Jessica Nickel on using a holistic approach for better outcomes when treating addiction~
“When we stop playing whack-a-mole, have everyone together, and look at this as a disease space, an illness that requires us to follow the science and make advancements, and treat our patients in a more holistic way, I think we’ll have better outcomes.
Jessica Nickel: We lose a 174 people a day to drug overdoses. That’s like a plane crash every day.
Brian Wilson: Jessica Nickel is the President and CEO of Addiction Policy Forum. From the earliest years of her life she’s been impacted by drug abuse and has made it her mission to advocate for the families of those who have had the same experience. Her refreshingly candid approach to public policy and the science of addiction has put her in the spotlight – a position she hopes to use to bring families together and carve a new pathway forward on how we view addiction.
We Need Access to Information to Learn to Separate the Disease of Addiction from the Person
Jessica Nickel: I remember my first show and tell in kindergarten class. I went to Mrs. Dean and I wanted to talk about why people shouldn’t use heroin, because my parents struggled with the heroin use disorder. My early years meant homelessness, and foster care, and hunger, and lot of instability. Then my mom went to prison as a result of her heroin use disorder when I was four. I spent some time with my maternal grandparents.
Then at eight, permanently went to live with my grandparents, as my parents’ health issues worsened. Because as a disease like any other disease, it gets worse over time if we don’t intervene with the right healthcare interventions and the right treatment, and medications, and support. My grandma was very progressive even before we had all of our fancy brain scans and the evidence of this as being a brain disorder. She always used to tell me, “Jessica Marie, you hate that disease, but love your mama.”
Brian Wilson: Yeah, and that’s a hard thing to do when you’re that young, isn’t it?
Jessica Nickel: It’s a hard thing for all of us to separate. Addiction is a brain disease that impacts some really important parts of your brain including your limbic system, which is our survival hard wiring. You have changed behaviors, and changed priorities. For all of us to understand how people that are close to us can feel and seem so different from the person that we know to really take that into account for some changes in the brain that can be treated and reversed is a new way of thinking about this and all of us whether it’s family members, or healthcare professionals, or folks in criminal justice, we all need to have access to that information to have more empathy for the things that are happening to our patients.
Brian Wilson: So then you started Addiction Policy Forum. Why?
Jessica Nickel on Why She Started the Addiction Policy Forum
Jessica Nickel: I felt like I was frustrated. I was frustrated for over 20 years working in this field or being involved in different ways. It felt like we were at the same yard line, like we’re literally sitting at yard two with an entire field in front of us that we are not advancing down. We have a tendency to focus on one drug over the others and that’s not how you should be approaching this. We need to focus on substance use disorders, not methamphetamines or opioids, or alcohol, and marijuana.
We need to look at this as an illness and make sure that the systems that we put in place can respond to any addiction and to all the substances, because they change our foundations on following the science and treating this like a health condition shouldn’t. So, I was frustrated about that. Frustrated that we tend to play whack-a-mole with the type of response. So, this decade its prevention is super sexy and fancy. Then it’s recovery, and then it’s treatment.
The reality is that we need to have all of the components at the same table to build a comprehensive response, and we shouldn’t eliminate anyone. There is no magic silver bullet. There is no one program or one response that is going to change the face of how we address addiction. It is by us all coming together at the same table that we make this the table that’s going to work that isn’t missing some of the key legs.
We get really focused on, oh that we’re working on a prescription drug epidemic and then it’s the opioid epidemic, or methamphetamine use disorder, and we play whack-a-mole. So, we focus just on that one piece, but it’s going to pop-up someplace else, because the drugs change over time, and we get lured into focusing on just one, because it’s in the news, it’s what is prevalent at the time for a variety of reasons, whether it’s availability, use patterns change. That can harm how we look at this, because while we’re focusing on that one upright corner, we’re like, “Oh, this is the issue,” whether that’s the drug du jour, the drug of the day, or the response of the day.
If you over focus on one of the elements to a comprehensive response and you don’t pay attention to all of them, you’re not going to have a robust system in place to really be able to handle this, because addiction is complicated. It’s a disease, but it’s technically called a disorder, because it’s complicated. It starts in different ways. Some people have genetic predispositions, others don’t. We have lots of substances of misuse and substance use disorders. We have lots of people at the table that have to be present to make sure that we have the right response. When we stop playing whack-a-mole, have everyone together, and look at this as a disease space, an illness that requires us to follow the science and make advancements, and treat our patients in a more holistic way, I think we’ll have better outcomes.
Brian Wilson: Jessica, give me your definition of addiction.
What is Addiction?
Jessica Nickel: Addiction is the severest form of a substance use disorder. The DSM-5 are psychiatrist breakdown, substance use disorder like stages of cancer, but there’s levels of severity. You have mild, moderate, and severe. A severe substance use disorder is an addiction. We need to make sure that we start fundamentally changing this pattern, so we are intervening when you have a mild substance use disorder or a moderate substance use disorder instead of this – a myth that exist in our culture where, “I’ll just wait for that mythical rock bottom when someone gets to the point where they’re going to be ready for treatment or something is going to happen in their lives, so they’re going to turn to this and be done with it.
It needs to be loved ones’ support systems wrapping up someone who is developing a substance use disorder who has misuse, you’re seeing signs and symptoms of an addiction, so we can stop that before it progresses and gets to the most severe level.
Brian Wilson: You know it strikes me that you’ve been through so much especially as a child. How are you able to overcome that and do something positive instead?
