BTG Fall 2018

WINTER 2018

3

4

Your Source for News and Information on Addiction, Recovery, and Everything In Between

5

Good Medicine Opiate blockers expand treatment options In recent years, one of the major advances in addiction treatment has been the development of medications designed to ease withdrawal from heroin and other addictive substances.

Bridging the Gap Director Melody McCreary says new drugs such as suboxone and vivitrol have expanded the options available to treat opiate addiction and alcoholism. Bridging the Gap offers medication-assisted treatment to its clients, administered by a certified addiction medicine specialist. Detox is very important to prepare an opioid-addicted client for treatment, McCreary says, since the physical effects of opiate withdrawal make it difficult or impossible for clients to focus on other aspects of treatment. Addressing the physical symptoms gives the client a much better chance of succeeding in treatment. “Medication-assisted treatment should

include setting up a treatment plan so the client can learn to live an abstinence-based lifestyle.” – Melody McCreary, Director, Bridging the Gap Services

6

History of help The oldest drug used in medication assisted treatment is methadone, which has been in use in the U.S. since the 1940s, first as a pain-reliever, then as a treatment for opioid addiction. Methadone clinics usually wean clients off the drug by gradually lowering the dosage, in order to reduce the risk of relapse. The opiate-blocking drug suboxone has been an FDA-approved treatment for opioid addiction since the early 2000s. It contains buprenorphine, a drug that helps fight the symptoms of withdrawal, and naloxone, the drug used to reverse opioid overdoses. In opioid addiction treatment, suboxone is used for either short-term detox (about two weeks) or maintenance treatment. One of the advantages of using suboxone to relieve opiate withdrawal symptoms is that, unlike methadone, it works “almost immediately,”McCreary says. Before suboxone became available, librium and Klonopin were more commonly used to relieve opiate addiction symptoms, “which took five to seven days to work.”

Protocol prevents abuse The protocol for administering suboxone is designed to prevent abuse or misuse of the drug, McCreary points out.The client receives the water-soluble suboxone strip under the tongue and must remain in the office until it has dissolved. One improvement over previous generations of medication assisted treatment programs is that most clinics require clients to also participate in group therapy to address the psychological aspects of their addiction and begin long-term recovery. Patients are also regularly tested by urinalysis to ensure they aren’t using any illicit drugs while in medication-assisted treatment. For most clients, medication-assisted treatment is intended as a short-term therapy, and should include a treatment plan developed and monitored by the physician “so the client can learn to live an abstinence-based lifestyle,”McCreary says. Vivitrol, the newest addiction treatment medication, has several advantages over methadone and suboxone. Because vivitrol is an extended-release medication, its effects last for 30 days – rather than requiring weekly or daily dosages – and it can be used to treat alcoholism. Going forward, as scientists learn more about the biology of opiate addiction, the availability and effectiveness of opiate blocker medications should continue to improve, she notes. “One of the advantages of using suboxone is that it works almost immediately.” – Melody McCreary

7

We have the ability to meet all of your needs and we also provide family counseling so that we can all recover! 240-318-5790

8

9

Out of the Haze Helping clients find their ‘inner expert’ When people get lost in the haze of addiction, they often lose touch with their better selves, and the innate, inner wisdom they need to live a healthy, fulfilling life. But by using expertise and experience, a good addiction counselor can help and then Coppin State University, where he earned a dual degree in substance abuse counseling and addiction services.Then he acquired a master’s degree in rehab counseling and psychological services.

clients regain those God-given assets and find recovery, says Guy Eldridge, the clinical supervisor at South Baltimore C.A.P., (Community Addictions Program) Inc., which provides residential treatment to Bridging the Gap clients. Like many other professionals in the addiction treatment field, Eldridge is himself in long-term recovery, since going through treatment about 17 years ago. After establishing his own recovery, Eldridge decided he would like to learn how to help other people with the same problem. He enrolled in Baltimore City Community College

Eldridge got his first job as a counselor at Tuerk House, a residential treatment program in Baltimore.Then he spent three years counseling patients at a methadone clinic. He went on to work at a nonprofit center called Healthcare for the Homeless, and also at the area’s largest treatment provider, Gaudenzia, Inc. During a seven year stint counseling clients at Gaudenzia, he rose to a supervisory position. Early this year, he joined the staff at Bridging the Gap.

“Although you are the counselor, the client is the expert at making the change.” - Guy Eldridge , clinical supervisor, South Baltimore C.A.P., Inc.

