“Nobody can go back and start a new beginning, but anyone can start today and make a new ending.” – Maria Robinson (Robinson, 2018).

Introduction

Heroin use has become a systemic problem in the United States. According to the Centers for Disease Control and Prevention (CDC), the use of this illicit substance has increased among men and women in nearly all age groups and income levels (CDC, 2015). Imagine this, the sun is just rising, and the birds are chirping. You should be getting up and getting ready for high school, grateful for another day. Instead, you lay in bed unable to move, or function because you haven’t been able to sleep all night. Your body is hot and cold, your eyes won’t stop watering and you can’t stop sneezing asking yourself “Why?”. It all started with some marijuana or alcohol and moved to taking your parents prescription pain pills. You told yourself you would never touch heroin and never touch a needle. But one day it came to that. You don’t know how or why, all you can explain is that it just happened. You continue to ask yourself why you must use heroin multiple times a day to feel “normal.” Your best friend tried it one time and never became dependent on it, but you tried it once and are now addicted. Despite multiple attempts to get help, you encounter barriers such as insurance gaps, lack of funding or bed availability. The country now faces challenges to address the heroin epidemic. Community Health Nurses will be pivotal to develop prevention and treatment strategies. The nurse can also help to educate clients, their families and the general public about addiction disorders and help breakdown stigmas. Many people are puzzled about the cycle of addiction and hold conflicting ideas about individuals with addiction disorders. According to the National Institute on Drug Abuse, addiction is not a choice; these disorders are complex diseases affecting the brain that make the addicted individual crave, go to any length to obtain and use that substance despite the consequences (CDC, 2015). Addiction is a complicated disorder to understand. However, I believe that with team work and determination, health professionals and community members can develop initiatives and strategies to tackle this epidemic.

Population

The population I chose to advocate for are adolescence. Adolescence encompasses the ages of 12 to 20 years old and is said to begin with puberty (Taylor, Lillis, Lynn & LeMone, 2015). Adolescence is a time of finding out who you are and where you belong. According to Erik Erikson’s theory, “The adolescent tries out different roles, personal choices, and beliefs in the stage called identity versus role confusion. Self-concept is being stabilized, with peer groups acting as the greatest influence” (Taylor et al., 2015, p. 410). During this developmental time frame adolescence are impressionable and it is important to educate them about the prevalence of heroin use, the health effects and consequences. This information may help prevent them from using heroin or empower them to help someone who does use it.

The adolescent age group needs community support and resources as heroin use more than doubled among young adults ages 18–25 in the past decade (CDC, 2015). These children and young adults are the future and perhaps through education and outreach, nurses can prevent more individuals from becoming addicted to heroin.

Risk Factors

Addiction is a controversial subject for many people. I believe that knowledge is power, and that knowledge is empowering and helps to reduce bias and prejudice. You may ask yourself, “Can anyone become addicted?” or “Could this happen to me or a family member?” The answer is not a definitive yes or no answer. Many factors play a role in developing a substance abuse disorder. These can be divided into modifiable and non-modifiable risk factors. Modifiable risk factors include those who are addicted to prescription opioid pain relievers, people without insurance or who are on Medicaid, addicted to cocaine, marijuana and alcohol, and those living in a larger city (CDC, 2017). Non-modifiable risk factors include being male, having a genetic predisposition, non-Hispanic whites and those that are between the ages of 18 and 25 (CDC, 2017). According to the Center on Addiction, other non-modifiable risk factors that can contribute to substance use disorders include having a co-occurring mental health disorder, such as eating disorders, high impulsivity or sensation seeking, anxiety, depression, and/or personality and other psychiatric disorders. “Exposure to physical, sexual, or emotional abuse or trauma, substance use or addiction in the family or among peers, access to an addictive substance, exposure to popular culture references that encourage substance use” can greatly influence the development of a substance use disorder (Who Develops Addiction?, 2017).

