits with that particular substance abuse narrative and is common among both men and women who suffer from opiate addiction. Although women do generally progress through the stages of addiction more quickly than men, it would seem that the mechanics and physiology of overdose deaths in both genders mirror one another. But, that’s just the how of it all. I don’t care as much about the how as I do the why and the what comes after. Obviously, I’m not able to speak with Laura and learn more about her battles with addiction, but I was fortunate enough to sit down with a few women at a transitional living house last month who were still in the throes of early sobriety and to listen to their stories. They were not Laura’s story, but they were certainly all variations on the same theme. One woman may have struggled with eating disorders and clinical depression, while another may have come from an abusive alcoholic home and been a victim of sexual abuse as a child, but it was abundantly clear in talking to all of them that the weight of their shared experience far exceeded that of their differences.

The first woman I talked to was Stephanie, a young lady from Knoxville who had come up to Cincinnati the year before in a last ditch effort to escape her addiction by changing her scenery rather than herself. Stephanie told me that she was 21, but by the looks of things, I’d wager that it had been a minute since she’d been carded at a bar. It’s not that Stephanie looked old—she really didn’t. It’s just that some mixture of drug use, trauma and genetic happenstance gave her the look of someone who was already world-weary beyond her years.

“It all started when I was 12 when I got my tonsils removed,” Stephanie told me. “I got prescribed hydrocodone—like the bigger bottles—and my mom is an addict, my dad’s an addict, my brother’s an addict, everyone in my family’s an addict. So, when I ran out of my medicine—my mom was the one drinking my medicine—I remember, she had to go out in the middle of the night and buy these pills—these little blue pills—and I didn’t know what the hell they was. They call em Percocet 30s up here. I call em Roxy 30s. Whatever, same thing, so that’s when it started for me and whenever I came off it I was withdrawing and didn’t even know I was withdrawing from pain medicine, so it never stopped from there. Started smoking weed, drinking, started doing pills every day. Started snorting pills…ended up getting suspended from school for overdosing. Took about 50 pills and uh…”

“You got suspended for overdosing?” I asked

“I was at school there and they took me off on stretcher.” Stephanie said. “Zero tolerance for drug abuse at school. I got suspended for 6 months and went to an alternative school.”

“So your school never sent you to treatment or anything like that?”

“Never suggested that I should go to treatment.” she told me. “Never any of that, so I went to alternative school and got suspended from alternative school for doing drugs there too, and while I was suspended from school I ran away. After that, I got put into foster care, about 2 hours from my hometown and it just got worse up there. My foster mom let me drive her car, we drank every day…the third day I was there all these cars just started piling up in the driveway and it was just like party, party, party every night there.”

“And this was your foster mom?” I asked.

“Yeah, and we just partied. She was like, ‘I’m the cool foster mom. You can drink so long as you drink at home.’ So I did and I found pills there so I started doing pills real bad. Got a job and spent the money on drugs—pills, pills, pills, pills, pills—and then moved back to Knoxville when I found out my mom got cancer when I was 18. She had just got out of prison and she got cancer in her back. So I took care of her and she had legal prescriptions and needles and everything, so it was like, ‘this is what’s up. I get free pills, free needles, let’s do it.’ So, I was pill sick one day and my brother was like, ‘aw, sis, mom ain’t got no more Roxies, we’re gonna have to get some of her morphine’, and I was like, ‘oh, shit, man’ and he was like, ‘you’re gonna have to shoot it up,’ and I was like, ‘okay, let’s do it.’ And that’s when the needles started for me. Morphine is, pretty much, just like heroin. I mean it really is. I was going really hard. I overdosed twice on it and when my mom died all shit went to hell. She died 3 years ago—my high school graduation—after that I just went downhill. Went to treatment once, left treatment, robbed the treatment facility for $1,000, high as shit and then went to jail for 9 months. Got outta jail, got off probation. I was getting high for another month and then I decided to go to Cincinnati—yeah, great idea. Started smoking pot up here, drinking—turned 21 up here—drink, drink, drink, drink, drink, then I found heroin and y’all know where that leads to.”

“Why Cincinnati?” I asked.

