The Power of Prevention

We’ve grown accustomed to hearing consistently bad news about the state’s opioid epidemic. But some data shows substance use among youth in New Hampshire is on the decline. The numbers show that prevention works.

High schools across New Hampshire participate in the Youth Risk Behavior Survey (YRBS) every two years. The survey, administered by the Centers for Disease Control and Prevention, measures attitudes and behaviors associated with substance misuse, mental health and other risk behaviors. The survey was administered in 2015 to 14,837 students in 67 public high schools across the state with the support of the New Hampshire Departments of Education and Health and Human Services.

The results, released in February, show the numbers going in the right direction. As the chart indicates, regular (past 30-day) use of alcohol and rates of binge drinking have dropped significantly since 2005. Marijuana use is also down. And, very significantly, the data show a decline in the misuse of prescription drugs since 2011. Since misuse of prescription drugs frequently leads to heroin use, this decline represents an important step in turning the corner on our current opioid epidemic.

Preventing substance use disorders is a priority area for the New Hampshire Charitable Foundation, and one of the areas of focus of our “New Hampshire Tomorrow” agenda for increasing youth opportunity. Generous donors have made it possible for us to work with a comprehensive network of partners – as part of a statewide plan to address the disease of addiction – to implement proven prevention strategies, expand access to treatment and support recovery.

When the Foundation began its 10-year investment in prevention in 2011, we chose YRBS as the data by which we would measure progress toward our goal of contributing to a five percent reduction in youth substance use in New Hampshire by 2017. As these data show, that goal has been met or exceeded in all areas measured. While it is difficult  to “prove” cause and effect based on any single strategy, there are takeaways from  the data that give us reason to celebrate.

The latest YRBS numbers demonstrate that prevention works. Significant investments by the Foundation and other public and private funders in evidence-based prevention strategies through the state’s Regional Public Health Networks and other partners are showing returns. Strong community coalitions across the state are working to provide education and support services for youth and families to minimize risk and intervene early to prevent problems associated with substance misuse. Pockets of innovation and effectiveness – like Youth Leadership Through Adventure, Media Power Youth and the Life of an Athlete program – are fast becoming part of the collective solution.

These data are not reason to let up – but reason to buckle down. They demonstrate that prevention of substance misuse, like other public health challenges, is long-term work that requires ongoing attention. And it’s not all great news: While youth binge drinking has indeed dropped since 2005, it remained level from 2013 to 2015. Lifetime rates of heroin use have remained flat – which means there is much more work to do. (YRBS does not track heroin use among high school students over the past 30 days, as with other substances reflected in the chart above, but only measures whether young people have ever used heroin. The data show no statistically significant change in lifetime rate of heroin use over the past five years.) And even though our overall rates of youth substance use are down, they still remain among the highest in the United States.

New Hampshire is in the middle of an opioid epidemic. Which means that a lot of focus – and appropriately so – is on needed expansions in treatment and recovery supports. But these data reinforce the fact that substance use disorders are preventable. We are making progress among a younger generation – and if we stick with them, we will help many of them avoid succumbing to the disease of addiction that now threatens so many individuals, families and communities across our state.

Read more about New Hampshire YRBS results and results as reported by public health region.

Tym Rourke is thechair of the Governor’s Commission on Alcohol and Drug Abuse Prevention, Treatment, and Recovery.

Recovery Myths ...

Honest, courageous and insightful aren’t words typically used to describe people who struggle with addiction. But if given the chance, many people with abuse issues end up developing qualities and contributing to society in a way they never imagined possible. These successes occur in spite of major obstacles, from the ever-present threat of relapse to the pervasive stereotypes they encounter along the way. Even with three decades of myth-busting research behind us, some of the most damaging beliefs about addiction remain:

#1 Addicts are bad people who deserve to be punished.

