What You Can Do to Help People in the NRV with Addiction

An executive brief on what you can do to help the over 16,000 people in the New River Valley of Virginia with substance use disorders.

Executive summary:

1. Do no harm. 
2. Help people get health insurance and medical care.
3. If they’re open to it, accompany people to their appointments.
4. Start a SMART Recovery meeting.
5. Lobby against federal and state restrictions on medications that treat addiction.
6. Host substance-free gatherings and events, both at home and in the community.
7. Help people help themselves.
8. Inform yourself about addiction and addiction treatment in our locale.

1) Do no harm.

A full explanation is here.

2) Help people get health insurance and medical care.

Use the Surgeon General’s report on addiction as a guide.

The Surgeon General’s report recommends substance use disorder treatment in this priority order: medications, counseling, and support.

Medications

Help people get health insurance. In the New River Valley of Virginia, help people with severe mental illnesses and low incomes call New River Valley Community Services at 540-961-8300 to make an appointment for help with enrolling in GAP. If they’ve previously paid federal taxes, sit down with someone at a computer and help them navigate healthcare.gov, or call Laura Goorskey at Muneris for help with signing up for insurance through the Affordable Care Act.

Help people make appointments with their primary care physicians (PCPs). While an appointment with a psychiatrist might be optimal, wait lists for appointments in our area are 6 months or more and require a referral from one’s PCP anyway.

Some medications that treat addiction, illogically, are not available in all areas of our locale, are available only through a wait list, or are available for cash only. If your person has an opioid use disorder, you will discover the horror of the double bind in which we place our citizens.

Join with community stakeholders to create attractive packages of positions, salaries, caseloads, housing and Virginia Tech football tickets – whatever it takes – to attract more psychiatrists and medical professionals to our area who have the expertise and credentials to treat addiction.

Counseling

Help create and update a list of counselors in our locale who are currently accepting new clients, who are open to taking clients with substance use disorders (many are not or don’t feel qualified to do so), who offer cognitive behavior therapy (CBT), the top recommended therapy for SUD, and who may give discounts to low-income individuals. Dialectical behavior therapy (DBT), is an increasingly evidence-based counseling approach as well.

Counseling does not directly treat addiction, but can assist people with abstinence, drinking or using less problematically, and with co-occurring mental and emotional issues. According to the Surgeon General’s report, individual counseling is the recommended modality, group therapy less so.

Support

The more local support group meetings we have on different days of the week, at different times, in various locations, the more people who need support for the 24-7 condition of addiction can get it.

3) If they’re open to it, accompany people to their appointments.

Study the Treatment section of the Surgeon General’s report, print out several copies, and highlight sections that pertain to your person’s condition. Be ready to point to those relevant section, others as they come up, and to hand over your highlighted copy. (Printouts of very recent research reports can be helpful. For alcohol, try pages 4-24 and 4-25 from the Surgeon General’s report from 2016, and this one from 2107. Although medications for methamphetamine use disorder are still unknown, this report from 2017 is promising. For opioids, this piece of journalism from 2016 is stellar.)

Demand for health care exceeds supply in our locale and many of our health care professionals are saving lives and relieving suffering, not studying the latest research on addiction. Some, unfortunately, offer belief-based treatment, not evidence-based treatment. Help inform them. Advocate if you need to. Keep what happens in the appointment rigidly, absolutely confidential.

4) Start a SMART Recovery meeting.

SMART Recovery does not require meeting facilitators to be in recovery from addiction themselves.That means that any citizen can volunteer to train quickly as a host, and more extensively as a facilitator, and we can, as a community of trained “citizen counselors,” offer therapeutically-based recovery support services to our own community members.

The more citizen volunteers we have hosting local SMART Recovery meetings, the more support we offer and the more stigma-busting we do. I share with permission that to support the launch of our locale’s first open community meeting of SMART Recovery, our town’s mayor, Ron Rordam, attended. If you can go to business, community, educational and religious buildings and see the butcher, the baker, the candlestick maker – and the mayor himself – at a SMART Recovery meeting, well, maybe addiction is just an unfortunate condition for which the whole community backs recovery and wellness.

Mob SMART Recovery Facebook pages like our local one with “Likes.” That explodes the stigma of  “Is she or he ‘one of them’?”and transforms “Us vs. Them” into “We.”

5) Lobby against federal and state restrictions on medications that treat addiction.

Contact your representatives and urge them to work to repeal federal and state laws, and Virginia Board of Medicine policies, that limit access to medications that treat or ameliorate addiction. The logic of the laws is that if people have trouble getting substances, or are punished for using them, they won’t use them. Given human nature – we’re wired for pleasure, excitement and experimentation – and the nature of addiction – addiction’s brain impairments result in persistence no matter what the cost, no matter what happens, and no matter what punishments are levied – this is a position of tragic illogic.

6) Host substance-free gatherings and events, both at home and in the community.

Brew Do, Fork and Cork, Cocktails and Collaborations…where can an adult go locally to be with other adults not using substances? And how about gatherings of family and friends accompanied by wine, beer, marijuana, or other substances? Research on addiction reports that environmental cues can illicit automatic use or near-use. Many people with substance use disorders simply cannot risk being around substances. Consider declaring or hosting one gathering per quarter as a substance-free event to protect and enhance the lives of citizens and loved ones with addiction.

To help coordinate gatherings and events, consider volunteering to launch a New River Valley recovery community organization (RCO). A .pdf of the recovery community organization toolkit from the Association of Recovery Community Organizations and Faces and Voices of Recovery is here.

(Recovery advocacy and activism is too lonely to be tolerated long-term by one person and, ultimately will be ineffectual. Faces and Voices of Recovery has found, “[R]ecovery voices are marginalized and ineffective when the work is shouldered primarily by lone individuals.” Groups of individuals can make things happen.)

7) Help people help themselves.

Given the scarcity of treatment and medications for addiction in our locale, and given that addiction is a 24-7 condition, most people with addiction will have to provide much of their own care much of the time. Innovative programs like this exist in other areas. Here, we DIY (do-it-yourself). Help people discover what’s helpful to them and to practice evidence-based self-care.

8) Inform yourself about addiction and about addiction treatment in our locale.

To become quickly informed about the science of addiction, I recommend the NIDA site. For further study, consider the Surgeon General’s report (minus the section on TSF, included for legacy reasons, but which is not an evidence-based treatment), and Maia Szalavitz’s comprehensive report on addictions research, the New York Times bestseller Unbroken Brain: A Revolutionary New Way of Understanding Addiction. Maia continues to report on addictions research and a list of her recent articles is here. Laurel Sindewald and I have written a series of brief reports listed here. This is an excellent academic article by Nora Volkow, M.D., and on pages 16-19 in this publication, she offers a more mainstream explanation of the science of addiction.

To inform yourself about addictions treatment in our locale, the next time you go to a health care appointment, ask your providers what they would do for you if you told them you had a problem with alcohol, opioids or another substance. You’ll learn why it takes 3,000 words to describe how to get addictions treatment in the New River Valley of Virginia.

The opinions expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends.  This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Last updated 4/27/17