“My dad lives up here.” Stephanie said. “I called him and I was like, ‘come get me, I can’t handle this. I’m tired of doing drugs. I’m tired of sticking a needle in my arm. I’m 20 years old, I don’t want to do this—follow in the footsteps of everyone else in my family.’ So, I moved up here and thought, ‘well, I don’t know nobody.’ I only had one friend that lived up here that smoked weed and I thought, ‘yeah, I can just smoke weed because that ain’t my problem. So, I started smoking weed, drinking—going to the bar because I was legal and it was about a year ago that I started doing heroin…I started shooting heroin in May, but I was snorting it first and I was like, ‘oh, it’s okay, I’m just snorting it. I’m not putting a needle in my arm. That’s my addiction. That’s the problem. The needle’s the problem, not the drugs.’ That wasn’t it at all.”

Within a couple of months, heroin had completely taken over Stephanie’s life and it wasn’t long until she lost her manager’s job at McDonald’s, got kicked out of her apartment building and started going through the revolving doors of detox on a regular basis, spending just enough time there to get well and going back to using as soon as she left. Eventually, Stephanie ended up going to the Center for Chemical Addictions Treatment—known in Cincinnati’s recovery parlance as “The Ccat House”—for inpatient rehab and ended up in a New Foundations Transitional Living house when she was released. At the time I spoke with her, Stephanie had 36 days clean, an amount of time that was near the median for the women I talked to.

A quick overview of the rise in drug overdoses in the state of Ohio

————-

With 10 months and 4 days of sobriety under her belt on the day I visited, a young redhead named Amanda had gone longer between drinks or drugs than any of the other woman in her house. It was an impressive achievement to be sure, but may not serve as a good barometer of her chances for long term sobriety because 10 months and 2 days of her clean time was obtained while in prison on charges of forgery and receipt of stolen property. Now, it’s not any more or less laudable to rack up stretches of sobriety in prison or an inpatient treatment center, but it’s worth noting that it is sobriety obtained in what are little more than highly regimented simulacra of the real world. Amanda may have had more than 10 months sober in prison—where, it must be said, drugs are still in abundance—but she was only on day 2 of sobriety without borders and at a greater danger of relapse and overdose than her non-incarcerated peers. Numerous studies bear out the increased risk of overdose death in the weeks and months after a prisoner’s re-entry to the community, with one study of more than 30,000 inmates in Washington state showing that prisoners have a 12.7 times larger chance of overdose death than the general population. Add to that the fact that women have been shown to have more difficulty quitting and a higher rate of relapse than men, and the prognosis for Amanda’s sobriety doesn’t look great.

For her part, Amanda didn’t seem too terribly worried. A 20 year old with a spiked up pixie haircut, puckish smile, and a generationally appropriate amount of metal and ink all over her person, she certainly didn’t behave like someone was uneasy with her freedom after close to a year in prison.

“From a really young age I knew there was something wrong with me.” she told me. “I was adopted so I always felt like there was this void in my life. And, my adopted dad is a cop, so I always wanted to rebel against him…I played softball—select softball—and I had a bad knee so sometimes they’d prescribe me Vicodin for that. So, that started and then I had an underbite and I had to get jaw surgery and they prescribed me Percocet for that. 2 big bottles of it. And then I started selling it. And then I realized, I like to drink on it more than I like to sell it. And so, I started doing that real bad and started going through the whole Percocet-Xanax ordeal, which is when I started partying a lot. Drinking a lot…I was drinking a 30-case of Budweiser to myself a night. And then I got introduced to cocaine and…I just loved it.”

“Had you gotten in any trouble at this point?” I asked.

“Sort of…that was about the time I started hanging out with those people and, like, my dad started noticing shit going on with me. My grades dropped, I stopped playing softball and you know, I went crazy with emo kid status. Like, I started cutting myself…attempted suicide a few times. I was like, ‘I’m really fucked up.’ So, I was really, really high on cocaine one night and I was like, ‘dude, I’m seriously going to die.’ Like, ‘I’m really going to have a heart attack.’ And my best friend just so happened to have some heroin with her, and I was like, ‘man, is this going to bring me down or is this going to explode my heart?’ And she was like—I’ll never forget her saying this to me—she said, ‘Amanda, I’m going to give this to you, but I’m just gonna warn you right now that it’s going to change your life forever.’ And I was like, ‘dude, I’m a fucking grown up, I know what I’m fucking doing’ and…”

“Were you actually a grown-up at that time?”

