The Opioid Crisis: How You Can Help

The U.S. Department of Health and Human Services declared the opioid crisis a public health emergency in 2017. This designation led to the release of a five-point strategy to fight the epidemic, which includes: improving access to treatment, prevention, and recovery services; increasing access to overdose-reversing drugs; strengthening data collection and reporting; helping to advance research on pain management and addiction; and improving pain-management practices.

While the crisis continues, this increased attention by policymakers shows there is potential to make a change. And with it are many ways to join the fight to end the opioid epidemic, which you’ll learn more about here.

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The Growth of the Opioid Crisis

What are Opioids?

Prescription opioids are commonly used for anesthesia and pain management. Common prescription opioids include oxymorphone, codeine, fentanyl, hydrocodone, and morphine. They’re generally considered safe if used for short periods of time and in controlled settings by low-risk patients. However, because opioids are highly addictive, and the misuse of prescribed drugs can also lead to heroin use, physicians are taking greater care in prescribing opioids.

Opioid prescription rates have declined steadily in recent years. The Centers for Disease Control and Prevention (CDC) notes that prescription rates dropped from 72.4 prescriptions per 100 persons in 2006 to 58.5 in 2017, which is showing progress. However, much more attention is being placed on prescribing practices as overdose deaths from opioids remain strikingly high.

In 2016, in response to the opioid epidemic, the Centers for Disease Control and Prevention (CDC) released updated guidelines on opioid prescribing practices, including suggestions for assessing patient risk factors. While not everyone who is prescribed opioids is likely to become addicted, many factors may indicate that the person is at higher risk for addiction. Some of those, according to the Mayo Clinic, include poverty, unemployment, family and personal history of substance use disorders, depression and anxiety, and/or heavy tobacco use. With those risk factors in mind, regulatory agencies, healthcare providers, and medical schools are becoming increasingly vigilant about prescribing practices and working to limit the rise in opioid deaths.

The Opioid Epidemic

Over recent years, deaths from opioid overdoses have risen steadily and rapidly, increasing from a little more than 3,000 in 2010 to 47,600 in 2017. The CDC says the first wave of the epidemic began in the early 1990s when opioid prescription rates increased drastically. The second wave began in 2010 when the rates of heroin overdoses increased. We’re currently experiencing the third wave of the epidemic, which started in 2013 and is linked fentanyl, a synthetic opioid most commonly used as anesthesia.

A 2019 article in Nature provides compelling insights about the rise of opioid use in the U.S. It explains that the epidemic resulted from a perfect storm of circumstances, including changes in pain-management treatment, the surge in marketing of opioid medications (in particular OxyContin, manufactured by Purdue Pharma, which has received increased scrutiny and even litigation over its role in the opioid crisis); vulnerability of the U.S. healthcare system, making physicians more prone to defer to pharmaceutical companies’ advice in pain management; and the convergence of other crises, such as economic declines.

Where the Epidemic Has Hit Hardest

From any map of overdose rates, the northeastern U.S. seems to be hit the hardest by the opioid crisis. The National Institute on Drug Abuse (NIDA) reports that the following states experienced the highest rates of opioid deaths in 2017:

While many of these states are in the eastern United States, the CDC emphasizes that no state or community is immune to the opioid crisis. Both metropolitan and non-metropolitan areas are affected, albeit in different ways. Research from 2017 indicates that heroin and synthetic opioid deaths were higher in metropolitan areas, while fatalities from natural or semisynthetic opioids were higher in non-metropolitan regions.

The opioid crisis isn’t only affecting the U.S. A 2017 United Nations report found that two-thirds of drug deaths globally were opioid-related. Canada, the United Kingdom, and other parts of Europe are experiencing higher rates of opioid overdose deaths.

Who is Affected?

Just as the epidemic touches all regions, it affects all demographic groups. However, a study published by National Vital Statistics Reports about opioid deaths reveals that men are three times more likely to die from an overdose. A 2019 Kaiser Health News report posits that one reason men die more frequently of overdose is that they’re more likely to use drugs without others nearby, making it less likely that their overdoses will be seen, reported, or treated.

The CDC study also shares grim new information: While almost every age group saw a rise in opioid-related death rates, the most significant increase was among young people ages 25 to 34.

Socioeconomic factors are most certainly a part of the crisis as well. The National Institute on Minority Health and Health Disparities noted that between 2012 and 2015, the counties with high unemployment, lower education levels, and low median incomes experienced the highest overdose death rates, and these factors seemed to affect white Americans disproportionately.

The heartbreaking truth is that almost all communities in the U.S. are affected by this epidemic. Not only does it affect the people with addiction, but it also affects their friends and families, who witness the decline of their loved ones with little hope and all too often must grieve their deaths.

