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.
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One of the new strategies in supporting people in substance use is the peer recovery coach (PRC). A peer recovery coach is someone who has experienced substance misuse or mental health issues and is currently in active recovery. In addition to their lived experience, the PRC has completed forty hours of specialized training and passed a certification test. A PRC is not a therapist, diagnostician or counselor, but part of a team of professionals who support people in their recovery. They walk alongside the substance user on the road to recovery. Research shows that PRCs have a strong impact on those they help. There is mounting evidence that people receiving peer recovery coaching reduce their substance use and have improved recovery outcomes. In addition to an increased access to support services people working with PRCs tend to stay in treatment longer, have improved relationships with treatment providers, have fewer arrests, relapses, and emergency room visits, and are less likely to be homeless. (SAMSHA.gov) The power of a PRC is that while the substance user’s brain is telling him that he will never overcome addiction, there is a live person sitting in front of him, saying, “I’ve been there. I am in recovery and you can be, too.” Many people in substance abuse have not ever seen what successful recovery looks like. Gina Fears from the Recovery Resource Center in Indianapolis shared, “sometimes the idea of how to change is really scary. When addiction is driving you, it will whisper things like ‘You can’t do that.’ To be in a setting where people have really done it and they are down-to-earth people talking and sharing their journey, it makes it easier.” . The PRC gives the user hope and encouragement that recovery is possible and attainable. Hope of a better future is critical for moving forward in recovery. One of the biggest obstacles to overcoming addiction is isolation. The PRC helps the individual connect to and trust first with his PRC, then the recovery community and finally his larger community. Many aspects of life in recovery are foreign to the individual coming out of addiction. The PRC helps the person navigate those adjustments and have success in a sober society. There are many paths to recovery: faith based or secular, inpatient, outpatient or residential, abstinence or medically assisted treatment. The PRC’s role is to share their personal story of recovery, help the person examine various paths to recovery, and develop a personal recovery plan. A common PRC question is “How can I help you in your recovery today?” The PRC helps the individual set up goals, and then establish small, manageable steps to get there. The PRC is knowledgeable about resources for food, housing, transportation, support groups, counseling, treatment, and other services in the community, and acts as a resource broker connecting the person to the services and resources he needs. The PRC helps set up appointments, arrange transportation, and support the individual during his appointments. The PRC fills gaps in transitions to recovery services so those in recovery are less likely to fall between the cracks and lose their way. There is good news! Beginning in September, White County will have access to peer recovery coaches through the North Central Quick Response Team. More on that next week. As families deal with the chaos, pain and difficulty of watching a loved one struggle with addiction, they struggle to know how to respond. They may receive conflicting advice from friends, family members, and social media. Here are some general suggestions from families who have faced this heartbreaking situation.
For almost every addict mired in this terrible disease, there is a family suffering too. Families are the hidden victims of addiction, enduring enormous levels of stress and pain, suffering deep anxiety and physical exhaustion brought on by worry and despair. Families tend to put their lives on hold and in a sense become hostage to the addiction, abdicating responsibility for their own well-being.
What families tend to forget is that they do not have to wait until their loved one has found recovery before they can begin to nurture themselves. In fact, families can rediscover simple pleasures, find ways to experience peace of mind, and even begin to laugh again—no matter what their loved one is doing. The key is for families to begin their own journey of recovery, learning healthier ways of interacting with their addicted loved one, and embarking on a path of self-healing. As families search for recovery, they are searching for peace of mind. Their lives can have value apart from their loved one’s struggles. There are many books written by family members of those involved in addiction. Saving Jake: When Addiction Hits Home by DeAnn Burwell was reviewed earlier in this series. Others are An Addict in the Family by Bev Conyers, and The Only Life I Could Save: A Memoir by Katherine Ketcham. Websites such as hazeldenbettyford.org and projectknow.com offer help for families of those involved in substance abuse. The following recommendations are a compilation from those websites and books. (This is not to be taken as treatment advice, but suggestions from various sources that have helped families in the past.)
The next article offers more help for families. We have looked at the neuroscience and culture of addiction. Today we look at how substance abuse affects the families of those involved.