“Almost.” Amanda said. “I was, like, 17. So she gave me a line that was this big (pinches fingers close together so they’re almost touching). I remember it was on a toilet seat at my friend’s basement party or whatever. I had already consumed  shit ton of alcohol…”

“The seat?” I asked.

“Yes, the seat of the toilet.” she said.

“Not the tank in the bank?”

“No, the seat of the toilet. So, the dopeboy that me and her went to, we didn’t know he sold heroin as well, but I was running his cocaine for him. He would pay me $10 every time I left the house. So, every time I left the house to just go down the street, he would pay me $10. And after that, after I did the heroin, I was like oh—my—god. Like, speedballing was my new thing. I didn’t know it had a name yet, but I started doing that. I was snorting it—didn’t think it was that bad because I was snorting it. And, um, I was a functioning addict there for a little bit. I really don’t think there’s such a thing anymore, but at the time I thought there was. I had a job, I moved out on my own to my own apartment. I was having a lot of house parties…beating people up…getting, like, stupid drunk. And then I got into dental school, and I was going to dental school and I was top of my class, but I was still using. I remember one day driving—I was pawning a lot of stuff—one day I went home to get some more stuff to pawn, and my dad’s a cop so of course I’m stealing all this shit from him. And, like, he was in the driveway, in his cop car. And I was like, you know, ‘this happens all the time’ and I was just gonna run in—I was in my scrubs all the time because I thought I looked more professional that way and that I could get away with more shit, which was true, but my dad called me into the car and he said—oh, and by this time I had shot up 3 times—and when I got into the car he was like, ‘I know you’re using heroin,’ and I just, like, broke down because I sorta knew I had a problem.”

“You sorta knew you had a problem?”

“I would withdraw sometimes, but I didn’t know what it was.” Amanda told me.

Her dad ended up sending her to an outpatient Suboxone clinic, but she got kicked out for selling the Suboxone instead of taking it and and went back out. It wasn’t long before she was enrolled in a different Suboxone clinic and she stayed clean for 4 or 5 months until her 18th birthday when she met her birth mother for the first time.

“I was sober when I met my birth mom.” Amanda said. “Me and my girlfriend went out to meet her one day and she was on Percocet, so, once I figured that out it wasn’t long before we started using together. Um, and this is when I got introduced to crack. And, I just…I was like, ‘this is the greatest thing in the universe’ and it took the place of the cocaine. I just loved the taste, the smell, the bell ringing in my head—it took away a lot of my issues and, I mean, I was really messed up. I ended up being homeless and me and my girlfriend were living in my car and then I, um, got in some trouble and I got a theft from Home Depot, which wasn’t that big of a deal at that point. They put me on diversion, or whatever, and then it got really, really bad because I was like, ‘I got away with it’ and I started doing a lot, a lot, a lot of drugs. So, I came up with the bright idea to steal my dad’s checks and forged a shit ton of checks. And then, this was back in October, I got arrested. The night after I had a mini stroke…”

“You had a mini stroke?” I asked.

“I had a mini stroke. They called it something else…it started with a T.”

“A Transient Ischemic Attack?”

“Something like that.” she said. “My entire right side was paralyzed. I called the ambulance on my cell and said don’t bring the cops and stuff like that. They brought the cops. But the cops just left me alone. They brought me to the hospital and let me go. Ummm, the next day they kicked down the hotel door and I was arrested for forgery and receiving stolen property.”

“Does anyone in your adopted family have problems with addiction?” I asked.

“No, no one in my adopted family is an addict.”

“So they don’t…do they have any idea what…?”

“They don’t understand anything about this lifestyle,” Amanda said. “But it was crazy, because when I met my birth family, like, everyone’s exactly like me. Like, it’s so fucking weird because…I don’t like that at all. I see so much of myself in my birth mom and it’s just disgusting to me. I mean, she tried to choke me out.”

“Your birth mother tried to choke you out?” I asked.