873 residents of Wisconsin fell victim to illegal drug use and lost their lives as a direct result in 2015 (Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016, p. 40). Deaths related to heroin and other opioids increased from 60 to 74% from 2006 to 2015 in the state of Wisconsin (Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016, p. 40). A common theme in Wisconsin and throughout the United States, is that there is a strong correlation between the use of prescription pain medication and heroin, including here in Dodge County. “Heroin abuse is tightly tied to prescription drug abuse. Almost half of people addicted to heroin are also addicted to painkillers. People are 40 times more likely to be addicted to heroin if they are addicted to prescription painkillers. Abuse of prescription painkillers is incredibly common — one in 20 Americans age 12 and older reported using painkillers for non-medical reasons in the past year” (HOPE Agenda/ Statistic, 2016). An interview by Sheriff Dale Schmidt of Dodge County supports the belief that these two factors are strongly associated, and it has affected our community. An increase in deaths in Dodge County related to overdose increased from 11 in 2014 to 20 deaths in 2015. Sheriff Schmidt is attributing the increase in deaths to prescription drug abuse. “And then they become addicted to the opioids and they are expensive and so they switch to heroin,” according to Sheriff Dale Schmidt (Collins, 2016). A specific example within Dodge County goes back to 2016 when Holly Nehls passed away of a heroin overdose. FOX 6 Now stated, “Nehls apparently became addicted to opiates while using them for pain management after sustaining injuries in a car crash some years ago, eventually turning to heroin” (NEWS, 2017).

One may wonder why research and education is targeting adolescents within our community when the research findings are not showing a problem within the adolescent age group.  The thought process behind targeting easily influenced adolescents is prevention, prevention for future adults to avoid the fatalities of heroin addiction.

Community Assessment

Socioeconomic:

The Wisconsin State Legislature policy states, “Declaration of policy: It is the policy of this state that alcoholics, persons who are drug dependent, and intoxicated persons may not be subjected to criminal prosecution because of their consumption of alcohol beverages or other drugs but rather should be afforded a continuum of treatment in order that they may lead normal lives as productive members of society” (Legislature, n.d.). Dodge County supports this legislative policy by its development of the TAD program here in our community. “The Department of Justice (DOJ) administers the treatment alternatives and diversion (TAD) grant program. The TAD program provides grants to counties to establish and operate programs, including suspended and deferred prosecution programs and programs based on principles of restorative justice, which provide alternatives to prosecution and incarceration for criminal offenders who abuse alcohol and other drugs” (Continued Funding of TAD Program Expansion and Drug Court Grant Program (Justice), 2017).

The following is data for Dodge Co according to the U.S. Census Bureau:

•         “The estimated population of Dodge Co as of July 1, 2017: 87,786” (QuickFacts, 2017).

•         “High school graduate or higher, percent of persons age 25 years+, 2012-2016: 89.0%” (QuickFacts, 2017).

•         “Bachelor’s degree or higher, percent of persons age 25 years+, 2012-2016: 16.3%” (QuickFacts, 2017).

•         “Persons without health insurance, under age 65 years: 5.4%” (QuickFacts, 2017). This is a modifiable risk factor as stated above. This number for Dodge Co is below the percentage of the United States as a whole.

•         “White alone, not Hispanic or Latino, percentage in Dodge Co: 89.9% of the population” (QuickFacts, 2017). This is another risk factor.

•         “Median household income (in 2016 dollars), 2012-2016: $54,111” (QuickFacts, 2017).

•         “Per capita income in past 12 months (in 2016 dollars), 2012-2016: $25,617” (QuickFacts, 2017).

•         “Persons in poverty, percent: 9.8%” (QuickFacts, 2017).

•         “Total employer establishments, 2016: 1,734” (QuickFacts, 2017).

•         “Total employment, 2016: 29,770” (QuickFacts, 2017).

Physical Environment:

The reported population from 2017 was 87,786 individuals living in Dodge County (QuickFacts, 2017). Southeast of Dodge County, about an hour commute, is Wisconsin’s largest city, Milwaukee. About an hour southwest of Dodge County is Wisconsin’s capitol, Madison. These two larger cities and the illicit drugs coming in from Chicago to Milwaukee and Madison affect the health of our small towns here in Dodge County. “Drug dealers from Milwaukee, Chicago and Madison are deciding to come to Beaver Dam to sell drugs. The defendant came here to line his pockets by furthering the misery of drug addiction in our community” said a Dodge County judge as he sentenced a 19-year-old in July of this year for distribution of illegal substances here in our community (Milwaukee drug dealer hiding cocaine in body sentenced in Dodge County, 2018).

