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Chicago Tribune
10 hours ago
- Health
- Chicago Tribune
Dr. Diana Fishbein: This is how addiction science is saving lives
Like many who have endured childhood trauma, Shannon Hicks turned to drugs at an early age. Pregnant by 16 and a mother of two by 19, she was married and living in her first home — believing she was living the dream. Shortly after her 20th birthday, Hicks was in a serious car accident and prescribed opioids for the resulting pain. But the medication unearthed long-suppressed trauma from childhood sexual abuse, intensifying her opioid use and deepening her dependence. She described the effect of drugs as similar to being shielded from a storm. 'When it's pouring down rain on your car, and it's so loud you can't hear anything else … then you go under a bridge and suddenly, it's quiet. Drugs were my bridge,' Hicks said. Over the next two decades, Hick's addiction spiraled out of control. She endured four aortic valve replacements — two due to heart infections from reusing needles. Her body was deteriorating, and death felt imminent. But surviving the unthinkable became her turning point. Determined to reclaim her life and help others do the same, she began her recovery journey. But how, given the depths of her addiction? Sheer determination and courage gave her the strength to try. And Suboxone (buprenorphine) was the catalyst that made it possible. Using a 'replacement' medication, called medication-assisted treatment (MAT), to treat opioid addiction is backed by decades of research that have led to the development of a suite of such drugs. Clinical trials to determine the effectiveness of MAT have since proved their worth by helping hundreds of thousands overcome opioid use disorders. It was the medical support Hicks needed to begin the challenging work of healing. Just as critical to her recovery were harm reduction strategies. Access to sterile injection supplies helped her avoid further infection. Naloxone, a drug used to reverse opioid overdose, offered a safety net. And efforts to reduce the stigma surrounding addiction gave her space to seek help without shame. Stigmatizing language portrays people who use drugs as immoral or criminal, pushing them away from care. Evidence shows that those who benefit from harm reduction and anti-stigma efforts are five times more likely to enter treatment than those not using the programs. These life-altering measures were made possible by federal investments in addiction science. The National Institute on Drug Abuse, part of the National Institutes of Health, has led much of the research on risk factors for addiction and how best to prevent it and, in those addicted, how to treat it. And the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control and Prevention have translated this science into public health practice — bringing treatment and prevention programs into schools, clinics and communities. These agencies have helped fuel transformative progress — increasing treatment access and outcomes, reducing secondary disease transmission, supporting families and preventing youth from using drugs. Policies informed by this research have lowered addiction-related crime, suicide, overdose and public health costs — proving to be not only effective, but also economically smart investments. But now, all the hard-won progress made for people like Hicks is at risk. Actions by President Donald Trump, the Department of Government Efficiency initiative, and Health and Human Services Secretary Robert F. Kennedy Jr. have already disrupted operations of federal agencies that fund addiction research. And most recently, the 2026 budget — otherwise known as the 'big, beautiful bill' — was passed into law, forecasting even deeper cuts to these agencies, billions below 2025 levels. Adding injury to insult, reductions in Medicaid, the largest single payer of behavioral health services in the U.S., including addiction treatment, will begin to take effect. If enacted, these cuts would further devastate addiction science and practice. Research into the causes, consequences and treatment of addiction would stall. Lifesaving clinical and community services would shrink or disappear. Programs shown to prevent youths from initiating drug use would vanish. We risk reversing decades of progress, condemning future generations to needless suffering and increasing the overall costs to society. This imminent threat has galvanized the addiction science community. In response, the Addiction Science Defense Network (ASDN) was formed to advocate for preserving addiction science research and research-based treatment, prevention and policies that help us to combat addiction. Nearly 500 addiction scientists and practitioners, 32 organizations representing more than 32,000 scientists and 100,000 providers, and the advocacy group Stand Up for Science — with 60,000 members — have endorsed a statement of concern. The statement and other advocacy efforts urge Congress, Kennedy and the directors of NIH, the CDC and SAMHSA to fulfill their responsibility to support science-driven policies and practices that protect public health. We ask that the damage already done be mitigated with bipartisan revisions to their budgets so that funding for these agencies is preserved to protect the solutions that help people recover, the services that stabilize families and the infrastructure that safeguards future generations from substance abuse. For Hicks, her story is one of both tragedy and triumph. Her life was nearly lost to addiction, but science-based treatment and compassionate care saved her. Today, she is a recovery coach, harm reduction specialist, youth prevention facilitator and enthusiastic advocate for medication-assisted recovery. She's also a full-time college student pursuing a master's in public health. Her transformation is proof of what's possible when research and recovery meet. With the right support, lives can be rebuilt. Futures can be reclaimed. Communities can heal. But without sustained investment in addiction science, Hick's story could become the exception — not the rule. Diana Fishbein, Ph.D., is a senior behavioral neuroscientist at the Frank Porter Graham Child Development Institute at the University of North Carolina at Chapel Hill and a part-time researcher at Penn State University.
