New program seeks to short-circuit addiction before it starts

0
Photo courtesy Wikimedia Commons

This is the eighth installment in a continuing look at drug abuse and its effect on the Island community. The series began on Jan. 2 with “Opiate addiction hits home,” followed on Jan. 22 by “Martha’s Vineyard police and physicians confront opiate abuse,” on Feb. 12 “Opiates, a love story,”  on May 7 “Battling addiction on Martha’s Vineyard,” on June 5 “Section 35: When addiction calls for drastic action,”  on June 25 “Intervention — tackling addiction head-on with Island and Cape resources,” and on August 27 “Island concrete contractor builds a foundation for recovery.”

Earlier this year, Governor Deval Patrick signed off on $20 million for the Department of Public Health (DPH) to map a long-term solution for the addiction epidemic in Massachusetts. In August, he signed a bill that requires insurers to reimburse patients for addiction treatment from licensed counselors, and guarantees coverage for up to 14 days for inpatient care. Yet as more and more resources are spent on the state and local level to fight addiction, the death toll from overdoses continues to climb.

According to Massachusetts State Police, there were 53 suspected heroin or opiate overdose deaths across the state this month. There have been eight overdose deaths on Martha’s Vineyard in the past 16 months, according to Dr. Charles Silberstein, resident psychiatrist and substance abuse specialist at Martha’s Vineyard hospital.

The demand for beds in detox and inpatient-care facilities continues to vastly outstrip supply. Outpatient services remain stretched to the limit, and the relapse rates for opioids and heroin, the most virulent substances in the addiction pandemic, remain as high as 90 percent, according to the National Institutes of Health (NIH).

More and more, clinicians are focusing on prevention rather than cleaning up the wreckage that addiction invariably brings. Gosnold on Cape Cod is a drug and alcohol rehabilitation center that treats the majority of the Vineyarders who seek inpatient treatment for addiction.

“The more we get into data analytics and the more we bring behavioral health into the mainstream of medical care, the things those of us in the field have known for many years are becoming apparent — patients who suffer with addiction add tremendously to the overall health care cost and to the social welfare cost,” Gosnold on Cape Cod President and CEO Ray Tamasi told The Times. “People tend to think of the immediate fixes, like we need more hospital beds. That may be the case, but my feeling is the longer-range solution has to involve something much more substantial and sweeping, which is where prevention comes in.”

Early signs
Mr. Tamasi said that there are clear markers for people who are prone to addiction, rooted in nature and nurture, that are often overlooked. “There are predisposing factors in addiction, and we know what they are. But we’re not doing an awful lot in response with that knowledge,” he said. “We know that there’s a much higher risk with children that are born into a family where one or both biological parents have addiction issues. I was talking to a husband and wife a few weeks ago; both of them are in long-term recovery, and they just had a child. On the first day of that child’s existence, he’s got a 70 percent chance of developing addiction. These considerations need to be addressed at birth.”

Mr. Tamasi said that addiction-prevention efforts are reaching out to an increasingly younger audience. “Historically when we’ve gone into schools it’s been mostly focused on high schools,” he said. “Now we’re in middle schools and we’re in elementary schools, and we go as early as kindergarten. Obviously these children aren’t using substances, but they are coming to school with enough distress that’s interfering with their ability to learn and to adapt to the school environment. Whether they come from a family that is predisposed to addiction or not, as they move along, without some intervention to address those emotional issues, when they encounter a substance that changes the way they feel, and makes them feel more normal, if you will, they are primed for the repeat experience, and when that happens, the train has left the station. The encouraging thing is we can identify these high-risk kids at an early age. The key will be, what can we do that can right the ship?”

ABCs of addiction
A pilot program, developed at Gosnold and funded in part by the Tower Foundation and the Bilezikian Family Foundation, is sending five licensed clinical social workers into 10 schools at all levels on the Cape.

Patty Mitrokostas, director of prevention and school-based counseling at Gosnold, told The Times, “A lot of what we are doing at the elementary level is responding to issues identified by teachers and counselors that are possibly rooted in family issues — the child is often tired or sad, not appropriately dressed, or maybe hasn’t had breakfast. Teachers are also educated on the signs of depression, anger-management issues, and anxiety disorders. If we can engage the family early enough, the chances are much better that the child will learn healthy coping skills and that mental health care can be destigmatized to adult family members who might resist it. If a child learns that it’s okay to be nervous sometimes and learns to cope at a young age, that’s an extremely valuable lesson to learn at school.”

Ms. Mitrokostas said an indicator of the program’s success is the increased demand for the counselors’ services: “In our original grant application, we were looking to fund five counselors. Now we’re looking to double that number by year three. I give kudos to the schools for being so receptive to the program.”

Talking to teens
The teenage years are crucial in predicting addiction predilection, according to Mr. Tamasi. “We know when young people start using alcohol and smoking pot before the age of 14, they have a four to six times greater likelihood of developing a dependence,” he said. “The biggest change in high schools has been the very rapid migration into opiate pain pills. From there we’re seeing a very quick move to heroin, which is where we’re seeing more and more overdoses. The introduction to mind-altering substances has traditionally been alcohol and marijuana, which is still often the case, but we’re seeing a lot more young people taking an opiate. There’s also the perception that if it’s made by a pharmaceutical company, it’s safe, but they don’t realize how rapidly these medications produce dependency.”

Mr. Tamasi said families can be very reluctant to acknowledge addiction. “No one wants this to be happening, and the natural tendency is to minimize it,” he said. “When you wait too long and the problem has become obvious to everyone, it’s a lot harder to get the horse back into the barn. The earlier you start talking about these things, the better chance you have of forestalling or preventing substance abuse.”

How should parents respond if their child comes home under the influence? “You sit down the next day and say, ‘We’re going to a professional and talk about this,’” Mr. Tamasi said. “That does not equate with ‘you’re addicted.’ It really has to do with education and awareness and interrupting the cycle. Teens often deny it. It’s like a lot of things, the first impulse is to say, ‘It’s not really a problem.’ There’s always someone they can point to who’s deeper in addiction. It’s not just the young person that does it; families often do it too.”

In general, Mr. Tamasi is not an advocate for drug testing at home. “If the young person has access to the family vehicle, that might be a reason to do it, but I’m not a great fan of testing, unless it’s recovery management,” he said. “I don’t think there’s a need for a family member to find incontrovertible evidence. You’re not trying a case. This is a family issue now, so if the teen won’t go for professional help, the family member can go. Then it’s a matter of customizing an approach. When all else fails, tell the truth and be candid.”

“Families are the most influential factor in a child’s development, even through high school,” Ms. Mitrokostas said. “The more educated the parents are about abuse prevention and mental health, the better for everyone.”

Dr. Charles Silberstein agrees with Mr. Tamasi and Ms. Mitrokostas. “The main reason people use substances is for a sense of connection,” he said. “Drugs can give an artificial sense of connection, and I think that’s why a lot of kids use them. The world feels lonely and they don’t feel connected to family. There was a study done that showed nightly family dinners are a predictor of not engaging in substance abuse,” he said, referring to the 2011 study by the National Center on Addiction and Substance Abuse at Columbia University. The study concludes, “Compared to teens who have frequent family dinners (5 to 7 per week), those who have infrequent family dinners (fewer than 3 per week) are almost 4 times likelier to use tobacco; more than twice as likely to use alcohol; 2½ times likelier to use marijuana; and almost 4 times likelier to say they expect to try drugs in the future.”