As we wrap up the final section of entries to receive an ‘Honorable Mention’ in our launch of the ‘Making an Impact Scholarship,’ the last three essays present valuable perspectives on substance abuse and treatment worth sharing. The way current students address the addiction crisis will help seed the changes we need to see for coming generations.

With a stirring final essay in long form, we hope to share the writer’s message of hope and close out the amazing response with an equally compelling essay. And, again, to all the students from across the country who took the time to address this important issue, we thank you from the bottom of our hearts.

You are all truly the answer to ‘Making an Impact,’ through your words and dedication to the cause of helping others recover from addiction: as students address the addiction crisis in different ways across the country, we applaud your outstanding efforts and wish you the best in your lives and studies.

1. E.R. (Oregon State University)

I believe substance abuse disorder rates could be drastically reduced through compassionate policy changes and expanded access to health care, universal basic income, and emerging therapies such as Iboga.

My brother suffers from severe bi-polar disorder and often turned to drugs to “self-medicate.” I have spent many hours pondering addiction and struggled with it myself in my twenties.

Addictions Are Not Proud

I came to this singular conclusion, “addictions are not proud.” It is important to remember that addiction occurs when people are vulnerable to it—whether that be through lack of emotional support, a hormonal imbalance, mental instability, social pressure, or a myriad of other reasons. It is rare that addiction plagues those with stable lives and fully met needs.

Therefore, it is key to treat the cause rather than the symptom— which is exactly what I intend to do as a Psychology graduate. For people to receive access to medical care, it is critical to create and implement a compassionate universal health care system accessible to all.

Reducing Poverty and a Universal Basic Income

Poverty is a major risk factor in addiction as it leads to negative emotional states, lack of access to support, and greater desire for escapism. Universal basic income has been studied and proven to be negatively correlated with drug, tobacco, and alcohol spending.

This means that universal basic income allows people to achieve upward mobility in life, thus reducing addiction rates overall. By changing laws, we can save more lives. Decriminalization of drugs has proved effective in lowering addiction rates, as exemplified by Portugal.

When addicts are no longer labeled as criminals, they can more safely access recovery assistance, use safe injection sites when they become available, and funds can be reallocated from incarceration into rehabilitation.

Students Address the Addiction Crisis: Alternative Treatments

The next legal step would be to allow for psychologists and doctors to explore the use of emerging therapies such as ibogaine, psilocybin, and ayahuasca. Current research into Iboga offers incredible promise, particularly for sufferers of opioid addictions, which are traditionally extraordinarily challenging to treat. The National Institute on Drug Abuse has recently partnered with Delix Therapuetics to research an ibogaine analogue to specifically be used in the treatment of addiction, certainly a step in the right direction!

By educating the public on these therapies, working to change their legality, providing support for mental and physical health, and by creating a means out of poverty through universal basic income, I see much promise in the future of addiction treatment

2. A.G.R. (Truckee Meadows Community College, Nevada)

I am not going to waste my word count debating the root causes of drug addiction or explaining how the various anti-drug programs that are in place fall short of keeping the community in a state of sober well being.

The bottom line is that drug abuse and drug addiction are sweeping up people in every town across the nation because the preventative efforts taken thus far are not working. I have no medical degree -or any degree for that matter- but what follows are the solutions that I believe would have kept myself, my intimate family, and countless others from drug addiction in America.

A Five-Fold Approach to Public Health

My first of five ideas is to improve the public’s general welfare by promoting civicism, community, recreation, and the arts. Drug usage is too often a hobby and social event for users (in addition to being an escape and a necessity) so, the American people need something else to do and people to do it with, especially as this pandemic is coming to a close.

I figure that if schools had more clubs and activities, cities had more parks and pools, that if museums sprouted up here and there, and good jobs were in plenty with minimal working hours, then people could feel more connected to one another and their surroundings and would enjoy reality enough to not search out ways to escape it. Intellectualism and old American pastimes need to be reinvigorated.

Further Efforts to Reduce Addiction

Ideas number two and three are less creative, but could be just as impactful in achieving our goal. Doctors over-prescribe medications of all kinds, and sometimes it is because they are incentivized to do so. Either way, scarcely do these same doctors develop treatment plans to wean their patients off the medication. This creates habitual users of sleep aids, muscle relaxers, antidepressants, pain-killers, etc., with no expected end to their usage.

Doctors neglect their duty to cure by creating life-long prescribed users or by creating a craving that patients did not originally have. These users end up in safe haven rehabs, but are then abruptly sent back into the harsh world. The medical field needs a wrap-around treatment for long term outpatient care that is similar to parole. I know the audience of this essay is well informed on this issue so I will cease here.

