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The opioid epidemic is driving gun violence in America in unexpected ways.

Researchers have long recognized that alcohol is a factor in gun-related violence. Past studies showing an association between gun violence and illicit drug use tended to group opioids with other drugs such as cocaine. Recent research specifically examining the relationship between opioid addiction and gun involvement found that opioid-dependent people are more likely than alcohol-dependent individuals to be involved with guns. These results suggest the full impact of opioids is even more significant than initially thought.

The study, published in 2018 in the journal Drug and Alcohol Dependence, found more than half of opioid users reported being present when shots were fired; about one-third reported owning a gun, carrying a firearm, or being shot. Compared with alcohol-dependent individuals, opioid-dependent individuals are 12 times more likely to take a gun for protection, seven times more likely to have been shot at, and six times more likely to have a gun-related arrest on their record. The takeaway is that people dependent on opioids are more likely to lead gun-involved lives, putting them at risk of dying from overdose and gun violence.

Researchers in a study published in 2018 surveyed 386 people seeking inpatient opioid detoxification and 51 people seeking alcohol withdrawal management in Fall River, Massachusetts. They found the rate of gun possession among respondents was more than double the rate of Massachusetts residents generally. They also found nearly one-third of opioid-dependent respondents that carried guns for protection had been shot at, and about half had been threatened with a gun or been present when shots were fired. For those who did not own a firearm, more than half said they could get a one quickly if they desired one. Further analysis found that being male, a person of color, experiencing homelessness, and being incarcerated at any point is significantly associated with increased gun involvement. In contrast, and suggesting possible interventions, higher self-control scores are associated with a significant decrease in gun involvement.

The illicit nature of the drug market means that being involved with guns may not be an irrational or unnecessary power trip. People who are opioid-dependent and reliant on the illicit market find themselves more often in unsafe situations. Carrying a gun could be considered a practical and self-protective measure and contributes to the perilousness of communities affected by the opioid epidemic.

Here are some more sobering statistics to contrast the twin crises of opioids and guns facing the country.

● In 2016 in the US - 1,681,359 years of life lost to opioids– 916,869 years of life lost to guns.

● In 2015 in the US - 1.7x more likely a white person dies of an opioid overdose than a Black person– 1.9x more likely a Black person dies of a gunshot than a white person.

● In 2016 in the US - 13.3 opioid overdose deaths per 100,000 - 4.6 gun homicides per 100,000 (82% of all gun homicides happen in the US)

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● $504 billion is the estimated cost of the opioid crisis in 2015 – $229 billion is the estimated annual cost of gun violence.

● In 2016 on an average day in the US - 96.2 people are killed by guns kill – there are 115 opioid-related deaths.

While the opioid crisis and gun violence are devastating communities, some of the efforts to combat them prove ineffective or even counterproductive. Mass shootings and drug overdoses naturally evoke fear and outrage; unfortunately, new laws and restrictions rarely reduce harm and often make matters worse. Good evidence-based public policies must rely on data.

While the availability of certain types of guns may make certain acts of gun violence more deadly, the fact that most gun deaths and most mass shootings are committed with handguns suggests we should pay more attention to “why” rather than simply “how” so many people are dying. In 2017 the CDC reported that 47,600 Americans died of opioid-related deaths. Similarly, death from opioids is blamed on the excessive prescription of opioids by doctors for addicting the population and moved to restrict the number of opioids doctors could prescribe - - despite data consistently showing no correlation between prescription volume and the nonmedical use of opioids or opioid addiction. In addition, medically prescribed opioids have lower overdose rates ranging from 0.022% to 0.04%.

People often mistake dependence for addiction, forgetting that they are two different things. Opioid dependence, while it can be a step away from addiction, is still a physical dependence on opioids that is characterized by the symptoms of tolerance and withdrawal. Addiction is more complicated. Addiction is marked by a change in behavior caused by the biochemical changes in the brain after continued opioid abuse. Substance use becomes the main priority of the addict, regardless of the harm they may cause to themselves or others. Addiction causes people to act irrationally when they don’t have the substance to which they are addicted in their system.

The National Institute on Drug Abuse director states that opioid addiction in patients is uncommon “even among those with preexisting vulnerabilities.” Studies showing a “misuse” rate of 0.6% in patients prescribed opioids for acute pain and roughly 1% in those on chronic opioid treatment suggest that medically prescribed opioids are not the driving force behind the opioid crisis. In fact, despite high-dose prescribing being down 58% since 2008, the overdose rate continues to rise, involving fentanyl or heroin 75% of the time. Furthermore, evidence showing a steady exponential increase in nonmedical use of drugs since the 1970s suggests complex socio-cultural factors drive the root causes of the opioid crisis. With prescription opioids becoming less available, both medical and nonmedical users find cheaper and deadlier options in the illicit market.

