British Columbia Analysis

THE FENTANYL FIX: 'The fundamental problem is we live in a screwed up world'

Researchers say we still haven't learned the lesson of curing addiction by treating trauma

February 05, 2017

In the Rat Park study a group of overcrowded, stressed rats chose to use opioids, while rodents housed in luxurious "Rat Park" abstained. (Shutterstock)

Dr. Carol Ann Saari will never forget one of her patients describing how she got herself to work every day: by dropping acid to escape the gut-wrenching effects of sexual abuse flashbacks.

The patient was a teenaged girl.


And she's not the only addict desperate to escape painful memories or childhood trauma.

Another patient saw a horrific suicide as a child and turned to drugs very young.

Others endured scenes of repeated violence in their home, or worked on the front-lines of healthcare or emergency services, where trauma is daily fare.

"They had some pretty horrific things happen to them," said Saari.

Trauma a main predictor

Saari's work with addicts on Vancouver's Downtown Eastside, and a research study she conducted over the past decade, have led her to believe that trauma needs more attention and funding to help prevent it from turning into PTSD and turning more people into drug addicts who then put themselves at risk of overdose.

While addiction is driven by a complex mix of social and genetic factors that science continues to unravel, trauma is turning out to be one of the main predictors.

Murals warning of the dangers of fentanyl cover alley walls on Vancouver's Downtown Eastside. (Pete Scobie/CBC)

"We need to talk about what drives people to take drugs," said Dr. Bessel van der Kolk, who has studied trauma-brain research for 45 years.

"People that feel good about themselves don't do things that endanger their bodies," said van der Kolk.

The correlation between child abuse and addiction is almost direct, he said.

Managing bodily sensations is key

To help staunch the flow of addicts, we need to go back to its underpinnings and give children the tools to cope, and parents the support to prevent the violence and sexual abuse that can lead to addiction, van der Kolk said.

He believes the key is to teach children body regulation skills, so they are in effect inoculated from reaching for substances to assuage the pain of abuse.

"Traumatized people feel agitated, restless, tight in chest. You hate the way you feel. They take drugs in order to stabilize their bodies," said van der Kolk.

That's why he believes that teaching children — as early as in kindergarten — methods of managing their bodily sensations is as essential as teaching reading.

Mental health services have declined

But in B.C. today, services aimed at the root of addiction are declining.

The number of psychiatric beds per capita is going down. In 2016, there were 1,229 psychiatric beds and 744 acute beds province-wide.

That means 26 beds for every 100,000 people in B.C, down from 30 beds for every 100,000 people in 2006, according to the Canadian Institute for Health Information.

Once a person uses and becomes addicted the brain wiring has changed and the choice is no longer there, says Dr. Patricia Mark. (Pixel addict/Flickr)

Provincial officials say they are opening a new 105-bed mental health facility on  the Riverview Hospital grounds in Coquitlam, B.C., and 100 beds at the Joseph and Rosalie Segal Family Health Centre in Vancouver, plus 75 at Royal Columbian Hospital in New Westminster.

But beds are only part of the solution.

More mental health professionals are needed — with only 755 psychiatrists across the province in 2015.

In addition, B.C. has just one-third the number of psychologists that are available in Alberta per 100,000 people.

Beyond crisis management

Doctors at the heart of the crisis add that addiction care needs to be modelled after other chronic, relapsing disease care models.

Dr Venu Karapareddy, addiction psychiatrist with Vancouver Coastal Health, said many countries are moving to integrate mental health and addictions care in a one-stop setting, with home delivery.

In the U.K., a mobile unit with a psychiatric nurse goes to patients home in some cities to support police at suicide and overdose calls to offer support and connections into the system, with success.

Neuro-feedback and methods which work to retrain an addicted brain intrigue van der Kolk and others.

When rats are too stressed and crowded together they opt for opioids over water, according to a 1970's experiment called the Rat Park study. (Surprise Truck/Flickr)

Van der Kolk, a Dutch researcher, doesn't think addiction will ever vanish.

"We are a self-destructive species," he said.

But he is still hopeful for a cultural shift that would end a "phobic" U.S. attitude toward research, looking at social conditions as a precursor to addiction.

He describes it as "overwhelming evidence ... staring us in the face."

Lessons from rats

And it's not new. Many researchers point back to a controversial study done in the 1970s called "Rat Park," in which a group of overcrowded, stressed rats chose to use opioids, while rodents housed in a luxurious "Rat Park" abstained.

The lead researcher, Bruce Alexander, believes people are like those rats.

"The fundamental problem is we live in a screwed up world," said Alexander, who has since written a book, Globalization of Addiction.

"We bring up children who are facing this. It goes right back to Rat Park," he said.

"If you want people to be in decent shape, you've really got to change the world."

That's a pretty sobering ounce of prevention.

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