The Importance of CASACs with Mark Bonacci, PhD

In this episode we sit down with Mark Bonacci, PhD, to explore the essential role of CASACs (Credentialed Alcoholism and Substance Abuse Counselors) in addressing substance use disorder. We delve into the nuanced aspects of  treatment, counseling methodologies, and the impact CASACs make in our community. Mark Bonacci's insights  highlight the imperative of addressing substance use disorder as a public health crisis that demands our collective attention and empathy.

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Transcript

Nada Fox: 0:18

Welcome public health enthusiast to another episode of the buffalo Health Cast, where we explore the latest trends, breakthroughs and expert insights in the world of health and wellness. I'm your host native fax, and today's episode promises to be a fascinating dive into the field of addiction counseling. Joining us today is a distinguished guest, Dr. Mark Bonacci. Dr. Bonacci has dedicated his career to advocating for effective strategies and addiction treatment and educating future health care professionals. Today, our focus will be around CASAC or Credentialed Alcoholism and Substance abuse counselors. Case acts play a crucial role in supporting individuals on their journey to recovery, providing guidance, empathy, and a pathway to sobriety. Dr. Bonacci has a wealth of knowledge and experience in this field makes him the perfect guest to shed light on the importance of case acts and their impact on the overall well being of those struggling with addiction. Thank you so much for joining us, for to speaking with you this evening. Now, before we begin,can you tell our listeners about your background and experience?

Mark Bonnaci, PhD: 1:27

Oh, sure. I took a kind of circuitous route to where I am now. When I was very young, I studied to be a social worker. I got a Master's in Social Work at NYU, about 45 years ago, I'm 66. Now I'm certainly not young. And I worked clinically for one year. And then I well, I worked at the Guven, near a psychiatric institution on the Lower East Side of Manhattan. And I found that in interdisciplinary treatment team meetings, I felt at any rate invalidated by the PhDs and the physicians. So I wanted to have more of a say more authority, I wanted a doctorate. And so I entered a PhD in Clinical Psychology program, actually, you be where you are now. But at any rate, I got the PhD in Clinical Psychology, and immediately began working at the West Seneca developmental center with mentally challenged intellectually challenged individuals. And I was there for four years as a clinical psychologist, and I was working on a living unit. with clients who are multiple diagnosed when I was thoroughly burnt out, I answered an ad to teach at Niagara Community College, and luckily got the position. So I would teach for a respite for one or two years, but actually loved teaching. And I've never left about 35 years later, I've really enjoyed it. I think it was around maybe 2009, that I was asked to design like a chemical dependency program. And that's what I do now I coordinate a human services Associates Degree and a chemical dependency counseling certificate, and I really enjoy it.

Nada Fox: 3:29

Can you provide us with a brief overview of what CASACs do and their role in addiction treatment?

Mark Bonnaci, PhD: 3:36

Yeah, do you know they really are the frontline people that work directly with the clients. And because the case hack is designed as a starting out as a peer counselor, about 50% of the people in the field, and indeed in our program at N triple C are in their own recovery. So they, you know, are really the frontline people and working with the clients. They can empathize with them, you know, they've had similar experiences. And as a first step towards counseling, the CASAC and the CASAC-T, the case EQ trainee credential are are just invaluable. I always encourage my students to go on to get, you know, perhaps a Bachelor of Social Work, or a Masters of Social Work or a PhD, you know, in order to have a more fulfilling career, but as a first entree to the field, the K sack tea and a K sack are extraordinary. I think they they get to do the most interesting work. And because of the president opiate epidemic, unfortunately or fortunately for them, there are many many unfilled positions in the field.

Nada Fox: 4:48

What is the difference between a CASAC and a CASAC-T.