Often in the early stages, the family has no idea that the changes they see in their loved one are drug-related. They may view them as typical teenage moodiness or rebellion. According to William Moyers, those involved in substance use become masters of manipulation, covering their behavior, using fear, guilt and pity as they exploit others. “Nobody sees what’s happening because that person is deft at conniving, scheming or outmaneuvering the world on the way to another drink or drug.” As the loved one begins the downward path into substance abuse, the signs are easy to hide. Families are often in denial about the reality of their loved one’s addiction, wanting to believe drug use is not the cause. The loved one will offer explanations of their behavior or symptoms, blaming it on allergies, tiredness, or stress. If pressed, the loved one may become defensive and begin verbal attacks on the person asking the questions, insulted by the questions or conversation. They may blame the family for the symptoms, deflecting and denying. There may be accusations of violating privacy or lack of trust, causing the parent/family member to question their original fear. The emotional intensity of the response may be out of proportion to the level of questioning. The excessiveness of the reaction may be an indication of how close the questioner is to the truth. The family may find itself treading more and more carefully around the loved one to avoid setting him off. Family dynamics may shift as the rest of the family tries to maintain normalcy and balance. They may find themselves covering for their loved one, making excuses, providing a safety net and rescuing him from consequences as they try to navigate the lies, deceptions and manipulations. The family may gradually change as they attempt to maintain balance in the constantly shifting behavior and mood of their loved one. They may have a sense that something is not right, but be unsure what is really going on. A local mother of an adult, addicted child reported “until they go off to rehab or jail, you don’t realize just how dysfunctional your life has become.” Another mom stated “addicts have an inability to face pain. Opioids help them get through their own pain. Then, it helps them avoid the consequences of how they have hurt the people around them.” Families suffer right along with the person involved in substance use. There is a constant sadness and mourning for the way the loved one used to be. There is the worry and anxiety of where they are, what they are doing, whether they are dead or alive. Some family members have expressed relief when their loved one is arrested. “At least I know she is safe and being fed when she is in jail.” Families often work harder at helping their loved one than the person who is actually using. Families can become angry, frustrated, resentful and depressed. They may disagree on the best way to deal with the problem. Other relationships may become strained as friends and family feel abandoned and neglected by the amount of time, attention, and energy the addicted one is consuming. The constant roller coaster of hope and despair is exhausting and draining. Next time: How can a family cope? William White is a pioneer in the field of addiction treatment and recovery. He has written several books on the subject, been recognized with multiple awards for his work, and maintains a website: williamwhitepapers.com
His book Pathways from the culture of Addiction to the Culture of Recovery (1996) gives clinicians and family members a picture of the world of addiction, the culture that that addicts live in and how treatment must address and replace all these elements to move people into a life of recovery. White gives a very vivid picture of this culture, its values, and the mind of those involved in addiction. He believes that those involved in addiction constantly change their words and actions based on who they are with and where they are, to maintain their drug supply and deny the seriousness of their addiction. The life of addiction is a ‘predatory lifestyle’ where survival depends on the ability to respond to the continually shifting environment of danger, threats and drama. The addict believes that everyone and everything in his environment is working to keep him from what his brain really needs (drugs) and make him face a reality is trying to avoid. He lie to his family, steals from a loved one, manipulates and cheats. As the addict continues down the path of addiction, these become easier and easier to do without remorse. Nothing is sacred or safe in the endless pursuit of drugs. His brain is telling him that his only focus and motivation is to obtain and secure a drug supply at any cost. White states that in this endless cycle of addiction, ‘drug users seek out and build relationships with other people whose drug use mirrors their own, nurturing the rituals of drug use, becoming a fully organized culture of drug use constituting a powerful stimulus promoting excessive drug use.‘ This culture separates those in addiction from those who are not. Values and priorities change from those not involved in drug use. Heroes of the drug culture are those who have learned how to manipulate and take advantage of others to promote their own drug use. Stories of avoiding arrest, maintaining a drug supply, obtaining money, working a hustle, aggression, violence, and surviving danger, glorify drugs and help others justify and minimize their own use. The more excessive and outside of societal norms, the more valued the experiences are. Those outside the drug culture are viewed as mockable, easy targets to be used and discarded when no longer useful. The culture of addiction separates people who are “in the life” from those who are not, providing acceptance and perceived value for those who may have never felt accepted and valued in normal society. I hope you are getting a sense of everything that must be overcome to enter into long-term recovery: attitudes, priorities, values, activities, friends, language, dress and appearance, etc. In addition to addressing the physical and psychological aspects of addiction, treatment must immediately provide ways to meet the needs filled by the addiction culture with another lifestyle. Any unmet needs can be a stimulus/trigger for relapse. Those in recovery say they have to replace their playmates, playthings and playgrounds. In other words, a whole new life must be adopted and embraced. Although it is a daunting task, there is hope. Treatment works. Recovery is possible! Knowing the science behind addiction, does not accurately describe the intense despair of those who are living it. Today we look at how people involved in substance abuse view their lives. The following article consists entirely of quotes from online videos and books relating the experiences of those in addiction; WARNING: May be too graphic for some readers.