Personal Ways Students Address the Addiction Crisis

My fourth idea is simple: any and all anti-drug advertisements need to be more personalized. Graphs, charts, and brain x-ray commercials seem grossly impersonal and hypothetical. These advertisements miss their audience, but they can be reached by hearing from real people and the sufferings they have personally faced and aim to prevent.

Idea five is about legalization of illicit drugs. This would counter-intuitively reduce accessibility to street drugs by bottlenecking them through harsh informative regulation. Legalizing illicit drugs destroys the street illicit drug market.

These ideas are in brief and somewhat idealistic, but they would have helped me have other purposes in life than getting high and would have given me the proper support system I craved.

3. J.J. (Pierce Community, transferring to Western Oregon University, Fall 2022)

The Opioid Crisis: The End Is Near

When I was in high school, I had tried to start a club called STAND, it stood for Students Taking Action, Not Drugs and I basically got bullied into never starting said club.

However, it’s rather ironic, and almost comical, to think that the girl in high school who tried to start an anti-drug club would go on to struggle with heroin addiction for almost eight years.

Even though I never started STAND, I still never did drugs in high school, I never smoked marijuana or drank or even smoked cigarettes.

The Many Paths to Addiction

So, you might be wondering how I did end up an addict for close to a decade and the reason is embarrassingly young and dumb, that reason being a guy. That’s right, I liked this guy and he asked if I wanted to try smoking a Percocet 30 and I said okay because I wanted him to like me. While we did go on to date for five years, those five years were also my plunge into addiction.

Luckily, after almost eight years of active addiction I was able to find my reason to want to get and stay sober but, I know my recovery could not be possible without my monthly Vivitrol shot injections.

There are tons of resources to help addicts to get clean and sustain absence because every addict is different and each person’s treatment plan must be different to ensure the highest chance of success.

However, even when I was actively using I remember other addicts telling me I should go to this or that treatment facility so that they can prescribe you Suboxone strips and then trading those Suboxone strips to their dude for dope instead, at about two points (0.2g) per strip, basically, they sometimes use the addiction treatment medication to barter for drugs instead.

The Risks of Medication Assisted Treatment

I always found it strange that treatment facilities really treat opioid addicts with things like suboxone and methadone, which just give the person a more controlled/prescription high instead but, they’re still getting high off opiates.

While I was in active addiction, I was in Pierce County jail for a couple of days and while I was in there a woman told me she had been in the jail for the past three months and was still withdrawing from methadone because when you’re in jail you can’t get even prescription methadone, they only allow pregnant women to be given Subutex by the jail medical staff.

When I detoxed off heroin the withdrawal symptoms were completely gone after seven days and this lady was still withdrawing three months later from her prescribed medication used to treat her opioid addiction?

Effective Forms of Medication Management

Something about that has never sat right with me. Why would doctors continue to prescribe these kinds of medications to new patients? Especially now with so many other options available like naltrexone or more commonly known as Vivitrol, which don’t mime the effects of opiates but instead actively block the opioid receptors in the brain (see figure 1).

Basically, even if someone on Vivitrol decided they wanted to try to get high they could use all the opiates on earth and they would never actually feel high because the Vivitrol is blocking those receptors but, this can be dangerous, since if relapse does occur someone might keep trying to get high by using more and more which would eventually lead to an overdose.

Most of the people reading this paper have probably never personally struggled with addiction, and don’t worry you’re really not missing much, but you can see from my example that sometimes the people you least expect somehow get sucked into the darkness of addiction and they don’t all make it out…

The Growing Reach of Opiate Addictions in America

So, while I genuinely hope that no one reading this ever has to struggle with their own addiction, it is still important to research and study and answer questions like these because opiate addiction is an ever-growing problem not only in the United States but also in other major parts of the world. You might think of run-down trap houses, third-world countries, and homeless encampments when you think of addicts but addiction wouldn’t be such a big problem if it was only amongst the poor.

The reason addiction has become such a large issue is because some of those now homeless addicts used to be multi-million dollar business owners who spent every penny they had on dope until there was nothing left. While not every addict starts off as filthy rich, most usually have decent jobs before their addiction takes over, addiction really can happen to anyone no matter your social status or how much you have in the bank.

Addiction Can Happen to Anyone

If you had asked me my senior year, in 2012, if I ever thought I might be an addict I would’ve laughed in your face. I never, ever thought I would be someone to fall into addiction but, I hope my example can show some people that addiction really could affect their life or the life of their loved one and that this should be a subject matter more people are talking about.

How OUD Medications work in the Brain

Figure 1 (Medication-Assisted treatment improves outcomes for patients with opioid use disorder)

Welcome to Recovery

Experts across the board, and even addicts, agree that someone cannot get or stay clean unless they want to do so. While there is no magical medication that can just make addiction disappear, there are many different medications used in helping opioid addicts and alcoholics stay the course and succeed in long-term absence.

