Summary of the LINCS Discussion on the Impact of the Opioid Epidemic on Adult Education

The following is a summary of the LINCS Discussion on the Impact of the Opioid Epidemic on Adult Education (March 7-8).  If you followed the panel discussion, what has been your thinking about addressing the epidemic since the event?  What additional resources are you looking for to help you address the epidemic with your learners?

Summary of the LINCS Discussion on the Impact of the Opioid Epidemic on Adult Education

Julie Neff-Encinas shared the challenges of counseling students to talk with their medical providers about the impact of their treatment on their ability to function in classroom, and the hesitation for undisclosed reasons.  Similarly, Katherine Cavanaugh shared her work with reentry adults who are in class because it is part of their probation requirements, or their recovery under the state’s vocational rehabilitation system.  She also wondered how to promote open-ended discussions among adult learners and still protect their privacy rights? She asked, “What should be the role of the educator to avoid 'preaching' and practice 'teaching to reach and help' reentry adults learn more effectively?”

Jeffrey Abramowitz shared that the realities of drug and alcohol treatment following prison is the fear that asking for help or support will lead to additional supervision, retribution or additional monitoring. It is important for returning citizens to understand that they can and will receive confidential and unconditional support, if they comply with their program, participate and stay dedicated to overcoming the challenges that they will be facing.  Jeff also highlighted the impact that shame plays in the re-entry process of formerly incarcerated adults. He noted that having successfully completed the sentence imposed by the courts, they next face a sentence imposed by society through barriers and challenges of finding employment, housing, and accessing addiction treatment.  He connected this need to implement holistic wrap around support services that provide contextualized learning as a way to bring students into career sectors that they are passionate about in building new futures.  Jeff commented that having peer mentoring with men and women that have traveled down a similar path is very helpful in keeping students engaged.  

Julie Neff-Encinas also commented that peer mentoring is key to creating highly successful treatment programs, but noted that probation often restricts persons from forming tight relationships with others with a criminal history, unless in controlled settings.  She noted that this is an obstacle to creating mentoring relationships for learners. Susan White Ahl wondered if a recovery community may have individuals interested in sharing their stories. 

Kathy Tracey shared the PBS resource Understanding the Opioid Epidemic for Educator as a resource to consider in answering the questions raised.  Jeffrey Abramowitz shared Guidelines for Successful Transition of People with Mental or Substance Use Disorder from Jail and Prison: Implementation Guide.

Paul Jurmo commented on the need to develop relationships with agencies to:

• Train staff on symptoms of opioid abuse, and how educators can respond.
• Develop referral relationships with those other partners.
• Include discussions on opioid abuse into basic skills classes.
• Review program security and plan steps to ensure learner and staff safety.
• Revise intake assessments/case management activities to facilitate confidential communication. 
• Join community/county/state task forces or coalitions dealing with issue in a comprehensive, systematic way. 
• Seek funding to strengthen adult education’s ability to respond to this issue.
• Add new staff to deal with addiction-related issues.

Andrew Pleasant commented that the prevention of opioid abuse should receive as much attention and funding as response and treatment.  Michael Cruse shared the  U.S. Health and Human Services's resource library, aimed at prevention-related services, and general advice on disclosure with adult learners from the Learning to Achieve resource, a research-based collection of professional development materials focused on increasing the achievement of adults with learning disabilities.

Jamie Harris asked about preventative methods to avoid addiction and also ways to identify when a person is in the beginning stages of addiction.  .  Michael Cruse shared Operation Prevention's classroom resources, which introduces learners to the science behind opioids, their impact on the brain and body, and is available in English and Spanish.  He also highlighted the LINCS Resource Collection's links to Operation Care, which has relevant materials on addiction, alcoholism, and depression that connect with many of the same issues experienced by individuals with opioid dependence and addiction.

Richard Bruno shared the analogy of Upstream-Midstream-Downstream Preventions. Upstream is primary prevention, which works to prevent people from falling into the river of addiction in the first place. Midstream is putting up a net to catch people before they fall over the waterfall and overdose, and includes harm reduction strategies for active users, like clean needle exchanges, safe consumption spaces, fentanyl testing strips, Medication Assisted Treatment to, and substance use counseling. Downstream is administering the antidote naloxone (Narcan) to someone who has overdosed and may drown at the bottom of the waterfall.

Richard noted that drug dependence is characterized by chronic use and withdrawal symptoms upon rapid cessation, which is different from addiction, which is characterized by compulsive use despite harm and cravings.  Opioid use disorder is characterized by DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) criteria for substance use disorder.  Richard suggested that providing resources – to include medical evaluation - may be helpful. He also noted the importance of using person-first language, such as PWID (People Who Inject Drugs) to refer to people struggling with addiction, and avoiding inflammatory language like ‘addict’ or ‘abuser’.

Michael Cruse connected the conversation to the U.S. Department of Labor, Employment and Training Administration’s National Health Emergency Dislocated Worker Demonstration Grant Pilot Program to Help Communities Fight the Opioid Crisis.  This $21million fund is enabling six states to retrain workers in communities impacted by the widespread opioid use, addiction, and overdose. These states are: Alaska, Maryland, New Hampshire, Pennsylvania, Rhode Island, and Washington.  The $21 million dollars from the grant funding to these six states will likely be used to create resources and programs that will be replicated across the U.S. to address the long-term impact on communities. Using Maryland as an example, he highlighted recently released guidance on the implementation of workforce solutions to address Maryland’s opioid crisis. This is supported by other efforts in the state aimed at the prevention of opioid use as early as K-12, through the Maryland State Department of Education's Heroin and Opioid Awareness and Prevention Toolkit.  Kathy Tracey also highlighted the Ohio Bureau of Workers’ Compensation’s Opioid Workplace Safety Program, which will provide up to $5 million over two years to help employers hire, manage and retain workers in recovery from an opioid addiction.

Richard Bruno cited research that the return on investment has been shown to be $1,538 for every employee undergoing over 60 days of treatment, noting that this leads to reduced absenteeism, tardiness, conflicts with managers and coworkers, and productivity lost.  He highlighted the therapeutic workplace program at Johns Hopkins Bayview Medical Center as a novel employment-based intervention that uses, "access to employment and wages to reinforce therapeutic behavior change”, and concludes that this type of intervention could be applied across many industries.