10

The client is the expert Of course, formal education is only part of what goes into making a skilled addiction counselor. In clinical practice, “one thing you learn is that, although you are a counselor, the client is the expert on making the change. You can only guide and help facilitate the change process. Ultimately the client makes the change.” For addiction counselors, it’s not uncommon to encounter clients who don’t want to change, especially early in the treatment process. What happens then? “I continue to work with the client to find out what they do want to change. If they didn’t want to change, they wouldn’t be in treatment. Not all clients are here voluntarily – some are ‘court ordered’ – but they may want to address something – medical, financial, housing, or something else. So you start from there.” Often, the amount of time counselors have to work with clients is limited by insurance guidelines or other factors. Twenty eight days is not a lot of time to address problems that developed over a period of years. “The most important thing is to set each client up with a good aftercare plan to address those issues, and continue to recover, when they are back living in the community.” Eldridge says one thing he appreciates about Bridging the Gap is the holistic approach to serving clients – not only helping them overcome addiction, but providing assistance with other areas of life, such as housing, employment, ID cards, and more. Addiction typically

“We encompass a lot of things in dealing with clients.” - Guy Eldridge

breeds a chaotic lifestyle, so helping clients get back to a stable situation provides a necessary foundation for long-term recovery, he notes, adding, “We encompass a lot of things in dealing with clients.” Eldridge believes his own experience as a recovering addict helps him develop a healing relationship with clients. Having been in their position makes it easier to empathize with clients, and also to get past clients’ defense mechanisms and “understand when people are not being forthcoming with the truth.” While working at Bridging the Gap, Eldridge is also continuing his schooling, finishing post-graduate class work toward earning his LCPC certification. He eventually may open his own practice, do some consulting work and possibly do some teaching at a local college to pass on what he has learned. With the need for effective addiction treatment continuing to grow, “everybody has something to bring to the table.”

11

1.800.GAMBLER HELPLINE IS FREE & CONFIDENTIAL 24/7

YOU CAN GET CONTROL OF YOUR LIFE BACK. WE CAN HELP! CALL NOW. 12

OF ADULTS ALMOST 90% GAMBLE. IN MARYLAND IF YOU THINK IT’S A SOLUTION, IT MAY BE A PROBLEM

VISIT US ONLINE AT: HELPMYGAMBLINGPROBLEM.ORG

TEXT US: 1.800.426.2537

CHAT WITH US: HELPMYGAMBLINGPROBLEM.ORG

13

14

15

We specialize in addiction treatment custom features and profiles 16

12,000 FACILITY DIRECTORY LISTINGS AND GROWING

Dramatically increase the online footprint for your facility Feature your facility alongside over 12,000+ other listings Custom facility feature and profile in our publications Work directly with our editorial writers and designers

If you are interested in joining, visit us online!

17

To improve and rebuild lives one at a time through compassionate and quality health care. OUR MISSION

18

WE ARE LOCATED AT 7902 Old Branch Ave. Suite 202 Clinton, MD 20735

19

20

At Bridging the Gap Services, it is our mission to improve and rebuild lives one at a time through compassionate and quality health care.

We can help you, call us now! (240) 318-5790 21

OUR LEVELS OF CARE

0.5

Outpatient Treatment This level of care is for individuals that are looking for help with their symptoms and issues related to substance use disorder but their risk for chronic addiction is less severe.

Education This level of care is for individuals with problems or risk factors related to substance use disorder and have had no prior treatment but are in need of substance use and alcohol education. This includes DUI/DWI.

If you are looking for help and would like more information, please contact us (240)318-5790

Intensive Outpatient Treatment This level of care is available for individuals that require a higher and more intensive ongoing structured monitoring while addressing and enhancing their knowledge about their disease of addiction.

visit us online bridgingthegapservices.com

22

23

Monday - Friday 10am - 8:30pm Saturday - Sunday 10am - 2pm

don’t miss a moment... Bridging the Gap Services understands that it’s just not the individual that is affected by addiction, but the family is impacted as well. We also provide family counseling so that we can all recover!

24

HELP IS ONE CLICK AWAY

23 5

“Everything we know about older adults and substance abuse probably doesn’t apply to Baby Boomers.” - Dr. Alexis Kuerbis, CUNY - Hunter College

26

overall numbers present a problem. “We’re grossly understaffed in being able to handle these problems,” says Dr. Dan Blazer, a psychiatrist at Duke University who has studied the issue extensive ly. “It’s a problem. I think it’s a problem that’s going to get larger as time goes on and we’re probably already seeing evidence of that.” But there’s also an issue of attitude. Baby Boomers, in general, have a more relaxed view of substance use, and experts fear they may carry those behaviors later into life. “There’s no evidence that they’re going to automati cally stop when they hit 65 years old,” Dr. Blazer says. “They’ve used them all their life, they say, ‘Why shouldn’t I use them now?’”

Even though elderly people show substance abuse issues in a much lower percentage than other age groups, the problem is more prevalent than many realize. And it appears it’s only going to get worse. Studies vary, but generally show between 2.2 and 9 percent of older adults have an alcohol use disorder, and experts say they’re already seeing a rise in marijuana and opioid abuse issues. With the large population of Baby Boomers aging, substance abuse numbers in the elderly population are expected to continue to rise, presenting serious problems for treatment providers and family members. Researchers say the problem is two-fold: part is sheer numbers, the other is attitude. With the number of older adults in the U.S. expected to increase from 40.3 million to 72.1 million between 2010 and 2030,

Experts say the lifestyle of elderly people presents a unique challenge for physicians and treatment providers. For example, because retired people don’t work, substance use doesn’t present a problem at their jobs, a HIDDEN DANGERS typical red ag for younger people. Experts also say too often doctors fall victim to their own prejudices and don’t ask the right questions that could lead to a diagnosis.

substance use. Although success rates in treatment can be better for older adults, the way they’re treated isn’t necessarily the same. Dr. Sacco says older adults respond better to more collaborative treatment programs that give them options. “For so long it was trying to t older adults into these programs, but now it might be changing these programs to t older adults,” Dr. Sacco says.