Opioid dependence is real but need not be inherently harmful. Many patients rely on opioids to control their pain well enough to live a healthy life. With new restrictions and crackdowns on prescribers, many chronic pain patients are being cut off from their medication, causing many to self-medicate with unpredictable and dangerous drugs on the black market and some even turning to suicide. The opioid crisis is also a consequence of prohibition and the dangerous black market it fuels, combined with a lack of safe alternatives to opioids for chronic pain, such as cannabis. Reducing overdoses requires redirecting resources from restrictive, prohibitionist interventions to those focused on reducing the harm resulting from drug use and providing safer alternatives to opioids or with opioids for managing chronic pain.

Drug overdoses and gun deaths are serious problems that require changing the status quo and embracing evidence-based policies and political realities, not fears demanding policymakers “do something” even if it is the wrong thing. Bad policies motivated by fear inevitably fail because they obscure problems instead of solving them, making bad situations tragically worse.

Posted 3-4-21

81,003. That’s the number of people who died from drug overdoses in the 12 months ending last June 2020. That is a 20% increase and the highest number of fatal overdoses ever recorded in the U.S. in a single year.

Drug deaths started spiking last spring as the coronavirus forced shutdowns and caused shelter-in-place orders. More recent statistics from cities throughout the U.S. and Canada show the crisis has only deepened. In Colorado, overdose deaths were up 20% and those involving fentanyl doubled; British Columbia reported nearly five overdose deaths per day in 2020, a 74% increase over the previous year; a study released this month showed emergency room overdose visits increased 45% during the pandemic, even as total ER traffic slowed.

The pandemic has ushered in stress, isolation, and economic disruptions, all known triggers for addiction and relapse, while robbing people of access to treatment options and support systems. Addiction specialists across the country report that the historic Covid-19 pandemic colliding with a preexisting drug epidemic, made even deadlier by the readily available and less expensive potent synthetic opioid fentanyl, has been devastating for their patients. Many have been lost to follow-up ; some have died; others have relapsed.

The increase in opioid deaths is a setback. We were finally making headway, thanks to growing public attention and government funding. Overdose deaths were falling in 2018 for the first time in years. But the spread of fentanyl erased those gains, and the pandemic has further undercut efforts to control the opioid epidemic. With public health officials rightfully focused on the coronavirus, suffering and death due to substance abuse have fallen off the radar.

The financial toll of the pandemic means many cash-strapped health care systems are cutting addiction treatment programs just when they are needed most. Even as opioid overdoses have skyrocketed amid the coronavirus pandemic, states are nevertheless slashing addiction treatment program budgets. Covid-19 has exacerbated the opioid crisis, and escalated overdose deaths, patients are falling out of recovery as the pandemic drags on, wearing people down. Jobs have been lost yielding economic stress, and grief - all taking a toll.

Addiction reshapes the brain; this has made the pandemic particularly challenging for those with substance use disorder. People in recovery have hypersensitivity to stress and diminished capacity to experience normal levels of reward.

Other pandemic-related factors are increasing the death toll as well. The pandemic is disrupting the supply chain for drugs. Users turn to unknown suppliers ending up with counterfeit drugs that look like prescription pills but contain fentanyl which lead to more overdoses. With stores closed and restrooms and public spaces inaccessible during the pandemic, people are now using drugs in public, rushing, not always taking time to be safe. Making this even more complicated, people who lose their supply or relapse and start using again are susceptible to overdose because their tolerance can fall sharply after a period of not using.

It’s the isolation that is the major contributor to the rising number of deaths. It keeps people from their social support networks and gives them more privacy to use. There is less opportunity to participate in any form of community. People can’t be around friends, go to the gym or restaurants; all of the everyday activities that help mitigate anxiety and depression are gone. Addiction grows in the dark, and in the pandemic, you have more people who are alone, not accountable to friends and family, and at risk. That can be fatal for someone using drugs: If they overdose, no one is nearby to administer the antidote naloxone or summon help.

Addiction is a disease that wants to get you alone and kill you, and the pandemic has created that lonely scenario for dying. People are isolated so it’s no surprise that the opioid epidemic has grown. The past year has also been challenging for organizations that provide treatment and other support for people in recovery. Social distancing requirements mean clients must now line up outside and wait for services, even in the bitter cold. Methadone clinic lines and packed waiting rooms leave clients vulnerable to the coronavirus requiring them to make appointments and practice social distancing in clinics, but if you don’t have a working phone, it’s hard to make appointments as the pandemic has shuttered libraries, coffee shops, and shared spaces that served as places for people without housing to charge phones and access services.

