Medication Assisted Treatment

An Entire Generation

Translation into most languages at tab to the right.

A generation is usually considered the years during which children are born, grow up, become adults, and begin to have children of their own. Approximately 20-30 years, averaging 25 years. Each generation becomes known by what characterizes the lives of those in it – what they do and how they impact society.

I’ve been thinking about my son, who would be 36 this year – if he had survived the opioid plague that began in the 1990’s with the prescribing of opioids for every ache and pain. What Purdue Pharma did is old news and well documented. But the effect of the immorality of the Sackler family set a course that destroyed the lives of an entire generation – the “Millennials” generation of my son and his contemporaries.

Far more than a million Americans have died due to a drug overdose in the past 25 years and the majority of those deaths are from opioids. (1) Initially it was prescription opioids, then heroin, then fentanyl. And now a daily variation of synthetic opioids mixed in with every variety of street drug. These are made from precursor chemicals from China and shipped around the globe where they are “formulated” into fake prescription pills or street drugs in jungle or backyard labs. Quality control is non-existent.

Beyond the deaths, there are millions of Americans who are suffering from life-threatening addiction. They will either be another statistic or live the life of an empty shell surviving from one fix to the next just to not feel “dope sick.” Many are homeless and jobless. All experience despair and hopelessness. It will take years to gain long-term recovery if they can access health care and programs.

There has been some good news. After the peak years of the Covid pandemic, when the rates of addiction and deaths from overdoses rose substantially, the statistics for 2024 finally show a decline in both. (2) It may be due to less anxiety and depression since the pandemic ended. It may also be due to more awareness of Medicated Assisted Treatment and better access to Harm Reduction tools such as pill testing and overdose reversal medication naloxone.

I think the best area for hope is the common knowledge the “Gen Z” kids are growing up with about the deadly dangers of drug addiction. That their parents are also more aware of the drug supply than parents of Millennials like me. The 2023 National Survey on Drug Use & Health found that the majority of adolescents (12-17 yrs. old) in the USA are not using substances, alcohol, tobacco products or vaping. (3) But ongoing effort is imperative. “Continued prevention programming, education, and public messaging focused on adolescents can delay or prevent substance use and avoid the negative impacts of substance use that have been widely documented.”

If we truly want to see future generations of children have the opportunity to grow up without the continual pull to use drugs, we need to keep our relationships with them open and healthy. Every year we can delay experimentation with addictive substances allows children’s brains to develop more fully in the area of judgment. We must all stay informed and aware and work in whatever arena we are able. As Barack Obama told Michelle when he was working for her as an intern, that he was in law school because grass roots organizing had shown him that meaningful societal change requires not just the work of the people on the ground, but stronger policies and governmental action as well. (4)

Fentanyl and the U.S. Opioid Epidemic

https://www.cfr.org/backgrounder/fentanyl-and-us-opioid-epidemic

2. The Opioid Crises and The Pandemic

Opioid overdoses soared during the pandemic, spreading to previously less-affected groups including teenagers and the elderly

3. NSDUH Data Show Most Adolescents in the US Are Not Using Substances

Click to access 2023-nsduh-spotlight-nonuse.pdf

4. Becoming, by Michelle Obama, Chapter 8

Born Imperfect, Complex, & Unique

(Translation into most languages at tab to the right.)

I think we would all agree that each and every one of us is born imperfect. There are so many complex and unique aspects to the human body which generations of genes have contributed. The things that make up our physical and mental attributes. One example is our face. It is estimated that only 2% of the world’s population has a truly symmetrical face. The right side usually appears larger than the left and eyes, nose and ears are not perfectly aligned. When you see a photo of a face with both sides exactly the same, its actually creepy. They lack character and look like AI.

