The Relationship Between ACEs and Substance Dependence

Substance Dependence? / It’s Not Your Fault  Start Healing –  

Here is a link to the original article, written by Frank Alix, the founder of Katlyn's Healing Center in Portsmouth, NH, and reprinted below.  I had erroneously attributed it to a New York Times staffer.  I thank Mr. Alix for the correction and I apologize to him for this error.  You can obtain more information about his work at https://www.katlynshealingcenter.org

Substance dependence has been around for a very long time. Humans have used psychoactive substances to relieve their emotional pain since our earliest recorded history. Homer’s Odyssey, written in the 8th century BC, tells us that Helen of Troy used a potion to treat Greek warriors, “presently she cast a drug into the wine of which they drank to lull all pain and anger and bring forgetfulness of every sorrow.” Experts believe this drug was most likely opium. The use of drugs to help comfort ancient warriors should not surprise us, but what makes substance dependence so common in our society?
Research tells us that like the warriors of Homer’s Odyssey, difficult human experiences or trauma are what cause our emotional pain. And our need for substances to relieve our pain, whether prescribed, legal or illegal, is directly related to the amount of adversity we’ve experienced (see Adverse Childhood Experience (ACEs) study). The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) states that, “Trauma is a widespread, harmful and costly public health problem … It is an almost universal experience of people with mental and substance use disorders.”
The inescapable truth is that the harmful, costly and growing problem of substance dependence is just a symptom of a larger social problem of increasing human suffering and adversity. When this adversity begins in childhood, as so often is the case, the resulting harm is even more severe. Dr. Gabor Maté, a best-selling author and leading authority on addiction writes in his book, In the Realm of Hungry Ghosts: Close Encounters with Addiction: “It’s just as many substance addicts say: they self-medicate to soothe their emotional pain—but more than that, their brain development was sabotaged by their traumatic experiences.”
That is, childhood adversity stunts normal brain development. The reason that opioids are so powerful for those who have experienced childhood adversity is because they stimulate the love/pleasure/pain relief centers of the brain that were underdeveloped as a child. Recovery from their opioid addiction is also more difficult because they developed less capacity for self-regulation and intentional decision-making during childhood, through no fault of their own. But this is not how we treat those who struggle with substance dependence.
Addicts are not normally treated with the kindness, care, and understanding needed to heal from their emotional wounds. They are told that their addiction is the problem, not the psychic pain from their life experiences that they’re trying to relieve. This only reinforces the stigma and shame that they already feel. The failure to acknowledge and address their underlying emotional pain likely explains why treatments for addiction most often fail, despite the rush to invest more resources in them. If you doubt there is a problem with current addiction treatment methods, here are some data points:
Results from Project MATCH, “… the largest and most expensive alcoholism treatment trial ever conducted … suggest that current psychosocial treatments for alcoholism are not particularly effective … Overall, a median of only 3% of the drinking outcome at follow-up could be attributed to treatment.”
Dr. Gabor Maté writes in his aforementioned book, “In the United States opiate relapse rates of 80 percent to more than 90 percent have been recorded among addicts who try to quit their habit. Even after hospital treatment the readdiction rates are over 70 percent.”
An article in The Atlantic states, “Peer reviewed studies peg the success rate of AA [Alcoholics Anonymous] somewhere between five and 10 percent.”
That current approaches to addiction treatment are largely ineffective may also explain why most people who struggle with substance dependence avoid treatment (SAMHSA estimates that 89 percent of people who needed substance use treatment in 2015 did not receive it). People not only avoid substance use treatment, but also fail to receive help for their underlying trauma. Per SAMHSA, “Unaddressed trauma significantly increases the risk of mental and substance use disorders … However, most people go without the services and supports needed to overcome traumatic experiences.”
This leads to another important question. Because of their failure to address the underlying problem, could current addiction treatment approaches be causing harm? The Project Match study cited above states, “Exaggerated claims of treatment effectiveness can have undesirable consequences for patients, for therapists, and for science. Patients who fail an ‘effective’ treatment may feel even more hopeless. This increased despair may be extremely deleterious in people with such life-threatening habits.”
One does not need to speak with many addicts to understand these sober truths about their failed attempts to get help. Those who repeatedly fail treatment end up feeling like they’re broken and can’t be fixed. We know that as addiction treatment has expanded, so has the incidence of overdoses. What if these increases are related? We also know that many overdoses are not accidental. When a person overdoses to put an end to their suffering and hopelessness, the correct term is suicide. These are hard questions/truths, but we need to better understand the problem before we can hope to solve it.
It’s time for a different approach to helping those who struggle with substance dependence, one that recognizes the effects of childhood and adult adversity/trauma and seeks to facilitate healing of the underlying emotional wounds. Research on trauma recovery tells us that healing requires safety, connection, understanding, and empowerment. In the past year, we’ve offered workshops based on these healing principles for those looking to overcome substance dependence. One participant who had struggled with addiction throughout her adult life, experiencing multiple overdoses and relapses, said after the workshop, “… I feel joy again, I feel love again, I feel worthy again … and feel that I am no longer at risk of losing my sobriety … I know I have the resources inside to heal and create a life worth living.”
If you’ve struggled with substance dependence and you’re looking for help, please visit our website, Katlyn’s Healing Center, where we offer free healing resources and an online Healing Support Program to assist those affected by trauma or other difficult life experiences. You may want to start with our presentation or video entitled, Substance Dependence, It’s Not Your Fault.
Substance Dependence, It’s Not Your Fault Presentation Video Clip
Our healing approach is based on five core beliefs that are offered here to give you hope:
1.  You’re not alone (we’re here for you).
2.  It’s not your fault. You’re a good person.
3.  What you feel is normal, given what you have experienced.
4.  You can learn skills to help yourself feel better
5.  Healing is also normal, with understanding, support, and practice.
That is, with sufficient understanding, support and effort, healing comes naturally. But your healing, like any journey, begins with a first step. So please take a step to help yourself and check out our healing resources. And if our approach to healing resonates with you, please encourage your peers and those looking to support your recovery to review the information as well. Then we can all make the healing journey together.

