Drug overdoses are currently the number one cause of death for Americans younger than 50, coming in higher than both guns and car accidents. In 2016, there were 42,249 overdose deaths in the U.S. that involved an opioid.

The opioid crisis has been declared a public health emergency, but what does that really mean? What makes this a “crisis”? How is it different than the other drug issues that are facing our country?

This is a complex issue because the category of opioids includes both legal and illegal drugs. For some, legal prescriptions to alleviate chronic pain may lead to addiction. Others start using with pills from friends or a family member. Still others purchase heroin or fentanyl from dealers.

For years, there has been overprescription of opioids in the pharmaceutical industry that has influenced this trend of addiction. Now, use of more potent opiates like heroin and fentanyl are increasing sharply.

This crisis has complex and dangerous implications on healthcare, the economy, and the well-being of millions.

Opioids & the brain

The term “opioids” refers to a category of drugs that includes prescription pain relievers, heroin, and synthetic opioids like fentanyl.

Opioids work by mimicking chemicals that naturally occur in the brain, which is part of what makes them so dangerous. They attach to the body’s opioid receptors in the brain and spinal cord. When these receptors are activated, they inhibit the transmission of pain signals. That is why they are used as prescription pain relief.

They also activate the brain’s reward center by releasing a neurotransmitter called dopamine. This is what creates the feeling of euphoria or “high.” This reward circuit enhances the highly addictive quality that opioids have.

Over time and with repeated use, the receptors in the brain become less sensitive to the drug, it takes more to achieve the same effect, and physical dependence develops.

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The price of the opioid crisis

Misuse of opioids also places a huge financial burden on society as a whole. It is estimated that this crisis costs the United States over $78.5 billion annually. We are talking about healthcare, criminal justice, and substance abuse treatment costs. It is important to understand the magnitude of this problem, and the massive majority of the population that is affected.

Specifically here in Georgia, there is an area north of Atlanta that has been called “the heroin triangle” because of the increasing concentration of heroin use. This is a largely middle-to-upper class suburban area that includes Cobb and Fulton counties, where heroin-related deaths have increased by 3,844% in the past six years.

The price of the opioid crisis goes far beyond finances. An increasing number of infants are being born with neonatal abstinence syndrome, as opioids pass through the mother’s bloodstream to the fetus. Essentially, babies are born into drug withdrawal, and they experience symptoms like excessive crying, sweating, and tremors. This often requires an extended stay in the hospital, and sometimes even medication.

It is easy to point fingers at brokenness when we are talking about something like this, but stigmas and misconceptions about addiction can perpetuate unhealthy behavior and prevent people from seeking the treatment that they need.Listen to some of our staff members discuss opioid treatment, as well as community and vulnerability.

Treatment challenges

Treating an opioid addiction is challenging because of the way that these drugs change the brain over time. Natural pathways have been interrupted by consistent drug use, and the brain has to re-learn how to operate on its own.

There is a high correlation between opioid use and mental health problems like anxiety and depression. Researchers have concluded that 48% of people who are addicted to heroin also experience depression. This is why comprehensive, whole-person treatment is important. We want to address both physical and mental health, as well as the underlying issues of addiction.

When someone is in active addiction, they often lack healthy coping skills. They have learned to react to tough emotions and challenging situations by using drugs to escape that reality for short periods of time. Learning coping skills is a huge part of treatment at MARR. We want our clients to be prepared for the challenges of a life in recovery and develop new habits to replace turning to drugs or alcohol.

The opioid crisis is a complex and widespread issue that has developed and changed over many decades, and there is no single and simple solution to end it. However, we want to take steps in the right direction. We believe that holistic, long-term treatment is the best way for individuals to step into recovery and begin a journey towards a better life.

There is hope and freedom beyond the crisis.

