Digest- V8, I3 Full Issue

2 TPC Digest O pioid painkillers are the most frequently prescribed class of drugs in the United States. Counselors must account for the acute effects of their use (e.g., relief from physical and psychological pain), unique side effects (e.g., opioid-induced pain sensitivity, painful withdrawal symptoms), ease and speed with which tolerance is established, and potential resulting impairments in daily functioning. Some people are naturally more vulnerable to developing opioid tolerance and dependence, and such users can quickly become reliant on the drug to function at a normative, baseline state. Misuse of these drugs often leads to heroin use, a cheaper and more potent alternative to prescription pills. Heroin is increasingly cut with the synthetic opioid fentanyl and its various analogs, such as carfentanil (a veterinary drug used to rapidly immobilize wild animals), contributing to a dramatic rise in overdose deaths. We suggest that Bronfenbrenner’s ecological systems theory is a useful lens through which clinicians can conceptualize clients struggling with opioid addiction. Ecological conceptualization and treatment planning can provide a structured template for helping counselors understand their clients as embedded in multiple systems and influenced by a wide range of variables. Using a composite case study, we demonstrate how eco-mapping can be used to create an ecologically- informed conceptualization of a client. Using this strategy, our client is not just a chronic pain patient who became addicted to prescription opiates and began using heroin intravenously. Rather, multiple interconnected variables in both the close and distant environment contributed to his current challenges and will influence his recovery. These include changes in the global economy; health care policies and resources; marketing strategies by the pharmaceutical industry; cultural norms and existential concerns related to his identity as a man, father, and worker; availability of community resources; and the intersection of this moment in his lifespan and this moment in history. Utilizing this model in clinical settings could enrich the lives of clients, who may come to embrace a more nuanced and inclusive way of conceptualizing themselves and their environment. Counselors-as-advocates are inherent in this model, since professionals who espouse ecological thinking cannot ignore the multitude of powerful forces that either enhance or impede our clients’ well-being. As focus and resources are directed to this complex problem, ecologically informed interventions by stakeholders in all of the interconnected systems are advised to both save and improve lives now and in the future. Jennifer L. Rogers, NCC, is an assistant professor at Wake Forest University. Dennis D. Gilbride is a professor at Georgia State University. Brian J. Dew, NCC, is an associate professor at Georgia State University. Correspondence can be addressed to Jennifer Rogers, P.O. Box 7406, Winston-Salem, NC 27109, rogersjl@wfu.edu. Utilizing an Ecological Framework to Enhance Counselors’ Understanding of the U.S. Opioid Epidemic Jennifer L. Rogers, Dennis D. Gilbride, Brian J. Dew