SafeRx Santa Cruz County Receives Support to Strengthen Local Efforts to Reduce Opioid Use, Opioid Use Disorder, and Deaths
(Santa Cruz, CA – April 3, 2018) — SafeRx Santa Cruz County, a community-based coalition, is tackling the opioid epidemic and will receive support to bolster its capacity to reduce new opioid prescriptions, advocate for safe pain management and effective opioid use disorder treatment, and challenge stigma and misconceptions surrounding opioid use disorder. The support, which is being provided to regional coalitions throughout the state, comes through the California Opioid Safety Network (COSN).
“As a community, we have to come together to solve this problem,” said SafeRx physician co-lead, Dr. Jen Hastings. “Tackling this epidemic takes people with diverse perspectives and experience, and that’s the kind of collaboration we’re continuing to build here.”
Funded by the California HealthCare Foundation and managed by Public Health Institute’s Center for Health Leadership and Practice, COSN will provide resources and tools to support SafeRx in continuing to forge a truly local response to the crisis. The momentum comes largely from dedicated volunteers – parents, physicians, pharmacists, and professionals in public health, behavioral health, and law enforcement - striving together to take concrete steps to prevent and treat substance dependence and save lives. Members of SafeRx meet monthly to review data, share their experience and insights, and plan and implement strategies that show promise here or in other parts of the country.
Led by Health Improvement Partnership and Community Prevention Partners, members have chosen to focus on reducing stigma, educating providers and community members on safer pain management and the concept of opioid failure, and increasing the distribution of the overdose reversal medication, naloxone (brand name Narcan).
SafeRx forged a proactive community response to the opioid crisis beginning in 2015. Early achievements have included developing a now widely accepted definition of opioid failure (supporting the idea that the medication has failed the patient and not the other way around), provider education on safe prescribing through five different continuing medical education events, production of new safer prescribing guidelines in the emergency department, creation of community messaging brochures and television commercials, and passing of an Extended Producer Responsibility (EPR) ordinance for the safe county-wide collection of medications and sharps. SafeRx has also been instrumental in achieving various positive trends including reduced opioid prescriptions and an increase in the number of medical providers who hold an X-license, which allows a provider to prescribe opioid-based medications specifically for the treatment of opioid use disorder.
Many Californians are increasingly aware of the scope of the crisis. SafeRx Santa Cruz County invites community members to get involved and bring their own experience and skills to the table.
“We are looking for volunteers from within our community – people who are action-oriented, able to be strategic, and willing to work together,” said Brenda Armstrong, Prevention Program Manager for the County’s Substance Use Disorder Services and Community Prevention Partners. Community members who are interested in contributing to SafeRx’s success can get in touch by contacting Rachel Stein at firstname.lastname@example.org.
At the statewide level, the California death rate has not declined for the last two years but it is holding steady. “At a local level, opioid overdose death rates are decreasing from 44 in 2015 to 25 in 2017”, says Dr. Stephany Fiore, Forensic Pathologist at the Santa Cruz County Sheriff-Coroner’s Office.
“We are seeing signs of progress in this fight, and local coalitions are among the most powerful forces we have,” said Dr. Kelly Pfeifer, Director of CHCF’s High-Value Care team.
The state’s dashboard, created by the California Department of Public Health (CDPH), contains statistics on opioid overdoses by county. See Santa Cruz County here [https://pdop.shinyapps.io/ODdash_v1/].
To learn more about SafeRx Santa Cruz County, visit https://www.hipscc.org/saferx.
Originally published on: https://www.hipscc.org/single-post/2018/04/03/SafeRx-Santa-Cruz-County-Receives-Support-to-Strengthen-Local-Efforts-to-Reduce-Opioid-Use-Opioid-Use-Disorder-and-Deaths
On June 1st 2017, Santa Cruz County was very excited to welcome a new Chief of Substance Use Disorder Services, Shaina Zura. Talk About It was able to touch base with Shaina to learn more about why she works in this field, her vision for substance use disorder services in Santa Cruz County, and some of the things she is excited about.
Talk About It (TAI): Tell us a little about your background. How did you end up as the Chief of Substance Use Disorder Services?
