Pittsburgh, Pennsylvania Faces Opioid Crisis
The opioid overdose numbers for Pittsburgh, Pennsylvania are grim. Nearly 38 out of every 100,000 people in Pennsylvania died from overdoses in 2016. According to a Drug Enforcement Administration report Pennsylvania lost 4,642 people to drugs last year — a 37 percent increase from 2015. The Center for Disease Control estimated that fatal overdoses for men is nearly double that for women. The rate of overdoses continues to be high across age groups between twenty-five and fifty-four.
Drug experts have identified two clear paths of development in the addiction crisis. Many middle-aged people are becoming addicted initially to pain medications that are legally prescribed for legitimate health issues. When the prescriptions expire, the addiction remains, and they seek street opioids.
For many young people in their twenties, addiction started with recreational opioid use in high school or junior high. Pills swiped from parent’s medicine cabinets become party drugs on the weekend. Now in their twenties, addiction is front and center in their lives and they turn to pills available on the street corners of Pittsburgh.
Conversion to Heroin
As prescription opioids become too expensive, even at the street level, many turn to heroin. This cheaper high replaces the prescription opioid and creates a heroin addict. As a result, both heroin and opioid overdoses have impacted Pittsburgh. For Westmoreland Country, the costs of opioid would range from $51 million to $102 million for heroin and from $54 million to $108 million for opioid medicines.
How Pittsburgh is Managing the Crisis
Pennsylvania’s governor has declared the state’s opioid addiction a public health emergency. He ordered a command center be set up like those used during weather disasters. The goal was to make rehabilitation more immediate to those seeking help. Also, the distribution of naloxone would help prevent many overdoses.
Over 4,148 kits of naloxone have been handed out to law enforcement and paramedics, the first line in overdose events. Additionally, medical personnel in hospital emergency rooms have been trained to administer the drug. Organizations like Prevention Point Pittsburgh also offers naloxone and training to help prevent overdoses in homes, schools and even public places. Though overdose prevention does not stop addicts from returning to drug use, it at least gives them a second chance to commit to recovery. Perhaps even in the wake of an overdose, an addict may be more likely to begin the change that brings he or she back to sobriety.
Identifying an Opioid Problem at Home
Before addiction reaches a crisis level in a household, parents can detect the problem among teens and loved ones. Knowing the red flags is critical. Here is what to look for:
- Bloodshot or glazed eyes indicate a continual use of drugs
- Dilated or constricted pupils
- Sudden changes in weight, especially weight loss
- Unexplained injuries such as bruises, infectious sores, especially those indicative of needle wounds
- An increase in aggression, irritability. They become quick to anger and are always impatient
- A distinctive change in personality
- Constant tiredness. They may sleep away the day
- Depression and extensive isolation in their rooms or away from home
- New friends. A sudden change in social circles is often a sign of bad influences
How to Intervene
Taking the first steps toward helping someone on drugs requires patience and courage, especially for parents. Approaching them with a sense of love and caring can help, but it may not be enough to convince them of a problem. Many professional interventionists will suggest an intervention session, in which a rehabilitation center is ready to provide professional assistance and all the addicted need to do is accept the addiction as a problem.
The confrontation must not be hostile. Everyone in the family and or loved ones must be able to express the harm that drugs are causing not only to the addicted but to the people who love them. Often intervention participants will express their emotions in heartfelt letters, hoping to persuade the addicted of the severity of the problem.
Interventionists present at the intervention can immediately offer help. There can be no delay or opportunity for the addicted to change their mind. Transportation to a residential facility and a bed waiting for them is the only answer.
Most importantly, those engaged in the intervention group must be prepared for hostility. The most common responses from addicts can include:
- It’s none of your business
- You just want me out of your lives
- Or, you are all hypocrites, a common statement that turns their addiction away from themselves and redirects it to someone else in their life that takes drugs or drinks
The addicted may even bolt from the intervention event altogether. Non-cooperation from an addicted loved one can be devastating, but future attempts are always possible with hopes that they will eventually realize they have a problem. Unfortunately, an overdose may be the turning point.
The Consequence of Overdose
During an opioid overdose the region of the brain that controls breathing is impacted. Slower respiration means the addict slowly slips into unconsciousness, possibly not recovering. The part of the brain that tells the body to breathe, simply stops giving that command.
