Editor's note: This story is part of Southwest Michigan's Second Wave's On the Ground Kalamazoo series.

There are always new trends in illicit drug use. They usually start at the coasts and eventually arrive in Kalamazoo, Chris Slater, chief executive officer of Community Healing Centers, says.

There are also new trends in the treatment of addiction.
 
Community Healing Centers provide a wide range of recovery services for people addicted to drugs and alcohol. They're sponsoring the Coming Together Conference Oct. 24-25. 

The conference begins with a free community event on Oct. 24, with keynote speaker Dr. John Kelly, professor of Psychiatry in Addiction Medicine at Harvard Medical School. Day two is aimed at professionals, with breakout sessions on the latest treatments and topics in recovery.

Opioids down, methamphetamine up, Fentanyl a big problem, and "tranq" headed for Kalamazoo

Slater has been working in community health for the last eight years. A certified public accountant, he comes from the world of finance and has a lot of experience in getting funds for addiction recovery efforts.

"Organizations that are serving low-income populations get funded very poorly and need to be very strategically, financially advantaged," Slater says. "The services we provide are expensive... having a doctor (on staff) is not cheap, having a nurse practitioner is not cheap, having 12 registered nurses on staff is not cheap," he says.

In Southwest Michigan, he's seen that "methamphetamine use has increased faster than any other region in the state." 

Chris Slater, chief executive officer of Community Healing Centers.Community Healing has been having a problem providing full detox treatment for meth users "because the insurance companies don't believe they experience severe enough withdrawal... All those decisions are being made on the east side of the state where methamphetamine use is very low."  

But here, "it's through the roof. Just in the last two years, the people we've been seeing whose drug of choice is methamphetamine has gone from about five percent to about 25 percent in just two years."
 
Part of the reason, Slater thinks, "is the unavailability of opioids. They're switching drugs — take one away, they go to the next one. 

"The doctors cutting everyone off didn't help. In my opinion, it made it worse because it pushed people to the streets rather than treatment." 

As doctors cut back on prescribing opioids, people turn to whatever was available: meth, heroin, and the many drugs spiked with Fentanyl. 

"Fentanyl's been nationwide. That trend, we follow the rest of the country."

A big trend on the East Coast is Xylazine, an animal tranquilizer, usually mixed with Fentanyl. Known as "tranq," it causes horrific flesh wounds around injection sites. It also can create psychosis or other mental health issues, Slater says. There is fear that it's coming to Kalamazoo. 

Another local change that he brings up is the legalization of marijuana. Some doctors in the recovery field think it could be helpful as a replacement for hard drugs, while some are against that use, he says.

"I don't know," he says with a shrug. "We're more worried about people who, if they don't quit drinking they're going to die in three months, trying to get people to quit using IV drugs."

New treatments

"The problem's growing so fast, it makes you feel like you're losing sometimes," Slater says. "But we're not losing... We need to understand that there is a lot of good work being done out there. And we'd be in even worse shape without it."

In the treatment field, methods are getting more diverse, and options are increasing, he says. 

Older 12-step programs, "the traditional AA (Alcoholics Anonymous) and NA (Narcotics Anonymous), and individual and group therapy, is still prevalent and still works for a lot of people." 

But now a new therapy, EMDR (eye movement desensitization and reprocessing), which has been used to help veterans with PTSD, is being applied to addiction recovery. MAT (medically assisted treatment) is bringing in new drugs to help block addicting drugs, and new types of group therapy are coming into play, Slater says.

All are available at Community Health Centers.

"There are so many different ways to approach (substance use disorder) now that we understand the brain," he says.

Chris Slater in front of the Elizabeth Upjohn Community Healing Centers, the Stadium Drive office of Community Healing CentersAll addictions have similar root causes in the brain, he says. "We're not just putting alcohol in one bucket, and gambling in another bucket, and heroin in this bucket — it's all the same... We're dealing with the same things." 

Traditionally, 12-step was the go-to that seemed to work "for some," he says. "We're seeing it works long-term for about ten percent of the people who participate. Now, that's actually a pretty strong number for long-term recovery. I don't want that number to sound discouraging, because recovery is hard." 