Sources:

https://www.cdc.gov/nchs/data/databriefs/db294.pdf

https://www.huffingtonpost.com/entry/the-opioid-epidemic-a-national-public-health-emergency_us_598b0179e4b0f25bdfb320c9

https://www.ncbi.nlm.nih.gov/pubmed/27623005

By Todd Valentine, LCSW

At MARR, men enter our care because drugs and alcohol have damaged or completely destroyed their lives. They often embarked on the path of addiction as an unhealthy method of coping with painful thoughts and feelings. Perhaps they experienced early childhood trauma in the form of parental neglect or bullying in school. Or as an adult, they underwent a traumatic event as a member of the military. Regardless of the “whys,” they relied on substances to stop the pain. Feeling absolutely nothing was the intended goal.

Unfortunately, once the substance, and its mind-numbing properties, is negated, the feelings he has so successfully avoided return in full force. He is like a man standing in a severe snowstorm without clothing; he is defenseless and vulnerable.

Consider this example: a man enters treatment because of a severe opiate addiction. Once detoxed, His mind is flooded with ghastly scenes from the past and equally bad future scenarios. How could he have bankrupted his family to buy drugs. Will his wife leave him? What will he do for income when he is sober?

These thoughts and fears spiral out of control; they overwhelm him and threaten to pull him down. This man is a single step away from picking up a pill bottle.

MARR recently integrated a new component into the treatment plans of our male clients to provide an option in this situation. It is mindfulness. Frequently, men are reluctant to engage in the practice, erroneously believing it is somewhat mystical or alternative in nature. Yet, by the conclusion of treatment, it is often these same individuals who prove most grateful for learning this valuable skill.

Mindfulness is the skill of being fully present, living in the moment, neither projecting into the future, nor obsessing on the past. Although easily learned, it is a strategy that necessitates time and practice to refine.

In the case of the man described above, a mindfulness technique is indicated. He is directed to inhale deeply, then exhale. This is followed by inhaling to the spoken count of four, holding for the count of seven, then exhaling to the same count.

During this process, the brain waves actually alter as does the chemical makeup of the brain. As a result, his body begins to relax and release tension. But even more important, his mind refocuses on the act of counting and breathing. The human brain, for as remarkable as it is, simply cannot focus on several things at once. With each inhalation and exhalation, the regret of the past and fear of the future is mitigated.

The beauty of this practice is two-fold: first, it stops the spiral in the moment; and second, it demonstrates that he must not be the ubiquitous victim to his own negative thoughts and feelings. This skill can be utilized anytime to reduce stress and reassert calm.

Another exercise I use is the mindful walk. We start by stretching, perhaps doing a couple yoga poses. The focus is on breathing and physical sensations such as the heart beating in the chest, or the thigh muscles offering slight rebellion. Instead of perpetually hurting their bodies with chemicals, this allows men to reconnect with their physical beings in a positive way. In time, as health returns, they often grow to appreciate, and even, respect their bodies for how miraculous and resilient they are.

Mindfulness is highly engaged with the five senses. Therefore, during our walk, they are encouraged to intentionally exist in the present moment: Smell the air, feel the ground beneath their feet, watch the shifting shadows created by the clouds. The past and future are superfluous; all that matters is the now. The ancient art of mindful Meditation also has incredible value. When in a deeply calm and relaxed state, the mind’s well being is enhanced. In addition, receptivity to positive affirmations about oneself is improved.

Healing from addiction isn’t easy for anyone. But having the practice of mindfulness in the recovery toolbox is invaluable. Reestablishing empowerment helps men feel strong, capable and less victimized by their thoughts and emotions.

As humans, we have an innate desire for connection. We want to feel accepted by the people in our lives, whether it be friends, family, or significant others. We want to feel like we belong. One of the biggest roadblocks to belonging is feeling shame: shame about things that happened in the past, shame about habits or actions or choices.

Author and researcher Dr. Brené Brown defines shame as “the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging – something we’ve experienced, done, or failed to do makes us unworthy of connection.”

A disease of isolation

When someone lets shame drive their life, they start to believe that they are not enough. They believe that there is something fundamentally bad about who they are, and they begin to isolate as a result of that.

