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Risk Factors
By lindamuralidharan on 2017-12-29 05:54:35
Over the years of working (for money) or volunteering in human services, I have known many heroin addicts....in various
stages of active using or recovery....as well as people addicted to myriad other drugs. I know people personally and in my
family who use addictively, with alcohol pretty much being the drug of choice in my own family (and in the families of
various generations of in-laws). I feel very vested in the hope for prevention and recovery with respect to chemical
addictions....and other behavioral addictions as well, for that matter. I believe it is much harder for citizens to concentrate on
issues of war or peace or international diplomacy when too many or their lives are obsessed with either getting more drugs
or worrying about family members whose lives have spun out of control because of chemical dependency. A lot of money
meanwhile is wasted on law enforcement, jails, and lost hours of productive work. And to say the least, it is humane and
loving to prevent suffering if at all possible. As we do read in the papers (or for some, I am sure, we observe the waste of life
and human talent first hand), there are mind boggling reports of overdoses and overdose fatalities, of huge quantities of
addictive medicines (mostly opioid types) dumped in certain communities, and of hand wringing by politicians, reporters,
and the like. I will not try to reproduce here the barrage of information about which states have the worst of the problem,
how overdoses have increased in recent years, or how many fatal overdoses have been recorded in given jurisdictions. With
one exception. I could not help but be struck by today's news report that in Chicago this year there have been 800 opiod
overdose fatalities. [caption id="attachment_ 10704" align="alignleft" width="341"]
e. lal
3 ) aD
a i
if ‘ Doctors who treat and prescribe[/caption] The connection for many
between abuse of prescription drug abuse and street drug (in particular illegal fentenyl and heroin) abuse has been
documented by any number of reporters. Maybe we are making a small amount of progress in some communities in both
prevention and treatment. However, I think it possible that the public may have "opioid abuse" burn out, and that the issue
of substance abuse in general may soon fade from the public mind. Except for the pin prick of a news article now and again.
[caption id="attachment_10705" align="alignright" width="450"]
| widow in graveyard looking at grave[/caption] For
example, as New Year's Eve approaches and recognizing the tendency to overuse alcohol on that occasion, even by those
who usually imbibe moderately, our news said today that in the state of Hawaii over 50% of traffic fatalities involve one or
more drugs. And yet I hear of no new significant funding for substance abuse or mental health treatment here. And at the
national level I believe there has been very uneven response by politicians or even the public to the issue. Some people call
ita "crisis". Maybe because that is an easy term to refer to and maybe because white people are being affected the most
now. And these white people are not necessarily in the poorest, sometimes referred to as "welfare", class. People who often
have been seen as "middle class" ... although many might have obtained their comfortable life style by good union jobs and
not by advanced education and white collar employment.... are in some states dying from opioid overdoses or in some other
states by a variety of suicidal means. White males are particularly at risk for suicide. [caption id="attachment_ 10706"
align="alignleft" width="620"]
NYS prison in Dannemora,
N.Y.[/caption] I write to encourage people to keep the problem of addiction near the_front burners of our public life. Even as
I write, I am sad for a grandmother who was once homeless, who has a mental illness (I believe the diagnosis is depression
in addition to addiction) and who has resources today for treatment of both issues. When I met her in a transitional shelter
two years ago she was managing fairly well, a participant in the activities there and in regular contact with at least one of her
adult children (she once had a home and husband and family before she went to live on the streets). After some time she fell
and had to have her replacement hips operated again and properly aligned. From then on I notice she was isolating a lot in
her studio apartment at the shelter and falling a lot. I finally asked and she owned up to taking a considerable amount of
prescribed opiates "for pain". Since I had had similar hip operations, I knew that this was well past the time she would need
this kind of medication for that pain. She claimed her wrist had such bad arthritis she had to keep on the medication month
after month. I suggested she return to her previous recovery program perhaps using all she once had learned in rehab and in
a 12 Step Program. She did read some material I offered her about the opiate type pain medication, but she was not willing
to ask for direct help. I had no way of talking to her doctor about this although I did express my concern to staff who could
pass on the concern to a case manager. I have no idea whether that case manager is experienced with this population or
understands addiction. Now, making a long story short and after this woman (of whom I am very fond having known her
for over two years) seemed to deteriorate both in physical functioning and in socialization experiences, she announced she
had been diagnosed with cancer....located I believe in the area of her esophagus. She is now residing in hospice and waiting
to die. We do not know that the medication caused the cancer. However, I believe that a life style of self-medicating with
both "recreational" and prescribed drugs, poor attention to treatment of depression, and lack of exercise....and for all I know
poor nutrition....zapped her will to live and also left her body vulnerable to diseases like cancer. In the recovery community
or rehab programs and 12 Step Programs we have a saying that continuing to use drugs addictively leads to one or more of
the following: jails, institutions, or death. Some of us believe there are quick deaths.....overdose, being shot while on a drug
buy, driving under the influence....and also slow forms of suicide such as continuing to use alcohol or other drugs when
there clearly is a problem. [caption id="attachment_ 10707" align="alignleft" width="133"] Hope by the
Sea, high end rehab in California[/caption] What are the risk factors for substance abuse? What is prevention all about?