Shaina: I have spent the past 15 years in community-based behavioral health services, with over 11 years focused specifically on substance use disorder service provision and administration. In my work with non-profit organizations I designed and implemented programs, navigated collaborative partnerships with varying stakeholders, conducted trainings, and led multidisciplinary teams. As an LCSW, my clinical expertise lies in gender responsive, trauma- informed care and motivational interventions. When the opportunity of the position of Chief of Substance Use Disorder Services with the County of Santa Cruz arose, it felt like a great match for my skill set and a unique prospect to utilize the body of knowledge I have been building throughout my career.
TAI: You said you are an LCSW (licensed clinical social worker) which can be a very diverse job. What motivated you to focus on substance use disorders specifically?
Shaina: Substance use disorders impact families and communities pervasively, profoundly and indiscriminately. Historically underrecognized and underserved, people who struggle with substance use and the associated trauma have immense capacities for positive societal impact if they are afforded an opportunity to heal and achieve wellness by a system that understands their unique needs. Facilitating that opportunity is what fuels my work.
TAI: What is your vision for Santa Cruz County Substance Use Disorders Services?
Shaina: There is a very clear vision for the future of Substance Use Disorder Services as part of an integrated Behavioral Health system. We intend to expand service accessibility, unite providers into a comprehensive network, and more successfully meet the demands of our community. Our efforts are supported by the Drug Medi-Cal expansion, which brings exciting opportunities for growth.
TAI: Substance Use Disorder Services is a recent name change for your department, formally the Alcohol and Drug Program? Why the change?
Shaina: The science of substance use disorders is more advanced than ever, providing us with medical and clinical data that fuels interventions and leads to strong outcomes. The evolution of the department name comes alongside our current approaches, developing consistency with how we identify and operate the department.
TAI: What are you are most excited about living and working in Santa Cruz County?
Shaina: As a former resident of both San Francisco and Oakland, Santa Cruz was one of my preferred weekend getaways. There are beautiful beaches and mountains to explore, and a progressive culture to enjoy. Living here has quickly turned my every weekend into a new adventure.
TAI: What are some of the things that you do for self-care?
Shaina: I prioritize my physical health with a plant-based diet and regular exercise via a gym routine and lots of outdoor activities. I like to travel, whether it be an international flight or a drive to a new town, as it helps me to stay grounded. I feed my creative side by making art on the living room floor. I am working on my doctorate, as learning and growing helps me be a better person in the world. I actively engage in identifying the things I am grateful for, as not to take them for granted. And, every once in a while I give myself permission to indulge in the art of doing absolutely nothing.
Please join us in welcoming Shaina and say hi if you see her around the community--perhaps giving a presentation on Drug Medi-Cal expansion. We look forward to Shaina's leadership and working together.
Research indicates that the language we use to describe substance use disorder can either contribute to or alleviate the stigma. Fortunately, the language is beginning to shift, just as it has around other diseases or mental health conditions. In a recent revision, the Associated Press Stylebook (a guide for journalists and writers) took an important step by recommending that writers no longer use "addict" as a noun, and instead choose phrasing like “he was addicted” or “people with heroin addiction” or “she used drugs”. This important change separates the person from the disease.
The AP Stylebook also prompts writers to distinguish between addiction and dependence in relation to drug use, as they are two very different things. A person may be dependent on a medication that provides important health and treatment benefits, whereas addiction is a medical disorder marked by compulsive drug use despite negative consequences. Failure to distinguish between the two has led some to refuse medication assisted treatment because they are concerned about trading one addiction for another. Medication assisted treatment, such as methadone or buprenorphine, is considered a very effective evidence based practice by treatment professionals. In an article by Maia Szalavitz published by NPR on June 11, 2017, Szalavitz explains, “Widespread media misunderstanding of the fundamental nature of addiction has led to some deadly misconceptions about how it should be managed… it [language changes] could genuinely help improve drug treatment and policy by reducing stigma against lifesaving forms of treatment…”
Having an influential organization such as the AP recognize the importance of how we talk about substance use disorders is a huge step forward in helping society understand SUD as a medical issue rather than a moral failing or lack of will power. As our community makes this change, it will lead to more people feeling safe in seeking treatment for this disorder.
About the Author: Pam Newbury is the editor of the League of Women Voters' VOTER Santa Cruz newsletter and a member of the Talk About It initiative.