Mark Bonnaci, PhD: 4:52

Right, the way the system is structured through New York State Office of Alcoholism and Substance Abuse Services is that students have to obtain 350 clock hours or contact hours of instruction. And they can do that either at a college or at a training institute. The college programs are very organized to fit into the CASAC requirements, you know, kind of to a tee that at any rate, once they get to 350, training hours educational hours, they sit for the New York state exam, threw away SAS, once they pass that exam, they are a K SEC t a case SEC trainee. Once they then have either two years of full time employment in the field, or it's equivalent 4000 hours, or if they have a master's degree, just one year is required it then the T drops off of their designation, and they become a full fledged CASAC, Credentialed Alcoholism and Substance Abuse Counselor. So really the difference between the CASAC-T and the CASAC is that work experience out in the field, it has to be done within 10 years. So if one is working very part time, you no one needs to step it up. Because those you know that two year equivalency has to be done within 10 years of passing the exam. But other than that, they really have a lot of flexibility. Because they need more and more CASACs and CASAC-T's in the field as so many people are retiring at this point. And there's just not enough young people to fill their shoes, their positions.

Nada Fox: 6:48

How do case acts adopt a holistic approach to addiction counseling, considering not only the immediate treatment, but also the broader well being of the individuals and communities?

Mark Bonnaci, PhD: 6:59

You know, I think a big part of being a CASAC or a CASAC-T is advocacy, and advocating not only for your own client and their needs, making sure that their needs are met by systems that are often unresponsive, but also advocacy in a broader realm. You know, I always tell my students about my work overseas. For about six years, I was a gratis director and unpaid Director of the Health Care projects of international voluntary services. And I was so privileged because I got to work in Cambodia, Vietnam, Laos, Ecuador, Bolivia, Zimbabwe. And we had such interesting programs. And I learned so much about advocacy, and how, you know, if a system is unresponsive, or a bureaucracy is dismissive of the clients, you owe it, you know, not only to the individual client, but to the whole field to advocate for change. So I think advocacy is a big part of the CASAC role. In fact, it's in the CASAC code of ethics, that you know that you will advocate for the rights of people suffering from substance abuse disorders.

Nada Fox: 8:22

Wow, that's really interesting. Addiction often carries a stigma, as you know, yes, unfortunately, how to case acts contribute to reducing the stigma and fostering a more understanding and supportive community.

Mark Bonnaci, PhD: 8:37

You know, once again, I think through advocacies, and especially just my own opinion, advocating for harm reduction methods, there are so many in our society still, who are very judgmental, and will say things like a drug as a drug as a drug. So, you know, I've heard people say, Oh, come on a methadone clinic, they're taking people addicted to heroin, and they're addicting them to methadone. And even like, I hate to use their terminology, but tell say they're turning heroin addicts into methadone addicts. And I always tell my students, let's not say that someone is an addict, let's not make an existential statement about them that that's what they are. They're a person suffering from a substance abuse disorder. And so if we believe that they have a disease, they have a disability, we need to do whatever we can to ameliorate their condition when we consider that only according to the National Institute of Mental Health, about 6% of IVD use intravenous drug users are in treatment programs. Well, what are we going to do for the other 94% harm reduction, whether it's a needle exchange program or advocating for safe injection sites, which you know, we haven't been all successful within the US, other countries are way ahead of us on safe injection sites advocating for those things that bring clients into agencies, bring them in contact with treatment communities, you know, because if we're only going to deal with the 6%, who are in treatment, we're really failing at our roles.

Nada Fox: 10:20

I think it's interesting that you bring up like the 6%. And like the harm reduction that's necessary for like the other 94%. Because I think people often like think, either I'm sober, or I'm not, and it's this very linear path I'm supposed to be on. And that might be true for some individuals. But that doesn't necessarily mean it's true for all individuals, right?