Addiction is a disease of isolation and disconnection. This isolation comes in many different forms, whether it be losing relationships with family, walking away from community, or disengaging at work. In active addiction, shame causes someone to be disconnected not only from those around them, but also from themselves

Listen to Caryn B.’s story of finding support and acceptance in her community at MARR:

The cycle of shame

At the core of addiction is an attempt to escape reality. If we do not know how to identify and process our feelings and emotions, it can be much easier to run from them than to face them. These emotions can stem from stress, trauma, abuse, or anything in between. For an individual who suffers from addiction, drugs or alcohol become a vehicle of temporary escape.

Addiction perpetuates a cycle of shame. Shame about past actions or experiences can push people towards substance abuse. Society’s stigmas about addiction can fuel more shame, which in turn pushes people back to drugs and alcohol to escape again.

As this cycle goes on and on, it digs deeper into one’s life. It fuels hopelessness, and someone may not think that they even deserve help or treatment because of this idea that they are a “bad” person.

Breaking the cycle: acceptance and community

In order to break the cycle of shame and escapism, we must use tools to combat these patterns. The opposite of escaping is engaging. Engaging with one’s emotions and with people who are willing to listen.

It takes a lot of courage to show up in recovery. It takes even more courage to present your true self: fears, failures, and messy feelings included. But this courage paves the way to true belonging.

At MARR, true belonging is found within the community. We tend to use this phrase a lot, simply because it is at the very core of who we are. We believe that lasting recovery requires growth and support. In order to grow, you need to know that you are not alone.

These communities create a safe space to begin a journey of recovery. With a home-like setting, a balance of daily activities, and group accountability, clients begin to develop the tools that they need for recovery.

These tools include:

• Learning how to identify and process feelings and emotions
• Developing healthy rhythms of work, rest, and responsibility
• Dealing with conflict and setting boundaries
• Setting and working towards goals

This kind of community is built on vulnerability and acceptance. This includes acceptance of others and self-acceptance. If you want to experience true acceptance, you have to be willing to show up exactly as you are and face the parts of yourself that are scary. In turn, you will be met with empathy and understanding from people who are walking alongside you towards a life of recovery.

You will be accepted at your worst. You will be accepted in the middle of the process when everything is messy. You will be accepted without any sign of perfection.

By Patrice Alexander, MS, LPC

At face value, the word detachment has a negative connotation and conveys a sense of loss. It is hard to imagine being “detached” or “separated” from someone we love. It is human nature when we see a loved one hurting to want to offer help to comfort and ease his or her pain. This is especially true for family members whose loved one struggles with the disease of addiction.

Addiction is a family disease that traps every member of the family. As the disease progresses, it starts to govern the thoughts, feelings and behaviors of every family member. The natural human responses of showing love through generosity, support and compassion become unhealthy responses in addiction. I have witnessed the disease of addiction turn the most loving bond between family members into a very dysfunctional and unhealthy relationship. Detachment is not easy; however, in order for the family to learn healthier ways to show their love and support without enabling the disease to continue to wreak havoc in their relationship, it is necessary. Through detachment, family members discover how to trust and open their hearts in safer ways. Detachment helps each member move toward personal growth, which can prepare him or her for healthy relationships.

I encourage family members to consider detachment as a decision to avoid participating in negative emotional connections, rather than a decision to abandon their loved one. In this sense, it can allow them to maintain boundaries, protect their values, preserve their integrity and steer clear of the undesired impact. As such, it becomes a deliberate mental attitude which can help them avert engaging in the emotions of others.

Detachment is choosing to allow other people to live their lives without giving them advice, even when there is a great degree of difficulty and possible danger involved. Most of us are not taught how to detach; it feels counterintuitive. Detachment is embracing our individuality and taking responsibility for our own lives instead of waiting for someone else to do something different so that our lives can be okay.

Admitting and accepting that we are powerless over other people and their decisions allows us to practice detachment. The Al-Anon book, Courage to Change, states, “Detachment with love means that I stop depending upon what others do, say or feel to determine my own well-being or to make my decisions.” Without detachment, it is much harder—if not impossible—to create an atmosphere for healing so that the gift of recovery can be discovered and passed on/shared with others.

