“I should know; I was an addict myself.” Edgar Capacio, now clean for 35 years, completely turned his life around.
As a young college student, when his mother decided to move away from him and his fiancé gave him the ultimatum: her or the drugs, he was forced to make a choice. Fortunately, the decision to stop taking drugs has given him the chance to rediscover a new way of living.
In fact, his past experience allows him to make deep connections with his clients in his current work as a substance abuse counselor in the San Diego County Psychiatric Hospital. Mild-mannered with a ready smile and soothing voice, Capacio exudes compassion. In his line of work, he sees the face of suffering each day, a service he has been offering for the past 28 years.
What changes has he noticed in this landscape? The choice of drugs and the type of therapy are perhaps the two most noticeable ones. For example, from his experience in California, the more commonly used drugs are methamphetamines (because they are cheaper and with longer-lasting effects), marijuana and cocaine; he has also seen a rise in opiate use. For example, OxyContin is a prescription medication usually covered by work insurance. But once work ends, people tend to switch to heroin.
According to statistics compiled by the National Institute on Drug Abuse
(NIDA), an estimated 1.7 million people suffer from substance use disorders related to prescription opioid pain relievers. Almost a third of patients who had been prescribed an opioid for chronic pain currently misuse them.
Investigations into pharmaceutical companies reveal a deliberate effort to push for the sale of these opioids. In fact, according to a recent NPR report, “in internal memos, Purdue Pharmaceutic executives acknowledged that their prescription opioids are far more addictive and dangerous than the company was telling doctors.” Sales representatives were also incentivized to target vulnerable people, including seniors and veterans.
While the government works on policies to help curb these prescriptions, much more funding is needed to run programs that support these people and to educate everyone on the dangers of addiction to prescription medicine. Capacio feels that this situation simply takes a lot of support and a variety of services to help people along the path to recovery.
First of all, what is addiction? It is a chronic brain disorder characterized by “uncontrollable, compulsive drug seeking and use, even in the face of negative health and social consequences.”
In the past, because addiction was seen more as a moral failure of willpower, treatment tended to focus on psychotherapy to modify the addictive behavior.
But more recent studies have shown that in the majority of cases, there is a dual diagnosis, or “co-morbidity.” Due to a pre-existing mental health issue, such as bipolar depression, anxiety or other conditions, patients begin to use drugs or alcohol to — as Capacio explains — “self-medicate, calm down, deal with pressure.”
It also happens that as people begin to abuse substances, they develop even more serious mental health issues which then require additional medication, and the cycle continues.
Therefore, as Capacio noted, the previous approach of requiring patients to simply practice total abstinence from such substances no longer seem to work as effectively. It doesn’t adequately address the need for medication for the mental health issue, to be taken in conjunction with the psychotherapy required to cope with the addiction.
Thus a more collaborative effort is needed from a team made up of a psychiatrist, a psychotherapist, and a substance abuse counselor.
Today’s approach is also more focused on “harm-reduction.” If the patient is not ready to quit, then the entire team works with him or her on that. There are medications such as methadone and suboxone that can be taken during therapy that either help detox the body, manage the negative withdrawal symptoms (shaking, sweating, nausea, anxiety), or help curb the cravings, so the patient can focus better on counseling.
By aiming to reduce stress, patients are helped to deal effectively with “triggers” (such as people, places, things or moods) that affect the brain circuit that associates them to deep-seated pleasure experiences.
All this, of course, requires many meetings, and none of that can take place if the patient is without stable housing. For this reason, Capacio works hard to connect people to resources for stable housing or residential treatment programs.
Since treating addiction is so costly in many ways, many educational programs are available to forewarn the general public. The causes of addiction are as varied as the personal history of each one touched by this situation. It can begin simply due to peer pressure or out of curiosity. In fact, according to NIDA, “the majority of first-time drug users are in their teens.”
Adolescents are particularly vulnerable to addiction because the prefrontal cortex responsible for the mental function of decision-making and self-control is still developing. By interfering with its natural growth process, the ability to decide to quit is compromised. Capacio’s now 27-year-old son grew up telling his peers,
“My dad’s a counselor so I can’t even touch that stuff. He’ll know.” A genetic predisposition also makes his son more vulnerable.
Coming himself from a difficult family situation, Capacio notes how healthy family dynamics are crucial for prevention. Parental involvement in the daily lives of their children allows for closer monitoring of their activities and circle of friends, as well as support for those inevitable moments of encounter with suffering.
Other environmental factors include the availability of drugs and periods of stress due to a transition, such as moving, changing schools or jobs, family divorce, etc. Drug-free areas of the community and schools thus help reduce risk factors.
The best form of treatment — lifelong training in keeping the cravings at bay — must necessarily work with the whole person. By the time addiction hits, an entire life is at stake, together with a network of relationships.
Among the ups and downs of Capacio’s line of work, he recalls a recent success story of a 40-year-old man who managed to get himself admitted for therapy.
The son of well-educated professionals, “Adam” stopped taking his medication for his anxiety/bipolar condition. He broke up with his live-in girlfriend, with whom he had an unhealthy relationship, and ended up being homeless. When he moved back home with his parents, he continued to abuse alcohol and became so belligerent with his father that the police had to be called.
Adam was brought to the psychiatric hospital where Capacio worked until he was stabilized. Refusing to take him back, both parents met with Capacio.
After family counseling, the parents decided to take Adam back under the conditions of a behavioral contract (that he go to a mental health clinic to receive therapy and be consistent with his medication).
Adam thus began his journey to recovery. After a few months, the son was back on track again and stable (His parents said this was the first time they saw their son ‘normal’ again). Over the holiday, the father wrote a deeply moving letter to Capacio, thanking him for all he had done to help “bring back” his son.