The trip to my post office box today began like every other day. The contents were like every day.....except for a Time Magazine that had a cover I looked at and made me do a double take. You see, my last job before I retired was as an inpatient substance abuse counselor. Of all the therapeutic and rehabilitation psychology jobs that I have passed through in my life, this job was the most rewarding and bittersweet. To be candid, one of the steps I resolved to take was that I had to leave the field behind completely after eight years doing substance therapeutic counseling.
What made my reaction so strong was the depth of tragic misery and sadness that chemically dependent people experience. Chemical dependence therapy is unusual. Generally, the type of therapy I did was an experience of an intense and time limited nature. Because our funding source was public, it was limited to roughly a little over five clients a month. In the years that I worked in this capacity, I heard a little under 2000 stories.
There were some common threads across all the people I worked with. The first was that the folks I counseled were completely unable to manage their lives. The second was that their health was so poor that further use of the various chemicals would kill them. A third was that they had virtually no friends or relatives who would help them....their habit had made their best friend a chemical, one that was totally demanding. Their "friend" would avenge being ignored by making the addict miserable even unto death.
The issue of Time featured several areas around the United States that have epidemic levels of opioid use with frequent deaths and hospitalizations. The Time Magazine, dated March 2, 2018, showed in pictures what it would take me or any therapist many thousands of words to communicate. The photographer who spent a year taking pictures is named James Nachtwey. His photos are not pleasant to view. However, they convey in images what would take hundreds of pages to explain. Mr. Nachtwey's photos in this issue are haunting.
The issue of Time was entitled "The Opioid Diaries." It was the first time that a single topic has been addressed in Time, going past their short newsy appoach to a more quiet and less confrontational approach to recording.
The late Seventies offered a mild increase in the number of people who were willing to confront the opioid crisis. The trouble that primarily African Americans, Hispanics and impoverished Caucasian addicts ran into was that an already highly addictive array of opioids were sold at very low prices until the people who started using became opioid dependent. Then, prices became high, inverse to the normal arc of dependence on opioids, in which higher potency and/or larger amounts are needed to maintain the same high experienced during first use.
The areas of the United States which were covered in the Time Opioid Crisis issue are "The streets of Boston and San Francisco (with opioid users), first responders in New Mexico, Ohio, and West Virginia, inside jail cells in Kentucky, in funerals in New Hampshire, and in prayer meetings in Massachusetts." Being a person from New Mexico, I was especially interested in learning about my home state's opioid problem.
The photographs that Mr. Nachtwey took were hitting a raw nerve in me because of my history of treating and counseling of opioid, meth, alcohol, and other substance addicts. Not only were the New Mexico photos jarring in their manner of opening up the use and consequences of opioid dependence, but they were taken in my home county in New Mexico, each photo within a 15 mile radius of my childhood home. It is no secret that Rio Arriba County has had a long-term issue with usage of and dependencies on a wide variety of illegal substances since the beginning of the Eighties.
In an ethnography on the use of opioids amongst the impoverished Hispanic and Indigenous peoples of the Espanola Valley and Rio Arriba County, Dr. Angela Garcia's The Pastoral Clinic: Addiction and Dispossession Along the Rio Grande (2011 University of Californa Press) documents the increasing dependence upon opioids amongst the low income people living in Rio Arriba County in New Mexico over a three year period. In what is perhaps a controversial method of gathering data for her book, Dr. Garcia not only spent research time at a clinic in the Espanola Valley, but also worked as a staff member for the clinic.
The opioids that come into this rural New Mexico situation tend to be from areas not near Rio Arriba County, or in the Espanola Valley. Using quality as an adult indicator of life experiences, it is a valuable idea to remove any contaminants from the sample's data set. Some early research shows promise. Ms. Garcia's time employed as a detoxification assistant was considered a potential unconscious bias by a few journal critics who read her work.
