The Surgeon General came to town recently. He took the stage at Vanderbilt University's Langford Auditorium to speak to an audience of local physicians, nurses and other medical personnel about America’s out of control opioid epidemic as part of the Vanderbilt University School of Medicine Grand Rounds series.

Our previous article consisted of what he had to say to this audience of professionals. Doctor Jerome Adams is the twentieth person to assume this position of medical authority in American history. Previously he was the State Health Commissioner of Indiana, a state that has not been too friendly to LGBTQ+ people as of late, and was appointed by a President who has his own share of problems.

That said: I like him - he was sincere and honest about his opinions. For those who do not know, Dr. Adams is African-American...and he did speak to the importance of diversity and respect for all communities. He did not come across as what you may expect from an appointee of this current administration.

We took what Dr. Adams suggested to a couple of friends in the LGBTQ+ community who have first hand experience with opioid addiction and treatment, and they have offered their own opinions to some of his suggestions.

Brian Sullivan is the Director of Public Relations for Addiction Campuses, a provider of inpatient, outpatient, and after-care based Drug and Alcohol Recovery Services across the United States. Brian is a survivor of a suicide attempt and continues to successfully battle issues of depression and anxiety in his daily life. He is a former journalist and past contributor to Out & About Nashville.

Amy Sulam-Gibbs is an LGBTQ+ mom to three kids and a contributor to Out & About Nashville. She is a survivor of drug addiction and continues her successful fight to stay clean.

We will introduce the others as we come to them. Let’s roll tape…

My own brother is in state prison right now after stealing money to support his own addiction...Yeah, the Surgeon General’s brother who grew up in the same house, in the same family...is sitting in state prison while I’m talking to you here on this stage...

I tell this story because stigma kills more than any other risk factor out there. Stigma kills more people than smoking. Stigma kills more than obesity. Stigma kills more people than drugs. The only way we’re going to lower stigma is by helping folks see addiction for what it is...a chronic disease. The way to do that is by telling stories...

It’s Rachel, whom I just met yesterday...beautiful and looks like your typical Southern Belle...she was hanging out with her boyfriend while drinking, and her heroin-using boyfriend talked her into trying heroin while she was in an intoxicated state...and she said it was just like a light switch. She spent the next several years trying to kick the habit. She’s now in recovery, but these are the faces of addiction.

— U.S. Surgeon General Dr. Jerome Adams

O&AN: Amy, can you give people like me who have never tried drugs a quick synopsis about how your heroin addiction got started? Just the basic story you wouldn't mind telling in public…

Amy Sulam-Gibbs: In brief, after my sexual assault...I was drinking a lot and taking pills. One of my friends suggested that I try smokable heroin. He told me that it was basically the same as taking a pill but it was a faster delivery.

O&AN: Was that the first time you ever did something like that?

Amy: No it wasn’t the first time I’ve ever done any drugs. I’ve done cocaine before but I never got addicted to that. When I used heroin it was like all the receptors went crazy. The same friend who offered me the smokable heroin pointed out to me that it was extremely cheaper than buying pills.

O&AN: For dumbs*** waspish people like me who have never done drugs in their life, why did you get started doing drugs in the first place?

Amy: When I first did cocaine, I did it because people around me were doing it. I’ve definitely seen it in movies and TV shows...so I figured what the hell I’ll try it. I tried it and I didn’t really like how it made me feel...but when it comes to things like drinking and taking pills...here was one for me. This is about escapism you know. I just wanted to feel numb. I’d rather feel nothing at all than feel all of that pain.

There is a person dying every 12.5 minutes from a drug overdose...Over 2.1 million people suffer from a substance abuse disorder. It is a scourge that is touching every single community…the one opportunity that exists in this opioid epidemic is that folks are seeing that there is no more “us” and no more “them”. It’s all of us...

Based on folks that I have talked to, and my own experience with my brother, unfortunately there are people out there that with their first taste of an opioid...it’s like a light switch. It is that powerful…

— Dr. Jerome Adams

O&AN: Amy, the Surgeon General told a story that for many people getting hooked on Heroin is just like turning on a light switch. It just takes one hit and then that's all for you...you just crave it. Does that sound accurate?

Amy: That is completely accurate. It was like something went on inside me that I had never felt before about anything or anyone. That drugs that off in my brain a land mine. I could not stop chasing that first time feeling

O&AN: You have been in recovery for awhile. Will you always crave drugs?

Amy: Yes. On some level, I will always crave drugs.

(Inpatient care) is a part of the fix, but in my opinion a small part. We need to increase outpatient treatment which studies show actually are more effective than inpatient treatment. Some people do better with intense inpatient treatment, but for more folks it’s better to have them in an outpatient home environment where they function a lot better and the begin to build up the resources in their community to be successful (in their recovery).

