Sean: Thank you so much. Today, we are going to be talking about occupational therapy's role in community coalitions.
What is a Coalition?
The basic dictionary definition of a coalition is a group of individuals coming together for a common cause. Ultimately this is an action-oriented partnership, grouping different subsets of the community in order to put together a plan, an action plan, that is going to cause change in the community. Butterfoss and Kegler (2002) have done a lot of work looking at coalitions, and they defined it as "a group of individuals representing diverse organizations, factions, or constituencies within the community who agree to work together to achieve a common goal." Per CADCA, a coalition should be "comprised of parents, teachers, law enforcement, businesses, religious leaders, health providers, and other community activists who want to make a community safer, healthier, and drug free."
Why a Coalition?
Why form coalitions? Coalitions typically form when something is wrong in a community. Here are some examples:
- Substance Abuse
- Healthy Living/Wellness
- Safety
- Social Justice
- Suicide
- Eldercare
- Teen Pregnancy
- Cancer Disparity
- Childhood Obesity
- Prevent Hepatitis B and Liver Cancer
- Child Vaccinations
One of the biggest issues facing our country across the country, and really across the world, has to do with substance abuse, and in particular the opioid epidemic that is going on. It is obviously a huge problem in the United States, but as I talk to people in other parts of the world, they are having the same issue with the opioid epidemic. There is also a big focus for healthy living and wellness which makes sense for us. As OTs, how do we help people to establish a healthy environment and healthier practices of living for people in the community? Coalitions form because of safety issues, like gang violence and things of that nature. They form out of social justice issues. They look at suicide epidemics that occur within communities. Coalitions can form to help the elder population or to address things like teen pregnancy within a community, or cancer disparity. For instance, why is there a large population of cancer occurring within a community? Other topics may be childhood obesity, diseases like Hepatitis B and liver cancer, and child vaccinations.
The Opioid Epidemic
As I said earlier one of the biggest problems that we are facing is the opioid epidemic. In 2015, 2 million people in the United States had a substance use disorder, involving pain relievers (Center for Behavioral Health Statistics and Quality, 2016). Many times people are prescribed pain meds, they become addicted to these, and then they build up a tolerance to these. The need for pain meds is greater. It becomes much cheaper to use heroin, than it does to use pain medication and to get those pain meds illegally. Typically people turn to heroin due to a prescription addiction.
It affects people like young athletes with sports injuries. It also affects people who are older. In fact, we are seeing a rise in heroin addiction amongst the elderly population because they are prescribed pain pills. Heroin today is very different than it was years ago. It is a much purer substance, and therefore instead of having to inject it, it can be smoked and snorted. Smoking marijuana is also a gateway to using heroin.
Drug overdose is the leading cause of accidental death in the United States with over 52,000 lethal drug overdoses in 2015 (Rudd, Seth, David, & Scholl L., 2016). Heroin related overdose deaths have more than quadrupled since 2010 (Center for Disease Control and Prevention [CDC], 2016), so we are talking about a little over six years where we have seen a 400% increase in heroin deaths. Just yesterday they released in New York City heroin deaths just in 2016 compared to 2015 have increased by over 40%. Although we are seeing that this is a problem, we are not necessarily addressing this issue. Now we have synthetics that are coming on to the market, this means that our risk for overdose is even greater. Overdose deaths involving synthetic opioids rose from 5,544 in 2014 to almost double, 9580 in 2015. It is a 73% increase in deaths related to synthetic opioids (CDC, 2016). Synthetics are much more powerful than standard heroin, like Fentanyl which is a hundred times more powerful than heroin. When someone builds up a tolerance for heroin they will use Fentanyl, and it is what a lot of dealers are cutting into heroin. Therefore it becomes a much more powerful and better quality substance from the user point of view and therefore people are more likely to go to them for that substance. What we are seeing now is that Carfentanil, which is basically an elephant tranquilizer, is now hitting the market, and this is a hundred times more potent than Fentanyl. If you have gone to a Narcan training recently, they are starting to talk about Carfentanil and how it can be absorbed through your skin. Thus, the person who is trying to help a person who has just had an overdose is susceptible to now getting an overdose themselves from contact with Carfentanil. As people start to use Carfentanil, there will be an even higher rise in overdoses. Will Narcan be able to reduce the overdoses associated with Carfentanil? I am not sure. Nine point one percent of teenagers that it is easy to get heroin across the United States (SAMHSA, 2014). That is a very scary number. It is a sign that we are not addressing this issue.
Benefits of a Coalition
There are many benefits of a coalition according to Community Catalyst, 2003. They are:
- Greater community voice
- Increased opportunities
- Shared resources
- Respect
- Connectedness
It is very hard for one person to make a change. By coming together with different community groups, it gives the community a greater voice. It gives much more power to what we are saying. It also presents increased opportunities for us. Coalitions are able to get grants, sometimes fairly substantial grants-- over $250,000, which gives more opportunities to make communities stronger and better. It allows for us to share resources. Different people bring different things to a coalition. It allows the pooling of resources together in order to make it much stronger. A coalition also brings greater respect. When it comes to community change we need to not only change the community, but we also need to change the public law within the community. We need to get people involved. There is a much greater respect going to a politician or to law enforcement as a member of a coalition. Finally, it allows you to be much more connected.