The pandemic has forced the cancelation of addiction support meetings and may be the ultimate “gateway drug.” There is hope; virtual therapy and outpatient services are more accessible now that federal restrictions for addiction medication have been loosened in response to the pandemic. The need for services remains high; while other businesses are closing their doors, more addiction clinics are opening as COVID winds down.

People are desperate for treatment but afraid to get it. As with other areas of medicine during the pandemic, the ability to deliver medical and support services for addiction virtually has been transformative but imperfect. On the plus side, new technologies could help provide treatment to the estimated 90% of people with substance use disorder who go without access to treatment.

Virtual sessions are not for everyone. It’s harder to develop rapport and earn trust over a screen. Opioid use disorder is stigmatizing. People with OUD know they’re going to be judged, so gaining trust is more challenging when you’re not in an office where you can close the door and sit face to face. A patient commented that “virtual sessions cannot check his urine so it’s easier to cheat.” So much of communication is non-verbal, gained from sitting in a room with other people, sharing, seeing their body language, responding naturally rather than mediated by technology. There is warmth, intimacy, and commonality in physically shared spaces that are inherently lacking in virtual spaces like Zoom. While more research is needed to prove that virtual therapy can be as effective as in-person sessions, it’s certainly better than nothing.

February 24, 2021

Today I want to talk about opioid overdoses. This isn't a fun, happy subject to talk about. However, we must recognize the magnitude of the problem and understand how through technology, innovation, and public policy, we can mitigate the problem, significantly reducing the amount of detriment this does to people with substance use disorder, to their families and to our society.

Overdose deaths are the #1 cause of accidental death for those under 50. Your friends, family, and neighbors under 50 are more likely to die from an unintentional drug overdose than in a car accident, a fire, or by guns. More people died in 2017 from drug overdoses than in the entire Vietnam war. Opioids affect people from all walks of life, from people with doctorates to people who haven’t graduated from high school. From young mothers to their unborn child. People who use drugs typically use opioids at about the same rate that ordinary people eat food every 4 to 6 hours.

In harm reduction, rule number one is never, ever use alone. That is not always practical, especially during a pandemic, but try not to use alone - access to life saving medications such as Naloxone (Narcan), which quickly reverses overdoses in minutes after being sprayed up a nose, needs someone there to administer this life saving medication. Finally, we need to work with lawmakers to increase access to treatment and educate people about harm reduction strategies, such as testing for adulterated drugs.

These measures are significant and tackle some of the major obstacles preventing people from successfully recovering from opioid use disorder. However, overdoses are still going up and life expectancy in the US, for the first time, is going down because of this epidemic.

When COVID- 19 hit, the country immediately passed a $1.9 trillion stimulus package. Suppose a small fraction of that money was put towards funding and identifying evidence-based solutions to these problems combined with good public policy. We could save many lives and help people cope with the combined impact of a pandemic and an ongoing opioid crisis.

This problem is not going away. It's getting worse year after year. It will not be going away until we recognize the devastating impact on our society and embrace data-driven approaches to finding solutions.

One possible solution to this problem may be found in existing technologies many people wear on their wrists. With the rise of wearable computing and the internet of things (loT), we are getting more comfortable being around technology and recognizing its importance in our everyday life. We are more comfortable trusting technology to inform us and guide our behavior. This opens up a massive opportunity for us to combine things such as wearables with sensors capable of monitoring our health, allowing us to take charge of our well-being in ways that we have never been able to do in the past.

Currently, Apple has a watch that will call 911 if it recognizes that you have fallen and is already saving lives. What if it could also be used to identify people experiencing an overdose? If you use alone, this might save your life. This could be an exciting area of development for an enterprising entrepreneur looking to do meaningful work that could prevent accidental overdose deaths and save lives.

Another way the technology could help solve the opioid crisis is precision medicine. Recent advances in DNA sequencing and analysis have identified correlations between a person's DNA and their risk of developing substance use disorder (SUD). Scientists have known that a person's DNA can affect the way they react to certain drugs. A person may have a genetic variant or variance that causes them to metabolize a drug more quickly or more slowly than normal. Additionally, epigenetic factors which underlie some of the interplays between the environment and our genes are also implicated in drug abuse risk. Studies have shown that DNA methylation, the most studied epigenetic mechanism in humans, is altered by opioid misuse or dependence. What if a test were available to determine a person's risk of developing SUD? Doctors could use it to identify genetic or epigenetic risk factors to educate their patients, inform patient care and improve health outcomes.