How Jessica Nickel Has Overcome the Risks of Addiction and Moved in a Positive Direction
Jessica Nickel: I’m glad you asked that question, because it’s science. I had a number of tricky pieces to this, and lots of risk factors. We talk about looking at someone’s risk for developing a substance use disorder that’s like a triangle, like a spear. Some of the spear is generic predisposition. I have that, obviously. There’s four generations of substance use disorder before me in my family. Then you have individual factors and you have environmental factors. The things that we can plus up that we can protect the factors to counterbalance the risks that we each have in developing a substance use disorder.
On the individual side, it’s so important to have things like clear expectations among your caregivers to have positive relationships with adults, to have mental healthcare, the things that you need. One of the biggest individual factors that we don’t talk about is delaying the onset of first use. Prevention is really about delaying the onset of first use. Kid brains are amazing in developing, and they don’t fully mature until they’re in their 20s. As much as you can push back alcohol, marijuana, tobacco, and other use, the more time that you have to protect that brain and make sure that person is safe from addiction. I did not drink alcohol till I turned 21, because I have a genetic predisposition.
My grandma was really clear about the expectations in the family. I had court ordered mental health therapy. I had a mentor through the Big Brothers and Big Sisters Program. I was involved and attached to things that were positive for me. We call that, “Attachment in pro-social engagement,” the feeling of belonging. I had all those things that if you think of this as a teeter-totter, I had a lot of risks and a lot of things going against me coming into this world. Homeless, foster care, high “ACES” score – that’s adverse childhood events – some early childhood trauma, lots of instability.
That teeter-totter got rebalanced and you’ve been put in the other direction over time by the positive things that happened through the systems that were involved in my care, in foster care to the courts, to my grandparents who raised me, to making sure that those items were added to my teeter-totter.
Announcer: You’re listening to Opioids: Hidden Dangers, New Hope. More when we return.
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Brian Wilson: Tell me about something that you’ve created called, “174aDay” campaign.
Jessica Nickel: So the 174aDay campaign is an awareness campaign to make sure that we’re remembering all of the families and loved ones that are at the epicenter of this epidemic. We lose a 174 people a day to drug overdoses. That’s like a plane crash every day, and these are real people, real sons, and daughters, and moms, and dads, and sisters, and brothers, and neighbors, and spouses that we are losing to an entirely preventable and treatable illness.
When we started this campaign, it was 129 a day, and then it was 144 a day, and now it’s 174 a day. Sadly, when our new CDC data comes out, it’ll be another larger number that is hard to. . .As a family member, that’s hard. We’re losing way too many people to this illness and we can do better. We try to remember the families and make sure that their stories, that this can happen to anyone. Addiction impacts families in every corner of this country from every walks of life. We need to make sure that we are being compassionate and find empathy, and raise awareness so people are coming out of the shadows to ask for help sooner rather than later.
I always talk about my frustration that when other health crisis or things happened to your neighbors, you’re bringing over trays of cookies and casserole dishes, and wrapping them up. Where’s our casserole dishes for those of us who are struggling with addiction? There’s still so much stigma around this disease. 174 A Day is about remembering the real people and families that are feeling the losses because of this illness.
Brian Wilson: Jessica, as an individual, you’ve been through a lot. As an advocate, you see a lot. How do you keep going even as this crisis continues?
Jessica and Others at the Addiction Policy Forum Turn Grief into Rocket Fuel to Keep Going
Jessica Nickel: For those of us that have lost someone and do this work as a way to manage the grief or a way to direct that difficulty, one of our staff, our team members says that, all of the families at Addiction Policy Forum, we take our grief and turn it into rocket fuel. This is what powers us to work hard and to move fast. We move with thoughtful urgency to try to help other families so they don’t go through what we’ve gone through.
The other part of this though is that advocating on Capitol Hill, or building programs, or working does not replace self-care. For those of us that are experiencing grief, that have active use disorder, that loves someone who’s in recovery or has active substance use disorder, we need to make sure that we take the time to take care of ourselves. One does not replace the other, so
that’s something that we really focus on within our entire team both volunteers and staff at Addiction Policy Forum.
I have the best job in the world in many ways. That is a little bit of where my care and watering comes from is just the people I get to work with every day. Then the other part is I’ve lost a lot of people to this illness. I lost 11 people that I love.
My family is wiped out at this point. We’ve lost for folks way too early, both of my parents, my grandparents, aunts and uncles, but I get to do things that I know would make my grandma, my mom proud. So, it’s like my love note I get to write every day.
Brian Wilson: So many addictions start in the home medicine cabinet. Give me your thoughts on that.
Clean Out Your Medicine Cabinets
Jessica Nickel: We need to make sure we’re starting with our own medicine cabinets. Opioids left unattended can be a risk for our family, our children, adolescence, other even visitors or neighbors, or an open house for when you’re selling your house can be a risk point there of this entering into the wrong hands. Making sure that we make it easy for families to understand that there’s risks with this, that we need to dispose of prescriptions when we don’t use them all up. We tend to be hoarders in this coun. . . We are hoarders. We’re like, “Oh, that antibiotic from 2012, I might need that someday so I’m just going to hold onto that thing.”
If you need an antibiotic or you need a prescription pain killer for some illness, go back to your doctor and get another prescription. We need to make sure that we are removing these items from our medicine cabinets, because they’re more likely to fall into the wrong hands, and it’s just much safer. It’s also a teachable moment to have a reminder to talk to your children, to talk to your family, talk to your parents even about the risks of opioids and make sure that we are being aware and cognizant of the risks that they present.
Brian Wilson: Thank you so much, Jessica.
Jessica Nickel: Yeah, thanks for having me.
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