My focus will be Waupun and surrounding areas for discussion of the physical environment. Waupun now offers parents to enroll their children in 3K, starting education early for our children, located at the Wesley Center, Waupun, WI. At 4 years old, children then move to Meadowview Primary school until 1st grade. 2nd through 6th grade is located at Rock River Intermediate School, and then children enter High School at 7th grade where they continue out their education. Another option for school here in Waupun is Central Wisconsin Christian School where they offer all the same in one school. College opportunities in our community include Moraine Park Technical College and Advanced College of Cosmetology. Watertown, which is divided into Dodge and Jefferson Counties, has a Madison Area Technical College campus for more higher education opportunities. There are a wide variety of recreational activities offered including recreational sports through the Rec Department. The Rec Department also holds a summer parks program at five out of the seven parks in Waupun, where children can go play outside, make arts and crafts and go on field trips with other children. Other past times offered include swimming at the relatively new Waupun Family Aquatic Center, playing with the Lego Club, joining in on story time, battling other children at Pokémon, or just stopping to find your favorite book at the Waupun Public Library. If traveling to other areas of Dodge County, you will find a YMCA and the Community Theatre for some entertainment in Beaver Dam, WI, and the TAG Center in Mayville, WI. There are lots of opportunities for adolescents to get involved in activities and stay busy while in and out of school.

Community Health Behaviors:

As discussed above, 89% of Dodge County’s population has an education level of high school diploma or higher. Health education in Waupun begins in 1st grade with a class called Guidance, teaching children about standard hygiene practices and continues to have what children call “The talk” in 5th grade where they learn about the change’s girls and boys experience as they mature. As for health education for adults, there are a variety of classes offered through Beaver Dam Community Hospital and Waupun Memorial Hospital including parenting classes and grief support to name a few. Because Dodge County has limited public transportation, it might be difficult for residents to attend these classes.

As mentioned previously, heroin abuse in Dodge County is on the rise. This is evident with the increased death rate related to heroin overdose. “Wisconsin residents ages 18-25 (7%) were more likely to abuse or be dependent on illicit drugs than were those 12-17 (4%) or over age 26 (2%) (Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016, 2016, p. 40). Although these statistics are looking at Wisconsin as a whole, Dodge County is no exception. These statistics support that adolescents and young adults are the most likely to use illicit drugs.

Healthcare Resources:

Hospitals and clinics available within the county include Beaver Dam Community Hospital, Watertown Regional Medical Center, and Waupun Memorial Hospital, with a UW health clinic in Beaver Dam and Dean Clinic in Waupun. In the smaller townships it may be more difficult to receive the healthcare individuals need due to transportation, or lack of, the distances between them, and the professional services they need (Taylor et al., 2015, p. 68).

Multiple organizations and projects have been created or expanded over the course of the last few years to meet the growing need treatment of heroin addiction. Dodge County has recently received a grant from the Department of Health Services to aid in the opioid epidemic. Reporter Terri Pederson stated, “The program was set up with the help of $666,667 from the Wisconsin Department of Health Services. The partnership of the health and human services departments in Dodge and Fond du Lac counties will provide treatment for opioid addiction in Adams, Dodge, Fond du Lac, Juneau, Manitowoc and Marquette counties. However, the services are available to any Wisconsin resident. Dodge County services include outpatient substance abuse groups, day treatment, intensive outpatient, family education, intoxicated driver program assessment, psychiatric evaluation and medication, metal health individual and group counseling and 24-hour crisis services” (Pederson, 2018). Other organizations that assist individuals with addiction disorders within our community include Stop Heroin Now and C.A.R.E for Dodge County, both of which are non-profit organizations.

Advocacy Plan

S.M.A.R.T. Goal:

Bring C.A.R.E for Dodge County seminars to all county schools at the beginning of each school year, to provide education and awareness about addiction, targeting prevention for adolescents.

