In this holiday season of reflection and gratitude, as I think back over the last 15 months as an AmeriCorps member in the United Against Opioid Abuse campaign, I am indebted to and grateful for the individuals, organizations and agencies that have been so supportive and willing to collaborate, working to make a difference in our county in the battle against substance misuse.
White County United Way: Nikie Jenkinson and her board had the foresight to convene local agencies and individuals to ask the question: What can we do about the substance use/opioid problem in our county? Because of this conversation, White County United Way obtained a grant to bring the AmeriCorps United Against Opioid Abuse initiative to our county. Thank you, Nikie and White County United Way board for taking the initiative to bring this program to White County.
First Responders, Government Officials, Criminal Justice Workers, and Public Servants at both the city and county offices: Thank you for the time you spent taking this rookie under your wings and bringing me up to speed about your work. You have offered guidance and wisdom. Thank you for the time you spent sharing your perspective on how drugs affect our county and what has been done, is being done and plans for the future. Thank you for sharing statistics and information to provide an accurate picture of what is happening. Thank you for graciously answering my calls and requests for information and data. You have been most generous with your time and patience.
IU Health White Memorial Hospital: Mary Minier and Melissa Dexter- Your partnership has empowered opportunities to provide information, meeting places, food, advice, and support for our work. Your help with grants and funding has continued the momentum, and your structural, institutional, and caregiving capacity to serve our community will continue to be an asset for all who need assistance.
Local Media: To our local newspapers, thank you for publishing this column and sharing information with the community about the realities of substance use and its effect on people. As William Cope Moyers indicated, “local journalism remains the single most important way to inform and influence people in a community.” To our new friends at WLFI, thank you covering stories related to our work and helping us get the word out! You always make us look good!
Local Nonprofit, Education, Faith, and Service Groups: Thank you for allowing me to sit in on your meetings and share information about what we are doing. Thank you for inviting me to speak with your members and share the many ways our work impacts the community at large. I am grateful to be a part of your groups.
Members of the United Council on Opioids: Thank you for joining the work and shouldering this task with us. Your input, experience, guidance, and hard work is making a difference and creating positive change.
Families of those in substance use: Thank you for sharing your stories and giving a face to the horror and devastation of watching a loved one self-destruct. Thank you for your courage, perseverance and love for these dear ones.
Friends in Recovery: Thank you for your willingness to talk about your experience and offer hope to those still ensnared in addiction.
The North Central QRT: Thank you for coming to White County. You are a breath of fresh air to us and offer a way to reach people who are struggling with substance use, opening the paths to recovery.
Those still struggling with substance abuse: You don’t have to live this way. There are people who want to help. Don’t give up! Recovery is possible. There is hope! A great place to start is calling: 765-490-0381. Someone will answer 24/7. They have been where you are and can connect you to what you need.
To the readers of this column: Thank you for your comments, encouragement and readership. Your words have inspired me to continue.
To Chad: Thank you for planting this seed of an idea for these articles.
Mostly I am grateful for the friendships and relationships formed over the past 15 months. It has been an exciting year of learning, processing and representing White County in this important work. I have been deeply touched by your stories and experiences. I am humbled and grateful for this partnership and collaboration. Thank you for sharing this journey.
Last time, we discussed stigma related to substance abuse. It is natural to look at someone else and make judgments. It is easy to assume we know about a person based on their appearance or actions. But, are our perceptions accurate? Are we projecting our personal biases on to others? Are these projections based on truth or opinion?
Stigma is powerful, complex and dynamic. Stigma can cause problems for people in substance use that are bigger than addiction alone. Stigma keeps people paralyzed in shame instead of hope and in isolation instead of community; defining a person by their addiction shuts them off from treatment and help. Stigma can be internalized, so the person believes what stigma says about them.
Stigma not only affects the person, but also their family, friends, and even those who try to help them. They may face the same judgement, shame or barriers of the person who is in addiction. The stigma may come in words or thoughts. The underlying attitudes allies may face are: Why would you waste your time with THOSE people? There is no hope for those in addiction. What did you do wrong to cause this? How could you allow this to happen?
