TPC Journal V8, Issue 3- FULL ISSUE

226 Jennifer L. Rogers, Dennis D. Gilbride, Brian J. Dew Utilizing an Ecological Framework to Enhance Counselors’ Understanding of the U.S. Opioid Epidemic This conceptual article provides a counselor-oriented overview of the origins and consequences of the current opioid epidemic in the United States. After a thorough review of Bronfenbrenner’s ecological perspective on human development, this article presents a case conceptualization model aimed at providing counselors with a tool and strategy to better understand how systemic complexities impact opioid-dependent clients and their communities. A detailed composite case study is used to demonstrate the influence of multiple ecological variables on a specific client. Individual, micro-, meso-, exo-, macro-, and chronosystem stimuli are explored, and the role of advocacy as inherent in systemic conceptualization and treatment planning is discussed. Keywords: opioid epidemic, ecological, Bronfenbrenner, opioid-dependent, case conceptualization Alarming national headlines related to opioid addiction highlight a public and mental health emergency across America. Overdoses and opioid-related deaths are skyrocketing (Rudd, Seth, David, & Scholl, 2016; Skolnick, 2018; Suzuki & El-Haddad, 2017), and the lifespan of many Americans, especially in rural areas, is declining for the first time in generations due in part to maladaptive use of narcotics (Katz, 2017a). Opioid painkillers are the most frequently prescribed class of drugs in the United States (Skolnick, 2018). Misuse of these drugs often leads to the use of heroin, a cheaper and more potent alternative to prescription painkillers (Skolnick, 2018). Heroin is increasingly cut with the synthetic opioid fentanyl (50–100 times stronger than morphine) and its various analogs, such as carfentanil (a veterinary drug used to rapidly immobilize wild animals; Suzuki & El-Haddad, 2017), contributing to the recent dramatic rise in overdose deaths (Katz, 2017b; Suzuki & El-Haddad, 2017). The opioid epidemic also is associated with increases in a host of other negative outcomes, including rates of HIV and hepatitis C, arrests and incarcerations, and neonatal abstinence syndrome (Skolnick, 2018). Addictions, mental health, rehabilitation, and school counselors are challenged to find better ways to understand and assist users, families, and communities being ravaged by this public health crisis. Clinicians and researchers have developed multiple individual and community-based strategies to assist clients with substance abuse, but current circumstances have underscored the need for members of the counseling profession to take a more comprehensive and ecological approach to both understanding and addressing the needs of people struggling with opioid addiction (Dasgupta, Beletsky, & Ciccarone, 2018; Hewell, Vasquez, & Rivkin, 2017; Keyes, Cerdá, Brady, Havens, & Galea, 2014; Kolodny et al., 2015). In subsequent sections, details of this public and mental health crisis are described, and an ecological case conceptualization model that utilizes eco-mapping to assist counselors in better understanding and developing systemic treatment plans is presented. A case study allowing for the application of the model is provided, and implications for counselors are explored. An Opioid Overview Mental and public health officials have long recognized the popularity and uniquely addictive potential of substances classified as opioids . Use of opium and morphine first became a problem in America during the late 1800s (Kolodny et al., 2015). Morphine was used to treat a variety of chronic The Professional Counselor Volume 8, Issue 3, Pages 226-239 http://tpcjournal.nbcc.org © 2018 NBCC, Inc. and Affiliates doi:10.15241/jlr.8.3.226 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.