– Frank Alix,  ACEs Connection, January 9, 2019

 

 

LINK TO MAINE DHHS CHILDREN’S BEHAVIORAL HEALTH SERVICES ASSESSMENT – FINAL REPORT (DEC 15, 2018)

The first study in twenty years concerning behavioral health services for children in Maine  can be accessed at this link:  https://drive.google.com/file/d/15acp2MKh5U15LExra-HZA7IFfHJZ97ts/view

It acknowledges the hard work done by DHHS children’s services staff but also cites the great needs for changes in the system.  Reading this report will be an eye-opener for all Maine citizens, especially those concerned with ACEs and children’s trauma.

 

Something To Think About: One Way to Help Address the Opioid Crisis

the opioid crisis is a major contributing factor to the prevalence of aces:  one tactic being used by a maine community to help people caught up in the opioid crisis

Kennebunk police have a plan to fight the opioid crisis: recovery coaches

BY JOE LAWLOR PORTLAND PRESS HERALD – JANUARY 5, 2019

A free four-day program will equip first responders and the public with skills necessary to help people with substance use disorder.

Kennebunk Police Chief Bob MacKenzie said he’s ready to try something different to combat the opioid crisis, by enlisting police officers and other first responders to help break a cycle caused by people struggling with substance use disorder.

The cycle begins with an arrest, and many times after the person is released, they return to using and are then arrested again, often for misdemeanor crimes. The ineffective system is frustrating for everyone, including police officers, sheriffs who run the county jails and people with substance use disorder, MacKenzie said.

Some die. Drug overdose deaths in Maine climbed to a record 418 in 2017, and were at 180 through the first six months of 2018. For those who survive, they often return to the same patterns, and police officers see the same people over and over again.

MacKenzie is championing a new approach, which will be to train police officers, firefighters and paramedics in Kennebunk and nearby towns to be recovery coaches, in a program that is likely the first of its kind in Maine.

A training session will be held in late January and early February, and members of the public also can sign up for recovery coach training. A total of 60 people will be trained.

OFFERING HELP AND SUPPORT
A recovery coach is someone who helps a person with substance use disorder obtain treatment and provides support during and after treatment.
“Instead of doing our business with them and saying ‘I hope we don’t see you next time,’ we want to work with people to minimize the chances that there will be a next time,” MacKenzie said. “It is just common sense.”

MacKenzie said many of the people with substance use disorder who are arrested have lost support from family or friends, allies who normally would help someone get into and through a treatment program.