Some of us are born with deficiencies that make life difficult and challenging, like being born blind, or deaf, or with a physical deformity. Because of amazing advances in science and medicine in the last century, many of these problems can be corrected. I had crowded teeth when I was young and am so thankful I was able to get braces and have a normal smile. We would not understand if someone had the opportunity to receive this kind of help and didn’t access it because they or others in their community thought they should just live as they are. We all want to feel comfortable and that we belong, are ‘normal’ in this world.

What about when someone is born with an internal deficiency such as a heart condition or kidney problem or blood disorder? We never think twice about having medical help or drugs and lifestyle changes to remediate the problem if it is possible. So why is there any discussion on whether someone who is born with an imbalance of normal brain chemicals or hormones should live in constant struggle and not access medication?

This thought came up as I considered the reasons behind why some people seem to need something like drugs to make them feel ‘normal’ to themselves and to the people around them. When everyone else seems to easily roll with the ups and downs of life while they get stuck on the downs. When how they think and process input and information is not the same as others. When their ability to be at peace or sleep is chronically unobtainable.

I’m not at all suggesting that individuals who seek drugs all have legitimate genetic or biochemical voids. As we know, many young people start drug use because of peer pressure and the environment that surrounds them. But underlying mental struggles or health conditions may be the determining factor that pushes them into, rather than away from, repeated use. I found it interesting that among my son’s high school and college friends, many tried all the drugs – uppers, downers, hallucinogenic – and some went on to addiction to uppers like cocaine and meth while others to downers like opioids and benzos and some walked away from all of them.

But once repeated and continual use happens, the chemicals and receptors in the brain are changed and more than ever, medication and therapy are going to be a big part of recovery from use and restoration of normalized brain signals. The need for medication may be short term or lifelong. Regardless, we all need to remember that just like shaming someone because they have a physical deformity is totally unacceptable, shaming someone who is struggling with mental health and/or addiction problems is also unacceptable.

This does not mean we enable destructive behavior or stop supporting someone to get professional medical and psychological help along with a supportive community. Never. If we want to see someone who is struggling become as healthy as possible, our love and support are crucial. And we know that in a country where public health care is a privilege rather than part of a foundation of society, finding the right care can be daunting. Let us be there to help our family, friends, and community receive the care they need by being encouraging and supportive.

Stigma of Addiction: The Effects, The Reasons, and How to Reduce Stigma

by Chris Elkins, MA

https://www.drugrehab.com/addiction/stigma/

Cognitive Behavioral Therapy Info Hazelden Betty Ford:

https://www.hazeldenbettyford.org/mental-health-services/cognitive-behavioral-therapy#:~:text=Learn%20more%20about%20this%20popular,techniques%20in%20working%20with%20patients.

The Importance of Friends – Pt 2

(Translation into most languages at tab to the right.)

How do clean and sober friends stay involved with a friend who is in active addiction and/or alcoholism? I ended last month’s blog asking this question. In particular, I want to discuss ways that teens and young adults can deal with this difficult and at times very frustrating problem.

What does being a good friend to someone who is addicted look like?

The first thing is to not pretend you don’t know about their addiction. Talk about it openly but without judgment. Understand that they may deny any problem, so you may have to cite specifics that have made you concerned. Express that you care about them and don’t think less of them as a person because of their struggles. Risk your comfort zone. “Greater love has no one than this: to lay down your life for your friends.” (1)

Be a good listener. A problem with drugs or alcohol may start from just experimenting with drugs at a party or concert. It may then turn into addiction and be fueled by problems at home or with friends or underlying mental health issues. When your friend feels cared for and accepted and not confronted with more guilt or shame, they will be willing to open up. Nobody planned to become addicted and nobody wants to be an addict. Here’s links to good info on how to help someone trapped in addiction. (2,3)

But, if you remain a good friend to someone who is living a self-destructive life, how do you help them without enabling their addiction? For young people who are good friends, enabling might be keeping secrets for them about their problem, especially from adults who may need to know in order to take life-saving action. It may be loaning them money or driving them to get drugs. The pressure would sound something like: “If you’re my real friend, you won’t tell…” Or “If you really want to help me you would…” Basically, when you support their problematic behavior in the name of ‘helping’ them, you are actually keeping them from living with the consequences of their poor choices. And this will only prolong their problems and delay change. (4)

