Transdisciplinary Approaches to the Opioid Crisis

In 2018, the NIH Office of Behavioral and Social Sciences Research (OBSSR) convened a unique and timely HEAL (Helping to End Addiction Long-term) Initiative meeting to address the rising opioid epidemic facing the United States that, at that point, had taken almost 50,000 lives and recently been declared a public health emergency. 

The Contributions of Social and Behavioral Research in Addressing the Opioid Crisis meeting was held in collaboration with the National Institute on Drug Abuse (NIDA), the National Institute of Neurologic Disorders and Stroke (NINDS), the National Center for Complementary and Integrative Health (NCCIH), and the National Institute on Minority Health and Health Disparities (NIMHD).

This meeting brought together a diverse group of experts across five panel discussions to examine and understand how the context of people’s lives contributes to opioid misuse and overdose—for the first time, moving beyond just the brain chemistry of addiction in opioid use disorders. Panelists included people with lived experience of the opioid crisis; medical professionals including emergency department, primary care, and dentistry providers; legal professionals; clinical research scientists; economists; and more, including Nova Institute’s president and founder, Professor Brian Berman, MD, all of whom offered different views on health and influenced ideas for possible solutions. 

This transdisciplinary array of perspectives, not likely to otherwise cross paths, provided invaluable insights into the lived experiences of those suffering from the opioid epidemic. These learnings culminated in a special issue of the American Journal of Public Health that examines ways to improve the opioid crisis response via actionable social and behavioral priorities and the identification of key issue areas for research. 

Fast-forwarding to 2022, the COVID-19 pandemic has only amplified the already increasing opioid crisis, with overdose deaths rising from about 70,000 in 2019 to 93,000 just one year later. Various factors magnified by the pandemic, like social isolation and economic hardship, continue to contribute to opioid use disorder and overdose deaths, making the research and findings all the more relevant for healthcare professionals, policymakers, and others in combating this crisis. 

The Nova Institute was honored to participate in these discussions, which highlight the value of transdisciplinary collaboration and the importance of examining the entire lived experience to advance health. We look forward to sharing more findings from this work and research as they are available.

Developing safety, persistence, trust

Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Acquiring Resources

Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
    • “I think I kept trying to convince him I was crazy. And he kept saying, ‘No, you’re not crazy.’ […] You wouldn’t necessarily say a Vietnam Vet was crazy. You’d say they are responding like you’d expect to extraordinary circumstances.”
    • “I’m not the only one who have [sic] this problem. A lots, millions of people, you know. […] They don’t have nothing to do with that. I guess I have to live.”
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
    “You need a lot of energy and a lot of work … it takes a lot of work. It doesn’t just happen. It’s not like a magic wand.” This patient understood that they had to actively participate in the healing process.
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

Helping Relationships

“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad. When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.) “When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”

Healing

Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.” Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. Healing, in this sense, does not mean cured—none of the study participants were cured of their ailments—”but all developed a sense of integrity and wholeness despite ongoing pain or other symptoms.” In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” When we begin to heal, we find increased capacity for hope, renewed motivation to help others, and are more able to accept ourselves as we are.

Suffering

Suffering is the ongoing pain from wounding. There is debate about whether or not one actually needs to experience suffering on the path to healing.

Wounding

Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors. “The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”