Mark Bonnaci, PhD: 10:42

Yes, yeah. The emphasis in our society is still I'm sorry to say, on blaming the victim and the you know, like the, the average person I think, would blame the person addicted to heroin, rather than the Sackler family, which, you know, push hydrocodone and oxycodone to within an inch of their lives. And, and then, unfortunately, New York State, as you know, instituted the ice stop program in 2014. And, uh, you know, not to anything, opioid related deaths in Erie County in 2014. Were 127, which is a tragedy, of course, but once the I stopped program started, and people couldn't doctor shop and get oxycodone, hydrocodone Demerol from physicians, unfortunately, they turned to street drugs, often laced with fentanyl. And so by 2016, there were 301 opioid related deaths in Erie County. And that was an unintended consequence of the eye stop program. And it wasn't until a nasal Narcan distribution was instituted in New York State in November of 2015. It wasn't until that point that the curve started to come down. And so in 2018, finally, we were back down to 125. Opioid related deaths, which, you know, one, opioid related deaths is too many. But it Thank God, we went from 301 to 125, because of the distribution of a nasal Narcan,

Nada Fox: 12:34

Right, and the more accessible we can make that for people and just making it like a normal part of your first aid kit to have,

Mark Bonnaci, PhD: 12:43

absolutely,

Nada Fox: 12:44

And removingthe stigma around it, right, you know,

Mark Bonnaci, PhD: 12:48

yes.

Nada Fox: 12:49

It's not only addicts, unfortunately, that need Narcan. There are people that just decide to have a fun Saturday night and buy the wrong thing, which yes, it should be more commonly accepted. And just like part of the norm, because,,

Mark Bonnaci, PhD: 13:04

Yeah, absolutely Yeah, you know, yeah. You know, Nada, I was Vice Chair of the Board of fellowship house, which was recovery agency for many years. And I remember a legislator said to me, Well, you know, why should there be these things like Narcan, Naloxone, people are just being revived to overdose again and again, and I remember saying, Well, do you have a child? And he said, Well, yeah, I have a teenage daughter. And I said, if your daughter was at a party, and she was overdosing on an opioid, wouldn't you want her revived? I mean, that's, for me, the bottom line, you know, even if someone overdoses 15 times, they still deserve another chance to try to live to try to recover, like the judge mentalism is still there in our society.

Nada Fox: 13:59

Yeah, the stigma is strong. And it's the it's the moral failing of the individual idea that we don't, we don't teach healthy coping skills a lot of the time, and we develop these maladaptive behaviors as just a way to deal or way to escape. And I think people like minimize that, you know, everybody's hardwired is a little different. So what might just be a regular Friday night where I got a little wild for me might mean, a path to something very dark for somebody else, you know? Yes. Yeah. Yeah. It's not like, you know, you try 15 times you're guaranteed to be an attic. That's true for some people. For other people. The threshold is lower or higher, or they're not wired that way.

Mark Bonnaci, PhD: 14:46

Yeah. So many individual differences. Yeah. You know what I like to tell my students I like to share with them. The Erie County Department of Health has a statistic that with opioid related deaths, the time of day A that is most common is 6pm. And I always, excuse me tell my students, well, why 6pm These people have jobs, these people work a nine to five, and they come home. And that's when they choose to unwind and do their drug of choice. They're just like you and me. You know, they're working people. They're not people lurking around street corners, and you know, all the stereotypes that people have

Nada Fox: 15:28

Right? Functioning, addiction is a real thing. And I think, yes, it's not talked about enough, because when you say the word addiction, there's, we all have a certain image that kind of comes into our brain. Some of them are working professional, some of them are soccer, and everything in between?

Mark Bonnaci, PhD: 15:45

No, absolutely.

Nada Fox: 15:47

I think that's an interesting thing that we need to like start talking about and kind of reframing in society. You know, what, because the image can be anything, just like a doctor can be anyone, just like a teacher can be anyone an addict can be anyone.

Mark Bonnaci, PhD: 16:02

Absolutely.

Nada Fox: 16:03

It doesn't know socioeconomic status, or any of those things. You know, it transcends all of that.

