By Suzan Mullane, CEI Faculty and Dana Asby, CEI Director of Innovation and Research Support
West Virginia, “The Mountain State,” has been at the forefront of the opioid crisis. West Virginia’s overdose deaths from meth and opiates are the highest in the nation (The Economist, 2019). As a counseling trauma consultant, the word “crisis” seems inadequate to describe the parental addiction and collateral family damage plaguing the state.
Youth in particular are stressed from the abandonment and/or incarceration of a parent. Dr. Jim McJunkin, Prevention Committee chairman with the West Virginia Chapter of the American Academy of Pediatrics, says, “Suicide is the second leading cause of preventable fatality in West Virginia teens (ages 10-17 years)” (McJunkin, 2018). At times, teens become the primary caretakers for the family. Ill-equipped to carry the load, teens often resort to self-harm, e.g., cutting themselves, due to grief and anxiety. Teachers often ask why teens cut themselves. Perhaps it’s a cry for help, a stress reliever, or a way for the teen to feel something other than numbing hopelessness. The common thread is emotional pain from secondary trauma. When this pain gets ignored, the consequences can be dire.
“Suicide is the second leading cause of preventable fatality in West Virginia teens (ages 10-17 years).” ― Dr. Jim McJunkin, Chairman, Prevention Committee West Virginia Chapter of the American Academy of Pediatrics Charleston Gazette-Mail
Here is some of the information I shared with schools in West Virginia:
I comfort teachers through active listening when they share students’ stories. This approach supports students sharing their own stories as well. Active listening is an essential trauma- sensitive intervention that teachers can then use to better understand what their students are experiencing. There are three simple steps to active listening:
Make eye contact so your conversation partners know you are paying attention. This will also allow you to better read the emotions on their faces.
Resist the urge to interrupt or let your thoughts drift and actually absorb the words they are telling you. Formulating a response is a natural inclination—instead, actually listen.
Listen without judgement. Instead of inserting your emotional response into the conversation or making assumptions, try to understand what the person you are listening to is trying to tell you with their words, tone, and expressions.
“It’s hard to come to school when I’ve been up all night caring for my baby brother and my parents are partying. But when I don’t come to school, someone calls and then I go and fall asleep in class. If I tell someone what’s really going on, we could end up in foster care. I know the drill. I want to try and keep us kids together. But I’m tired of the cover-up and trying to do it all. I wish my parents loved us as much as shootin’ up.” ―High School Student
Fortunately, West Virginian grandparents and extended families provide some stability. I’ve talked to many grandparents, held their hands, listened to their stories and discussed self-care plans. Counseling referrals are offered because many West Virginia schools provide on-site, Medicaid mental health services. The key is to get the permission slip. In what’s referred to, often, as, “hillbilly culture,” outsiders are not trusted; this is especially true when there is family addiction, “on the down-low.” Sadly, the youth that need counseling the most, are often hidden in the shadows
“Identifying disenfranchised grief in secondary students is lifesaving. To help remember the warning signs, the American Association of Suicidology has developed a suicide mnemonic for counselors: “Is path warm?” (Kennebeck & Bonin, 2018)
Ideation – Talking about or threatening to harm or kill oneself; looking for ways to kill oneself; talking or writing about death, dying, or suicide
Substance abuse increases – alcohol and/or drugs
Purposelessness – No reason for living; no sense of purpose in life
Anxiety – Worry, fear, agitation, or changes in sleep pattern
Trapped – Feeling like there is no way out of a bad situation
Hopelessness – a feeling or state of despair; lack of hope
Withdrawal from friends, family, and society
Anger – Rage, uncontrolled anger, seeking revenge
Recklessness – Acting reckless or engaging in risky activities, seemingly without thinking
Mood changes – particularly those that are dramatic in nature
“There is a cultural movement in the white working class to blame problems on society or the government, and that movement gains adherents by the day.” ― J.D. Vance, Hillbilly Elegy: A Memoir of a Family and Culture in Crisis
I learned about the drug pipeline from Detroit, MI to Huntington, WV in 2016. I toured addiction treatment centers, talked to emergency room doctors, and visited with first responders. Dealers call Huntington “Moneyington,” according to one man from the Cabell County Fire Department.
“We’re not alone; southern Ohio is also getting slammed. Drug pushers sell opiates on the ‘drug pipeline roadway’ before they get to us, and, Fentanyl, 100 times stronger than heroin, is their big money-maker. It’s killing people. The strange thing is, when people die, the price goes up. What sense does that make? We give Narcan for overdoses, only to see some folks two weeks later for the same issue. I’m counting the days until retirement.” ― First Responder for Cabell County
Daniel Nelson, Child Psychiatrist from Cincinnati Children’s Hospital, not far from West Virginia, also near that “drug pipeline roadway,” saw a connection between teen suicide and opioid overdoses when he analyzed the data. He found that most of the overdose deaths were people in their 20’s and 30’s, in other words, individuals who are often parents. With colleagues, Nelson maintains a map of the addresses of 300 children admitted to the hospital due to suicidal behavior over a three month period. They immediately recognized a pattern in Price Hall—a community struck by both poverty and a high rate of opioid overdoses—had an alarming rate of youth suicide. The doubling of the U.S. suicide rate (CDC, 2018) motivated Nelson to work with county coroners across the country to expand his pool of data (Murgia, 2017).
After four years in Cabell County, it is gratifying to know that much of our work will continue through Marshall University. Mindfulness for emotional regulation, the creation of trauma teams, and the promotion of restorative justice to reduce school suspensions, are truly a priority. Hopefully, grief groups and personalized learning with bibliotherapy (the use of books as therapy in the treatment of mental or psychological disorders will continue for teens. Jeb Flower’s, “Together WE Can Program,” a peer-to-peer teen support to increase high school attendance, has been supported and promoted throughout the community. By creating a compassionate community at school, teenagers whose lives are disrupted by the opioid crisis and/or poverty-related trauma have at least one safe space to turn to when they have suicidal thoughts.
The Economist. (2019, March 9). Scourge upon scourge: Amid the opioid crisis, a different drug comes roaring back. The Economist website.
Kennebeck, S. & Bonin, L. (2018). Suicidal ideation and behavior in children and adolescents: Evaluation and management. UpToDate website.
McJunkin, J. (2018, January 18). Jim Junkin: Among WV teens, suicide is 2nd top cause of death, usually by firearm. Charleston Gazette-Mail website.
Murgia, M. (2017, August 24). Mapping out the cause of suicide in teenagers and children. The Washington Post.
Vance, J.D. (2016). Hillbilly elegy: A memoir of a family and a culture in crisis. New York, NY: Harper Collins.