Opioid treatment plans must include a trauma-informed approach

According to the Centers for Disease Control (CDC), the opioid epidemic claimed the lives of more than 64,000 people in 2016, nearly double the number of people who died in deadly automobile accidents.

These numbers are shocking, and yet they don’t begin to communicate the full impact of this deadly epidemic. In fact, there is a growing consensus among brain science experts that addiction may actually be a symptom of an even larger problem — one that can have its roots in childhood trauma.

{mosads}This was the conclusion shared by experts who gathered for the “Substance Use and Childhood Trauma: Addressing the Impacts of the Opioid Crisis on Children” briefing last week on Capitol Hill hosted by Sens.  Dick Durbin (D-Ill.) and Heidi Heitkamp (D-N.D.).

Dr. Nadine Burke Harris, a pediatrician and author of a book, “The Deepest Well: Healing the Long-Term Effects of Childhood Adversity,” spoke about the impact of toxic stress on children who grow up in households with substance abuse, child abuse, domestic violence, and other types of trauma.

Frank Kros, president of The Upside Down Organization in Baltimore, Md. and a member organization of the Alliance for Strong Families and Communities noted, “Childhood trauma is both the cause and the consequence of the present opioid crisis and is, in fact, the most important public health issue of our time.”

Studies have shown that Adverse Childhood Experiences, known as “ACEs,” can have a profound and lasting impact on a child’s ability to focus, learn, apply impulse control, resist negative behaviors, and even has a measurable impact on health outcomes, increasing risk for substance abuse, chronic lung disease, heart disease, Alzheimer’s, and more, across a lifetime.

These perspectives are critical as federal policymakers work to move forward a broad package of legislation in response to the opioid epidemic. The S.2680 Opioid Crisis Response Act of 2018, introduced by the Senate Health, Education, Labor, and Pensions Committee (HELP), and the Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018, introduced by the Senate Committee on Finance, aim to improve the ability of federal agencies to not only address the crisis, but also its ripple effects on children, families, and communities.

One such consequence can be found in the foster care system. A recent report from the Administration for Children and Families (ACF) showed that parental drug abuse has contributed to a massive increase in the number of U.S. children placed in the foster care system.

Following over a decade of decline, data now shows a gradual increase in the number of children entering the system starting in 2012. According to the most recent federal statistic, nearly 92,000 children were removed from their home in fiscal 2016 because one parent had a substance abuse issue.

Child welfare workers are sounding the alarm that children of those addicted are entering the foster care system at a younger age, presenting with complicated physical and mental health issues, and are staying in the foster care system much longer as their parents continue to struggle with their addiction.

The current state of the foster care system illuminates the need for a two-generation approach to treatment and recovery — one that keeps families intact while both parents and children receive the treatment and supports they need.

One of the challenges to this approach is that there is not enough current infrastructure to provide for the needs of families in one facility. The Senate Finance Committee’s bill would provide additional federal investment in family-based treatment to address this gap in capacity.

What is clear is that the opioid crisis doesn’t fit neatly into any one jurisdiction or system. It impacts children and families, communities and states, and our national system as a whole, across the spectrum of health, education, child welfare, law enforcement, housing, labor and public health systems. All of these have a role to play in responding to this crisis, and should drive toward addressing root causes.

The bill is an important step in that direction. It includes critical provisions in support of trauma-informed approaches, including prioritizing trauma-informed training, expanding CDC data collection on ACEs, and development of an interagency task force on trauma-informed best practices.

To support such an approach, Congress must work across jurisdictions to align federal resources and public policies within a framework of prevention and trauma-informed care that takes a multi-disciplinary approach to treating and healing the whole family. There must also be an infusion of federal resources to provide age-appropriate services and supports for infants, toddlers, youth and young adults who are at-risk of becoming addicts due to exposure to ACEs, toxic stress and trauma that stem from a trusted caregiver’s addiction.

This will require a holistic approach to addressing this crisis — one that moves beyond simply limiting the supply of opioids in communities. It will require an investment into national supports for addicts and children of addicts to prevent future generational cycles of addiction.

We urge all members of Congress to push federal policies to better support family well-being and spread the practice of trauma-informed approaches and two-generation treatment and supports as part of the federal response to the opioid crisis.

Marlo Nash is the senior vice president of public policy and mobilization for the Alliance for Strong Families and Communities, a strategic action network of hundreds of social sector organizations across the nation. She served as moderator of the Capitol Hill briefing on opioids and childhood trauma.