When Someone Finally Says “I Need Help,” We Should Be Ready

There is a moment families affected by addiction wait for.

Sometimes for years.

The phone rings.

A son says:

“Mom, I’m done.”

A daughter finally admits:

“I can’t keep doing this.”

Someone survives an overdose and says:

“That scared me.”

A person wakes up in an emergency room and whispers:

“I need help.”

And everyone around them thinks:

YES! FINALLY!! LET’S GO!!!

Then reality shows up.

Where?

Who do we call?

Do they have a bed?

Do they take insurance?

What if there is no insurance?

Does this place offer medication for opioid use disorder?

Can somebody see them today?

Do they need detox first?

Can they get there?

What if they don’t have transportation?

What if they have nowhere safe to go afterward?

And suddenly the person who finally managed to say: “Help me,” is expected to become an expert navigator of one of the most confusing systems imaginable.

While possibly sick.

In withdrawal.

Ashamed.

Scared.

Exhausted.

And craving the very substance they are trying to stop using.

There has to be a better way.

“Go Get Treatment” Sounds Much Easier Than It Is

We say it constantly.

They need treatment.

And yes.

Sometimes they absolutely do.

But treatment isn’t one simple thing.

For opioid use disorder, evidence-based treatment can include medications such as buprenorphine, methadone, and naltrexone, along with medical, behavioral, peer, social, and recovery supports depending on the person’s needs. NIDA and SAMHSA recognize medication for opioid use disorder as evidence-based treatment, and methadone and buprenorphine are associated with reduced overdose and mortality risk.

So when someone says “Get them into treatment,” the next question should be What treatment?

Because sending somebody somewhere is not automatically the same thing as connecting them with care that matches their condition.

Detox Is Not the Same Thing as Treating Addiction

I think this confuses a lot of families.

Someone stops using.

They go through withdrawal.

They get the drug out of their system.

Wonderful.

That can be an important first step.

But simply completing withdrawal does not treat all of the things that make opioid use disorder continue.

Cravings can remain.

Patterns remain.

Mental-health needs may remain.

Housing problems remain.

Trauma may remain.

Relationships remain damaged.

The person’s entire environment may still revolve around substance use.

And after a period of not using opioids, tolerance can decrease—which can make returning to opioid use especially dangerous.

That is why treatment needs to extend beyond “Get clean.”

The real question is:

“What will help this person stay alive and build a life in which recovery can actually survive?”

The Emergency Room Could Be More Than the Place That Saves Someone Tonight

Think about what happens during an overdose.

Someone stops breathing.

Narcan is given.

Paramedics arrive.

Maybe they are transported to the emergency department.

Their life has just been saved.

That’s extraordinary.

But there is another opportunity sitting right there.

What happens next?

NIDA specifically identifies emergency departments as an important setting for opioid-use-disorder treatment and provides clinical resources for starting buprenorphine there after overdose or during withdrawal. Buprenorphine can reduce withdrawal symptoms and cravings and can be initiated in emergency-care settings.

Imagine the difference between:

“You almost died. Here’s your discharge paperwork. Good luck.”

and:

“You almost died. Before you leave, somebody is going to sit beside you and help figure out what comes next.”

That second sentence feels much closer to what Keep Them Here is supposed to mean.

Because the Time After an Overdose Matters

A nonfatal overdose is not simply a scary event someone walks away from.

It can signal enormous ongoing risk.

A federal study highlighted by NIDA followed Medicare beneficiaries after nonfatal overdose and found major gaps in follow-up care. In that specific population, only 4.1% received medication for opioid use disorder after the overdose, and among those who did receive medication, the average wait was 72 days. The same study found lower odds of subsequent fatal overdose among people who received methadone, buprenorphine, behavioral-health assessment or crisis services, or naloxone.

Seventy-two days.

Think about that.

Someone has already overdosed.

Already survived.

Already demonstrated that their drug use could kill them.

And in that study, people who eventually received medication waited more than two months on average.

That number doesn’t represent every person in America, the research involved Medicare beneficiaries, but it illustrates exactly the kind of treatment gap we should be talking about.

Because motivation can change in seventy-two minutes, let alone seventy-two days.

“They Have to Want Help.”

Yes.

And no.

This phrase is everywhere in addiction:  “You can’t help them until they’re ready.”

There is truth in that.

We cannot force another adult to deeply embrace recovery.

Families learn this painfully.

You cannot want sobriety badly enough for someone else.

You cannot attend counseling for them.

