Lisa Ganz is the clinical director at Long Island Council on Alcoholism and Drug Dependence (LICADD) serving both Nassau and Suffolk Counties. She opened up about treating substance abuse users in a time when numbers of overdose deaths are skyrocketing.
When I pursued my master’s degree and my license in social work, I decided to specialize in substance use…just because I knew no matter where I went in the world or in the field, substance use would be an issue that impacts all communities, all people—it doesn’t discriminate.
Addiction knows no bounds. It doesn’t target based on demographic. It doesn’t target based on race or gender, where they live or how old they are…[But] the epidemic we are seeing right now is primarily affecting upper middle class white men. The theory is that’s the reason it’s getting so much attention…What took us so long? This crisis was in underserved communities and we didn’t pay attention. Now that it has hit upper middle class white men, people are paying attention.
People may be paying more attention, but the numbers are rising. Long Island eclipsed more than 500 opioid overdoses for the first time this year. Of those deaths, 242 were related to fentanyl. Compare that to 2010, when 223 people died of an opioid overdose, including 18 from fentanyl.
Dollars invested in prevention saves a significant amount of money across the board and yet is not talked about enough. Prevention as an idea can start in kindergarten. The goal is not teaching kindergarteners about oxycodone and heroin. The goal is to talk about what is healthy for our bodies and what’s not healthy for our bodies. What’s a healthy decision and what’s an unhealthy decision? How do we talk to friends in a way that’s nice rather than a way that’s mean? How do we solve problems? How do we identify how we feel? It’s teaching them how to cope with life on life’s terms. People use drugs for a reason. It’s often because they never learned how to manage the primary emotions we experience which aren’t comfortable like anger, sadness, fear.
Not having anyone [to help] until middle school, high school…we are missing that opportunity in many cases to teach people as they are developing how to engage in the world in healthy ways, how to take care of their bodies. That’s a huge piece that we are really trying to integrate in the schools.
A study published in Archives of General Psychiatry found that 42.5 percent of teens between 13 and 18 tried illicit substances. Sixteen percent of the teens could also be identified as drug abusers.
[LICADD is] in more than 90 schools across Long Island everywhere from Elmont to Montauk…Mostly high schools and middle schools, but also elementary schools…Sometimes we do assemblies where schools gather all their students. Sometimes we do health class push-ins where we are in health classes all day and speak to each class. Ideally we are going there multiple times, like once a week, with the same group [when] a school has identified a group that’s at risk and we are doing some kind of psychoeducation (therapeutic intervention to provide information and education), emotional regulation…These schools reach out to us and we also reach out and let schools know we are here and these are the things we can do to help…More schools than ever before are starting to get on board with this.
And then it’s really important that we invest in recovery support. You’ll see that with THRIVE (a recovery center opened in March helping individuals and families focus on maintaining recovery through various methods like peer-based support), making sure that when people engage in the process of recovery that they stay in that process.
One of the most difficult things right now is that the volume of people struggling is more than the beds that are available. The number of people struggling without insurance is significant and the number of people struggling with insurance that won’t pay for their treatment is significant. The hardest part of my job and LICADD’s job used to be motivating and engaging people to engage in a treatment process; to believe that recovery is a thing they can actually achieve. Now our biggest barrier is…not only getting them a bed but finding them a treatment center where they can stay a minimum of 28 days; it’s almost unheard of at this point. Part of LICADD’s role is to help individuals and families navigate the system but…it’s very frustrating. You have someone sitting in front of you saying, “Any suggestion you have, I’ll take it. I’ll go to treatment, I’ll go anywhere.” And I got insurance saying, “We won’t pay for it,” or there’s a two-week wait before they could get in anywhere.
There’s no cookie-cutter answer. What we do know is neurologically it takes about a year before the brain, like our physical being, develops its natural homeostasis again…First we are looking at detox because you have to physically be OK enough to start figuring out what’s going on…Inpatient works when the person needs to be removed from their current environment and put in a more structured environment where they are constantly supported 24 hours a day and all they have to do is focus on the treatment and their recovery. The next step after that is learning how to reintegrate back into a community. You can’t live in inpatient forever, it’s not realistic. The ideal would be inpatient and then outpatient in a supportive environment whether that’s a sober home in outpatient or a supportive home environment in outpatient.
President Donald Trump’s new health care bill could make things worse since it pushes back protection for those with pre-existing conditions. Drug or alcohol abuse was a “declinable condition” before the Affordable Care Act, according to the Kaiser Family Foundation.
We need leadership from the top. We had a great leader all this time, Michael Botticelli (served as the director of the White House Office of National Drug Control Policy from March 2014 to the end of President Barack Obama’s second term). Things moved and things changed. The message that sends is that this isn’t a priority at the federal level…States and counties and all our local governments need that guidance and need that push from the top because it speaks to our country’s dedication in addressing this epidemic. It is certainly concerning.