“They’ve burned a lot of bridges with family, and the support just isn’t there for a lot of them. They’re left more or less by themselves,” MacKenzie said. “Unless they get help, they’re going to go right back to what they know.”

The free all-day training will be held on four days, Jan. 29 through Feb. 1, at the West Kennebunk Fire Department, and is being run by Recovery Coach University in New York. More than $50,000 in donations was raised by Maine nonprofit charity Above Board, which makes the program free to participants.     Maine-based Enso Recovery also will help with the program.

Kennebunk police Officer Kaitlyn Sawyer attended a different recovery coach training in March, and said it already has had an impact on how she does her job, primarily on how she interacts with people who are suffering from substance use disorder. “It’s really taught me to take that big, deep breath and be empathetic,” Sawyer said.

She said before she may have not been relating to the people she arrested as much, and was more focused on the tasks of being a patrol officer. Now, she tries to look at issues from their perspective.  “We frequently encounter people at their lowest point,” she said. “If we can treat people as humans rather than criminals we can really help people.” Sawyer said she sees herself as a pre-recovery coach, making sure those who need help get access to treatment.
But Sawyer said if someone commits a crime, they should still be arrested. “Part of recovery is taking responsibility for your actions,” she said.

MacKenzie believes the program will be the first of its kind in the state where the police department acts as a partner in recovery coach training, and treatment advocates say that’s likely the case. Recently, there’s also been a movement – supported by Gov. Janet Mills – to make substance use disorder treatment more widely available in county jails. Other police departments, such as in Scarborough and Sanford, have worked to connect people to treatment programs. Also, in recent years, Maine police and fire departments are more likely to carry naloxone, an overdose antidote.

MAKING TREATMENT AVAILABLE
Medicaid expansion, implemented Thursday by Mills on her first day in office, also will open up treatment to previously uninsured Mainers because the patients now will be referred to programs that are reimbursed by Medicaid. That is important to recovery coaches, MacKenzie said, because the coaches will be able to refer people into the programs rather than tell them they have to wait for one of the very few treatment slots available for uninsured patients.

Connecting patients to treatment has been one of the major shortcomings in Maine’s approach to alleviating the opioid crisis, health policy experts have said.
MacKenzie said the recovery coach program “fills a big gap” because prospective patients often are being missed by the health care system.

Lori Drescher, who heads up the Rochester, New York-based Recovery Coach University, said research has shown that recovery coaches are effective, and New York has developed a licensing program to standardize the service.
“Peer supports have been around in mental health for many years, but it’s been slow to catch on in substance use recovery,” Drescher said. “It is an evidence-based approach.”  Drescher said it’s unusual to partner with a police department, but it makes sense to do so.

“First responders and emergency rooms are where we can meet people where they are at, a point where they can be offered treatment,” Drescher said.
Dr. Lisa Letourneau, associate medical director at Maine Quality Counts, noted that recovery services are largely unregulated in Maine and most states, so it’s significant that the coaching program adheres to a licensing standard and follows a “best practices” model to make sure the service works well.

“It intuitively makes sense, and there’s emerging science that indicates recovery coaches can help with outcomes,” said Letourneau, who has worked on opioid policy in Maine for several years.

Comments?  Suggestions?  
Please use the form below.  Thank you!

https://www.centralmaine.com/2019/01/05/kennebunk-police-have-plan-to-fight-opioid-crisis-recovery-coaches/

HUNGER — PART OF THE PROBLEM

View some of the alarming facts about the effects hunger has on our Maine people (courtesy of the Good Shepherd Food Bank) - once you open the link, click on "Enable Editing" to view the information.

http://sanctuarycaswell.net/wp-content/uploads/2019/01/BW-CHHP-One-Page-Flyer-1-1.docx

A Very Real Adverse Childhood Experience,
Hunger — Food Insecurity — Is Not Going Away.

Ten years after the Great Recession, The U.S. Department of Agriculture’s Economic Research Service reports that 14.4 percent of Maine households are food insecure – a rate far higher than the national average of 11.8 percent. These new numbers from September 2018 show that the food insecurity rate in Maine is finally falling, but still hasn’t reached pre-Recession levels.