You cannot take their medication for them.

You cannot love them into making every decision you wish they would make.

But sometimes I think we use “they have to want it” as an excuse for a system that expects people to demonstrate an almost heroic level of persistence before they are allowed to receive care.

Those are two different things.

A person saying “Yes. Help me,” should not then have to make seventeen phone calls, leave six voicemails, find identification they lost months ago, solve an insurance problem, arrange transportation, wait a week, and somehow remain perfectly motivated through withdrawal.

At some point, we have turned “wanting help” into a test of endurance.

What If We Met Them During the Window?

This is where I really like the idea of low-barrier care.

SAMHSA describes low-barrier treatment as care designed to reduce unnecessary requirements and restrictions that keep people from accessing substance-use treatment. The idea is to meet people where they are and reduce obstacles to engagement.

That phrase matters:

Meet people where they are.

Not where we wish they were.

Not after they have already proven sobriety.

Not once they have fixed their transportation.

Not once their life is organized enough to fit nicely into office hours.

Where they are.

Today.

Maybe that means somebody meets them in the emergency room.

Maybe a health navigator calls the treatment provider instead of handing over a phone number.

Maybe medication begins before withdrawal drives them back to fentanyl.

Maybe someone helps arrange transportation.

Maybe a peer in recovery says, “I know what this feels like. I’ll walk through this with you.”

Maybe instead of saying, “Here are some resources,” we say, “Let’s call together.”

That’s a very different experience.

Sometimes the Smallest Barrier Is Enough to Lose the Moment

For somebody who has never navigated addiction treatment, certain obstacles may sound ridiculous.

Just make the call.

Just drive there.

Just fill out the paperwork.

Just wait until Tuesday.

But imagine being in withdrawal.

Imagine your body aches.

You can’t sleep.

Your stomach is a wreck.

Your brain is screaming for the substance that will make all of that stop.

You are ashamed.

Your family is furious.

You may not have a car.

Your phone may be shut off.

You might not have a safe place to sleep tonight.

And then somebody says, “Your intake appointment is next Thursday at 10:30.”

Next Thursday might as well be six months away.

That does not mean treatment programs don’t care.

Many are working under enormous pressures themselves.

It means we need more bridges between “I need help,” and  “Here is help.”

The distance between those two sentences can matter enormously.

Medication Is Treatment

We need to say this clearly too.

There is still stigma around medications like methadone and buprenorphine.

I have heard,  “They’re just replacing one drug with another.”

But that is not how major medical and public-health agencies describe these medications.

SAMHSA explains that medications for opioid use disorder are evidence-based treatments that can reduce withdrawal and cravings and help normalize body functions rather than simply substituting an uncontrolled addiction for another drug.

Buprenorphine can now be prescribed in office-based settings by appropriately registered clinicians, which expands opportunities for treatment outside traditional opioid-treatment programs. Methadone for opioid use disorder remains primarily dispensed through federally certified opioid treatment programs.

Medication will not solve every problem in a person’s life.

Neither does insulin.

Neither does an antidepressant.

Neither does blood-pressure medication.

We don’t usually demand that one medication repair someone’s childhood, marriage, finances, housing, job, and entire emotional life before we’re willing to call it medical treatment.

We shouldn’t hold addiction treatment to that impossible standard either.

Recovery Needs More Than Medication Too

And the opposite is also true.

Giving someone medication doesn’t magically create:

Housing.

Employment.

Transportation.

Mental-health treatment.

Healthy relationships.

Childcare.

Food.

Community.

Purpose.

A safe place away from the people they previously used with.

Recovery support.

All of those things can affect whether someone is able to build stability.

That is why I keep thinking:

We cannot treat addiction as though it exists in a vacuum.

Sometimes the substance is only one part of an entire life that needs support.

This Is Where Navigators Make So Much Sense to Me

For my local Newark and Licking County friends, I discovered something while researching this series that I think more people need to know about.

The Licking County Health Department has Community Navigators and Health Navigators whose purpose is essentially to help people do exactly what we’re talking about today.

Their current Community Navigator program says staff can help people identify needs, coordinate appointments and services, find community resources, address transportation barriers, and support people and families affected by substance-use disorders.

Licking County also participates in a regional Prevention & Linkages to Care Collaborative. Its Health Navigators work in healthcare settings, community programs, harm-reduction programs, and public-safety settings across Licking and nearby counties to connect people with treatment and support and reduce barriers to care.

That is exactly the kind of thing I mean by:

What if help found people?!

