For every 10 Denton County residents, about two say they drink excessively and have poor mental health days for nearly two weeks per month, Denton County Public Health reports.
On par with nationwide trends, Denton County is seeing pervasive issues with mental health and substance abuse that affect adults and adolescents alike.
To get to the bottom of why addiction is more than just a bad habit and promote empathy for people who struggle with addiction, Denton County MHMR hosted a substance use disorder seminar.
Promoting the movement to reframe addiction is Drew Dutton, whose Project Empathy seeks to explain the set of disorders through neuroscience and positive psychology.
The seminar’s keynote speaker, Dutton is a licensed professional counselor supervisor, a licensed chemical dependency counselor and an advanced certified prevention specialist. He is the president and CEO of Phoenix House Texas, a nonprofit that provides low-income teens with substance abuse treatment.
How prevalent are substance use disorders?
The number of people suffering from mental illness is on the rise, Dutton said, and when people’s mental and emotional needs are not met in healthy ways, they often seek to fulfill them in unhealthy ways.
Denton County Public Health reports that about a quarter of residents say they do not have sufficient social and emotional support.
Substance use disorders, which make up a category of formal mental health diagnoses, are frequently co-occurring with other mental health disorders, too, and one disorder often worsens the other.
Two in 10 Denton County residents report that they experience 13 or more days of poor mental health per month, according to DCPH.
About 22% of residents report that they drink heavily or binge drink regularly, according to DCPH, and about 20% of fatal motor vehicle crashes in the county include alcohol as a contributing factor.
Nationwide, about 1 in 6 people over the age of 12 have a substance use disorder, Dutton reported, citing the Substance Abuse and Mental Health Services Administration.
The U.S. specifically has a crisis on its hands with adolescent substance use, Dutton said, and it could be worse than statistics show.
“With this data, I think it’s important to note the context is self-report in a classroom,” Dutton said. “You’ve been told it’s anonymous, right? But you are in a classroom being asked about your illicit drug use by your teacher, right? Odds are it might be skewed down or minimized.”
One in five middle schoolers reported they were beginning to experiment with illicit substances.
Over half of 12th graders reported the same.
“Why is that relevant? Well, your risk of developing a substance use disorder more than doubles if illicit use starts in adolescence,” Dutton said. “We have half the population already at over twice the risk out the gate.”
This adolescent crisis, as Dutton calls it, is also a matter of life or death. He said that 22 students die of drug overdoses, by and large fentanyl, every 10 days in the U.S.
During North Texas Overdose Awareness Day in Denton in 2019. Attendees hold up purple glow sticks to commemorate those who have died from substance use.
DRC file photo
Out of the 2.2 million adolescents who meet the criteria for needing some kind of help, Dutto said only about 70,000 access any type of treatment, and of them, about 25,000 will complete a treatment program. Relapse rates can be anywhere from 40-60%, Dutton said.
“If you look at that success rate, it’s half a percent. Name any industry where you’d be comfortable with that. Would you go to a heart surgeon if about half a percent of the time the patients wake up from heart surgery?”
At the core of addressing this crisis, Dutton said, is better understanding addiction.
What is addiction?
To understand what addiction is, Dutton said, we also have to understand what it is not.
It is not a choice, a moral failing, a lack of values or an absence of discipline or punishment, Dutton said.
Dutton defined addiction in the following way: “Addiction is a treatable chronic medical disease involving complex interactions among brain circuits, genetics, the environment and an individual’s life experience.
“People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences,” he said. “Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.”
Some people can have all the risk factors and never develop an addiction, Dutton said, while others can have no risk factors and develop one.
Neuroscience can offer us insight into why that is.
Dopamine is our brain’s internal dog-treat system, as Dutton described it. Our brain releases dopamine when we perform actions that are essential to our species’ survival — eating, exercising, procreating — which acts as an incentive to keep performing those actions.
When a person consumes a drug, it releases an excessive surge of dopamine in their brain. So, to reach a stable equilibrium, the brain will begin to shut off the receptors for that dopamine.