We cannot ignore the needs of those suffering chronic pain any more than those living with SUD. We must acknowledge people with SUD as patients. We must improve health coverage for access to complimentary alternatives or adjuncts to opioids for pain management, such as cannabis. We must leverage technology to improve the lives of those living with SUD by informing them about their risk, helping to monitor their health, providing support in their addiction, and practice harma reduction tactics to prevent overdose deaths.We need to provide realistic pathways to physical and mental wellness. We need to prevent - but accept relapse. It is only by taking a comprehensive and holistic approach to solving a problem that intersects our lives and affects our communities that we will make progress.

Feb. 11, 2021

A strong support network, including family members, friends, counselors, and health care providers, are an important part of recovery from opioid use disorder (OUD). Whether a person has recently started using, is entering treatment, or is already in recovery, having family and friends’ support can be crucial for a person’s recovery. Starting a conversation about opioids can be difficult, but it’s important to start the conversation and keep it going when it gets tough.

Talking to someone about their opioid use

Let’s start with how to have a conversation with someone who you are concerned about. Talking to someone you care for about addiction can be awkward, challenging, and a little terrifying, especially if the reasons for having the conversation have to do with changes in their behaviors or attitude. You may worry that you’re being intrusive or that bringing it up could make the problem worse or hurt your relationship. But if someone you care about shows signs of opioid abuse or dependence, it’s important to confront the situation early before it becomes a problem you can’t avoid. By starting a conversation, you may be the turning point that leads your loved one to recovery.

Before confronting someone regarding concerns about their drug use, be prepared that they may not be ready to hear what you have to say. They may go through stages similar to those of grief before being able to accept your concerns: denial, anger, downplay the problem, depressed and eventually accepting. The best thing you can do in all of these situations is to listen more than you speak. By asking guiding questions and keeping the conversation going, you allow your loved ones to talk about what’s going on in their lives, share how they are feeling, and hopefully open up the lines of communication so that your loved ones feel less alone, less isolated and start working toward acknowledging that they have a problem and committing themselves to their recovery.

Here are some ways to start a conversation with someone you’re concerned about. The key here is to focus on what you see, how you feel, and what you think. The goal is not to judge or shame, but ultimately to listen and understand.

—I just wanted to check in with you to see how you’re doing.

—I noticed that you’ve been acting a little differently lately. Is everything okay?

—I’m worried about you.

—I’ve noticed you’ve been drinking a lot more than usual lately. Is there anything you need to talk about?

—I’ve noticed you’ve been using more pain medication and I’m worried about you. Is your pain worse? —I want you to know that I’m here for you if you need anything.

Once the conversation has started, you can ask more leading questions such as these:

—How long have you been feeling like this?

—Is there something you’re trying to escape from or to forget?

—Is your pain worse?

—Do you feel that your drug use is a problem?

—How would you feel trying not to use your pain medication for 24 hours? A week?

—How can I best support you right now?

—Have you thought about getting professional help?

Remember, you’re there to listen and to be supportive. You’re not there to fix the situation or lead the conversation. Listen to what is said and respond directly, when appropriate, with encouraging words, such as:

—I want you to know that you are not alone.

—I am here for you, and I want to help you in any way that I can.

—I know it doesn’t seem like it right now, but you can be in control of your life again.

—I may not understand exactly how you feel, but I love you, and I’m here to help.

The best thing you can do in these situations is to listen, asking guiding questions, and allow the person you care about to talk about what’s going on in their lives.

Talking with someone living with OUD

Treating OUD is hard. It’s important to seek professional help by contacting a local addiction center or mental health professional. Even your family doctor may have experience treating people living with OUD or can refer you to someone who does. Some doctors and clinics specialize in treating OUDs and getting an initial evaluation can be a critical first step on the road to recovery.

Find a local support network. Alcoholics Anonymous and Narcotics Anonymous aren’t for everyone, but they can be a good place start. These groups provide a network of encouragement and solidarity with those who are working to overcome their addictions. Follow up with your loved one on their own treatment. As they make changes to their social habits, exercise routine, or other behaviors to help them cope with their addiction, be sure to acknowledge those changes and affirm them. Change can be scary and old habits can come back quickly if not supported. And remember, everyone is different. Some may make progress quickly and stick with it; while others may relapse. Some may take a long time to come around, but when they do, they are fully committed. It takes time to find the “right fit” when it comes to treatment. Not all programs will work for everyone, and it may not be easy, but it’s important to be patient, forgiving, and kind towards those who are struggling to live with their condition.

Be encouraging. People living with OUD often believe that they will never recover from their condition or that their addiction is a personal moral failing, and that they are undeserving of help. They may feel shame about things they’ve done or said, people they’ve hurt, or relationships they’ve harmed. They need someone who can always remind them that they are worthy, that they are loved, that things can get better and will.

