Opioid Crisis: What People Say vs. What Research Says

“Addiction is bad people doing bad things.”

“Addicts use drugs for pleasure.”

“Addiction is a choice.”

  • Brain studies reveal that addiction compromises brain structures including the basal ganglia, extended amygdala, and prefrontal cortex.
    – Nora D. Volkow, M.D., George F. Koob, Ph.D., and A. Thomas McLellan, Ph.D., Neurobiologic Advances from the Brain Disease Model of AddictionNew England Journal of Medicine, 2016
  • “People suffering from addictions are not morally weak; they suffer a disease that has compromised something that the rest of us take for granted: the ability to exert will and follow through with it.”
    – Nora Volkow, M.D., Can the Science of Addiction Help Reduce Stigma? Advances in Addiction & Recovery, Fall 2015

“Lock ’em up. That’ll serve ’em right. That’ll cure ’em.”

  • The primary symptom of the illness of addiction is persistence in use despite negative consequences – including persistence despite the punishing, negative consequences of jail, prison, loss of custody of children, loss of one’s job, license to drive, license to practice a profession…
  • For those with opioid addiction in the criminal justice population, maintenance medication can reduce rates of re-incarceration by 20% or more.
    – Larney et al., Effect of prison-based opioid substitution treatment and post-release retention in treatment on risk of re-incarceration, Addiction, 2011
  • Treatment is up to 7 times cheaper than incarceration.
    NIDA, “Is drug addiction treatment worth its costs?”, 2018

“Abstinence treats addiction.”

“Abstinence from opioids treats opioid addiction.”

“People with addiction need to go to rehab.”

“Drugs cause addiction.”

“Big Pharma and prescription pain pills are to blame for the opioid crisis.”

“Doctors are to blame for the opioid crisis.”

“Prescription pain pills are a gateway to heroin addiction.”

“Overdose deaths are skyrocketing.”

  • The spike in opioid-related deaths is presumed to be caused, not by prescription pain pills, but by inadvertent overdose through street supplies of heroin poisoned with illegally-made fentanyl and its analogues.
    Opioid Data Analysis, Centers for Disease Control, 2017

“If we declare war on opioids, we’ll solve the opioid problem.”

“Medication trades one addiction for another. Because methadone and buprenorphine are opioids, giving them to opioid ‘addicts’ substitutes one addiction for another.”

“Babies are born addicted.”

“Opioid addiction is the biggest problem facing America today.”

  • Marijuana overdose deaths: 0 (Source)
  • Terrorism-related deaths, U.S. citizens, overseas and domestic: 32 (2014: Source)
  • Prescription opioid drug-related deaths: 16,000 (2015: Source)
  • Opioid-related deaths: 35,000 (2015: Source)
  • Gun-related deaths: 35,000 (2014: Source)
  • Drug overdose deaths: 64,000 (Provisional, January 2017: Source)
  • Alcohol-related deaths: 88,000 (2015: Source)
  • Obesity-related deaths: 300,000 (Source)
  • Tobacco-related deaths: 480,000 (Source)

Oh, wait. Breaking news. Not 70s heroin? Not 80s crack cocaine? Not 2010s opioids anymore? Meth again?

  • “The scourge of crystal meth, with its exploding labs and ruinous effect on teeth and skin, has been all but forgotten amid national concern over the opioid crisis.”
    – Frances Robles, Meth, the Forgotten Killer, Is Back. And It’s Everywhere, New York Times, February 13, 2018
  • “Four legs good, two legs bad!”
    – The Sheep, George Orwell, Animal Farm, 1945

Image: iStock

. . . . .

I will be giving a talk entitled “Opioid Epidemic? What Are the Facts?” for the Lifelong Learning Institute at Virginia Tech on Tuesday, March, 13, 2018, 3:15 – 4:30 PM, at Warm Hearth Village Center in Blacksburg, Virginia. The event is free and open to the public.

More information about the talk is here and here.

