The story of Jessica Grubb’s battle with heroin addiction so touched President Obama that when he traveled to Charleston, W.Va., last fall, he invited her parents to attend his public forum on opiate addiction.
“Jessica Grubb had tried several programs, and she had been successful,” said Sam Hickman, executive director of the NASW West Virginia Chapter in Charleston. “She was doing well.”
Then she had an accident, and her physician — who did not know of her past heroin-addiction problem — prescribed an opioid painkiller, he said.
Grubbs died in Michigan in March.
“It’s really tragic,” said Hickman, who also attended Obama’s forum — along with the chapter’s president, Kimberly White. “It really brings home how sad and troublesome (addiction) is for families.”
During the community forum in October, Obama discussed his administration’s commitment to address prescription drug abuse and the heroin epidemic.
As Congress begins taking action on the opioid-addiction problem, social workers continue their decades-long battle to help patients and stem the rising tide of drug use, addiction and death.
“I’m in southwestern Virginia, and this has been the epicenter of the problem, I think more than anywhere else,” said Michael E. Hayter, whose private practice, Appalachian Clinical Services, is based in Abingdon. “Over the last 10 years, it’s exploded.”
He said when OxyContin first came out around 1999 to 2000, drug representatives were promoting the opioid drug in the area “as a non-addictive for chronic pain.”
“They really marketed that in the rural South,” said Hayter, who is on the NASW board of directors. “Within a couple of years of when that stuff came on the market, it was an explosion. It’s a 100 percent increase in the last 10 years that we’ve seen.”
Rebecca Mowen, whose private practice, Recovery 360, is in St. Louis, has seen a steady increase in addiction since about 2003.
“It’s been a big increase the last four or five years,” Mowen said. “People are dying right and left. That’s a hard conversation to have with family who come in — (to) tell them we may not win this battle.”
Hickman said West Virginia has the highest rate of opioid overdose deaths in the nation per capita.
“People are looking for some kind of escape,” he said. “It’s been going on for years. As states make it more difficult to purchase ingredients to make meth and make it more difficult to illegally acquire opiates, people turn to other methods such as heroin, which is accessible and cheap.”
“ If you don’t want to experience the horrendous effects of withdrawal and can’t find another way, you turn to heroin,” Hickman said. “And heroin is not a controlled substance, so you never know what’s in it. So they overdose.”
Hayter said alcohol has always been a problem in his area.
“And now we’re seeing cannabis and opioids and methamphetamine,” he said.
Mowen sees methamphetamine and heroin use. “As all kinds of new drugs come out, they use just whatever not to feel, or to feel good.”
Jack B. Stein, MSW, Ph.D., is director of the Office of Science Policy and Communications at the National Institutes of Health’s National Institute on Drug Abuse.
“The main elements when you talk about opioids these days is the non-medical use of prescriptions like OxyContin and the surge in heroin use,” he said. “They’re all opioids, and the chemical structure of all opioids are basically the same. The effects are the same, and they’re all of great concern.”
Stein said the most recent statistics on addiction are “very interesting.”
“What we’re actually seeing is a decrease in the use of opioids because of good practices — fewer prescriptions,” he said. “What isn’t in proportion is overdose rates. Opioid overdoses in this country have really skyrocketed. That’s what’s at epidemic proportions.”
“We get at least a call a day or several a week — parents or family members call and say they lost a child or an adult,” he said. “I’ve worked for more than 20 years, and I’ve never seen this.”
When it comes to who can become addicted, it’s anyone.
“It’s an equal-opportunity dilemma, an equal-opportunity disease,” Hickman said. “It can affect anyone. There’s stereotypes of who is more susceptible, but we’ve had people who drive a Mercedes-Benz as well as poor people.”
“It’s normal people that develop substance abuse over time,” he said. “It’s all populations. I think the wide spectrum has always been there. I think everybody in southwest Virginia knows somebody that’s addicted.”
Mowen estimates that about 10 percent of the U.S. population is addicted.
“It’s an equal-opportunity abuser,” she said. “No matter the color, race, culture, rich or poor, age, gay or straight, it doesn’t care. It takes everybody.”
Hickman thinks there are a couple of reasons why so many in his state become addicted.