What not to say when talking with someone living with OUD

“Don’t threaten, don’t force, don’t lecture, or use harsh words. No matter how frustrated you feel, you can’t “scare someone into recovery.” Threatening to kick them out, cut them off, or take their children away from them if they don’t stop will only play into their fears and insecurities, pushing them farther away and possibly leading them to make even more harmful or rash decisions. You also can’t force people with OUD disorder to stop using or taking drugs – but you can provide them with the support and encouragement they need to choose to seek help and get treatment. Lecturing also doesn’t work. It will only make the emotional pain they feel worse by compounding it with your feelings of disappointment or disillusionment. Lecturing can feel productive to the person doing the talking but can make your loved ones feel like they’re not being heard; that they are a burden, or affirm other negative thoughts they have about themselves.

Using harsh words, like “alcoholic,” “drug addict,” or “junkie,” can minimize the feelings your loved ones have shared with you and can make them feel that you weren’t listening or don’t care about their feelings. It's not your job to assign labels to other people’s struggles. Instead of labeling, focus on describing the challenges using words or phrases like “problems with alcohol” or “difficulty with drug use.” Don’t assign blame or guilt. Avoid saying things like, “you’re ruining your life,” “your drug use hurts me,” or “think about what you’re doing to your family.” These kinds of comments will also reinforce the negative feelings and emotions a person has about their condition and push them farther away and deeper into crisis.

Don’t minimize or make excuses for their problem. Saying things like, “oh, you’re just stressed right now” or “you could stop if you wanted to” can interfere with your loved one’s recovery process, which starts with acknowledging that there is a problem. When you talk with someone under the influence, don't try and reason with them. They're not in a clear frame of mind, cannot fully understand you, and may react more negatively than if they were sober.

OUD can be difficult to overcome. It’s impossible to know what kind of challenges your loved one will face along the way. Setbacks or even relapse are not a reflection on the strength of your personal relationship, and they do not mean that your loved one doesn’t care or doesn’t want to recover. Don’t blame yourself, and don’t blame the person you care about. You can’t cure someone else’s addiction. Even if you could, it isn’t your responsibility. It’s up to the individual to make a personal commitment to their own recovery. The only thing you can do is to love and support them on their journey. To celebrate them in recovery and help them to pick themselves up when they fall short.

Visit 100MillionWays.Org and check out Buddy-Bot, a peer support process, and join the conversation.

January 26, 2021

You may not believe this, but some of the best advice you get can actually be the worst advice. Bad advice can sometimes validate what we already knew to be true but were in denial about it. This advice is not meant to be helpful nor to be followed. The goal instead is to highlight some myths about recovery. To be aware of things that can cause confusion or misunderstanding about what is helpful for those living with addiction or with a dependence on opiates. You may meet individuals on your journey or recovery that are so caught up in their own problems or mistaken beliefs about recovery that their advice should be suspect. What follows are some examples of the worst advice you are ever going to hear about addiction, dependence, and recovery. It is strongly recommended that you ignore this advice completely.

To Break Free of Addiction, You Need to First Reach Rock-bottom

The idea that you need to lose everything to escape addiction is based on a misunderstanding of what hitting rock bottom actually means. There is nothing magical about hitting rock bottom. You can decide that you have reached this point at any time you like. Rock bottom simply means that you have decided you are ready to change, that you have lost enough, and do not want to lose anything more. The problem with waiting until you lose everything is that you are more likely to die while waiting to stop. This is because the deeper you fall into addiction, the harder it can be to make the necessary changes in your attitude or behaviors to break free.

A better option is to recognize when you are giving up things you want or need because you need to satisfy your desire for a drug you crave. When you refuse to give up anymore, you are ready. The sooner you ask for help and commit to your recovery, the more likely you are to be successful. There is no benefit to staying trapped in a cycle of addiction for even one minute more than you have to. I know, easy to say. But the sooner the better, because it gets worse and life flies by while you wait to stop. Life is absolutely better free from the shackles of addiction.

There is Only One Road to Recovery from Addiction.

Most experts agree that a ‘one size fits all’ approach to addiction recovery is not effective. People are different, they become addicted or dependent for different reasons, and they struggle with their addiction for different reasons. Different approaches to sobriety are necessary. What works for one person might now work for you or someone else. You should not feel guilty about wanting to try a different path to your recovery. And you should not feel guilty about having to try different paths.

You Only Get One Chance at Recovery.