“Uh-huh. One night I went to my dopeboy and I guess I didn’t get enough crack for her liking so she tried to choke me out when I was driving her back home. It was so mind-blowing, I mean, I was like, I didn’t have her my whole life and now I met her and she’s treating me like this. She told me I was a piece of shit, like all of this…like, ‘this is the reason why I gave you up for adoption.’ So, I’ve just been to a lot of rehabs, a lot of psych wards, I’ve been to rehabs for eating disorders. You know, the whole nine…”

herointreatment08

A Northern Kentucky mother grieves at the funeral of her 22-year old daughter, who died of a heroin overdose last September (The Enquirer/Carrie Cochran)

—————

Sitting next to Amanda the entire time she was talking was Jessie, a 23-year old woman who, despite over a decade of hard drug use, looked young enough to still be in high school. Due to her youthful appearance and waifish frame, Jessie’s disposition—which could have come off as argumentative and abrasive—took on a precocious air. Whenever she talked, her arms and hands would languidly gesticulate about her body, often displaying relatively fresh bruising from her IV heroin use in the crooks of her elbows. To hear her story, it’s pretty obvious that Jessie never had much of a chance of avoiding the clutches of addiction.

“My mom’s an addict and so’s my sister,” Jessie told me, “so, I was kind of already introduced to it. I started at a really young age, like, my dad wasn’t around. Nothing like that. I lived with my mom until I was about 7 and then she overdosed at my elementary school. So, me and my sister was…”

“She overdosed at your elementary school?”

“Well, they had called her in because I had been getting in a lot of trouble at school—like, stealing shit from other kids and stuff—so, I guess someone called her in to have a parent-teacher conference or something about it and while she was there she overdosed.”

For a few seconds there was just silence. After an trying and failing to find some sort of adequate response to this information, Jessie just continued talking.

“Yeah, so then they called CPS (Child Protective Services) and then my grandma ended up calling CPS because of that and because my sister got pregnant at the age of 12.” she said. “She got pregnant at the age of 12 and had my nephew when she was 13, so my grandma already knew that shit was not right and that my mom was an addict. So, my grandma called CPS and she took me and my sister away from my mom, and then we lived with her and I would run away from there all of the time because I wanted to be with my mom, but my mom would never let me come there so I would just find myself at random places.”

“And how old were you?” I asked.

“8—I was 8 years old. After a couple of years of me running away from my grandma’s I started drinking and smoking and she just got sick of it, so when I was 14 she sent me away to my dad in Kentucky. I didn’t even know who he was and he ended up beating the shit out of me so I didn’t stay there long. Basically, they all got sick of sending me places and me running away, so they all just said that I was living with them and just let me go off and do my own thing. So, I started living on my own at 16. Like, just different places. Wherever I could.”

“Were you going to school at this point?” I asked.

“No. I did, like, the first 2 weeks of my freshman year and then I left and haven’t been back to school since.” she told me. “Okay, so…in that time, my mom met a sugar daddy. She met a sugar daddy when I was 16 and she started working for, like, his firm thing. And he was addicted to Oxys, and she was addicted to Oxys, so, it was like a perfect little thing. And, um, he had this huge house and he had, like, 5 cars and—yeah—my mom was like, ‘Yo, I got money. You don’t have to live on the streets no more. You can come live with me.’ And I was like, ‘Alright. This house is huge. This is nice.’ And he bought me all this cool stuff and, like, he didn’t know that I knew that my mom did pills and stuff…and that I knew that he did ’em…and that she was secretly giving ’em to me too. Yeah, so my mom…my mom started me on Oxys and then my sister, she got kicked out of her apartment so she was living in the house too and we were all just snorting Oxys together.”

“Like the family that snorts together, stays together?”

“Yeah. Honestly, it brought us closer together. I mean, my mom never really loved me—at least, that just what I feel like.” She said.

“Really? So, the times that you were using with your family…”

“I felt like my mom loved me. Like, I had my family. I had my mom and my sister and we was a family when we was getting high together. I don’t know, that probably sounds crazy to you, but it makes sense in my head. Okay, so I did that. I stayed there for a while. And then my step-dad found out—he left town and somehow my mom figured out where he kept all his money in his safe and by the time he got back she had drained his safe and all 84 of the Oxy 80s he had left, you know, because she was supporting my habit and her habit and my sister’s habit and my baby’s dad’s habit, who I had picked up from Norwood somewhere in there.”