Spotlight: AB 109 and Alcohol and Drug Treatment Coordinator, Rosie Murillo, whose dedication to client wellbeing translates to impact
Rosie Murillo works as a Mental Health Client Specialist through the county. She primarily works with the AB 109 population of Santa Cruz County by assisting them in their drug and alcohol treatment programs. Rosie is described by her clients as someone who is truly dedicated and makes a real difference in people’s lives.
Rosie Murillo grew up in Weslaco, Texas with her family of nine and later moved to Watsonville, California when she began the 2nd grade. When asked about the origins of her inspiration to pursue her current line of work, she gives a large amount of credit to the actions of her parents. Murillo’s mother played a vital role in influencing Murillo’s future career with her community oriented outlook. She recalls that her mother would engage in various community focused activities ranging from passing out lunches to the neighborhood’s homeless population to watching the children of other families while their parents were at work. Murillo even remembers an instance when her mother took in a child for five years while the child’s parent was getting their life back on track. Murillo’s father influenced her greatly because of his refusal to give up what he loved. With this combination of her mother’s community driven outlook and her father’s passion, Murillo was sent on a path that fueled her want and desire to help those whom she loves, and those within her community.
Murillo first began her line of work in the community by helping assist friends, family, and loved ones dealing with alcohol abuse. Finding the proper treatment for them was incredibly important to Murillo. Her approach was not to try and force people to change, but rather to determine ways to empower and motivate them to change on their own. Some examples of Murillo helping with this discovery of self empowerment included taking individuals to community events, or even leaving brochures ranging from domestic violence to substance abuse around their homes. She says that her ultimate goal was to help those who did not know how to ask for help and to start the conversations about such topics within the community. An example of getting the community conversation started can be seen with her early work volunteering at a farm workers clinics, where many of the clients expressed that alcohol was important to them and that it would ease the pain of a hard day's work.
Today, Murillo works as a “Mental Health Client Specialist,” though she refers to herself as a “Service Coordinator.” Murillo has been working in alcohol and drug programs for the past 30 years. And as of June 2017, she will have worked in Santa Cruz county for 17 years. She began this work when many of the drug and alcohol support programs in operation today were non-existent. The population she works with today is primarily the AB 109 population who, Murillo stated several times, she absolutely loves to work with (For more information about the AB 109 population and the program’s impact within Santa Cruz County, visit http://bit.ly/2rwqVWn).
Murillo currently works through the Santa Cruz County probation department and her work with the AB 109 population includes receiving referrals for inmates from the local Santa Cruz county jails and the Watsonville Roundtree facility (a rehabilitation and reentry facility). Once a referral has been sent, Murillo then conducts an assessment and interview with the client in order to determine the level of care and support needed for treatment. The range of treatment options for clients range from community support to housing in a sober living environment. Murillo loves working with this program because of how much assistance it provides to those who enter into it.
When asked what the highlight of her career has been, there was a loss for words because she said that there were too many positive impacts and highlights to think of but she narrowed the plethora of highlights to a concept that she says is the reason she loves to get up and go to work every morning. Murillo’s biggest highlight was expressed through a client whom she helped while Murillo was working in Monterey County. This individual is now leading their own assistance program. They and Murillo still speak every so often and Murillo says that this client always says “thank you.” To Murillo, this thank you means more than a "thank you" for the assistance provided, but a "thank you" for giving the the client their own way to find themselves. Murillo believes that this is the most important thing that her clients need. Her objective in helping people empower themselves, from when she first started helping her friends and community members, has been unwavering during her 30 years in this line of work.
Looking to the future, Murillo appears to have no plans of slowing down. She is currently of retirement age and tells herself that maybe she’ll retire in a few years, but has been telling herself that for several years already now. Murillo plans to continue in her father’s footsteps and never stop doing what she loves because according to Murillo, addiction will always be around unless that vicious cycle is broken. Even if she does eventually choose to take the path of retirement, Murillo says that she will likely spend her time volunteering at one of the many local Santa Cruz County organizations that treat and work with members of the community suffering from substance use disorder.
About the Author: Leyland Reid is a UCSC student and United Way of Santa Cruz County Intern.
Substance use disorder. That phrase comes with a backstory. The language we use when discussing those who suffer from the disease of addiction matters. Addict. User. Alcoholic. Junkie. Drug abuse. Drug habit. Is she clean? Is he dirty? These words make no distinction between the person and the disease. They shame, blame, demean and place the fault on the “addict”. They deny the medical nature of the condition and suggest that those with this disorder can simply choose to change their habits.
