By Ed Runyan
Nickola Ceglia, a social worker for the past 40 years who has worked with drug addicts, gives a presentation he calls “Recognizing the Addict in All of Us.”
He doesn’t mean to suggest that the raging heroin epidemic killing thousands of Ohioans each year will be coming to all of our doorsteps.
But the issues that contribute to a person becoming addicted to a substance such as heroin or alcohol exist in every living room in the Mahoning Valley, he says.
Ceglia, who was director of the Trumbull County Mental Health and Recovery Board a decade ago and now is an instructor at the Behavioral Health Institute at St. Elizabeth Youngstown Hospital, has passed on counseling advice in recent presentations in the hope that it will help the public better understand addiction.
At the Behavioral Institute, he trains physicians, resident-physicians and student nurses through a federal grant to “recognize substance use early on before it becomes such a big problem.”
The frontal lobe of the brain is the one that controls “executive skills,” such as being able to remember, manage and plan, he said. The middle part tells a person to run, fight, sleep or eat.
A person using addictive substances is more likely to use the middle part of the brain, which is why he or she acts more impulsively. “The addict, the alcoholic needs to use. Family doesn’t become important, job doesn’t become important,” Ceglia said.
What kind of young people are likely to become addicted? Ceglia cited the work of psychiatrist Patricia Conrod that listed people prone to thrill-seeking, anxiety-sensitivity, impulsivity and hopelessness.
Ceglia said it’s the impulsiveness that makes him fear the effects of marijuana use in young people, saying the frontal lobe doesn’t fully mature until the mid- to late 20s, “so if they are messing with pot, then it delays that, and that increases the impulsiveness and puts kids at risk.”
When a person displays extreme sensitivity to anxiety, “that relates to their self-image.” As for hopelessness, “I hear this a lot from patients ... they feel like they don’t have a sense of purpose, a mission.”
Ceglia also cited the writing of Nicholas Stinett in describing characteristics of healthy families, things that can reduce the likelihood of addiction, such as a commitment to family and the ability to cope with stress.
“Promoting healthy families keeps us away from substance use,” he said.
“Spiritual well-being is also really important,” he said. “It doesn’t matter what religion. What matters with families is forgiveness, being able to forgive, demonstrate mercy, show compassion, and move on.”
“If you lack a viable role model in your home, that’s a risk factor,” Ceglia added. “If you lack the ability or faith in being able to solve problems, that’s a factor.”
He continued, “Are you able to say, ‘I’m a capable person who is able to face my problems and my challenges and gain wisdom and strength through my experience?’ Addicts have a difficult time doing that.”
Ceglia shows several graphics depicting the way a person’s “pleasure threshold” changes when drugs are part of their life.
In a nonaddict, a family vacation or job promotion triggers a pleasure threshold of one kind. But when opioids are added, the old pleasure threshold is overcome by the pleasure of the drug.
“You get a new threshold. The old [pleasure] threshold goes up. And as that goes up, you don’t respond to the same type of satisfaction as you did when you went on vacation, when you had a family, when you did whatever. It hijacks the brain,” he said.
Ceglia described three types of treatment used in an effort to free a patient from addiction: outpatient counseling; partial hospitalization; and residential, inpatient and medically-managed intensive care.
Partial hospitalization is in a group setting three to four times per week “as they are weaning themselves off of drugs or alcohol, we are trying to work that frontal part of the brain — the coping skills, the self-esteem,” he said.
That lasts about two months, but then normally needs to be followed by a recovery community, such as Alcoholics Anonymous or Narcotics Anonymous.
Anyone trying to help an addict should avoid sarcasm, accusations, blame, guilt, judgment, he said.
Part of treatment is about teaching accountability. “I’m accountable for my actions and choices,” he said. “I have the power to influence my life. Recovery is about accountability. You have to be honest with yourself, and you have to be honest with the people you rub elbows with every day and then participate in a recovery program.”