This goal would be evaluated by assigning a community nurse from Dodge County to attend these seminars, ensure they are taking place, answer additional questions, and provide information as needed to these students. A contract between C.A.R.E and Dodge County would be created, stating that they agree to provide these seminars with the community nurse to prevent further heroin and drug addiction. In addition, an anonymous survey would be created for these students to complete after each presentation, evaluating if it was a valuable learning experience.

Interventions:

1. Assess how each age group and population learn best to provide optimal education.
2. Split the students into groups according to the teaching style that is most beneficial. Provide materials and presentations based on this evidence.
3. Contact C.A.R.E for Dodge county and ask if they are willing to commit to provide these seminars. Ask if they have any members that would be willing to speak about addiction from their own personal experiences. Stories provide a strong impact on individuals. Set up potential dates and collaborate with the schools who are on board for this.
4. Contact each school, speaking to the person who oversees setting up presentations to see if they are willing to participate in providing this education.
5. Collaborate with the schools, C.A.R.E, Stop Heroin Now, Rise Together to set up a fundraiser/benefit to raise funds to make this educational opportunity possible. C.A.R.E is non-profit and will do presentations for no charge, but a donation to benefit this group would be a welcomed gesture.
6. Provide presentation to schools throughout Dodge county; the public health/community nurse and C.A.R.E will work together to put on these presentations. In the Nursing and Allied Health Database, from the article “2010: U.S. Drug and Alcohol Policy, Looking Back and Moving Forward” the Surgeon General suggested that coming together and working as a community within schools is a strong preventative measure when dealing with addiction (Lee, 2010).
7. Assess students’ knowledge, biases, beliefs, etc. before and after presentation.

Collaboration

County workers, including the community/public health nurse, will collaborate with school faculty at each school location in Dodge County to strengthen the advocacy plan that is being implemented. Get each school nurse involved in the presentation, providing information and letting students know that the school nurses’ door is always open if the students need support. The guidance counselor and the school liaison officer could also play a strong roll alongside the school nurse. Organizations mentioned above such as Stop Heroin Now and Rise Together could help as they continue to provide rallies and informational sessions to a variety of age levels in various settings. They all support the same cause: prevention, helping those who are addicted to drugs get help, and assisting those individuals who have found recovery to stay sober.

Vulnerable Populations

Disabled:

Whether we are talking about physical or mental disabilities, addiction can affect anyone. According to the Substance Abuse and Mental Health Service Administration, the quality of life and the health of those with disabilities are being harmed from substance abuse (Substance Use Disorders in People with Physical and Sensory Disabilities, 2011). The advocacy plan that is being implemented will benefit the disabled population as well, adjusting each learning style for each targeted population.

Homeless:

Think back to prevention. This advocacy plan could help adolescents that are homeless or in shelters become more educated as they are at risk for drug addiction as well. Another take will be in the effort to educate all students in targeted age group through these presentations to possibly prevent an increase in homelessness related to drug addiction.

Mentally Ill:

As stated above under risk factors, having a mental illness can contribute to the development of a substance abuse disorder. Research suggests that individuals with mental illness sometimes self-medicate. Education for those individuals that are still in school can possibly learn not to attempt to treat themselves with alcohol and other drugs, but instead to go see their physician and be tested and medicated through a professional. Addiction is termed a disease and a mental illness; through this education, prevention of drug abuse may be possible (Who Develops Addiction?, 2017).

Elderly:

The elderly are becoming victims of financial abuse by family members who are addicted to drugs (Elderly Being Targeted for Financial Abuse by Addicted Relatives, Friends, 2018). This advocacy plan could protect our elderly population from further abuse and possibly prevent more cases in the future by providing education to our youth.

Adolescents:

This is the targeted population of the entirety of this advocacy plan. As outlined in Erikson’s theory, adolescent peer groups are easily influenced, and peer pressure is continuously happening in and out of school (Taylor et al., 2015). These children and young adults are the future of America. If we can implement a plan to these age groups, maybe one person in each group of friends could say “No” if offered some mind-altering substance. This may set a trend for the rest of the peer group and decrease these numbers of those addicted and maybe even prevent overdose deaths related to heroin and other opioids.