Different options work better for different people, however, as a recovered addict one thing I never understood was why doctors would have people on agonist medications, such as methadone, that make them feel similar effects to their drug of choice and even longer and worse withdrawals (Gossop, 1991).

Now with several opioid antagonists, like naltrexone, available in different forms doctor’s should be aiming to only prescribe new patients antagonists instead of agonists. Instead of mimicking the effects of the drug inside the brain like agonists do, antagonists do the exact opposite and bind to the receptors and effectively block them, because these antagonists are much less likely to become drugs of abuse and they do not result in sustained physical dependence (Kalmoe, 2020).

If you personally have never had the misfortune of dealing with addiction, consider yourself lucky because more than 760,000 people have died since 1999 of a drug overdose and in 2018 two out of three drug overdose deaths involved an opiate (DCD). There is already some evidence that Medication Assisted Treatment, or MAT, has drastically reduced the number of opiate related deaths (see figure 2).

Mat Reduces Heroin OD Deaths

The Phase-Out

The main reason I feel we should try to phase out the use of agonist medications is because not only do they just replace the street opiate with another drug that induces acute similar effects but, these drugs that replace the opiates are just as often abused as the opiates themselves.

Whereas antagonist medications block the opioid receptors in the brain, the opioid antagonist naltrexone is also proposed to have an “anti-craving” effect as well and while the neurobiology is complex it appears that naltrexone does this “by reducing brain reactivity to drug cues in the medial orbitofrontal cortex and in the nucleus accumbens” (Kalmoe, 2020).

Like many others I realize it’s not possible to just stop treating those on agonists and, since these agonists are similar to opiates, in order to switch to antagonists patients would first have to detox from those agonists, which ones like methadone have been found to cause more severe withdrawal symptoms in the detoxification phase, up to day 13, and even into the recovery phase when compared to heroin (Gossop, 1991).

Increasing Availability of Effective Medications

Experiencing severe withdrawal symptoms could cause some patients to relapse and that is the opposite of what the goal is but, since more antagonists – like naltrexone – are now more readily available I believe physicians at rehab facilities and treatment centers should offer addicts antagonists first.

If an addict is already at a rehab facility or treatment center, then they are usually open to help and I know personally, it would have saved me a few years if antagonists had been more readily available or talked to me about sooner.

Like many other addicts I tried rehab many, many times before I finally stayed clean for an extended period of time and the only reason, I have been able to stay clean for this extended period of time is because of my monthly depot injection of naltrexone.

I want more addicts and more people in general to know about these antagonists because there are countless benefits they have over agonists and maybe more people will find that pharmacotherapies involving antagonists are the change they needed in order to sustain long term absence, the same way I did. The opioid crisis is only getting worse and this may not seem like very much but, more people finding sobriety with antagonists may just be the factor that helps end the opioid crisis.

Conclusion: Is the End Near?

I hope I was able to give some readers a glimpse into addiction from a personal aspect they might not otherwise know. While I’m far from proud of the long time I wasted as an addict, I do feel that the experience humbled me. I realize that it’s equally as important to help those around you do better, as it is to ensure that you yourself do better.

Ever since I got clean, I have jokingly called myself the Vivitrol spokesperson or walking billboard because I literally tell every person I know that is still actively using. It’s even more important to tell more addicts because the Vivitrol shot is covered by Washington State health insurance now, so it doesn’t cost anything.

If someone is ready to get clean, they can easily make it through eight or ten days of detox before they can get the Vivitrol shot. Once you get the shot it’s truly amazing how antagonists work and, like magic, just make any cravings go away like they weren’t ever there, which is good because after the detox phase, addicts no longer suffer from withdrawal symptoms but cravings still pose a high risk for relapse. Plus, the fact that antagonist medications also block the patient’s ability to get high on opiates is also very helpful in sustaining absence.

Maintaining Abstinence From Addictive Behaviors

I believe if enough addicts are able to sustain absence, with antagonist medications or whatever works for them, then we might actually have a shot at ending the opioid crisis. The war on drugs has been ongoing in America since the 1980’s but the opioid crisis began in the 1990’s with prescription pills such as Percocet and saw another wave begin in 2010 with a rapid increase in overdose deaths involving heroin. I believe antagonist medications can help bring the opioid crisis under control, since it may never be possible to completely end the opioid crisis.

The next best thing we can do would be to at least have it more under control so that there are significantly less deaths related to opioids. I know I speak for anyone who’s struggled with opioid addiction when I say, we need to at least get this crisis under control because I’m tired of having people I know, and my friends die as the casualties.