As we think about the issues we struggle with as a society, especially the current opioid epidemic, we reflect this holiday season on how and why we arrived at such a place. We are all too familiar with our loved ones overdosing and the ensuing death toll. We are keenly aware of the struggles the people who suffer from substance use disorders experience when seeking treatment. We have placed the blame on nefarious figures, but the root causes and the issues aren’t all that different from the problems of the past.

People seek pleasure, relief, and comfort through substance use, whether it be alcohol, drugs, food, gambling, sex, shopping, etc.  The drug use and compulsive behaviors previously mentioned provide some sort of relief, albeit temporary, and offer a respite from their current discomfort.  

We know more now than ever before about the brain and its functioning, how drugs and compulsive behaviors affect our brain chemistry, and produce the euphoria and escape sought by those in distress, bored, or simply looking for thrills.  We can understand the mechanisms of the drugs, their effects, their power, and their related behaviors, but what continually eludes us as a society is “why”. Despite all the negative consequences, often life ending, we continue to consume more and more of these harmful substances, and exhibit even riskier behavior.

We look to find hope in a brighter tomorrow, despite the present overcast skies.   

After 30 years of working in drug and alcohol treatment, it occurs to us that working toward prevention and early intervention is where we need to focus more of our efforts and resources.  There is an old parable about a small bucolic village with a beautiful river running through it.  The story goes something like this. On one bright sunny morning, without warning lifeless bodies started to appear floating downstream.  The villagers all ran to the river to try to rescue these young beings.  As the good townspeople frantically tried to save these young lives, they realized that their efforts though heroic were not saving nearly enough of these young adults.  After a few grueling and heartbreaking hours, the villagers noticed a that few people had stopped helping and started to turn away.  Somewhat bewildered they yelled “where are you going, we need all the help we can get.” Those running said, “we’re going upstream to see where these lost souls are coming from.”   

We have been pulling bodies out of the stream for a long time now, work which is difficult, stressful, tiring, and frustrating.  Especially when we seem to be losing more than we save. We believe that we should put more of our focus “upstream”, to understand why so many individuals among us seek relief, entertainment, or social connection with substances, and risky behavior.  Our fear is that if we don’t resolve the source of the problem, we will always be watching our loved ones floating down the river.  

When should that help begin? How far upstream do we go? In broad terms we must embrace and practice the South African term “Ubuntu” or “humanity towards others”, a phrase that is often used in a more philosophical sense to mean “the belief in a universal bond of sharing that connects all humanity”.

In research done by the Noble Prize winner James Heckman, Director of the Center for the Economics of Human Development, and echoed by Bessel Van der Kolk, MD, Boston Center for Trauma, we find that in today’s world one’s zip code rather than one’s genetic code is a more reliable determinant for having a safe and healthy life. Trauma and its antecedent social ills such as poverty, discrimination, violence, poor housing, community disruption and lack of opportunity are seen to be the major contributors of the epidemic. If we look at some sobering statistics, since 2001, more Americans have died at the hands of their partners or family members than the wars of Iraq and Afghanistan; American women are twice as likely to suffer domestic violence as breast cancer; and the American Academy of Pediatrics estimates that firearms kill twice as many children as cancer, we may discover the real culprit for our nation’s insatiable drug seeking behavior, and an opportunity to effect real change

Recent research suggests that our most pressing Public Health Crisis can be found in the ‘Pair of Aces’ depiction of the results of the Adverse Childhood Experiences study and the Adverse Community Environments, often considered the soil in which children’s lives are rooted.

As children develop and grow into adolescents, they are exposed to all that life offers, including stress, relationships, societal norms and practices, uncomfortable feelings and having to manage those feelings. For those whose lives intersect with exposure to divorce, homelessness, domestic violence, physical and emotion neglect, a mechanism for healing needs to take place early in the developmental stages. We also know from practical experience that mental health issues, attachment disorder, and trauma all have strong correlations to substance use disorders and surface as the predominant co-occurring issues and most difficult to treat.

Reaching our children while they are in school and talking with them about emotions, relationships, life’s challenges and healthy coping methods to help them manage what lies ahead is an important step in preparing our youth to meet the allure of alcohol, drugs, or other harmful practices.  It’s happening in places which have been previously considered “off limits”, like our public-school system.  Credit should be given to the administration of the Worcester Public School system. Over the past few years, new ideas beyond the teaching of math and science have emerged. Our public-school system is now educating children (and faculty/administrators) about bullying and drug awareness, skills that will help them navigate the difficult parts of life without seeking out the comfort of drugs, alcohol, or unhealthy behaviors.

While noteworthy, these initiatives are the beginning of what must become a national commitment to face the undeniable truth that trauma and its antecedents is our most urgent public health issue. “It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” -Charles Darwin

 

About Robert Pezzella, Dr. James Direda, and Jack Maroney

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