Editor’s Note: This is the first installment of a five-part series on the Drug-Alcohol Coalition of Iredell’s recent “In The Know” event.
BY DEBBIE PAGE
Over 200 people from across the state attended the Drug-Alcohol Coalition of Iredell (DACI) “In The Know” event to learn about the effects of substance misuse on young people as well as ways to reach youth with the data and science to discourage use of harmful substances that affect their brain and physical development.
Iredell County Board of Commissioners Chairman Bert Connolly thanked the many in attendance who treat and care for those with addiction issues. He noted that the county’s jail is the county’s largest alcohol and drug detox center since many incarcerated persons have substance use disorder (SUD).
Connolly urged those with issues to step forward to get treatment and counseling from the many resources available in Iredell County (Iredell SU Resource Guide, 4th edition).
DACI Program Director Christie German said that DACI and those in attendance are united in the efforts to educate the community, support recovery, and take action to flatten the curve of substance misuse because it affects everyone in the community, directly or indirectly.
German reported that in 2024, Iredell County EMS answered 1,290 alcohol and 743 drug-related calls, and administered NARCAN 115 times. She noted that the NARCAN use number is likely low because law enforcement, first responders, and bystanders have often administered the life-saving opioid reversal medication before EMS arrives on overdose calls.
DACI distributed 1,307 medication lockboxes and pouches, 698 medication disposal kits, 584 doses of NARCAN, 974 resource guide copies, and 403 fentanyl test strips to help keep the community safer.
Jeff Eades, regional director of Community Operations for Partners Health Management, urged the audience to share information and support to others because “we never know when something we say or do has an impact that changes the trajectory of others’ lives.”
BRAIN DEVELOPMENT AND ADDICTION
Keynote Speaker Delton Russell, Region 4 Tobacco Control manager who has worked in the addiction field for 17 years, noted that drugs, alcohol and nicotine offer a cheap dopamine for that feel good rush that distracts the person from solving their underlying problems.
Whether it’s a sugary donut or heroin, the brain’s craving for cheap dopamine highs show the person’s “maladaptive coping skills,” which include substance use, physical and mental escapes, self-injury, binge eating, risk-taking, avoidance of problems or past trauma, and low self-esteem.
“Addiction shouldn’t be called addiction; we should call it ritualized comfort-seeking,” he said.
Russell also warned about seeing addiction as a moral failing. People with addiction have intense unaddressed stress or past trauma that cause high levels of cortisol in their brains — so they are looking for things that will release dopamine.
“To say that addiction is a moral failing is to say that a 13-year-old with a genetic predisposition, adverse childhood experiences, and an environment in which substance use was not only condoned but endorsed, made a clear, rational decision to start using drugs and alcohol,” he said.
The only way to address the addiction in a way that will lead to a sustained recovery is to help users develop adaptive coping skills, including active problem-solving, seeking support, changing their expectations, regulating their emotions, and changing how they think about stressors in their lives.
Though the process of teaching these coping skills is long and arduous, if the person’s pain is not addressed, then the addiction cannot be either, Russell said.
Addiction is a way to let the pressure off, but this short-term release does not address what is causing the pressures. Unfortunately, addressing symptoms instead of the root of the person’s problem is futile, he added.
Russell noted that the number one cause of death for persons under 49 is unintentional overdose. In addiction, 50 percent of the 23.5 million people in recovery will die of a tobacco-related illness, illustrating that nicotine addiction substitute will kill too, just not as quickly.
Russell said the first question that should be asked is not what is wrong with addiction but what is right about it? What benefit are they getting that they cannot otherwise access?
The constant loop of pressures and stressors, relief through substance use, and the return to underlying problems just keeps spiraling downward, without ever addressing the underlying problems, he explained.
On the best day of one’s life, Russell explained that a person might experience a rush of 100 nanograms of natural dopamine. An addictive substance offers 700 to 800 nanograms, while a cigarette offers 150 to 200.
Because these “cheap dopamine” rushes are so much higher, the person losses the ability to feel happy without the huge dopamine rush.