The views expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Talk on the Opioid Crisis in Blacksburg, VA, March 13, 2018

I will be giving a talk entitled “Opioid Epidemic? What Are the Facts?” for the Lifelong Learning Institute at Virginia Tech on Tuesday, March, 13, 2018, 3:15 – 4:30 PM, at Warm Hearth Village Center in Blacksburg, Virginia. The event is free and open to the public.

If America is facing an “opioid epidemic,” why isn’t evidence-based emergency, urgent, and routine medical care for opioid use disorder available in our town? Ask that question of lawmakers, judges, policymakers, public officials, journalists, treatment professionals, and society at large and watch the spluttering begin. For no other health care condition is belief, opinion, and myth accepted as the standard of care. This presentation focuses on the latest addiction research, with a focus on opioid use disorder, challenging what society has to say about addiction with the available science.

For context, I recommend this article:

And this one, too:

For further reading, I’ve compiled suggestions here.

I gave a talk on opioids for the Montgomery County, Virginia Democratic Party on August 17, 2017. Here is the first half of an expanded version of the talk. The second half is here.

Speaking in Blacksburg, Virginia

Directions to Warm Hearth. As you enter the Warm Hearth complex on Warm Hearth Drive, you will pass Nuthatch Way on your left. Take the next left into the driveway and parking lots for Warm Hearth Village Center.

(LLI requests mail-in registration, but it is not required. Here’s the registration form and here’s a list of all events scheduled for LLI during Spring 2018.)

If you have questions or I can be of service, please feel free to contact me.

Photo: Bonnie Lyons

How to Help a Loved One with Addiction: An Evidence-Informed Approach

Learn. 

Learn what constitutes an evidence-informed treatment plan for the medical condition of substance use disorder, popularly termed “addiction.” Acknowledge that debate rages, even among experts and researchers, about what addiction is and what effectively treats it. Discourse is, of course, necessary, but your loved one needs help now. Learn what the evidence suggests helps most people with substance use disorder, most of the time, better than other treatments, and better than no treatment.

Co-create solutions

Understand.

Learn enough about addiction to understand what people with the disorder experience, why their actions may not make sense, why abstinence is neither a cure nor a relief, and why they might not want treatment. Understand that substance use disorder occurs with multidimensional complexity and variability. Use terms related to addiction accurately.

In particular, understand that the neuroscience of addiction suggests that through compromising the brain’s basal ganglia, extended amygdala, and prefrontal cortex, addiction under-sensitizes people to pleasure, over-sensitizes them to pain, automates use of the substance to feel, not necessarily good, but normal, weakens decision-making abilities, magnifies emotional highs and lows and incapacitates the ability to regulate them, interferes with recognizing cause-and-effect relationships, and confounds the ability to make a plan and follow through with it.

“Do not attempt to take away a person’s main means of trying to cope with pain and suffering until you have another effective coping strategy in place.”
– Alan Marlatt, Ph.D., 2004

Encompass.

Be brave.  Beyond the medical condition of addiction which compels use, become aware of, seek, and acknowledge all the possible current conditions, risk factors, and pre-existing conditions – including trauma and mental illness – that might lead your loved one to find use of substances appealing, helpful, or meaningful. Without judgment, be open to discussing these with your loved one. What substances do for a person will need to be adequately replaced before a person can do without them. Expand and deepen your empathy and compassion for these conditions and reasons, and for the person who has them.

Love.

Offer love love, not tough love.

Co-create.

If your loved one is in an emergency state, dial 911 or get him or her to an ER.

If not, your loved one may be newly released from the hospital, newly released from treatment, or in need of urgent care.

Having grounded yourself in learning, understanding, compassion, and love, confer with your loved one about what next steps might be helpful. Although the situation might seem dire, co-decide on the smallest step that might make a slight improvement – perhaps finding an answer to a question through a phone call or a Google search – and do that. Don’t try to strategically build trust – be trustworthy.