“People think this person doesn’t look like a substance user,” says Dr. Paul Sacco, an expert on substance abuse in older adults. “Sometimes physical problems associated with alcohol abuse are assumed to have a different cause in older adults.” Substance abuse can be even riskier for older adults as their bodies become less resistant to the stresses brought on by

PLANNING AHEAD

different for an older adult.” But because Baby Boomers use substances more than previous senior groups have, experts say treatment providers may have to nd new ways to treat an old problem. “Everything we know about older adults and substance abuse probably doesn’t apply to Baby Boomers,” Dr. Kuerbis says. “All bets are off.”

To mitigate the expected problems as much as possible, experts say we need to train more counselors and physicians on how to best treat older adults, and how to spot potential problems in the rst place. “With just a little bit of education about older adults, I think you could make a very big impact,” says Dr. Alexis Kuerbis, a researcher who also works with older adults. “The rst step is awareness on what might be

“We’re grossly understaffed in being able to handle these problems.” - Dr. Dan Blazer, Duke University 27

StartingYoung Insight into adolescent addiction comes as new guidelines urge early prevention

Treatment providers have known for years that adolescents are more susceptible to drug use and consequently, addiction. But now they might know why. Researchers recently discovered a specific pathway in the brain that makes adolescents more prone to problematic substance use, which could lead to stronger prevention efforts. By studying how cocaine affected the behavior of young and adult mice differently, researchers found that a mechanism in the brain which regulates specific protein production also controls addictive behaviors. By manipulating that mechanism, researchers were able to mitigate cocaine’s addictive effects. “Now we have a bidirectional switch that can turn on and off the cocaine-induced changes in the brain,” says lead researcher Dr. Mauro Costa-Mattioli of the Baylor College of Medicine.

“ The excitement of this study is that now perhaps we have a signalling pathway that could be targeted for the treatment of addiction. ”

- Dr. Mauro Costa-Mattioli, Baylor College of Medicine

One size fits all What’s most exciting about the study is that the pathway does not appear to be specific to cocaine. A second study examining nicotine returned similar results, leading researchers to believe any treatments targeting the pathway would be effective for all substances. “In the case of nicotine, it’s exactly the same thing,” Dr. Costa-Mattioli says. “All the drugs of abuse, they reduce the activity, they hijack or change this mechanism.” Researchers say they’re still interested to see if the mechanism plays a role in the transition from social substance use to more problematic use. But they say simply identifying such a crucial link of the substance use chain could lead to significant prevention methods. “Of course, the excitement of this study is that now perhaps we have a signalling pathway that could be targeted for the treatment of addiction,” Dr. Costa-Mattioli says.

26 28

Total improvement Experts say the benefits of implementing early intervention efforts far outweigh the cost. Although limited data exists, studies show investing just one dollar can produce anywhere from a few dollars to $26 in cost savings down the road. “Thus a well-designed, well implemented early childhood intervention can dramatically benefit the community and society as well as improve children’s and families’ quality of life,” Dr. Volkow says. But the benefits of early intervention go beyond substance abuse. Experts say many of the risk factors for substance abuse are the same indicators for other social, behavioral and academic problems. They say creating a prevention program to address and reduce the risk of substance abuse will pay big dividends across the board. “Interventions designed to reduce early risk factors show benefits in a wide range of areas,” Dr. Volkow says. “Including improved personal and social functioning, better performance in school, and less involvement with the juvenile justice system or mental health services.” 

“ Early childhood intervention can dramatically benefit the community and society as well as improve children ’ s and families ’ quality of life. ” - Dr. Nora Volkow, NIDA director

First eight years To address adolescent drug use, experts say prevention efforts have to start earlier than most would expect.The National Institute on Drug Abuse (NIDA), the government’s top agency on substance use, recently released new guidelines suggesting prevention education should start in the first eight years of a child’s life. Officials acknowledge that early childhood is not a time period normally associated with drug use. But they say factors with family, school and community environments can shape development of certain emotional and behavioral issues that can manifest in substance abuse problems even decades later. “Central to intervening early is the idea of shifting the balance of risk and protective factors in a way that builds a foundation for optimal social development and resilience,” says NIDA Director Dr. Nora Volkow.

27 9

“The concept of addiction as a disease of the brain challenges deeply ingrained values about self-determination and personal responsibility.” – Dr. Nora Volkow, Dr. George Koob, Dr. AThomas McLellan

Fighting for the Brain Disease Model Model can complicate messaging in treatment plans

Fighting public opinion can be an uphill battle, sometimes even a futile one. Despite years of progress and scientific advancements, researchers and treatment providers still find themselves having to convince the general public that substance use disorder is a disease. But it’s a message that can often complicate treatment plans as much as it seeks to inform.