Unfortunately, the lynch pin from many addicts is a drug overdose. If an addict is lucky enough to survive this near-death episode, it may be the turning point where they accept the severity of their drug use and begin seeking help.
Preparing the Addicted for Rehabilitation
Before a patient can be admitted to a recovery facility a battery of tests and interviews help create a clear and definitive profile of the patient. These examinations will also help outline a customized plan that recovery specialists will follow to help the addicted toward recovery.
- A physical exam will determine if the drug addiction has caused physical harm as well as determine if other medical conditions are present that may make drug treatment more complex. Diseases acquired from shared needle use can complicate drug treatment and require additional medications and medical procedures. Also, drug use alone can compromise health and recovery specialists may need to provide additional nutritional and medical support for those situations.
- A psychological evaluation determines if drugs are causing hallucinations, anxiety or other mental disorders. The evaluation will also test to see if pre-existing psychological disorders may impact drug treatment. Mental illness is often one of the reasons many turn to drugs. Identifying everything from depressions to schizophrenia is key to treatment. Other medications may be prescribed, and mental health experts may also need to intervene.
- Cognition testing determines how drugs are compromising thinking, decision-making and other thought processes. If drugs have truly began impacting brain performance, how treatment proceeds may require a slower process for some whose ability to think and speak clearly have been compromised.
- Toxicology tests will determine what drugs and how much of any substance is currently compelling addiction. Often addicts may be taking a mixture of drugs to establish a normal way of life, often mixing stimulants with depressants to create a balance that for them is their functional normalcy.
- Family history is explored so that an understanding of the person’s background is made clear. Background reports are essential for determining underlying causes of addiction that may be rooted in family life. Many times, family abuse and household drug use are foundations for drug addiction later on in the teen years. Sorting out these complexities will be one of the key issues that recovery specialists address when treatment begins.
What Happens When Someone Goes Through Rehab Intake?
The intake process involves the recovery specialists in educating the intake patient on what is expected and what will be the goals of treatment. The addicted must understand that the process is more than a medical treatment in a hospital. Rather it is a complete transformation of spirit, mind and body with the goal of sobriety. Recovery specialists will outline certain specifics that are vital to the addicted individual’s recovery.
- Immediate treatment. The sooner an addicted person starts treatment, the sooner they can reach recovery. Drug treatment is not a minor medical procedure that can be put off for a later date, especially if the drug-addicted person has already experienced an overdose.
- There is not one treatment, but many. Every recovery specialist is seeking to define a customized treatment plan. All the details from pre-intake now serve to create that plan.
- Recovery must go deep because the source of any addiction is not trivial. Psychological probing goes deeper into the root causes of the addiction and is critical for success.
- Mental health issues will be addressed. The mental health evaluation will now serve the recovery specialists in treating other mental health issues if they exist in conjunction with drug addiction.
- Physical health issues are addressed. Medical treatments for diseases and poor health overall are all issues that need the attention of physicians working side by side with recovery specialists.
- Detox is not the only step. Many addicted people think that treatment is just about detox. That is the first step, but not the only one. Residential treatment for thirty to ninety days follows. Drug rehab is a long-involved process and eliminating drugs from the system of the drug addicted is just the beginning.
- Introducing family as part of the treatment. Involving family maintains the key support many addicted people need in their lives. Family may also need treatment themselves because of the trauma caused by managing an addicted person. These deep wounds need to heal, and family health is critical to the treatment of the addict.
- Medications can help with the recovery process. Prescribed medications can ease the detox process, making it easier to manage. Many prescribed medicines have been proven to help curb cravings during treatment and may be part of the customized plan for recovery,
- Personal commitment is a major factor. The addicted person needs to commit to treatment. If they feel coerced or that the treatment is just a joke, nothing they experience will be of much help. Accepting treatment as a solution and cooperating with recovery specialists is the only way any treatment plan will be successful.
Detox, Withdrawals and How Recovery Specialists Help
Eliminating drugs from the body is a difficult and dangerous process. That is why it is never recommended that anyone ever try to detox on their own. The withdrawal symptoms that accompany the detox process can be intense and recovery specialists can be on hand to help either by easing the symptoms with prescribed medications or with moral support for the addicted person enduring the detox process. The recovery specialists are there most importantly to observe for any medical emergencies that might arise during the process. It is not uncommon for recovering addicts to experience seizures and having medical personnel present is critical to prevent serious consequences.