Substance use disorder. It’s a mouthful, so let’s break it down. “Substance” can refer to one or more of several types of legal or illegal products that cause a release of dopamine in the brain. The dopamine release overstimulates the brain’s “reward circuit”, causing the pleasurable “high” feeling, leading to the substance being overvalued to the point where is becomes a problem. These substances include alcohol; cannabis (marijuana); hallucinogens (LSD, peyote); inhalants; opioids (heroin; oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine); stimulants (cocaine, methamphetamine); and tobacco. Those with this condition may use one or more of these substances, or cycle through them.
“Use” covers a broad spectrum of behavior from mild misuse, to a degree of habituation and psychological dependence, to full-on addiction. Use at any stage along the spectrum can be a problem, and each stage requires a different treatment.
When we label this condition as a disorder, we understand that it is a chronic disease, one that cannot easily be cured. A combination of genetic, environmental, and developmental factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction. Co-occurring disorders, such as trauma and mental health issues, can increase the risk of addiction and make recovery more difficult. The earlier substance use starts, the more likely it will become addiction, and the harder it will be to recover; this makes prevention a key strategy in reducing the instances of SUD. With proper treatment, those with this disorder can recover.
At the League’s April meeting, we learned how substance use disorders (referred to as “SUD”) affect our community, and we heard from two members of our community who have struggled with this condition.
Nicole Keadle coordinates the Community Corrections Partners speakers’ bureau, which is a six-week course for individuals who have had involvement in the criminal justice system. Participants write a speech about their experiences and learn how to be comfortable with public speaking. Nicole started as a participant in the program two years ago; now she runs it. She also works with the Talk About It campaign (http://www.talkaboutitscc.org/), a community partnership that fosters an informed and compassionate county-wide response to substance use disorders and breaks down barriers to treatment of SUD in order to improve health and well-being for all in Santa Cruz County.
Keadle stressed that we must stop talking about addiction as a social issue, or a poor choice someone has made with their life: SUD is a disease like any other. Of the 22,000 people in Santa Cruz County diagnosed with SUD, 94% do not receive treatment. Addiction knows no boundaries: no family, gender, socioeconomic status goes unaffected. No neighborhood or college degree can keep this disease from affecting your family
SUD affects the entire family, “…from the individual suffering from addiction, the parents who have paid that price throughout that entire addiction, the parents themselves that might be facing the addiction, and the children caught in the aftermath.”
Those seeking help with SUD for themselves, a family member, or a friend can call 211 to get connected to the services they need. This service, provided by United Way of Santa Cruz County, is available 24/7, 365 days, in 170 languages, and is free and confidential. The Talk About It website, talkaboutitscc.org, also lists resources for help with SUD. It also has information for those wanting to understand more about this condition or learn how to start a conversation about it.
Keadle related her personal experience with addiction. Because of our county’s unique idea that “it’s treatment over incarceration”, when she found herself in jail, they connected her to service providers and she received the treatment she needed. “Because of that,” she noted, “I’ve been clean now for over four years. It is possible; you just have to give people that chance.”
“We want to live in a thriving, safe place. It starts with opening our minds and our hearts and living in compassion and realizing that this is a treatable, preventable situation.”
Untreated addiction costs our community 208 million dollars a year. Each dollar spent on treatment saves seven. It costs $105 per night to house somebody in jail. On average, it costs $22.50 a night to send somebody to a treatment program. If we could invest that savings into the community, we could work on education, intervention, and preventing SUD in our community’s youth. “We want to live in a thriving, safe place. It starts with opening our minds and our hearts and living in compassion and realizing that this is a treatable, preventable situation.”
Of the 22,000 diagnosed with SUD each year in SCC, only 2,300 ask for help. Of that number, only 1,200 receive the help they need. Whether they are scared or ashamed to ask for help, or just don’t know where to go, those are things we can work to change. “We can live in compassion; we can make it OK to talk about addiction,” Keadle said, “You don't need to feel shamed because you need help. That's something that we can do as individuals. We can make it OK to have this discussion. Talk about it with your family. Talk about it with your co-workers. Talk about it to those that you care about. Let them know that it's OK to ask for help, and that this disease affects everybody. You're not unique, you're not different, you're not something that is shameful. We can help before you hit rock bottom.