“Hold on.” I said. “When in all of this did you have a kid?”

“Oh wait, I was pregnant. I forgot about that. But, I still did pills while I was pregnant.” she said.

“Okay, and this was when you were, what, 16?”

“Yep…No, actually this was when I was 17.” Jessie told me. “So, he moved in and he’s my baby’s dad now, but he wasn’t my baby’s dad at 16. It took a year for me to get pregnant, you see what I’m saying? So, I moved him in there and my mom didn’t want to cut him in on the pills, because he was doing pills too. Okay, so he wasn’t happy with that so we had to move out…and because my mom threw him down the stairs…”

“Your mom threw your boyfriend down the stairs?”

“Yeah, well, here’s the story behind that one.” she said. “Like, she’s got this really big bedroom, right? And along with a really big bedroom comes a really big closet. Well, that’s where we would all go to…see, she had this mirror that she would scrape the pills onto and we just knew that, when we got up in the morning we’d just go in there and do our line. Well, that morning he happened to follow me in there thinking that he was going to get a line and my mom was like, ‘uh-uh…you ain’t getting nothing.’ And they started arguing and she pushed him down the stairs. And he was like, ‘oh no, we ain’t living here no more. Your mom won’t get me high. I ain’t sitting here sick watching you guys get high.’”

“What did you do after that?” I asked.

“After that we had to move out to Indiana where my baby’s dad’s mom lived. And when we first got out there we didn’t have to pay for pills anymore because his mom just got us high, but after a while she’d run out of Percs and we’d buy them. I don’t know how we were getting money…oh yeah, he was kicking in doors and shit. He kicked in the neighbor’s door because the neighbor sold weed. And he was actually his friend…and, like, stole his safebox and it had $6,500 so that kept us alright for a little bit. And then, in that time, me and him got into it and he tried to put me out on the street so I moved back to Cincinnati because I didn’t know anybody in Indiana. And, I can’t be on the streets out there, know what I’m saying? So, I caught a bus and went back to Cincinnati.”

“Where was your baby during all of this?”.

“He was with me.” Jessie said. “Oh, wait. Yeah, I got pregnant in Indiana, came back and…oh man, did I miss all of that? Woah. I got pregnant in Indiana and moved back to—that’s why I moved back to Cincinnati. I said I didn’t want to have my baby in Indiana. I was just against it. I didn’t know anybody, besides the fact that I didn’t want to be there anyway and that was my prime excuse. So, I moved him back to Ohio with me and got us an apartment in Mt. Carmel, in a place that was like dope fiend central. Everyone was on pills except for a select few and I didn’t really talk to the few that was on heroin cause I was on pills and they was like, way worse off than me, you know what I’m saying? I was still doing pills when I was pregnant, but I had stopped doing the Oxys and in my head, I’m like, ‘this is better, I’m not doing Oxys’, and I just did Percs. Well, my son came out…well, he came out with clubbed feet, but it wasn’t cause I was doing pills. My baby’s dad has that bloodline in his family, like, his cousins have it and shit—umm, that’s what my doctor told me. So, I have my apartment, and I had my baby, and we was getting high, but I was still a good mom…I think. And I still took care of my kid and all that. And then, he kicked in my front door, or something happened. My baby’s daddy kicked in my front door.”

“Are we talking about literally kicking in your front door?” I asked.

“Literally kicked in my front door…and then we fist fought upstairs for about an hour. And, when stuff like that happens—it was a Section 8 apartment—when stuff like that happens it’s like, no tolerance and you’re getting kicked out. So, I left and I brought my kid with me and moved into my sister’s in Goshen. And, when I got there, her baby’s dad had just got out of prison and their way of making money was he was selling heroin. And, I had never seen it, I had never done it, but when I got there I knew that I hadn’t had anything in 2 days and I was sick and I didn’t have a lot of money. So, my sister was like, ‘you’re sick, so I’m not going to charge you for this, but here’s this line of heroin.’ And I was like, ‘I seen what this shit does. I seen what it does and I don’t want to no part of it,’ but I did it anyways. And, uh, yeah. That was the first time my sister gave me heroin.”

“And you were how old? 20?”