28 30

Setting the Record Straight Earlier this year, three of the nation’s leading drug experts wrote a paper seeking to explain, once and for all, how substance use affects the brain in the same way as similar diseases. In an article published in the New England Journal of Medicine, NIDA Director Dr. Nora Volkow, NIAAA Director Dr. George Koob, and Treatment Research Institute founder Dr. AThomas McLellan say they hope to reaffirm the brain disease model while simultaneously addressing common misconceptions about addiction. “The concept of addiction as a disease of the brain challenges deeply ingrained values about self-determination and personal responsibility that frame drug use as a voluntary, hedonistic act,” the authors write. The authors argue that public skepticism about the brain disease model comes from researchers’ inability to articulately describe the relationship between changes in neurobiology and the behaviors associated with addiction. Although countless scientific studies have proven the brain disease model to be accurate and effective, the authors admit more work may be needed to change public perception. “A more comprehensive understanding of the brain disease model of addiction may help to moderate some of the moral judgment attached to addictive behaviors and foster more scientific and public health–oriented approaches to prevention and treatment,” the authors write.

“You have to emphasize the responsibility on the part of the person, but you also have to explain why the behaviors are happening.” – Bob Rohret, MARRCH executive director

 Scientific studies attest that a person’s brain chemistry can be altered as a result of addiction.This fact can provide a needed explanation as to why continued use can still be a problem for people who clearly desire to get clean. “When you start to apply an explanation of why certain behaviors occur,” Rohret says, “it provides people some comfort in understanding why they’re doing what they’re doing.” 29 31 Mixed Messages But as confident as many in the medical community are about the nature of substance abuse disorder, the idea that addiction is a disease presents something of a double-edged sword for treatment providers. “The messaging has to be sort of finessed,” says Bob Rohret, executive director of the Minnesota Association of Resources for Recovery and Chemical Health (MARRCH). “You have to emphasize the responsibility on the part of the person, but you also have to explain why the behaviors are happening.” Rohret says treatment providers have to inform those in recovery about the nature of their disease, while also making sure knowledge of that disease doesn’t become a crutch or an excuse for inaction. When presented correctly, Rohret says patients should understand their addiction and responsibility toward it in much the same way someone with heart disease may understand their affliction. Although they cannot change the biological makeup of their body immediately, they can make behavioral changes and take actionable steps that lead to more positive outcomes.

Integrated treatment works best for victims of sexual abuse who are also addicts. Researchers have found a dramatic link between the

“ 1 out of every

occurrence of sexual abuse and substance abuse. According to alcoholrehab.com, “sexual abuse victims are three times more likely to suffer depression, six times more likely to suffer PTSD, 13 times more likely to abuse alcohol and 26 times more likely to abuse drugs than those who have not been sexually abused.” They go on to say that one out of every six women and one in 33 men in America have been the victim of sexual assault or rape in their lifetime.

6 women and one in 33 men in America have been the victim of sexual assault or rape in their lifetime. ” -alcoholrehab.com

Integrated treatment

Treatment centers are beginning to recognize the need for integrated treatment techniques for victims undergoing substance abuse recovery. Since there’s such a high prevalence of sexual abuse among addicts, integrated treatment offers a fuller recovery for sexual abuse victims. Trauma-focused Cognitive Behavior Therapy (CBT) is one common form of treatment. In CBT, individuals are offered psychoeducation, therapy instructing and empowering them to deal with their condition in an optimal way. Stress management tools are also helpful. Individuals can be taught to change their situations or their reactions and how to maintain appropriate personal boundaries. The regulation of emotions can be a challenge for a person who has been sexually abused. In CBT, clients learn what emotions are socially tolerable and they learn how to be flexible enough to permit some spontaneity. Survivors are also taught how to delay emotional reactions as necessary.

Individuals can be taught to change their situations or their reactions, and how to take good care of themselves.

 Integrated treatment for those suffering from substance abuse addiction and sexual abuse greatly increases the chance that this person will remain sober for the long haul.They can also experience greater joy and healing than if they were treated for substance abuse alone. Telling their story One effective aspect of CBT is for the person to do a “trauma narrative.” In addition to telling their story by the spoken word or writing it down, they can also use drawing, painting or other art forms to communicate the trauma.The narrative can then be shared with a safe person, like a trained therapist or substance abuse counselor.The hope is that the survivor will be able to let go of some of the trauma. Healing can then take place. Another facet of CBT is behavior management training. Clients are encouraged to stay calm in an emotionally charged situation, manage their own responses, learn what limits are appropriate, handle challenging questions and learn how to prevent physical confrontations with others. According to the Rape, Abuse and Incest National Network (RAINN), survivors are also encouraged to do what they can to heal themselves. Good sleep and nutrition, exercise, and regular routines like starting and ending the day in a peaceful way are a good place to start for people from this background. Those in recovery are also urged to write down leisure activities they find enjoyable and engage in those activities regularly. Clients are also encouraged to use journaling and inspirational reading to further grow in their recovery. Finally, having a supportive group of friends and family will help an individual recover emotionally from this kind of trauma.