The Intensity of Withdrawals
During detox the body responses violently to the absence of drugs. Many addicts have described a feeling of “tearing up” as the overall sensation during detox. Withdrawal symptoms usually occur within a few hours of detox. Symptoms may include:
- Extreme tension
- Runny nose
- Disturbed and fitful sleep
- Extreme nausea
- Muscle pain and stiffness
- Muscle spasms
- Difficulty breathing
- Trouble concentrating
- Achy bones
- Racing heartbeat
Drugs Administered During the Detox Process
Depending on the addiction, some medications can reduce cravings and ease the pain of withdrawals. Though some of the medications can end up as abused street drugs, under the careful application by recovery specialists, they can help during this point of recovery. Some of the following medications commonly used are:
- Methadone-helps the body adjust to the changing level of opiates in the blood
- Subutex-helps manage the moderate to severe physical pain accompanying detox as well as after detox
- Subozone -generally used to ease symptoms of opioid withdrawal
- Naltrexone-helps decrease the appetite for opioids and blocks the effects of opioids on the brain
- Antidepressant-helps manage the psychological symptoms during detox which can include severe depression
- Anti-nausea medications-used to manage the abdominal pain, nausea and vomiting commonly experienced during detox as a withdrawal symptom
Options for Inpatient Care
Inpatient treatment requires residence in a facility where behavior can be monitored, consoling can be provided, and any prescribed medications can continue to be administered. It is during this step in the process that many recovering addicts begin to feel the most intense cravings for their drug of choice. The potential for relapse is great and it requires a combination of assistance from recovery specialists and the commitment of the recovering individual to make the process successful. More psychological symptoms will begin to appear during the residential stay, which can go from thirty to ninety days.
Regular therapy sessions begin to help the patient see a new way without drugs. Time in the facility will also be spend relearning and rethinking how to function as a sober person in everyday life. The disciplined structure of inpatient treatment also helps guide the addicted person slowly towards long-term recovery. There are two types of treatment that may occur.
- General Residential Treatment- provides accommodations to the patient as they recover, gradually helping them well past the detox stage with frequent therapy sessions that have been customized to their needs.
- Partial Hospitalization-provides for more severe cases a medical observation of patients to ensure they will not experience severe, long-term reactions after detox.
Types of Therapy Used During Inpatient Care
Personal sessions with a recovery specialist can get at the roots of a drug addiction. Patients can explore reasons and solutions independently with the guidance of the counselor. The personal individual approach to therapy is usually suggested with a patient who is also struggling with other issues such as depression, bipolar disorder or other emotional disorders. These issues must be managed in conjunction with drug addiction recovery and one on one therapy is often the best strategy.
Group therapy, guided by a recovery specialist allows recovering addicts to help each other through addiction to recovery. By sharing personal stories and addressing issues as a group, many individuals will find personal enlightenment regarding their own addiction. Group activities are also assigned to help individuals gain insight into their addiction issues.
Family therapy is an essential part of recovery when family-related issues have impacted drug addiction. Often, other family members may also be struggling through addiction and their usage may influence a recovering addict. The recovery specialist must help the family through this crisis to prevent relapse once the recovering addict has completed treatment. Family therapy is also helpful for healing personal issues among family members that have been caused by the addicted person’s behavior. Distrust is usually developed during addiction and family members harbor resentment for an addict’s behavior. Family therapy is a process that addresses these issues and hopes to overcome the pains caused by addiction, offering a path of healing for future family relationships
Reality therapy is a type of therapy that focuses less on the past and more on what the addicted person is experiencing right now in the present. This unique approach is usually recommended when there are no family issues to mend. Rather, the therapy sessions deal with the issues that led to current drug addiction and how to overcome them. Reality therapy focuses on what’s happening right now, and what can be done in the future.
The Option of Outpatient Treatment
Outpatient is an additional option for many recovery addicts who are not experiencing a severe addiction. Often residential treatment is not necessary, and the addicted person still needs to function in the outside world, maintaining responsibilities such as work, school and family. If a recovery specialist feels this option will work, they will suggest outpatient treatment strategies. The outpatient program approach allows patients to conduct treatment during set periods during the day, then return to their other responsibilities. Many dynamic therapies may be employed through outpatient care.