A far more important point is that the clinic staff of people who do these programs usually require family members to take a role in the family program segments with the opioid addict if the family truly wants their relative to be clean and sober. Research has revealed the importance of family and sober friend showing strong support in response to the detoxification and treatment outcomes.
There must be a circle of support for the family and the addict who is entering aftercare. In an ideal world, the family would attend a week of therapy and education to learn how the progression of opioid dependence occurs, with the provision of separate classes and support services to families by the clinic. Often called Family Week, the clinic will provide housing of town relatives and spouses of the person in treatment.
As the field of substance abuse grows and improves, there must be ongoing program evaluation and accreditation to keep services up to speed with important scientific advancement and program innovations. Environments of many types are examined in substance abuse clinics, innovations in their program is often shared in local, regional, and national programs. Two of the major accreditation organizations also require a site visit by peer professionals to ensure that the program is in line with program and financial standards.
In the Espanola Valley, the clinic at which services were performed as documented in Ms. Garcia's book, was grossly underfunded. An air of the feeling of hopelessness was documented. There, people who received detoxification services anticipated a return to the clinic after discharge. The overwhelming prevalence of opioids' availability in Rio Arriba County, combined with poverty led to higher than average crime in that county and surrounding counties. Most homes have alarm systems and steel bars over windows.
Using data gathered by the New Mexico Department of Health, the 2012-2016 prevalence of intentional and unintentional death by overdose in Rio Arriba County came in at 89.9 per 100,000 people. The band of confidence (95% probability of accuracy-range of 75.6 to 105.2) indicates that the total, adjusted for probability is significantly stable at the 89.9 figure. The table measuring severity of Rio Arriba's opioid death rate as "Reason for Concern" on a range classified by level of significance from "Excellent to Reason for Concern." Reason for Concern is defined as Rio Arriba County's 89.9 opioid death due to overdose is statisically significant at a 95% band of confidence when compared with the State of New Mexico's 24.6 or the United State's rate of 16.4 deaths due to opioid overdose from 2012-2016 at a 95% band of confidence.
Further analysis of the overall health data for Rio Arriba County indicates that while opioid overdose rate of 89.9 is the highest in any county in New Mexico, there are statisically similar findings of Reason for Concern in the difference between Rio Arriba County and the State of New Mexico. Rates of Deaths per 100,000 people for Alcohol are in the Reason for Concern category at 144.1 Deaths per 100,000 with the difference being statistically significant at a 95% band of confidence (126.8 to 161.3).
Perhaps the prevalence of
hospitalizations for diabetes is germane to the rates of alcohol and drug deaths per 100,000, being a health condition that accompanies alcohol and opioid dependence. The rate per 100,000 for diabetes hospitalization falls at 34.3 for the period of 2014 to 2016. This is with a band of confidence at the 95% band of confidence (28.1-40.7).
Why I have taken the time to cite these findings from the State of New Mexico Health Department is the idea that the deaths of Rio Arriba County citizens as delivered by the New Mexico IBIS system is of sufficient concern to the Health Department to show that the prevalence of Deaths for Rio Arribans due to drug overdoses, some 90+ percent were opioid related. This is from 2012-2016. The deaths for Alcohol consumption in Rio Arriba County were 150% ABOVE drug deaths per 100,000. Hospitalizations for diabetes, often brought on by substance abuse were again statistically significant at the 95% band of confidence.
I am not sure how Rio Arriba County compares with the other locations in the Time Magazine Opioid issue. That comparison is beyond the scope of my article. What I will say, as a final point is that my sister Susan died from complications of diabetes. She went into status epilepticus, a continual and fatal seizure brought on by disregard for her personal health while using IV opioids and alcohol. She was my best friend and companion until I went to college. Her death occurred in Albuquerque, but most of the use was in Rio Arriba County. For me, substance abuse has been a personal situation due to her use. That is the point Time Magazine made eloquently. Death due to opioid abuse was a personal issue for surviving family members, including me.
