In Your Corner - Alameda County Young Adult Opioid Initiative

The stigma of substance use disorders and particularly opioid use disorders (OUD) is significant. More than three-quarters of respondents in a 2016 national survey reported viewing individuals with OUD as to blame for their substance use. Stigma is a major barrier to help-seeking, according to 2019 estimates, less than 35 percent of adults with OUD had received treatment for opioid use in the past year and the delay between disease onset and initial treatment receipt has been estimated to be, on average, in the range of four to seven years. Further, research has found that stigma can negatively influence health care provider perception of substance use disorders, which can impact the care that they provide. The findings of our local research for this project echoed this as fear of the consequences, stigma, lack of trust and understanding from adults were all things young adults in extended foster care reported prevented them from seeking help.

“I feel like society really frowns on people for substance abuse, people have a negative view on others with mental illnesses. They are just mean to people like that and it’s just difficult to exist in a society when everyone thinks you are a bad person”
- Alameda County, Young Adult in Extended Foster Care

“It’s just difficult to admit that you need help sometimes, it’s difficult to admit that something is wrong. It’s also just really scary because you don’t even know if you get help what are the consequences of what’s going to happen? It’s just scary and really confusing”
- Alameda County, Young Adult in Extended Foster Care

One way you can help break down this barrier is by learning to have an effective conversation with a young person who is struggling. An effective conversation begins with taking a hard look
at the language we use and the signals it sends to the young people we want to support.

Stigmatizing language, whether used intentionally or unintentionally, can construct a space that may be unwelcoming. Many common phrases used to talk about people who use drugs imply
stigma, judgment, and shame. This is easy to understand in overtly derogatory instances like the use of terms such as “junkie,” “crackhead,” etc., but language matters in much more subtle
ways and can reveal assumptions about a person or their substance use that may be unfair, inaccurate, and harmful.

You can learn more about terms to use and avoid when talking about addiction here .

*This information was adapted from the National Harm Reduction Coalition, you can read more here .

While it may be necessary at some point, harsh confrontation or accusing the young adult can be potentially damaging causing them to shut down. The first step is an honest and open conversation.

Before the conversation

Prior to engaging a young adult in a conversation about substance use there are some steps you
can take that may help you be more prepared.

● If you’re nervous before the conversation try doing something that relaxes you, like taking a walk
● Find a comfortable and private space to have the conversation
● Be aware of your organizational policies and procedures in regards to client substance use
● Educate yourself on the facts about substance use, specifically what substance you are concerned about the young adult using
● Be informed about their treatment options should they agree to help
● Have hotline, warmline and crisis line information on hand to provide as a resource

While there is no one-size-fits-all approach to successful dialogue with a young adult about substance use, the principles below may be helpful.

○ Ask open-ended questions

■ Open ended questions are questions that cannot be answered with a
‘yes’ or a ‘no’. They are phrased in a way that requires a more expansive
response and can lead to more rich discussions.

● Open-ended

○ “Can you tell me what you heard or know about opioids?”
○ “Tell me what is appealing or interesting about drugs?”
○ “Why do you think some of your friends would use drugs?”

● Close-ended

○ “Do you know about drugs or opioids?”
○ “So, you aren’t using drugs, are you?”
○ “I know you and your friends are using drugs, right?”

○ Use active listening

■ Active listening is the practice of listening to a person while providing feedback indicating that the listener both hears AND understands what the person is saying. Active listening can help to build trust and establish rapport.

● Verbal affirmations:

○ “I see”
○ “I understand”
○ “Tell me more”

● Non-verbal affirmations

○ Nodding
○ Eye contact
○ Leaning forward

○ Be non-judgmental
○ Don’t make assumptions
○ Offer empathy and support
○ Listen and affirm what they know and offer additional information or facts

Examples of effective communication

The below includes reflective listening and empathetic statements to destigmatize addiction
while promoting open and positive communication.

