It could be your neighbor. It could be a man huddled under a bridge with his dog. It could be a favorite niece injured while playing soccer.
Substance use disorders and addiction touch everyone’s life in one way or another. Most have known people who deal with the complicated and sometimes devastating effects of drug misuse or experienced it themselves. Whether it’s opioids, excessive alcohol, methamphetamines, nicotine, cannabis, or increasingly a combination of drugs, public health issues around substance misuse are now under a glaring spotlight.
The situation across the United States and in Washington state has grown dire. According to the state health department, 17,502 Washingtonians died from a drug overdose between 2007 and 2021 and 68 percent of those deaths involved an opioid, with fentanyl leading the way. Since 2019, the annual number of opioid drug overdose deaths has nearly doubled, and Washington had the sharpest rise in overdose deaths of any state in the most recent 12-month reporting period, according to the Centers for Disease Control and Prevention.
These are not just statistics. They are people who struggle, or who have died, because of substance use problems. Researchers, Extension staff, and others at Washington State University share that empathetic view as they investigate effective treatments, seek to understand the complex nature of addiction and substance use, and educate people to prevent substance use disorders.
Celestina Barbosa-Leiker, executive vice chancellor at WSU Spokane and a professor in the College of Nursing, is one of those researchers, leading an interdisciplinary research team to assess mothers, infants, and health care providers in order to better care for women with opioid use disorders.
During one study, Barbosa-Leiker (’06 MS, ’08 PhD Psych.) and her team looked at what blocked or helped access to medication-assisted treatment for women with an opioid use disorder as they go from pregnancy to parenthood. What she heard from pregnant women and new moms was “so powerful, it was hard to present without my voice cracking from emotion.”
Barbosa-Leiker said one participant told her, “I was one of those women that was homeless and pregnant and feeling helpless and hopeless and not having the resources or the support. Having a support team has helped me tremendously. And that includes my treatment and my family and loved ones, friends that are sober. And my kids, of course.”
Understand and treat
Barbosa-Leiker is part of WSU’s Program of Excellence in Addictions Research (PEAR), which brings together scientists and researchers from many disciplines to advance innovative, scientifically rigorous approaches to understand, treat, and prevent addictions.
Started by John Roll in 2006, PEAR houses some of the largest health science projects at WSU Spokane, where Roll is vice dean for research at the Elson S. Floyd College of Medicine.
The holistic approach looks at the effects of drugs on behavior, how behavior contributes to the ways drugs are used, behavioral and pharmaceutical therapies, intersection of mental health and substance use, and other areas.
Roll (’94 PhD Psych.), an internationally recognized expert in the field of drug and alcohol abuse, sees this as the right approach to such a complex problem. “Scientifically, I think it’s a mistake to look at addiction in a vacuum. You have to really look at the whole person and the environment in which they exist,” he says.
He recalls an incident that changed his approach to helping people with substance use disorders. When Roll, an experimental psychologist, was working on a study on cigarette smoking and people with schizophrenia, he connected with a participant his age. “We were even both wearing exactly the same blazer, probably bought at Kmart or somewhere. We started talking and I realized we both had very similar aspirations in life. It was also clear to me that, through no fault of his, he was less likely to realize those aspirations. It seemed profoundly unfair, and after that experience much of my research took a decidedly more applied turn.”
Roll’s broad ideas of substance use research continued with his students and mentees who eventually became leaders in the field, such as Barbosa-Leiker and current PEAR director Sterling McPherson.
McPherson (’08 MS, ’10 PhD Psych.), also a professor and assistant dean for research at the College of Medicine, says the goal is to improve treatment outcomes with evidence-based therapies.
One is contingency management, a behavioral therapy that rewards patients for staying sober, that “is far and away the most effective treatment for any stimulant right now,” McPherson says.
College of Medicine professor Michael McDonell (’01 MS, ’04 PhD Clinical Psych.) and his team have led studies that show how well contingency management works.
Another trial leverages technology to help people with substance use disorders. Using Bluetooth-enabled caps on therapeutics, such as buprenorphine for opioid use disorder, a patient can be reminded to take medicine and have accountability with health care providers.
“The goal is to intervene and act now before it cascades into a relapse,” McPherson says.
Part of McPherson’s own research looks at co-addiction—when people use more than one substance. Co-addiction is very prevalent; for example, studies over the last three years show that 70 to 80 percent of people addicted to opioids also take other illicit substances. Stimulants, such as meth, were present in 42 percent of opioid overdoses last year.
He notes that PEAR was one of the first research groups to launch a trial treating smoking and heavy alcohol use together. It’s an expanding problem that flies under the radar during the ongoing opioid epidemic.
“It’s hard to get society to focus on more than one drug at a time. I always have to say we still have this major public health problem of smoking, and a major public health problem of alcohol, especially post-pandemic,” McPherson says.
McPherson explains that use of multiple substances is linked both neurobiologically and behaviorally, and there’s potential to craft some combined therapeutics.
“There probably isn’t a single silver bullet therapeutically for addiction,” McPherson says. “We’re talking about different substances that affect people differently. But no substance use disorder exists by itself.”
Substances affect people based on gender as well. Barbosa-Leiker studies these disparities along with nursing assistant professor Ekaterina Burduli (’08, ’11 MS, ’16 PhD Psych.).