“West Virginia has a large number of people working high-risk jobs,” he said. “Whether it’s legitimate or not, they’re prescribed opioids for pain, and they become addicted. Another factor is the downturn in the economy. There’s always been an underground drug supply network. I think, in part, the sense of hopelessness, the wondering ‘What’s going to happen next for me?’ led some people to escape.”
Mowen believes a genetic propensity can make addiction more likely, and the age of a person when they first use also is a factor.
“If a person starts at 13 or younger, there’s a greater risk factor,” she said. “I believe brain development has a lot to do with it. If an adolescent starts using at 15 or 16, their brain stops developing — the prefrontal cortex, the part of the brain that tells you not to do stupid stuff.”
And once a person is hooked, it’s very hard to overcome.
Stein said there are a several reasons people might try a particular drug, including curiosity, to alleviate pain, or because of peer pressure.
“Once you become addicted, you literally lose self control,” he said. “Your body tells you ‘I need them.’”
“Heroin, unfortunately, is widely available in this country, and over the years, the price of heroin has dropped significantly,” Stein said. “If you need it, if you desire it, if you have to have it, unfortunately it’s affordable.”
Hickman said treatment depends on the person, but just what method to use is “quite a controversy in the treatment community,” and there are two camps.
The chronic-disease view is to treat it like diabetes: something you always have to treat. That involves “medication-based treatment of controlled doses of other medications that allow you to function normally without the effects of withdrawal,” Hickman said.
“The other camp says that’s just replacing one addiction with another, and if you’re not all clean, you’re not recovering,” he said. “For them, the 12-step program is the only way out.”
“Those two opposing poles reflect the dilemma we’re in on treatment programs,” Hickman said. “We need a full continuum of services over time to impact the problem at all levels.”
Hayter said there is no cookie-cutter approach to treating addiction.
“I think there are three key components,” he said. “You need to understand the individual. I think motivational interviewing is a key component. That’s really understanding the individual and where they’re at with their addiction.”
The second component is adding a treatment, like the medication-assisted treatment. Third is using therapy, like cognitive behavioral therapy, Hayter said.
“You have to help people understand their thought processes and understand themselves,” he said. “I think harm-reduction therapy — where you cut back slowly — is an important area as well. Cutting back is like using the patches for quitting smoking and increasing other things — positive things.”
Mowen said treatment centers all over the country use a “bridge” like suboxone, a “medication assisted treatment” drug.
“They use it while we’re teaching them how to deal with life,” she said.
She finds a 12-step program “very effective,” and said therapy should be used in conjunction with it all.
“Urine testing as accountability helps,” Mowen said, and family members must be involved.
When it comes to the federal Comprehensive Addiction and Recovery Act (CARA), Mowen would like to see a heroin task force added to the bill. (Please see article in this issue about CARA and other legislation related to addiction.)
Hayter thinks adequate services are already available, so he would like to see more professionals trained in the addiction-treatment field.
“I really think that more money to really push that is a better way,” he said.
Whatever the outcome of the legislation, social workers are best positioned to continue their work helping people overcome addiction problems, Stein and Hickman both say.
The NASW West Virginia Chapter has skill-building sessions, Hickman said.
“We’re a rural state with all kinds of problems, and we need a pretty large bag of tricks,” he said. “We’re trying to increase and enhance the skills of practitioners so they know what to do to help people start the road to recovery.”
Stein said social workers have “a huge role at the practicing level as well as making services available to people.”
“Regardless of the type of setting — medical, clinical, school, business — one of the most important roles social workers play is their perception that there may be a possible problem,” he said. “Just like any other health problem, you have to identify it.”
“Social workers play a really incredibly important role on the entry level of the opioid problem,” Stein said.
Hayter said he had a patient who had done cocaine and crack “back in the day” before he entered a recovery program.
“He goes to his recovery group every week. He’s doing his program. He’s really working it the way it needs to be worked,” Hayter said. “He’s really successful. It’s tremendous.”
Hayter enjoys farming on the side, and made this analogy: “Some seeds grow, and some seeds don’t,” he said. “You have to realize you can’t change everyone. But if you make a difference in someone’s life, you’re a success.”