Keadle concluded, “We treat other chronic diseases, like cancer or diabetes, and we open our hearts all of the time, we look at them with compassion and say ‘Can we help you?’ We need to look at addiction that way.”
Renee Delisle has been through the first two phases of the speakers’ bureau and is working on phase three, mentoring others. She is now getting her message out to the community.
“The day after my senior prom, (my first Mother’s Day), my own mom passed away from cirrhosis to the liver, the heart, and the throat. I was devastated; I vowed to never drink again, but that didn’t last long.”
“I never in a million years would have imagined that I would become a hopeless drunk, a felon, and an escort who would choose addiction over my own precious child,” Delisle began, “but it happened; not purposely, but it happened.” Delisle took us through her childhood growing up with parents who were “big time partyers and dealers.” At 12, she moved in with her grandparents, but soon she found that weed, alcohol, acid, and crystal meth made her feel alive and accepted, “I finally belonged. My high school years were crazy. I ended up pregnant with my first child, but continued with school. The day after my senior prom, (my first Mother’s Day), my own mom passed away from cirrhosis to the liver, the heart, and the throat. I was devastated; I vowed to never drink again, but that didn’t last long.” Her life spiraled downward, and in spite of many attempts to regain her footing, she “continued to be out of control; I was lost in life.” Her turning point came when her partner, the father of her son, “got belligerently wasted. He punched me in my face while I had the baby in my arms. I had had enough. I called the cops.”
After struggling with alcoholism for the majority of her life, she now has hope, “I’m working my program harder than ever, I work the steps…I go to meetings and have a wonderful sponsor. I’m independent and feel strong.”
Paul Maartense began his story with a grim statistic: “One in four adults suffers from some form of mental illness or substance use disorder. I suspect this statistic to be even higher because of the stigma, shame, and denial associated with mental illness and addiction. It took over 30 years to admit the possibility of mental illness and 40 years before I was finally treated.”
The child of parents who themselves suffered from alcoholism, Maartense’s childhood was marked by homelessness, poverty, bullying, trauma, isolation, and his sense that “I was never enough.” In his teens, Maartense discovered that drugs left him feeling happy and whole, “I couldn’t imagine wanting to feel any other way.” This worked wonderfully, Maartense says, “…up to the point that they decimate everything in my life and I’m sitting in a jail cell trying to make sense of how it all happened.”
“…those visceral feelings of empty coldness were incessant. I was being held hostage in my own mind, thinking thoughts against my will. Thoughts that wanted me dead.”
Over the years, Maartense cycled in and out of addiction. Each time he got his life together, he still felt like a mess inside. “Each time I recovered from drugs, I would put in more effort than the time before, I would attempt new behaviors, methods, and means to make life work right for me.”
Finally, “Afraid of life, but scared to die,” Maartense sought help from a psychologist, who diagnosed him with post-traumatic stress disorder, manic depression, attention deficit disorder, and substance use disorder. At first, Maartense, determined not to use prescription medication, tried many methods of therapy and counseling, but, while he obtained valuable tools, he relapsed and was again placed in rehab. The true breakthrough came when he realized that, despite having many good things in his life, “…those visceral feelings of empty coldness were incessant. I was being held hostage in my own mind, thinking thoughts against my will. Thoughts that wanted me dead.”
Turning back to psychology, a diagnosis of being bi-polar was added to the list, and they found a non-narcotic medication that was right for him. For the first time, he saw his life through clear eyes, “with no inkling of impending doom or inadequacy.” After months of taking the pill, he came to the realization that he no longer needed to take them. Now, having left behind the false beliefs that had limited him, he finds the ups and down of life to be manageable. “Today,” Maartense says, “my disabilities have become my strengths, my experience my greatest asset.”
Those in recovery from substance use disorder have done so through determination and tenacity. They deserve our respect and admiration. We have the means to reduce the impact of substance use disorders on our loved ones and on our community. In order to do so, we must be willing to change how we think about this condition and be willing to commit resources to prevent and treat it.
BY: Pam Newbury, League of Women Voters' VOTER newsletter Editor
To view a video https://youtu.be/wdH5DkqWI8o of this presentation and hear Paul and Renee tell their stories, go to lwvscc.org/videos http://lwvscc.org/videos.html.
