The rates of death by opioid overdose in the United States have risen steadily since 1999, fueled by prescription opioids, heroin, and synthetic opioids like fentanyl. By 2016, the U.S. Department of Health and Human Services reported that 116 Americans per day were dying of an opiate overdose. In fall 2017, U.S. President Donald Trump declared the crisis a “health emergency”—yet he requested no funds to address the problem.
Canada has also seen a spike in deaths by opioid overdose, with an estimated 4,000 people dying in 2017. High rates of overdoses in Vancouver—more than 200 in 2016—have put a strain on the city’s police and fire resources.
In American and Canadian streets, rehabilitation centers, classrooms, newspapers, and on the steps of government offices, Adler students, faculty, and alumni face the problem with real action motivated by the philosophy that the overdose crisis is not just a public health emergency but also a social justice issue.
Meet four members of the University community who are tackling the epidemic in word and deed. Their work reflects Adler’s holistic approach to fighting for the victims of the overdose epidemic. They work directly with people who use drugs and advocate for policy changes that will address systemic issues. They stress the need for harm reduction, supporting practical strategies aimed at reducing negative consequences associated with drug use. They approach people who use drugs with compassion, instead of viewing them as criminals. They understand that we cannot prevent future deaths with punitive measures. We have to address the root causes by advocating for policy change.
Finding Meaning in Unspeakable Loss
When the Overdose Epidemic Got Personal, Deb Bailey
Responded the Only Way She Knew How
Vancouver—Before retiring this spring from her position as the Vancouver Campus’s Social Justice Practicum Manager, Deb Bailey, M.A. ’92, facilitated partnerships between Adler University students and organizations that address the overdose epidemic, like the British Columbia Centre on Substance Use and Vancouver’s legal safe-injection facility, InSite.
When the Adler Student Association asked Bailey, now an adjunct faculty member, how it could help fight the epidemic, she suggested it pair with Moms Stop the Harm, an advocacy group she belongs to that agitates for more effective, realistic, and compassionate policy to reduce death by overdose. In late 2017, Adler students worked with Moms Stop the Harm in a campaign to bring the crisis to the Canadian prime minister’s attention by bombarding him with envelopes filled with the names and photos of deceased loved ones.
“I included a picture of my daughter,” Bailey says.
Deb Bailey’s daughter Izzy died of an overdose in 2015 after struggling to obtain Suboxone, an opiate blocker often prescribed with onerous restrictions that prevented Bailey from acquiring the drug on behalf of her daughter. “That’s how I got started with advocacy—there were so many systemic barriers with Izzy that just didn’t make sense,” Bailey says. Her personal mission is for the government to lift confidentiality restrictions for families trying to help an addicted person.
“We get the idea of confidentiality, but there are so many cases where families wanting to help are locked out of the process,” Bailey says.
The Adlerian concept of social interest motivates her as an activist and as a parent, Bailey says. “I wasn’t just interested in advocating for myself and my daughter. I could see what happens to all the parents and kids who just don’t have the skills to advocate for themselves.”
Adler students also took part in Moms Stop the Harm’s 2018 Flags of Hope demonstration, which Bailey describes “as a visual representation of all the people that we have lost.” Volunteers made small flags in honor of each person lost to the crisis and brought them to the British Columbia Parliament Buildings. Bailey says, “We’re asking the government to take action toward legalization and regulations in addition to medically assisted treatment.”
Bailey helped bring the fight against the epidemic to the Vancouver Campus by facilitating 2017’s Community Action Day. During the session, students learned how to administer lifesaving naloxone nasal spray, receiving their own portable bright blue kits so they are equipped to reverse an overdose should they witness one. “I generally carry mine clipped to the outside to my purse,” Bailey says. “I’m hoping that people will ask me what the kit is, so I can explain how you can get it. In Vancouver the kits are free—anyone can carry one. “
As part of Community Action Day, Adler students also took a different type of neighborhood tour. While the Vancouver Campus is located in the city center, it is not too far from the Downtown Eastside neighborhood, which is particularly affected by the crisis.