This article copyright 2018 by Peter Reum
All Rights Reserved
What made my reaction so strong was the depth of tragic misery and sadness that chemically dependent people experience. Chemical dependence therapy is unusual. Generally, the type of therapy I did was an experience of an intense and time limited nature. Because our funding source was public, it was limited to roughly a little over five clients a month. In the years that I worked in this capacity, I heard a little under 2000 stories.
There were some common threads across all the people I worked with. The first was that the folks I counseled were completely unable to manage their lives. The second was that their health was so poor that further use of the various chemicals would kill them. A third was that they had virtually no friends or relatives who would help them....their habit had made their best friend a chemical, one that was totally demanding. Their "friend" would avenge being ignored by making the addict miserable even unto death.
The issue of Time featured several areas around the United States that have epidemic levels of opioid use with frequent deaths and hospitalizations. The Time Magazine, dated March 2, 2018, showed in pictures what it would take me or any therapist many thousands of words to communicate. The photographer who spent a year taking pictures is named James Nachtwey. His photos are not pleasant to view. However, they convey in images what would take hundreds of pages to explain. Mr. Nachtwey's photos in this issue are haunting.
The issue of Time was entitled "The Opioid Diaries." It was the first time that a single topic has been addressed in Time, going past their short newsy appoach to a more quiet and less confrontational approach to recording.
The late Seventies offered a mild increase in the number of people who were willing to confront the opioid crisis. The trouble that primarily African Americans, Hispanics and impoverished Caucasian addicts ran into was that an already highly addictive array of opioids were sold at very low prices until the people who started using became opioid dependent. Then, prices became high, inverse to the normal arc of dependence on opioids, in which higher potency and/or larger amounts are needed to maintain the same high experienced during first use.
The areas of the United States which were covered in the Time Opioid Crisis issue are "The streets of Boston and San Francisco (with opioid users), first responders in New Mexico, Ohio, and West Virginia, inside jail cells in Kentucky, in funerals in New Hampshire, and in prayer meetings in Massachusetts." Being a person from New Mexico, I was especially interested in learning about my home state's opioid problem.
The photographs that Mr. Nachtwey took were hitting a raw nerve in me because of my history of treating and counseling of opioid, meth, alcohol, and other substance addicts. Not only were the New Mexico photos jarring in their manner of opening up the use and consequences of opioid dependence, but they were taken in my home county in New Mexico, each photo within a 15 mile radius of my childhood home. It is no secret that Rio Arriba County has had a long-term issue with usage of and dependencies on a wide variety of illegal substances since the beginning of the Eighties.
In an ethnography on the use of opioids amongst the impoverished Hispanic and Indigenous peoples of the Espanola Valley and Rio Arriba County, Dr. Angela Garcia's The Pastoral Clinic: Addiction and Dispossession Along the Rio Grande (2011 University of Californa Press) documents the increasing dependence upon opioids amongst the low income people living in Rio Arriba County in New Mexico over a three year period. In what is perhaps a controversial method of gathering data for her book, Dr. Garcia not only spent research time at a clinic in the Espanola Valley, but also worked as a staff member for the clinic.
The opioids that come into this rural New Mexico situation tend to be from areas not near Rio Arriba County, or in the Espanola Valley. Using quality as an adult indicator of life experiences, it is a valuable idea to remove any contaminants from the sample's data set. Some early research shows promise. Ms. Garcia's time employed as a detoxification assistant was considered a potential unconscious bias by a few journal critics who read her work.
A far more important point is that the clinic staff of people who do these programs usually require family members to take a role in the family program segments with the opioid addict if the family truly wants their relative to be clean and sober. Research has revealed the importance of family and sober friend showing strong support in response to the detoxification and treatment outcomes.
There must be a circle of support for the family and the addict who is entering aftercare. In an ideal world, the family would attend a week of therapy and education to learn how the progression of opioid dependence occurs, with the provision of separate classes and support services to families by the clinic. Often called Family Week, the clinic will provide housing of town relatives and spouses of the person in treatment.
