Precept #1: Most drug use isn’t about drugs; it’s about life.

The new paradigm is rooted in recognizing that drugs are a symptom, not a cause, and whatever problems underlie them must be (and can be) addressed. (David Sheff, Clean)

“This epidemic is like no other we have ever seen,” points out Steve Carrel, the chief executive officer of Muskingum Behavioral Health since 1981. “More people are dying from this drug epidemic than any other.  More people have died from overdose than died in the Vietnam war.  It’s the leading cause of death for people under the age 50! 

“I have been in the addiction field for 36 years.  What we do today is totally different than what we did when I first started in this field,” says Carrel.  “Actually, it’s different than what we did five to ten years ago.  We’ve become more data driven.  We use more evidence-based programming.  We listen to the patients and work with them and their families.  We know so much more today.  Brain scans show the changes in the brain.  We have medications to help in the recovery process. I’ve seen moms and dads get their children back, [and recovering addicts] get homes and jobs.  I’ve seen slips and relapses, some with a positive outcome and some not so positive.”

The possibility of relapse is very real in recovery from the disease of addiction, information that not everyone is happy to hear, but that Carrel knows needs to be broadcast.  “Addiction is a chronic brain disease, with potential for relapse,” he says.  “Let’s look at it in a parallel universe – that of heart disease, or HD. HD is a chronic disease.  There are acute symptoms, but it’s a chronic disease.  It evolves over time, and once diagnosed, it’s treated. With treatment, the symptoms go away, but the disease is still present. The causes of the disease could be eating habits, genetics, lifestyle, many things.  People with HD are supposed to eat healthier foods, reduce salt and fat intake, exercise moderately, etc.  But how many of them are at a fast food restaurant ‘relapsing’ and not doing what needs to be done to keep the HD symptoms at bay?”  

It’s the same, he says, with addiction. “Getting someone drug-free is the easy part.  Keeping them that way is where the rubber meets the road. Treatment is often needed.  Like the HD patient, the person with addiction needs to establish healthy habits, [and identify] supportive friends and family, leverage community supports like employers who will hire persons with addictions.” They need safe, affordable housing, Carrel says. Just as there are support groups for people with heart disease, there must be parallel supports for those with the disease of addiction. Currently, that’s not the case.

“When an HD patient relapses and the symptoms return,” Carrel points out, “they seek and receive immediate help.  This is not necessarily what happens to people with addiction.  Many times, they are scolded for ‘falling off the wagon.’  They are told they have a weak will. ’You just need to stop!’ they are told, but they can’t.” 

Some treatment professionals, Carrel points out, ‘punish’ relapsing addicts by not seeing them, believing they ‘obviously aren’t ready for help.’  “More often than not, there is not treatment capacity, thus they wait,” says Carrel.

Carrel agrees with David Sheff’s first precept, that drug use isn’t about just drugs; it’s about life. “When treatment and prevention efforts focus only on the drug or drug use,” he says, “those treatments will not be effective. Good ‘drug’ prevention is also good pregnancy prevention, suicide prevention, health promotion…All of those have similar ‘life’ components.  

“Effective recovery programs not only address the ‘drug’ impacts of health and life, but also help those with addiction develop the skills and attitudes which increase the chances of leading a life with lower risk of major problems. This could include money management, accountability for behaviors, hygiene, coping skills, anger management – the list is endless.  Treatment should be tailored to the patient, and not be a cookie cutter approach,” says Carrel.

Drug addiction is an equal opportunity affliction; it cuts across economic status, educational backgrounds, race or ethnicity, age, and family background. “One obvious area of susceptibility,” Carrel says, “is major surgery, major accident, sports injury – anything that causes great physical pain,--pain at a level of needing opiate pain management.  Many patients are not educated on the proper use of, and the cautions necessary with, these medications.  

“I’ve talked with parents,” he says, “whose teenager was in surgery. They cannot believe their child’s friends are calling to see what pain medication was prescribed, now much they got, and how much they will sell it for.”  

Carrel notes that childhood trauma also makes individuals susceptible to drug use. “The more trauma a child experiences, the more the chances of them getting involved in substance use increase exponentially,” he says, noting that stress, depression, anxiety, mental illness, lack of coping skills, and lack of appropriate adult modeling of behaviors, all contribute to vulnerability.

And the risk is highest in the young. “For those under the age of 25,” says Carrel, “their vulnerability is increased because their part of the brain that is developed first is the ‘go’ part.  ‘Jumpin’ off that roof sounds like a great idea!’” he says, or, “’Smoking this joint has no dangers associated with it.’” The part of the brain that knows to say ‘no’ is not fully developed until the mid-twenties. Before then, he notes, teens are prone to doing risky things, and their risk of becoming addicted, if they experiment with drugs, is high. 

But Carrel believes that recovery is possible; he sees it happen. But people need to know, he says, that “…it’s not as easy as ‘Just Say No,’ or ‘You wouldn’t use if you just chose to stop!’ This is a very complex issue that needs to be addressed in multiple ways by all parts of the community.” 

Born and raised in the southeastern part of the state, Steve Carrel is very much attuned to the social problems plaguing rural Ohio. He is one of the members of the Imagine: A Clean Community planning initiative that is working to bring David Sheff to Secrest Auditorium on September 13. Married to Lynn, with two daughters, Lacey and Abbey, he lives in Zanesville. He has taught about addiction, child abuse and neglect, and alcoholism, at Ohio University-Zanesville and Zane State College; he has a BA in psychology from Marietta College and an MSW from the Ohio State University. He serves on many collaboratives seeking to address addiction and other social issues.