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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Boston's 'Mass and Cass' area, with its large homeless population and open-air drug market, remains a trouble spot for city officials, but staff at the nearby Engagement Center say they are making inroads and helping drug-overdose survivors get the help they need.

Researchers interviewed 59 overdose survivors, more than half of whom were living on the street, to find out what was preventing them from getting treatment.

Jeff Desmarais, research and evaluation scientist at Institute for Community Health, said a lack of basic amenities, such as housing and access to a cell phone or proper ID, made a big difference, but that it also came down to a personal touch.

"Having staff that really care about folks and treat them with respect and dignity was one thing that folks were drawn to and helped them engage in and stay in care," Desmarais said.

More than half of Black and Latinx overdose survivors said they had encountered some form of discrimination in trying to access city health services. A lack of available treatment beds due to staffing shortages is also preventing people from getting clean.

The opioid epidemic, along with a lack of affordable housing and COVID, have all contributed to the increase in homelessness in the 'Mass and Cass' area. The Engagement Center offers the nearby population help to find housing, medical care, jobs, or even just a warm cup of coffee and a shower.

Yailka Cardenas, associate bureau director for recovery services with the Boston Public Health Commission, said some staff at the center have experienced addiction and homelessness themselves and can meet people where they are.

"No matter what they come to us with," Cardenas said, "we always try our very best to come up with a solution, and they feel very supported that even if we can't figure it out that day, we will figure something out for them within a timely manner."

Cardenas said personal relationships go a long way in helping people get clean, and that the Engagement Center can serve as a model for other day facilities serving similar populations. She said survivors, many of whom experience instability and trauma on a daily basis, report feeling safe and welcomed at the Engagement Center, which is the first and most important step in helping them change their lives.

A new tool is calculating the financial impact of the opioid crisis in Virginia. The opioid cost calculator opioid cost calculator developed by the Virginia Department of Health and Virginia Commonwealth University, demonstrates the monetary impacts of the opioid epidemic on Virginians in 2020. It tracks different categories such as lost labor, health care, crime, household costs, and state and federal costs. In total, the state's staring at a price tag of $3.5-billion. Derek Chapman, interim director of Virginia Commonwealth University's Center on Society and Health identified the largest costs of the opioid crisis in the state.

"The largest costs, actually, of that $3.5 billion comes from households, actually," Chapman said. "So, that's lost workforce productivity, lost labor costs from people unable to work, either, obviously due to passing away, but also unable to work because of opioid addiction. Those lost labor costs were $2.3-billion."

Chapman said there are some things you can't put a dollar amount on such as the value of those lives lost to opioid overdoses. However, according to the opioid cost calculator, the labor losses relating to overdoses
amounted to $1.9-billion.

Although the opioid cost calculator is still relatively new, the teams that worked on it have hopes for its future. Lauren Yerkes, injury and violence prevention senior epidemiologist with the Virginia Department of Health, said this as a way to keep the conversation about the opioid crisis alive. She hopes this will inform people about how to work together with policymakers in their communities on how to reduce the opioid cost burden. Yerkes talked about what comes next.

"We are hoping to continue to have as many people look and see the opioid cost calculator," Yerkes said. "Right now, we recognize that we are in 2022, and 2020 data is on the cost calculator, so our next step is to provide even more recent data moving forward."

She wants the cost calculator to include the impact of the COVID-19 pandemic on the opioid crisis. Given that opioid overdoses rose at the beginning of the pandemic, Yerkes added this will push costs up further. According to the National Institute on Drug Abuse, more than 68,000 people died of opioid overdoses nationwide.

Overdose deaths in Ohio are on track to fall below the record pace of last year, but the opioid crisis is far from over.

The group Harm Reduction Ohio estimated that overdose deaths for 2022 will drop below 5,000 for the first time since 2019. However, after falling at the beginning of the year, rates appear to have increased since May.

As a registered nurse at The Ohio State University's Wexner Medical Center, Rick Lucas has a firsthand view of the opioid epidemic. Lucas, an Ohio Nurses Association union leader, said he carries naloxone at all times to respond when patients - and sometimes, hospital visitors - overdose.

"The stress that everybody is under through the pandemic has only really made things tougher," he said. "Children losing parents, parents losing children, families split apart because of addiction. This is very much something that needs to continue to be front and center, and addressed."

The epidemic is a top issue in the U.S. Senate race between Democrat Tim Ryan and Republican J-D Vance, who wrote a memoir detailing family addiction. Vance has faced criticism of his nonprofit, which he said fights opiate abuse. Media reports have questioned the organization's spending on a political advisor and opinion polling. While financial disclosures indicate the nonprofit is now shuttered, Vance's campaign says it's on a temporary hold due to the Senate race.

Lucas explained that local health-care providers and organizations on the ground have worked tirelessly to help Ohioans struggling with addiction, as state and national resources have fluctuated.

"These folks need not only in-hospital care, but out-of-hospital care, and a lot of the funding comes from the federal government," he said. "So, it is really important that we have legislators in Washington that are gonna take this serious and push policies that have an impact on this crisis."

Lucas said states such as Ohio need more help tackling the opioid crisis, including its increased burden on the health-care system. And he argued that more investments are needed to help people struggling with addiction in rural communities.

"It's a real hardship for folks to travel 30 or 60 miles for ongoing treatment; they don't stick with it," he said. "So we definitely need a more proactive approach in addressing the mental health-care needs of individuals, so they're not turning to self-medicating with opioids or other illicit substances."

According to Harm Reducation Ohio, the worst overdose death rates in 2022 so far skew heavily toward the Appalachian counties in southeast Ohio.