As the field of substance abuse grows and improves, there must be ongoing program evaluation and accreditation to keep services up to speed with important scientific advancement and program innovations. Environments of many types are examined in substance abuse clinics, innovations in their program is often shared in local, regional, and national programs. Two of the major accreditation organizations also require a site visit by peer professionals to ensure that the program is in line with program and financial standards.
In the Espanola Valley, the clinic at which services were performed as documented in Ms. Garcia's book, was grossly underfunded. An air of the feeling of hopelessness was documented. There, people who received detoxification services anticipated a return to the clinic after discharge. The overwhelming prevalence of opioids' availability in Rio Arriba County, combined with poverty led to higher than average crime in that county and surrounding counties. Most homes have alarm systems and steel bars over windows.
Using data gathered by the New Mexico Department of Health, the 2012-2016 prevalence of intentional and unintentional death by overdose in Rio Arriba County came in at 89.9 per 100,000 people. The band of confidence (95% probability of accuracy-range of 75.6 to 105.2) indicates that the total, adjusted for probability is significantly stable at the 89.9 figure. The table measuring severity of Rio Arriba's opioid death rate as "Reason for Concern" on a range classified by level of significance from "Excellent to Reason for Concern." Reason for Concern is defined as Rio Arriba County's 89.9 opioid death due to overdose is statisically significant at a 95% band of confidence when compared with the State of New Mexico's 24.6 or the United State's rate of 16.4 deaths due to opioid overdose from 2012-2016 at a 95% band of confidence.
Further analysis of the overall health data for Rio Arriba County indicates that while opioid overdose rate of 89.9 is the highest in any county in New Mexico, there are statisically similar findings of Reason for Concern in the difference between Rio Arriba County and the State of New Mexico. Rates of Deaths per 100,000 people for Alcohol are in the Reason for Concern category at 144.1 Deaths per 100,000 with the difference being statistically significant at a 95% band of confidence (126.8 to 161.3).
Perhaps the prevalence of
hospitalizations for diabetes is germane to the rates of alcohol and drug deaths per 100,000, being a health condition that accompanies alcohol and opioid dependence. The rate per 100,000 for diabetes hospitalization falls at 34.3 for the period of 2014 to 2016. This is with a band of confidence at the 95% band of confidence (28.1-40.7).
Why I have taken the time to cite these findings from the State of New Mexico Health Department is the idea that the deaths of Rio Arriba County citizens as delivered by the New Mexico IBIS system is of sufficient concern to the Health Department to show that the prevalence of Deaths for Rio Arribans due to drug overdoses, some 90+ percent were opioid related. This is from 2012-2016. The deaths for Alcohol consumption in Rio Arriba County were 150% ABOVE drug deaths per 100,000. Hospitalizations for diabetes, often brought on by substance abuse were again statistically significant at the 95% band of confidence.
I am not sure how Rio Arriba County compares with the other locations in the Time Magazine Opioid issue. That comparison is beyond the scope of my article. What I will say, as a final point is that my sister Susan died from complications of diabetes. She went into status epilepticus, a continual and fatal seizure brought on by disregard for her personal health while using IV opioids and alcohol. She was my best friend and companion until I went to college. Her death occurred in Albuquerque, but most of the use was in Rio Arriba County. For me, substance abuse has been a personal situation due to her use. That is the point Time Magazine made eloquently. Death due to opioid abuse was a personal issue for surviving family members, including me.
I would like to cite Angela Garcia's valuable book, The Pastoral Clinic: Addiction and Dispossession Along the Rio Grande (copyright 2011-University of California Press), and Time Magazine's March 2, 2018 issue as a source for this article. The excellent statistical information on the New Mexico Department of Health IBIS website was invaluable in the preparation of this Reuminations article.
This article copyright 2018 by Peter Reum
All Rights Reserved
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