31 3

More college campuses are dedicating housing to students recovering from addiction

House parties, keg stands and spring break. The stereotypical images of American college life may revolve around drinking and party culture, but that image may be changing as more universities look to make campus a welcoming space for recovering addicts to live and learn. In the fall of 2016, a growing number of colleges will debut new Living-Learning Communities (LLCs) speci cally for people in recovery. While LLCs typically occupy a oor of a dormitory and center on a

shared interest or academic eld, these new student housing sections will provide a safe and positive environment for recovering students.

“It’s something I’ve always wanted to see implemented at the university,” says Dr. Gerard Love, a drug and counseling professor at Slippery Rock University in Pennsylvania where a new eight-person LLC will open in the fall of 2016. Slippery Rock of cials hope to offer recovery-related programming at least once a week with topics such as nutrition, team building and spirituality. The hope is that the apartment-style living space will provide students a network to help them focus on both academics and recovery.

W A T

L Y

E R

O N

“I see them as being leaders here on campus.”

– Kris Barry, University of Minnesota - Rochester

34

“It’s really just about being around like-minded people and developing that ‘we’ as a support system.”

– Dr. Gerard Love, Slippery Rock University

“Universities are supposed to be about dialogue, and having this is a great opportunity for dialogue,” Dr. Love says. “Bringing this whole notion of addiction out of the shadows and increasing understanding, I think will be a good byproduct of this.”

“It’s really just about being around like-minded people and developing that ‘we’ as a support system,” Dr. Love says. Dr. Love says simply having a recovery space on a college campus could help change perceptions about recovery and remove the stigma surrounding addiction.

Of cials at the University of Minnesota – Rochester will also be opening a new recovery LLC for the fall 2016 semester. Of cials say it’s necessary to provide recovering students with the tools they need to succeed academically and in their personal lives. “Historically, students who are in recovery really struggle to come back to campus without that [supportive housing] program,” says Kris Barry, the school’s health and wellness advocate. The LLC will house six to 10 students and feature evidence-based recovery programming. Of cials say the LLC speaks to the school’s mission as a health-focused university. But more than that, they say they hope to foster a culture of personal growth among all students, particularly those in recovery. “I see them as being leaders here on campus and then taking that and changing the dialogue about addiction,” Barry says. “We know that the traditional college experience can be hostile to the goals of anyone in recovery, and we want to support them as much as possible.”

Boyd Austin says student communities centered on recovery provide a welcome relief for students to explore their university in a supportive and positive way. “It o ers a space, it o ers a culture, it o ers a community of people who are engaging in college in the same way,” Boyd Austin says.

Experts say universities are increasingly adding recovery programs focused on creating a community among students, but ones incorporating housing are still few and far between. “This started about 30 years ago, but it has really taken off in the last 10 years,” says Amy Boyd Austin, president-elect of the Association of Recovery in Higher Education.

33 5

Learning to Drink

Study finds alcohol changes the brain from the very first drink

“ Drugs of abuse basically hijack the normal learning and memory processes. ” - Dr. Dorit Ron University of California - San Francisco

Preventing escalation

The NIAAA-funded study did not establish a relationship between initial use and addiction, or even problematic drinking. But the hope is that further understanding of how alcohol affects the brain initially could lead to better treatment and prevention efforts down the road. “If we can control that step, we may be able to prevent further escalation,” Dr. Ron says. More research is needed to determine which other components of the brain are affected by initial alcohol exposure. Dr. Ron says she believes the changes that occur during first exposure could be reversed with prolonged abstinence from alcohol. But she said the more a person drinks, the harder it is to reverse those changes as the brain forms stronger connections to drinking.

One drink is all it takes. That’s what one research team found when studying how even the first exposure to alcohol can affect a person’s brain. A team from the University of California - San Francisco exposed mice to alcohol and then studied the synapses (connections) in their brains.The team found that even the first drink produced significant changes in the brain’s biological structure, calling the changes a “learning event.” “This is basically the first step,” says Dr. Dorit Ron, one of the chief researchers. “You are basically placing a memory trace.” Dr. Ron says the entire study was based on the idea that “addiction, and not just alcohol addiction, is thought to be a maladaptive form of learning and memory.” In essence, the study showed that first exposure to alcohol primes the brain for further use and lays the foundation for future “learning.” “Drugs of abuse basically hijack the normal learning and memory processes,” Dr. Ron says. “The behavior becomes habit.”

34 36

Predicting behavior

A new study also suggests that the earlier a person starts drinking, the stronger those connections may become. Researchers recently set out to identify which substance people use first in their lives and found the majority of people try alcohol before any other substance.The team also looked at how a person’s age when they start drinking affects substance use later in life. Researchers say the earlier someone starts drinking, the more likely they are to use more than one illicit substance, and they’re also more likely to develop an addiction. “It’s a very nice predictor for polysubstance use,” says Dr. Adam Barry, the study’s chief author. “The later you delay, the closer you are to 21, the less likely you are to be alcohol dependent or dependent on other substances.”