Axios
4 days ago
- Health
- Axios
What to know about civil commitment, Trump's new policy for homelessness
President Trump 's new executive order to combat homelessness encourages local governments to revive civil commitment, a process to place people with mental health issues in treatment facilities without their consent. Why it matters: Involuntary civil commitment has historically been used as a preventative method to confine people before they harm themselves or others, and most frequently affects vulnerable groups such as LGBTQ+, people of color and people with disabilities, according to several studies. Context: The order Trump signed Thursday calls for shifting homeless individuals into "long-term" institutions for "humane treatment" which the administration says will "restore public order." The order directs officials to determine if federal resources can be used to ensure that those "with serious mental illness" are not released back into the public solely because government facilities lack enough beds to hold them. The order also requires the Justice Department to evaluate homeless people arrested for federal crimes to determine if they are "sexually dangerous persons." The other side: Critics say the order won't help people afford homes and that previous attempts at mass institutionalization frequently violated Fourteenth Amendment due process rights. "These executive orders ignore decades of evidence-based housing and support services in practice," Donald Whitehead, Jr., executive director of the National Coalition for the Homeless, said in a statement. He added that the orders "represent a punitive approach that has consistently failed to resolve homelessness and instead exacerbates the challenges faced by vulnerable individuals." Here's what you need to know about Trump's new executive order: What is civil commitment? Involuntary civil commitment is the process in which a judge, or someone else acting in judicial capacity, orders a person be admitted to a psychiatric hospital or a supervised outpatient treatment facility without their consent. The specific criteria that a person needs to exhibit to be confined varies in every state, but the guidelines usually mention those with mental illness, developmental disabilities and substance abuse issues that pose a danger to themselves or others. Modern day commitment proceedings have to follow due process laws under state and federal law. How was civil commitment previously used? Before the late 1960's, people with mental health issues were often thrown into jails for vagrancy alongside criminals, according to the Substance Abuse and Mental Health Services Administration. The standards that states had to follow to commit someone had little legal oversight. Since then, there's been a push to orient facilities towards mental health treatment rather than incarceration. More than 500,000 people were committed to mental health treatment facilities in the 1950s, according to a 2010 study. That number fell to 30,000 by the 1990s with a shift in focus on treatment. The Supreme Court has also stepped in to define the boundaries of civil commitment. In a case out of Florida in 1975, the court ruled that an individual must pose a danger to themselves or others to be held against their will. The court ruled in a separate case in 1979 that a "clear and convincing" standard of proof is necessary for involuntary civil commitment. Who was most likely to be affected by civil commitment? The American Psychiatric Association classified"homosexuality" as a mental disorder until 1973, making it easy for states to send LGBTQ+ people to institutions because of their sexuality. Having a "mental abnormality" is typically a requirement for admission to a facility, according to the Prison Policy Initiative, which researches the effects of mass incarceration. The group argues that having a definition that broad would imply that all people who are civilly committed are disabled, which made it hard to accurately determine the number of disabled people in the population studied. Patients of color are more likely than white patients to be committed to involuntary psychiatric hospitalization, according to a 2022 report from the American Psychiatric Association.