— Dr. Jerome Adams

O&AN: Now that got some heat when I showed the speech transcript to Addiction Campuses’ Brian Sullivan. He lined up some professionals from Addiction Campuses to offer their opinions about this quote and more exclusively for Out & About Nashville’s readers...

(Inpatient care) allows patients to get away from their using environment, breaks the cycle of using. The patient is in a healthier environment, 24/7, interacting with addiction treatment professionals and others suffering from the disease of addiction. Medical staff monitor vital signs as a patient is detoxing. This is when drug cravings are common and they can be difficult to overcome, often leading to relapse. This constant medical care and controlled environment helps guard against relapse.

It takes time for someone to physically detox from opioids and then it takes time to “practice" and become comfortable and learn to deal with the emotions that come up when not drugged.

In a controlled environment of residential treatment, the impulsivity that is often associated with opioid addiction can be monitored, medications can be adjusted on the spot, and staff are available to discuss the pros and cons of their distorted thinking around using.

— Toril Newman, LCSW, Chief Clinical Officer, Addiction Campuses

Research has shown that most people need at least 3 months in treatment in order to have the best possible chance at remission from addiction. Best outcomes have become consistently tied to longer treatment durations...Residential treatment offers clients a stable living environment free from many of the daily triggers for use that suffering individuals experience in their day to day home environment. It incorporates medical stabilization and therapeutic treatment, that will help move them toward a life of recovery and giving back to those who struggle. Policy makers need to recognize the importance of inpatient residential treatment as a first step in many cases...Limiting this essential step, or failing to provide further funding in future (legislation) is a mistake.

— Dr. Theodore Bender, PhD, Chief Executive Officer of Turning Point (a part of the Addiction Campuses network)

Addressing the underlying problems that cause addiction, like trauma, is critical and is often best done in residential settings to ensure patients are safe and able to focus on these issues.  Outpatient is an important part of the continuum but does not need to take the place of residential beds. What we want is a full continuum of care available for all patients at all times. And the level of care needed should be based on a professional assessment of individual patient needs.

— Maeve O'Niell, MEd, LCDC, LPC-S, CDWF, Vice President of Compliance, Addiction Campuses

O&AN: The Surgeon General touched on the economics of the problem, in his view:

We are not going to be able to spend our way out of (the opioid epidemic)...because if we look at the numbers we will never be able to, or willing as a country to throw all the money at this thing that folks are saying we need. We need to rethink the way we deliver care. Everyone is not going to be able to get intensive inpatient six-month treatment. It’s just mathematically not going to work. We need to look at models that emphasize outpatient treatment, at alternative care models...and then only for the people who most need it choose inpatient treatment.

— Dr. Jerome Adams

O&AN: Brian and his colleagues launched into that argument too...

Not all patients need six months but some will and all patients deserve whatever level needed available to them…Four to six weeks is a great start for anyone, and then transition them to outpatient treatment...This goes back to the consistent debate on healthcare: is it a privilege or is it a human right? What many do not realize is that by treating healthcare as a privilege, we as a society end up spending more in the long run by not providing a continuum of care. If someone goes to the emergency room, they could be hospitalized and end up spending a lot more than if they had caught the problem early. And we have to ask ourselves, if we are going to hold to the model of a civilized nation, what sacrifices we are willing to make for the healthcare of all of our citizens?

— Brian Sullivan, Director of Public Relations, Addiction Campuses

Everyone's brain reacts differently to different addictive substances, depending on the length of time a patient has been using, their overall physical health, and any possible adverse childhood experiences. Withdrawal symptoms aren't pleasant for any drug, and the psychological dependence on the opioid may be stronger than the physiological dependence. In residential treatment, patients are learning skills to help with their addiction, they're given education about the disease of addiction, they have opportunities to practice and discuss this new knowledge in a safe environment away from the temptations of their old life.

— Toril Newman, LCSW, Chief Clinical Officer, Addiction Campuses

We want more outpatient options as well to support the continuum but not to take the place of residential options.  Given the patient acuity due to substances used, trauma, medical and psychiatric issues many people will need all levels of care to meet their needs for long term recovery.   We don’t have to give up beds to give clients the care they need, the goal is to engage patients in care for as long as possible, 6 months to a year ideally to fully support recovery.  So a full continuum allows for high quality care in the safest settings.

— Maeve O'Neill, MEd, LCDC, LPC-S, CDWF, Vice President of Compliance, Addiction Campuses

O&AN: Amy, the Surgeon General is recommending a mostly outpatient treatment approach for not only for cost reasons, but also for social adjustment reasons. Could you have gone outpatient route and stopped using heroin?