Since there is no “one size fits all” road to recovery, this means that for many, failure is part of the process. The road to recovery has many on-ramps and off-ramps. Falling off the wagon, as they say, only means you get up, dust yourself off, and get back on the wagon. You may fear judgment and feel shame about r failure; this isn’t easy, find pride in starting again. It takes willpower, a commitment to self-care, and a willingness to feel compassion for yourself and forgive yourself for your failures. Start again and focus on rebuilding a life worth living.

Sobriety is All about Willpower

For some, willpower may be enough. For most, it may be enough to stay sober for a few days, maybe a few weeks or months, but it is unlikely to be enough to keep you going long-term. This white-knuckle, cold-turkey approach to recovery tends to mean treating recovery as if it were a punishment, something to be endured rather than embraced. Recovery is not a punishment; it is a gift. Relying on only willpower, often motivated by fear of failure, can be exhausting. Again, it works for some. Once you have been sober for a little while, this fear of failure may fade – but could be replaced with a kind of irrational confidence that if you survived the worst, whatever else happens you’ll handle it. However, if you can’t handle it and if you don’t have the support you need, you may find yourself falling back into addiction. This is why it is important to find a web community and build a life community away from addiction. With a community you will no longer have to rely on willpower alone to stay the course. It is a place to share feelings, get or give experiential advice and be anonymous. Explore participating in online communities. 100MillionWays.Org offers a free BuddyBot program for online peer support.

Sobriety Requires a Certain Belief System.

Epistemology matters. Understanding what we know about things and how we come to know them is essential for distinguishing between justified beliefs and opinions. The fact that there are so many successful paths to recovery proves that no single set of beliefs are necessary. In fact, trying to believe things because they make you feel uncomfortable may actually prove detrimental in the long run. Listen to the facts then pick and choose which elements of any recovery approach appeal to you without having to accept every aspect of it. The best advice is to use trusted sources for information and only use what works for you.

You Can Never Safely Drink or Use Drugs Again After a Period of Sobriety

Most people who have developed physical addiction or dependence on any drug, are unlikely to ever be able to use the substance again safely. There are many examples of people relapsing after successfully recovering from addiction – even with long periods of sobriety. To fully break free from the cycle of addiction or dependence, you need to accept that substances have no place in your life. There can be no ambiguity about this, or else it can be the seed of your own relapse. For others, abstinence is not an option. For those who experience chronic pain and are physically dependent on medication, it may be necessary to find a healthy balance between abstinence and effectively managing symptoms. In these cases, it may be helpful to consider complementary or alternatives approaches for managing symptoms. If you need pain medications, try to use stronger drugs less frequently. Just using less strong pain medications like opioids will improve your quality of life and decrease your chance of dying from an overdose. The blogs and perspectives posted in 100MillionWays.Org touch on many of these subjects. Share your personal saga if you are so inclined.

Only the Most Serious Cases Require Medical Supervision

Addiction is a disease formally called substance use disorder. A medical disease can benefit from medically supervised care. Modern medicine relies on evidence to guide decision making. This applies to both individuals and groups; knowing what works for most helps to determine what will work for an individual. Depending on the case and the individual, a medically supervised detox can be helpful to those who want to break free of their addiction or dependence in a way that will increase their comfort levels and make them more likely to stick with their recovery and stay sober over the long-term.

Overcoming Addiction Is All You Need To Do To Live A Perfect Life

One of the most common reasons individuals relapse after a period of sobriety is a disappointment due to unrealistic expectations. Life happens. The road to recovery is a journey, not a destination. There is no graduation or event to mark the end of a successful recovery. The only guaranteed reward for a successful recovery is sobriety in itself. While you may notice some improvements in your life due to ending the cycle of addiction or dependence, that is only the start of your journey. There will be many challenges that you will face on your journey so it is important to be prepared to face these challenges soberly and with realistic expectations. Sobriety is a kind personal development course that lasts a lifetime but if you stick with it, your life will continue to improve as long as you continue making positive changes. Eventually, you may reach a stage where you can enjoy a sense of serenity most of the time. However, you will not arrive at this place overnight and aren’t guaranteed to stay there should you arrive.

You Will Never Not Miss Using Drugs

Some who have been physically sober for a long time still miss using alcohol or drugs. This fact underscores the seriousness of addiction and how deeply it can affect you, but his fact does not mean that everyone will feel the same way. For some, embracing sobriety is the end of their journey, but without building a better life free of substances, you may find lingering feelings of nostalgia preventing you from moving on completely. You can build a better life where drugs no longer hold your interest free of those feelings towards drugs that might draw you back in.

