WINTER 2021
Substance Use In Plain Sight plus Youth Alcohol Use
pg 14
Behind Closed Doors
pg 25
Soft Landing Need help starting or maintaining recovery from stimulants or opioids? We can help!
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We want to work with you to give you and your baby the Soft Landing that you both deserve. For referrals or more information, contact softlanding@towerhealth.org or call 484-628-9050 for more information. Referrals accepted from individuals or professionals. “Get Help Now” by contacting (1-800-662-HELP)
Think teen drinking teaches moderation? Think again. Those who drink before age 15 are 6.7x more likely to develop alcohol use disorder. Be educated about teen drinking.
Learn more and request free materials on this campaign at cocaberks.org/parentswhohost Parents Who Host Lose the Most is a public health media campaign designed by Prevention Action Alliance to prevent underage drinking. Statistic Source: “Trajectories of Alcohol Initiation During adolescence.” Journal of the American Academy of Child & Adolescent Psychiatry. 2018. Paid for with Pennsylvania Taxpayer Dollars
The Response is published through funding from county and state dollars in concert with the Berks County Opioid Coalition under the guidance of the Council on Chemical Abuse. cocaberks.org • 610-376-8669
EDITORIAL BOARD
T.J. Huckleberry Executive Officer, Berks County Medical Society John Adams District Attorney, County of Berks Kevin S. Barnhardt Commissioner, County of Berks Marcia Goodman-Hinnershitz Director of Planning & Resource Development, Council on Chemical Abuse Tracy Hoffmann Hoffmann Publishing Group Lee Olsen Olsen Design Group Architects, Inc. Stanley J. Papademetriou Executive Director, Council on Chemical Abuse
BERKS COUNTY’S OPIOID COALITION, SOS BERKS www.sosberks.com
BERKS OPIOID COALITION LEADERSHIP WITH SOS BERKS Kevin S. Barnhardt and Stanley J. Papademetriou Coalition Co-chairs
CONTENTS
WINTER 2021
FEATURES 8
14
19
The Overdose Event Youth Alcohol Use Drugs and the Adolescent Brain
COMMUNITY SAFETY COMMITTEE
21
Trudge the Road of Happy Destiny
COMMUNITY AWARENESS COMMITTEE
25
Behind Closed Doors
John Adams and Yvonne Stroman Co-chairs Jennifer Kirlin Chair
DATA COMMITTEE
23 Celebrating Life Drug and Alcohol -Free 28
BERKS COUNTY OPIOID COALITION
Compassion Fatigue
Justin Loose and Kathy Noll Co-chairs
PREVENTION EDUCATION COMMITTEE Cory Trevena and Jaclyn Steed Co-chairs
TREATMENT COMMITTEE Stephanie Smith and Bernice Hines-Corbit Co-chairs
IN EVERY ISSUE
FROM THE COALITION
LETTER FROM THE EDITOR
6
12 The Overdose Epidemic in
My friend John
Berks County
OPIOID COALITION VISION Identify opportunities to remediate the opioid crisis through the provision of evidence based/best practice strategies and resources. OPIOID COALITION MISSION The mission of the coalition is to determine the extent to which Berks County is being affected by the non-prescriptive use of opioids and the use of heroin through the examination of its devastating effects, both personal and societal, and to set recommendations that address the prevention, intervention, treatment and recovery supports of local residents that suffer from opioid addiction. 2669 Shillington Road, Box #438 Sinking Spring, PA 19608 | HoffPubs.com | (610) 685.0914 Designer | Kim Lewis The opinions expressed in this publication are for general information only and are not intended to provide specific legal, medical or other advice or recommendations for any individuals. All rights reserved. No portion of this publication may be reproduced electronically or in print without the expressed written consent of the publisher or editor.
FOR ADVERTISING INFO CONTACT: Alicia@hoffpubs.com, 610.685.0914, ext. 210
READ THE RESPONSE ONLINE AT Response.HoffmannPublishing.com RECEIVE THE LATEST UPDATES BY FOLLOWING US ON SOCIAL MEDIA 5
LETTER FROM THE EDITOR
T.J. Huckleberry Executive Officer Berks County Medical Society
We D o n’t Understand S
ometimes, I feel that I am ill-suited for the task of editor of this magazine. “Write what you know,” was perhaps Mark Twain’s best advice to all authors; and being fair to all of you, I am not a trained expert on substance use disorders, I am not in recovery, and I have never yet been in the trenches with a loved one seeking sobriety. I simply do not know enough.
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THE RESPONSE // WINTER 2021
So, it is a challenge for me to write a sincere and authentic article concerning alcohol use disorder. Especially, because I am a guy who enjoys having a beer or two with his friends, I also have my share of college stories and other fond memories which included the use of alcohol. I believe I am in the majority of people that ambivalently believes that alcohol is, to quote the poet Homer Simpson, “the cause and solution to all of life’s problems.” The fact is thankfully, I may never know the feeling of completely losing control. Or the anxiety of the potential of one sip leading to an empty bottle. I will never have to endure temptations of an open bar wedding or at a holiday gathering. As a father, one of my deepest fears is that this disorder might affect my children; and that I may experience the helplessness and anguish that a parent must feel when watching their children struggle. But thankfully these fears are still hypothetical, and I am only left imagining. The fact is recreational drinkers will never fully understand alcohol use disorder. If we can stop at one drink, why can’t they? For generations, that has been the question and for generations we have been giving the wrong answer. We stigmatized the disorder, dumbed it down into character flaws and weakness. We swept sobriety under the rug and made it a personal problem. As a community, it feels that we are only slowly grasping the concept of mental health. We are beginning to understand the dangerous differences between a perceived weakness of character and a clinical diagnosis. Substance abuse is a treatable brain disorder and deserving of our compassion, not judgement.
(God)grant me the serenity to accept the things I cannot change, The courage to change the things I can, And the wisdom to know the difference. On behalf of Berks SOS and The Response Magazine, I would like to wish you all a happy and healthy New Year.
In terms of an individual’s mental health, we are simply not meant to understand the what and the why. We are only meant to recognize the who and the how. Who is the person, and how can I help? Perhaps when we try to make sense of this disorder ourselves, we all should be utilizing the mantra that so many in recovery have turned to for clarity.
7
FEATURE
THE
Overdose
EVENT By David A. Kostival
8
THE RESPONSE // WINTER 2021
A
s we appear to be in the waning stages of the COVID-19 pandemic, drug abuse and overdose-related deaths continue to rise at alarming rates on both the local and national stages. Every day in Pennsylvania ten people die as a result of some form of substance abuse disorder. The National Institute on Drug Abuse reported that in 2019 close to 50,000 people in the United States died from drug overdoses. And the Center for Disease Control recently released data that pushes drug overdose deaths to over 90,000 in 2020. Upon hearing drug overdose statistics, victims receive very little empathy from those in the general public who don’t understand the nature of the problem. Prescription opioids are especially dangerous. According to the pa.gov website, long-term dependence on a prescription opioid becomes a very real possibility after only five days of use. That means the problem could become a reality for just about anybody being treated for serious pain. As a result, abuse of opioid drugs has been on the rise since the 1990s when healthcare providers began to prescribe opioid pain relievers at an increasing rate.
Berks County has not been immune to any part of the crisis. According to the overdose fatality reports provided by the Office of the Berks County Coroner, in 2020, there were 130 confirmed deaths from overdoses, which was up from 126 the previous year. And the fatality reports, as of October 31, 2021, have reached 137. While the toxicology reports are still outstanding for 2021 overdose fatalities, the crisis in Berks County continues to escalate. BATCH OF DRUGS CAUSED OVERDOSE SURGE The impact of the crisis was really driven home the weekend of September 11 and 12 when Berks County experienced an extreme surge of 101 overdoses and three deaths from what was reported as a bad batch of drugs. Berks County District Attorney John Adams said this was an isolated incident because of the uniqueness of the drug combinations that were discovered in the packets that caused the overdoses. “I think that this incident brought to light that this was a blackeye on our community and we really need to address the use of drug use and drug abuse,” Adams said. “So many overdoses in such a short period of time is somewhat of a black mark, but it hits home that we need to make the efforts from a global perspective, not only from law enforcement, but also treatment facilities and resources to attack this problem. “We can’t let our foot off the pedal,” Adams emphasized. “We have great resources in our community. We have to engage those most in need and make sure they get the appropriate services and hopefully stop using controlled substances.” NO QUALITY CONTROL IN STREET DRUGS The September overdose incident was a result of a lethal mix of drugs sold to unsuspecting users. “When buying drugs in the street, there is no quality control,” Adams noted. “I am fairly certain that no one knew that this drug (Butonitazene) was in there, as this drug has not been seen very often.” But the incident does raise a lot of concerns for those involved in enforcement and treatment. “In this situation, we reacted and we stamped out the source quickly, but that does not mean the source has been stamped out completely,” Adams shared. “For our purposes, this is an on-going investigation which will continue until we can stamp out what we believe is the ultimate source.” Adams explained that after he was tipped off that there was a problem that weekend in September, he contacted his detectives who responded immediately. Within 24 hours, a search warrant was issued which closed down one of the suppliers. “This was quick work by the detectives from my office and from the Reading Vice,” Adams continued. “And that led to a second search warrant to be executed within 48 hours, which stamped out the two sources.” By Sunday afternoon, two individuals were taken into custody and charged with felony drug charges and on Tuesday, three others were arrested and charged with possession with intent to deliver.