Through biofeedback, recovering addicts learn to establish greater control over their psychological and physical urges for drugs. Using a combination of relaxation exercises, addicts can gradually learn to manage cravings.
Cogitative Behavioral Therapy
Cogitative behavioral therapy seeks to reconnect addicts with their thoughts and feelings. Often drugs isolate individuals from their own minds and this approach attempts to make addicts more aware so that can overcome addiction.
Dialectical Behavior Therapy
Dialectical behavior therapy is often used to treat addicts when mental disorders are present. The strategy of this therapy attempts to create mindfulness and emotional regulation as well as assist the recovering addict in separating personal disorders from addictive issues.
Experiential therapy is a non-traditional approach to healing that works to help addicts by removing them from group session environments and placing them in unlikely environments. Through activities like rock climbing and sculpting addicts learn to redirect drug abusive energies to other activities and relearn how to experience the world with sober eyes and minds.
Faith-Based Drug Rehabilitation
Some outpatient therapies will also use faith as a healing tool. Helping addicts relearn their personal connection to God can be a meaningful approach that is less clinical and feels comfortable to addicts with a spiritual background that was lost during addiction.
Another approach to therapy that is non-traditional is the use of holistic methods to treat the patient. A combination of natural medication, nutrition and exercise are used to heal the mind and body through natural methods.
Aftercare and Managing Life in Twelve Steps
Beyond treatment, whether it be inpatient or outpatient, the process of aftercare is a critical part of the recovery process. It is during the absence of counselors or the controlled environment of a residential facility, that the risk of relapse rises. Aftercare programs are often suggested to maintain the new sobriety that a recovering addict has discovered. The long-term recovery success of the now once-addicted person depends heavily on twelve-step programs.
Understanding Twelve Step Programs
Twelve-step programs such as Alcoholics Anonymous are used by seventy-four percent of rehabilitation and drug treatment centers with great success. The basic underlying concept is that addicted person uses the support of other addictrf persons to work through addiction to recovery. With the support of like-minded others, sobriety becomes both a goal and a personal motto.
Most Twelve Step Programs include the following steps:
- Admitting a powerlessness over the drug of choice
- Accepting a greater spiritual power than oneself
- Choosing to turn to a deeper, spiritual approach to life rather than superficiality of drugs
- Self-examining without fear to get to the root causes of addiction
- Admitting to the wrongs you have done to yourself and others
- Accepting the removal of defects through spiritual healing
- Asking God to remove shortcomings
- Revisiting those you have harmed and make amends
- Making direct amends whenever possible to prevent harm
- Continuing to take personal inventory and admit to wrongdoing
- Seeking salvation through prayer and meditation
- Experiencing a spiritual awakening
The Option of Sober Living Facilities
In many instances, the family life a recovering addict may be returning to may not be healthy and may in fact in inhibit recovery. Also, if a recovering addict is still uncomfortable with the stresses of sober life there are other options. Sober living facilities provide a haven for recovering addicts who may still be involved in aftercare programs, but for whatever reason still need the support of a residential environment. Sober living facilities provide this sanctuary, offering group therapy sessions and a place for addicts to stay while they go to work or school during the day. If house rules are followed, and the recovering addicts stay sober they are able to continue a life at these facilities until they become more confident with independent sober living.
To Live a Life of Sobriety
Learning to live a sober life requires the constant vigilance against relapse. The risk of relapse wans as time passes and an addicted person has spent more time sober. But they must always be aware of the common risks that can lead to a slip back into drug addiction.
Take Sober Life One Day at a Time
Trying to be sober is a positive goal but can also be overwhelming. Taking on too much responsibility too soon can lead to stress and the inability to cope. Recovering addicts must learn to take a sober life gradually until they are fully capable of handling the pressures of work, school and family. Recovery specialists in both outpatient and inpatient treatment centers will offer a comprehensive timeline to help the recovering set realistic goals without compromising sobriety.
Defining New Relationships
Though an addicted person may be enjoying recovery, old drug friends may not. Many old relationships that were built around drug use can revisit a recovering addict and lure them back into the addictive lifestyle. The recovering person must be able to recognize those bad influences from the past and leave them in the past. For a person just learning a sober life, sober relationships are the only solution. Many recovering addicts join church functions and find new, healthy friendships there. Others will continue to find solace in aftercare programs. The very people who helped a recovering individual through the crisis of addiction, can now become long-term friendships.