But there is hope. Because of the increased attention directed toward the opioid crisis, more resources are becoming available. The battle is being fought on many different fronts, with experts and professionals from many fields working to bring about change, including those in mental health, public health, public policy, social services, and advocacy. Numerous ways to get involved and to help reverse this epidemic are being developed and implemented.

The Effects of the Opioid Crisis on Mental Health Professionals

Mental health professionals are essential in helping combat the opioid crisis. They are on the frontlines of providing substance-use disorder treatment, supporting patients with depression and anxiety (issues often related to addiction), and counseling families and loved ones of people with addictions. While essential in the fight against the opioid crisis, the work is challenging and can take a toll on providers’ own mental health.

A decades-long shortage of clinicians who treat substance use disorders has only worsened since the rise of the opioid crisis. Low staffing also requires providers to take on even more work. Overall, being overworked and emotionally strained can cause burnout. This has not gone unnoticed, however.

In 2018, the Health Resources & Services Administration (HRSA) released a set of behavioral health workforce projections for 2016 through 2030, which acknowledges those gaps that are intensified by high turnover, low pay, and a lack of trained professionals. With these statistics in hand, the National Council for Behavioral Health is working with the federal government to find ways to close those gaps. One such approach is loan-forgiveness programs for those entering the profession to combat addiction—part of a comprehensive opioid package signed into law in 2018. Hopefully, this promising investment will lead to an increase in the number of professionals who can help combat addiction.

Identifying Opioid Addiction: Symptoms and Signs

The American Psychological Association (APA) defines addiction as a “chronic disorder with biological, psychological, social, and environmental factors influencing its development and maintenance.” Its website also notes that around half of the risk for addiction is genetic. What’s essential here is that addiction isn’t any one person’s fault—not the person with the addiction nor that person’s family or friends. It is, sadly, a part of the human experience. But it is treatable, and those with addiction can be helped.

While it might be hard at first to see symptoms that someone you know is addicted to opioids, the following signs could be a potential indicator a friend or loved one is addicted to opioids (according to the National Institute on Drug Abuse and the American Society of Anesthesiologists). Note that many of these signs also may be associated with depression or anxiety, which are often linked to opioid use:

• Poor hygiene and not taking care of themselves
• Friends or loved ones being pushed away, isolating themselves
• Loss of interest in what previously were favorite activities
• Frequent mood swings or bad moods
• Either very low energy or extremely high energy and erratic behavior
• Missed appointments
• Regular problems with work or school
• Sleep at unusual hours
• Problems with the law
• Difficulties with money and finances

Supporting a Loved One With Opioid Addiction (Even If You Are Not a Therapist)

Preparing to Help

The first thing to do is to acknowledge there is an addiction and then to educate yourself about it. The American Addiction Center emphasizes that addiction is not a moral failing; it is a disease. Understanding this is an essential part of genuinely offering support to your loved one. Learn more about addiction and even seek out therapy yourself to identify ways to best support your friend or family member who is struggling with addiction.

To educate yourself, look into the following:

• Understand the science behind the disease.
• Research the different treatment options.
• Self-reflect and identify unhealthy patterns that may exist in the relationship you have with the person who has the addiction. The best way to do this is by going to therapy yourself. The American Addiction Center addresses codependency and how codependent relationships (often with someone very close, such as a partner, good friend, child, or parent) can enable the addiction.

How to Approach Someone About Their Addiction

The next step after educating yourself is to approach your loved one. Because addiction and its corresponding symptoms can cause rifts in your relationship, it’s essential to approach your loved one with compassion and love. This person is struggling, and it’s the disease that is causing the rifts, not the person.

One of the first considerations is timing. You don’t want to approach someone who is under the influence when you’re ready to have this meaningful discussion. Make sure that the person is clearheaded and in an environment that feels loving and safe.

It can be challenging knowing how to discuss your concerns. The Hazelden Betty Ford Clinic says there’s no perfect way. If it feels appropriate, it can be helpful to bring someone who has also has experienced addiction or to have that person available by phone. Having someone who has gone through recovery be part of this discussion can help establish trust and show that recovery is possible.

StartYourRecovery.org provides some helpful ways to start the conversation suggestions for what questions you can ask. Questions such as, “I wanted to check in with you because you haven’t seemed yourself lately,” and, “I’ve been worried about you lately,” demonstrate your concern, compassion, and love for the person. Then you can delve more deeply by asking:

• Do you feel like you’re trying to escape anything?
• What can I do to support you?
• Have you thought about getting help?

The Hazelden Betty Ford Clinic also has recommendations about what to say to a variety of people in your life, including co-workers, partners, or friends.