Mark Bonnaci, PhD: 16:11

Yeah. And you know, if anything, a lot of people feel that drug court or employee assistance programs are doomed to failure, like I've had students even say, Well, you can lead a horse to water, but you can't make them drink. I've had students say, unless the treatment is voluntary, it won't be successful. But one of the leading principles that the NIH put out was treatment does not have to be voluntary, to be effective. You know, if someone is diverted from the criminal justice system, and they're sent to a treatment facility instead, well, they might begin resistant, perhaps, but oftentimes, they get with the program, they see other people in recovery, they see other people putting their lives back together again, and they get in recovery. So, you know, the idea that mandated treatment doesn't work, you know, that perception held by the average person, it doesn't play out at all.

Nada Fox: 17:06

It's interesting, you bring that up? How do you feel about the concept of forcing the bottom, like forcing an addict to bottom out? Do you think that's an effective approach into getting somebody into treatment? Or do you think that's unnecessarily traumatic?

Mark Bonnaci, PhD: 17:21

You know, I would say, don't try this at home. You know, like, I mean, I've consider myself a humanist. And so to put someone through unnecessary trauma, I really believe that people will find their own bottom, you know what I'm saying? Yeah, like, like, when it's time, and I don't think we can force that as clinicians. We're not that powerful. I mean, that's my opinion. At any rate, you know, I've been I mean, they always say, you should have a trained clinician there when you're doing an intervention, you know, because something dreadful could occur.

Nada Fox: 17:58

Right. And you could do more damage than yes, when the overall goal is to help your loved one or individual.

Mark Bonnaci, PhD: 18:05

Yes, absolutely. And not for anything, it is a common misperception that the goal of the intervention is to have the person of in quotes completely recover or in recovery for the rest of their lives. But actually, the theorists who devised this idea argued that the end goal is to get the person to agree to begin treatment. And so you know, it's not that we can dictate that anyone can dictate that someone else will just never use for the rest of their lives. But it's, you know, we will withdraw our support from you, if you do not enter treatment. You know, it's not If you do not use drugs for the rest of your life. Yeah,

Nada Fox: 18:47

It's an interesting distinction.

Mark Bonnaci, PhD: 18:49

Well, I really feel, you know, one step at a time, and nothing succeeds like success. And so when someone you know, gets into a treatment facility and feels that they're having some small successes that can be built upon, but to face someone with what, like, for example, I like an occasional glass of wine. And it's not like I have the DTS if I don't have one once a week, but it would be hard for me to say, I will never have another glass of wine, I will never have another drop of wine. Even though I don't consider myself an alcoholic, it would be hard for me to say, uh, you know, for all time, I'm going to give this up. And I think that's why we set people up a lot of people for failure. They're just not ready for that yet, but maybe they're ready for tapering off or, you know, trying some other kind of sedative drug for their overarching and overwhelming anxiety. I think when we set very ambitious treatment goals, we kind of set people up for failure, but that's just my opinion.

Nada Fox: 19:51

Now that makes sense to me. Because it's it's also very difficult to say 20 years from now, what am what is that going to look like? keep, you know, just Yeah. I don't know who I'm going to be next week. You know, let me focus on today. Right.

Mark Bonnaci, PhD: 20:07

I agree. I agree. Yeah.

Nada Fox: 20:10

So I think I think that's really important, an important message to drive home. And that is how do CASACs collaborate with other health care professionals and organizations to address issues on a larger scale, and improve the overall public health outcomes.

Mark Bonnaci, PhD: 20:26

We really like the idea of an interdisciplinary treatment team. And I think ideally, each person on the treatment team is respectful of all the other disciplines, or those coming up more and more. Yes, you know, in most agencies now, I would say it's not the old medical model, it's more an interdisciplinary treatment team, meeting on behalf of each client, you know, examining their goals, their progress, you know, what's been happening with the client. And, of course, inherent in the interdisciplinary treatment team, is the idea that the client, him or herself is a member of that team, you know, they should be included in planning meetings and case meetings. Because who would know their situation better than they do?

