IU School of Social Work, Hoosier Uplands partner to eradicate stigma with community series

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BEDFORD, Ind.— A new series has successfully shed light on the stigma around substance use in Lawrence County, organizers say.

Three years after Lawrence County’s health department declared a state of emergency following a sharp rise in hepatitis C cases—and a year after county commissioners ended its needle exchange—providing resources for people with substance use disorders has remained a hot-button issue among locals.

IU School of Social Work assistant professor and Lawrence County resident Dr. John Keesler first began planning “From Stigma to Hope” last November with his graduate-level class.

“With faculty support, the experience allowed students to hone their skills in working as members of a team and to collaborate with a community organization to deliver a quality presentation.  Often times, students work on presentations for a course that are delivered to their peers.  This opportunity took students to the next level and was something they engaged in above and beyond their coursework,” Keesler said.

The series, which spanned from April to May in three installments and received backing from the Hoosier Uplands Economic Development Corporation, centered largely around themes of harm reduction—approaches and strategies that reduce the harm caused by substance use—and stigma.

After several collaborative planning meetings with Keesler and students, Hoosier Uplands social worker Ashley Gilstrap said she was pleased to watch the students inspire meaningful community conversations.

“We had 30 minutes to an hour of just questions, and lots of interaction,” Gilstrap said. “Many people shared personal stories about family members who were dealing with an addiction, and were able to ask some hard questions.”

“The students definitely learned that you have to look at issues and solutions in a different way than one would in a more urban setting,” Gilstrap said.

Janet Delong, adjunct professor with the IU School of Public Health and recent MSW graduate, shares her experiences with the "From Stigma to Hope" program.

During the 2017-18 academic year, some of Keesler’s students developed a community survey at the request of Sheriff Mike Branham and other stakeholders.  The survey explored citizens’ attitudes and experiences regarding mental health and substance use. Surveys were available both online and in paper with information distributed creatively, stuck in everything from church bulletins to utility bills.  This project was launched in partnership with IU’s Center for Rural Engagement.

A decent amount [of surveys] were returned, and these fueled our presentations,” Master of Social Work student Kym Blackford said.

Consider saying things like ‘maintaining sobriety’ instead of ‘getting clean’, which implies dirtiness, and instead of ‘addict’, say ‘somebody who uses substances.

Sean Abraham, IU student

Classmate Sean Abraham said a few of the written survey responses he read, like “addicts are sinners,” revealed that stigma – or negative perceptions around substance use disorder – were a significant issue in the community.

Abraham, who is in long-term recovery, used the roundtable discussion following his presentation to explain stigma and share harm reduction techniques with audience members.

He shared a simple step that can make all the difference in addiction-informed care: tweaking our language.

“Consider saying things like ‘maintaining sobriety’ instead of ‘getting clean’, which implies dirtiness, and instead of ‘addict’, say ‘somebody who uses substances,’” Abraham said. “And it’s substance use, not abuse; we’re all people first.”

Abraham also noted that some participants questioned whether buprenorphine (Suboxone) and naloxone (Narcan) actually helped substance users, he said. Others asked if it was possible to overdose on those drugs or suggested the “cold turkey” method.

“[Instant sobriety] doesn’t work for everybody, but it was good to be able to have that constructive conversation where we were both able to learn about the fears on one hand and the successes on the other,” Abraham said.

To me, trauma-informed care is about certain values and goals—it’s giving people who have experienced trauma an atmosphere of care and safety.

David Vornholt, IU student

In his slides, David Vornholt (MPA ’19) shifted the focus from substance use to trauma, in order to humanize the discussion.

“To me, trauma-informed care is about certain values and goals—it’s giving people who have experienced trauma an atmosphere of care and safety,” he said. “It’s about the simplest things, even giving them a choice of what they want for lunch, because a lot of traumas can take that control away from you.”

To show just how pervasive trauma is, Vornholt helped sample the average ACE (adverse-childhood-experience) score of the room. Some reported a number over six; the CDC considers a score of four or over serious, citing a 460% higher likelihood of depression and 390% increased risk of chronic obstructive pulmonary lung disease (COPD).

Vornholt asked how many thought the score would be lower.

“Everyone raised their hand in surprise,” he said. “It was a powerful way to show that you can see someone and know someone, but not know what they’ve gone through.”

Blackford said the nonjudgmental environment she and her peers were able to create with the help of Hoosier Uplands made this type of sharing possible.

“It was intimate and close-knit,” Blackford said. “This experience solidified that I really do want to seek out more involvement in rural communities.”

The IU Center for Rural Engagement improves the lives of Hoosiers through collaborative initiatives that discover and deploy scalable and flexible solutions to common challenges facing rural communities. Working in full-spectrum community innovation through research, community-engaged teaching and student service, the center builds vision, harnesses assets and cultivates sustainable leadership structures within the communities with which it engages to ensure long-term success.