Yahoo
4 days ago
- Politics
- Yahoo
Lopez: Trump's order on homelessness gets it all wrong, and here's why
President Trump has the answer to homelessness. Forcibly clear the streets. On Thursday, he signed an executive order to address 'endemic vagrancy' and end 'crime and disorder on our streets.' He called for the use of 'civil commitments' to get those who suffer from mental illness or addiction into 'humane treatment.' This comes after last year's U.S. Supreme Court ruling making it legal for cities to punish people for being homeless, even if they have nowhere to go. There's some truth in what he says, and California's record on housing and homelessness is ripe for criticism. I've watched too many people suffer from addiction and mental illness and asked why the help is so slow to arrive. But I also know there are no simple answers for either crisis, and bluster is no substitute for desperately needed resources. Like a lot of what Trump does, this is another case of grandstanding. In the meantime, the Washington Post reported Thursday that the "Trump administration has slashed more than $1 billion in COVID-era grants administered by the Substance Abuse and Mental Health Services Administration and is proposing to slash hundreds of millions more in agency grants." As it happens, I was in the middle of a column on the latest Los Angeles homeless count when news of Trump's executive order broke. I had just spent time with two homeless women to hear about their predicaments, and none of what Trump is proposing comes close to addressing their needs, which are tragically commonplace. Namely, they're living in poverty and can't afford a place to live. In his executive order, Trump said that 'nearly two-thirds of homeless individuals report having used hard drugs … in their lifetimes. An equally large share of homeless individuals reported suffering from mental health conditions.' I don't know where he got those numbers, but truth and accuracy are not hallmarks of this administration. Read more: 'Very aggressive treatment' on the streets of Skid Row from a 'Renegade M.D.' No doubt, addiction and mental illness are significant factors, and more intervention is needed. But that's more complicated than he thinks, especially given the practical and legal issues surrounding coercive treatment — and it's not going to solve the problem. When the latest homeless count in Los Angeles was released, a slight decline from a year ago was regarded by many as a positive sign. But when Eli Veitzer of Jewish Family Service L.A. dug into the numbers, he found something both unsurprising and deeply disturbing. The number of homeless people 65 and older hadn't gone down. It had surged, in both the city and county of Los Angeles. 'This isn't new this year. It's a trend over the last couple of years,' said Veitzer, whose nonprofit provides meals, housing assistance and various other services to clients. 'It's meaningful, and it's real, and these people are at the highest risk of mortality while they're on the streets.' The numbers from the Los Angeles Homeless Services Authority showed a 3.4% decrease in the total homeless population in the city, but a 17.6% increase among those 65 and older. The county numbers showed a 3.99% decrease overall, but an 8.59% increase in the 65 and older group. In the city, the increase over two years was from 3,427 in 2023 to 4,680 this year — up 37%. Reliable research has shown that among older adults who become homeless, the primary reason is the combination of poverty and high housing costs, rather than mental illness or addiction. 'They or their spouse lost their job, they or their spouse got sick, their marriage broke up or their spouse or parent died,' Dr. Margot Kushel of UC San Francisco's Homelessness and Housing Initiative was telling me several hours before Trump's executive order was issued. Her team's landmark study, released two years ago (and covered by my colleague Anita Chabria), found that nearly half the state's homeless residents were 50 and older, and that participants in the study reported a median monthly household income of $960. 'The results … confirm that far too many Californians experience homelessness because they cannot afford housing,' Kushel said at the time. Among the older population, Veitzer said, the jump in homelessness comes against the backdrop of federal and local budget cuts that will make it harder to reverse the trend. And harder for nonprofits, which rely in part on public funding, to keep providing group meals, home-delivered meals, transportation, social services and housing support. 'Every provider I've talked to in the city of L.A. is cutting meal programs,' Veitzer said. 'We're going to have to close two of our 13 meal sites, and last year we closed three. We used to have 16, and now we're down to 11.' On Wednesday, I went to one of the sites that's still up and running on Santa Monica Boulevard, just west of the 405, and met Jane Jefferies, 69. She told me she's been camping in her vehicle since February when living with her brother became impossible for various reasons. She now pulls into a Safe Parking L.A. lot each night to bed down. Jefferies said she collects about $1,400 a month in Social Security, which isn't enough to get her into an apartment. At the senior center, she uses her own equipment to make buttons that she sells on the Venice boardwalk, where she can make up to $200 on a good weekend. But that's still not enough to cover the cost of housing, she told me, and she's given up on government help. 