April 29 is “National Prescription Drug Take Back Day,” a federal program designed to encourage safe, convenient, and responsible ways of disposing of prescription drugs, while also educating the general public about the potential for abuse of medications. The program is designed to address several interrelated national issues:
-Addiction to opiates is at an all-time high in America, due in part to the easy availability of leftover medicines in homes across the country.
-Drug overdoses are also soaring, especially among the young and the elderly.
-Leftover drugs are feeding a lucrative black market, encouraging crime and abuse.
-Leftover medicines and used sharps are polluting our environment, endangering the public and causing harm to wildlife.
-There is a lack of safe and convenient ways to dispose of leftover drugs and used sharps.
Santa Cruz County and all local cities have taken a bold and innovative approach to the problem. Local ordinances now require all pharmacies to accept used sharps and leftover medicines for proper disposal at no cost to the consumer. The program is paid for by pharmaceutical manufacturers, and there is no cost to pharmacies or local taxpayers. Santa Cruz County has won a number of awards for this groundbreaking program.
“The program has been a great success. Almost all local pharmacies are now on board, and the rest will be soon," said County planner Tim Goncharoff, who administers the local program. "Last year alone, we collected more than 17,000 pounds of drugs and over 10,000 pounds of needles. This is a big step forward for the people and environment of Santa Cruz County.”
Residents are encouraged to ask their local pharmacist about the program. The County wants to remind people that used needles and leftover medicines should never be flushed or thrown in the trash. “Just take them back to the pharmacy next time you go,” Goncharoff. “What could be easier?”
For more info on local programs, go to: www.santacruzcountyrecycles.org,
For more info on National Prescription Drug Take Back Day, go to:
League of Women Voters of Santa Cruz County Presents "Understanding Substance Use Disorders" April 20th Event
Substance use disorder affects everyone in Santa Cruz County. The term “substance use disorder” (SUD) describes a broad spectrum of overuse of a substance, resulting in adverse consequences, often accompanied by co-occurring mental health problems.
The League of Women Voters of Santa Cruz County presents “Understanding Substance Use Disorders”, an event on increasing access to treatment and recovery services and how this can improve the quality of life for everyone in our community.
Nicole Keadle, program coordinator for the Community Corrections Partnership Speakers’ Bureau through Sobriety Works, will discuss how the Talk About It campaign fosters an informed and compassionate county-wide response to substance use disorders and co-occurring mental health disorders. You are given the opportunity to find out how this community partnership breaks down barriers to treatment in order to improve health and well-being for all in Santa Cruz County.
You’ll hear from two speakers’ bureau participants about their journey to recovery from substance use disorders. Paul Maartense, an extraordinary man who has never let life’s struggles overcome him, will speak about the connection between substance use disorders and mental illness, and about the ability people have to change if given the chance. Renee Delisle, an inspiring young mother, has used her lived experience and struggles to start over to create a positive change in our community. She will share her recovery experiences and her passion for helping those affected by homelessness and domestic violence.
To learn more about SUD and hear about lived experience, join the League of Women Voters and the Talk About It campaign on Thursday, April 20 at Encompass Community Services, 380 Encinal Street #200, Santa Cruz, CA 95060. Bring your own lunch; doors open at 11:30; the presentation will be from noon to 1 pm. The meeting is free and open to the public.
For more information: lwvscc.org 831-325-4140 email@example.com
The holiday season is a great time to take a break from work, and gather with family, friends, and other loved ones. It can be a time of festivity, joy, and appreciation! However, this time of year may bring stresses of its own, and represent a break in routines established to support sobriety. The holidays include celebrations around every corner; family feasts with 'festive' drinks, company holiday parties, and New Year’s Eve soirees. Although there is no, one, specific way to handle these obstacles, there are many tips and strategies to help navigate the holiday season sober and with minimal strain.
Substance misuse thrives in silence and secrecy. For each us who knows, works with, or loves someone who is misusing alcohol or other drugs, there is something we can do to help: get informed and talk about it with all of the compassion and courage that you can muster. Research shows that it takes an average of ten years from the time someone starts misusing alcohol and drugs until they get help. So much suffering could be avoided if people got help sooner. You may not be the first person to talk about it, and you may not be the last. Sometimes it may take multiple conversations for a message to get through. Show that you care by Talking About It, and by listening.