The Front Lines of the Opioid Crisis

A starting point for understanding

I attended a presentation by Cody Gardner of the Redpoint Center in Longmont, CO on “What We Have Learned — Addiction, Mental Health and Recovery in Colorado.”

The Redpoint Center is an outpatient substance abuse treatment facility that seeks to empower its clients to live meaningful lives of Community, Purpose, Recovery. Their goal is to foster healing through the cultivation of practical recovery skills, the addressing and healing of past-trauma, and by building a strong community around each of their clients.

According to the National Institute on Drug Abuse, “it has been known for many years that the ‘treatment gap’ is massive—that is, among those who need treatment for a substance use disorder, few receive it. In 2011, 21.6 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem, but only 2.3 million received treatment at a specialty substance abuse facility.”

More than 140 Americans die every day from an opioid overdose, according to the Centers for Disease Control and Prevention. As Mr. Gardner put it, “that’s like a plane crash a day.”

President Trump has said “We are currently dealing with the worst drug crisis in American history. It’s just been so long in the making. Addressing it will require all of our effort. We can be the generation that ends the opioid epidemic.”

One point that Mr. Gardner emphasized was that “Substance Use Disorder is a diagnosable and treatable condition of the brain.” There’s a tremendous amount of science demonstrating these drugs trigger a rapid release of dopamine into the pleasure center of the brain. “Addictive drugs provide a shortcut to the brain’s reward system by flooding the nucleus accumbens with dopamine. The hippocampus lays down memories of this rapid sense of satisfaction, and the amygdala creates a conditioned response to certain stimuli.

A compelling point was that if these drugs didn’t make the addict feel good, they wouldn’t do it. Which, of course, is part of the problem since no one wants to part with things that make them feel good — even though they may be killing them. While part of this is personal choice, the science indicates that addictioin is also traceable directly to the function of the human brain leaving the person virtually powerless to stop.

Another interesting observation was that the process of getting pleasure from these drugs largely circumvents the reasoning centers of the brain. Alcoholics, he mentioned, will sometimes say things like “the car drove itself to the liquor store” by which they mean that they simply were acting on the need to repeat the pleasurable experience without the ability to overpower the need with logic. With help, the addict can begin to train themselves to process more logically but the interesting point is the physiological nature of going from wanting to needing.

Mr. Gardner noted that “it takes, on average, seven tries for someone to break an addiction.” There are a couple good points here of which the first is that it’s not unusual for patients to relapse into old patterns. For instance, Type I Diabetics fail to take medication as prescribed or don’t follow diet and exercise recommendations at a rate of 30-50% according to the National Institute on Drug Abuse. Drug addicts relapse at a 40-60% rate. The key is that relapse is not a failure but part of the human experience and best results are obtained through long term treatment that helps patients understand the source of triggers that could cause them to relapse.

There is a drug known as Suboxone that provides a way for people to gradually be weaned off their pre-existing addiction, while minimizing the opioid withdrawal symptoms that would come from the process. While Mr. Gardner fears that Suboxone is being used as a one size fits all answer, in his own instance he was able to kick a heroin addiction until the allure of “that real high” he enjoyed so much drew him back to heroine and he relapsed.

Mr. Gardner commented on the need for custom crafted solutions that address the broader scope of what’s going on in people’s lives. “One thing I know is that we need to create safe places for people who haven’t been in a safe place for a really long time.”

What are things we know that work according to Mr. Gardner:

  1. Evidence Based Treatment such as motivational interviewing, behavioral therapy, and trauma therapy.
  2. Dosage and frequency are key. In other words, you have to do it intently, often, and over a long period.
  3. “When we look at someone with a substance problem, actually looking at the problems in their life, rather than simply applying a by the book approach, has a much better impact.”

“One thing I know for certain,” Mr. Gardner said, “is that we can’t incarcerate our way out of this problem.”

Mark Rosneck

Written by Mark Rosneck

Site owner and whipping boy. Posting entirely in whiteface.

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