DANGEROUS AND POTENTIALLY LETHAL SIDE EFFECTS Dr. William Santoro, chief of the division of addiction medicine at Tower Health, explained the dangers of Butonitazene, saying it has a high dependency potential as well as dangerous adverse side effects. “Butonitazene is an analgesic opioid of the benzimidazole opioid class, which acts as a powerful analgesic, hypnotic, and sedative,” Santoro said. “Vomiting and respiratory depression may occur at high doses. You can only buy Butonitazene online as a designer drug for chemical research.” Santoro warns that the adverse effects can potentially be fatal, and the real danger for drug users is the unknown factor. But Santoro added that it is still unknown what proportion of butonitzazene was used in the September overdose concoction. “Although it appears that butonitizene was the culprit, it is still not a one-hundred percent certainty that it was the sole cause of the problem,” Santoro said. He also noted that Fentanyl is a typical adulterant to almost any illicit product sold on the street. But there are others. “This includes methamphetamine, cocaine and even marijuana,” Santoro added. Although the mixtures often use over-the-counter drugs, Santoro advised it is best not to publicly identify them. “Since we don’t know what chemicals these drugs are mixed with, we don’t know what the interactions are or even what the action of the original substance will be,” Santoro said. “We end up treating symptomatically based on how the patient presents until we can definitively determine what drugs are in play.” Santoro emphasized a very real danger of unknown chemicals in the drugs is that the administration of Naloxone doesn’t always have the desired effect. Naloxone – more commonly known by its brand name Narcan – is a medication which is designed to rapidly reverse opioid overdose. When it comes to the source of powerful drug mixes, Santoro shared that he stays away from speculation as to what is the philosophy of those amateur chemists. But Santoro said he worries about the users. “These people who are using are not in a normal frame of mind,” he added. “It worries me when we see depictions on TV which show people using drugs thinking straight.” TOO MUCH STIGMA ATTACHED TO DRUG ABUSE Santoro emphasized that he has been a big anti-stigma campaigner for many years. “People who are addicted do not want to be addicted, and because of the stigma, they don’t get treatment,” he said. Santoro related a conversation he once had with a friend who indicated he was frustrated with the overdose situation and how it was taxing the health care systems. “He believed a solution would be to limit the number of times a person could be saved to three,” Santoro shared. “Six months later, this same person was reaching out for prayers for his son who had overdosed. Until it affects them personally, they feel like it is someone else’s problem. I don’t want people to have a moment like that,” he added. “We have to learn about it without having to see first-hand the pain and devastation it causes.” Santoro stressed that people should not be defined as addicts, Continued on page 10 9
but rather as having a medical condition. “I may have high cholesterol, but I am not defined as high cholesterol,” he explained. Santoro noted that the COVID-19 pandemic only made the opioid crisis worse. “Addiction is a disease of isolation,” Santoro explained. “Because of the pandemic, people were appropriately told to shelter in place and isolate. While this might be good for the pandemic, it was not very good for people with a substance use disorder.” He likened it to telling a person with an alcohol problem to hang out in a bar. “It’s setting them up with a difficult situation,” Santoro said. “People use when they are alone.” BRINGING FOCUS TO THE DISEASE But Santoro said he remains the eternal optimist that progress is being made. “We are making ground in that we are turning the lights on this disease,” Santoro concluded. “My friends in oncology are not looking to cure cancers, but looking for better treatment and better outcomes. The same can be said here. We have better treatments and are making progress.”
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THE RESPONSE // WINTER 2021
Marcia Goodman-Hinnershitz, the director of planning and resource development for the Council on Chemical Abuse said a takeaway from the September overdoses is to better strategize. “We have to make sure all the data is collected so that we are able to understand the nature of the overdoses, which will better enable us to target our strategies to the problems more directly,” Goodman-Hinnershitz said. While the user never really knows what mix of chemicals they may be taking, Goodman-Hinnershitz advised that it is not effective to use this as a scare tactic. “We don’t use scare tactics, but rather educate people with their decision making,” she noted. “We have to be realistic in knowing that people will use, so we have to make education accessible to everybody.” Goodman-Hinnersitz said that in the wake of the September overdoses, she has seen growing concerns in communities. INCREASED ACCESSIBILITY OF NARCAN “I think there has been continual concerns that we have to build our resources,” she shared. “One of the areas we focus on is to expand accessibility to Naloxone (brand name Narcan®), a medication that can reverse an overdose caused by an opioid drug (i.e. prescription pain medication or heroin). The Council on Chemical Abuse, in collaboration with the SOS Berks Opioid Coalition, promotes the availability of Narcan® to the community on
the whole through community wide informational mailings and distribution at health fairs. Initiatives have also been targeted to populations at higher risk for opioid overdoses including individuals served by the criminal justice and drug and alcohol systems. OUTREACH TO THE UNDERSERVED Bernice K. Hines-Corbit, the case-management supervisor for COCA, said it is important to reach out to the groups who are underserved. “We have stepped up our outreach efforts and are working more collectively with Centro Hispano (the Hispanic Center in Reading) and the NAACP,” Hines-Corbit said. She added that COCA is trying to get education into the community through health fairs and community events. “COCA is here for the community,” she explained. “We’re here and we can help the uninsured and the under-insured. We want to see more treatment access and remove the barriers. It’s a work in progress and we are always looking for new groups to reach out to.” UNDERSTANDING THE DEPTH OF THE PROBLEM Stanley J. Papademetriou, COCA’s executive director, stressed that the results of the September overdoses clearly demonstrated a true collaborative effort in Berks County. “The system worked,” Papademetriou said. “The hospitals responded and law enforcement was able to cut off the supply in a relatively short period of time. Only three deaths occurred. That’s three too many, but that could have been a lot worse.” Papademetriou added that a key to combatting the crisis is the availability of the resources in the community and the stakeholders in the community working collaboratively and highlighting the work to let people know they are there. “We’re cautiously optimistic that we will start to see the numbers coming down,” he shared. “We don’t know and can’t tell what effect the pandemic has had. We can’t assume one way or another.”
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“But I do believe that services are out there and more and more people understand the depth of the problem,” Papademetriou explained. “Many people don’t realize how pervasive the problem really is, as many people do not look at local news. Community awareness is a big part of this.” Papademetriou said the September overdoses amounted to poisonings of unsuspecting users. “That’s why it was extremely important that local law enforcement found where the source was and stopped it,” he noted. “We’ve done some outreach and found many do not realize what they are actually buying.” Papademetriou places an emphasis on the idea that what happened in September can’t just be forgotten but has to remain at the forefront of the whole community education process. “When it happened, it made a big splash in the media and then it just disappeared,” Papademetriou concluded. “We never hear the aftermath; it is just dropped.” “It goes beyond the initial story,” he added. “This was a bad drug that really hurt people and that could hurt people for years to come. This really has to be about community awareness.”