Nada Fox: 21:11

I like that clients are included now. And this because, you know, it's, it always seems like these things are happening, you know, behind closed doors or something, are they you weren't somehow privy enough to the information? Let the experts decide for you, but you're the expert on you?

Mark Bonnaci, PhD: 21:28

Yes, yeah. Yeah. Hopefully, we really are moving away from that old patronizing medical model where, Oh, honey, you don't need to know all the particulars. Just do what we tell you it because that just doesn't work. People have to have ownership of their whole treatment plan. And they really have to be included in planning it out.

Nada Fox: 21:46

So the more the more they have in it, right? Like they absolutely, you know, the more they get a say the more they're gonna buy in.

Mark Bonnaci, PhD: 21:54

Absolutely, yes. People who are suffering from addictions are still I feel treated as second class citizens. And for example, in the US, we do not at all have treatment upon demand, you know, the average person will say, oh, there's programs, there's help, you know, these people just don't want help. But I've tried to help clients, students, family members, and I've been told, well, sorry, we have a six to eight month waiting list. Well, you know, if if you put someone if you put someone on a waiting list, you've lost that critical moment, when they bottomed out when they, in their opinion, when they've humbled themselves and asked for help, and you've basically rebuffed them, and that that client will be lost to the system, I would say, for the most part, you know, because they become more demoralized, they've asked for help to help his refused. You know, I don't mean to be Eurocentric, but in most European Union countries, there is treatment upon demand. And that's so important. You know, we talk about someone bottoming out, someone asking for help. And when we put them on a waiting list, what are we saying?

Nada Fox: 23:04

Put pause on that, we'll come back to you in six months, maybe we'll have a bed for you. Like that's insane. Because it is it's a moment of clarity and somebody that's going through, you know, a health crisis. And whenever I hear somebody kind of do the rhetoric against like, medication assisted treatment and stuff like that, I'm like, but would you judge somebody for taking cholesterol medication? Yeah, no, it's not. It's no different. It's yes, different organ, but it's the same concept like

Mark Bonnaci, PhD: 23:34

Oh, absolutely. I live with lupus. And I take several medications each day. How is that different from someone who has overarching anxiety and needs Xanax rather than turning to opiates? How is that any different? Yeah,

Nada Fox: 23:48

There's a lot of, you know, mental health issues and addiction issues at us and how they kind of, you know, it's the chicken or the egg. Are you mentally ill who became a substance abuser? Are you a substance abuser who used so much who became mentally ill? It's the chicken or the egg. You know,

Mark Bonnaci, PhD: 24:07

Years ago, I worked at Bouvenier psychiatric, and there was a psychiatrist, Vicki, who always said to me, Mark, all of the clients are MICA clients. And at the time, I didn't quite get it. But over the years, I've realized that if someone has a long term substance abuse disorder, very rarely Haven't they triggered off some kind of mental health symptoms, even psychotic symptoms. And conversely, if someone is suffering from a psychotic disorder, or even a mood disorder, it's very common for them to want to self medicate with alcohol or other drugs. Uh, you know, maybe they ran out of their prescription, maybe their insurance company wouldn't cover it anymore. Maybe their prescription drug caused them to gain a great deal of weight. And so you know, people or maybe abused alcohol instead of taking their anti anxiety prescribed medication. As you said, the two just go hand in hand. And you know, it's easy for someone to be judgmental about it. But you know, if I had anxiety, I look at it this way, if I had anxiety to the point that I was just ready to jump out of my skin at all times, wouldn't I try anything that would help that? I would?

Nada Fox: 25:26

Like, it just seems like a natural like human response, right? Like, because we don't nobody wants to feel that way that that discomfort in your own body in your own skin? Yeah, it just seems like, again, as maladaptive is the behavior it seems almost like a rational behavior, then at the same time.

