CHARLESTON, W.Va. — Brain science can help explain why people with serious addictions are so out of control, and why many addicts have trauma in their history.

Jessica Holton is a licensed clinical social worker and addiction specialist teaching in Charleston this week. She said in her practice, almost all of the addicts have trauma in their background, as well as Substance Abuse Disorder. Holton said this is because both addiction and trauma take over the limbic system - the animal part of the brain - bypassing the rational decision-making part.

"We often think that it's a choice, a moral failure. But really the science shows that the survival part of the brain, the limbic system, actually gets hijacked for those who have a true addiction,” Holton said.

Addicts sometimes say it's as if they've lost control of their own hands. Holton describes that as a symptom.

She'll be in Charleston for the Spring Conference of the National Association of Social Workers, West Virginia. That conference starts Wednesday. It's the largest event of its kind in the country. This year's schedule also includes discussions of foster care and social work in schools.

The limbic system controls pleasure and fear, and the out-of-control impulses known as the fight-or-flight response we experience when threatened. Holton said for those experiencing a trauma, or reliving one, the limbic system is pumping out fear messages that can override everything else.

She said drugs - at least at first - make the system put out pleasure messages. That's part of why people with post-traumatic stress disorder are vulnerable to Substance Abuse Disorder.

"Addiction tends to help people numb out and helps them to avoid,” Holton said. “In trauma, that same part of the brain works in overdrive. So it makes sense as to why when the brain is overreacting and over-responding and everything is a threat, substance use and trauma tend to go hand in hand."

Fairly quickly, serious substance abuse can overwork the limbic system's ability to create pleasure, which is why addicts say they no longer enjoy it. They just take substances to avoid withdrawal, a big part of which is the limbic system sending out fear messages.

Holton said the good news is that even if addiction can't be cured, an addict's limbic system can return to a state closer to normal after some months sober.


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States such as Minnesota continue to grapple with recent spikes in fatal overdoses tied to opioids. Now, a federal agency has taken what aid groups say is a big step in preventing such deaths.

This week, the Food and Drug Administration approved over-the-counter sales of the nasal version of naloxone, which rapidly reverses the effects of an opioid overdose. Sold under the brand name Narcan, the product has only been available through a prescription.

Minnesota recently recorded a 44% increase in opioid overdose deaths.

Maddy Reagan, overdose prevention manager for the Steve Rummler HOPE Network, pointed out in 2021, there were nearly 5,000 nonfatal overdoses.

"So what that said to me is that Naloxone is having an important impact in keeping people alive," Reagan explained.

The FDA said its action paves the way for the lifesaving medication to be sold directly in places beyond pharmacies, such as grocery stores and gas stations, as well as online.

Reagan and various medical organizations worry about the cost, potentially still keeping it out of reach for many individuals. The drug's manufacturer declined to comment on what the new price structure would look like.

Currently, Narcan doses typically cost around $130 for those without insurance. Reagan emphasized the price forces harm-reduction groups to focus on certain strategies to distribute the product to those who need it.

"We primarily distribute intramuscular Naloxone, because it's significantly less expensive," Reagan noted. "We're able to get high volumes out into the community."

Intramuscular Naloxone involves injections, and some health agencies say the nasal form is easier to use and more appealing for those worried about using needles. As for the prescription requirement, many states, including Minnesota, have already adopted laws to make it easier for an individual to obtain the medication from a pharmacist.


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More than 4,000 people in North Carolina died of overdoses in 2021, the highest number of overdose deaths in a single year on record in the state, according to recently released data.

Dr. Susan Kansagra, assistant secretary for public health with the North Carolina Department of Health and Human Services, said before the pandemic, the state's opioid overdose deaths had been leveling off, but now, she said they are on the rise, and communities have spent the past few years grappling with the loss of loved ones.

"We're seeing an increase in poly substance use as well," Kansaghra said. "Not just deaths caused from opioid overdose, but really we're seeing multiple substances have been used. "

She said the manufactured opioid called fentanyl is driving fatalities. In 2021, more than 77% of overdose deaths in the state likely involved fentanyl. The state's 988 Suicide and Crisis Lifeline offers 24/7 access to trained crisis counselors who can help people experiencing distress. Since the launch of 988 last summer, the call center has seen an 85% increase in people identifying substance use as their primary reason for calling.

Kansagra added health insurance is a major component of addressing the opioid epidemic. Lawmakers recently reached a bipartisan agreement that puts the state on a path to allow access to health care for an additional 600, 000 North Carolinians.

"One of the things we know in North Carolina is that we we are working on Medicaid expansion. And that's really important so that people have the ability to get high-quality care," Kansagra said.

She said the state has also expanded its mobile crisis care resources, where a person experiencing a behavioral-health or substance-use crisis can receive an assessment on the spot, whether at home, school, work or other location.


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Another Minnesota House committee has endorsed a bill that would allow sports betting within the state, but there are calls to add some provisions as the measure advances.

If approved, licenses would be provided to tribal nations around Minnesota to create sportsbooks at casinos, and Minnesotans age 21 and older could also place wagers through their phones, using online apps.

Bill sponsors have said revenue would go toward regulations and consumer protections, with another 40% used to address problem gambling. Susan Sheridan Tucker, executive director of the Minnesota Alliance on Problem Gambling, said that language is appreciated, but she asked lawmakers if information-sharing can be included, too.

"Operators and their licensees will be collecting quite a bit of data that can help answer many questions that researchers have concerning gambling behaviors," she said, "and can provide insights into whether more individuals are becoming addicted to gambling."

Tucker, whose organization is neutral on legalizing sports betting, stressed that no personal information, including a bettor's identity, would be shared. She said at least two other states have these provisions in their laws. The Minnesota Indian Gaming Association has said it needs more information before commenting on that recommendation.

Key supporters of the plan have said that with more than 30 other states already allowing sports betting, it's time for Minnesota to take something already being done on the black market and put it under the state's purview.

David Prestwood, government affairs manager for the online betting firm DraftKings, echoed that sentiment in his testimony.

"An estimated 1.17 million people in the state are making a combined total of more than $2.5 billion in illegal wagers annually," he said. "Nearly all of these wagers are placed online in the robust illegal market, where sophisticated illegal operators capitalize on the popularity of this form of entertainment."

As for the sharing of aggregated data, the bill's sponsor expressed a willingness to have more discussions about it. More broadly, the current version excludes horse tracks, potentially complicating final passage in the Legislature.