This is subtle, but the goal of helping someone with substance use disorder isn’t to take over the person. The goal is to help the person be himself or herself and move towards health, in the increments that work for him or her, while having this condition.

Use the best of your heart, mind, knowledge, experience, wisdom, and presence, all together, all at once. The substance is perceived as needed to survive. The illness of addiction, the symptoms of co-occurring illnesses, and the impact of substances themselves can interfere with a person’s reasoning. Co-creating solutions with a person under such duress will take the very best of your full humanity.

Coordinate.

Serve as your loved one’s case manager and do what you can to make the components of the treatment plan happen. Make inquiries and appointments, make phone calls and follow-up phone calls, make copies of all documents, keep originals in a safe place, create a notebook of the copies, provide or find transportation, and accompany your loved one to as many appointments as possible, notebook of copies in hand.

Advocate.

Your loved one has a medical condition needing medical care, but society at large believes it is a moral and criminal problem needing redemption and punishment. Even your loved one may believe he or  she is a good person gone bad. Your natural inclination may be to walk away from care providers who hold these views. Since it’s a position held by the majority, doing so may leave you with no alternatives and no care. Instead, you may need to learn to skillfully and strategically advocate to procure the necessary treatment component from each individual or entity.

Insist on outcome-based treatment. If the treatment providers don’t have data that the treatment works – data that counts all the people who tried the treatment, not just the people who finished – ask them for the criteria used to decide which treatment protocols are offered. If a treatment isn’t known or proven to work, why would your loved one be required to do it? People mandated to treatment may have to attempt to make the best of what’s offered. You can convey, however, that you will be overseeing your loved one’s progress.

Commune.

Find others with loved ones with substance use disorders and connect with them in ways that are supportive, informative, and empowering. Community Reinforcement and Family Training (CRAFT) is an evidence-backed approach, developed first for alcoholism, and known since the 90s to foster engagement between people with substance use disorders and those who love them towards achieving treatment goals. Even if implementation of a CRAFT program is not possible in your area, finding others who value a CRAFT goal – “Minimize distress and increase positive lifestyles for all family members” – may be encouraging and strengthening. (Here’s the CRAFT manual – .pdf opens in new tab.)

“Love, evidence & respect.”
– Maia Szalavitz’s answer via Twitter to the question, “What fights addiction?”

Recommended reading

Watercolor by Jesi Pace-Berkeley

The views expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

It Cannot Be Concluded That General Group Counseling is Effective for Reducing Substance Use

“Unfortunately, despite decades of research, it cannot be concluded that general group counseling is reliably effective in reducing substance use or related problems.”
– Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health, November, 2016, Page 4-26

For research citations on the ineffectiveness of counseling – individual or group – for opioid use disorder, please see On Counseling and Medication-Assisted Treatment.

For more excerpts, quotes, and definitions related to substance use disorder, please see Addiction Recovery: Define Terms and End Conflation.

The views expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Open Letter to People Thinking About, or Mandated to, Long-Term Abstinence from Substances

Dear You,

The reality of recovery from addiction is that one has to walk side-by-side with ever-present, unmet, unmeetable longing. Some people experience this more intensely than others; sometimes an individual experiences this more intensely than at other times. For some people, the longing fades like the details of a bad dream. But the mysterious “turn” that happens in the brain from addiction can make that longing elemental, experienced in the heart, mind, body, and spirit.

Hug yourself again and againAnd a person has to do this walk, sometimes limping, without direct help. Other than a few medications for some substance use disorders, no one knows how to make the longing that underpins those “impairments in…voluntary control over substance use”* go away.

When someone is asked to consider abstaining, or is mandated to abstain, that’s the inhumane reality they face. Abstaining risks the anguish, with one’s whole being, of, to quoth Poe’s raven, “Nevermore.”

If you are someone who is thinking about, or mandated to, abstain long-term, here are my simplest, most direct suggestions. They are based on my reviews of the research on addiction, my professional training and experience, and my personal experience developing alcohol use disorder in association with a school shooting occurring in my small, rural, college town.)

