Speaker: U.S. likely to exceed 70,000 overdoses in 2018
SARANAC LAKE — At a Tri-Lakes Community Alliance for Addiction Prevention event Monday night a consultant in substance abuse and education outlined the effects of addiction on the brain and discussed modern stressors and drugs plaguing American youth.
“I will tell you that there are some, and I don’t want to be alarmist, but there are some frightening interesting innovations in the drug world … causing a substantial amount of distress within our country,” said Michael Nerney, a consultant in substance abuse prevention and education with more than 35 years experience in the field.
Life expectancy in the U.S. has declined in recent years at a steady rate not seen since World War 1 and the spread of the Spanish Flu, according to the Centers for Disease Control. This largely is driven by an increase in suicide and drug overdoses. There were more than 70,000 drug overdoses in 2017. There were more than 47,000 deaths from opioids like fentanyl and heroin. These are record numbers.
“It’s estimated this year, in 2018, we’re going to exceed 70,000,” Nerney said.
Nerney, eschewing a podium, paced around the floor of the Saranac Lake High School auditorium outlining the factors in substance abuse risk to attendees. He said risk comes down to a trifecta of genetics, and an individual’s environment and experiences.
“All of our brains have these remarkable variances and so someone can have far more receptor sites for that opioid family, and the dopamine rich areas of the brain that anybody else has,” Nerney said in reference to a person’s genetic vulnerability to substance abuse.
A child that grows up in the presence of drug users, or witnesses that drugs are necessary components to celebrating or stress relief, “will be far more likely to get access to drugs early,” Nerney said.
Experiences also play a vital role in susceptibility because of trauma’s ability to impair stress relief, Nerney said.
“Traumatic events can prohibit our brains from our normal ability to manage stressful situations,” Nerney said. “And so some people, particularly if they’re untreated, start to rely on drugs and alcohol to treat that kind of stress for them.”
Nerney cited Adverse Childhood Experience studies showing that if a child suffers caretaker abuse, they stand a 12.7 percent higher chance of developing substance abuse problems. Children of divorce suffer a 23.3 percent elevated risk.
European model myth
Nerney said that as his lecture circuit brings him closer to NYC, parents inevitably ask him about the European model. That is, allowing children to drink alcohol at dinner settings and the like. When Nerney asks these parents why that is a good idea, he said they say things like “well it teaches them to drink responsibly.”
According to data published by the European Union, Nerney said that is a myth. Of the 35 EU member states, 33 “have higher levels of binge drinking on the weekends through their teenage years, by their teenage years, than we do have in this country,” Nerney said.
“We’re seeing a lot of these technological advances show up,” Nerney said, speaking to advances in nicotine delivery in electronic smoking devices like JUULs, caffeine inhalers and vape pens capable of burning hash oil and synthetic marijuana.
“It’s a whole new world out there from when we were kids,” Superintendent Diane Fox said. “Life has changed tremendously and we have not changed at the rate our children have changed and what they’re addressing today is very different. We can’t support our kids if we can’t see it and can’t identify it and offer the support.”
Nerney addressed three paths that adolescents often venture down to substance abuse. First, through emotional overload and stress. An adolescent’s brain, and the changes it undergoes through puberty and beyond, result in emotional experiences magnitudes greater than that of adults.
“If they’re struggling, their struggles are two to four times bigger than our (adult) struggles are,” Nerney said. “And often they have far fewer resources, far fewer skill sets than we have to manage that stress, that anxiety. But there’s drugs out there that will help them do that.”
A recurrent theme throughout Nerney’s talk was the question of ‘What are we doing about that?’ Again and again, Nerney left the question in the air of how best to support adolescents and mitigate risk factors.
“They have the highest stress in the United States (among age groups),” Nerney said. “We (adults) can generally manage a 3.8 on a scale to ten with our internal and external resources. And look, 27 percent of teens are saying they have eight to ten on a daily basis … who’s helping them? How do we deal with that?”
