President Trump declared we have the worst opiate crisis in U.S. history but, as the Tribune reported on October 29, there have been other opiate crises, including when the Vietnam veterans returned.
Their demand for heroin prompted the federal government to fund the National Institute on Drug Abuse (NIDA) to research ways to treat and prevent drug abuse. What we have now is more of a crisis of opiate overdoses. This is caused mainly by more potent opiates such as car-fentanyl and other fentanyl variants being imported from Chinese labs by mail. These drugs are more potent than heroin and potentially lethal.
Why do more people want opiates and other pain killers? It is true that many have become addicted when they were prescribed pain killers. Most do not continue, but some do keep requesting opiates. Why?
As the former SAMHSA Center for Substance Abuse Prevention (CSAP) Director during the Clinton Administration and a NIDA prevention researcher, I felt it my duty to bring scientific research to Washington on causes and cures of addiction. Addicts have environmentally induced and/or inherited genetic risks, including neurotransmitter imbalances.
When I first started in addictions treatment, I was told by older psychiatrists that addictions were “a family disease.” Those with a family history of early onset (before 15 years) were likely to have genetic risks.
Recent research finds that some genetic factors result in depression/anxiety and desire for fast-acting carbohydrates, such as sugar and alcohol, that increase serotonin. Other genetic factors can lead to a craving for uppers, such as methamphetamine and cocaine. However, addiction is also a disease of lifestyle. Exercise and contact comfort increase endorphins — the body’s natural pain-killer.
My own causal research using statistical modeling (SEM) conducted in Utah and CSAP using 12,000 adolescents suggested that the primary pathways to drug use were through the family, not the schools or communities. Family attachment, parental supervision and monitoring and communication of positive family values and expectations were the strongest protective pathway. Girls were more impacted by family breakdown.
In the mid 1990s, nationally we had an 800 percent increase in opiates and a 200 percent increase in marijuana use in adolescents. A real drug crisis. The major reason for the sudden increase in drug use in the mid-90’s was girls’ increased use — a Virginia Slims Effect. Girls were free to be more like boys in substance abuse and delinquency.
I shared my research with the federal drug czar, Gen. Barry McCaffrey. He became aware he was spending his $200 million for media campaigns focusing on the wrong target — teens and not parents. With his media experts, we crafted “Parents the Anti-drug campaign” to replace “Your Brain on Drugs,” which was not working. I shared this research with congressional staffers who crafted legislation to fund 150 communities nationwide to implement one of the 35 evidence-based family interventions. With increased funding for prevention at CSAP we created NREPP — the National Registry of Effective Programs and Practices to let agencies and states use their federal block grant funds on drug prevention that actually worked.
Over the next 10 years, substance use in adolescents decreased with this focus on family-based and evidence-based prevention. Unfortunately, once I returned to the University of Utah, the Bush administration killed funding for my family programs and adolescent substance abuse increased. With more addicts needing treatment, funding was pulled from prevention to fund treatment.
Now Trump wants an effective media campaign targeting youth, but better he adopt the Utah Parents Empowered media campaign (www. parentsempowered.org). Doug Murikami’s article in Nov. 11 Tribune says it was funded by our Utah state Legislature in 2012 with a tax on alcohol.
Trump doesn’t have to spend millions creating a new campaign, but find ways to use the Utah media campaign and promote it nationwide. Also helpful is increased funding for prevention that actually works, such as family interventions. The PBS series on addiction mentioned student-focused Life Skills as the most effective. However, Oxford’s Cochrane Reviews find Utah’s Strengthening Families Program, now in 36 countries, is the most effective. Even children of drug addicts have better developmental outcomes because of improved child and parenting skills.
Karol L. Kumpfer, Ph.D., is a psychologist and professor emeritus at the University of Utah who specializes in dissemination of evidence-based family strengthening interventions. She developed, trains and evaluates the Strengthening Families Program worldwide.