One way to combat stigma is to recognize the stigma we hold personally. We may not realize the beliefs, assumptions and thoughts we have that stigmatize others. The Central East Division Addiction Technology Transfer includes the following questions in its Anti-Stigma Toolkit to help people consider their own levels of internal bias: Do you believe that those who are struggling with addiction are weak, lazy or immoral? Do you believe some addictions are worse than others? For example: is it worse to be addicted to illegal drugs than prescription drugs? Do you believe that some people are beyond help, that they will never get better? Do you believe that some treatments for substance abuse are better than others? For example, do you believe that abstinence is better than medically-assisted treatment? Do you believe that there is only one path to recovery, like a 12-steps program?
Another powerful tool in breaking stigma is to allow individuals and family members to tell their story. It is easy to stigmatize people we don’t know. The judgement and condemnation of stigma silences individuals and makes them fearful to share their journey. Taking the time to listen, understand, and recognize the person behind the label offers dignity and respect to someone who may have lost belief in themselves. Seeing acceptance in your eyes may be a small encouragement that opens the person to the possibility of healing.
Learn as much as you can about substance use, treatment, prevention, and recovery. Share what you have learned. As you notice misinformation and inaccuracies in interactions with others, speak up and challenge mistaken ideas.
Don’t use stigmatizing language. Calling someone a junkie or addict does not help them rise out of that life style. The old adage that sticks and stones may break my bones, but words can never hurt me denies the negative power of words that promote shame and judgment and keep a person in the hopeless state that crushes hope of recovery.
Stigma never helps. It can be broken and stopped. When we recognize the power of stigma and its negative consequences we begin the change process of healing. Addiction doesn’t have to be the end. Treatment works. Recovery is possible. If you or someone you know is ready to seek treatment, please call the Quick Response Team at 765-490-0381.
We often hear about stigma related to mental illness and substance abuse, but what does that really mean?
Stigma is a form of discrimination. It includes making negative judgements and assumptions about others based on perceptions of who they are, what they look like, and what they do. Stigma decides who merits dignity and respect and who does not. Stigma often means distancing yourself from those you deem unworthy.
Stigma isolates and divides people into US and THEM. Stigma uses attitudes, words and actions to separate “innocent” people from bad ones. Where substance abuse is concerned, it separates junkies from those who deserve help and divides addicts from those worthy of resources.
Stigma keeps families silent about their loved ones who struggle with addiction. Stigma says that if your child is involved in substance misuse, you are a bad parent. It silently accuses you of doing something wrong, even though a third of all families in the United States have a loved one struggling with addiction.
Stigma ignores the fact that addiction can happen to anyone, and that no one is safe. As the fifth graders in the We are the Champions drama club said,” Addiction is an equal opportunity destroyer.” No one is immune. Stigma says It can’t happen to me or mine.
Stigma keeps communities from reaching out to those in need. Stigma means thinking that people involved in substance use just need to snap out of it and pull themselves up by their boot straps. It has us believing they are weak-willed and lacking self-control.
Stigma is the cashier who looks with disdain at people using food stamps. Stigma is the receptionist who treats clients with tattoos and piercings differently those who don’t. Stigma is an educator who expects less of the children from “that family.” Stigma is the medical professional whose words or actions communicate that the patient is a hopeless addict. Stigma is smugly shaking your head, looking down on others, glad you are too smart, good, or virtuous for that to happen to you.
But when you listen to the stories of families and people involved in substance use, you begin to understand it could happen to anyone. I hear stories of people who received prescription opioids, hated the way it made them feel, and refused to take more. Perhaps they are the lucky ones. There are stories of others who upon that first opioid prescription, finally felt complete and that they had “arrived,” taking their first steps downward into substance misuse. Stories abound of youth who experimented believing they were invulnerable and invincible only to become ensnared in the world of addiction. The stories of children whose families embraced the drug culture and never knew anything different are devastating, as they often become addicted to substances before they enter middle school. Stigma is children whose lives are impacted by decisions that other people make for them.