For more information and to schedule an appointment
610-750-6130
832 North Park Road, 1 Park Plaza Wyomissing, PA 19610 Monday – Friday 8 a.m to 5 p.m. Contact us at
www.NDTS.org
NDTS is a private 501(c)(3) non-profit company that has been providing service since 1980. 11
FROM THE COALITION
THE OVERDOSE EPIDEMIC IN BERKS COUNTY
by Coalition Co-Chairs: Kevin S. Barnhardt, Commissioner, County of Berks, and Stanley J. Papademetriou, Executive Director, Council on Chemical Abuse
T
he overdose epidemic in Berks County continues to rage and as is fitting much attention has been given to the crisis. The number of deaths continue to rise and in fact 2021 looks like it will eclipse the previous two years as the worst year for overdose deaths in Berks County. An added stressor to our community was the recent ‘overdose event’. During a 36-hour period in September over 100 individuals experienced an overdose, most of whom required hospitalization. The ongoing wave of overdoses in our community does not appear to be receding. It is imperative that the community continues to face and address the overdose crisis here in Berks County. However, there is an issue that is lurking in plain sight and not receiving the attention it deserves. That is alcoholism and alcohol use disorders.
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THE RESPONSE // WINTER 2021
WHILE ALARMING, NONE OF THIS IS NEWS. THESE PROBLEMS HAVE BEEN WITH US FOR DECADES. The SOS Berks opioid coalition focuses primarily on opioids and overdoses. However, we have seen the need to bring to light the fact that alcohol use has been and continues to be an issue in our community. Studies show that alcohol use has increased dramatically during the COVID-19 pandemic and the stress that comes with uncertainty has given rise to increased alcohol use.
on the venue, is promoted. Most people who use alcohol can do so responsibly and without devastating consequences. But not everyone who uses alcohol can do so in that manner. Some develop an alcohol use disorder marked by the diminished ability to control one’s alcohol use and/or undergo physiological changes in response to the alcohol use.
However, to be clear, the COVID-19 pandemic has not caused alcohol related issues – they have always been here with devastating effects. According to the Centers for Disease Control, alcoholrelated causes are the third leading cause of death in the United States. Health related issues, motor vehicle crashes, suicides and accidents account for thousands of deaths each year.
There are others who may not develop an alcohol use disorder, but who experience binge drinking. The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking alcohol that brings the blood alcohol concentration to 0.08 percent or higher. While not all those that binge drink automatically develop an alcohol use disorder, a consistent pattern of drinking in this manner very well could result in health, legal, interpersonal or economic problems.
Excessive alcohol use and alcoholism are significant contributors to violence and crime. Assaults, homicides, domestic violence, as well as other crimes, can be linked back to excessive alcohol use. It is no secret that the jails and prisons have a significant number of inmates who committed crimes while under the influence of alcohol. Excessive alcohol use over time can create many adverse health effects. High blood pressure, liver disease, heart disease and digestive problems are not uncommon for those with an alcohol use problem. Families are significantly impacted, in some cases for generations, due to the effects of alcohol use disorder and alcoholism. The emotional, physical and psychological toll that alcoholism has on families is enormous.
Again, alcohol-related problems are not new. The consequences of such problems can be disastrous. However, the good news is people can and do get better from an alcohol use disorder. Receiving appropriate treatment and making healthy lifestyle changes is the first step for many in getting better. There is no magic pill or single road for someone to overcome such a problem. Our community has tens of thousands of individuals who have overcome an alcohol use disorder. They are living proof that people can and do get better. There is plenty of help available in Berks County. For those experiencing an alcohol problem and for those living with someone with an alcohol problem, there is always hope.
Alcohol use disorders tremendously impact individuals, families, loved one and the community as a whole. But there are also significant economic impacts. The CDC estimates that alcohol use-related issues costs our society $200 billion annually (that is a two followed by eleven zeros). These costs are related to law enforcement, prisons, and healthcare as well as job-related lost productivity. While alarming, none of this is news. These problems have been with us for decades. What makes alcohol-related problems so insidious is that alcohol use is socially acceptable and, depending 13
FEATURE
Youth Alcohol Use A n Eve r-p rese nt Public Health Challeng e by Anita Miller, Community Prevention Partnership of Berks County
DO YOU KNOW THAT ALCOHOL CONTINUES TO BE THE MOST WIDELY USED SUBSTANCE AMONG YOUTH, ON BOTH A NATIONAL AND LOCAL LEVEL? Statewide, 32.3% of 8th grade students who responded to the 2019 Pennsylvania Youth Survey (PAYS) reported having consumed alcohol. In Berks County, numbers were slightly higher, at 35.1%. For 12th grade PAYS respondents, those figures were nearly doubled, with 63% statewide and 64% for Berks County.
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THE RESPONSE // WINTER 2021
PAYS also asks students about their 30-day use of alcohol. In 2019, 30.4% of Berks County 12th graders and 10.3% of 8th graders reported drinking in the last 30 days. These figures are slightly higher than those reported nationally by Monitoring the Future, which found that 7.9% of 8th grade students and 29.3% of 12th grade students reported consuming alcohol in the past month.
THE TOP THREE SOURCES OF ALCOHOL IDENTIFIED BY BERKS COUNTY YOUTH IN 6TH THROUGH 12TH GRADE IN THE 2019 PENNSYLVANIA YOUTH SURVEY WERE:
Binge drinking, defined as having five or more drinks in a row, remains a key concern, even for students as young as age 13. Again the numbers reported by Monitoring the Future and PAYS were similar. Nationally 14.4% of 12th grade students and 3.8% of 8th grade students reported binge drinking in the last two weeks, compared to 13.3% and 4.3%, respectively, in Berks County.
• PARENTS GAVE IT TO THEIR CHILD
• YOUTH TOOK IT WITHOUT PERMISSION FROM HOME
• OLDER SIBLINGS OR FRIENDS WHO ARE 21 OR OLDER GAVE IT TO THEM
EFFECTIVE STRATEGIES FOR PARENTS When it comes to influencing the behavior of youth, parents remain the most powerful force. Parents can help delay experimentation by talking to their kids early and often about healthy habits and the negative effects of alcohol and other substances. A recommended strategy is to engage kids in a number of short conversations (for example, in the car). Many small talks, with one or two facts at a time over several years, has more impact on values and actions than one long lecture. The Substance Abuse and Mental Health Services Association’s (SAMHSA) “Talk. They Hear You” offers a number of resources to help parents converse with children about the dangers of alcohol and other drugs at (https://www.samhsa.gov/talk-they-hear-you/ parent-resources). SAMHSA suggests the following talking points for parents: • Share personal values and let your kids know you disapprove of underage drinking. • Tell your kids that you care about their health and goals. Explain that alcohol negatively impacts the developing body and brain, which can affect their ability to do what they love and achieve goals. For older youth, discuss legal consequences of underage drinking and how that can affect their ability to drive. • Show them you are a reliable source of truthful information. • Let them know that you pay attention to and care about the things they do. • Help them develop a plan to deal with peer pressure, and role play saying “no thanks.”
PROVIDING ALTERNATIVE ACTIVITIES Providing youth with positive, alternative activities, such as substance-free movie nights and dances, offers a means for them to socialize without attending parties that include alcohol. In Berks County, several school districts offer Fifth Quarter events after evening sporting matches, providing safe spaces at the school or other community location, where students can hang out in a healthy environment. Alternative, substancefree activities are especially important on occasions, like New Year’s Eve, when adults traditionally consume alcohol. Youth need an opportunity to celebrate without the temptation to drink alcohol.
EVIDENCE-BASED PROGRAMS Building on SAMHSA’s research, many evidence-based prevention programs have been developed that have been proven to reduce the prevalence of both underage drinking and other drug use. Two evidence-based programs that are offered by the Council on Chemical Abuse in Berks County include Life Skills Training (LST) and Strengthening Families Program for Parents and Youth 10-14 (SFP). These programs are designed to reduce the peer and family risk factors that lead to youth substance use. LST is a school-based program offered in middle and high school grade levels. SFP is a community-based program with youth, parent, and family sessions offered over seven weeks. SFP has also been successfully adapted to offer as a virtual program where families can be offered the program in their homes. INVOLVING YOUTH IN ALCOHOL PREVENTION It’s important for adults to give youth a voice, and to listen without judgment. Youth are a powerful influence on their peers, and they are not only the “Leaders of Tomorrow,” but the “Leaders of Today.” National groups such as SADD (SADD | Student Organization | Washington, DC) or Aevidum( Aevidum – I’ve got your back) can nurture leadership skills while involving teens in prevention activities. In Berks County, numerous organizations promote youth leadership in prevention, including the Reading School District’s Project Peace, the Olivet Boys and Girls Club’s Berks PRIDE, and the Council on Chemical Abuse’s Teen Prevention Coalition (cocaberks.org). SOCIAL NORMS CAMPAIGN A powerful tool that youth can use is to plan a “social norms campaign” that promotes accurate, healthy norms about alcohol use. A social norm is defined as a pattern of behavior that is accepted as normal. When it comes to alcohol use, many young Continued on page 16
15
FEATURE
COALITIONS USE THE FOLLOWING STRATEGIES TO REACH THAT GOAL: TO AFFECT COMMUNITY CHANGE
• PROVIDE INFORMATION TO YOUTH AND ADULTS • ENHANCE SKILLS OF YOUTH AND OTHER COMMUNITY MEMBERS • PROVIDE SUPPORT • ENHANCE ACCESS/REDUCE BARRIERS TO SERVICES • CHANGE CONSEQUENCES • CHANGE PHYSICAL DESIGN • MODIFY OR CHANGE POLICIES These strategies help limit access to substances, change the culture and context around substance use, and modify the consequences associated with substance use.
