What to Know
- Dr. Nicholas Kardaras has researched and taught the physiology of addiction on Long Island, and runs the Dunes facility in Easthampton
- He says a "perfect storm" of factors created the opioid epidemic on Long Island, including a socioeconomic struggles
- Here, he explores potential preventative measures targeting children to start effecting a turn in the epidemic
Dr. Nicholas Kardaras, Ph.D., LCSW-R, has been the executive director of the Dunes drug rehabilitation center in Easthampton for seven years. He spent 10 years as a clinical professor at SUNY Stony Brook, where he specialized in addiction, teaching the physiology and treatment of addiction. He spent 15 years working with schools on Long Island. He is also the author of “Glow Kids.”
In this conversation with News 4, Kardaras argues the opioid epidemic isn't just about supply and the availability of drugs -- it's also about a demand that stems from cultural factors, including lack of economic opportunity and a digital overstimulation.
There are many places to turn if you or a loved one has an addiction. Here's the breakdown of trusted resources for tri-state area residents.
THE EPIDEMIC ON LONG ISLAND: ‘WE’RE A VULNERABLE POPULATION THAT FEELS NOT MEANINGFULLY ENGAGED’
Source: nyc.gov; Map: Will Mathis/NBC
I think this is what gets underappreciated in this epidemic: you're seeing the biggest spikes in this epidemic in distressed communities, communities that are socioeconomically struggling. So we started seeing real spikes of the opioid epidemic along the Rust Belt -- Ohio, Michigan, West Virginia.
Long Island, while not West Virginia, while not necessarily Ohio, it's going through its own levels of economic upheaval and turbulence. Long Island has gotten over the last few years more disenfranchised, and for young people, it’s gotten more expensive to live in. There's a sense of feeling trapped. A lot of the addicts that I work with talk about feeling trapped. We're a vulnerable population that feels not meaningfully engaged.
Source: CDC; Map: Will Mathis/NBC
Just because communities tend to be affluent, the millennials don’t necessarily share in that affluence, they don’t have the same dream. When you talk to the opioid addicts about their vision of their future or their hopes and dreams, typically you’ll get a pretty bleak picture. A person who is addicted will say, “I don't see any future for myself. I don't see any opportunity.” And that's a big driver of why they choose to escape in what’s most available, which happen to be the opiates right now.
OPIOID ADDICTION IN THE DIGITAL AGE
We have to look at culturally, why are we so inclined to escape? This might seem like an odd connection, but if you were raised in the digital age, you're much more prone to the instant gratification, compromised impulsivity. An 18 year old today, because they grew up in an age where they pushed a button and got an instant result, they're much less willing to suffer through discomfort, whether it's emotional discomfort or physical discomfort. This generation is much more likely to go for the happy pill, for the escape pill.
There’s over 200 research studies that show that digital technology is priming those kids toward addiction. There's about a dozen brain imaging studies that show that kids who are on screens for excessive periods of time, their frontal cortex gets compromised. Somebody who has a compromised frontal cortex is more prone to compulsive, addictive kinds of behavior.
That 5-year-old who can’t get off his iPad is primed to become an opioid addict when he’s 14 because he hasn’t learned how to regulate himself, because the screen has done some neurological and clinical impacting on that child's development. I've seen it clinically and I've done the research on it, where this generation of digitally addicted kids are primed for substance addiction as they get older because it’s just switching to a more powerful addictive escape. It primes these kids for being more mood disregulated, more impulse disregulated. They develop an addictive profile.
I’m not saying get rid of the tablet. I'm saying don’t give it to the 5 year old. Wait till they’re a little older, when their brain has developed a little bit more and they have more executive functioning control.
I know it’s kind of a shocking revelation but I think if we want to meaningfully do a preventative component to this, it’s also acknowledging what’s driving our children’s impulsivity, and that’s only one aspect of it.
‘IT’S ABOUT FORTIFYING THE KIDS’
I think we have to go back to primary, elementary school programs that give kids that sense of resiliency, sense of empowerment, because those are the two fundamental ingredients that can be immunizing from future addiction. So if you can help nurture those three things in some kind of school program, whether it’s sports in schools or having civics classes or character development.
I’m an old retired martial artist, I was involved in a karate and counseling program in a school district where we would teach karate to middle school and high school kids, and these kids had better outcomes. Karate taught you self-discipline, impulse control, how to focus.