Mark Bonnaci, PhD: 25:45

Yeah. And we have to have empathy for the person who's pushed to use alcohol or another drug, simply because of, you know, for example, the insurance company stopped providing the the Xanax or, you know, whatever the drug prescribed was

Nada Fox: 26:03

A little disheartening. It's impacted and touched, I think just about everyone's lives on this in our country. At this point, we've all gone to school had a friend, a family member, a loved one.

Mark Bonnaci, PhD: 26:16

Well, yeah, you know, I've had a lot of students say to me, you aren't an alcoholic, you haven't suffered from a substance abuse disorder? How could you possibly understand and, you know, I always say, I've had compulsive disorders, and a compulsion is a compulsion. For years, I had workaholism, I really did. And, you know, I thought, as long as I was working 16 or 18 hours a day, everything was fine. You know, and that obviously, was fueled by not wanting to look at my own issues. I, you know, obviously, I finally I acknowledged it, and I try to work like a rational person now, like eight or 10 hours a day instead of 16, or 18. So it to me a compulsion is a compulsion. When I was very young, I had an eating disorder, I was five feet 11, and I weighed 120 pounds, which, you know, no human being at 511 should weigh 120 pounds, you know, obviously, there were things I was masking and early traumas I was trying not to deal with. So I was self starving. And to me, you know, it's so analogous to someone may be, you know, spinning their wheels in quotes, with gambling, or with, you know, going onto the streets and getting crack. I mean, to me, it's all of a piece. It's spinning our wheels not to deal with our trauma, our repressed anxiety, things we don't want to look at in our lives,

Nada Fox: 27:46

That avoidance, I just don't want to deal with pain. So anything that makes this discomfort stop is fine. Yes, yeah. Yeah, I like gambling and stuff, because I don't think people understand like about gambling, addiction, sex addiction, like it's all in the same family.

Mark Bonnaci, PhD: 28:03

Yes, it's all of a piece. And not to stereotype. But I think grief and loss are frequently overlooked in our field. You know, so many of our clients have had tragic lives have had a lot of grief and loss. And, you know, I can say, having experienced some losses, the the tendency to want to spin my wheels and not look at the grief, and not really experience the grief, I can understand that I really can.

Nada Fox: 28:33

Yeah, it doesn't sound appealing, like, you know, the saying, "The only way out is through." But it's the idea of going through though it can be so overwhelming and so paralyzing that it's I can't go through this. I'll just pause right here. Here is safe. Yes.

Mark Bonnaci, PhD: 28:50

Yeah. It's grief and loss are. I think we discount even I would say, and I don't mean to get so philosophical. But I would say a lot of the society is suffering from PTSD. Now, because of the COVID years, those were very traumatic years, we were self isolating, we were afraid that we were going to die. You know, I mean, they were a very strange time to have lived through. And I don't think we like as clinicians as public health authorities. I don't think we acknowledge the degree to which that changed people.

Nada Fox: 29:28

I think that's very interesting that you bring up like the trauma and the PTSD of COVID and like the impact that is going to have and how we need to like acknowledge it in these fields like this is real trauma that everyone has gone through it no matter what everybody's lives changed when COVID happened at the world shutdown.

Mark Bonnaci, PhD: 29:48

You know, nothing anything. I was caring for new family members in their 80s and I just kept thinking you know, if either of them contract COVID They're done for the The degree to which I self isolated so as not to, you know, infect my loved ones not to bring back home. It was an extraordinary time. And I remember one day, you know, I'll be totally honest with you. I found at the bottom of my closet, like a container, a canister of wet ones. And I was so surreal that I found these like disinfectant wipes that I literally wept. I like I was so thrilled, I was like, weeping because I had these wet ones. And when I think about that, you know, like, how could you not have PTSD from being so frightened of something for so long?