What is the responsibility of the rest of us? I think we could start with getting honest in our public presentations and
reporting. We cannot afford to lie to children any more (remember how marijuana was presented as a complete menace in
drug prevention propaganda 50 years ago? Or the egg on a hot griddle as metaphor for your brain on "drugs"? Almost all
common drugs can be used safely if understood and used properly. That includes cocaine and the rest. Personally I avoid
everything illegal and if all were legal I would still avoid PCP and if I had any tendency to psychosis I would completely
avoid the hallucinogenic ones. I would avoid marijuana in the latter instance. Also I would avoid the designer
drugs....although if they became legal their chemical components and side effects might have to be published on the label
and they might become safe. Now I view them as too much of an unknown quantity. [caption id="attachment_ 10708"
align="alignright" width="600"]
Windward Way
rehab[/caption] The other biggest turn towards honesty would be to be sure the news media and such stop saying "alcohol or
drugs". You see this phrase used consistently when a crime is being investigated for cause. The media needs to start saying
something like "alcohol or other drugs" or perhaps just the one word "drugs." Alcohol is a drug. Pretending it is not may be
the result of the liquor lobby propaganda or just the lazy and ignorant thinking of the public. A recent report here in Hawaii
said that in over 50% of this year's auto fatalities alcohol was a factor. In some cases other drugs were involved as well.
Whether these were prescribed or not was not stated. Beyond honesty we need to begin in schools and in senior centers and
in family education programs to explain that prevention starts early. Preserving the self-esteem of young people is critical.
Improving the openness and clarity of family communication can be key. Promoting resilience and good decision making
skills are of the greatest importance for success in life as well as for preventing run ins with the law and substance abuse.
Schools, families, the media, and all aspects of community life need to understand the issues. So education about prevention
is a never ending loop of educating the human service agencies and the doctors and the schools to educate the children and
the parents who later become doctors and educators in their own right.. One public movement to improve recovery is being
conducted by Attorney Generals in many states. They are urging insurers to include nontraditional methods of pain control
and recovery enhancement in their health care policies. Example of enhanced coverage would include acupuncture, yoga,
and similar holistic approaches. People can become more aware and tactfully outspoken when peers indicate they cannot
have fun if not getting high. I believe people have the right to a any recreational drug of their choosing in moderation.
Marijuana or a cocktail or mug of beer can be completely harmless as well as enjoyable. But people need to know how to
kick back and enjoy themselves with sports and humor and good company and maybe lemonade on occasion rather than a
Bud. People need to know good times can be had without getting smashed. More importantly, when somebody says "I
need a drink", there ought to be red flags. Once in a blue moon a gin and tonic after a long arduous day won't hurt the
person who is not an alcoholic (the latter literally cannot afford even one drink as a matter of life or death). However the
"attitude" that the main coping skill for stress is a mood altering substance is one reason we as a society lose millions of
dollars a year to the ravages of substance abuse. Remember, the issue is substance abuse, not substance "use". [caption
id="attachment_10709" align="aligncenter" width="300"] Valley HealthCare
affordable treatment in West Virginia[/caption] In addition to personal risk factors that need attention and in addition to
personal strategies that can be addressed to reduce addiction, there are also preventive public policies. Among these are
eliminating advertising of mood altering substances to young people and reducing the excessive prescription of mood
altering medicines whether anti-anxiety types or pain management types. Twenty years ago I began accusing the medical
profession of harboring as many "pushers" as street corners did. Apparently medical schools were severely deficient in
teaching about addiction. My experience at the time was mainly with people trying to stay clean from recreational drugs.
They would understandably have aches and pains and injuries and other medical conditions in sobriety. However if a doctor
chose the wrong kind of drug to treat these people they would have a stimulant to their craving right in a legal bottle of
pills. And some over the counter medications were suspect also. Relapse sometimes followed taking the wrong medication,
and the staff in one program had a local pharmacist on call to advise us what were "safe" medications for our clients. We
could not trust the doctors to know what was right for addicts. Yes, treatment is important and we need to lobby for more
and better versions of that. However, each of us is responsible for mitigating the destruction of addiction in the same way
we are responsible for following traffic safety laws and for fire prevention in our homes or at our camp sites. We are
responsible for knowing risk factors and for eliminating as many of them as are under our control. That applies to ourselves
and to others.