people believe that most of their peers drink. The media has long glamorized youth attending parties with copious amounts of alcohol. However, survey data shows that most youth do not share that experience in real life. For example, while one third of Berks 8th grade students have consumed alcohol, two thirds haven’t. Youth can run their own “social norms campaign” to emphasize that drinking is not the norm. We all want to belong, and it can be easier to turn down a drink when teens know most of their peers don’t drink either. MAKING CHANGES LOCALLY The Northeast Community Springboard Coalition, in Reading, mobilizes communities to prevent and reduce substance use among youth. The coalition serves the entire Reading community and works to build and strengthen a network of parents, youth,
• • • •
Data analytics Reporting solutions Program evaluation Consultation
Deerfield Data Management, LLC supports the Berks SOS Community Coalition
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transforming data into knowledge
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THE RESPONSE // WINTER 2021
610-212-6793
www.deerfielddata.com
and organizations to look at local data and identify risk and protective factors. They work to make the community a healthier place by addressing local issues that lead to substance use. At the same time, they promote activities that reduce youth use, such as a drug facts Quiz Bowl with parents vs. their middle school youth. The coalition has also provided information on medication safety in the home, along with medication lock boxes and medication disposal pouches for families.
ADOLESCENT SUBSTANCE USE IN BERKS COUNTY PAST 30-DAY AND LIFETIME SUBSTANCE USE B E R K S CO U N TY 2 0 1 9 P E N N SY LVA N I A YO U T H S U RV E Y
Past 30-DAY AND LIFETIME SUBSTANCE USE BERKS COUNTY 2019 PENNSYLVANIA YOUTH SURVEY Use in the Past Thirty Days
Lifetime Use
15.20%
40.80%
8.80%
15.60%
A LCOHOL
M A RIJ UA N A
1.80% 7.70%
1.30% 4.20%
CIGA RE T T ES
P RES CRIP T ION PA IN RE L IE V E RS
Past 30- Day = 0.10% Life time = 0.30%
HE ROIN
17
HOW TO GET A FREE NARCAN® KIT The Council on Chemical Abuse is able to provide an Opioid Overdose Reversal Kit to all Berks County residents and businesses at no charge. Kits include Narcan® Nasal Spray.
Contact the RISE Center: Call (610) 750-7550 between 8:00 a.m. and 4:00 p.m. Monday through Friday to coordinate a time to pick up your kit.
Complete an online Narcan® training, at home or at the RISE Center: Visit cocaberks.org/getnarcan for more details and links.
Receive your kit: We will review the contents of the kit with you and take the time to ensure you are comfortable using Narcan® in the event of an overdose.
(610) 750-7550 I cocaberks.org/getnarcan
Recovery. Resiliency. Wellness. Community Care, a nonprofit recovery-focused behavioral health managed care organization, manages mental health and substance use disorder services for individuals in Berks County’s HealthChoices program. Our goal is to improve the health and well-being of the communities we serve. We offer substance use disorder services for adults, including: • Withdrawal management • Rehabilitation • Medication-assisted treatment • Certified recovery specialists If you would like more information about services or help with your recovery, call Community Care at 1.866.292.7886.
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THE RESPONSE // WINTER 2021
Dru g s an d t h e
Ad ol es ce n t B r ai n by Alicia Kline, Council on Chemical Abuse
T
he brain remains the most complex and amazing organ in the human body. Responsible for every breath, movement, thought, and action, scientists continue to study the complexities of how the brain develops and functions. Made up of cells called neurons, humans are born with over one hundred billion brain cells that communicate with each other to form connections that allow us to grow cognitively, physically, and mentally. By the age of three, a child’s brain creates over a quadrillion connections and will continue to develop until they reach their mid-twenties. Promoting healthy brain development relies heavily on the way we encourage, protect, and nurture those connections, which begins at the time of conception. Continued on page 20
19
FEATURE
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THE RESPONSE // WINTER 2021
Supporting a mother in a healthy pregnancy provides a positive start in the promotion of the child’s healthy development. In addition to proper nourishment, rest, exercise, and reducing stress, helping mothers stay not only drug free but alcohol free helps protect fetal development. Even a small amount of alcohol can harm a developing fetus. Consuming alcohol while pregnant damages the cells in baby’s brain and spinal cord because the same amount of alcohol passes from the mother’s blood stream to her child’s. Upon delivery, parents and caretakers play a key role in assuring those neurons continue to make healthy connections to protect the brain’s development. Communities also play a part in healthy development by providing parents/caretakers with safe environments and the means to help their children live and grow. Every day parents/caretakers stimulate healthy brain development through attachment and bonding, communication, modeling positive behaviors, and meeting basic needs. This creates children with positive self-images, self-worth, and the ability to make healthy decisions for their lives, including the ability to resist the urge to use drugs and alcohol. Due to the legality of alcohol, we often forget the dangerous effects it causes to the human body, especially the developing brain. Ethanol (drinking alcohol), a neurotoxin, affects the brain causing slurred speech, lack of coordination, blurred vision, delayed reaction times, and memory loss. Neurotoxins are chemicals that harm the way the cells function. While ethanol creates temporary changes to brain functioning, long term exposure or exposure during development can leave permanent neuron destruction. During adolescence, the brain enters a growth spurt where the development of neurons significantly increases. This period of development leaves the adolescent brain vulnerable to long lasting effects to their memory, the ability to learn and make healthy decisions. Furthermore, as neurons create pathways or connections very quickly during this stage, excessive amounts of alcohol during adolescence increases the risk of developing an addiction. Prolonging the onset of alcohol consumption is crucial for creating cognitively and emotionally healthy adults. Unfortunately, for adolescents during this peak development, the last section of the brain to develop is the frontal lobe or the decision-making part of the brain which leaves them prone to risky and impulsive behaviors. Therefore, early prevention by parents/caretakers is important in helping adolescents remain drug free. Supporting children to feel connected or bonded at home, at school and in their communities decreases the chances of early experimentation with drugs and alcohol. By working together in prevention efforts, we can protect adolescent brain development and secure a future with healthy adults and stronger communities. Sources:
Lees B, Meredith LR, Kirkland AE, Bryant BE, Squeglia LM. Effect of alcohol use on the adolescent brain and behavior. Pharmacol Biochem Behav. 2020 May;192:172906. doi: 10.1016/j.pbb.2020.172906. Epub 2020 Mar 13. PMID: 32179028; PMCID: PMC7183385
TRUDGE THE ROAD OF
happy
DESTINY
A
1934 Bill W. checked into Towne’s Hospital in New York City and was separated from alcohol and he remained that way until his death in 1971.
A LITTLE HISTORY In the late fall of 1934, a broken down stock speculator by the name of William “Bill W.” Wilson was paid a visit by an old childhood friend named Edwin “Ebby’’ Thacher. Ebby’s history with Bill was much storied as he and Bill adventured through life as consummate drinking partners. Bill, who at the time of Ebby’s visit, was in the grips of alcoholism, was in poor health and unemployable. Ebby wanted to visit Bill because he had some exciting news that he wanted to share with him. The news that Ebby brought to Bill was that he had, by applying a few simple spiritual principles, found a way to stay sober and live a useful productive life. This news was to change Bill’s life forever. In December of
In the Spring of 1935, Bill was on an important business trip to Akron, Ohio. Had the trip been successful Bill would have been in a position to make quite a sum of money and to procure himself a top executive position. The business trip was a failure and Bill was dejected. Bill knew he needed another alcoholic to talk to. After a series of phone calls Bill was put in contact with an Akron, Ohio surgeon and physician who too suffered from the illness of alcoholism. Not too certain that he wanted to talk, he grudgingly
lcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for A.A. membership; we are self supporting through our own contributions. A.A. is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy, neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety. (Copyright © The AA Grapevine, Inc.)