Nada Fox: 30:41

Right to live in that heightened fear state for such a consistent, prolonged period? And then on top of it, like, you know, it wasn't just COVID going on, it was, you know, like the the civil uproar during all of it. The political uproar, like, it was like, not one facet of your community felt safer, recognizable anymore, like, yeah, yeah,

Mark Bonnaci, PhD: 31:05

yeah, so many Americans lost family members and couldn't even visit them in the hospital couldn't, a very good friend of mine, his father died, and he had to, they couldn't have a regular funeral because it was COVID. They had to go in individually, to view the body and then exit, then there was like a disinfecting process. And then the next person came in, and the idea of collectively grieving together seems to have been lost in that era. You know, at least it wasn't possible in that era. And I think we have to acknowledge that. We were all really affected.

Nada Fox: 31:41

We missed out on on the community aspect of it. Like, we're social beings, we're social creatures, we need each other. For better or worse. we're in it together, right? Yes, yes, yes. And even like the triumphs during that period, I had a niece and nephew born during that period, and it was no going to the hospital and seeing the baby. No, you know, so even those things that were positive, that should be celebrated. Those moments were taken away from us, when you think about like how important community is and how much we need each other. You know, it's just you're right. It can't be understated, how traumatic that period was. And I think we all do this thing where we kind of minimize the trauma that it was,

Mark Bonnaci, PhD: 32:30

yes, yeah. Yeah. You know, it's like, we can't just flip a switch and go back to normal. I think we really have to look at what we went through and process it. I really believe that.

Nada Fox: 32:42

And you're right, it was just this huge, massive collective experience of trauma.

Mark Bonnaci, PhD: 32:47

As you said, you you don't even look back on it as being that way. You know, I think a lot of people were really traumatized. And,

Nada Fox: 32:57

yeah, for sure. Like we saw, you know, unfortunately, like loneliness spiked in every single, you know, category, the disconnection, the incidences of overdose and alcoholism, domestic violence, all of these things were so impacted, but it's, it's a trauma response and looking at it in a way like, well,

Mark Bonnaci, PhD: 33:20

you know, relating to opioid related deaths. In all seriousness, one of the biggest risk factors of an overdose deaths is someone using alone, you know, because if they're using with others, at least there's someone there who could, you know, perhaps have Narcan, or at least call 911, you know, because of the Good Samaritan laws of people are more likely now to call 911 to bring someone to an emergency room and say, you know, this person took heroin, it might have had fentanyl in it, you know, because they they can't be prosecuted unless they have like so much of an illicit drug on them, the person reporting that it's evident that they were a big time dealer. Also, there's the proviso, if you should say, Well, you know, take care of my friend, because my eight year old is at home alone and has been there all day alone. You know, you can still be examined, investigated for child abuse or neglect. But other than those provisos, the Good Samaritan laws really hold. No one should be afraid to bring someone into an emergency room or to call 911. The biggest risk factor is someone using alone.

Nada Fox: 34:33

I know they started doing the use safe hotlines and things like that, like,

Mark Bonnaci, PhD: 34:37

that's wonderful. Yes. Isn't that wonderful? Yeah. Absolutely.

Nada Fox: 34:42

Yeah. It's kind of like the 211 service now for mental health and those sorts of issues.

Mark Bonnaci, PhD: 34:48

Yeah, that's progress. Yeah. Yeah.

Nada Fox: 34:52

Baby steps in the right direction. Yes,

Mark Bonnaci, PhD: 34:55

yeah. Now, other risk factors, and I'm sure people know that But I'll just repeat the obvious if someone has just left a rehab facility, that's a very high risk factor. If they've just left prison, that's a very high risk factor. And the theorists, the researchers believe that it's because if I used a certain dosage of heroin before I went into a treatment facility, and now it's six months later, and my tolerance is way down, but I go back to my initial dose, that could be an overdose. Why me? So yeah, it's like, believe it or not, it's it's using after leaving rehab, or prison, that are very high risk factors, because you've lost the tolerance or your tolerance has decreased greatly. And you're likely to use the amount that you normally use.

Nada Fox: 35:51

Looking ahead, what trends or development Do you foresee in the field of addiction counseling? And how might they impact future public health strategies?