Not literally chasing somebody down the street with a clipboard. 😂

But putting knowledgeable human beings in the places where people experiencing addiction already show up.

Hospitals.

Health departments.

Community programs.

Public-safety settings.

Harm-reduction services.

Places where someone can say, “I don’t know what I’m supposed to do next,” and somebody answers, “That’s okay. I do.”

Newark and Licking County: If Someone Says “I’m Ready,” Start Here

I want this campaign to be useful, not simply thoughtful.

So for my local people, save this part.

The Licking County Health Department currently lists multiple drug and alcohol treatment resources serving the Newark/Licking County area and links directly to SAMHSA’s national treatment locator. Its local listings include Behavioral Healthcare Partners, Licking County Alcoholism Prevention Program, BrightView, Mid-Ohio Psychological Services, and additional regional providers serving Licking County residents.

The Health Department’s Community Navigator program can also assist with appointments, services, transportation, community resources, and barriers to care. LCHD’s main Newark office is at 675 Price Road and can be reached at 740-349-6535.

And if you aren’t in Licking County, SAMHSA’s national treatment locator can help search for mental-health and substance-use treatment by location. LCHD links directly to it from its overdose-prevention resources.

Put those numbers somewhere you can find them.

Because searching, “Where do I take my child for fentanyl addiction?” while terrified at 2:00 a.m. is not when anybody wants to begin researching the system.

And Families Need Navigators Too

I want to say this because the person using drugs isn’t the only one who becomes overwhelmed.

Families have absolutely no idea what they’re doing either.

A parent learns an entirely new vocabulary almost overnight.

Detox.

Residential.

IOP.

Outpatient.

MAT.

MOUD.

Buprenorphine.

Suboxone.

Methadone.

Recovery housing.

Peer support.

Insurance authorization.

Assessment.

Withdrawal management.

And everyone seems to assume we were handed the instruction manual somewhere.

We weren’t.

Families need someone who can say :

Here are the options.

Here is what this means.

Here is who you can call.

Here’s what we can do today.

Here’s what you cannot control.

Here’s what you can.

Sometimes helping the family navigate the system helps the person struggling too.

We Also Have to Stop Treating Relapse Like Proof Treatment Was Pointless

This one frustrates me.

Someone goes to treatment.

They relapse.

And people say, “Well, treatment clearly didn’t work.”

Would we say that about every other chronic condition?

Would we say that to someone dieting and later goes back to past eating habits?

A person with hypertension needs medication adjusted?

We don’t announce, “Blood-pressure treatment is a scam.”

Someone with depression has symptoms return.

We don’t conclude, “Apparently therapy doesn’t work.”

Substance-use disorders can involve relapse, and treatment plans may need to be restarted, adjusted, intensified, or changed. NIDA describes addiction as treatable and emphasizes that ongoing treatment and support may be needed over time.

Relapse is dangerous.

It can absolutely be fatal.

It needs to be taken seriously.

But it does not prove the person is hopeless.

And it does not mean we should wait for them to become “motivated enough” to deserve another attempt.

What Happens After Narcan Matters

Remember Day 3?

We said, Narcan gives tomorrow a chance.

This is tomorrow.

This is what we meant.

Naloxone keeps someone alive long enough for another opportunity.

But saving someone over and over without building stronger pathways into treatment leaves families and communities trapped in a cycle:

Use.

Overdose.

Narcan.

Hospital.

Home.

Use.

Overdose.

Narcan.

Again.

Naloxone is doing its job.

The question is, “Are we doing enough with the life it just gave back?”

Maybe the Overdose Is the Opening

I hate that anyone has to overdose.

But when somebody survives one, there may be a brief moment when something has shifted.

Fear.

Clarity.

Exhaustion.

A family member standing beside the hospital bed.

A realization:

I almost died.

That doesn’t guarantee recovery.

Nothing does.

But it may be an opening.

And research increasingly supports using emergency-care encounters to initiate medication and connect patients directly with ongoing treatment rather than treating overdose reversal as the end of the intervention.

What if someone were ready to step into that opening with them?

Not, “Here’s a brochure.”

But, “Here’s our navigator.”

Not, “Call this number Monday.”

But “We’re calling now.”

Not, “Try to find somebody who prescribes buprenorphine.”

But, “Let’s connect you.”

Not, “Come back when you’re sober enough.”

But, “You’re here. Let’s start here.”

That is what I mean when I say help should find people too.