He recalled speaking with high school students taking five advanced placement courses, studying and completing homework until 1 a.m., getting five hours of sleep and then heading back to school. “They’re train wrecks emotionally,” Nerney said.
As a result of academic and social stressors, depression is rampant among adolescents. Nerney cited a recent study from Columbia University that said teens today are suffering the highest rates of depression ever recorded.
“Anywhere between 6 and 7 percent of teenage boys are suffering clinical depression,” Nerney said. “And anywhere between 19 and 21 percent of teenage girls are suffering from clinical depression.
“So many people are using drugs to medicate their emotions. In terms of adolescence, and I mean 11 to 25, I want you to be sure you understand that that is not the main path. The other path will be some peer pressure. But a powerful path will also be exploring the risk taking behaviors in adolescents.”
That third path, citing research by the University of Pittsburgh, Nerney said accounts for large portions of substance abuse in adolescents. Teens do not calculate risks and assess them in the same way adults do. According to that study, Nerney said by the time most individuals turn 13 their brains will reap larger and larger emotional rewards from risk taking in itself.
“How do we get them to have risk taking that’s got structure and security? Because the mall will do it,” Nerney said. “Or right now, FaceTime will do it. Right now, Instagram will do it. Right now, Periscope will do it.”
Nerney said that this desire to take risk, which can result in drug experimentation, can also result in other behaviors such as acting out on camera or shoplifting.
“But that’s not because they’re deviant,” Nerney said. “That’s because it’s exciting and risk taking. So how do we help them manage that? Because if we ignore it, there’s plenty of drugs out there that they can try.”
Nerney also mentioned that diet can play a large role in risk factors for both adolescents and adults. Serotonin, simply put, a chemical essentially linked to the brain’s feelings of happiness and satisfaction, cannot be synthesized by the brain. It must be derived from food containing the amino acid tryptophan. Nerney said he’s seen students coming into school drinking energy drinks and eating Pop-tarts — food items that are low in tryptophan.
Tryptophan can be gleaned from proteins or some dairy products. Milk, eggs, fish, poultry, oats, nuts, sunflower seeds and chickpeas are all good sources of the amino acid.
How opioid addiction functions
“Why is it that people are willing to give up everything that they love? Because it turns out when you flood your brain with a drug like heroin what will happen is a new compound shows up,” Nerney said.
That chemical, called dynorphin, is rarely seen otherwise in the brain, Nerney said.
“Dynorphin shows up and shuts down all the pathways that made your life once beautiful,” Nerney said.
“You love your 5-year-old? No, you can barely identify that child as yours,” Nerney said. “You erode every pathway that made you what you were, yourself.”
Once an individual starts using, Nerney said, their liver becomes more tolerant while their brain builds more receptor sites — requiring greater quantities of use to maintain the same high.
“You can’t stop dreaming, thinking, obsessing about that drug,” Nerney said. “You lose control.”
It’s this fundamental understanding — that addiction is not a character weakness but a disease, that Nerney said is essential to treatment. He said more than half of the U.S. now believes in this premise, but accepting the “tough philosophical idea,” of medically assisted rehabilitation is an ongoing process.
“All of the research on medically assisted treatment,” Nerney said, “whether people complete the treatment or not, it shows that there is a 50 percent reduction for all fatalities related to drug abusers.
“They’re not all going to be perfect and wonderful citizens returned to our society,” Nerney said. “It’s not going to happen. Anywhere from 50 percent, all the way up to 90 percent of people that go to treatment for the first time relapse in the first year.”
And that’s not surprising, Nerney said, because drug use has embedded the memory of that high in their emotional centers. It can take two to five years to forget that high, Nerney said.
“You’ll need 18 months to recover the joy of being a dad to your two pre-teen kids,” Nerney said. “If people fail the first time, we re-enroll them in treatment … what we do not do is give up on them. This is not about character. It’s about these remarkable changes inside our brains that we can all be a part of helping restore.”