Monday, February 29, 2016

Your Neighborhood, Your Brain

Here's an interactive map that can predict what is happening in people's brains.

It shows, by Zip code, the distribution of poverty and wealth across the United States.

When people live in wealthier communities, they tend to do better. When people live in poverty, they get trauma. Trauma degrades mental function. People have trouble thinking (they lose executive function); they have trouble managing emotions; their relationships are disrupted; and they tend to operate on missing or outdated information.

In this era of globalization, money (and the lack of it) has a kind of gravity. The poor clump together, the rich clump together, poverty and wealth get concentrated, and there is less movement of people from one extreme to another.

The map is a product of the Economic Innovation Group.

Thursday, February 25, 2016

How communities stop heroin

I have been looking at what ordinary people can do about the heroin epidemic, especially action that helps directly. Many kinds of direct help fall within the skill set of ordinary people.

Heroin use is inherently traumatic. A person at the starting point of a heroin recovery journey is someone with a medical problem who has trouble thinking, whose emotions are out of whack, whose relationships need rebuilding, and whose stock of basic information is deficient. Add to that the risk around the person’s former criminal habits, and the potentially fatal risk of relapse that lingers on the horizon. The only way to proceed safely is to systematically address risk within the global experience of a person’s life.  The sheer number of people at risk means we must build recovery support structures at the lowest possible cost.

Think of the resulting social structure as a kind of pyramid. The most expensive and most highly regulated clinical services are at the top. Treatment starts with a visit to a doctor, medicine to stop opiate cravings, and individualized therapy. Social support begins at the next layer. The middle layer consists of paraprofessionals. Peer support workers and case managers function as part of the clinical team, while health educators, system navigators, housing workers, and training programs function as the community service team. Ordinary people in communities and neighborhoods form the base of the pyramid.

Communities support everything.  Family members, friends, volunteers, and neighbors are most likely to be in contact with people as they live their lives. These so-called "natural supports" are best positioned to deliver comfort, recognize escalating risk, and defuse relapse triggers. The person who is moving away from heroin is reentering this positive, safe world of ordinary community life. The first step of trauma healing is safety and a place of refuge. As recovery work proceeds, the person comes to terms with the trauma and effects of heroin use. As this process of recovery moves forward, the person builds skills, gains a new perspective, and returns to full participation in community life.

We have some data to show why community support is so important. In 2013-2014, volunteers from NKY PAR conducted an informal survey of 304 local people who received addiction services. Dr. Perilou Goddard of Northern Kentucky University scored the surveys, and produced a surprising list of perceived barriers to recovery. The top three concerns for both men and women were:
  • Returning to environments associated with past drug use.
  • Coping with life situations (car breaks down, can’t pay rent)
  • Figuring out how to structure your time.
Other concerns included
  • Coping with financial problems
  • Worrying about letting other people down.
  • Needing transportation.
  • Overcoming other people’s unrealistic expectations about recovery.
  • Finding housing when you have a felony conviction.
  • Trying to have a healthier lifestyle (better nutrition, exercise and healthcare).
  • Coping with financial obstacles to treatment.
The most surprising feature of this list is that so many of these items are among the strengths and competencies of the very population that is moving away from drug use. There is no shortage of drivers, roommates, and sympathetic souls with coping skills among people in recovery (particularly among those somewhat further along). 

Unfortunately, our society has done a poor job connecting these skills and competencies with people who might benefit. Anonymous-model mutual support programs have not produced these support structures. Clinicians have no way to search for talents hiding unused within their caseloads because professional boundaries and privacy protections make problem-solver matchmaking unthinkable, even illegal.

What people need to survive heroin is up to ordinary people. We must learn how to help each other out. We market all sorts of products to clinical populations. Why not market friendship?
My team at Human Intervention LLC  has a Kentucky-certified case manager training program we have adapted for community volunteers. It covers basic safety, crisis de-escalation, and principles of personal recovery. Call me (513) 494-6280 or send an email (komarek AT  to set up a session for your group.