by Elena Vidrascu, MSc

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JPHMP presents Preventing America’s Next Drug Epidemic: A Multidisciplinary Approach, a new series designed to introduce the many facets of substance abuse, and how integrating the work of multiple partners may be the best approach towards prevention and treatment. This series will feature posts that integrate information from interviews in written, audio, and video format, as well as evidence-based research articles that may altogether inform best practices for tackling this current epidemic, as well as preventing future ones.

If you want to live to be 100 years old or more, you might want to consider putting more effort into your relationships and into socializing with the people around you. At least among the inhabitants of the Italian island Sardinia, those seem to be the two strongest predictors of living longer (see image below). Why is it that we should have a conversation with the cashier next time we’re at the grocery store, rather than tune into our headphones and listen to that Beyoncé song?

The answer might lie with oxytocin, the “love” hormone involved in maternal behavior, diabetes, cancer, sexual activity, stress, and the immune system. Oxytocin is essential for building trust and therefore social bonding. When comparing brain scans of individuals who either interacted live in a conversation or watched someone talk in a video, those who had the live partner experience showed greater activity in brain regions associated with attention, social intelligence, and emotional reward. In another study, some of the same brain regions affected by drug abuse were shown to have greater activity during the anticipation of positive social feedback. However, not everyone will find the rewarding aspect of that conversation with the cashier rewarding. Social stimuli depend on context, so it depends on how the recipient processes it. If socializing is rewarding, why aren’t we prescribing more of it to improve health?

Drug addiction is often preceded by signs of abuse when somebody starts to dissociate themselves from their normal group of friends and family, are irritable when not using and apathetic to activities they once found pleasurable. This reduced interest includes social interactions, with long-term use of drugs disrupting attention and social skills. It’s hypothesized that dopamine and oxytocin interact with one another to contribute to successful and rewarding human social interactions by increasing the motivation for pleasant sensations and reducing social impairment, respectively. Synthetic oxytocin has been clinically effective at various stages of the addiction cycle, helping to reduce cravings that makes one vulnerable to seeking drugs.

If individuals who abuse drugs have problems processing social reward, can we increase the levels of the aforementioned key chemical players without medication? I gained some insight by talking with Dr. Parissa Ballard, a developmental psychologist whose research focus is on civic engagement.

Activism, voting, and volunteerism are three forms of civic engagement. Dr. Ballard’s previous research efforts have revealed that volunteering early in life is linked to decreased depressive symptoms and risky health behaviors in adulthood. Almost one third of adolescents struggling with substance use disorder also have a co-occurring major depressive disorder, so school programs may be an efficient outlet for helping these vulnerable populations. Ballard suggests that to achieve positive effects of volunteering, the activity should be sustained, the engagement must be meaningful, and it’s helpful for young people to get direct positive feedback. Helping others can become a part of the individual’s identity, which can sustain continued motivation. Indeed, compassion is linked with activation of the brain’s reward center. Therefore, aside from oxytocin, which Ballard believes may be one potential link between civic engagement and positive results on mental health, dopamine may also be involved.

By strengthening healthy brain circuits, civic engagement could serve as a prevention tool for drug abuse. Ballard suggests starting as early as 4^th and 5^th grade to help children develop foundational skills for civic engagement, such as empathy and collaboration with others. A key impetus to keep youth involved in volunteerism or activism is the knowledge that someone else is benefiting from their actions; youth need to feel that what they’re doing matters. Sources of Strength is a suicide prevention peer-led program in which youth leaders are trained by adult mentors to introduce new norms and behaviors among their peers, including perception of what is typical behavior. Increased referrals of suicidal youths to adults and increased acceptability of seeking help were among positive results of this program. Utilizing this interactive approach – when developing drug abuse intervention programs – with peers who don’t use substances may prevent the likelihood of increased substance use, a common occurrence among at-risk individuals who are grouped together in prevention programs.

Aside from decision making and natural adult mentors, community connectedness also promotes positive youth development by giving meaningful roles that enable individuals to exert influence. A peer-led approach might be what makes the Insight Program (discussed in my previous post) so successful in helping youth and young adults stay abstinent from drugs. But if community engagement was introduced, positive effects might be enhanced. Additionally, building relationships might facilitate re-integration into society for young adults who have abused drugs during critical developmental years and fear judgement from others.

Generation Citizen is one program that gets young people involved with addressing civic and political issues through student-driven projects, by putting them in contact with community leaders and local government. For example, students in Queens, NY got actively involved in tackling pedestrian safety by holding protests and writing letters. Dr. Ballard and colleagues found that Generation Citizen projects involving safety issues were associated with an increase in future civic commitments and civic self-efficacy. Addressing issues that are directly relevant to the students themselves may make them feel more empowered and connected to their peers.

A tough barrier to overcome is how to motivate individuals in recovery to re-engage with their communities. In addition to declined social interest, there are struggles with anxiety, stress, and emotional impairment that may persist for months or even years after quitting drugs. Society further prevents successful recovery with a continually pervasive stigma that pushes individuals to feel alone. Civic engagement could become one component of a public health approach to rehabilitation programs, with a focus on the timing and extent of reintegration, and how to cater differently to individuals from various racial and ethnic backgrounds.

I will leave you with the following question, adapted from the documentary The Anonymous People: If we dig up a dying tree, move it to another community and replant it in healthy soil, and then when it comes alive again we bring it back and replant it into the same hole, what might we infer if the tree becomes sick again?

You can read more about public health approaches to prevention and treatment of substance abuse by reading ASTHO’s President’s Challenge. And don’t miss my next post, which will address the current efforts of Forsyth County’s Task Force in tackling the opioid epidemic.

For related reading, please see these other articles published in the Journal of Public Health Management and Practice*:

• Love as a Public Health Intervention
• Overdose Education and Naloxone Distribution Program Attendees: Who Attends, What Do They Know, and How Do They Feel?
• 2017 ASTHO President’s Challenge: Public Health Approaches to Preventing Substance Misuse and Addiction

*Articles may require a subscription to JPHMP or purchase.

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Elena Vidrascu, MSc, recently graduated from Wake Forest University with her MSc in Physiology and Pharmacology. Her primary field of interest is substance abuse, with goals to disseminate information to the public, including addicts and those in recovery, and to influence policy change to push for more integrative approaches towards prevention and treatment. In her spare time, she enjoys playing tennis, hiking, doing puzzles, and cuddling with her kitten Maple.