“By talking about addiction in the light of day — and by celebrating recovery out loud — we can help correct the misinformation and stigma that become obstacles for people who want to live healthy, productive lives.” – Gil Kerlikowski

In 2012, Gil Kerlikowske, Director of the Office of National Drug Control Policy, delivered a speech that called for a “paradigm shift” on substance abuse, whereby addiction would be considered a public health issue and not a crime.

Kerlikowske’s speech focused on changing the way Americans view addiction, moving away from punishment and toward prevention, treatment and recovery. But in order for a real “paradigm shift” to occur, there are a few common myths of treatment that must be debunked.

Misconceptions can be a barrier to treatment. They can feed a cycle of shame, resent, and negativity. They can prevent addicts from asking for help when they need it. The best way to combat misconceptions is to be educated about the truth.

Myth #1 – Addicts/Alcoholics Are Just Weak

In his speech, Kerlikowski noted that addiction “is not a moral failing on the part of the individual, but a chronic disease of the brain that can be treated.”

Society often views addicts/alcoholics as simply lazy and unlikely to change. This is just not true. Addiction is a disease that crosses all socio-economic boundaries, from high-functioning executives to high school dropouts. Although most addicts/alcoholics are resistant to treatment, they will begin to see the possibility of a fuller life once they begin the recovery journey. The important thing is: they are not “bad” people with just a lack of self-control.

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Myth #2 – Addicts/Alcoholics Have to Hit Rock Bottom

Addicts/alcoholics come in many forms — even if the individual has not hit the stereotypical ‘rock bottom,’ he or she can still benefit from drug and alcohol treatment. The ultimate goal of recovery is to prevent the all-time low from taking place.

Myth #3 – Addicts/Alcoholics Have to Want Treatment

Oftentimes family members believe the addict/alcoholic has to want treatment in order to experience success. Nothing could be farther from the truth. It is rare that a person enrolls in treatment out of sheer desire. Instead, he or she is typically forced into treatment by a spouse or significant other, the judicial system or an employer, to name a few. It isn’t until some time has passed in addiction treatment that the individual sees the promise of recovery. It is okay if someone doesn’t have a desire for treatment; there can still be a potential for change.

Myth #4 – Addicts/Alcoholics Must Recover for Themselves

This sort of ties back to myth #3. Addicts/alcoholics don’t have to want to be in treatment, nor do they have to recover for themselves. If they maintain the frame of mind that they’re in recovery for a loved one, that’s okay. There are many parents that enter into recovery for their children’s sake. And that’s okay. The point is, they are in treatment. The important thing is that they are supported, accepted, and capable of change.

Myth #5 – All Addiction Treatment Facilities Are the Same

Sometimes the addict/alcoholic goes through several rehab centers until he or she finds lasting recovery. Family members often become exhausted and discouraged at this point, and they begin to think all facilities are alike. This is simply not true. Every addiction treatment center is different.  Here at MARR, we focus on gender-specific, long-term residential treatment and the Therapeutic Community model. When searching for the best drug and alcohol rehabilitation center, conduct extensive research before making a decision.

Reference: 

http://articles.latimes.com/2012/jun/11/news/la-heb-drug-addiction-mental-illness-kerlikowske-20120611

By Jim Seckman, MAC, CACII, CCS
“One of our responsibilities as counselors is to have healthy boundaries. These boundaries can easily become blurred if, or when, we begin to intrude on the personal lives of clients outside the professional relationship.

“Professional judgment includes how we conduct ourselves in public, even in our leisure time, which includes what we post on a Facebook page for all to view.”

– Frances Patterson, PhD, MAC, To Facebook or Not to Facebook, NAADAC News, March/April 2012

Social media (e.g. Facebook, Twitter, etc.) has become an integral part of our lives. No matter how active our involvement, we cannot deny the impact that this form of communication has had on our society. Social media has given us unprecedented abilities to communicate to large numbers of people, and therein lies the problem. Whether we like it or not, we leave behind a digital footprint nearly everywhere we go. Dialogue placed within social media outlets is broadcasted to the public arena, whereby individuals read and interpret such communication any way they wish.