Encourage them to get help through programs like SMART Recovery groups or AA for alcohol and NA for narcotics. Very few people overcome addictive behaviors alone. Community is key. Go with them if you can or drive them. And remember, drug and alcohol recovery take lots of time and most people don’t succeed the first time they try to quit. Dr. John F. Kelly, clinical psychologist and addiction medicine expert, says it can take 8 years and 4-5 treatment attempts at recovery to achieve one year of sobriety from opioid and other drug addiction. It can take years to achieve stable recovery and Medication Assisted Treatment (MAT) is an important aspect. Gone are the times when a 30-day detox/treatment was seen as the solution to addiction. It may be an important first step in the process of ongoing recovery. People can and do recover, but it will likely be a lifetime journey. Here’s a YouTube 2025 video of Dr. Kelly giving a session on: The New Science on Addiction Recovery. (5)

You can encourage your friend with each small step and success, even through relapses. In our son’s recovery program, we ended each session by saying together: “Keep coming back ‘cause it works if you work it.” It takes hard work and it can be very discouraging for your friend to relapse because your friend wants to be free. No one wants to live controlled by addiction. No one. Encouragement to stick with it is vital.

If your friend or family member is using opioids, you should get naloxone (a medicine that can temporarily reverse the effects of an opioid overdose) and keep it handy. Available through local community-based programs or pharmacies.

It’s worth saying again: Friends are SO important for people in active addiction.

Don’t ever give up on your friends trapped in addiction. They need friends more than ever, friends who love them and will invest in their lives and let them know they are a worthwhile human – while you also need to encourage them to seek help in order to become sober and stable. And to remind them by example of what a normal and joy-filled life is like and one that they too can have.

A best friend is someone who believes in you

even when you’ve stopped believing in yourself.

– Unknown

John 15:13, New Testament
Helping Someone with a Drug Addiction

https://www.helpguide.org/mental-health/addiction/helping-someone-with-drug-addiction

How to help someone who is misusing drugs or alcohol:

https://www.healthdirect.gov.au/help-someone-who-is-misusing-drugs-or-alcohol#:~:text=Celebrate%20small%20successes%20and%20try,Narcotics%20Anonymous%20and%20SMART%20Recovery.

Four Signs of Enabling and How to Stop

https://health.clevelandclinic.org/enabling

Dr. John F. Kelly, Ph.D. The New Science on Addiction Recovery (lecture)

The Cycle of Harm – End It For Good

(Translation into most langugages at tab to the right.)

Recently, I connected with Christina Dent, Founder & President of End It For Good. The mutual connection came through a drug advocacy organization in Australia where they also promote options other than incarceration for drug addiction.

The End It For Good website is a treasure worth exploring (see below). Although Christina has been mainly focused on her home state of Mississippi, they are now expanding and reaching out across the United States. Their website states:

Our goal is a future where fewer people are harmed by drugs. To get there, we need to shift away from a criminal justice approach and towards a health-centered approach to drug production, distribution, and consumption. As a 501(c)(3), we educate citizens, advocates, and policymakers to elevate solutions that prioritize life, health, strong families, and safe communities. This is the path to a world where more people have an opportunity to thrive.

In her TED Talk, Christina shares her learning journey about the destructive impact of a criminal justice approach to drugs and addiction, as well as the mounting evidence that a health-centered approach would be much more effective.

And Christina has written an award winning and very favorably reviewed book:

CURIOUS: A Foster Mom’s Discovery of an Unexpected Solution to Drugs and Addiction. It gives a vision for unexpected solutions that save lives, heal families, and promote public safety.

