TPC Journal V8, Issue 3- FULL ISSUE

230 The Professional Counselor | Volume 8, Issue 3 neighborhood, or how patients of a local physician who frequently prescribes pain medication may experience an increase in the off-market availability of such medication within his or her neighborhood, family, or peer group. The exosystem is comprised of processes occurring between two or more environments, at least one of which does not include the individual of interest (Bronfenbrenner, 1979, 1994). Even though a person may not exist within a certain setting, outside events can indirectly influence that person’s immediate environment. Examples of exosystem processes include how a new local company’s practice of only hiring college-educated workers influences less educated workers in a nearby neighborhood, or how decisions by legislators regarding health care policy influence local hospitals and family decisions about medical care. The macrosystem represents the patterns, policies, laws, values, and trends that comprise the broad cultural, political, economic, and societal/environmental backdrop of an individual’s life (Bronfenbrenner, 1979, 1994). Macrosystems include mega factors such as advances in technology and the rapid transition into the information age, the precipitous move away from manufacturing in the United States, the increasing need for a college education to obtain a salary that can sustain a middle-class lifestyle, changes in how health care is funded and delivered, the decline in membership in organized religious institutions, and a growing cultural emphasis on individualism. Other trends include changes in how information is delivered and consumed, and the increasing gulf between rural and urban communities. The chronosystem describes changes in an environment over time related to each of the other systems (Bronfenbrenner, 1994)—the normal growth and development of a person or family, the effect of a move or migrations of families or groups, and the effects of large historic events such as wars, natural disasters, and recessions. The chronosystem highlights that along with living within nested or interacting systems, a person also lives within the history of their own life—as well as within the history of their family, community, state, nation, and world (Bronfenbrenner, 1994). Ungar, Ghazinour, and Richter (2013) expanded Bronfenbrenner’s model in their studies of resilience to include a focus on the success of individuals and groups to secure resources leading to healthy development, even in adverse circumstances. Ungar and colleagues’ model describes systems as reciprocal rather than hierarchical. The effect of a systemic variable is not just related to its proximity to an individual (per Bronfenbrenner’s nested model as described above and in Figure 1), but rather on its importance to a particular person at a specific point in time. For example, a war and its related geo-politics (a macrosystem issue) may be much more salient than school (a mesosystem issue) for a particular child living under siege in Syria. An Ecological Conceptualization of Opioid Addiction A social-ecological perspective is tacit in many popular journalistic efforts focused upon the opioid use epidemic, including books (e.g., Hillbilly Elegy; Vance, 2016), documentaries (e.g., Warning: This Drug May Kill You; Peltz, 2017), and investigative news reports (e.g., Talbot, 2017). In these long-form examinations, a multitude of distal and proximal variables influencing opioid use patterns among individuals are described. Recent scholarly publications outside of the counseling literature have utilized implied (Dasgupta et al., 2018; Kolodny et al., 2015) and overt ecological (Hewell et al., 2017; Keyes et al., 2014) lenses to examine this problem. Keyes and colleagues (2014) undertook a large ecological synthesis of the extant empirical literature related to the opioid crisis in rural America. They identified the following risks in their analyses: (1) increased availability and access; (2) lower