From there, you can assist them in seeking resources to get the help they need. This is where your prior research about treatment options will come in helpful. Having thought about it, you can present your ideas and thoughts and get feedback. Again, it might be useful to have someone who has experienced addiction to help guide the process.

Do’s and Don’ts for Bringing Up a Loved One’s Addiction

Here are some do’s and don’ts for how to go about this (sources: VeryWell Mind, American Addiction Center):

Supporting a Loved One During Treatment

The do’s and don’ts referenced above continue when supporting someone during treatment. What’s important to understand, though, is that there is no magical treatment that will make the addiction go away immediately.

Treatment for addiction can be a long and painful process. It’s going to take resiliency and compassion to help them through this process. This Psychology Today article provides a dozen recommendations for supporting someone with an addiction—two of which are especially necessary as the person is in recovery: Don’t give up, and take care of yourself. Below you’ll find some tips on self-care.

Providing Support After Treatment Is “Completed”

While it’s important to celebrate a person’s treatment, overcoming addiction is a lifelong process and requires constant support. The Substance Abuse and Mental Health Services Administration (SAMHSA) outlines the four primary elements to support recovery:

1. Health: You can assist your loved one in managing their disease by helping them stay healthy in general. Part of this is helping to keep them sober, but supporting them to make healthy lifestyle choices through healthy eating and physical activity also is helpful.
2. Home: As someone close to this person, you can ensure they have a stable and safe place to live to help maintain sobriety.
3. Purpose: You can help them find meaning in life, which includes day-to-day independence by earning a regular income, and helping them participate in society by finding meaningful activities.
4. Community: Social networks and relationships are what help a person maintain their recovery. You can provide them with love, friendship, and hope, and you can encourage other loved ones to show their support.

Beyond these four elements, continuous therapy for both the person with the addiction and yourself is crucial. Additionally, if your spouse, partner, child, or parent is experiencing addiction, family therapy can be extremely valuable in navigating recovery as a family.

What Can Psychologists Do for Those with Opioid Addictions?

Because one of the most significant risk factors of opioid misuse is experience with mental health issues such as depression and anxiety, psychologists can play an essential role in helping patients with opioid addictions.

Preventing Opioid Addiction

A June 2019 APA article by Zara Greenbaum highlights recent research that shows how psychologists can prevent, diagnose, and treat opioid addiction most effectively:

• Identify at-risk patients to prevent misuse of opioids: Because depression, anxiety, and other mental health disorders can lead to opioid addiction, psychologists are in a vital position to potentially intervene in substance use issues through clinical treatment before disordered behavior sets in.
• Conduct outreach as a part of prevention: Because patients may not see their doctors regularly enough to understand their everyday behaviors, there are ways psychologists can reach patients. One example is an easy-to-use app that researchers from Harvard Medical School and Brigham and Women’s Hospital created to assess patients’ risk levels for opioid addiction. Additionally, psychologists can conduct outreach and make connections with pain-management providers to assist patients with chronic pain who are more likely to become dependent on opioids. There are successful psychological pain-management methods that can be used instead of opioid prescriptions.
• Employ and embrace integrative care: For patients with chronic pain, psychological treatment by itself might not be enough. So psychologists can collaborate with professionals in other disciplines, such as occupational therapists, nurses, pharmacists, and psychiatrists, to take an integrated approach to the individual’s treatment. This also goes beyond utilizing creative coping strategies. For example, the Mayo Clinic’s cross-disciplinary pain-management program involves patients not only participating in cognitive behavior therapy, but also in physical therapy, yoga, and restorative techniques to provide a more comprehensive treatment approach.

Treatment for Addicted Patients

Because not everyone can be prevented from experiencing opioid addiction, psychologists also play an essential role in treatment. A 2017 American Psychological Association article highlights some treatment methods for psychologists.

• Provide treatment that goes beyond traditional practices: While traditional therapy tools can help some, people with addiction often encounter barriers. Some non-traditional methods include helplines where patients have 24-hour access to licensed professionals by phone.
• Help design contingency management programs: These programs help provide incentives for people in recovery. They have proven successful in some environments and are beginning to expand. Psychologists can be essential in designing programs that are rooted in evidence-based practices to ensure they’re most effective.
• Help fill the gap for addiction-recovery providers: Gaps in care are also attributed to the lack of trained professionals. Because of that, the APA is making continuing education (CE) accessible to psychologists through online modules (the APA currently offers 19 online courses and book-based exams related to addiction).