'All the funding has been cut, and I don't know if it's because a lot of the city and state funding is subsidized by the federal government. We all know Trump hates California,' she said. As Veitzer put it: 'There's nowhere near enough low-income senior housing in L.A. County. Wait lists open up periodically," with far more applicants than housing units. "And then they close.' His agency delivers a daily meal to Vancie Davis, 73, who lives in a van at Penmar Park in Venice. Her next-door neighbor is her son, Thomas Williamson, 51, who lives in his car. Davis was in the front seat of the van when I arrived, hugging her dog, Heart. Her left leg was amputated below the knee two years ago because of an infection, she told me. Davis said she and another son were living in a trailer in Oregon, but the owner shut off the utilities and changed the locks. She said she reached out to Williamson, who told her, 'I've got a van for you, so you'll have a place to live, but it's going to be rough. And it is. It's very, very rough.' I've heard so many variations of stories like these over the years, I've lost count. The magnitude that exists in the wealthiest nation in history is a disgrace, and a sad commentary on an economic system and public policy that have served to widen, rather than narrow, the inequity gap. On Thursday, Trump's executive order on homelessness grabbed headlines but will do nothing for Jane Jefferies or Vancie Davis and for thousands like them. We know the interventions that can work, Kushel said, but with deep cuts in the works, we're moving in the wrong direction. Davis' son Thomas told Times photographer Genaro Molina about another person who lives in a vehicle and has been a neighbor of theirs in the parking lot. She wasn't there Wednesday, but we'll check back. It's a 91-year-old woman. Sign up for Essential California for news, features and recommendations from the L.A. Times and beyond in your inbox six days a week. This story originally appeared in Los Angeles Times. Solve the daily Crossword
Los Angeles Times
4 days ago
- Politics
- Los Angeles Times
Trump's order on homelessness gets it all wrong, and here's why
President Trump has the answer to homelessness. Forcibly clear the streets. On Thursday, he signed an executive order to address 'endemic vagrancy' and end 'crime and disorder on our streets.' He called for the use of 'civil commitments' to get those who suffer from mental illness or addiction into 'humane treatment.' This comes after last year's U.S. Supreme Court ruling making it legal for cities to punish people for being homeless, even if they have nowhere to go. There's some truth in what he says, and California's record on housing and homelessness is ripe for criticism. I've watched too many people suffer from addiction and mental illness and asked why the help is so slow to arrive. But I also know there are no simple answers for either crisis, and bluster is no substitute for desperately needed resources. Like a lot of what Trump does, this is another case of grandstanding. In the meantime, the Washington Post reported Thursday that the 'Trump administration has slashed more than $1 billion in COVID-era grants administered by the Substance Abuse and Mental Health Services Administration and is proposing to slash hundreds of millions more in agency grants.' As it happens, I was in the middle of a column on the latest Los Angeles homeless count when news of Trump's executive order broke. I had just spent time with two homeless women to hear about their predicaments, and none of what Trump is proposing comes close to addressing their needs, which are tragically commonplace. Namely, they're living in poverty and can't afford a place to live. In his executive order, Trump said that 'nearly two-thirds of homeless individuals report having used hard drugs … in their lifetimes. An equally large share of homeless individuals reported suffering from mental health conditions.' I don't know where he got those numbers, but truth and accuracy are not hallmarks of this administration. No doubt, addiction and mental illness are significant factors, and more intervention is needed. But that's more complicated than he thinks, especially given the practical and legal issues surrounding coercive treatment — and it's not going to solve the problem. When the latest homeless count in Los Angeles was released, a slight decline from a year ago was regarded by many as a positive sign. But when Eli Veitzer of Jewish Family Service L.A. dug into the numbers, he found something both unsurprising and deeply disturbing. The number of homeless people 65 and older hadn't gone down. It had surged, in both the city and county of Los Angeles. 'This isn't new this year. It's a trend over the last couple of years,' said Veitzer, whose nonprofit provides meals, housing assistance and various other services to clients. 'It's meaningful, and it's real, and these people are at the highest risk of mortality while they're on the streets.' The numbers from the Los Angeles Homeless Services Authority showed a 3.4% decrease in the total homeless population in the city, but a 17.6% increase among those 65 and older. The county numbers showed a 3.99% decrease overall, but an 8.59% increase in the 65 and older group. In the city, the increase over two years was from 3,427 in 2023 to 4,680 this year — up 37%. Reliable research has shown that among older adults who become homeless, the primary reason is the combination of poverty and high housing costs, rather than mental illness or addiction. 'They or their spouse lost their job, they or their spouse got sick, their marriage broke up or their spouse or parent died,' Dr. Margot Kushel of UC San Francisco's Homelessness and Housing Initiative was telling me several hours before Trump's executive order was issued. Her team's landmark study, released two years ago (and covered by my colleague Anita Chabria), found that nearly half the state's homeless residents were 50 and older, and that participants in the study reported a median monthly household income of $960. 