Chronically Ill:

When I think of someone with a chronic illness, I think of pain medication. A huge risk factor for individuals developing heroin addiction is the mis-use of prescription pain medications (HOPE Agenda/ Statistic, 2016). This population may be at risk for family or friends stealing their pain medications. Insurance companies will not refill prescriptions until a certain date. If the chronically ill individual is out of their prescription pain medication, they may resort to buying heroin off the street. Some chronically ill people still attend school, as you could become chronically ill at any time in life. They also could benefit from learning about the dangers of switching from prescription pain medications to street drugs such as heroin.

Cultural Diversity in Dodge County:

White only: 94.4% (QuickFacts, 2017).

Black and African American only: 3.3% (QuickFacts, 2017).

American Indians and Alaskan Natives only: 0.6% (QuickFacts, 2017).

Asian only: 0.7% (QuickFacts, 2017).

Native Hawaiians and other Pacific Islander only: 0.1% (QuickFacts, 2017).

Greater than two races: 1.0% (QuickFacts, 2017).

Hispanic or Latino: 4.9% (QuickFacts, 2017).

White, neither Hispanic or Latino: 89.9% (QuickFacts, 2017).

As the population in Dodge County continues to grow culturally, it is important to target all races as everyone is at risk for developing the disease of addiction. Most individuals are affected in one way or another by addiction whether it be a family member, friend, co-worker, acquaintance, or an old class mate; the list goes on. Education is the key to prevention.

Part 2: Service Learning

I had the opportunity to volunteer with the Community Awareness Recovery Environment (C.A.R.E) for Dodge County. This is a non-profit organization that advocates on behalf of those suffering from addiction or who are in recovery. C.AR.E. also provides services such as monthly support groups, game nights and many other community resources. The organization was started by a woman affected by drug addiction with the intention of helping other families in similar situation through education and community initiatives.

I volunteered for four hours at Pizza Ranch in Waupun for their inaugural fundraiser. The C.A.R.E board members and I set up an informational table and provided pamphlets explaining the mission and goals. We had a group of eight volunteers and each of us had an assignment. I bussed tables, cleaned dishes and interacted with fundraiser participants. I spoke with several individuals who shared their stories with me on a very personal level. C.A.R.E received 10% of the proceeds raised, and it wouldn’t have been possible without the group of volunteers to make it happen. This money will go towards recovery coaching and helping those suffering find the help they need; just another resource available in our community. Recovery coaches go to the hospitals when someone overdoses to provide support on a different level, walk with them through their recovery and meet with them on a weekly and as needed basis. This has become a big movement throughout Wisconsin.

There was a diverse population who attended the event including people in recovery, families who were affected by addiction, those of different races, different age ranges from children to elderly, and groups who weren’t even aware that it was community awareness night at Pizza Ranch. We even got their staff in on what the organization does and asked them to reach out if they or anyone they know needs help.

For as long as I remember, I have been empathetic towards people suffering from mental illness and addiction and compassionate about caring for them. I had a very positive view point of this population before I went in and my opinion and drive to advocate for them has only gotten stronger because of this opportunity. I currently work in mental health and plan to continue in this specialty as a RN. I will be able to incorporate C.A.R.E as a resource when providing education to those who are struggling with addiction from the knowledge I gained about the organization and what they do there.

The most valuable lesson I will take away from this experience is that no matter your background this disease could affect you in some way; nobody is immune. Finally, the power the community has to come together to raise money for such a wonderful cause just fills me with joy. We were able to raise 210 dollars that will go back into making the community a healthier place mentally and physically. The president of the group offered me an opportunity to become a recovery coach and to continue to volunteer with them which would be an excellent way to continue to give back to this population. I told her it will have to wait until May (after graduation).

Reflection

I have been aware of the opioid problem within the community since high school. The statistics are shocking and illustrate how pervasive the heroin epidemic is. Personally, my 33-year-old brother succumbed to his addiction in 2015 as the result of a heroin overdose. His loss has had a significant impact on our family. This project has inspired me to follow my dreams and become a RN in a detox or treatment facility. I plan to use the resources and knowledge gained to help educate my future patients. If I can impact just one individual, the time invested into this project will be worthwhile.