If AA or NA "is getting ten percent of them clean, that's a pretty good number."

EMDR is a technique that helps "reprocess old trauma" in the brain, trauma that can lead to addiction.  "The data is still new, but it's certainly had a profound impact on treatment." When used with vets suffering from PTSD, "the success rates were very high, and the feedback was positive."

A new drug used to prevent drinking, Vivitrol, is proving to be more effective than older medications. 

Medications that cause people to get sick if they take a drink used to be in daily pill form. "You can just stop taking the pill, and you can drink in a couple of days." Vivitrol "is a 30-day shot, so if you get the shot, you're signing up for 30 days."

Medication that puts a halt to drug or alcohol abuse — "medically supervised detoxification," is the term, Slater says — helps give the patient time to get their life back in order. Suboxone, for example, a maintenance drug for those addicted to opioids, puts the addiction on pause "while you do things like figure out housing, get employment back on track, getting your driver's license, working out legal issues... The medications are extremely successful."

It's also been found that Suboxone can help curb cravings for opioids and methamphetamine, he says. 

There've been rapid advances in helping people recover from addiction in the past years, and Slater is expecting more. "In ten years we're going to have new tools than what we're talking about now." 

Addiction is a medical issue

Addiction needs to be treated as a medical issue, "rather than a social choice," Slater says.

At some point — likely in their teen years, he says — a person may have made the choice to drink, "but we didn't commit then to saying, 'I want to be a raging alcoholic for the rest of my life.'" 

Alcohol or drug abuse is at the center of a range of other life problems — it may come from these life problems and exasperate them. "If you go to detox and get clean in two weeks, great. But then if you leave and haven't got s**t to go back to except a tent, you don't have a driver's license, you've got court dates... Willpower only lasts so long. You're going to fall down."

Recovery is a bit easier "for those who have stuff to go back to, like a house and a family and a job."

People in need of recovery range from the unhoused using meth, to someone who's functional in their family and job, but binge wine every night.

"It's no different than somebody who doesn't have a roof over their head...  'This looks really seedy, dirty, ugly, disgusting. This is, well, it's wine.' But it's the same exact thing." 

Who do they see from the community? Who comes in needing help?

"Everybody," he says. "It is so unbelievably diverse over at Gilmore (Gilmore Community Healing Center) in our in-patient facility." 

Educating the next generation

Slater seems frustrated at the topic of stigma, how some people see addiction as a moral or behavioral weakness and not a medical problem. "It's just going to come with a stigma, okay? It's just going to. But that doesn't mean we can't keep moving forward educating the most people we can."

He hopes people come to the community event, the night before the conference, to learn more about how to get help. Slater points out that the next day's conference attendees are from the worlds of medicine, law, social work — and pediatrics.

"We really need to pay attention to the next generation.... pass it on to them at much earlier ages than some professionals think. Because they're ready to hear about it at eight or nine. From people other than their friends." 

Previous generations of parents didn't want to expose their children to the dark world of drug abuse. They tended to pass along simplistic messages like "Just Say No."

The topic of addiction "is not dark and seedy, it's just life," he says. "My son's nine, and he's heard all about it. He understands it's bad." 

Children need to know "why it happens, why it's bad, what's going to be the outcome. We didn't get those conversations. We got D.A.R.E t-shirts, 'Just Say No,' the whole Nancy Reagan campaign.

"I think parents are better (now) at having those conversations with kids and making it not-awkward," he says. "When I was growing up, you just didn't talk to your parents about that kind of stuff." 

Prevention is an aspect of addiction recovery that shouldn't be ignored, he says. "Prevention's a lot easier than treatment, and cheaper." 


Coming Together Conference

Coming Together Community Event, Oct. 24, 6 pm, WMU Homer Stryker M.D. School of Medicine. Free.

Coming Together Conference, Oct. 25, 8 am-4 pm, WMU Fetzer Center. $140 or $50 for students. Continuing Education Credits provided by WMU Homer Stryker M.D. School of Medicine.