“ Alcohol consumption among youth doesn’t occur in a vacuum. ” - Dr. Adam Barry, Texas A&M University

 strategies that prevent drug use and then applying those in an alcohol setting.” Curbing use Researchers acknowledge there’s a difference between a first sip and a first binge drinking event. But they say age at first use of any kind is still a good predictor of behavior later in life. To combat problematic drinking, Dr. Barry says educators need to address all factors of a child’s life, not just the substance itself. In keeping with new guidelines from the National Institute on Drug Abuse, Dr. Barry and his team recommend beginning substance education as early as third grade. “Alcohol consumption among youth doesn’t occur in a vacuum,” Dr. Barry says. “It’s really just trying to find evidence-based

35 37

HAS BEEN SHOWN TO PREVENT OVERDOSES AND STOP OPIOID “DESIGNER DRUGS” FROM AFFECTING THE BRAIN vaccine ? ARE A new

T

Treating addiction with vaccines is a relatively new idea with many unanswered questions Treating ad iction with vac ines is a relatively new idea with many unanswered questions

that arise out of a lack of research. But a new study suggests vaccinating against illicit drugs is not only possible, it could be extremely effective. At the Scripps Research Institute in California, researchers were looking for a way to guard against the lethal and addictive effects of synthetic opioid “designer drugs.” A potentially deadly opioid, fentanyl, is often used as a heroin substitute or mix-in by drug dealers, so that arise out of a lack of research. But a new study sug ests vac inating against illicit drugs is not only pos ible, it could be extremely effective. At he Scrip s Research Insti ute in California, researchers were lo king for a way to guard against he lethal and ad ictive effects of synthetic opioid “designer drugs.” A potentially deadly opioid, fentanyl, is often used as a heroin substi ute or mix-in by drug dealers, so researchers developed a vaccine to try to mitigate its effects. Researchers injected mice with three rounds of the vaccine and then exposed them to doses of fentanyl. They found the vaccinated mice did not display any “high” behaviors even months after the last series of vaccine injections. Researchers say the immune systems of the mice developed antibodies that successfully blocked the drug from reaching the brain. “The results were the best we’ve ever seen for any drug vaccine,” says Paul Bremer, a graduate student at Scripps Research Institute who worked on the study. researchers developed a vac ine to try to mit gate its effects. Researchers injected mice with thre rounds of the vac ine and then exposed them to doses of entanyl. They found the vac inated mice did not display any “high” behaviors even months after the last series of vac ine injections. Researchers ay the im une systems of the mice developed antibodies that suc es fully blocked the drug from reaching the brain. “The results were the best we’ve ever se n for any drug vac ine,” says Paul Bremer, a graduate student at Scrip s Research Insti ute who worked on the study.

VACCINES THE ANSWER

“

The results were the best we’ve ever seen for any drug vaccine. - Paul Bremer, Scripps Research Institute

38

“ WE WERE ABLE TO BLOCK EXTREMELY LARGE - Paul Bremer DOSES OF FENTANYL TO PROTECT AGAINST OVERDOSES

SAFE AND POWERFUL Not only was the vaccine able to stop intoxication (something researchers suggest could aid in opioid addiction treatment), the vaccine also proved extremely effective in blocking the potentially lethal effects of fentanyl as well. While the chemical is not necessarily toxic in itself, it does produce psychoactive effects that can shut down breathing and stop a person’s heart. Researchers say mice injected with the vaccine could withstand doses of fentanyl up to 30 times the normal rate. “It was just a rst generation vaccine, but it did prove to be very potent,” Bremer says. “We were able to block extremely large doses of fentanyl to protect against overdoses.” A SINGLE PURPOSE Researchers say the vaccine would not protect against heroin or oxycodone, and a mixture of vaccines would be needed to protect against all opioids. But that was somewhat by design. To make sure the vaccine would not interfere with any medications a person may take responsibly later in life, researchers targeted speci c molecules so the vaccine would only block fentanyl and its derivatives.

“For unrelated drugs that you would be taking, there would be no effect from the vaccine,” Bremer says. LOOKING TOWARD THE FUTURE Although still in the early stages of development, researchers say the vaccine represents an exciting step forward in drug vaccine research. The lab is beginning more advanced trials on a similar heroin vaccine which should give them a better idea of how successful the fentanyl vaccine could become. But until more testing can be completed, researchers say they were pleased with the progress and excited for the future of vaccines in the treatment of addiction. “This concept of using a vaccine for addiction isn’t just an academic pursuit, it could really be used in practice,” Bremer says. “I think it’s really promising.”

safe and powerful

37 39

Marijuana users are five times more likely to develop an alcohol abuse disorder, according to a new study

When it rains it pours. The old idiom may be familiar to many drug users who often find themselves battling more than one addiction. While previous research has shown multiple substance abuse disorders often go hand in hand, a new study suggests simply using marijuana can lead to a much higher risk of developing an alcohol use disorder.

