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'Diseases of despair': The roles trauma, mental illness and inequity play in the opioid crisis

Saint Paul Pioneer Press - 12/31/2017

Dec. 31--Jason Roberts watched his mother die of a brain aneurysm on Christmas Eve when he was just 4 years old.

Joe Nickelson's mom overdosed on cocaine on Halloween when he was 12. She never fully recovered.

Tom Johnson lost his dad when he was 10 and fell into a deep depression.

All three men turned to alcohol and drugs to cope with the trauma they experienced as children.

In the end, they were hooked on opioids.

"I had a void I needed to fill," Roberts said of the loss of his mother.

"I did it for enjoyment, to be numb," said Johnson. "It felt good not have a care in the world, not to have any worries. It stopped you from feeling pain."

Childhood trauma, depression, chronic pain and other conditions public health officials call "diseases of despair" are a root cause of Minnesota's opioid crisis. The drugs killed a record 395 Minnesotans last year.

People suffering from such diseases are much more likely to turn to drugs and alcohol to cope with their emotional and physical pain, said Tim Walsh, who leads long-term recovery programs at Minnesota Adult and Teen Challenge.

"They use drugs to feel better," Walsh said of the participants of his organization's year-long substance abuse program. "It's rare if they have not had traumatic experiences."

"Diseases of despair" have driven an alarming increase nationally in deaths of blue-collar, middle-aged white men by suicide and drug poisonings. Addiction experts believe economic struggles hasten the sense of hopelessness that makes drug addiction more likely.

In Minnesota, those economic struggles include a large disparity between residents of color and their white neighbors.

State leaders say economic racial inequities play a role in Minnesota having one of the nation's largest disparities in drug overdose deaths for American Indians and black Minnesotans compared with white residents. Those two racial groups also face some of the state's largest inequities in education, income and employment.

The despair caused by inequity is no surprise to Dianne Binns, president of the St. Paul chapter of the NAACP, or Melanie Benjamin, chief executive of the Mille Lacs Band of Ojibwe.

"This has been happening in our communities for years," Binns said of the toll drugs take on people who are struggling. "It didn't become a crisis until it started happening to (more) white people."


By the time someone is admitted to a long-term recovery program, like the one Walsh oversees at Minnesota Adult and Teen Challenge, they've tried to get clean and failed an average of four times.

That typically means they've been using drugs and alcohol to cope with mental health conditions for years, Walsh said. His clients often suffer from trauma that began in childhood and has dominated their lives ever since.

The result of that trauma is people with high levels of stress who are routinely experiencing the body's "fight or flight" reaction usually reserved for life-threatening experiences.

"They want to escape that constant feeling," said Walsh. "It's not just to get rid of pain. It's so they can feel positive emotions."

Nickelson and Johnson, who both participated in the Minnesota Adult and Teen Challenge long-term recovery program, as well as Roberts, who completed a similar program offered by the Salvation Army, all acknowledged the role the trauma they experienced as children played in their decision to experiment with drugs and alcohol.

All three said they struggled to feel normal and fit in with their peers. Their substance abuse progressed from drugs like alcohol and marijuana until they were using methamphetamine and heroin to cope.

"It took my identity," said Johnson. "I completely lost myself."


Once addiction has taken root, it's hard to shake. Walsh says graduates of his organization's long-term recovery program have been in treatment an average of six times before they're successful.

Addicts not only have to address the physical and psychological dependence of the drug use, but the underlying factors that led to their substance abuse in the first place.

They also have to live with the long-term impact addiction has had on their lives. Walsh says most serious addicts don't reach the milestones of the rest of society like graduating from school, having a career and building long-lasting relationships.

That lack of accomplishment in life weighed on Nickelson.

"I haven't made any progress in the last 10 years other than screwing up my life and screwing up other people, too," he said.


Not all despair is caused by traumatic events in a person's life. Some communities face long-standing challenges that make escaping with the help of drugs and alcohol more appealing.

Benjamin, chief executive of the Mille Lacs Band, says native communities have suffered from historic trauma since Europeans first colonized North America.

"We have been beaten down," Benjamin said. "We always have something people want (to take away)."

Those struggles have led to wide economic disparities in American Indian communities. U.S. Census data show that American Indian households have incomes roughly half of white Minnesotans with considerably higher rates of unemployment and families living in poverty.

Black residents face similar inequities.

Yet, Minnesota's disparities are not just economic. State data show that American Indian and black Minnesotans are much more likely to die of drug overdoses than other residents.

American Indians are more than five times as likely to experience a fatal overdose and blacks are more than twice as likely. These disparities are some of the nation's largest.

Benjamin says economic disparities may be part of the reason her community has been ravaged by opioid addiction. On the Mille Lacs reservation, an ongoing dispute over law enforcement is also having an impact.

So far this year, about 75 people have overdosed on the Mille Lacs reservation, including more than a dozen fatalities, Benjamin said. That's almost a 10-fold increase in overdoses from the year before.

Binns, the St. Paul NAACP leader, says black communities face a similar historic trauma. Residents struggle to find well-paying jobs, affordable housing, good schools and safe neighborhoods.

"We live with trauma everyday," Binns said. "I don't know when I leave home in the morning whether I'm going to come back at night."

Binns and Benjamin both argue that state leaders need to address deep-rooted inequities and institutional racism if Minnesota is going to combat the opioid crisis in their communities.

"It's like a tornado going through our community," Binns said. "It's tearing up everything."


While public health officials continue to explore the role "diseases of despair" play in drug addiction, substance abuse experts are quick to point out that the growing opioid crisis is more complex. Opioid abuse isn't just rampant in struggling communities; there are plenty of affluent families who have been hit by it, too.

Prescription opioids have flooded the nation over the past decade, including 3.5 million prescriptions in Minnesota last year alone, enough for 62 percent of the population to have one. The drugs have hooked patients prescribed them by doctors and people who obtained them illicitly.

"Drug abuse is an equal-opportunity phenomena," said Carol Falkowski, an addiction specialist who has worked in state government and with recovery programs. "People take drugs to feel good or feel better. That crosses socioeconomic bounds."

Opioids present a unique challenge because in some more prosperous communities, leaders might be hesitant to talk with young people about the drugs dangers until it is too late.

"Our drug abuse situation is as different as it has ever been, and we have to get better at talking about it," Falkowski said.


(c)2017 the Pioneer Press (St. Paul, Minn.)

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