Stigma keeps people silent, isolated and shamed. Of the millions of Americans involved in substance abuse, only 10 percent seek out treatment. According to the NAMI Cure Stigma website, stigma prevents people from seeking help because of shame or fear of judgement. Stigma says there is no hope for recovery.
Stigma points a finger offering blame and judgement, instead of compassion. Stigma never helps.
Next time, how to combat stigma.
Last time we discussed how substance misuse affects businesses. Today we will look at what employers can do to address substance abuse in the workplace.
According to the National Safety Council, 10-15% of all employees are personally affected by substance abuse, whether it is alcohol, opioids, marijuana or other substances. When family members are included the number affected is closer to 30%.
When considering that nearly one out of three employees are directly or indirectly affected by substance use, employers need to have a plan.
Some employers have found success with the following strategies. Please consult your own legal council and professional organizations to discuss your particular circumstances.
Many employers do not realize that alcoholism and addiction to legally-prescribed opioids is now considered an ADA-protected disability. Current use of illegal drugs is not protected. An individual who is in recovery from a problem with alcohol or with legal or illegal drugs is protected from discrimination under the ADA. However, employers can take action against an employee who uses or possesses alcohol or drugs in violation of the employer's policy, is unfit for duty because of alcohol or drug use, or fails to meet the employer's expectations in terms of performance, conduct or attendance, even if the failure is because of substance abuse.
Again, this information is not intended to be legal counsel, but only suggestions as to actions employers might take.
Past articles have focused on the processes of substance misuse and its effects on individuals and families. Now we turn our attention to the impact of substance misuse on businesses and employers.
I recently had a conversation with the human resources director of a local employer who indicated how hard it is to hire people. She indicated that 50% of their applicants could not pass a drug screen. When given the opportunity for a second screen, half of those still didn’t pass. Many business leaders wonder what to do with people who fail drug screens. They are unsure of their role in assisting employees and potential employees who are struggling with substance use. Some employers have opted to stop drug testing completely.
Mike Thibideau from Indiana Workforce Recovery says that eighty percent of Indiana businesses have a need for additional employees. According to the Federal Reserve Economic Research, the August 2019 unemployment rate in White County was 2.5%. There is a desperate need for additional workers.
Seventy-five percent of Indiana employers report that substance abuse impacts the workplace in absenteeism, shortage of workers, negative publicity for the company, decreased productivity, increased insurance costs, accidents, and theft. Ninety-five percent of overdose deaths occur in working-aged adults. White County overdose deaths are no exception to these statistics.
Indiana Workforce Recovery surveys show that over 200,000 employed Hoosiers have substance use disorder, and forty-two percent of Hoosiers seeking treatment for substance use are employed. Another forty-one percent of those in treatment are looking for work. Nationally, there are 28.5 million Americans in long-term recovery and only ten percent of them are employed.
When thinking about recovery, Thibideau reports there is no greater source of change than a good job. When people receive employer supported and monitored treatment, they tend to be more successful in staying in treatment longer and maintaining long-term recovery than those referred by family and friends. Employers find that supporting their employees in treatment and recovery shows a thirty-six percent decrease in absenteeism and a thirteen percent decrease in employee turn-over rate. The financial incentive for businesses to support their employees involved in substance misuse is real.
Stigma continues to be an obstacle for working people entering treatment. In 2016, 31,000 Hoosiers wanted to engage in SUD treatment, but they chose not to get treatment for fear of losing employment. In Indiana, a failed drug screen is just as likely to result in termination as it is to lead to a referral to treatment.
Jim McClelland, Indiana Executive Director for Drug Prevention, Treatment and Enforcement states, “Everyone understands that substance abuse in the workplace can be a problem. But there is a big opportunity here. We know that businesses need a healthy workforce and we also know that people in recovery from substance use disorder need jobs.”
Next time, we will discuss what employers can do.
Recent research on substance abuse shows that many factors are involved in who becomes addicted to substances and who doesn’t. More and more studies indicate that childhood trauma influences many long-term health outcomes.