Finding the Link Researchers at Columbia University analyzed data from 27,461 people who had used marijuana at the time of first testing, but had no history of alcohol related disorders. When researchers checked back three years later, they found marijuana users were five times more likely to have developed an alcohol abuse disorder.

Researchers said they were surprised the link wasn’t between marijuana use disorder, but simply marijuana use itself. “I think it’s important for people to be aware that there are certain behaviors that come with specific risks,” says Dr. Renee Goodwin, one of the lead researchers. “It would be particularly useful for youth.” Because youth are at a higher risk of experimenting with both drugs and alcohol, researchers said educating them about the total scope of risk is not only important, but could help curb problematic behaviors. “Preventing or delaying the onset of marijuana use could prevent or delay the onset of alcohol use disorder,” Dr. Goodwin says. “Statistically it should.”

“I think it’s important for people to be aware that there are certain behaviors that come with specific risks.” -Dr. Renee Goodwin

38 40

“Preventing or delaying the onset of marijuana use could prevent or delay the onset of alcohol use disorder.” -Dr. Renee Goodwin

Uses In Treatment For those already struggling with marijuana or alcohol use disorders, researchers said the knowledge that the two behaviors are linked could help people see the bigger picture of their addiction, and could prove useful in their journey toward recovery. “In some ways it may seem self evident, but it may not be,” Dr. Goodwin says. “If you’re trying to quit drinking, it’s good to know that quitting marijuana could increase your chance of being successful.”

Zero relationship to mood and anxiety disorders As marijuana use has increased in the U.S., with some states even voting for legalization, some have wondered what the psychological cost will be to users. To investigate the question further, other researchers at Columbia University also conducted a recent study to determine if a link exists between increased marijuana use and psychiatric disorders. Although the results, published in the journal JAMA Psychiatry, mimicked previous research in showing a strong relationship between marijuana use and other substance abuse disorders, the findings in regards to psychiatric disorders were much different. The study showed no relationship between marijuana use and increased instances of mood and anxiety disorders, only substance abuse disorders. But despite the lack of a connection, researchers still cautioned against public policy that could lead to increased marijuana use. “The lack of association between more frequent cannabis use with increased risk of most mood and anxiety disorders does not diminish the important public health significance of the association between cannabis use and increased prevalence and incidence of drug and alcohol use disorders,” the authors wrote. 

39

41

New study looks to pinpoint transition from prescription opioids to heroin

Stopping heroin use before it begins may be the best remedy for the country’s growing epidemic. A new study looks to pinpoint the times and ways that young people rst use the dangerous drug in hopes of strengthening prevention efforts. For three years, researchers at Wright State University tracked nearly 400 18- to 23-year-olds in Columbus, Ohio, who used illicit prescription opioids but were not opioid-dependent. Of the 362 participants, 27 eventually transitioned to heroin, a rate of 7.5 percent. “We were surprised at the number of people who transitioned to heroin,” says Dr. Robert Carlson, the study’s lead researcher. “We had really no idea of what exactly we’d be able to predict.”

Predicting risk

Researchers found several predictors of increased risk of heroin use, starting with the ways in which the opioids were being used. Those who crushed or snorted the prescription drugs were far more likely to transition to heroin. “It increases the speed at which the drug is hitting the system and makes people much more liable to becoming dependent,” Dr. Carlson says. “If people can become aware that if they even think about starting to use via a non-oral route, they are heading off on a very dangerous path.”

40 42

“We were surprised at the number of people who transitioned to heroin. ” - Dr. Robert Carlson, Wright State University

Racial divide

The new NIDA-funded study targeted 18- to 23-year-olds because they are arguably at the highest risk for substance abuse. The study did not look at other age groups. But when considering the factors that may move a person from prescription opioids to heroin, Dr. Carlson believes age is just a number. “I wouldn’t think the risk factors for transition to heroin would be much different regardless of age group,” Dr. Carlson says. While the risk factors may be the same across age groups, the most deadly effects of heroin use are not. Research has shown that those most at risk of a heroin-related overdose fall in the 25 to 44 age range. It’s important to keep in mind that the vast majority of prescription opioid users will not move on to heroin. And signi cant research is still needed to determine the social, environmental and biological factors that contribute to a person transitioning to heroin. But Dr. Carlson says he’s encouraged by the progress being made and believes the groundwork has been laid to develop effective treatment and intervention programs. “The really exciting thing to come out of this is it really gives us a rm foundation of some variables that could be targeted to prevent transition to heroin and transition to dependence,” Dr. Carlson says. Targeted approach The study also saw a difference in race among those who eventually turned to heroin. Despite roughly half the participants being African-American or Hispanic, all of the individuals who ultimately used heroin were white. Although the study could not determine the reasons behind such a strong racial divide, Dr. Carlson suggests that social networks, generational use and other circumstances could be signi cant factors. National data shows the heroin epidemic has increasingly hit white males the hardest. The Centers for Disease Control estimates that between 2002 and 2013, heroin use among non-Hispanic whites increased 114 percent. Age is just a number

41 43

42 44

(240)318-5790

At Bridging the Gap Services it is our mission to improve and rebuild lives one at a time through compassionate and quality health care. At Bridging the Gap Services we offer:

• Assessments • Group & Individual Counseling • Drug & Alcohol Testing • Alcohol/DWI & DUI Education • Relapse Prevention with Aftercare sessions in an outpatient setting.

