heroin — Blog — Online Museum of African American Addictions, Treatment and Recovery

For years I specialized in working with African American adolescents who primarily smoked marijuana. Most began smoking marijuana between the ages of 11 to 13 and just about all made a declaration that marijuana was not addicting and that they would never use real addictive drugs like crack and heroin. When asked the reasons they would never use crack or heroin, they would say things like:

My aunt smoked crack and she sold her body for pennies to buy more crack

My uncle used heroin and overdosed in an alley with a needle in his arm.

Evidence indicates that in spite of the declaration of marijuana only, many of these youth will graduate to cocaine, opioids and other drugs as they age and as addiction progresses. Many of these youth begin experimenting with xanax, molly and other pills. When they turn 21, they celebrate adulthood by buying their own liquor, legally for the first time. As they enter emerging adulthood many will begin to add stimulants like cocaine, Oxycotin and heroin to their menu of drugs.

One study found that if an adolescent smokes marijuana for over 200 days in a year, they become more vulnerable to stimulant and opioid dependence. I have seen this in clinical practice and have talked with colleagues who have also witnessed this phenomenon.

For states which legalize marijuana, legalization begins at age 21. For teens who begin smoking marijuana before age 16 they become more vulnerable to mental health symptoms and a permanent drop in IQ caused by early marijuana use. In addition, many youth who start smoking marijuana at young ages do so to medicate childhood trauma and are at an increased risk of addiction. Many African American adolescents have said to me, “There is gun violence and gangs in my community. Of course I smoke marijuana to deal with that!” Once the addiction process has set in, they become more vulnerable to cocaine and opioid dependence, in spite of the early declaration, “I'll never use those drugs!”

For African American adolescents, prevention of stimulant and opioid dependence can involve addressing marijuana use as early as possible including primary and secondary prevention. Early treatment for those whose marijuana use has been diagnosed as early stage dependence is also recommended. Addressing the trauma which often precedes substance use is of the upmost importance.

On September 6, 2021, Emmy Award Nominated Actor Michael K. Williams died of a drug overdose which included a combination of, cocaine, heroin and fentanyl. Williams played the iconic role of Omar in the HBO series The Wire and Chalky White in the HBO Series Boardwalk Empire. When drug related deaths occur, substance use disorders counselors are able to examine these tragedies from our clinical lens and think about the implications of such tragedies for our future work.

As a youth Michael K. Williams experienced abuse, neglect and depression. We now know that these co-occurring conditions lie at the core of addiction and almost always precede a substance use disorders. At seminars I often ask substance use disorders professionals to raise their hands if they are a trauma or co-occurring disorders specialist? Approximately 1% of participants raise their hand. In addition, many professionals in our field remain resistant, sometimes even hostile regarding the idea of harm reduction.

It is time for more substance use disorders counselors to become trauma specialists. According to Dr. Gabor Mate, trauma is at the core of addiction. The fact that over 50% of individuals with a substance use disorder also have a co-occurring disorder provides a strong rationale for us to become dual disorders specialists as well. With fentanyl being 50 times more potent than heroin, would Michael K. Williams still be alive if fentanyl strips were used as a harm reduction strategy? How many of your clients would stay alive long enough for the miracle of recovery to occur if harm reduction strategies were used?