References

•         Collins, J. (2016, March 14).

Four likely overdose deaths in Dodge Co. in three weeks: “Taking its hold on our rural community”

. Retrieved from FOX6 Milwaulkee: https://fox6now.com/2016/03/14/four-likely-overdose-deaths-in-dodge-co-in-three-weeks-taking-its-hold-on-our-rural-community/

•

Continued Funding of TAD Program Expansion and Drug Court Grant Program (Justice)

. (2017, May 9). Retrieved from Legislative Fiscal Bureau: https://docs.legis.wisconsin.gov/misc/lfb/budget/2017_19_biennal_budget/050_budget_papers/406_justice_continued_funding_of_tad_program_expansion_and_drug_court_grant_program.pdf

•         Center for Disease Control. (2017, August 29).

Opioid Overdose

. Retrieved from Center for Disease Control: https://www.cdc.gov/drugoverdose/opioids/heroin.html

•          Center for Disease Control and Prevention. (2015, July 07).

Vital Signs

. Retrieved from Center for Disease Control and Prevention: https://www.cdc.gov/vitalsigns/heroin/

•

Elderly Being Targeted for Financial Abuse by Addicted Relatives, Friends

. (2018). Retrieved from Desert Cove Recovery: https://desertcoverecovery.com/blog/elderly-being-targeted-for-financial-abuse-by-addicted-relatives-friends/

•

HOPE Agenda/ Statistic

. (2016, February). Retrieved from HOPE Agenda: legis.wisconsin.gov/assembly/hope/statistics/

•          Lee, P. R. (2010). 2010: U.S. Drug and Alcohol Policy, Looking Back and Moving Forward.

ProQuest

. Retrieved from https://search.proquest.com/nahs/docview/603217705/9E877AB05C2749B3PQ/6?accountid=8903

•         Legislature, W. S. (n.d.).

51.45 Prevention and control of alcoholism and drug dependence.

. Retrieved from Wisconsin State Legislature: https://docs.legis.wisconsin.gov/statutes/statutes/51/45

•

Milwaukee drug dealer hiding cocaine in body sentenced in Dodge County

. (2018, July 12). Retrieved from Channel 3000: https://www.channel3000.com/news/milwaukee-drug-dealer-hiding-cocaine-in-body-sentenced-in-dodge-county/767050195

•         NEWS, F. (2017, January 20).

Clyman man sentenced in heroin overdose death of 42-year-old woman

. Retrieved from FOX6Now.com: https://fox6now.com/2017/01/20/clyman-man-sentenced-in-heroin-overdose-death-of-42-year-old-woman/

•          Pederson, T. (2018, August 17).

Opioid treatment center opens in Dodge County

. Retrieved from Daily Citizen: https://www.wiscnews.com/bdc/news/local/opioid-treatment-center-opens-in-dodge-county/article_a76d6b7d-ec70-57c3-af5a-f9b86e075977.html

•

QuickFacts

. (2017). Retrieved from United States Census Bureau: https://www.census.gov/quickfacts/fact/table/dodgecountywisconsin,US/HEA775216#viewtop

•         Robinson, M. (2018, August 30).

Quote of the Day

. Retrieved from Good News Network: https://www.goodnewsnetwork.org/maria-robinson-quote-on-new-endings/

•

Substance Use Disorders in People With Physical and Sensory Disabilities

. (2011, August). Retrieved from Substance Abuse and Mental Health Services Administration: https://store.samhsa.gov/shin/content/SMA11-4648/SMA11-4648.pdf

•         Taylor, C., Lillis, C., Lynn, P., & LeMone, P. (2015). In

Fundamentals of nursing: The art and science of person-centered nursing care (Eighth ed.)

(p. 1414). China: Wolters Kluwer.

•

Who Develops Addiction?

(2017, April 14). Retrieved from Center on Addiction: https://www.centeronaddiction.org/addiction/addiction-risk-factors

•

Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016

. (2016, November). Retrieved from Wisconsin Department of Health Services: https://www.dhs.wisconsin.gov/publications/p4/p45718-16.pdf