The Adverse Childhood Experiences (ACEs) assessment is one example of this research (also known as Kaiser Permanente CDC Study). In the late nineties, 17,000 middle class Americans were given health assessments and a ten-question survey looking at childhood abuse (physical, emotional or sexual), household dysfunction (having a parent incarcerated, with a mental illness, involved in substance abuse, mother treated violently, parents separated or divorced), and physical or emotional neglect. (The entire questionnaire can be easily found online by searching for “ACE Questionnaire.”)
The reason adverse childhood experiences are so impactful is that young children quickly learn whether or not the world is safe by how their needs are met. Babies and young children learn this through the care or neglect of a caregiver. Unmet needs increase the production of cortisol, causing the stress response system in the brain to be on constant high alert, diverting energy away from other parts of the brain. This toxic stress weakens the parts of the brain that develop healthy emotional self-regulation, social interactions, and abstract thinking. These stressors early in life affect not only emotional health and educational achievement, but long-term health and wellbeing as well.
As a person’s ACE score increases, so does the risk for negative outcomes. In their continuing studies, the CDC found that almost a quarter of those surveyed had three or more ACEs. There is a dramatic link between having three or more ACEs and engaging in risky behaviors (accidents, injury, being a victim or perpetrator of violence), having psychological issues (mental illness, suicide, depression), serious chronic health conditions (including obesity, diabetes, heart disease, cancer, COPD), and lower educational attainment. The Substance Abuse and Mental Health Services Administration (SAMHSA) cautions that “Each ACE increases the likelihood of early initiation into illicit drug use by 2- to 4-fold.” People with six or more ACEs are likely to die twenty years earlier than those without ACEs. Studies also show that children of parents affected by high ACE scores are likely to experience them as well, affecting future generations.
CDC research indicates that the economic toll of individuals having five or more ACEs costs the United States four hundred billion dollars each year in health care, special education, criminal justice and child welfare services.
In addition to drastically increasing the likelihood of substance misuse, adverse childhood experiences have negative long-term effects on individuals and our society at large. Next time we will discuss what can be done.
In the past two articles I shared two stories of journeys to recovery. Why do some people recover while others do not?
Several factors influence an individual’s recovery. One important factor is the severity and length of substance use. The longer a person is involved in substance misuse, the harder recovery becomes. Early intervention is important.
Another factor is Recovery Capital. Robert Granfield and William Cloud developed the concept of “recovery capital,” defining it as the amount of assets and supports an individual has that help begin and sustain recovery from substance abuse. Recovery capital varies from individual to individual and differs within the same individual over time. A person with a higher amount of recovery capital has a better probability of being successful in achieving recovery.
There are four areas of recovery capital: physical, human, social and cultural.
Physical recovery capital includes things like: having safe, stable, secure housing, employment/financial assets, physical health, clothing, nutritious food, transportation, insurance, and other basic physical needs of an individual.
Human recovery capital looks at the range of skills, strategies and attributes that allow an individual to function effectively in society and the ability to navigate daily life. These include mental health, values, life skills/coping strategies, knowledge, experience, education, interpersonal skills, problem solving abilities, aspirations, hopes, and having a purpose.
Social recovery capital indicates the supports and obligations/commitments to social groups and personal relationships, including family, friends, work, social networks, memberships to organizations, and church. A great challenge for those in recovery is developing relationships outside of the substance using community.
Cultural recovery capital is the collective values, beliefs and attitudes of the community. These include access to treatment and recovery, public awareness of and perceptions about substance abuse, regional and local laws, and community attitudes towards addiction.
Recovery capital includes the resources and ability to act in one’s best interest to meet basic needs and take advantage of recovery opportunities.
Sadly, some people have never learned how to live without drugs and function successfully in society. A drug and alcohol counselor working in a local jail indicated that rehabilitation—teaching inmates how to live in a healthy manner without drugs, only works with people who, at one time, had those skills. For others, habilitation is necessary to build recovery capital.
For people living with trauma and economic instability related to substance abuse, the obstacles facing them in beginning recovery can be overwhelming.
One of the goals of a community that desires to help people recover from substance abuse is to increase the amount of recovery capital available. Even changes in attitude make a difference in the response to those involved in substance abuse. Viewing addiction as a disease rather than a moral failing helps an entire community to build recovery capital.
More on this next time.