There Is a Difference Between Rescue and Recovery

Families learn this one painfully.

You can rescue someone from an overdose.

You cannot single-handedly create their recovery.

Those are different jobs.

Keeping Narcan available is not the same as taking responsibility for another adult’s entire life.

Connecting someone to treatment doesn’t mean you have to let them move back into your home.

Helping arrange an appointment doesn’t mean giving them money.

Supporting medication treatment doesn’t mean ignoring harmful behavior.

You can say:

“I will help you find treatment, ” and “You cannot use drugs in my house.”

You can say:

“I love you,” and “I won’t lie for you anymore.”

You can say:

“Let’s make the call,” and “I cannot do recovery for you.”

Keep the humanity.

Keep the boundaries too.

The System Cannot Want Recovery for Someone

But It Can Stop Making Recovery Harder Than Necessary.

I think that is the distinction.

No program can guarantee that someone stays.

No navigator can guarantee sobriety.

No medication guarantees recovery.

No mother can guarantee her child chooses treatment.

No doctor can promise there will never be relapse.

But we can ask whether our systems are doing everything reasonable to make the next good decision easier to make.

If someone says, “I’m ready.”

Can we respond quickly?

If they survive an overdose?

Can someone connect with them before they disappear back into the same environment?

If withdrawal is pushing them toward fentanyl?

Can medication be offered?

If transportation is the barrier?

Can somebody help solve it?

If the family has no idea where to begin?

Can somebody guide them?

Recovery will always require participation from the person.

But the path does not need to include unnecessary hurdles simply to prove they deserve it.

Today’s Conversation 💬

Today’s question is for all of us:

If somebody I love said, “I need addiction treatment today,” would I know what to do next?

Not next month.

Not after I spend three days researching.

Today.

Find one number.

One treatment locator.

One community navigator.

One healthcare provider.

Save it in your phone.

And if you already know somebody struggling with opioid use disorder, maybe ask:

“If you ever decide you’re ready for help, do you want me to help you figure out where to start?”

Don’t promise you can fix everything.

Don’t promise treatment will be easy.

Don’t promise there will never be another relapse.

Just offer one thing: You don’t have to figure out the first step alone!!

Sometimes that’s enough to get someone moving.

love and light,

~Mandy💜

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Tomorrow — Day 8 🌎

What Portugal Tried—and What America Might Learn

Tomorrow, we’re stepping into a conversation people tend to have VERY strong opinions about. 😬

Decriminalization.

And before anybody starts yelling at me through their phone:

No.

Decriminalization does not simply mean:

“Make all drugs legal and let everybody do whatever they want.”

Portugal did something much more complicated.

We’re going to look at what actually changed there, what role police still play, how people who possess drugs for personal use can be directed toward a health-based administrative system rather than ordinary criminal prosecution, what Portugal did not legalize, where the approach has had successes, where the story is more complicated than internet memes make it sound—and what parts might or might not make sense in an American community.

I don’t want Day 8 to be, “Portugal solved drugs!” because it didn’t.

And I don’t want it to be, “Decriminalization means giving up!” because that isn’t accurate either.

We’re going to do what this whole series has tried to do:

Look at the information before deciding what we think about it. 💜

Sources & Further Reading

National Institute on Drug Abuse (NIDA) — Evidence-based treatment for opioid use disorder, including emergency-department treatment and medications such as buprenorphine, methadone, and naltrexone.  https://nida.nih.gov/nidamed-medical-health-professionals/treatment/opioid-use-disorder-treatment

NIDA — Care After Nonfatal Overdose — Federal research on treatment gaps following nonfatal overdose and associations between post-overdose interventions and lower subsequent overdose mortality.  https://nida.nih.gov/news-events/news-releases/2024/06/federal-study-examines-care-following-nonfatal-overdose-among-medicare-beneficiaries-identifies-effective-interventions-and-gaps-in-care

SAMHSA — Substance Use Treatment Options — Evidence-based medications for opioid use disorder and low-barrier models designed to reduce obstacles to receiving care. https://www.samhsa.gov/substance-use/treatment/options

Licking County Health Department — Drug Overdose Prevention Programs — Local treatment listings, Health Navigators, regional linkage-to-care services, Project DAWN, and the SAMHSA treatment locator. https://lickingcohealth.org/drug-programs/

Licking County Health Department — Community Navigator — Local assistance with appointments, transportation, resources, and barriers affecting individuals and families, including those affected by substance-use disorders. https://lickingcohealth.org/community-navigator/