'The results … confirm that far too many Californians experience homelessness because they cannot afford housing,' Kushel said at the time. Among the older population, Veitzer said, the jump in homelessness comes against the backdrop of federal and local budget cuts that will make it harder to reverse the trend. And harder for nonprofits, which rely in part on public funding, to keep providing group meals, home-delivered meals, transportation, social services and housing support. 'Every provider I've talked to in the city of L.A. is cutting meal programs,' Veitzer said. 'We're going to have to close two of our 13 meal sites, and last year we closed three. We used to have 16, and now we're down to 11.' On Wednesday, I went to one of the sites that's still up and running on Santa Monica Boulevard, just west of the 405, and met Jane Jefferies, 69. She told me she's been camping in her vehicle since February when living with her brother became impossible for various reasons. She now pulls into a Safe Parking L.A. lot each night to bed down. Jefferies said she collects about $1,400 a month in Social Security, which isn't enough to get her into an apartment. At the senior center, she uses her own equipment to make buttons that she sells on the Venice boardwalk, where she can make up to $200 on a good weekend. But that's still not enough to cover the cost of housing, she told me, and she's given up on government help. 'All the funding has been cut, and I don't know if it's because a lot of the city and state funding is subsidized by the federal government. We all know Trump hates California,' she said. As Veitzer put it: 'There's nowhere near enough low-income senior housing in L.A. County. Wait lists open up periodically,' with far more applicants than housing units. 'And then they close.' His agency delivers a daily meal to Vancie Davis, 73, who lives in a van at Penmar Park in Venice. Her next-door neighbor is her son, Thomas Williamson, 51, who lives in his car. Davis was in the front seat of the van when I arrived, hugging her dog, Heart. Her left leg was amputated below the knee two years ago because of an infection, she told me. Davis said she and another son were living in a trailer in Oregon, but the owner shut off the utilities and changed the locks. She said she reached out to Williamson, who told her, 'I've got a van for you, so you'll have a place to live, but it's going to be rough. And it is. It's very, very rough.' I've heard so many variations of stories like these over the years, I've lost count. The magnitude that exists in the wealthiest nation in history is a disgrace, and a sad commentary on an economic system and public policy that have served to widen, rather than narrow, the inequity gap. On Thursday, Trump's executive order on homelessness grabbed headlines but will do nothing for Jane Jefferies or Vancie Davis and for thousands like them. We know the interventions that can work, Kushel said, but with deep cuts in the works, we're moving in the wrong direction. Davis' son Thomas told Times photographer Genaro Molina about another person who lives in a vehicle and has been a neighbor of theirs in the parking lot. She wasn't there Wednesday, but we'll check back. It's a 91-year-old woman.
Axios
17-07-2025
- Health
- Axios
LGBTQ+ youth lose specialized 988 suicide line support
LGBTQ+ youth who call the national 988 suicide prevention hotline will lose access to counselors specifically trained to serve their needs starting Thursday. Why it matters: Nearly 40% of LGBTQ+ youth seriously considered attempting suicide in 2023, according to the Trevor Project, and 988's specialized services for LGBTQ+ youth were considered a lifeline for young people who were struggling. Driving the news: The federal Substance Abuse and Mental Health Services Administration (SAMHSA) will stop funding the program, nearly three years to the day after it launched. What they're saying:"Everyone who contacts the 988 Lifeline will continue to receive access to skilled, caring, culturally competent crisis counselors who can help with suicidal, substance misuse, or mental health crises, or any other kind of emotional distress. Anyone who calls the Lifeline will continue to receive compassion and help," SAMHSA said in a statement. Between the lines: Illinois is one of 12 states that has a law that ensures funding for the general 988 suicide line, but that's not specific to LGBTQ+ callers. The other side:"There are a lot of youth that are concerned," Chicago-area therapist Christina Geiselhart tells Axios. "They had almost this extended family of ... 'I have this whole community of people who do support me and do love me for who I am.' We're taking that away; we're taking away these safety nets for these youth." "Having to kind of advocate for yourself and figure things out and figure resources out for yourself because the main system doesn't acknowledge you is so hurtful for so many people." By the numbers: Since its launch, the 988 line has received 16.5 million contacts, including more than 11 million calls, nearly 3 million texts and 2.4 million chats, KFF reported this week. Nearly 1.5 million of those contacts were routed through to the LGBTQ+ service since 2022, and it received more than 69,000 contacts in May, the most since that service has been available. In Illinois, 25.7 per 1,000 people called the hotline in 2024. What's next: The Center on Halsted hosts drop-in hours every Wednesday from 10am to 1pm for young adults ages 18–24 and TransSafe drop-ins from 2pm to 5pm Mondays at its Northalsted location.