“Before my brother’s death I was just a normal kid, playing video games and sports. Going through the grief of my brother’s death, his friends told me, just take this drug and you won’t have to feel anything anymore. When I took it I felt numb. Any problem I had went away. My addiction got worse, I stole more and hurt more people I had no one. I wasn’t even getting high at this point, I was just not being sick. It cost me around $300 a day. The mental addiction to this takes over your mind. I had no choice, I just needed to feel ok. And so that was the first time I tried heroin and there was no going back after that. I ended up overdosing, almost dying only a few feet from where my brother was found dead. It took four shots of Narcan to bring me back.” (The Dark Path by Andrew D., Brendan P., Joshua M. in McDonald PA: from the operationprevention.org) “I saw myself as a pathetic creature, a fool, so completely obsessed with a stupid drug. I was in trouble because my sickness called for a cure that only made it worse: more ominous, more dangerous. I was in trouble because, though I didn’t quite get it yet, some part of me would erode further every time I came into contact with opiates in the future. My attraction would burgeon with alarming suddenness, my control would give way, and I would take risks that I couldn’t yet imagine. Opioids made me feel safe and warm, cared for, soothed and I would need them all the more to combat the shame and depression they themselves engendered.” Memoirs of an Addicted Brain “Drugs took my mind over and made me do things that I’d been brought up not to do. It turned me into a monster.” “Drugs became my full time job. The needle was my boss, a very demanding boss. My whole day revolved around it. It’s a never ending vicious cycle. The same thing over and over and over. You go to sleep doing it. You wake up and are dope sick, so you got to do it all over again. You got to at least do enough just to where you are not sick anymore.” “I stole checks from my grandma. Anything that wasn’t nailed down I stole and pawned. I stole my mom’s debit card. Heroin cost me $300 a day. You don’t think about anything. You don’t think about the people you are hurting or the lies you tell. You don’t think about getting arrested. All you can think about is getting another fix. I didn’t care what it was going to do to me later on, I just wanted the feeling of it right then and there.” “It’s not worth it. And it will get you. You are no different than anyone else. It will destroy your life. You will end up in jail or dead or in some institution for the rest of your life.” Quotes above are from Chasing the dragon: The Life of an Opiate Addict: justthinktwice.gov These testimonials give you a sense of the power of addiction and the difficulty of achieving recovery. But there is hope. Treatment works. Recovery is possible. 605 words In these articles, we have presented a very neutral view of people involved in substance misuse/addiction, but their families and the people around them will tell quite a different story. They will tell you that the person addicted to a substance is not the person they used to be. Things that interested them in pre-addiction days, no longer have any appeal. Their loved one is consumed with obtaining drugs and maintaining the drug supply. Drugs overpower every other motivator in life: family, job, hobbies, work, even children.
Brain research backs this up. “Drug addiction isn’t as simple as a person making bad choices. Rather, it reflects a disease of the very system that makes good choices possible.” Dr. Nora Volkow In their book, The Molecule of More: How a Single Chemical in Your Brain Drives Love, Sex and Creativity—And Will Determine the Fate of the Human Race (BenBella Books, 2018,) Daniel Lieberman and Michael Long describe the major role of dopamine in the chemistry of addiction. They explain how the dopamine desire circuit is designed to promote behaviors that lead to survival with an eye on the future. Dopamine urges you to possess and accumulate anything that might help keep you alive—whether you need it or like it—dopamine doesn’t care. It makes us want it right now. Dopamine activation in the desire circuit triggers motivation, energy, enthusiasm, and hope. It feels good. Dopamine turns on the imagination, producing visions of a rosy future. But, it is the salesman in no position to make the dreams come true, only making promises it cannot keep. Addictive drugs hit the dopamine circuit with an intense chemical blast, hijacking the brain. Nothing else can match it, stimulating it far more intensely than natural rewards like food or sex. The substance misuser’s entire life becomes focused exclusively on the drug. Drugs become the most important thing, overwhelming all other motivation and concerns. From the outside it looks like substance misusers are making irrational choices, but their brains are telling them that their choices are perfectly logical. The euphoria of drugs provides a bigger dopamine dose than just about any experience you can name. Substance abusers take drugs until they pass out, get sick, or run out of money; the gnawing craving is never satisfied. Many of the decisions that substance misusers make are impulsive, because they can only think of the immediate pleasure, not long-term consequences. Desire for dopamine overpowers the more rational parts of the brain, causing the user to feel powerless to resist. It’s as though their free will has been comprised by an overwhelming urge for the immediate pleasure of drugs. Addiction is not a sign of weak character or lack of will power. Instead it is a vicious cycle of the desire circuits getting thrown into a pathological state, powerfully demanding more stimulation, consuming all attention and motivation, and profoundly influencing a person’s will. In spite of these neurological changes, treatment works, and recovery is possible. People do recover from the snares of addiction with treatment and support. Last time, we discussed the policies at the state and national level that are creating positive change related to substance abuse. In addition to those discussed last week, Indiana has also implemented these legislative and policy changes.