Thus, when the high is over, that person is not able to receive as much natural dopamine. The person will seek that drug out again to get that surge of dopamine but, gradually, more receptors will shut off, leading to a cycle of chasing a high that becomes increasingly dulled.
“For some people, the brain gets so convinced [the drugs] are necessary for survival, it actually cuts off the blood flow and oxygen to their prefrontal cortex,” Dutton said.
Our prefrontal cortex controls our logic and reasoning.
When the prefrontal cortex shuts down, the amygdala takes over. This part of the brain controls our fight-or-flight response.
While in this cycle of prefrontal cortex dysfunction; a.k.a hypofrontality, Dutton said; it is not that different from what happens to everyone when they feel extremely angry.
“We also lose our prefrontal cortex. … We pick fights with drywall, we slam doors, we break phones, we tell loved ones hurtful things,” Dutton said. “I don’t think anyone would say, ‘I stand by it. This is who I am. It represents my morals and values.’ So many of those same people turn around and go, ‘But when you do it, you’re a criminal and a bad person. But when I do it, I just lost my temper,’ … not realizing someone in addiction is in that same state as you, but they get stuck in it for weeks, months or years before they come out, versus a few hours.”
Dutton has given this lecture many times and said when he explains this to adolescents, they usually ask if he can repeat that same explanation to their parents.
Once it gets to this point, Dutton said, people do not want to keep doing it and feel shame and embarrassment over continuing to use drugs.
Even when someone is trying to be sober, Dutton said, their brain still has a reduced ability to receive dopamine.
Shut-off receptors can eventually repair themselves over prolonged periods, Dutton said. Until then, the person will have an inability to feel positive emotions. That is why many people in the early stages of recovery are irritable.
Yet, Dutton said, the leading reason adolescents do not complete treatment programs is because they are kicked out for fighting or because they ran away.
Many interventions and treatments put patients in a state of fight-or-flight, Dutton said, but then demonize patients for being irritable or having difficulty completing treatment.
“We blame them for the brain doing essentially what it’s supposed to do,” Dutton said.
What do we do about addiction?
Attendees at the seminar got to hear from those in recovery from addiction, as well as loved-ones-turned-advocates who have funneled their grief over losing a family member to substance use into promoting awareness and action.
Sharon Roland, captured in a 2022 file photo, sits at a computer displaying a collage of her son, Randy, who died after an ongoing strugge with substance use. Roland was one of the family members who spoke at Denton County MHMR’s seminar and spoke about how stigma around addiction is alienating for both people with addiction and grieving family members.
DRC file photo
A common theme in their stories: They or a loved one were good people who, in the throes of disease, sometimes made poor decisions.
Those in recovery expressed that an empathetic family member or counselor made all the difference to them.
Dutton said the statistics support those anecdotes: People who had an unempathetic counselor were more likely to relapse than those who never received any treatment at all.
Addiction is highly treatable —more so than hypertension, Dutton said — but less so if empathy is not at the core of treatment.
It is sometimes hard for family members or health care workers to handle patients with addiction who seem to have no desire to help themselves, Dutton said. Again, he said, it is not about choice but rather a neurological inability for people with active or recent addiction to feel hope and joy.
Until the brain begins repairing itself, it is hard for people with addiction to find the reward in intervention, Dutton said. So, it is important to remember that this is a symptom of the disease instead of punishing them for their negativity or frustration.
“Remember this word: symptoms,” Dutton said. “I think the part we confuse a lot is their behavior. ‘They’re misbehaving. They’re disrespectful. They don’t think about the consequences of their actions. They’re bad kids or young adults.’ This [behavior] is a symptom of hypofrontality. They have lost the ability to think things through.”
Once people can temporarily suspend their own personal experiences and take the time to understand addiction, Dutton said, they will be better equipped to help.
“You can’t fix what you don’t understand,” Dutton said. “Empathy doesn’t excuse behavior — it explains it. When we understand people, people can change.”