“A person in active addiction quits doing everything that matters to them because these things do not release as much dopamine in the brain as the drug does, but getting high does not lower the cortisol level. It just overpowers it for a time.”
“Emotional wellness is the only thing that can get between the person and the addiction. Emotional wellness is recovery in a sustainable form,” he said.
Russell recalled that Carl Sagan once said, “You have to know the past to understand the present.”
However, the past does not have to dictate a person’s future. “Once you understand how the past is impacting the present, you can make decisions about how you choose to respond to it,” he said.
Instead of focusing on quitting the addictive substance, Russell said the key is to focus on WHY the person is using the drug. Without the skills to manage stress or past trauma, the person will too often return to use.
Developing neuroplasticity, the brain’s ability to learn, adapt, grow, and meet new and increased demands, makes sobriety sustainable.
“Addiction is only a symptom of the real problems,” he said.
ACES
The adverse childhood experiences (ACE) study in the late 1990s, conducted by the Centers for Disease Control and Kaiser Permanente, is one of the largest investigations of how childhood abuse and neglect and household challenges affect a person’s later life, health, and well-being.
ACEs in a childhood household include emotional, physical, and sexual abuse, substance abuse, domestic violence, exposure to community violence, bullying, chronic anger, mental illness, poverty, divorce or separation, incarceration, illness or loss of family member, lack of social connections/friends, and physical and emotional neglect.
The ACE questionnaire provides the respondent an adverse experience score. Individuals with a high number of ACEs are at an increased risk for negative adult outcomes, including chronic disease, mental illness, substance misuse, and unrealized life potential.
The more ACEs a person has experienced, the greater the risk for these negative outcomes because ACES increase the incidence of depression, anger, or anxiety. These feelings lead them to seek cheap dopamine coping mechanisms to elevate their moods and possibly later chronic substance misuse.
Of those with a score of 4 to 8 in the study, one in six smoked, were alcoholic, or had heart disease, one in 30 were IV drug users, and one in five had attempted suicide.
Other risk factors for addiction are guilt and shame, PTSD, age of first use of alcohol or drugs, and parental substance misuse (three generation effect).
Maternal stressors are also passed on genetically because if children are born with a higher level of cortisol in their systems, they are more likely to seek cheap dopamine hits.
YOUTH SUBSTANCE MISUSE
Russell said recent data indicates that 46 percent of high school students use addictive substances. One in three meets the medical criteria for addiction, but only one in 70 will receive treatment because of lack of available treatment options.
Additionally, nine out of 10 adults who are in addiction started using before age 18.
Unfortunately, Russell said, “early use of tobacco products, drugs, and alcohol and childhood trauma impacts cortical modulation, which translate to poor impulse control.”
This brain response to addictive substances affects youths’ “capacity to moderate frustration, impulsivity, and aggression.”
Since the brain is not fully developed until age 25, early use of addictive substances arrests a youth’s brain development because it reduces the development of neuroplasticity.
Epigenetics — how the things in a person’s environment and the choices the person makes change the way genes work — also is a factor.
Russell said that means that every thought, action, and movement a person makes changes how the inherited genes are expressed and therefore alters the person’s destiny by transforming the brain and body in either positive or negative ways.
Russell quoted Dr. Pamela Peeke, who said, “Genetics load the gun, but epigenetics pull the trigger.”
To create opportunities to positively affect epigenetics, develop neuroplascity, and promote emotional wellness, those seeking recovery should discontinue use of nicotine, alcohol and drugs, eat dopamine-boosting foods and promote gut health through pro and prebiotics, get eight to nine hours of sleep, exercise, and do yoga and meditate, and do breathing exercises to promote calm.
Russell also called out companies that market their alcohol and tobacco products to young people because they understand that to survive, they need to grab a large share of the youth market. They market and package products containing alcohol or THC in ways that attract them.
Tobacco and alcohol industries should be pressured to stop marketing that appeals to young people and to restrict outdoor advertising for these companies. Russell also suggested advocating with elected officials for ordinances to regulate advertising and product placement that might attract youths.