Aaron’s Law was passed in 2015, allowing Hoosiers to obtain a prescription for Naloxone if they believe someone they know is at risk of an opioid overdose. This was recently updated to allow individuals to purchase Narcan without a prescription at pharmacies. Some Medicaid and private insurance companies may pay for Narcan. Check with your insurance provider. Indiana's Aaron's Law also contains Good Samaritan provisions that offer some legal protections to individuals who administer Narcan and call 911 at the scene of an overdose. Grants are available to county health departments to provide training and increase the availability of Narcan to law enforcement and families with loved ones involved in substance abuse. The White County Health Department is participating in this grant program, providing training and Narcan to the White County sheriff’s department. Removing unused opioid prescriptions is another important step in combating the opioid crisis. As mentioned in previous articles, the White County Sheriff and Monticello Police Department have drug take back containers that are available 24/7 for the safe disposal of unused medications. They do not take sharps, syringes or liquids. Indiana Medicaid and HIPP are increasing coverage of MAT for substance and alcohol abuse allowing more people to access these services. In White County, the United Council on Opioids (UCO) was developed to coordinate efforts and services centered around opioid and substance abuse. The UCO includes more than seventy community members who are actively engaged in creating solutions to the local substance abuse crisis . These members are working in emergency medicine, law enforcement, health care, education, the judicial system, probation, mental health care, city government, health navigation, peer recovery, or are families of those involved in substance abuse, those in recovery, community agencies, health department, treatment and interested citizens. The UCO has three task force groups; prevention, treatment, and recovery. Each group has specific action oriented short-, mid-, and long-term goals. They are achieving their goals and making a difference in our community. They have completed a working directory of treatment and recovery support services, and obtained funding for a billboard campaign to promote prevention and awareness of substance abuse. They are working on prevention activities for local schools and protocols for helping people transition from jail, hospitalization, and treatment into long term recovery. In conjunction with these efforts, White County was selected to be a part of the North Central Quick Response Team, which begin services in September. Exciting things are happening nationally and locally to combat the opioid crisis. In previous articles we discussed how the current opioid crisis did not happen overnight. A series of events, perceptions and policies brought us to this place where Americans are more likely to die of an overdose than a car accident. The death toll is equivalent to a fully loaded 737 falling from the sky and killing everyone on board 365 days a year. https://www.clarionledger.com/story/news/2018/01/26/opioid-epidemic-solutions-naloxone-overprescribing-overdose-deaths/964288001/. As a local school counselor asked in the face of this crisis: “What can we do to make a difference?” The good news is exciting things are beginning to happen nationally, at a state level, and locally.
Development in brain research began exploring the effects of substance abuse on the structure and wiring of the brain. Scientists have learned how substances such as opioids change the chemistry of brain synapses, creating a chemical desire for the drug. Drug use changes the areas of the brain related to motivation, problem solving, and impulse control. This better understanding of how addiction affects the brain is aiding in the development of evidence-based treatment options. On a policy level, many things are happening to decrease the negative impacts of substance use in Indiana. The INSPECT prescription monitoring system keeps track of the number of opioid prescriptions written by doctors and filled by patients. Just the awareness that someone is watching, has led to a 35% decrease in the number of opioid prescriptions doctors have written since 2013. https://www.ibj.com/articles/74228-report-indiana-opioid-prescriptions-down-35-since-2013 Narcan is saving lives. Narcan is an opioid overdose reversing agent. If used within six minutes of an opioid overdose, restore breathing and prevent death. As the mother of an addicted child said, “Dead people don’t enter recovery.” Narcan is now available without a prescription and can be purchased at local pharmacies. Many health departments can provide it free to families of those involved in substance use disorder. With the prevalence of fentanyl, some say that it is prudent for families with a loved one using any illicit drugs to have Narcan on hand. There are more and more opioid treatment centers opening around the state. In 2018, there were 18 opioid treatment programs in Indiana. By 2020, ten additional sites will open. Governor Holcomb’s goal is to have an opioid treatment program within an hour’s drive of every Hoosier. In addition to reducing the number of opioid prescriptions written, another positive response is the number of drug take-back containers and programs. Over 50% of people who misuse substances get them from the medicine cabinets of friends and family. Here in White County, there are drug take back containers in the lobbies of the Monticello City Police as well as the White County Sheriff’s Department. Indiana Medicaid/HIPP is providing coverage for substance abuse treatment and MAT (medication assisted treatment, providing more access to those in need of services. Probably, most importantly, people are becoming educated about opioids, addiction and treatment. Public opinion is beginning to accept the disease model of addiction, understanding how brain chemistry and changes influence behavior in addiction. |
AuthorLynn 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. Archives
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