14.4%  of Maine’s households are considered “food insecure.”
9th  Maine’s rank in the nation for food insecurity
1 in 5  Maine children are food insecure.
16th  Maine’s rank in the nation for child food insecurity.
16%  Of Maine seniors are at risk of going hungry.
13%  Maine’s poverty rate
18%  Maine’s child poverty rate
14%  Of Mainers participate in SNAP as of September 2016
37%  Of Maine’s food insecure population does not qualify for public assistance.

To read more about the prevalence of hunger among Maine’s children, families, and elderly, go to  https://www.gsfb.org/hunger-in-maine/

Van Buren Has A Food Pantry To Serve Our People

HUNGER IN OUR MIDST:  In Van Buren, out of a population of  about 1800, the Food Pantry serves an average of 120 households, totaling 250 persons each month.

Our Food Pantry exists because of wonderful, hard-working volunteers and the support of many area businesses.  The regular food distribution takes place on a monthly basis on a Thursday from 1 to 3 o’clock in the afternoon at the Mini-Mall in Van Buren (same building as the “People Helping People” Thrift Shop.

Here are the dates:

January 31       February 28       March 28       May 2       May 30       June 27    

If there is an emergency or if you need more information about Food Pantry services, please send us the comment form below, or call Nancy (868-5324), Dan (868-5707), or Norm (498-9570).

 

Comments??

 

Resilience in Children: A British Viewpoint from the Guardian newspaper, London

https://www.theguardian.com/lifeandstyle/2019/jan/05/six-ways-to-raise-a-resilient-child

Six ways to raise a resilient child
Want to help your children deal with stress and adversity? It’s easier than you think

Dr Rangan Chatterjee
Sat 5 Jan 2019 01.00 EST Last modified on Sat 5 Jan 2019 03.51 EST

Resilience is ‘the ability to overcome difficult experiences and be shaped positively by them’.  Helping our children navigate the stresses and strains of daily life is more important than ever. Figures released in November last year by NHS Digital show a worrying rise in young people’s mental health problems; sadly, my experience as a GP confirms this. One in eight children aged between five and 19 in England has a diagnosable mental health condition; the prevalence of emotional disorders, including anxiety and depression, has risen by 48% since 2004. “The pressures young people face range from school stress, bullying and worries about job and housing prospects, to concerns around body image,” says Emma Saddleton, helpline manager at the charity YoungMinds.

While we may not be able to remove all these challenges, we can pass on skills to help young people cope with stress and adversity. “It’s what’s known as resilience,” Saddleton says. “The ability to overcome difficult experiences and be shaped positively by them.” Our brains respond to the information around us, so resilience can be taught, modelled and nurtured at any age. “By doing this, through strong support networks and encouraging communication, we can help young people understand when they feel down and know what they can do to make themselves feel better,” she adds.

As a parent myself – I have a son of eight and a daughter of six – it’s something that’s high on my agenda, and I’ve discovered some effective techniques. Crucially, they don’t require you to overhaul your parenting style, but simply to make a few tweaks that will help your children thrive.

  1.  Have one-on-one time with each child, without distractionsI have a full-on job, two school-age children, and an elderly mother to care for, so I understand that we’re all busy; I’m not trying to pile on the guilt. But I’ll never forget what my daughter, then four, said one day. We were working on a jigsaw, but I kept nipping to the kitchen to check my phone. When I rejoined her for the third or fourth time, she rightly observed, “Daddy, you’re not really here, are you?”

Resilience comes from relationships; children need nurturing. It’s not a magical “inner strength” that helps kids through tough times; instead, it’s the reliable presence of one, supportive relationship, be it parent, teacher, relative, family friend or healthcare practitioner. My key point is, it’s quality, not quantity, that counts. Ten minutes of fully focused attention is better than an hour when your mind is on other things. If you’re on your tablet at the dinner table, you’re teaching them it’s OK to always be distracted. And that they are not important enough for your sole attention.

One-on-one time doesn’t have to be time carved out of an already hectic schedule. Make bathtime, car journeys, meals, queues count. Chat, listen, talk about your feelings, encourage them to express theirs. Once these one-to-ones become regular, your children will know they always have a safe space to open up.

2.  Give sleep a chance
I see so many children who are struggling to sleep, waking tired, with dark circles under their eyes. A lack of good-quality sleep is a huge driver for stress: it has a negative effect on memory, concentration, cognitive function, and decision-making.