“Uhhhh…no, 19.” Jessie said. “I was 19. And, so I got a job, like, out of nowhere, 2 days after I came back to Cincinnati. I was getting fat checks and I was all getting spent on dope. Like, I was my sister’s number 1 customer. Plus, I lived in the house, you know what I’m saying? It was like, on demand. I got to ride with him when he was going to re-up and we was just snorting dope the whole time.”

“And your kid was with you, the whole time this was going on?” I asked.

“Uh-huh.” she said. “And my sister had a kid too. It was just one big crack house, heroin using family.”

“Did all of the usual, motherly duties and such happen while you were there?”

“Yeah, I told myself that was why I was doing the heroin.” said Jessie. “To keep myself energized so I can take care of my kid. Because, in my head, I’m a single mom now because I’ve left my baby’s dad, and I need this to keep me up and…I can’t be sick with my kid…you can’t do that. So, you know, I did everything I was supposed to do and my kid was well taken care of. I was a normal mom. ”

A normal mom? To us, banging heroin while living with your junky sister and her drug dealer boyfriend ain’t normal. But for Jessie—someone who had to sit and watch EMTs cart her OD’ed mother away from her school in an ambulance at the age of 7 and whose idea of taking care of her kids was making sure they had their line of Oxy ready for them when they woke up—that was normal. The only hope that Jessie, her kid and all of the women I talked to have is that they find a new normal before they start the cycle all over again

~~~~~~~ Author’s Note ~~~~~~~

<em>On the night before I was to publish this article, one of my cousins died at the hands of this insidious disease of addiction. The last time I saw her was early Thursday morning after a midnight meeting of a 12-step group in Cincinnati. She had used sometime earlier that day, but was not high so much as she was in state of blurry wellness peculiar to opiate addicts who have built up a tolerance to the drugs they use. When she shared during the meeting, she had been very emotional, talking about how it seemed like it was just so much harder for her to get clean this time and hoping that this increased degree of difficulty would help keep her sober for longer than the periods when she had been able to stop using more easily. Once the meeting was over, we talked about how she was doing and about how much we loved another one of our cousins who had died from Hepatitis C as the result of this disease, but who had more than 20 years sobriety when he passed. As we parted ways, she asked me if I could drive her to a meeting the next night and I told her I could and that she should give me a call tomorrow night, knowing that there was a more than decent chance I wouldn't hear from her. The next time I saw her face it was on a memorial on someone's Facebook wall. She was 24 years old and had a 6-year old son.</em>

<em>I simply ask you to consider donating a little money to the <a href="http://www.ccatsober.org/index.cfm?fuseaction=home.viewPage&page_ID=8CE35C4E-7E90-9BD4-C2E453F58A4F4DEE">Center for Chemical Addictions Treatment in Cincinnati</a>, which helps hundreds of addicts and alcoholics to get sober each year.</em>

<em>Thank you,
Drew Gibson</em>

~~~~~~~~~~~

The Language of Effective Social Work

I find it fascinating that we, as social workers, proclaim we want to help people make better choices and choose healthier behaviors on their own, but then we speak to them as though they don’t have any power. In the past, I have noticed some of my colleagues experience trouble connecting with those we serve due to their language. The language portrayed two completely false ideas as if it was the honest truth such as our clients had no options/say-so in their own lives or we are psychic and know exactly what was going to happen to them at any given moment in the future.

We tell them that they have to do something or need to be somewhere. As Morgan Freeman/Joe Clark proclaimed in the movie Lean on Me, “I don’t have to do nothin’ but stay [insert your race here] and die!” Some of us may still talk to our clients in the exact same way. Whatever we choose to call this pattern of speech  ‘aggressive’, ‘controlling’, even ‘male’, I’ve found that I am much more successful and a more effective practitioner (and a healthier wife, sibling, child, friend, and co-worker) when I lean towards making a few simple changes in the way I talk to others.

Try to Avoid Telling People What They Can and Can’t Do

notlisteningDoes anyone have to go to treatment? No.  Do people need counseling? Not at all.