Although every story is different, there are general patterns of substance use, treatment, relapse and recovery that emerge in the study of those in recovery.
Jack’s story is fairly typical. He did well in school, played sports, and had lots of friends. After a sports injury, his doctor prescribed an opioid painkiller. He loved the way he felt when taking them. When his prescription ran out, he was able to find them from friends. Although the first few pills were given to him for free, soon he had to pay for them. At first, he only took them on weekends or at parties. Soon he was taking them through the week as well. He quickly discovered that if he didn’t take them, he began to be anxious and have flu-like symptoms. Initially, he was able to pay for them with the money he earned at his part-time job. As his need for the drugs increased, he went through his savings. He started looking though medicine cabinets of friends and family members to find prescription medications he could sell or trade for opioids He convinced himself that he didn’t have a problem, as there were others who were in worse shape than he was. He wasn’t using needles or taking heroin.
He began taking things from his parents’ home to pawn or sell for drug money. When someone suggested he try intravenous injection, he was unsure he wanted to cross that line. But with encouragement, he allowed himself to be injected and there was no going back.
Jack’s parents had noticed changes in their son, but Jack was able to create stories that covered his drug use. He was just tired, had a touch of the flu. He spent more time in his room and with his new friends. When asked about his former friends, he said they were lame and didn’t want to hang out with them any more. As his grades at school plummeted, he became angrier and more belligerent about people being on his case and not leaving him alone.
He couldn’t wait to go to college and get away from all the rules and people who didn’t “get him.” Once there he used his new freedom to connect with other drug users and partiers. He only lasted a semester at the university before he flunked out. When his parents confronted him, he said the school was stupid and the professors were too harsh and expected too much. After several confrontations, Jack confessed that his problem was drug-related and his parents got him into a treatment center. Jack went from being relieved that the problem was out in the open to being angry and resentful of the rules and strict routine of the treatment center. He managed to complete the program with plans to go back to school, but once released, he ran into a friend from his former days and soon was using again. Thus began a several year cycle of treatment and relapse. His family grew more and more frustrated with him and eventually cut off ties.
Jack spent many years couch surfing and then was homeless. After several overdoses and Narcan administrations, an EMT connected him with a recovery organization and a medically assisted treatment facility. Initially, Jack did not have much hope, but through the counselling and medication, he began to see that recovery was possible. He had several missteps, but with the support of his counselor and new friends in recovery, it was not a catastrophic fall back into the life of addiction.
Slowly Jack relearned how to function again in healthy society. He developed new interests and began to help others on their roads to recovery. It has not been easy and has taken a long time to rebuild trust, but his relationships with his family are slowly being restored. Recently Jack met a woman in recovery and they are beginning to plan a future helping others develop a vision for their own recovery.
Names and details have been changed to protect Jack’s privacy.
In previous articles, we have discussed many aspects of substance use, treatment and recovery. In this article, I will let Chris tell a story of recovery.
I started using when I was a teenager. I went through multiple treatment programs and relapses. I almost died several times. Many of my friends did. I don’t want to glamorize what I did but only say I was stupid and reckless.
Most of the time I was in treatment, I was just going through the motions, doing what I was expected to do, so I could get out and get high. After hitting the bottom several times and coming to my senses, I came to the realization that the most important thing in my life had to be staying sober. AA says you are as sick as your secrets. I had to figure out what was driving me to use drugs, what underlying pain was I running from?
It took a long time. It is a daily struggle. There are still triggers out there that cause cravings, usually stupid stuff like the bleach in the laundry aisle of the grocery store, that I used to clean my needles. Or driving by the places where I used to use, a smell, an object that reminded me of when I was using.
I know now that I can only stay clean when I am in community. My sponsors and friends in recovery hold me accountable and I do the same for them. We offer each other encouragement and call BS when we are lying to ourselves and others.
The people who helped me didn’t judge me, criticize me or make me feel worse than I already did. They didn’t give up even as I continued in denial and self-destruction. They saw me as a person who was lost and needed help: a person worth saving. Their eyes offered acceptance and kindness, holding out hope until I was finally able to accept it for myself.