Feeling Depressed Means You Need to Work Harder at Recovery

Depression, like addiction and dependence, is a medical condition and experiencing depression has nothing to do with how hard you are working at your recovery. If you find that symptoms of depression prevent you from getting the most out of recovery, see a doctor and get a proper diagnosis and treatment. It’s a disease like substance use disorder. But through your journey it is most important to only accept medical advice from those properly qualified to offer it.

We invite you to explore the 100 Million Ways, read the blogs, and share your own saga.

January 11, 2021

Media coverage of addiction issues tends to focus on individual stories and recovery against the odds. Celebrities confessing their struggles and describing their recovery as dramatically as possible along with confessions and criminal indictments. This creates an impression that addiction is a problem caused by individuals affecting individuals and that treatment starts and ends with the individual overcoming their addiction or dependence on opiates. Viewing opiate addiction or dependence as a "personal problem" isolates us from the reality of its community roots, impact, and responsibility.

The Stigma of Addiction

There is a saying that "every addict impacts six other people in their addiction." This is true but it also means that every recovering addict will affect six other people in their sobriety. This means that recovery is possible through connection to others in your community. This includes services provided by the community at large for those struggling with opiate addiction or dependence as well as friends and family. Unfortunately, not everyone has access to treatment services which means that many are reliant on informal connections and support from friends and family who may not be qualified or able to provide meaningful support. Some may be resistant to entering treatment and recovery, even when services are made available. This can be due to stigma or denial about the seriousness of their condition. This stigma and the beliefs about addiction take the focus away from the community and place it solely on the individual.

Here are some common false beliefs about addiction:

1. Addiction is a moral failing caused by personal weakness or character flaw, that a person with sufficient willpower and character can overcome addiction by sheer strength of will.

2. Addiction is caused by our biology and that physical differences in addicts explain why some people become addicted or dependent while others don’t suggest. This suggests that medication or lifestyle changes alone can overcome opiate addiction or dependence

3. Addiction is an attempt to "self-medicate" or treat trauma or other mental health issues and that treating the trauma or depression will resolve a person’s desire to use drugs.

4. Addiction is caused by family dynamics related to generations of drug and alcohol use. Often these families face additional issues such as poverty, crime, or neighborhood drug use. The solution then is to change the dynamics of the family which encourages addiction, address the related social problems, and find a connection with a healthier support group.

5. Addiction is caused by feelings of alienation, a "hole in the soul" that needs to be filled leading a person to feel isolated and lack direction resulting in them filling that whole with drugs and getting high. The solution is to help the person connect with something greater than themselves, a higher power, and to develop a greater sense of purpose.

Most treatment professionals agree that addiction is the result of all of these things and that only by recognizing ALL of these possible explanations for addiction can we ever hope to play a useful role in recovery. Addressing all of these areas increases the likelihood of successful, long-term sobriety.

Many of these factors involve making changes to our communities and families, giving our families and our communities ownership over addiction and dependence thus making them a pillar of treatment programs that are vital in making long-term recovery a viable reality. Humans are social creatures. We live within layers of a connected society made up of individuals. It is very difficult to heal in the confined space of individuality. Treatment that is embedded within a community has a much greater chance of addressing the root causes of addiction and dependence.

Solutions to the Stigma of Addiction

Traditional approaches were founded on scare tactics, such as “Just Say No” campaigns or “This Is Your Brain on Drugs.” These programs, such as DARE and Scared Straight, do not work. They have consistently been demonstrated to have little to no long-term impact on a person's decision to use alcohol and drugs. And showing people in hand-cuffs does not change long term recovery rates. Another approach is crisis-based and mandatory treatment. People who are forced to enter the recovery process through interventions, criminal charges, medical crisis, job threats, custody battles, and divorce ultimatums are often enough for a person to temporarily interrupt their use of drugs. Unfortunately, research shows that while mandated treatment has a better treatment completion rate than "self-referred" clients, over the long term they are no more likely to maintain their sobriety.

Community-Based Solutions to Opioid Addiction and Dependence.

Social marketing emerged in the 1970s as a way to shift the traditional consumer-focused marketing strategies selling products to selling ideas and services to enhance the health of the general community. Examples include commercials and billboards encouraging prenatal care, discouraging smoking, and wearing safety-belts. This approach was effective at changing community conversations about smoking and drunk driving, as well as what to do when you become pregnant. This strategy may be key to shifting the conversation about recovery from an emphasis on getting people through treatment quickly and into recovery to a social awareness about the root causes of addiction and a shared understanding that addiction is a chronic condition requiring longer-term support from a variety of sources. Social marketing could be a powerful tool for sharing stories about successful long-term sobriety and what it takes to stay sober long term.