It wasn’t looking at drugs, because you’re looking at the wrong end of the telescope when you’re focusing on the drugs. It’s looking at how we can help fortify these young kids growing up so that when they do swim in the socioeconomic cultural waters we've created as a society, they’re better immunized to handle it, they’re better conditioned to handle it.
That, I think, is really the big picture solution: understanding that we’ve got to help make our young kids stronger, more resilient, and more emotionally stable. And not just drop a tablet into the crib and not just not talk about these issues or giving them some kind of condition in that way.
‘WE’RE NOT GOING TO NARCAN OUR WAY OUT OF THIS EPIDEMIC’
Throwing money at treatment isn’t necessarily the solution, because by the time you’re treating someone, the horse has already left the barn. The person’s already addicted. What gets to me is these Narcan initiatives -- every first responder is getting Narcan now, there’s a movement that school librarians have Narcan. We are not going to Narcan our way out of the opioid epidemic. It is saving lives, I'm not going to deny that, but it’s not addressing the issue. It’s putting the Band-Aid on the dead person after they already fallen down the rabbit hole. It doesn’t address why they’ve fallen down the rabbit hole.
Portugal had the highest rates of opioid addiction, heroin addiction in all of Europe 15 years ago. They hired a top panel of experts to make recommendations to the government at the time and they recommended decriminalization but also switching all resources -- because at that point they sort of had the American war-on-drugs model and a lot of criminalizing the problem. So they shifted resources into job training, micro loans, treatment -- basically giving a person a reason to get up in the morning, to feel a sense of purpose and connectedness in their lives. So that person is much less likely to reach for the bottle of Vicodin in their parent’s medicine cabinet than the person who’s just drifting without any sense of purpose, without any job or hope or without any sense of self concept.
ADDRESSING THE UNDERLYING PROBLEM IN TREATMENT
The biggest predictor of success and recovery is length of time in treatment. Obviously you have to be abstinent for a period of time, obviously you have to detox the person. You can’t paint a house before you put out the fire. You have to put out the fire though a detox process. So typically opioid addicts will get detox with either suboxone or methadone. They’ll get detox for a period of anywhere from three to 14 days. The research shows that the slower you taper or the slower you detox someone, the more effective it is because there’s less of a rebound effect.
But that’s not the end of the game because the mistake that a lot of people make is they go to detox or they go to rehab for 30 days, and they pat themselves on the back and they say, “I'm done.” These people typically are what we might call them the frequent fliers of treatment, because they're not addressing the underlying drivers of the problem and they're not giving themselves enough time to reshift their lifestyles and their maybe negative thought pattern. So the biggest predictor of long-term success is how long a person stays tethered to an outpatient program therapy, 12-step, connection -- those are the things that help keep people on the path.
MENTAL HEALTH AND OPIOID ADDICTION
The one other driver of this epidemic that I haven’t talked about enough -- a new study just came out that showed the large percentage of opioid addicts who have dual diagnoses where they have mental health issues, primarily anxiety and depression. We know in the addiction treatment community that addiction tends to be co-morbid with other mental health issues. The average addict, 65 to 70 percent of the time, also have some underlying depression or some underlying anxiety. In fact, we might say the primary issue is the anxiety and depression and that the addiction is just the self-medication of the underlying issue.
We do know that depression rates are rising. The World Health Organization said that depression will be the number two chronic debilitating illness by the year 2020. And so increased depression equals increased vulnerability to addictive disorders. We do know that anxiety rates are rising, again partially, I think, because of a 24/7 digitally overstimulating world.
THE 'PERFECT STORM' EXPLODES INTO EPIDEMIC
You’ve got the perfect storm of factors that come together to this explosion of the opioid epidemic. We have to look at all the storm fronts: the socioeconomic, the mental health, the cultural. The availability, the supply. The increased strength of the opiates. The fact that medical doctors and medical schools are getting one day of addiction training. All of that comes together in a pretty toxic way. It is a complex issue, and these are the drivers.
There are mornings that I wake up and I think, “Oh, my God, this is not going in a good direction.” And because I do understand the cultural socioeconomic complexity of it, that’s what makes it such a difficult fix. If it was just some law that can be passed, if it was just some PSA campaign, OK, then we might have some hope. But because of the complexity there are times it seems really bleak.
But it's like a 12-step program, you can’t get better until you admit that there’s a problem. I think that the more understanding we can have about this as a society, the better we’ll be able to create solutions, rather than sort of knee-jerk Band-Aid problems.
** This interview have been edited for length and clarity.