Those who didn’t help demanded to know how I could do this to myself and my family. Why didn’t I pull myself up by my bootstraps, show some willpower and stop being such a loser? I knew what I was. I hated myself and what I was doing. I didn’t need anybody else telling me that. I was already worthless and ashamed.
The most important thing to tell people who are in the depths and darkness of addiction is that I used to be where you are. I recovered and you can too. There is hope. Our details may be different, but our stories are the same. We couldn’t face the pain in our lives and drugs/alcohol made us feel good and forget our problems temporarily. But the drugs only added to the pain and hopelessness of what we were doing to ourselves. It comes down to two choices: You can recover or die. You don’t have to die, you can recover.
For the families who are going through this with them: You can’t save someone who doesn’t want to be saved. But you can keep the door cracked open to offer hope when they are ready. And take care of yourself while you wait. It still pains me to think of what I put my family through. On many levels, I did not know what I was doing to them until it was too late. I was so self-absorbed and unaware of anything but me. Saying I’m sorry a million times can’t fix it. I cannot express how thankful I am for the relationships that are healing and being restored.
The details of Chris’ story have been changed (including the name) to protect Chris’ privacy. This path to recovery is unique as every person’s recovery is a little different. What worked for Chris may not work for others. But this story offers hope. The journey may be long, but don’t give up. Help is out there. Recovery is possible.
Earlier this year, Valley Oaks in Tippecanoe County obtained a grant from the Family and Social Services Administration/Division of Mental Health and Addiction, Addiction and Forensic Treatment Team to expand the Tippecanoe Quick Response Team (QRT) into White and Jasper Counties.
Many community members have been involved in the planning process. We have had representatives from the Mayor’s office, the judicial branch, law enforcement, health care administrators and workers, educators, pastors and community members working together to develop the plan. Their vision statement is “Working Together to promote healthy recovery for those involved in substance abuse and trauma.”
Through this grant, the North Central QRT will begin work in White County starting September 1, 2019. When someone in White County has a Narcan or substance abuse contact through 911 or the IU Health White County Memorial Hospital, a peer recovery coach (PRC) and an EMT will make contact with them within 72 hours of the event. At that contact, the team will offer wellness and recovery services to the individual. “Since the PRC has experience in substance abuse and/or mental health as well as formal training, they can offer the individual self-directed, strengths-based peer support. This approach has proven to be successful in winning the confidence of a highly resistant population. The addition of clinical supports as well as wrap-around services offers clients a trauma-informed, multi-faceted menu of options to both initiate and sustain long-term recovery.” (North Central QRT Facebook page)
Another benefit of the QRT is providing transportation to services. Often those in early recovery have difficulty finding transportation to community services. Not only does the QRT help set up appointments, they also can provide transportation.
In addition, people may call their hotline number (765-607-6771) for themselves or to refer someone else. When calling the QRT number you will hear a recording asking you to respond to four questions: Your name, your age, a brief description of your situation, and an address or phone number where you can be reached. The team will make contact within 72 hours.
One of the biggest challenges for the QRT can be finding the individual. The contact information given during an emergency room or EMT visit may not be correct. The person may be staying with a friend or relative, or may be homeless. Many times in Tippecanoe County, the QRT responds to the address of a family member. Even then, they are able to offer resources and support. In one instance, the QRT was on a follow-up call related to a Narcan incident. Although the individual who received Narcan was not present, QRT made contact with his distraught mother, who had not seen her son for several months. They listened to her story, offered her Narcan, and taught her how to administer it. They encouraged her to call if they could be of further assistance. Several months later, she did call. When the team arrived, they were greeted with hugs. She invited them in, and sitting in the living room was her son with a suitcase by his chair. He had overdosed at her house the day before, she was able to save his life with the Narcan the QRT had provided, and he was willing to initiate treatment.
The QRT presence in White and Jasper Counties is a tremendous source of hope, and we are grateful to Valley Oaks for initiating this possibility.
Lynn Saylor is the AmeriCorps member working with the United Against Opioid Abuse Initiative alongside the White County United Way. She is a major facilitator of the United Council on Opioids serving White County and a regular contributor to local media.