Bill learned from Ebby that in order to stay sober he would have to carry this message to others. He immediately commenced to do this to no avail. After five months of attempting to sober up others he had no success. Discouraged by his lack of success it was Bill’s wife Lois that pointed out to Bill that although no one else got sober Bill still was. This experience allowed Bill to discover one of the primary building blocks of sobriety: the principle of “carrying the message to the still sick and suffering alcoholic.” This action helped keep Bill sober.
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FEATURE agreed to speak to Bill. They spoke for over five hours and both came to the agreement that they were on to something special. On June 10, 1935 Alcoholics Anonymous was born. MY JOURNEY I grew up in a hardworking, educated professional household. My father had a thriving dental practice in a small steel/military town in South Central Pennsylvania. To say that alcohol was a focal point in family activities would be an understatement. Both my father and mother grew up in large, blue-collar families where drinking alcohol was the norm. I am certain that my childhood environment laid the groundwork for my own drinking career. I had my first negative experience at the age of five, a not so healthy benefit of an alcoholic grandmother. It was not a pleasant experience. I would be remiss if I didn’t talk about how I felt emotionally as a child growing up. I believe from a very young age that there was something amiss in my wellbeing. I never quite felt like I fit in, measured up or was comfortable in my own skin. I have discovered in my journey of recovery that many others I have met along the way felt the same as I did. At the age of fourteen I discovered alcohol in a different way than I had experienced it at the age of five. All the uncomfortability that had plagued me since an early age melted away. I had arrived and life was great. At fourteen, sixteen, eighteen, twenty and twenty-one I got arrested for alcohol-related legal violations. It wasn’t until my last arrest at the age of twenty-one that I was asked an obvious and very simple question; “Do you think you might have a problem with alcohol?” There are times in the life of all people that we experience moments of clarity. The question was asked at the right time, by the right person and I acknowledged, for the first time, that alcohol ruled my life. I was referred to counseling and the walls of denial began to soften. After five weeks of counseling, that my therapist informed me that he believed I needed more than he could offer. He informed me that there existed a local facility that works more intensely with alcoholics. He said to me that this place had an international reputation of being one of the best organizations in the world in helping people overcome alcohol problems. He instructed me to take a week to think about my decision and to let him know what I wanted to do. Another moment of clarity; I told him yes. And in September 1977, I arrived in the admissions’ office of the world-renowned treatment facility “Chit Chat Farms,” Wernersville, PA. It was there that I was introduced to the program of Alcoholics Anonymous. I have not had a drink since September 11, 1977. THE PROGRAM OF ALCOHOLICS ANONYMOUS AA is an experience. It is based on thirty-six spiritual principles: the Twelve Steps, the Twelve Traditions and the Twelve Concepts. Many people are familiar that AA is a Twelve Step program; how-
ever, few really know what they are. To simplify this mystery let me briefly explain. Step one lays out the problem. Steps two and three give us the solution, and the remaining steps; four through twelve; provide the successful program of action needed to live one day at a time that frees the alcoholic from the deadly obsession to drink alcohol. It is important that one also understands that AA is less about not drinking, but more about “right living.” When the program is properly applied to living problems; the recovered alcoholic knows and lives in the solution and drinking as an option disappears. It is a “One Day at a Time” way of living that promises a life of freedom from alcohol and permits the alcoholic a way of living that eliminates the internal “dis-ease” which has plagued them to evaporate. Now the Twelve Traditions were designed to provide unity within the program of AA. They provide guidelines that allow for conformity within the fellowship. The Twelve Concepts were created to allow the Fellowship to live in concert with the world.
On-line meetings now fill the internet making access to AA available twenty-fours hours a day; three-hundred and s i x t y - f i v e d a y s a y e a r. THE FUTURE OF ALCOHOLICS ANONYMOUS For the past seventy-seven years, AA has functioned as a world-wide society with one primary purpose; to carry the message of recovery to the still sick and suffering alcoholic. The Twelve Step model has been so successful that there are now over two-hundred Twelve Step programs addressing a multitude of problems. The future of AA is strong. Bill W. once wrote that AA should never fear change but rather embrace that change which would benefit AA. Over the last several years; AA has embraced the Internet as a vehicle in delivering its life changing message. AA can now be found by anyone with an internet accessible device and an internet connection to meetings offered on a worldwide basis. On-line meetings now fill the internet making access to AA available twenty-four hours a day, three-hundred and sixty-five days a year. Whether it is in person or on-line meeting, AA is strong and as vital as ever. Every AA’er knows that it is their responsibility to secure and adhere to AA’s responsibility pledge which states: “I am responsible. When anyone, anywhere reaches out for help, I want the hand of AA to always be there, and for that, I am responsible.”
(Disclaimer: Although I have been a member of Alcoholics Anonymous for over 44 years, I do not represent or speak for the organization of Alcoholics Anonymous as a whole. The opinions expressed in this article are mine based on my research and experience in the Fellowship of Alcoholics Anonymous.)
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THE RESPONSE // WINTER 2021
Celebrating Life DRUG AND ALCOHOL-FREE
I
by Scott Althouse, Executive Director of Easy Does It, Inc. (EDI)
am a person in long-term recovery, free from the grips of drug and alcohol addiction since 2011. Alcohol used to be my daily companion, accompanying me to every family gathering, holiday, restaurant, sporting event, and other social activities. This addiction eventually consumed me to the point of rock bottom. After repeated efforts to get sober, a higher power intervened in my life and removed the obsession to drink. With the loving support of my family, sponsor, and circle of friends, my journey in recovery has been through the 12 steps. I have learned to love myself and once again enjoy life – drug and alcohol free. Having worked with hundreds of individuals in early recovery, the following are some of the common challenges and suggestions to navigate the holidays and a year of firsts, drug and alcohol-free. Our culture has tied in alcohol use with all types of celebrations from birthdays to holidays to sporting events. In the midst of football season and the holidays, it’s impossible to avoid the constant barrage of alcohol advertising that bombards our homes and devices. Alcohol manufacturers are masters of illusion with their glamourous portrayal of seemingly perfect people enjoying their perfect lives all while drinking alcohol with impunity. But obviously it is not only in the media where we encounter the glorification of alcohol. Alcohol consumption is deeply embedded in our culture, especially with sporting events, holidays, and other celebrations. Unless you have sat in section 217 at Lincoln Financial Field, it’s nearly impossible to attend an Eagles game without having to pass a beer to another fan. And when’s the last time you attended a holiday party or ate at a restaurant that didn’t serve alcohol? Persons in recovery are not immune from the cultural norms that glamorize alcohol use. While it’s certainly true that many people consume and enjoy alcohol responsibly, for persons in recovery it can be challenging to not get resentful, be tempted, or have a fear of missing out. The irony is that quite a few of us were never social drinkers to begin with and our own experience is far from the norm. We call this acceptance; it’s a process that takes time. Continued on page 24
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FEATURE There is a prevalent suggestion that persons in the early recovery journey should avoid people, places, and things that were connected with their drinking. For some people who are very early in their recovery or still struggling with an obsession to drink, it is vitally important to seek out alcohol-free options, especially over the holidays. Increasing attendance at 12-step meetings or other mutual aid groups, attending alcothons, speaker jams, and sober dance parties are great ways to surround yourself with like-minded people who can share their experience, strength, and hope. Church events and sober family functions can also be good options. Similar to the experience of losing a loved one, when a person stops drinking alcohol there is a full year (or longer) of firsts: first concert, first football game, first Thanksgiving, first New Year’s Eve, first birthday party, first date, first new job, the first fill in the blank. In a year of firsts, we are vulnerable. While each of these events can be viewed as a temptation or a trigger, they can also be viewed as an opportunity to grow in our acceptance and grow in our recovery. I have learned through my own experience that it is critical to have a game plan of strategies to navigate these firsts successfully without drinking or getting resentful. Here are some tips that I found useful. Talk with a sponsor, friend, or member in your support group about the event or celebration you are planning to attend. Think it through and examine your purpose and motivation for attending. Go with a supportive friend. Say a prayer. Have an exit strategy and be willing to leave early. Do not isolate or avoid conversation, but rather look for opportunities to engage and contribute to the event or celebration. Easy Does It, Inc. (EDI) values the importance of having fun in recovery and celebrating the freedom that a drug and alcohol-free life brings to individuals. As a recovery community organization (RCO), EDI has a rich history of hosting drug and alcohol-free events for the 50 residents in our recovery housing program and for the recovery community of Berks County. Through holiday dances and parties, to Soberstock, to our New Year’s Eve Gala, and a Super Bowl party, we provide opportunities to have fun in recovery and be happy, joyous, and free. As we grow in our recovery and our acceptance, many of us find ourselves in a position of neutrality when it comes to alcohol and social drinking at sporting events, family gatherings over the holidays, and other celebrations. We are neither tempted nor resentful, we know that drinking alcohol is simply not an option for us and we let others make their own choices. 24
THE RESPONSE // WINTER 2021
IN RECOVERY? – 10 WAYS TO CELEBRATE THE HOLIDAYS WITHOUT ALCOHOL - LUMINOUS COUNSELING If you’re in recovery, here are ten ways to celebrate the holidays without alcohol. 1. GET OUTSIDE! First, why not get outside for the holidays. You don’t have to be a nature-buff and go camping for a week in the mountains (but that’s not a bad idea!). Instead, get together with some friends to go ice skating or hit a few rounds of golf. And of course, if you live in an area that gets snow, there’s always going cross-country skiing or snowshoeing.