“We haven’t done a really good job as scientists with making sure that treatment is valid and sound for all demographic groups, and that includes women,” Barbosa-Leiker says. “We need more research to look specifically at women with substance use disorders.”
The effects of addiction have hit women particularly hard. Heroin deaths among women increased at more than twice the rate than among men from 1995 to 2015. In addition, there has been a drastic increase in the rates of deaths connected to synthetic opioids such as fentanyl; these deaths increased 850 percent in women between 1999 and 2015.
Barbosa-Leiker says many women with substance use disorders face other factors such as early trauma, domestic violence, or other barriers to treatment. She and her team want to highlight their voices.
“We’re sharing the stories of folks who have to drive an hour and a half to the methadone clinic every day, before or after work. They have these other burdens, like access to shelters or even daycare for the kids if they need to go and get treatment,” she says.
Another crucial element of treating opioid abuse is managing pain. While overprescribed opioids fueled the crisis, now people with chronic pain have difficulty getting help. Marian Wilson (’13 PhD Nursing) in the College of Nursing leads work to identify non-medicinal ways to manage pain. A new WSU interdisciplinary program also trains health care practitioners how to prevent and treat their patients’ pain.
Other areas of future research, McPherson says, include the interaction of sleep and substance use disorders, tailoring treatments based on genetics, more nuanced methadone dosing, and identifying better biomarkers for substances. The work involves many researchers across WSU.
“This disease does not discriminate,” Barbosa-Leiker says. “We really need an all-hands-on-deck approach.”
Connect and educate
Some of those hands include colleagues like Elizabeth Weybright, an associate professor in human development who works in addiction prevention and harm reduction.
“We really need to pair treatment and recovery with prevention,” Weybright says. “Harm reduction is this perspective that if we want to move the needle, we can’t just tell people to stop. And if they’re going to continue to use, how do we support them to reduce the negative consequences of use?”
She also emphasizes the importance of engaging youth in addressing substance use disorders. As co-director of the Northwest Rural Opioid Technical Assistance Collaborative, for example, Weybright oversaw a program in which teens in Yakima, Spokane, and Clallam Counties helped peers and neighbors understand the opioid crisis.
Through WSU Extension’s 4-H Youth Development Program, they wanted to address stigma around opioid use and start conversations. The participants increased their familiarity with opioid misuse and medication safety.
Weybright sees teens as agents of change, especially in rural counties that are more impacted by opioid addiction than urban areas. She stresses the need for a team approach in rural communities, involving youth, pharmacists and other health care providers, Extension services, and community members, to effectively address substance use disorders with trusted partners.
Nicole Rodin, clinical assistant professor in the College of Pharmacy and Pharmaceutical Sciences, works with PEAR and on outreach with Weybright. As a practicing pharmacist, she agrees with Weybright that prevention requires community support.
Rodin also explains the need to treat substance use disorders as health care. “It is a disorder. It is a medical condition, and we have yet to treat it that way as a society,” she says.
PEAR and WSU, Rodin says, recognize the public health needs. “Instead of keeping it in papers and journals, they’re working a lot with our community partners and expanding their efforts so that it gets translated to our communities.”
Reduce the stigma
Addiction is treatable and much can be done to get people the treatment they need. Many people living with substance use disorders want help, but stigma often blocks the way.
“We hear from our pregnant participants that they’re often stigmatized when they go in for their prenatal health care. If they feel stigmatized, there is a good chance that they’re not going back. And if a mom is not getting prenatal health, that’s sometimes the most dangerous thing for mom and baby,” Barbosa-Leiker says.
Weybright says rural outreach, too, requires local credibility. “It needs to come from trusted individuals to reduce stigma and support folks where they are, whether that’s prevention, treatment, or recovery.”
Reducing stigma, and getting people the help they need, comes down to open discussion and connection. Substance use disorders cross all differences, affect everyone, and need all of us to engage.
“We thrive on human interaction, and I think in our world there’s so much loneliness, despair, and lack of hope. We need to help people in the world have hope,” Roll says.
Contingency management works, so why isn’t it being widely used? (Feature Part 2)
Understanding pain (Feature Part 3)
How to talk about substance use (Feature Part 4)
From the archive: The Epidemic (Fall 2016)
From the archive: No pain’s a gain (Spring 2015)
Cougs for Recovery: Helping WSU students in or considering recovery from substance use
On the web
48 Million Americans Live With Addiction. Here’s How to Get Them Help That Works. (New York Times op-ed, December 13, 2023)
Washington officials turn to schools in fight against opioid epidemic (Washington State Standard, January 11, 2024)
WA congressman’s opioid crisis report shows grim reality, but path forward (Cascadia Daily News, January 25, 2024)
How we can fight the fentanyl scourge in Indian Country (Seattle Times op-ed, November 7, 2023)
Inslee wants to spend $50M more to combat opioid crisis (Washington State Standard, December 4, 2023)
Spokane County, health district decide to end Regional Opioid Task Force (KXLY, December 27, 2023)
Study on how memories influence drug relapse receives $2.9 million grant (WSU Insider, June 15, 2023)
Facing addiction (Nick Shahbazyar)