One of the fastest ways to improve sleep – for all of us – is to limit screen time before bed. The type of blue light emitted by digital devices suppresses production of melatonin, the hormone that signals to the body it’s time for sleep. In addition, looking at screens before bed keeps us emotionally wired and stimulated, making it harder for us to switch off.

It’s a steely parent who can ban tech completely, and I don’t think you need to. But I would urge you to issue a household ban on devices at least an hour before bedtime. Turn off the wifi, if need be. (TV isn’t so bad if you need that as a compromise; we tend not to sit as close to the screen.)

Earlier in the evening, insist everyone uses “night-time mode” on their devices, which swaps the blue light for a warmer glow. You can download apps that do this (such as f:lux), too, or buy blue-light-cancelling glasses. It’s also worth switching your children’s night lights to red ones – red has the least impact on melatonin production. When I did this in my children’s rooms, they slept in more than an hour later the next morning.

3.  Get out and exercise
We all know that regular activity is important, and that most of us, children included, need to do more of it. But what if I told you that, as well as keeping them physically fit, exercise will increase your child’s resilience? It actually strengthens the brain.

It’s well documented that exercise is on a par with medication when it comes to treating mild to moderate depression and anxiety. This could be because it gets the body used to moving more fluidly in and out of the stress state. The same hormones released when we’re stressed (cortisol and adrenaline) are raised temporarily when we exercise. Regular physical activity teaches our stress-response system to recover more efficiently.

It can be a lot of fun to do this together, and I’ve learned that kids do what they see us doing, not what we tell them to. I’m a big fan of “movement snacking” – short bursts of exercise throughout the day. I’ll put on the radio before dinner and we’ll all dance around in the kitchen. Or my kids will join me doing squats, star jumps, bear crawls or frog hops. The sillier I look, the more they seem to enjoy it.

4.  Teach delayed gratification                                                                                         Resilience means understanding you can’t always have what you want as soon as you want it. It’s an important concept to pass on in the age of Amazon Prime, Spotify, Netflix and Uber. Psychology teaches us that people who can accept delayed gratification lead happier, healthier lives. Without the ability to defer pleasure and reward, our kids are losing an important skill for their wellbeing.
One of the best ways to teach it? Playing board games. These require impulse control, turn-taking, and mental flexibility. They exercise the prefrontal cortex, the rational part of the brain involved in decision-making, emotional regulation and, yes, resilience. Board games are also a good way for you to model resilience by being a good loser.

But there are no shortage of other ways to encourage delayed gratification: learning a musical instrument; listening to whole albums instead of skipping from track to track online; mastering a new sport; even watching a TV series together week by week, instead of bingeing in a couple of sittings.

5.  Eat the alphabet
Nutrition has a significant impact on mental health. Good-quality food changes the composition of our gut bugs, which helps send calm signals to the brain. Poor-quality, highly processed food sends stress signals instead. A diverse diet, rich in fibre, will lead to greater diversity in our gut bugs, which in turn will help make us more resilient, and anxiety and depression less likely. Persuading kids to eat more healthily can feel like an uphill battle, though, especially if they’re fussy, so this is not about becoming a top chef – just trying a few tricks that can really benefit them emotionally.

I like to challenge the whole family to “eat the alphabet” over 30 days. I think it’s a realistic goal to consume 26 different plant foods in a month: A for asparagus, B for banana, C for chickpeas, and so on. It turns healthy eating into a game, and encourages children to try new foods. Turn it into a competition and see who can tick off all the letters first.

6.  Model gratitude
Instead of pestering your children with questions such as, “How was school?” and, “What did you do today?”, teach them to reframe their day.
The following is a game I learned from a friend, who played it with his daughter over dinner. Everyone must answer three questions:

1) What did someone do today to make you happy?
2) What did you do to make someone else happy?
3) What have you learned today?

I love this simple exercise for how it helps us all find the positive in every day. It teaches gratitude, nurtures optimism, and recognises kindness. It doesn’t matter what may have happened at work or school, or how stressed any of us may have felt when we sat down at the table; the whole mood seems to lift once we’ve played this game. I learn things about my kids that they’d probably never have thought to tell me otherwise. Try it. It might just become the highlight of your day.

• The Stress Solution (Penguin, £16.99), by Dr Rangan Chatterjee, is out now. For details about forthcoming events, visit drchatterjee.com/events. Chatterjee is host of the iTunes number 1 podcast, Feel Better Live More.