“If you’re a visitor to Vancouver and you walk around the Downtown Eastside you might be alarmed by what you see,” Bailey says, referring to residents who are homeless, mentally ill, or using drugs. “We have people that sleep in the doorways. It reminds me of when we were down on Michigan Avenue in the ’80s in the Adler building in Chicago. We’re right in there.” However, she says, “It’s not a dangerous area,” although she allows that it’s dangerous to the users. “They tend to victimize each other.”
Bailey says the discreet tour, where students met the neighbors and handed out bottled water, was organized with the goal to “make our students comfortable, like this is our neighborhood and these are our people.” By doing so, she hopes Adler students get an idea of what their work will entail. “You can intellectualize social justice, but until you actually get out there working in the streets, you don’t internalize it,” she says.
Bailey speaks openly with Adler students about Izzy’s death, hoping it illustrates the urgency of the epidemic. “If this is going to happen to the child of one of their professors, it can happen to anybody,” she says. In turn, the school community rallied to her side. “When my daughter passed away, the student body buoyed me up with their care and concern. They were very supportive of anything I did, and were always asking what was the latest.”
Bailey wants Adler students to witness not only what happened to her but what she’s doing about it. “I think I’ve been an example to them by being open about what has happened and also showing them that this is how advocacy works. ‘This is the latest thing I’m doing; jump onboard if you want to.’ You start to see the impact that just one person can have.”
Art and Science
Helping People in Recovery with Counseling and Art Therapy
Addison, Illinois—Kristin Yarnell, M.A. ’17, puts her degree to work every day as a counselor at a residential treatment center run by Serenity House Counseling Services, Inc., in Addison, a suburb of Chicago.
Early training: I studied art therapy and counseling at Adler. I knew going into school I wanted to work with the addiction population, so I sought out internships that focused on that specifically. They train you like full-time staff as an intern at Serenity House. They don’t dance around and say, “You’re just an intern; you’re not doing these things.” They really give you the ability to work in the field. When I was hired on full time, the workload shifted minimally.
There’s a lot of responsibility as an intern. Specifically for the opioid crisis, they provide the interns with naloxone training. When we have a majority of younger clients like we do now, the drug of choice is heroin. It’s not just heroin; it’s fentanyl [which is highly lethal even in small doses].
A changed perspective: Previously, I had this perception that addicts were bad people. I learned that wasn’t the case. Coming into my practicum and now my work, it’s extremely inspiring to see how our clients are like superheroes. Many of them have felonies on their record; some are self-referral and they’ve never had any legal involvement.
I get asked, “Do you ever fear working with these people?” I feel like it’s no different than working at Starbucks. They’re all regular people.
High expectations: The 90-day program at Serenity House is very rigid. These men and women are jumping through hoops to be here. They’re obtaining jobs, although it’s not their dream job. They’re struggling with cravings, learning basic skills, along with little things like obtaining a driver’s license after having it suspended or giving up cigarettes and not drinking coffee. I don’t know if I could make it through the program myself. We set these high expectations and so to see people being so passionate and so determined about their recovery and really changing their life around, it’s inspiring.
When addiction wins the battle: You see it sometimes: clients who are high when they come home. People ask, “Why would you do that?” If you don’t have anywhere else to go but you’re getting high, then you go to the place where your stuff is. When you’re actively using, you’re not really considering anyone else. Sometimes you’ll see multiple relapses in a row. It’s really challenging and triggering for other clients, to see somebody you had a close bond with come home high. It’s not only the coming home high but the not coming home: when you have clients who you expect to see at a specific time and they’re not home. There’s this harsh realization that they’re not coming back.
Preventive measures: Of course with the opioid epidemic, we don’t send our clients out of the house without providing naloxone. We have to discharge if they come home high, but they are provided with something that can save their life. We actually give them two doses. When you have a client who has obtained up to three months’ sobriety, if they go back to using the same amount that they were using before, it really increases their chances of overdose. Two doses aren’t even enough.
Lessons at work: It’s incredible to utilize my knowledge from my very first addiction class with [Adjunct Faculty Member] Armando Reyes. I wrote a paper that pushed me to address women and addiction, and that’s extremely applicable to what I’m doing now.