However, these things could be very helpful, may have some benefit, and could help people achieve their goals in life.Can you see the difference between “You have to go to treatment or you’ll never get better” and “You might want to consider entering treatment. I’ve seen it help a lot of people get their lives back on track.”?Let’s listen to ourselves, our clients, and our peers for the following phrases in bold, and see if we can start using (and encouraging others to use) the words and phrases in italics:

You have to   –   You might like to…, You might want to consider…

She should   –   It might have been more helpful to…, Maybe a better choice would have been…

You can’t   –   You might run into some problems if you…, I haven’t seen people be very successful when they…

I know   –   I get the impression that…, It seems as though…, I can understand if…

He always   –   I often see him…, I’ve noticed that he usually…, I can’t remember a time when he didn’t…

Addicts never   –   People suffering from an addiction often don’t…, Alcoholics generally don’t…

I’ve especially noticed a resistance to more aggressive language from people who have issues with authority figures, due to their past experiences with them. However, when we interact with them with an attitude that expresses the fact that they have all the power, and every right, in the world to get up and walk out our door, they seem to feel less of an urge to actually do that. They don’t have an overly controlling figure to “rebel” against. Think about how it takes two to tango, just like it takes two to argue. Let’s try to steer clear of being that opposing force that they use to push themselves away from us and, in many cases, a healthier lifestyle.

Being someone that is there to help, versus someone who is there to control someone else’s life, can be really helpful in building stronger, more effective helping relationships with the people we assist. As a bonus, speaking in a less controlling manner to our spouses, family members, and co-workers can often have a similar effect. The relationship becomes more open, more relaxed, and people feel more comfortable sharing their problems (and successes) with us.

Steer Clear of the Habit of Prophesizing

I’ve found it helpful to avoid telling people what is going to happen to them. Sharing what I have seen or experienced in the past, or even giving them and idea of my fears for them should they make a certain choice is one thing. However, I’ve seen many a practitioner guarantee (they sometimes even literally use that word) that something catastrophic or fantastic is going to happen to someone if they make a certain choice.

“If you don’t go to treatment, you’ll die.”

“If you try to live independently, you’ll fail. Schizophrenics need assisted living–it’s a fact!”

“If you stay in treatment for 30 days, you’ll live a happy, healthy rest of your life.”

“If you don’t go to the therapy group for help, your wife’s gonna leave you–plain and simple.”

“If you quit using heroin, you’re going to have so much more money!”

“You don’t stand a chance without Narcotics Anonymous.”

“If you start a business, you’ll just shoot all the profits up your arm.”

While I understand that most of us have been in the field long enough to have seen multiple examples of people struggling with addiction after leaving treatment or having a hard time living independently with a mental illness, there are (many) exceptions to those situations. So, if we decide to essentially promise someone that something will happen, when we really have no way of knowing, the second that terrible thing doesn’t happen to them, or it doesn’t happen to someone who our client knows, we become somebody who has no credibility. It’s hard to trust somebody without credibility, so we have just severely injured our relationship with that person. Try using phrases like “I’ve never seen,” “It’s not impossible, however,” and “Feel free to try, but I’ve never heard of” in order to express humility. We can still give the person the caring warning and advice that we want to offer without delivering it like Ms. Cleo.

Here are some tweaks to the above example sentences to make them more realistic:

“I’ve seen lots of people avoid going to treatment and it often leads to them living a really hard, chaotic life, or even dying. I’d hate to see that happen to you.”

“Trying to live independently can be hard for people who don’t have any mental health concerns. I’m worried about you wanting to live on your own, but let’s look at some ways we might be able to make that more feasible, such as hiring an aide to check in on you or getting you on some medications.”

“Though there are no guarantees, I’ve seen people do a lot better in their recovery when they have some form of formal treatment.”

“I know your wife threatened to leave if you didn’t get help, and I can’t predict what she’s going to do, but her and I both are encouraging you to attend a bipolar support group. Is not going really worth the possibility that she might actually divorce you?”

“Stopping your heroin use can really increase the amount of money you have left to save or spend as you please.”

“I’ve seen kicking a habit be a real struggle for some people, but they often seem to do a lot better when they have the support of the people at Narcotics Anonymous.”

“It’s not impossible, however, I have witnessed several incidences in which people suffering from addiction who do actually gain a profit from running a business slip back into using because they have large sums of money that they’re handling on a daily basis.”

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