The reason I used this particular statue for the blog graphic this month relates perfectly to this subject. Justice & Mercy was designed by sculptor L. Glynn Acree III and stands in front of the Cumberland School of Law at Samford University in Birmingham, Alabama. Justice is blindfolded and the scales she holds are perfectly balanced. The angel, Mercy, is whispering in Justice’s ear. An important reminder that in order for justice to be true and impartial, mercy and kindness must temper her decisions – because as humans, we are all imperfect and fail in many ways.

End It For Good

Addiction Constriction

John Leif Trang – March 10, 1989 – August 2, 2014

(Translation into most languages at tab on right)

On March 10th, our son would have been celebrating his 33^rd birthday. That day is now a painful reminder of all the potentials and possibilities that a young person should be experiencing in the 4^th decade of their life.

After JL died of a heroin overdose in 2014, I began the dreaded process of sorting through his belongings – which included his computer and phone. Many of the photos on his phone I had never seen and some have now become permanently seared into my visual memory. One is of JL with a Boa wrapped around his shoulders and neck.

Boas are constrictors. Constrictors don’t chase their prey. They are ambush hunters. A boa grabs its prey with its teeth, then quickly coils its body around the prey and squeezes. It doesn’t break the bones – it constricts so tightly that its prey can’t breathe. With each exhale, it tightens its coils until its prey dies slowly from an overwhelmed circulatory system due to blood not getting to the brain. Once dead, the snake swallows its prey whole.

Reaction Recovery

Translation into most languages at tab to the right.

A few weeks ago, John and I were interviewed by Jeff Simone for his Surviving the Opioid Epidemic podcast (see YouTube link). We had a really great conversation about our family living with a teenage son with opioid addiction and how his death from overdose affected us and changed our lives. Jeff serves the addiction community with a coaching service called Reaction Recovery.

https://reactionrecovery.com

Here are some insights into his recovery approach.

Reaction Recovery is a private coaching service designed to help individuals thrive in their life of recovery from substance use disorders. It is a one to one, intensive behavioral approach to help individuals identify areas to make focused and intentional lifestyle modifications. Dr. Simone has been formally trained in clinical pharmaceutical and dietary supplementation advisory and management. He has earned degrees in nutrition, physiology, is a certified life coach, and has personally worked with over 200 people recovering from substance addictions.

Why ‘Reaction’ Recovery? Who is reacting and to what?

Reaction Recovery was started as a “reaction” to the current treatment approach to addiction. The medical community is doing a good job offering short-term acute care crisis management for addictive disorders, but are doing poorly offering long-term treatment for those who have become abstinent but not yet stabilized. This describes our son’s – and most others we know – situation perfectly. Addiction needs long-term care and support.

The basic coaching approach addresses the physiology of the addiction, post-acute withdrawal syndromes, nutritional interventions, dietary supplementation, and how this all can safely integrate with other pharmaceutical treatment strategies that might already be on board.

Based on what Dr. Simone has called the ’12 Daily Rules for Recovery,’ their coaching techniques will systematically and methodically help the individual identify specific areas to be adjusted and then develop individually tailored strategies to affect real change.

The 12 Rules focus on building up a support community – first and foremost – then developing a healthy and consistent morning routine, understanding the importance of full-day nutrition, ensuring the body is receiving all nutrients necessary to support a strong and optimal brain and body, establishing a safe and appropriate dietary supplement regimen, expanding the mind with helpful books and information, developing a realistic exercise routine, carefully auditing the external distractions in our lives, constructing a regular nighttime routine, and more.

When these considerations get repeated across thousands of iterations, and with a little guidance and accountability, they become a foundation upon which the rest of the individual’s recovery will be built. Eventually – through ruthless repetition – new neural pathways begin to form until eventually this life of abstinence doesn’t feel so difficult and a sustainable, meaningful recovery is able to take shape.

Jeff’s approach of community as essential and creating new, healthy habits to replace old, destructive ones has been the topic of several of my blogs (see below). Whatever habits we create will become automatic and will serve us and our life-goals well as we go through each day.