Amy: No. The outpatient route would not have worked for me. You need to detox, to learn coping skills...and you need to be away from your (prior surroundings) to learn what your triggers are. You need to have some time by yourself and also be with other people in recovery. It’s eye-opening…If you don’t have family support then you really need a good set of friends or maybe a halfway house (upon leaving inpatient care.) Recovering from addiction is just like recovering from something like cancer. It is really hard to do if you don’t have people around to help you with your aftercare.

O&AN: Brian, if you believe that the inpatient approach is the primary way to go...how do we pay for it?

Brian Sullivan: Congress needs to put more funding into the Comprehensive Addiction and Recovery Act to go toward treatment. More states and municipalities need to join the lawsuit against opioid makers and distributors that allegedly engaged in unethical marketing practices, and we need to pursue drug makers losing tax cuts for spending in marketing. We take that money from the lawsuits to fund addiction treatment. We are one of only two countries that allows pharmaceutical companies to advertise narcotics on television. Us and New Zealand...and we’re the only developed nation that does not bill them for prescription takeback programs. We need more accountability from lawmakers. I would like to see a pledge from lawmakers to say “I’m not going to take any money from the opioid lobby, period.” But we’re not likely to see that. Campaigns cost money. The pharmaceutical industry lobby is much more powerful than the NRA lobby and gives a lot more money.

O&AN: Brian, based on what the Surgeon General said about economics...is an outpatient approach better than nothing if we cannot get a full inpatient approach?

Brian: Anything is a start, and anything helps. But do we want to kick the snake a few feet or cut off its head? I’m not saying that outpatient is not going to work for anyone. For some, it will. But what of those who need more? And what of those who are developing an addiction as we talk right now? We prefer to stop looking for bandaids and start prepping for surgery. Because our country needs it. And our citizens deserve the level of care that is going to give them the best outcome they can have. It’s hard enough for the ones who have and can afford the care they need.

“How come (we) care more about the opioid epidemic now because there are white people dying from it?” Dr. Adams quotes as a question he receives all the time...on this occasion from a fellow African-American medical professional in the audience.

Here’s my answer every single time. There are folks who spend their entire lives trying to get people to pay attention to the scourge that is opioids. If we’re going to get real about this subject...it is a little bit disingenuous to say now that people are engaged, for whatever reason, that happened, but now we have got an opportunity.

What I am focused on, instead of looking backwards and applying blame, is trying to make sure that policy and funding that comes out (in response) to the opioid epidemic is applied in an equitable way to lift up all communities. What I want to make sure is that the funding does not all go to to rural white America and skips over communities of colour and communities in need. (If that happens) we’re just going to continue this vicious cycle.

— Dr. Jerome Adams

O&AN: This one is for both of you. An African-American Surgeon General took a question from an African-American medical student about public reaction to the opiate epidemic. He was wondering how Dr. Adams felt about the overwhelming response to this addiction now that is hitting the white majority suburbs? Either of you have a take...

Amy: In my opinion, the overwhelming response is because thirty years ago, when the crack epidemic was going on, we didn’t know then what we know now about addiction and its treatment possibilities. When I worked in recovery, the number of recovering crack addicts I had...far outnumbered the heroin addicts.

Brian: I would agree. There’s no denying that rural white America stirred a wake up call in this country to what was happening. Minorities still make up only 19% of Congress, but 38% of the population. When crack was hitting poor black communities, addiction was more criminalized. That’s just a fact. And when we see people who look like us, there may be a tendency to empathize more. I prefer, as apparently the Surgeon General does, to be thankful for the education and acceptance of knowledge that we have now and to move forward. It will take every community eradicating the stigma associated with the disease and working together to solve the problem...When Americans are confronted with a killer, we close ranks and work together. If you take someone from every ethnicity, economic and social status, gender and sexuality, and put them in a room, and there’s a monster outside that room, they’re going to fight together. There’s a monster outside of our door right now. And it’s poised to kill another generation if we don’t work together.

The idea that locking someone in a cage would cause them to magically emerge a changed person is not only a fantasy, but evidence has been consistent that it does not work. There are some instances where someone has said to me that it was a wake up call, but for the majority, in our experience, most have said that it perpetuated a cycle of addiction, arrest and poverty. We must treat the disease of addiction as the clinical issue that it is, not a criminal one. This is a health epidemic, not a crime spree. Addiction is the only disease that you can get fired for. In the LGBTQ community it is just as important that we eradicate the stigma associated with addiction as it is that we combat the stigma associated with HIV/AIDS, which Nashville Cares and Mr. Friendly have done amazing work in raising awareness about in our community. No one wakes up one morning and says 'I want to be addicted'. A course of events propels them into the condition, and at that point, they need help, not handcuffs.