We can help you, call us now! (410)528-8692

45

braddeeles

YOU CAN GET HELP NOW Baltimore has a 24/7 help line. Call the Crisis Information & Referral Line CALL 240.318.5790 46

GET HELP & INFORMATION • Crisis intervention services • Substance use treatment • Mental health treatment • Overdose prevention resources Around the clock service 365 DAYS A YEAR.

47

Just as the United States has become a more ethnically and culturally diverse society, so has the population of clients seeking addiction treatment. For that reason, treatment programs like Step N2 Recovery Services are putting more emphasis on the cultural competence of their Becoming Culturally Competent Treatment programs adjust to diversity

“Counselors have to learn patience.” – Rhonda Poole Addiction Counselor Step N2 Recovery

as approaching the counseling process from the context of the personal culture of the client. Professional ethics require that counselors must make sure that their own cultural biases do not get in the way of the counseling process, according to Rhonda Poole, an addiction counselor at Step N2 Recovery Services.

include spirituality, religion, region, language, and livelihoods. Culture is live in their communities.

48

Starts at intake Cultural competency starts at the intake desk, when a client enters treatment, according to Poole. At intake, if a counselor is having difficulty understanding a client’s language, “What do I do, as a counselor? Turn away, bite the bullet and deal with it, or learn more about their culture? I choose the third option,” she explains. Learning to see past cultural differences is important for any counselor to be able to “reach” and help clients, Poole notes. Language differences may initially make it more difficult to communicate and understand a client, but counselors learn early in their careers to overcome those. (Step N2 offers interpretation services when necessary). Communication difficulties can be frustrating, but it’s important for the counselor not to show frustration, Poole adds. Building a rapport with the client is essential to be effective. Cultural differences can manifest themselves in the attitudes of clients and counselors. A cultural difference may sometimes impede a client’s willingness to trust and share information with those whose job it is to help them, Poole says. Another thing the counselor needs to remember is that, because of language or other differences, “They also may not understand me,” she says. Being aware of negative stereotypes, which are often based on false beliefs about a given group of people, is also important. “For example, someone may think that all drug addicts are thieves and liars, based on what somebody said,” rather than striving to see each person as an individual, Poole points out. Part of that process is finding out each client’s personal strengths, so those can be used to help him or her recover.

“They are all addicted to a substance. Addiction doesn’t have a culture; it destroys

cultures.” – Rhonda Poole

Treatment programs like Step N2 need to be open to anyone who needs addiction treatment, Poole notes. So, when a client is going through intake, it’s important not to let a difference in language or some other cultural aspect stand in the way. Counselors “have to learn patience,” she says, in assessing each client’s needs and understanding their cultures. Regardless of racial, cultural or other differences, the clients who seek help at Step N2 Recovery all have at least one thing in common, Poole says: “They have all misused alcohol or some other substance. Addiction doesn’t have a culture; it destroys cultures.” 49

WHERE THERE IS LIFE

7902 Old Branch Ave. Suite 202 Clinton, MD 20735

50

THERE IS HOPE

240-318-5790

51

Striking a Delicate Balance Counselors combine empathy, objectivity

Addiction counseling is a challenging field in which much of the most essential learning takes place on the job rather than in classrooms, as new counselors develop the skills to deal with the infinite variety of human personalities and behaviors. One thing Meeker has learned in her three years of practice is the importance of maintaining healthy boundaries in dealing with treatment clients and not becoming too wrapped up in their problems. “It’s very easy to become friendly, get close to clients and end up taking the job home with you,” Meeker notes. If a client relapses or is dismissed from the program for behavior related reasons, she has learned not to blame herself or second-guess her counseling approach.

For addiction counselors like Bridging the Gap Services’Tina Meeker, helping clients find recovery involves striking a balance between empathy and maintaining a healthy objectivity. It’s a balance every counselor must learn to maintain to be effective. It was Meeker’s own struggle with addiction, and seeing the damage alcohol and drugs did to the people around her, that motivated her to enter the counseling profession. “I wanted to do something about it,” she says. Growing up in Baltimore, Meeker began using alcohol and drugs as a pre-teen, while hanging out with an older group (she has three older brothers). She was introduced to heroin at 19, after moving to Aberdeen, Md. After struggling for several years, in 2009 she entered a methadone and outpatient treatment program in Harford County. While in the program, Meeker enrolled at Harford Community College and Baltimore Community College, earning an associate degree in counseling. She completed a counseling internship at Powell Recovery Center in Baltimore, and eventually joined the staff at Bridging the Gap in September of 2013.

“I wanted to do something about it.” -Tina Meeker, counselor, Bridging the Gap Services

52