2. COOK A MEAL AT HOME Closer to home, why not spend an evening cooking your favorite meal? Invite a friend over to share. Preparing food and sharing with others is certainly another part of the holiday season that sometimes gets overlooked when you’re focused on alcohol.
3. HOST A HEALTH-THEMED POT-LUCK DINNER Speaking of food, you could invite friends and family to a health-themed pot-luck dinner. The idea is that instead of everyone bringing the tired old staples of pot-lucks (chips, casseroles, alcohol), you bring healthy alternatives. For instance, dishes made from clean and organic ingredients.
4. EXERCISE! Working out is healthy and it helps to keep your mind from thinking about the holidays… and the drinking. Plus, it helps to get in a few workouts at the gym to fend off the extra calories from all the food you’re eating. If you already belong to a gym, check to see if they will have a special holiday workout planned.
5. RUN A 5K Okay, maybe running isn’t your thing. That’s alright. But in the interest of trying new things for the holidays, why not sign up for a 5K race? It could be a different way to get out, enjoy the fresh air, get some exercise (see above), and meet new people.
6. VOLUNTEER Of course, there are people who are in need all year long. However, the holidays can be particularly hard. Consider volunteering with a nonprofit or charity in your area that connects with your values. Whether it’s helping the homeless, working at a kitchen that serves hot meals, or even building trails—it’s your choice.
7. ATTEND A HOLIDAY PERFORMANCE Ever thought about attending the theater or seeing a concert during the holidays? Whether it’s a holiday classic like The Nutcracker or seeing your favorite band that happens to be in town, there are plenty of options available. Why not look for one that interests you?
8. CONNECT WITH YOUR SPONSOR If you have a sobriety sponsor as part of a recovery program, make sure to connect with them. Of course, this doesn’t mean connection just when you are in crisis. Why not get together for coffee and just chat? It helps to know that someone out there understands what it means to stay sober during the holidays.
9. THROW AN ALCOHOL-FREE HOLIDAY PARTY One of the best ways to own your sobriety is to be open and frank about it. So, why not host an alcohol-free party yourself? It might be hard putting yourself out there, letting everyone in your social group know that you want to celebrate sober. However, you might be surprised by how willing people can be to not just support you but also attend an event that doesn’t have alcohol.
10. START A NEW TRADITION This could be something that you do yourself or with family and friends. Why not make this year the start of a new tradition that embraces and celebrates not just the holidays but your sobriety too?
behind closed doors alcohol and the covid-19 pandemic
by Erin Deneke, Ph.D., Senior Director of Research, and Olapeju Simoyan, M.D., MPH, BDS, FAAFP, FASAM, Executive Director of Research, Caron Treatment Centers
C
OVID-19 has reshaped the United States over the last 2 years. To date the United States has over 43,289,203 cases of confirmed COVID-19 illness and 694,701 deaths (Center for Disease Control [CDC]). Pennsylvania alone has 1,429,940 cases and experienced 29,400 deaths (John Hopkins Coronavirus Resource Center, 2021). The ever-evolving nature of this virus has led to a constantly shifting approach in the management of this disease. While effective vaccines have been developed and are available for free, only 58% of Pennsylvanians are currently fully vaccinated (John Hopkins Coronavirus Resource Center, 2021). Public health measures have included social distancing, temporary closure of non-essential businesses, stay-at-home orders, mask mandates, and companies implementing vaccine mandates for employees. While the economy is in the process of recovering from the devastating economic blow that COVID dealt, the societal and emotional toll of the pandemic is still being felt. A study conducted by Verdery, Smith-Greenaway, Margolis and Daw (2020) explored kinship networks in the United States and found that one coronavirus death impacts nine surviving family members. This suggests that approximately 6.25 million individuals (to date) have been personally impacted by the death of a loved one due to the pandemic. This does not include impacts on social circles. The impact on mental health was not unexpected. Previous research has demonstrated the impacts of disaster and epidemics on individuals (Bonanno & Gupta, 2012; Boscarino, Galea, Ahern, Resnick,
& Vlahov 2002; Tracy, Norris, Galea, 2011; Vlahov, Galea, Ahern, Rudenstine, Resnick, Kilpatrick & Crum, 2006). The isolation, job losses, and economic stressors due to the pandemic impacted the mental health and well-being of Americans on a large scale. Treatment options were limited for individuals with already pre-existing conditions, both physical and mental, and for individuals with new conditions. Symptoms of anxiety increased from 8.1% in the second quarter of 2019 to 25.5% in June of 2020 and depressive disorders increased from 6.5% to 24.3% (Czeisler, Lane, Petrosky, et. al., 2020). According to a Kaiser Family Foundation poll (Panchal, Kamal, Orgera, Cox, & Garfield, 2020), 53% of respondents reported that their mental health has been impacted by the coronavirus pandemic. Specifically, they reported difficulty sleeping (36%) or eating (32%), and an increase in substance use (including alcohol) (12%). While a great deal of attention has focused on the increase in overdose deaths due to prescription opioid and heroin use over the pandemic, little attention has focused on a more hidden problem, alcohol. So why use the term “hidden”? After all, news programs were showing people with shopping carts full of wine and liquor at the state stores the day before they were closed due to the pandemic and Zoom Happy Hours started appearing between friends and co-workers. According to the Nielsen Company, national sales of alcohol increased 54% during the week ending March 21, 2020, compared to 2019. Early March 2020, Governor Tom Wolf closed Continued on page 26
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FEATURE all wine and spirit stores in the state of Pennsylvania due to the COVID-19 pandemic, while beer distributors were left open as essential businesses since some of the stores often carried additional food items and sundries. This did not receive as much attention and much of the excessive drinking that occurred was behind doors. With the closing of bars and restaurants, those “social outlets” disappeared. Alcohol use increased during the pandemic. A survey conducted in June 2020 found that 13.3% of the respondents reported either having started or increased substance use to cope with the feelings brought on by the COVID-19 pandemic (Czeisler, Lane, Petrosky, et. al., 2020). Barbosa, Cowell, and Dowd (2021) found statistically significant increases in risky drinking behaviors, average drinks per day and binge drinking in April of 2020 after lockdown took effect as compared to February 2020. A poll by the American Psychological Association (2021) found that approximately 23% of adults reported drinking more alcohol to cope with stress and 48% of fathers and 29% of mothers with children under the age of 18 reported drinking more. In older adults (50 and older), 14% reported an increase in alcohol use (Malani, Kullgren, Solway, Fernandez, Singer, & Kirch, 2021). Of those who reported the increase, 49% reported they drank to handle pain, 48% to cope with stress, boredom (46%), and improve mood (38%) (University of Michigan, June/ July 2021). The good news is alcohol use has not increased over the course of the pandemic in adolescents (Miech, Patrick, Keyes, O’Malley, Johnston, 2021). Approximately 7.2% who had an alcohol use disorder received treatment in 2019 (Substance Abuse & Mental Health Data Archive (SAMHDA), National Survey on Drug Use and Health (NSDUH) 2019). Moreover, most individuals with alcohol use disorders (AUDs) are more likely to present with a medical issue related to AUD to a primary health care provider (O’Connor, P. G., Nyquist, J. G., & McLellan, A. T., 2011) than to treatment. Individuals seeking treatment for alcohol use disorders often have co-existing health conditions. Medical conditions in the alcohol use disorder population are higher than in the general population (85.3% vs. 55.3%; p<.001) (Bahorik, A. L., Satre, D. D., Kline-Simon, A. H., Weisner, C.M., and Campbell, C.I., 2017). Common medical conditions in individuals with alcohol use disorders found in this study to occur at higher rates were asthma, chronic obstructive pulmonary disorder (COPD), hypertension, ischemic heart disease, hepatitis C, obesity, diabetes mellitus, and pneumonia (3.3% vs. 1.3%)(Bahorik, A. L., Satre, D. D., Kline-Simon, A. H., Weisner, C.M., and Campbell, C.I., 2017). Individuals with these medical conditions have been shown to have a poorer prognosis when infected with COVID-19. The COVID-19 pandemic led to delayed or unmet care in 32% of U.S. adults and 12% of adults seeking urgent or emergency care (CDC, 2020). In addition, emergency rooms and urgent care facilities experienced a burden not seen before and it was not uncommon for primary health care facilities to move to a telehealth format, limiting healthcare for many individuals. Lack of access to broadband highspeed internet was a huge health disparity during the pandemic, more significantly impacting people of color, older individuals, 26