— Brian Sullivan, Director of Public Relations, Addiction Campuses

O&AN: Amy, you and I go back a couple of years. What made you stop? I know you wrote about being incarcerated. Can you tell us the story of how you stopped...

Amy: I stopped when I had an overdose. For me (it was) my children and the realization that I was not invincible and did almost die (that made me stop.) The fact that one of my children was old enough at the time to know what was happening and realizing she almost lost her mother (played a part.)

O&AN: Could you see yourself stopping otherwise? Did it take a life-altering event like your overdose to do it? Or do you think it would have stopped over time?

Amy: I’m pretty sure I had myself holding to thinking I can quit anytime I wanted to. The fact that I had depression and suicidal tendencies definitely did not help. In some cases...it made me do more faster knowing that it was dangerous. Realizing that there were people who actually would give a s*** if I died I think that was a wake up call for me because I felt so worthless at the time.

If Sully wasn’t my best friend and I want married to (my husband) the chances of me relapsing would be significantly higher. But because my best friend and husband both work in addiction recovery my chances (were) better than other people.

(Full disclosure: Brian Sullivan is her best friend. Out & About Nashville has many photos in its possession disclosing this very obvious fact…)

O&AN: Amy, I hear you. Honest answer please...Would being put in an incarceration situation have done the same to help your addiction if they had appropriate addiction treatment there?

Amy: No! I’ve been f***ing furious that I was in jail for months and couldn’t go home and see my family.  And now I would have something on my record I can lose my children...there’s no f***ing way. When something goes on your record and you can’t get a job...you could lose your kids, you might not be able to rent an apartment and your credit goes to crap because you have been locked up for months. You have to be an idiot to think (incarceration with treatment) would really help anybody. You just destroyed their life when their life was already s***.

(Brian interjects as I emerge from hiding under my laptop…)

Brian: Amy is also the sole reason why I do what I do. I never would have left television had it not been for my experience with her. Seeing the life and color come back into her face. I knew there were other friends who I wanted to help experience that. I would not be the man I am today, nor be in the position I am, had it not been for Amy. She has saved me in every way a person can be saved. Mentally, spiritually and physically.

Amy: A big part of my recovery was changing who I socialized with. Support is huge...so he basically came in and filled the role of parents and family helping take care of me...gave me aftercare and (helped) to monitor my social interactions so that I wasn’t hanging around people with drugs. (Otherwise) I likely would have used again.

O&AN: Amy, both you and I are LGBTQ+ parents. What do you tell your teenage kids about your experience if I may ask? My parents were drug addicts and I share with my teenage child the cleaned-up version of the horror stories I had to go through...

Amy: (My oldest daughter) lived through it. There are parts of her that are broken because of me that I’ll never be able to fix. The fact that her only concern was that I was alive still shocks me. She is so much more grateful and attached now. I’m honest with my kids. Now (she) is the one in her peer group who warns her friends about drugs, drinking and smoking. She doesn’t romanticize it or think it’s cool at all.

O&AN: The last question for both of you I will go ahead and just pitch it. What message do you have for LGBTQ+ people who are addicted? What's the best thing they can do for themselves and how can they get help?

Amy: Honestly? Don’t be your own worst enemy and let your minority status stand in the way of you socializing with others who are getting help. Learn to embrace who you are and love who you are while you’re in recovery. This is your time to come out as an addict and an LGBTQA member. We already know what judgment feels like, so f*** it...and be fabulous in your recovery.

Brian: If you’ve ever been around someone addicted or in recovery, then you know that illicit drugs do not enhance your life, they complicate it. If something is impacting your life and everyone around you, LISTEN. We have people on the ground and on the phone to help someone 24/7. They can call our helpline or log on for a confidential chat, we will even meet with them in person.

The hardest part I think is recognizing that you are WORTHY of a better life. That you are WORTH fighting for. Bigotry comes in all forms, and you have to be careful when selecting a place to recover. We can get you somewhere safe where you will be loved and cared for. We don’t care who you sleep with or what’s underneath your clothes. We care that you’re living a happy and balanced life. The LGBTQ+ community sometimes requires a special level of care. They have been bullied, are more likely to have severed relationships, and are three to five times more likely to develop an addiction. We’re equipped with a loving environment that fosters love and understanding. And that is the foundation on which recovery is built.

O&AN: Thanks folks. Brian Sullivan and the medical experts he brought to the table come from Addiction Campuses. Their addiction hotline is 888.614.2251 and is crewed 24/7. More information about who they are and what they do may be found at addictioncampuses.com.

The Substance Abuse and Mental Health Services Administration National Healthline is 800.662.HELP (4357) and is also crewed 24/7 by trained people who help refer callers to appropriate treatment options at no charge. SAMHSA is a government agency and is affiliated with the U.S. Department of Health and Human Services.