Addiction and Drug Use

Kimberley Enyart was never interested in doing recreational drugs. But then she was in a car accident — and her doctor prescribed a powerful opiate for the pain.

"It just would put me off in la-la land, and make me feel better," she says. "I loved it. I loved that high."

When Enyart's prescription ran out, she did whatever she could to convince other doctors that she needed more. Eventually, she moved on to dentists.

"I even had two back teeth pulled over it," she says.

Andrew Chambers is one of five addiction psychologists in the state of Indiana.
Andrew Chambers

Containing the nation’s growing heroin addiction and ongoing prescription opioid abuse epidemic, is often presented as a law enforcement problem. But behavioral health specialists say the addiction treatment side of the equation is equally urgent. And it’s an uphill battle in many states where addiction psychiatrists are few and funding is lacking.


Making morphine — or heroin*, for that matter — isn't easy. You have to know a bunch of fancy chemistry to synthesize the drug from scratch. Or you have to get your hands on some opium poppies and extract morphine from the flowers' milky juice.

The latter is tougher than it sounds. Sure, the beautiful flowers grow across millions of acres around the world. But farming and trading poppies are tightly regulated both by laws and by drug kingpins.

Be.Futureproof / flickr

Several years ago, Missouri State Representative Holly Rehder’s daughter struggled with prescription drug abuse. “She had cut her thumb at work and went and got stitches and got a prescription,” Rehder recalls. When her prescription ran out she continued using the pain killers, says Rehder, “because they were so easy to obtain.”

Now, Rehder is sponsoring a bill to make it harder for addicts to obtain drugs in Missouri.


Patrick Pezzati walks briskly through downtown Turners Falls in western Massachusetts with a hard plastic bottle in one pocket of his shorts and a pair of latex gloves in the other.

He stops to peer down steps leading to a basement. Later, he peers under a chunk of carpet lying outside.

The local record store owner is scouring the back alleys of this picturesque former mill town for used needles.

Even after an accident with a carload full of pills gets her arrested, Nurse Jackie Peyton can't be honest about her addictions. Especially not while explaining her sudden absence to her ex-husband Kevin.

"Where were you this past week?" Kevin asks, tensely.

"Really, you want to know where I was?" Jackie responds. "I went to a detox program."

"Is that what you call jail?" he shoots back. "I was notified of the accident. The car's still in my name."

Number of Providers per 1,000 Adults with Addictions
Jeff Zornitsky / Advocates for Human Potential

This story was provided to Sound Medicine by Stateline, an initiative of the Pew Charitable Trusts.

The number of people with insurance coverage for alcohol and drug abuse disorders is about to explode at a time there’s already a severe shortage of trained behavioral health professionals in many states.

Until now, there’s been no data on just how severe the shortage is and where it’s most dire.  Jeff Zornitsky of the health care consulting firm Advocates for Human Potential (AHP) has developed the first measurement of how many behavioral health professionals are available to treat millions of adults with a substance use disorder, or SUD, in all 50 states.

Zornitsky’s “provider availability index” – the number of psychiatrists, psychologists, counselors and social workers available to treat every 1,000 people with SUD – ranges from a high of 70 in Vermont to a low of 11 in Nevada. Nationally, the average is 32 behavioral health specialists for every 1,000 people afflicted with the disorder.  No one has determined what the ideal number of providers should be, but experts agree the current workforce is inadequate in most parts of the country.

“Right now we’re in a severe workforce crisis,” said Becky Vaughn, addictions director for the industry organization National Council for Behavioral Health.  The shortage has consequences, she said. “When people need help for addictions, they need it right away. There’s no such thing as a waiting list. If you put someone on a waiting list, you won’t be able to find them the next day.”

The shortage of specialists threatens to stall a national movement to bring the prevention and treatment of SUD into the mainstream of American medicine at a time when millions of people with addictions have a greater ability to pay for treatment thanks to insurance.

Shane Avery practices family medicine in Scott County, Ind. In December, a patient came to his office who was pregnant, and an injection drug user.

After running some routine tests, Avery found out that she was positive for HIV. She was the second case he had seen in just a few weeks.

"Right then, I kind of realized, 'Wow, are we on the tip of something?' " Avery says. "But you just put it away. ... It's statistically an oddity when you're just one little doctor, you know?"

Founded by two men in Akron, Ohio, in 1935, Alcoholics Anonymous has since spread around the world as a leading community-based method of overcoming alcohol dependence and abuse. Many people swear by the 12-step method, which has become the basis of programs to treat the abuse of drugs, gambling, eating disorders and other compulsive behaviors.

Pages