I use art therapy in my individual and group settings. Many clients in recovery are learning who they are for the first time sober, and they don’t understand what they’re feeling. When they’re using, they’re not fully feeling those emotions. I have a lot of patients who speak vaguely like “I’m sad,” and I’m like, “Let’s work toward that more specifically.” I sometimes ask clients to depict their emotions as weather. Words can be really intimidating, but art can be an escape, and weather is something you understand, it’s tangible.
There was one client in particular who really enjoyed the art-therapy process. I gave her a prompt to draw what her recovery looked like. She created a rendering of a lotus flower, a symbol of light and change, emerging from murky water and ascending into clear water. Her piece harnessed an impressive depth of symbolism from one simple prompt.
There is sometimes a fear that a grown person won’t have the ability to create art and it will look elementary. I tell those clients, “It doesn’t matter if you use stick figures. If these stick figures represent who you are, I don’t care what it looks like.”
Cause No Harm
A Humanistic Model of Therapy in the Classrooms and in the Streets
Chicago—Geoff Bathje, Ph.D., a faculty member in clinical mental health counseling, is actively leading programmatic, research, and policy initiatives that address the overdose crisis. Whether he’s teaching, coordinating clinical services for the outreach program Chicago Recovery Alliance, providing five-minute therapy sessions to homeless people on the street in the North Lawndale neighborhood, or writing grant proposals to fund his work, his efforts are all aimed at using harm reduction—a realistic, human-centered strategy to fight overdoses—to help people who use drugs.
When did you first become involved with harm reduction?
My very first clinical experience was during my master’s program at an in-patient addiction treatment facility, where 90 percent of the program was abstinence-only. I found it frustrating: people would leave and come back in shortly for treatment again and had very confrontational relationships with the staff. It had me curious to find an alternative way of doing things.
Ten years ago, I became more aware of the public health aspects of harm reduction, which means things like syringe exchanges, overdose prevention, and testing drugs for contaminants like fentanyl. My second year at Adler in 2012, I got to teach in Vancouver for a semester. They have one of the most well-known safe-consumption spaces in the world, InSite, where people can legally use drugs within the facility and get advice on vein care. It was such a calm atmosphere and well organized, it was almost like voting day. It was the drug users’ space and they respected it.
What’s changed in the field of harm reduction since then?
One of the biggest developments is the growth of seeing harm reduction as a model for counseling, not just public health. It’s a person-centered, humanistic model of therapy. In traditional addictions counseling, we have concepts like, “You’re enabling if you do anything that doesn’t deter people’s drug use.” That puts the therapist and family members in opposition to a person who is using drugs rather than seeing them as a whole person beyond their drug use and meeting them where they’re at.
How does this play out with your own patients?
My patient population is entirely homeless. Close to 100 percent of them have [post-traumatic stress disorder]. There are very high rates of addiction, serious mental illness, and depression. They’ve been stigmatized or mistreated. If they’ve gotten addiction treatment, the focus was on the drug use and not the root causes of the drug use, like trauma or mental health issues. You can see they’ve rarely had their own opinion respected when it comes to mental health. [But with harm reduction therapy,] very quickly there is a spark where they take ownership with the group. It’s a unique space where they’re there to support each other’s healing.
What work do you do to effect policy change in this area?
I was involved in the organizing to get Cook County jails to give people naloxone when they’re discharged. Coming out of jail is one of the riskiest times for drug users—their tolerance is down, and they are at really high risk of overdose. But if issuing naloxone at discharge can become universal, that would put a major dent, over time, in overdose numbers. I’m also one of the founding members of the Drug Users Health Collective, which is a mix of professionals, allies, and drug users who advocate for policy changes. Right now we’re focused on investigating safe-consumption spaces and what it would take to see one in Chicago. We’re confident we’ll get one.
What role does language play in harm reduction therapy?
I try not to use moralizing terms like “clean” and “dirty” to describe syringes or drug-screen results. I try to use person-first language, not “addict” or “user.” It’s still embedded in our thinking that drug use is a moral issue, which it’s not. In that case, taking an antidepressant or drinking alcohol is also a moral issue.
How does the overdose epidemic relate to social justice?
It’s not something that cuts equally across race or class, even though levels of drug use are the same for every racial group. Part of that is tied to the criminal justice system: jails increase risk of overdose, people are mandated to treatment they don’t want, which also increases risk of overdose. As a result, African Americans overdose at higher rates even though they’re not using the drug at higher rates.