· “Sometimes medications cause problems that we cannot anticipate”
· “You are not alone. All kinds of people have problems with opioids”
· “I understand you have been struggling and know that discussing change can be distressing”
· “Getting help for this is like getting help for any other chronic medical problem”
· “I want you to have the best possible care and this difficult, but productive conversation is the first step for us”
· “There are a number of treatment options. Let’s explore them together”
· “We will work together to find a treatment plan that works best for you”

For additional tips on how to start the conversation or conversation starters visit the links
below:

Tip Sheet: Prescription Drugs
Tip Sheet: Alcohol
Tip Sheet Marijuana

● Let them know you’re there to talk in the future. The first conversation is the first step in what might be an ongoing conversation about drug and alcohol use, it’s important that the young adult knows they can talk to you again.
● Ask them “permission” to check-in. This opens the door for you to follow up with them in the future. You might check-in with the young adult again in a week or even the following day to see how they are doing.
● Connect them with a substance use professional and/or treatment. In order to perform a proper assessment, as well as to potentially help reduce or stop their drug or alcohol use assist them in finding the right services when they are ready.
● Provide them with the ‘In Your Corner’ pocket card (insert link). It’s important for them to walk away with resources, this resource includes valuable local and national hotline and warmline information.

If they do not want to change or receive help encourage them to learn how to reduce their risk of harm until they’re ready to stop using drugs or alcohol. Harm reduction strategies, such as the below, are aimed at meeting individuals “where they are at” by reducing negative consequences associated with drug use.

The National Harm Reduction Coalition explains it this way: “Harm Reduction supports and celebrates any positive change while resisting a narrative that would treat the substance use spectrum as a moral ladder. A positive change is one that reduces risk to oneself and one’s community, that makes space for a person to pursue spiritual, emotional, and physical health and wholeness, that emerges from and increases their agency. One person’s positive change may be to start smoking heroin instead of injecting it, thereby reducing the risk both of overdose and of many infections; another’s may be to shift from heavy use to occasional use in order to make more time for a job, hobby, or relationship; another’s may entail giving up one or more substances entirely to prevent harm. Principles of non-judgment and non-coercion require that none of those choices be treated as morally superior or inferior to another. Everyone’s path is their own, but Harm Reduction offers compassionate, evidence-based support on the journey.”

● Syringe Access: If individuals are injecting drugs, it is possible to completely avoid or reduce injection related health risks if they have a sterile syringe and proper equipment for every injection. Syringe service programs (SSPs) such as the HIV Education and Prevention Project of Alameda County ( HEPPAC ) distribute sterile syringes, safer drug
use supplies and education to people who inject drugs.
● Opioid Overdose Prevention: Educate clients and family members on signs and symptoms of overdose, as well as what to do in the event of an overdose. This can include sharing information and access to Naloxone, the opioid overdose reversal drug.
● Fentanyl Test Strips: Overdose deaths involving fentanyl have quadrupled in recent years and many individuals consume fentanyl without knowledge, while others use it intentionally because of its potency.
● Other: Other harm reduction strategies for opioids specifically include 1) adjusting dosage to a lower dose preventing the likelihood of overdose 2) staggering when using within a group so someone is alert enough to react if there is an overdose 3) switching from injecting to smoking or snorting 4) making sure that at least one person in the
group using has Naloxone 5) not using along, making sure that you have a friend with you to monitor.

The above serves as a glimpse into available harm reduction strategies, you can learn more
about from the National Harm Reduction Coalition here as well as from the HIV Education and
Prevention Project of Alameda County (HEPPAC) here .

It has been found that substance use tends to escalate through adolescence and into young adulthood and can be amplified by experiences of trauma and maltreatment, mental illness and exposure to parent alcohol and drug use. Given the presence of trauma in the lives of many extended-foster care youth and the comorbidity between substance use and trauma, systems and providers are encouraged to adopt trauma-informed approaches to providing services. Trauma-informed approaches acknowledge the need to understand the client’s life experiences in order to deliver and provide effective care, and has the potential to improve client engagement, treatment adherence, health outcomes and provider and staff wellness.

● Substance Abuse and Mental Health Services Administration (SAMHSA) Four “R’s”
In order to increase sensitivity in client care, as well as prevent re-traumatization
SAMHSA developed the Four R’s of a trauma-informed approach to guide individuals as
well as organizations:

● Realizing the widespread impact of trauma and understanding the potential
paths of recovery. This includes an understanding that trauma impacts
individuals coping strategies, as well as plays a role in mental and substance use
disorders.
● Recognize the signs and symptoms of trauma in clients, families, staff and others
involved in the system. This may include utilizing trauma screenings and
assessments.
● Respond by fully integrating knowledge about trauma into your own practices,
policies and procedures. This can include ways in which you promote trust,
fairness and transparency in your work, as well as provide opportunities to
empower the client and utilize strengths-based approaches.
● Resist Re-traumatization individuals with histories of trauma and substance use
are more likely to engage in high-risk behaviors and to experience subsequent
traumas. Assist clients in identifying unsafe coping mechanisms and
self-destructive behaviors and replacing them with safe and healthy coping
strategies. This also includes making sure that you’re making