Social marketing can also challenge stigmas replacing dramatic pictures of addicts at rock-bottom with more compelling images of recovery and sobriety showing the collective benefits of sobriety. Instead of focusing on what people will lose through addiction or dependence, focus on what people will gain through their recovery and sobriety. They get their families back, their careers, their children, a stable home, long-term relationships, better physical health, and more compelling interests.

What this all means is that a healthy community is the only known cure for addiction and that people with long term sobriety need to "come out" and demonstrate that recovery is not just possible, but probable with the right individualized self-care plan AND support from the community.

Please consider joining the online community at 100.MillionWays.Org. You will make it a better place!

References

1. The effectiveness of Drug Abuse Resistance Education ...

2. http://www.drugabuse.gov/publications/principles-drug-abuse-treatment-criminal-justice-populations/legally-mandated-treatment-effective

3. The media and addiction recovery - William White Papers

4. Social marketing - Wikipedia

Perspective #14 Cannabinoids in Cannabis Improve Resilience in Patients with PTSD and Reduces Drug

Craving and Anxiety in Patients Recovering from Opioid Use Disorder

A new study shows that cannabis could help those living with Post Traumatic Stress Disorder or

PTSD. It adds to a growing body of research suggesting a key role for cannabinoids in managing

risks associated with the disorder. PTSD is a chronic condition that can occur after a traumatic

incident causing those who experience it to relive their trauma over and over again, causing stress,

anxiety, and depression, and leading to panic attacks, hypervigilance, overwhelming emotions,

detachment from loved ones, and sometimes even self-destructive or addictive behavior.

Researchers found that people with PTSD who used cannabis saw greater reductions in their

symptoms and were more than two and a half times more likely to recover from PTSD during the

study than those who weren’t using cannabis. Sadly, PTSD is not an easy condition to treat or to

live with. Still, some PTSD sufferers say they’ve found relief from their intense symptoms through a controversial treatment - medical cannabis. People with PTSD are also more likely to experience

chronic pain which puts them at risk of developing an addiction or dependence on opioid pain

relievers.

The incidence of PTSD and other psycho-social and pathophysiologic conditions have led to the widespread use of opioids in the United States which has resulted in an unprecedented epidemic of opioid addiction and dependence. A few treatments for opioid use disorders (OUD) are currently available, such as methadone and buprenorphine, and can help reduce opioid use and reduce the risk for opioid-involved overdoses. In some areas, however, these medications are underutilized and difficult to access, creating a treatment gap in which those who need medications face barriers to actually receiving them. Furthermore, 20-40% of OUD patients do not want to take agonist treatments.

A randomized, placebo-controlled clinical trial designed to test whether cannabidiol (CBD), a non-

intoxicating cannabinoid that is found in the cannabis plant, could reduce drug craving and anxiety

in recently-abstinent individuals with heroin use disorder, found that, compared to those who

received a placebo, individuals who received a dose of CBD medication showed reduced craving

for heroin as well as reduced anxiety lasting for about a week. The study involved 42 participants

who received one of two different CBD medication doses, or a placebo, once a day for 3 days. They

were then exposed to drug-related or neutral cues to see whether CBD could reduce opioid

cravings and anxiety, factors strongly associated with relapse to opioid use. The study medication

used in this study, EPIDIOLEX, is an FDA-approved plant-derived CBD medication in a liquid

formation. In addition to measuring the effect of the medication on opioid craving, anxiety, the

authors also collected measures of positive and negative emotions, vital signs (skin temperature,

blood pressure, heart rate, respiratory rate), and salivary cortisol levels, which measure stress

response. Authors examined whether patients who received CBD, compared to those who received

placebo, showed differences in opioid craving, anxiety, positive and negative emotions, or vital

signs, after being exposed to the drug or neutral cues. The results were very promising.

● Individuals receiving the CBD medication reported fewer cravings after being exposed to

drug cues compared with individuals receiving placebo.

● CBD reduced measures of stress response after the drug cue.

● Individuals receiving CBD reported less anxiety after being exposed to drug cues compared

with individuals receiving placebo with no significant differences between those receiving the

low-dose vs. the high-dose of CBD.

The implications of this study in light of the impact of the opioid epidemic underscore the need to

identify as many strategies as possible to curb opioid addiction and more effectively manage

chronic pain

In the past few years, scientists have asked whether or not cannabis could help individuals recover from opioid use disorder or serve as a less-risky pain management approach than pharmaceutical opioids. The small, experimental study here shows a potential benefit of CBD in reducing cue-induced craving and anxiety in heroin-abstinent individuals. This suggests a potential role for CBD in relapse prevention of opioid use disorder and showed that CBD substantially decreased cue-

induced craving and anxiety.

If you are interested in learning more about CBD or have your own story to share, please reach out

and let us know.

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