TPC Journal V8, Issue 3- FULL ISSUE

228 The Professional Counselor | Volume 8, Issue 3 term use of prescription opioids in the treatment of chronic non-cancer pain (Kolodny et al., 2015). Methodologically questionable research studies were widely cited to minimize the perceived risks associated with long-term use and addiction. Sales of Purdue Pharma’s doggedly promoted, non- generic OxyContin grew from $48 million in sales in 1996 (316,000 prescriptions) to almost $3 billion (more than 14 million prescriptions) in 2001–2002 (Van Zee, 2009). Though the time-release formula was touted as a deterrent for misuse, users discovered the pills could be crushed and then snorted or injected. In 2000, Purdue released a 160 milligram tablet (up from the previous high dose of 80 milligrams) approved for use by patients who had developed opioid tolerance, further increasing OxyContin’s draw as a drug of abuse (Van Zee, 2009). An increase in opioid supply via both unwitting and unscrupulous prescribers was quickly followed by the rapid acceleration of opiate abuse across the country (Van Zee, 2009). Unlike other illicit substances (e.g., cocaine, methamphetamine, ecstasy), these pain-killing medications were prescribed by medical professionals and therefore assumed to be safe. Prescription opiates were accessible through doctors, family, friends, the internet, and on the black market. Long-term use of prescription opiates can lead to tolerance and eventual physical dependence, requiring a continuous supply of drugs and financial resources to purchase them. Users of prescription opiates have increasingly turned to heroin (Skolnick, 2018) as a cheaper, more readily available option to keep painful withdrawal symptoms at bay. With increased availability and visibility, many people now report that their opioid use started with heroin rather than prescription drugs (Dasgupta et al., 2018). The rise of the presence of illegally manufactured fentanyl in opioids available on the illicit market has had increasingly deadly consequences, with fentanyl-related deaths in the United States up 540% between 2013 and 2016 (Katz, 2017b). Average life expectancy is now declining among some segments of the population—unusual except in times of war (Dasgupta et al., 2018). Unlike other U.S. drug use crises that have disproportionately affected minority populations (e.g., crack cocaine), there has been a focus in this crisis on over-prescribing as the root cause, rather than the moral failings of individual users. This broader view may help destigmatize the current situation, but it is imperative to recognize that complex factors lead to susceptibility to all such crises. For instance, in areas particularly affected by the opioid crisis, mortality associated with alcoholism, drug overdoses, and suicide (known as “diseases of despair”) has increased as local economies have declined (Dasgupta et al., 2018). The devastation of individual lives, families, and communities resulting from this epidemic is clear, and the complexity of the issues it has engendered requires counselors to expand treatment strategies and interventions. In the next section, we review Bronfenbrenner’s (1979, 1994) ecological systems theory and present a strategy designed to help counselors both understand and intervene with clients and communities battling this challenge. Ecological Perspective Bronfenbrenner’s foundational work, The Ecology of Human Development (1979), described how a child develops within a series of interrelated systems. He posited that human development processes are influenced by individual characteristics, as well as features in one’s immediate and more distant environments. Over the course of a lifetime, development progresses through a series of increasingly complex and reciprocal interactions between an individual and the people, things, and symbols in their environment. Research designed to investigate this developmental progression is described as aligning with a process-person-context model (Bronfenbrenner, 1994) and is endemic in our current understanding of psychological health and illness.