To learn more about trauma-informed approaches to care, and what you, as well as your
organization can do click here

YES! Addiction is a treatable disorder, with an estimated 22 million individuals in the United States currently in recovery. According to SAMHSA, recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. An individual's process and journey through recovery is highly personal and can occur through many pathways. Hope, the belief that challenges and conditions can be overcome, is the foundation of recovery. Recovery from drug or alcohol addiction is characterized by continual growth and improvement in one's health and wellness, that includes setbacks. Because setbacks are a natural part of life, resilience becomes a key component of recovery.

Research on the science of addiction and treatment methods for substance use disorders has led to the development of research and evidence-based methods that help people stop using drugs or alcohol, also known as being in recovery. Because addiction can affect so many aspects of a person’s life, treatment should address the needs of the whole person in order to be successful. There are countless treatment options a person can choose from and there is no one-size-fits-all approach.

• Withdrawal Management - Detox: Detoxification, detox or withdrawal management is the process of safely, comfortably and effectively flushing out all of the toxins in an individual's system accumulated from drug or alcohol use through medical, holistic and therapeutic approaches. For opioids the purpose of this type of treatment is to safely manage withdrawal symptoms such as nausea and anxiety, which if left unassisted may not be life threatening, but may be highly uncomfortable and lead to a higher chance of using again. It is important to note that some drugs, especially alcohol, have more significant withdrawal symptoms than others and may be life threatening. Learn more about alcohol withdrawal symptoms here and other commonly used drugs withdrawal symptoms here. Regardless of the drug used, if there is prolonged or heavy use, withdrawal management may lead to a higher chance of sustained abstinence.
• Opioid Treatment Program (OTP) / Medication-Assisted Treatment (MAT): OTP or MAT is the use of FDA approved medications, in combination with counseling or behavioral therapies, to provide a whole patient approach to the treatment of substance use disorders. The use of medications in the treatment of opioid use disorder has been found to result in a reduced rate of opioid use, fewer overdose deaths related to opioids, decreased criminal activity, and increased retention in treatment. Overall, the medications used in this type of therapy aid in managing cravings and withdrawal symptoms, enhancing the chance for overall recovery.
• Residential or Inpatient Services : This is the highest level of care, for individuals who are battling chronic forms of addiction, or those requiring a safe living environment. Lasting typically anywhere from 3 - 6 weeks long, individuals reside in a substance-free facility and receive around the-clock medical and therapeutic support.
• Intensive Outpatient or Outpatient Treatment: A step down from residential or inpatient services, these types of programs offer many of the same kinds of services including individual, group and family therapy; however, while attending this type of treatment individuals do not reside in the same building as they are receiving treatment rather they will live at home or in a recovery residence. Outpatient programs vary in the types and intensity of services, with treatment being attended typically a few days and hours a week, sometimes as little as two hours for one day per week.
• Recovery Residence: Oftentimes for individuals who have been using substances, removing themselves from their environment in which they were using, may help to reduce the chance of relapse. Sometimes referred to as a ‘Sober Living’ or ‘Recovery Homes’, these types of residences are monitored living environments that help to provide ongoing structure and support in an alcohol and drug free setting. Individuals may choose to live in a recovery residence while attending treatment, as well as afterwards.
• Recovery Support Services: Many individuals at some course in their treatment will engage in recovery support services, often in the context of meetings. This includes support meetings such as alcoholics anonymous or narcotics anonymous. These types of meetings provide individuals with the opportunity to connect with others who have also struggled with addiction, to form a network of peers working towards the same goal: sustained recovery from drugs or alcohol.

The information below is a selection of local drug, alcohol and harm reduction service providers for young adults in extended foster care throughout the city of Oakland and Alameda County. For a full list of treatment providers, visit SAMHSA’s treatment locator.