Addiction puts you in one of the most stigmatized groups in society. Yet if somebody uses because they were sexually abused by a random babysitter when they had different babysitters every week because their mother was working several minimum-wage jobs, that’s a social-level failing. When people have been harmed tremendously, we blame them for their situation.
We’re in the position of battlefield doctors trying to patch people up and keep them functional, overwhelmed by the flow of new patients coming in. Prevention is the only real solution, and true prevention means changing laws and social structures in ways that promote wellness, physical and mental. I want to encourage counselors to not just treat their individual clients but to consider the systemic factors that put their client in that situation, and address those issues, too.
A Seat at the Table
How One Alumna’s Activism Is Affecting the Overdose Epidemic in New York
New York—A woman with short hair and hoop earrings holds a blue overdose rescue kit in one hand. The other holds a sign that reads, “Mr. Mayor, ‘SOON’ is too late. We need SCS NOW!” Her black hooded sweatshirt bears the logo of Voices Of Community Activists & Leaders (VOCAL-NY), the group that sat in, protested, and chanted “Release the report” on the steps of City Hall in spring 2018.
The report in question was a 2016 study sponsored by the City Council to measure the feasibility of safe-consumption spaces (SCS) to help make drug use safer, to better respond to overdoses, and to provide health and addiction services. However, Mayor Bill de Blasio had stalled on releasing the results of the study, saying in February 2018 he would release the report “soon.” With people’s lives in jeopardy, VOCAL-NY and other affiliated groups spoke up.
Jasmine Budnella, M.A. ’17, is VOCAL-NY’s drug policy coordinator. “That action in April was extremely powerful,” she says. “People got dragged out. When they were blocking the doors of City Hall, they started listing the numbers, one by one, of how many overdoses there have been since de Blasio said ‘soon.’” The rally—boosted by a Facebook livestream and an editorial she published in the New York Daily News—helped further open the public discussion over safe-consumption spaces, Budnella says.
While it’s hard to find wins in the war on drug overdoses, VOCAL-NY helped notch one. In May 2018, de Blasio announced plans to open four safe-consumption spaces in the city.
VOCAL-NY is a grass-roots membership organization that not only advocates for but is largely made up of low-income people affected by HIV/AIDS, hepatitis C, the drug war, homelessness, and mass incarceration.
The organization’s offices include what is known as a low-threshold bathroom. “People come in, they bring their drugs, they inject in our bathroom,” Budnella says. “When they overdose, we bring them back to life.” The offices also provide connections to treatment and housing for those who request it. Budnella says the bathroom is used every day, including by one participant who has been coming regularly since she began working at VOCAL-NY in November 2017. He recently told her he’d decided to go to detox. “It’s wonderful to see,” she says.
Budnella first became interested in the issues of policy and equality in regards to the war on drugs when she was an undergraduate at the University of Denver, taking courses in political science and gender studies. With the backdrop of Colorado’s legalization of marijuana, she interned at a Denver syringe exchange. “I noticed how the healthcare system has really been harmful for people who use drugs,” she says. “I really wanted to change that.”
That realization led Budnella to obtain her public policy degree with an emphasis in human rights at Adler University’s Chicago Campus.
“To learn how to work the system, you have to know the system. I really wanted to learn policy to be able to change it,” she says.
At Adler, Budnella saw community bridge building at work. “I always tell people that the criminal justice organizing in Chicago is amazing. It’s the gold standard.” However, she was frustrated to see that the people influencing policy were not the ones directly impacted by it. She contemplated how to better coordinate activists for harm reduction and criminal justice. “They’re closely knitted,” she realized. “If we all could do a little bit better at organizing in all advocacy spaces, we could galvanize to do some really amazing work on both fronts.” She was alerted to a job opening at VOCAL-NY and soon found herself at work, deep in policy and activism, working alongside those who need it most.
“It’s absolutely stigmatizing to say, ‘Somebody who uses drugs doesn’t know how to influence policy, but somebody who is a Ph.D. does,’” she says. “People who use drugs are experts at what they do.” She feels lucky to work at an organization that embodies her attitude about activism. “The people at the table aren’t the people who need to be, usually. VOCAL turns that on its head. Let’s get together and fight.”