Reputations, both personally and professionally, have become tarnished in an instant; confidential information can quickly become public knowledge; and company bad-mouthing can spread like wildfire.

We, as citizens, have the constitutional right to freedom of speech; however, as addiction treatment professionals, we have an ethical responsibility to represent our field, our colleagues and our facilities, in both our professional and personal lives, with respect, courtesy, sensitivity and fairness. When we lose sight of this responsibility, our boundaries loosen, and that can lead to ethical violations in the form of dialogues that are inappropriate, insensitive to colleagues and hurtful to clients.

Most ethical standards and confidentiality laws have not really caught up with what is taking place in the world of social networking. But, the NAADAC NCC AP Code of Ethics was revised in 2016 and offers guidelines by which we as treatment professionals can determine the ethical implications of our social media involvement. In the previous NAADAC Code of Ethics, in the Introduction, it states:

“NAADAC recognizes and encourages the notion that personal and professional ethics cannot be dealt with as separate domains. […] Addiction professionals must act in such a way that they would have no embarrassment if their behavior became a matter of public knowledge and would have no difficulty defending their actions before any competent authority.”

The Code of Ethics states very clearly that professional ethics and personal ethics should remain consistent in the life of the treatment professional. Any actions, words or behavior, whether professional or personal, are held against the same standard. If we live our lives from two disparate ethical perspectives, we will not only experience internal conflict, but the negative viewpoints and behaviors of one will ultimately contaminate the more positive viewpoints and behaviors of the other as well.

However, while our ethical stance should be consistent in our lives, when it comes to Social Media, the Code of Ethics is very clear about the distinction between our professional and personal presence:

“Addiction professionals shall not accept client ‘friend’ requests on social networking sites or via email. Providers who choose to maintain a professional and personal presence for social media use, shall create separate professional and personal web pages, and profiles, which shall clearly distinguish between the professional and personal virtual presence.”  – Principle VI-19 Friends

I think the important concept here is that of boundaries and how we use our “presence” to either benefit or harm the client.

“Addiction professionals shall be aware of their influential positions with respect to clients, trainees, and research participants, and shall not exploit the trust and dependency of any client, trainee, or research participant. Providers shall not engage in any activity that violates or diminishes the civil or legal rights of any client. Providers shall not use coercive treatment methods with any client, including threats, negative labels, or attempts to provoke shame or humiliation. Providers shall not impose their personal, religious, or political values on any client. Providers shall not endorse conversion therapy.” – Principle I-22 Exploitation

We have a lot of power as professionals. Often, we don’t understand just how much power we have in the lives of clients. When we make public our opinions and beliefs, particularly in a manner that comes across as forceful, it is no longer just a matter of debate or discourse. Our opinions are seen as having more value and authority by our clients. We must be extremely careful what we say, how we say it and where we say it.

How do we live our lives? As treatment professionals, we dedicate our working lives to the healing and benefit of others. Our personal lives should reflect the same dedication.

Oftentimes we might express things that we intended to be taken lightly or casually, but others interpret them as offensive. At that point, it no longer matters whether or not we intended them to be offensive—they simply are offensive. It is always our responsibility to consider our actions and, if necessary, make amends. Ethical guidelines exist so that, as treatment professionals, we have:

• A common understanding of expectations
• A corrective influence on personal bias/problems
• A common understanding and obligation among members of the profession
• Responsibility and accountability
• Boundaries for the protection of the client and the professional

Social media is challenging our boundaries and ethical guidelines in ways we could not conceive of 10 years ago. It is critically important that we maintain congruency in our lives, both professionally and personally. Our involvement with social media places a greater responsibility on us as professionals to maintain healthy boundaries, and is either an opportunity for, or a detriment to, respect, healing and recovery.

Jim Seckman, MAC, has over 30 years of experience working in the field of addiction treatment in a variety of clinical settings, including inpatient, outpatient and residential. Jim is past president of GARR (Georgia Association of Recovery Residences), has served on the Ethics Committee for GACA (Georgia Addiction Counselors Association) and conducts regular training workshops on addiction treatment.