THE RESPONSE // WINTER 2021
individuals with limited financial means and individuals in rural areas (Lai & Widmar, 2020; DiMaria-Ghalilim Foreshaw Rouse, Coates, et. al., 2021). With all the stressors experienced by individuals and families during the pandemic, those in recovery were at high risk of relapse. Social distancing measures, limiting group sizes, and the closure of churches and other public spaces where meetings were generally held reduced the ability for healthy, supportive social connection which is essential for recovery. This created a perfect storm, increasing the risk of relapse for those in recovery. Twelve-Step support groups moved online which limited availability for individuals who did not have access to the necessary technology. In most cases, outpatient substance use treatment moved to telehealth for treatment with its before-stated limitations. Medication assisted treatment was available to the degree that the doctors’ offices were open. While one study looking at data from 10 disasters showed that problematic drinking increases during disasters, very few go on to develop a postdisaster AUD (North, Ringwalt, Downs, Derzon, & Galvin, 2011). However, in the same study 83% of the individuals either with an existing AUD or in recovery drank (North, Ringwalt, Downs, Derzon, & Galvin, 2011). Unfortunately, we are only beginning to see the consequences of increased alcohol intake during the COVID-19 pandemic. There have been regional reports of increased referrals for severe alcohol-related liver disease in Baltimore (Chen, Ting, Almazan, Chander, Cameron, & Gurakar, 2021), as well as anecdotal information such as that from the University of Southern California (USC) which has experienced a 30% increase in alcohol-related liver disease hospital admissions since March of 2020. USC reported that included not only those who relapsed but those who had no history of AUD (MSNBC News, July 17, 2021). Caron Treatment Center’s inpatient treatment center in Wernersville, PA has seen the percentage of individuals admitted with alcohol as a drug of choice rise from 960 in 2019, to 1183 in 2020 (a 5.37% increase). As of the first week of October 2021, 72.4% of individuals entering treatment reporting alcohol as a drug of choice; a 7.90% increase since 2019 and another 2.4% since 2020. While early data suggests an increase in alcohol-related problems, it will most likely be two or more years before the full impact of the pandemic is known. Sources:
American Psychological Association (2021) Stress in America: One year later, a new wave of pandemic health concerns. March 2021. Bahorik, A. L., Satre, D. D., Kline-Simon, A. H., Weisner, C. M., & Campbell, C. I. (2017). Alcohol, Cannabis, and Opioid Use Disorders, and Disease Burden in an Integrated Health Care System. Journal of addiction medicine, 11(1), 3–9. https:// doi.org/10.1097/ADM.0000000000000260 Barbosa, C., Cowell, A.J., & Dowd, W.N. (2021). Alcohol consumption in response to the COVID-19 pandemic in the United States. Journal of Addiction Medicine, 15(4), 341. doi: 10.1097/ADM.0000000000000767 Bonanno, G. A., & Gupta, S. (2012). Resilience after disaster. In Y. Neria, S. Galea, & F. H. Norris (Eds.), Mental health and disasters (pp. 145–160). Cambridge University Press. Boscarino, J. A., Galea, S., Ahern, J., Resnick, H. S., & Vlahov, D. (2002). Utilization of mental health services following the September 11th terrorist attacks in Manhattan, New York City. International Journal of Emergency Mental Health, Summer 4(3), 143-155.
Center for Disease Control and Prevention (CDC, 2021). https://covid.cdc.gov/ covid-data-tracker/#datatracker-home Accessed 10/1/2021. Center for Disease Control and Prevention (CDC, 2020). Delay or avoidance of medical care because of COVID-19 – Related concerns – United State, June 2020. Morbidity and Mortality Weekly Report (MMWR), Vol. 69 (36); 1250-1257. https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a4.htm Accessed 10/22/2021. Chen, P-H., Ting, P-S., Almazan, E., Chander, G., Cameron, A. & Gurakar, A. (2021). Inter-hospital escalation-of-care referrals for severe alcohol-related liver disease with recent drinking during the COVID-19 pandemic. Alcohol and Alcoholism, 1-6. doi:10.1093/alcalc/agab047. Czeisler, ME, Lane, RI, Petrosky E. et al. (2020) Mental health, substance use, and suicidal ideation during the COVID-19 pandemic – United States. Morbidity and Mortality Weekly, Vol 69(36); 1049-1057. doi: 10.15585/mmwr.mm6932a1. Accessed October 8, 2021 DiMaria-Ghalili, R., Foreshaw Rouse, A., Coates, M., Hathaway, Z., Hirsch, J., Wetzel, S., et. al. (2021). Disrupting disparities in Pennsylvania: Retooling for geographic, rachial and ethnic growth (white paper). AARP Pennsylvania. https:// aarp-states.brightspotcdn.com/6f/b6/ de161f3a4a63a23e811693d90b68/aarp-drexel-pennsylvania-disrupting-disparities-design-0421-final.pdf Johns Hopkins University and Medicine. (2020) Coronavirus Resource Center. Johns Hopkins University and Medicine. https://coronavirus.jhu.edu/region/us/ pennsylvania Accessed October 1, 2021. Lai, J. & Widmar, N.O. (2020). Revisiting the digital divide in the COVID-19 era. Applied Economic Perspectives and Policy, vol 43 (1), 458-464. https://doi. org/10.1002/aepp.13104 Malani, P., Kullgren, J., Solway, E., Fernandez, A., Singer, D., & Kirch, M. (2021). National Poll on Healthy Aging: Alcohol Use Among Older Adults. https://deepblue.lib.umich.edu/bitstream/handle/ 2027.42/167901/0236_NPHA-Alcohol-report-FINAL-06082021.pdf?sequence=4 Accessed 10/21/2021. Miech, R., Patrick, M., Keyes, K., O’Malley, P., Johnston, L. (2021). Adolescent drug use before and during U.S. national COVID-19 social distancing policies. Drug and Alcohol Dependence, 226(1), 1-7. https://doi.org/10.1016/j.drugalcdep.2021.108822
MSNBC News (July 17, 2021). During pandemic, hospitals see rise in alcohol-related liver disease. https://www.nbcnews.com/health/health-news/during-pandemic-hospitals-see-rise-alcohol-related-liver-disease-n1274216 Accessed 10/22/2021. Nielsen Company. Rebalancing the ‘COVID-19 Effect’ on alcohol sales. Published May 7, 2020. Accessed August 27, 2020. https://www.nielsen.com/us/en/insights/ article/2020/rebalancing-the-covid-19-effect-on-alcohol-sales/ Accessed October 12, 2021. North, C., Ringwalt, C.L., Downs, D., Derzon, J., & Galvin, D. (2011). Postdisaster course of alcohol use disorders in systematically studied survivors of 10 disasters. Archive of General Psychiatry, 68(2), 341. O’Connor, P. G., Nyquist, J. G., & McLellan, A. T. (2011). Integrating addiction medicine into graduate medical education in primary care: the time has come. Annals of internal medicine, 154(1), 56-59. doi:10.7326/0003-4819-154-1201101040-00008 Panchal, N., Kamal, R., Orgera, K., Cox, C., Garfield, R., Hamel, L., Muńana, C., & Chidambaram, P. (2021). The implications of COVID-19 for Mental Health and Substance Use. Kaiser Family Foundation. https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/ Accessed October 8, 2021. Substance Abuse & Mental Health Data Archive (SAMHDA), National Survey on Drug Use and Health (NSDUH) 2019). https://www.datafiles.samhsa.gov/ dataset/national-survey-drug-use-and-health-2019-nsduh-2019-ds0001 Accessed 10/22/2019. Tracy, M., Norris, F. H., & Galea, S. (2011). Differences in the determinants of posttraumatic stress disorder and depression after a mass traumatic event. Depression and anxiety, 28(8), 666–675. https://doi.org/10.1002/da.20838 Vlahov, D., Galea, S., Ahern, J., Rudenstine, S., Resnick, H., Kilpatrick, D., & Crum, R. M. (2006). Alcohol drinking problems among New York City residents after the September 11 terrorist attacks. Substance Use & Misuse, 41(9), 12951311. doi: 10.1080/10826080600754900 Verdery, A. M., Smith-Greenaway, E., Margolis, R., & Daw, J. (2020). Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United States. Proceedings of the National Academy of Science of the United States of America. 117(30), 17695-17701. https://doi.org/10.1073/pnas.2007476117
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FEATURE
COMPASSION FATIGUE THE CHALLENGE OF CARING
by The Rev. Dr. Jeremiah Sassaman, D.Min., S.T.M., M.Div., EMT
C
ompassion fatigue is ever present these days. Whether you are reading this as a caregiver, a first responder, or anyone of a million other human vocations that matter, you are tasked with the daily responsibility of giving yourself to the world. Yet, despite the cultural adages and uplifting phrases, there will never be enough compassion to patch everyone up. You may try; but you will fail. You cannot be everything to everyone. I can quote you a bunch of fancy definitions and give you a ton of personal stories. I will not do that though. You already know why you are reading this. You are finding it difficult to care.