(This advice is based on the assumption you are medically stable, have detoxed through medical monitoring, and/or have been medically cleared as having successfully detoxed on your own, and/or are stable on medication treatment. You either have received, or have appointments to receive, medical care for the medical conditions that can accompany addiction.)

Give yourself a big hug. This is sad and hard.

With hope that knowing possibilities may offer you calm and resolve – and with hope that those who love you may understand a little better – these may be true:

  1. How you currently feel, what you feel, and what you think without alcohol and other drugs may last.
  2. The improvement in feeling, thinking, and physical condition – even bliss – that you experienced with substances may not be possible without the substances.
  3. You may always have to hold opposing truths in your mind: “I want” AND “I don’t want.”
  4. Spontaneity may be endangering.
  5. Mandating perfect standards for imperfect humans is cruel, especially when they are ill. Inability to abstain is the primary symptom of the illness of substance use disorder. Abstinence is a cruel standard.

The possibility of these challenges does not preclude the presence of other meaningful and satisfying alternatives. For now, the task is not to try to make these realities go away, but to figure out how to live with them without using or drinking. To abstain, then, we must help ourselves not use or drink.

Ways that might help you not use or drink:

1a. Figure out what alcohol and/or drugs, themselves, did for you originally. Focus on then, not now, on before, not during. (This may be challenging, but try. Use may be essentially automatic now. Given a perfect storm – addiction is actually rare, i.e. only 1 in 10 Americans has it – of pre-existing conditions, and enough use for long enough, if the “turn” happens, it’s a brain thing that no one can figure out.)

1b. Find ways to do manually what alcohol and drugs did automatically. (In vastly oversimplified, general terms, substances help people “Feel better,” “Feel good,” or “Do better,” by adjusting the volume on emotions, focusing or distracting attention, prioritizing thoughts, and/or providing physical stimulation or comfort.) The new ways have to work no matter what happens – however shocking, painful, joyous, or boring.

2a. Figure out what the process, itself, of drinking alcohol and doing drugs did for you.

2b. Accept that nothing will probably ever duplicate what substances did, and anything may only ever be “good enough.” Still, find enough “good enough” replacements, enough of the time, with enough safe people, meaningful enough to you, that meet your needs, that sorta, kinda do what substances did. It will take a bunch of them. One thing might be necessary, but no one thing is likely to be sufficient over the long-term, although, initially, it might feel that way (falling in love, for example, or feeling embraced by a support group).

3. Think hard, ponder, and muse about the research on addiction that says the way the brain functions with love, bonding, and attachment may be the same as the way the brain functions after addiction has developed. Did our ability to connect, bond, attach, and love get shifted to substances? How do I use this information to help myself not use or drink? Is the ever-present ache and longing I feel since the death of _______ or the loss of _______ related to how I feel while abstaining? Is how I keep putting one foot in front of the other after that loss how I can help myself keep going without substances? Might finding other people, things, and ways to connect – even love – help me not use or drink?

4. Be self-kind. If it’s possible – again, stated in grossly oversimplified terms – that love may directly treat the brain for addiction, then it’s practical for me to have empathy, compassion, and love for myself. It also helps me “Feel better,” “Feel good,” and “Do better,” especially when compared with the excruciating experience of self-judgment and self-reprimand.

Give yourself a hug again. And again. I know this is starting out sad and hard for you. But it’s possible that basic humanity and applying the research on addiction may actually help things end up being pretty okay, maybe even pretty soon. Wouldn’t it be something that, after medical care, simply being thoughtful, kind, and caring towards ourselves might help us recover from addiction?

Wishing you the very best,
Anne Giles
Blacksburg, Virginia
January 10, 2018

* “A substance use disorder is a medical illness characterized by clinically significant impairments in health, social function, and voluntary control over substance use.” Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health, 2016, Page 4-1

This post is part of a series. The table of contents, with links, is here.

Photo: “Self-hug” of Casey Sapienza by Mia Sapienza

The views expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.