2021 Aug 15, Connection is Crucial

2021 March 28, The Freedom of Habits

2021 Jan 03, Who is My Neighbor?

2020 Dec 27, Missing Community

2020 Aug 15 & 22, Loneliness

Celebrating Freedom and New Life

April 4, 2021

(I am taking a break from the chapter by chapter topics from Opiate Nation to focus on the significance of this holy week. Translations into most languages available at tab to the right.)

Spring is the season of regeneration, freedom, new life. The time of year when the whole earth seems excited to be alive after being dormant all winter. For the northern hemisphere, March and April are Spring – for our friends and family in Australia, right now it is Autumn. Regardless of what season it is where you live on this planet, it is Easter Sunday and the end of Passover week. Both the Christian and Jewish traditions celebrate the freedom from bondage and the beginning of a new life, although from differing perspectives and beliefs. Both begin the time with reflection and prayer. (I don’t understand Islamic tradition well enough to comment on it except to say that Ramadan is observed around this same time of year with introspection and fasting in remembrance of Muhammad receiving the Quran.)

For Christians, the freedom is from the bondage to sin in one’s life; for Jews, it is the freedom from bondage that the Israelites suffered under in Egypt. Both faiths look to an historical event in the past. They also remind us that while bondage was dealt with symbolically once – whether personally or communally – it is an ongoing problem in this imperfect world.

The Freedom of Habits

(Twenty-fifth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

I’ve heard a saying: “The chains of habit are too weak to be felt until they are too strong to be broken.” And just like chains, some habits are stronger and deadlier than others. Conversely, healthy habits can be just as strong and powerful – but instead of bondage, they bring freedom to live our lives to the fullest.

In The Power of Habit, Charles Duhigg says, “Habits are a three-step loop: The cue, the routine, the reward. They become automatic beginning with a cue that triggers a routine and a craving for a clear reward. Craving is an essential part of the formula for creating new habits…You can never truly extinguish bad habits. So in order to change a habit, you must keep the old cue and deliver the old reward (that you are craving), BUT insert a new routine.”

The Vortex of Shame

(Twenty-third in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

For generations, the combination of personal shame and public stigma has produced tremendous obstacles to addressing the problem of alcoholism and drug addiction in America. Addiction stigma prevents too many people from getting the help they need. –Hazelden-Betty Ford Institute for Recovery

Historically, the word shame was used interchangeably with guilt – the appropriate pang of conscience that followed doing something wrong. In reality, there is an important distinction between shame and guilt. Shame is about who you think you are; guilt is about what you have done.

Stigmas are linked to shame. In the Greek and Latin worlds, a stigma was a mark or brand, especially for a slave, identifying them as “inferior.” Later, it became known as a mark or stain we can’t see with our eyes: social stigmas that are based on perceivable characteristics, associated with certain behaviors that distinguish a person from other members of society. They convey disapproval and disgrace.

An Ounce of Prevention

(Eighteenth in a series of topical blogs based on chapter by chapter excerpts from Opiate Nation. Translation into most languages is available to the right.)

In 1735, Benjamin Franklin wrote a letter to his own newspaper, The Pennsylvania Gazette, where he used this now-famous phrase: An ounce of prevention is worth a pound of cure. He wasn’t referring to a pandemic or keeping your roof in good condition so it won’t leak or changing the oil in your car so you won’t ruin your engine or, my personal example, brushing your teeth to avoid tooth decay and gum disease.

When I was growing up in the 1960’s, brushing our teeth every day was a new habit for most Americans. Even though the toothbrush was invented in 1857, it wasn’t until after WWII that we got in the habit of regularly brushing our teeth. When I was young, I didn’t give much thought to personal care and it seems I didn’t brush my teeth often – I was too busy living life – which is why my two older sisters gave me the endearing nick-name “moss-mouth”. (FYI, I must have good teeth genetics because I didn’t have my first cavity until I was 30.)