In addition, as addiction is often co-morbid with other mental health diagnoses, dual diagnosis treatment is frequently recommended. This method is used to help those who have both an addiction and a separate mental health diagnosis or behavioral disorder. Co-occurring disorders require different treatment, as the brain responds differently with additional diagnoses, genetics play a significant role, and there are triggers beyond those solely for addiction; for instance, a traumatic event may affect a person with dual diagnoses in a manner unlike it would for those who solely have an addiction diagnosis.

Careers Working with People with Addictions

How to Take Care of Yourself When Helping a Person with Addiction

“Compassion fatigue” or “burnout” are terms commonly used when describing how people in the helping professions (e.g., counselors, medical professionals, and clergy) are affected by working with people with diseases, who are in distress, or who are particularly vulnerable. These terms can be applied to loved ones as well. The absorption of clients’ and family members’ pain is particularly relevant for mental health workers working to treat those with substance use disorders and their loved ones. Burnout can lead to adverse physical and mental health outcomes for caregivers, but signs can also be challenging to identify.

If you work in any capacity with someone or have a loved one who is addicted to opioids or other drugs, prioritizing your self-care is essential for you to have the energy and ability to continue your work and support. Here are some tips on what you can do to take care of yourself:

• Seek out therapy for yourself: While therapy is important for your loved one experiencing addiction, you are also living with the disease and need to learn how to navigate the world with that reality. Therapy from a trained professional may help guide you through it. Additionally, if you are a therapist or work in the mental health field, you may also experience compassion fatigue, and working through those challenges with another mental health professional can help prevent burnout.
• Attend family support groups: Support groups are an excellent way to connect with other family members dealing with addiction, to process it as a group, and to find encouragement to continue to support and navigate the world with your affected family member.
• Do things that you enjoy: Living with addiction doesn’t mean that it has to consume your entire life. If you find ways to bring joy to your life (with or without the person with the addiction), you will have more energy to provide support. Whether it’s taking up a new hobby or finding enjoyment in the activities you’ve always done, such activities can be useful distractions that keep you from being consumed by the addiction.
• Take care of your mind and your body: Exercise and regular movement are often connected to boosting mental health. This is especially important for those working and living with people experiencing addiction. Additionally, you might benefit from taking up activities that are rooted in mindfulness and healing, such as meditation or journaling. com has some recommendations on what kind of activities can be helpful.
• Know when you need to step aside: NarcAnon recommends you do the best you can to stay by the side of the person with the addiction. However, if the situation is dangerous or harmful to you or your children, you may need to step aside. The organization recommends communicating with love and kindness to the sufferer that you still support them and want them to recover, but that you or your children are being harmed in the process.

Additional Resources on the Opioid Crisis

• • The Addiction Center: The Addiction Center provides an overview of the opioid crisis and offers resources and articles that are useful both for people with addiction and those supporting them.
  • The American Addiction Centers: This site provides comprehensive resources and treatment guides tailored to specific groups, such as those experiencing addiction, couples, first responders, and people with children.
  • American Association of Nurse Anesthetists: The AANA is the leading professional organization for Certified Registered Nurse Anesthetists (CRNAs). It offers resources for providers and patients and is participating in efforts for meaningful decision-making to prevent addiction.
  • The American Psychological Association: The APA is the leading professional organization for psychologists. It provides resources for professionals working in behavioral health fields.
  • American Public Health Association: This professional organization for public health professionals provides resources for those focusing on public mental health.
  • American Society of Anesthesiologists: Because opioids are commonly used in anesthesia, the profession is focused on identifying and preventing addiction.
  • Centers for Disease Control and Prevention: The CDC is an arm of the U.S. Department of Health and Human Services that leads the nation’s health security efforts through funding, creating, and disseminating research around health and safety.
  • Collaborative for Effective Prescription Opioid Policies: CEPOP works to fight the opioid epidemic through comprehensive and collaborative public policy efforts.
  • National Council for Behavioral Health: With a mission to ensure that everyone has access to mental health services, the National Council represents mental health service providers nationwide, providing advocacy support and professional development to advance the field.
  • National Institute on Drug Abuse: NIDA creates, disseminates, and funds research on drug abuse and provides information and resources useful to professionals, researchers, and those experiencing addiction.
  • Psychology Today: This is both a magazine and an online resource center for psychology and psychology-related professions, as well as people seeking treatment.
  • Start Your Recovery: This site provides resources and support for people with addiction, family members, and healthcare providers.
  • Substance Abuse and Mental Health Services Administration: SAMHSA is an arm of the U.S. Department of Health and Human Services that leads efforts to provide resources and research around public health efforts in behavioral and mental health.
  • The Hazelden Betty Ford Clinic: As one of the best-known addiction rehabilitation centers in the U.S., the Hazelden Betty Ford Clinic also provides comprehensive information for people experiencing addiction and their loved ones.