You don’t need a lot of research to confirm reality. And the reality is very few Boise State students — or for that matter, any students, anywhere in the United States — live lives untouched by substance use disorders.
It might be an aunt. A friend. Your brother. A neighbor. It might be you.
The real problem — the fundamental problem, according to Susan Esp — is that there appear to be few healthy ways to talk about substance use, due to stigma. Esp means to change that.
Esp, an associate professor in the College of Health Sciences School of Social Work and associate director and co-training coordinator for the Institute for the Study of Behavioral Health and Addiction at Boise State, a partnership with the university’s College of Education, will serve as coordinator of the new undergraduate certificate in Addiction Studies.
The certificate, available to undergraduate students, was approved by the Idaho State Board of Education in March; the first students will begin work toward certificates this fall.
Boise State previously offered a minor in addiction studies; the certificate, which is to some extent replacing the minor, is in many respects a sign of the times. It recognizes, among other things, that many, many jobs and lines of work intersect with substance use and misuse, in complicated ways that traditional educational models often have not kept up with. And it allows for more students to be trained and equipped, given the prevalence of substance and addiction challenges in society.
Esp points out some of the many complications and variables that make the study of and skill-building around substance misuse so meaningful, among them:
- In general, prevention doesn’t start early enough; problem-solving tends to happen long after the problem has set in.
Misuse often doesn’t look like what people think it looks like, and people with substance use disorders often aren’t who you might think they are.
- Because many people view substance misuse in terms of extremes, there is a fundamental lack of awareness around the damage done in the middle. Examples include fatty liver disease and many forms of cancer associated with alcohol misuse, health impacts that don’t evoke mental images of a person lying in the gutter, yet every bit as painful and tragic. Education and programs traditionally have focused on addiction and overdose, but misuse is very different, and many do not understand that.
- America has had a substance use problem since before it was a country; substance use and misuse are woven into the very fabric of who we are.
- Substance abuse disorders and addiction disproportionately affect vulnerable populations, ethnic groups not in the majority and populations that have historically been marginalized; by the numbers, all of these groups together arguably then become the majority.
- There are very few comfortable ways to speak of substance misuse, given the shame and stigma that often sink the conversation before it begins.
And that’s even before events of the past several years, during which thousands of people — our relatives, our friends, perhaps even ourselves — took to drinking and drugging alone during the pandemic, in the privacy of home.
Esp, who notes that the misuse problem postpandemic “is not additive; it’s exponential,” wants the conversation to come out of the shadows. One way that can happen, she believes, is to equip as many people as possible to have healthy conversations about the problem — and the tools to begin to solve it.
She points out that while in recent years, opioids and fentanyl have become a focal point, the country has a far bigger problem with alcohol. And there are the politics of how substance use and misuse are viewed and managed; so, for example, the alarming increase in alcohol misuse among those designated female, particularly in recent years, is overshadowed, so long as the “misuse problem” can be viewed as an “opioid problem.”
And because “the problem,” no matter how it gets viewed and managed, has been so burdened with shame over decades, it’s nearly untouchable as a conversation — even though anecdotally, nearly every adult in the country — and the college community — is likely to have a story of substance-associated hardship or outright tragedy.
“We’ll talk about depression, we’ll talk about anxiety … We’ve made progress in some areas, but with substance use, we’re blind. We’re behind when it comes to having comfort with this conversation,” Esp said. “We need to open up the conversation, in a calm way, in a caring way, in a compassionate way.”
Historically, students, many of them drug and alcohol counselors working in Idaho who needed to be certified and who often were themselves working through substance use histories, sought out the minor. But the times have changed, Esp observes, and addiction studies are increasingly applicable in many work environments. The certificate makes sense for nursing students, for criminal justice students, for social work students, for public health students, for education students, for any student of the social sciences … Esp is hard-pressed to imagine a line of study that, given the prevalence of substance use in society, would not benefit from the knowledge that comes along as the certificate is earned.
To arm more students with more information more conveniently and effectively — that’s the point to the new certificate. Students can more readily earn the certificate than the minor within the constraints of degree requirements.
“We were looking at, how can we educate more people, rather than less?” Esp said. “What we want to do is educate more people. That was the overarching goal of this, was to increase access.”
Esp is hustling now to make sure all students, advisers and instructors know about the offering. The grapevine also has kicked in, and she’s been getting expressions of interest.
“The word must be out already,” she said. “It’s a huge benefit to our BSW students.
“We were trying to find a way to make this more doable for students, with this as an element of their professions. We’re ready to roll.”
Esp feels some urgency beyond just fall enrollment. She’s thinking about her legacy as well.
“The majority of people in our society have a story about addiction, and I think that’s pretty powerful,” she said, adding that most people are conditioned not to discuss it.
“Our entire society has been touched by it, whether they know it or not,” Esp notes. “We’ve all been exposed to it in some manner.”
Having the conversation is especially critical as substances get more dangerous, laws become increasingly outdated and unmatched in terms of the substances themselves — and we continue to minimize the matter.
“How do we start having these conversations? We don’t have to have the stigma about it.”