Man or woman, rich or poor, young or old, if a person develops an addiction, there’s a widespread assumption that they are bad, weak-willed or immoral. The hostility toward people who struggle with addiction takes a form unprecedented among other chronic illnesses, prompting harsh legal sanctions and judgments like, “Let them kill themselves, they asked for it.” It is true that many people can do reprehensible things. Driven by changes in the brain brought on by prolonged drug use, they lie, cheat and steal to maintain their habit. But good people do bad things, and sick people need treatment – not punishment – to get better.

#2 Addiction is a choice.

Recovery isn’t as simple as exercising enough willpower. People do not choose to become addicted any more than they choose to have cancer. Genetics makes up about half the risk of addiction; environmental factors such as family life, upbringing and peer influences make up the other half. Brain imaging studies show that differences in the brain are both a cause and effect of addiction. Long before drugs enter the picture, there are neurobiological differences in people who become addicted compared to those who do not become addicted. Once an individual starts using drugs, prolonged drug use changes the structure and function of the brain, making it difficult to control impulses, feel pleasure from natural rewards like sex or food, and focus on anything other than getting and using drugs.

#3 People usually get addicted to one type of substance.

At one time, we believed most people who struggle with addiction had one drug of choice and stuck with it. Today, polysubstance abuse – the use of three or more classes of substances – is the norm, not the exception. Some people use multiple substances to create a more intense high (e.g., combining cocaine and heroin, or “speed-balling”) while others take certain drugs to counteract the undesirable effects of another drug (e.g, using alcohol to come down from stimulants). Some supplement their primary drug of choice with whatever is readily available (e.g., using prescription opiates and heroin interchangeably). Polysubstance abuse appears to be particularly common among males, those who begin using drugs at an early age, and adolescents and young adults. People who abuse multiple substances are more likely to struggle with mental illness, which when complicated by drug interactions and side effects, makes polysubstance abuse riskier and more difficult to treat than other types of drug abuse.

#4 People who get addicted to prescription drugs are different from people who get addicted to illegal drugs.

Despite the fact that prescription drug abuse has reached epidemic proportions in the past decade, the use of “legal” drugs to get high carries less stigma than the use of illicit drugs. Because medications like Vicodin, Xanax and Adderall can be prescribed by a doctor, are relatively safe when used as prescribed, and are already sitting in most people’s medicine cabinets, there is a widespread misconception that they are safer than street drugs.

They are not. When a person takes a prescription medication in a larger dose or more often than intended or for a condition they do not have, it affects the same areas of the brain as illicit drugs and poses the same risk of addiction. It’s not just curious, misinformed teens but also their parents who minimize the problem. According to a recent survey by The Partnership at Drugfree.org, only 14 percent of parents mention prescription drugs when they talk to their kids about drugs, and one in six parents said prescription drugs are safer than street drugs.

#5 Treatment should put addicts in their place.

Even though the leading authorities on addiction agree that addiction is a chronic disease similar to heart disease, diabetes and cancer, addicts are still treated as second-class citizens. Many treatment centers believe confrontational, shame-based methods are necessary to motivate people who struggle with addiction. Quite the contrary. In addition to contributing to the stigma of addiction and deterring people from seeking treatment, research shows that shame is a strong predictor of relapse.

Still, the media perpetuates the myth that there is a right way and a wrong way to recover, and that treatment that is luxurious or comfortable is inherently bad. Despite a significant body of research showing that therapies strengthen the relationship between therapist and client, improve long-term abstinence rates and increase treatment retention, the media sends the message that addicts deserve to suffer.

The myths about addiction are damaging not only to people who struggle with addiction and their families but to all of us. What if the many influential business leaders, inspirational artists, best-selling authors, and history-making politicians who join the ranks of people in recovery from addiction were shamed into silence? By understanding addiction as a brain disease and allowing people to recover in the way that works best for them, we can make significant strides in addressing the nation’s leading public health problem.

David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a network of mental health and addiction treatment centers that includes Promises, The Ranch, Right Step, The Recovery Place, The Sexual Recovery Institute, Malibu Vista, and Spirit Lodge.

May 2013, Psychology Today