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Fatigue is a common enough experience. We get physically tired and mentally exhausted, and yes, we also get emotionally exhausted. Each affects us in different ways. Yet when we are emotionally spent, it can have repercussions on our bodies, minds and spirits. We can overcome physical tiredness with a nap, and mental fatigue with a similar rest. Emotional fatigue is not the same. More so when we are tasked with the role of being compassionate providers for others. It is difficult, day in and day out, to hear the same complaints, treat the same broken people and care for the same stricken souls. We know we are supposed to wish all people well and care about every concern that ails our fellow human beings. Yet, we really hit a wall. We just cannot care anymore for those that continually put themselves into the same situations. Drugs and alcohol, dangerous living, overeating and stupid decisions. We get sick and tired of people needing us, when a few moments of forethought or effort would allow us to just stay in bed at the station, or maybe even at home ourselves. So, what do we do about it? My introduction to being a first responder was very different than that of many. It was in my final year of study in seminary that I decided to become a volunteer with the fire service. The events of September 11th, 2001 drove me to rethink the ways in which I might serve the community as both a newly minted Lutheran pastor, and a willing servant in the emergency services. Serving as a chaplain with the fire service of a small central Pennsylvania town, was my first experience with being a first responder. I had so much to learn. I was excited and ready to change the world. Fast forward twenty years. I have worked with thousands of people, in hundreds of unique and different emotional, spiritual and even physical situations. I have cared as you have cared and wept as you have wept. Life is hard enough when lived for one. To journey alongside so many and take part in their pain and joy, sorrow and celebration, wears a person down. We become exhausted by simply being compassionate. Unlike being burned out, which is another very real danger, compassion fatigue can hit a person swiftly. It does not always exhibit itself in the same ways for every person and can look very different depending upon the nature of the interactions between the one cared for, and the caregiver. Treating a victim of child abuse can have a very different outcome for providers with children of their own, than it might for single providers fresh out of training. Compassion fatigue may hit you differently when you rescue a pet from a burning building than it might when you resuscitate a young victim of drowning. For each provider the reactions, symptoms and treatments may look different, yet the core truths remain the same. We are fatigued. “What does compassion fatigue look like?” you may be asking. Well, as stated above, compassion fatigue may present in many ways. Often, we become irritable, dissatisfied, anxious and disconnected from our own compassionate selves. We can lose touch with who we are as caregivers. Especially if we allow our compassion fatigue to remain untreated. Maybe we find ourselves caring less, overstressed and physically exhausted as well. All these things lead to a decreased ability to successfully care about the very ones we strive to care for. Perhaps, we develop self-disgust and feelings
of worthlessness. Compassion fatigue can affect us physically as can any form of stress, good or bad. The question becomes, “How do we deal with it?”
FOR EACH PROVIDER THE REACTIONS,
Like many things in life, compassion fatigue can be treated. SYMPTOMS AND Awareness is the first step in healing. In a similar manner, TREATMENTS it is also essential to admit we may have a problem. As a fel- MAY LOOK low first responder (a chaplain and EMT), I understand the DIFFERENT, importance of this self-reflection and awareness first- YET THE CORE hand. I, like so many, spent years self-medicating in order TRUTHS REMAIN to fight my fatigue. It was not until I admitted my own THE SAME. problems that I was able to begin healing. After 15 years of sobriety and compassionate caregiving work, I continue to learn, grow and find ways to cope. What I have found though, are several basic things that have made the journey to wellness easier. It may seem obvious, but exercise, proper diet and getting restful sleep all lead to a much more well-balanced self. Seeking out colleagues and caregivers to talk and share experiences is also essential. Even the most quiet and introspective among us are made stronger when we are heard. We are made stronger when someone acknowledges our pain and fatigue. Take plenty of time for family and self. It may not always be easy, yet such self-care can keep you caring for others and serving your neighbors with the energy and drive that called you into compassionate service in the first place.
WE ARE FATIGUED.
Over the past years, much has been written, and much spoken about fatigue among those who are called to care. Some of it is easy to digest, and some of it is too technical for me. I encourage you to look and raise your own level of awareness. Find the ways you may be able to instigate conversation and institute policies that take the challenges of a caregiving vocation seriously. You may serve your community as a first responder wearing any one of a dozen different hats, yet you must always take the time to respond to yourself. May your service by satisfying, your hearts remain open, and your minds continue to grow. May God bless you all.
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Binge Drinking Facts Binge Drinking Facts Binge drinking is the consumption of 4 or more drinks for women or 5 ordrinking more drinks men, per occasion Binge is thefor consumption of 4 or more drinks for women or 5 or more drinks for men, per occasion
Nationally, over 4.2 million youth aged 12Nationally, over 4.2 20 were binge drinkers million youth aged 12in the past month 20 were binge drinkers in the past month
Binge drinking increased in Berks Binge drinking County youth 6th increased in Berks graders between 2015 County youth 6th and 2019 graders between 2015 and 2019
61.9 million people In the U.S., one in four age 21 and older in 61.9 million people women has engaged in In the U.S., one in four the U.S. report binge age 21 and older in binge drinking in the women has engaged in drinking the U.S. reportpast binge month binge drinking in the drinking past month
White youth have the highest binge drinking White youth have the rate (64%), followed by highest binge drinking Hispanic youth (20%) rate (64%), followed by Hispanic youth (20%)
A higher percentage of females (53%) A higher percen ages 12-20 binge of females (53% drink compared to ages 12-20 bin males(47%) drink compared males(47%)
In Berks County, 6.2% More than half of of students in grades 6, Binge drinking is on the underage In Berks County, 6.2% More than half of 8, 10, and 12 reported rise among older adults— youth and young adults of students in grades 6, Binge drinking is on the underage binge drinking in the more than 10 percent of who use alcohol binge 8, 10, and 12 reported rise among older adults— youth and young adults past two weeks older drink binge drinking in theadults ages 65 andmore than 10 percent of who use alcohol binge reported binge drinking past two weeks adults ages 65 and older drink in the past month reported binge drinking in the past month
Sources: 2019 National Survey of Drug Use and Health Sources: 2019 Pennsylvania Youth Survey 2019 National Survey of Drug Use and Health 2019 Pennsylvania Youth Survey
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