Mark Bonnaci, PhD: 36:01

I'm hoping that we have more safe injection site that are approved, you know, as you know, in a safe injection site that a person brings in their own drugs, the facility is not providing the drugs for them. So anyone who says, well, that's just enabling facilitating No, it's just that you want a registered nurse or a physician who observe someone after they've used that drug, and to ensure that they're not overdosing or having an allergic reaction, or that they've injected in a way that was unhealthy, you know, that you want people to inject as safely as possible. So I'm hoping that we move more towards safe injection sites

Nada Fox: 36:47

for harm reduction strategy than anything. Absolutely, yes, absolutely.

Mark Bonnaci, PhD: 36:51

And you know, even people who blame the victim and say, Well, you know, they choose to do that. So they should suffer the consequences. Well, how about tertiary infections? How about the child that steps on a discarded needle and syringe on a beach? You know, and contracts hepatitis? How about that? That child, you know, certainly is blameless. And so, you know, a safe injection site, or a needle exchange program, where people bring in their use needles, and then those needles are incinerated, but they're given clean, fresh needles, you know, why not? And, you know, I was talking to a clinician the other day, who was working at a needle exchange program, and he said, which was so interesting to me, he said that he had clients over the years, come in with their needles and syringes, and it was an even exchange, of course, you know, those programs are not allowed to give out more than they take in. So they're not encouraging needle use. They're just giving people a safe way to use. But at any rate, he said, you'd be surprised how many people it brought in a shoebox and said, Oh, my God, this really is a lot of needles and syringes. Maybe I should be using less. You know, and you'd be surprised, like people are concerned about their health, you know, they may feel compelled to use, but that doesn't mean that they're not concerned about their health.

Nada Fox: 38:19

What do you say to the people that do the not in my backyard argument? They're, they're fine with these things. But we don't want them in our neighborhood, not in my backyard.

Mark Bonnaci, PhD: 38:32

You know, ironically, that turns out to happen in a lot of urban centers, where, if you think about it, people would be using in alleyways and abandoned buildings. So wouldn't you rather that they used in a safe facility that they were supervised that there weren't needles and syringes just being, you know, left on on city streets, that people weren't just injecting on subways and public buses? I don't know. It seems counter intuitive. This NIMBY syndrome, you know, treat them somewhere nice and somewhere horrible out in a, you know, a country like place away from my inner city. You know, it doesn't make sense to me, you know, because you've got to treat people where they're using so they're using in inner cities and suburbia, and in rural areas, and we need facilities in in all those places. We really do. Yeah. And it's, it's, it's so weird to me, you know, enough for anything. I worked with the developmentally disabled for four years at the developmental center. Then there was a huge push to send them out to community agencies, which I thought was great. Now there is a supervised residence for mentally challenged people across the road from N triple C and I've been at N triple C 35 years, I have never heard of one incident where one of those people raw walked across the road and caused any kind of problem of any kind, you know. So what are we really afraid of? If people are in a facility and they're supervised, and they're getting help? What are we really afraid of? It doesn't make sense to me.

Nada Fox: 40:20

I think you you hit the nail on the head, what are you really afraid of? And I think everybody wants to turn the blind eye to this problem or not ignore just not see it. You know, it's unsightly, I don't. And we want to ignore the fact that these are human beings. These are somebody's family, somebody's friend, somebody's loved on and that they value their people. We all we're all a part of this great experience together. Well, if you can have people walk away with one thing after this podcast, what would you like that to be?

Mark Bonnaci, PhD: 40:57

I would say less judge mentalism. You know, because truly, I have very rarely met a person that didn't suffer from one compulsion or another, whether it was workaholism, or, you know, an exercise addiction and obsession about their physical appearance. Compulsive gambling, compulsively acting out sexually. I have very rarely met a person that didn't have some kind of compulsion. So why is it when it comes to alcohol and other drugs? All of a sudden we put that in a different category, and we judge people. I mean, we say we don't, but we still do.