BAART

Berkeley Addiction Treatment Services (BATS)

Beyond Emancipation

Bi-Bett Corp

City of Fremont - Substance Use Disorder Program

H.A.A.R.T

HEPPAC/Casa Segura

Highland Hospital

Horizon Services

La Familia

Lifeline Treatment Services

Magnolia Women’s Recovery

Needle Exchange Emergency Distribution ( NEED)

New Bridge Foundation

Oakland Behavioral Health Clinic

Second Chance

Trust Health Center

West Coast Children’s Clinic

West Oakland (WOHC)

Syringe exchange programs provide people who cannot or will not stop injecting illegal drugs with new syringes and a place to safely dispose of used syringes. The sites also may serve as a point of access to health education and other physical and mental health services such as: free naloxone distribution, referrals to drug treatment, and first aid. A list of syringe exchange programs throughout the Bay Area can be found here .

The best way to dispose of old, unused, unwanted, or expired medicines (both prescription and over the counter) is to drop them off at a local drug take-back site. A full list of local safe disposal sites is provided by the Alameda Contra Costa Medical Association here.

Call 2-1-1 for help in Alameda County

Alameda County’s Mental Health ACCESS Program: 800-491-9099
Alameda County Behavioral Health Care Services (BHCS) is the system-wide point of contact for information, screening, and referrals for mental health and substance use services and treatment for Alameda County residents. Licensed mental health clinicians are available between M-F from 8:30 – 5:00 PM for general behavioral health questions and eligibility for outpatient services. After hours calls are answered by Crisis Support Services of Alameda County.

The Alameda County Substance Use Referral Help Line: 844-682-7215
Staffed by Alameda County Social Services Agency, the Alameda County Substance Use Referral Help line is available 24 hours a day/7 days a week for screening and treatment referrals to any substance use level of care.

Crisis Support Services of Alameda County: 800-309-2131
Trained counselors are available 24/7 for individuals struggling with difficult circumstances or uncomfortable thoughts and emotions.

California Substance Use Warm Line: 844-326-2626
Staffed 24/7 by experienced physicians and pharmacists, the California Substance Use Line provides free, fast, reliable, patient-tailored guidance and resources that can facilitate substance use prevention and treatment efforts.

National Substance Use Warm Line: 855-300-3595
Available M-F 6 AM-5 PM PST, the Warm Line provides free telephone consultation from addiction medicine-certified physicians, clinical pharmacists, and nurses with special expertise in substance use evaluation, pharmacotherapy, and management.

California Poison Control: 800-222-1222
The California Poison Control provides 24/7 free, immediate, and expert treatment advice including: identification of opioid withdrawal, medication-assisted treatment, and solutions or troubleshooting a plan to connect patients with treatment providers.

National Suicide Prevention Lifeline: 800-273-8255
The National Suicide Prevention Lifeline provides 24/7 free support for individuals in distress, as well as prevention, crisis resources, and best practices for professionals.

SAMHSA’s National Helpline: 1-800-622-HELP (4357)
Free, confidential, 24/7 365-day-a-year treatment referral and informational services (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

Designed as a resource guide for helpers and peers, this pocket-card provides individuals and family members who are at risk of or currently using substances with local Alameda County resources including food, housing, addiction and mental health services.

You can view, download and print the pocket-card here.

To receive pocket-cards for distribution or for more information contact Michelle Schurig at
mschurig@acgov.org.

The National Institute on Drug Abuse’s (NIDA) Opioid Risk Tool and the NIDA Quick Screen are available to help practitioners screen for substance use in general medical settings. Visit NIDA at drugabuse.gov for additional information and to access the screening tools.

● Active Listening: Hear What People Are Actually Saying
● Drugs, Brains and Behavior: The Science of Addiction Treatment and Recovery
● Easy to Read Drug Facts
● Get Smart About Drugs: A Resource For Parents, Educators and Caregivers
● Heroin, Fentanyl & Other Opioids: A Comprehensive Resource for Families with a Teen or Young Adult Struggling with Opioid Use
● How Do You Talk About Addiction? Stigma and Language
● If You Have a Problem with Drugs: For Teens and Young Adults
● National Center on Substance Abuse & Child Welfare: Child Welfare Training Toolkit
● National Institute on Drug Abuse (NIDA)
● Partnership for Drug-Free Kids
● SAMHSA: Opioid Overdose Prevention Toolkit
● Toolkit for Communities of Faith Facing Overdose
● Words Matter: How Language Choice Can Reduce Stigma