How a Friend’s Death Turned Colorado Teens Into Anti-Overdose Activists
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Gavinn McKinney loved Nike shoes, fireworks, and sushi. He was studying Potawatomi, one of the languages of his Native American heritage. He loved holding his niece and smelling her baby smell. On his 15th birthday, the Durango, Colorado, teen spent a cold December afternoon chopping wood to help neighbors who couldn’t afford to heat their homes.
McKinney almost made it to his 16th birthday. He died of fentanyl poisoning at a friend’s house in December 2021. His friends say it was the first time he tried hard drugs. The memorial service was so packed people had to stand outside the funeral home.
Now, his peers are trying to cement their friend’s legacy in state law. They recently testified to state lawmakers in support of a bill they helped write to ensure students can carry naloxone with them at all times without fear of discipline or confiscation. School districts tend to have strict medication policies. Without special permission, Colorado students can’t even carry their own emergency medications, such as an inhaler, and they are not allowed to share them with others.
“We realized we could actually make a change if we put our hearts to it,” said Niko Peterson, a senior at Animas High School in Durango and one of McKinney’s friends who helped write the bill. “Being proactive versus being reactive is going to be the best possible solution.”
Individual school districts or counties in California, Maryland, and elsewhere have rules expressly allowing high school students to carry naloxone. But Jon Woodruff, managing attorney at the Legislative Analysis and Public Policy Association, said he wasn’t aware of any statewide law such as the one Colorado is considering. Woodruff’s Washington, D.C.-based organization researches and drafts legislation on substance use.
Naloxone is an opioid antagonist that can halt an overdose. Available over the counter as a nasal spray, it is considered the fire extinguisher of the opioid epidemic, for use in an emergency, but just one tool in a prevention strategy. (People often refer to it as “Narcan,” one of the more recognizable brand names, similar to how tissues, regardless of brand, are often called “Kleenex.”)
The Biden administration last year backed an ad campaign encouraging young people to carry the emergency medication.
Most states’ naloxone access laws protect do-gooders, including youth, from liability if they accidentally harm someone while administering naloxone. But without school policies explicitly allowing it, the students’ ability to bring naloxone to class falls into a gray area.
Ryan Christoff said that in September 2022 fellow staff at Centaurus High School in Lafayette, Colorado, where he worked and which one of his daughters attended at the time, confiscated naloxone from one of her classmates.
“She didn’t have anything on her other than the Narcan, and they took it away from her,” said Christoff, who had provided the confiscated Narcan to that student and many others after his daughter nearly died from fentanyl poisoning. “We should want every student to carry it.”
Boulder Valley School District spokesperson Randy Barber said the incident “was a one-off and we’ve done some work since to make sure nurses are aware.” The district now encourages everyone to consider carrying naloxone, he said.
Community’s Devastation Turns to Action
In Durango, McKinney’s death hit the community hard. McKinney’s friends and family said he didn’t do hard drugs. The substance he was hooked on was Tapatío hot sauce — he even brought some in his pocket to a Rockies game.
After McKinney died, people started getting tattoos of the phrase he was known for, which was emblazoned on his favorite sweatshirt: “Love is the cure.” Even a few of his teachers got them. But it was classmates, along with their friends at another high school in town, who turned his loss into a political movement.
“We’re making things happen on behalf of him,” Peterson said.
The mortality rate has spiked in recent years, with more than 1,500 other children and teens in the U.S. dying of fentanyl poisoning the same year as McKinney. Most youth who die of overdoses have no known history of taking opioids, and many of them likely thought they were taking prescription opioids like OxyContin or Percocet — not the fake prescription pills that increasingly carry a lethal dose of fentanyl.
“Most likely the largest group of teens that are dying are really teens that are experimenting, as opposed to teens that have a long-standing opioid use disorder,” said Joseph Friedman, a substance use researcher at UCLA who would like to see schools provide accurate drug education about counterfeit pills, such as with Stanford’s Safety First curriculum.
Allowing students to carry a low-risk, lifesaving drug with them is in many ways the minimum schools can do, he said.
“I would argue that what the schools should be doing is identifying high-risk teens and giving them the Narcan to take home with them and teaching them why it matters,” Friedman said.
Writing in The New England Journal of Medicine, Friedman identified Colorado as a hot spot for high school-aged adolescent overdose deaths, with a mortality rate more than double that of the nation from 2020 to 2022.
“Increasingly, fentanyl is being sold in pill form, and it’s happening to the largest degree in the West,” said Friedman. “I think that the teen overdose crisis is a direct result of that.”
If Colorado lawmakers approve the bill, “I think that’s a really important step,” said Ju Nyeong Park, an assistant professor of medicine at Brown University, who leads a research group focused on how to prevent overdoses. “I hope that the Colorado Legislature does and that other states follow as well.”
Park said comprehensive programs to test drugs for dangerous contaminants, better access to evidence-based treatment for adolescents who develop a substance use disorder, and promotion of harm reduction tools are also important. “For example, there is a national hotline called Never Use Alone that anyone can call anonymously to be supervised remotely in case of an emergency,” she said.
Taking Matters Into Their Own Hands
Many Colorado school districts are training staff how to administer naloxone and are stocking it on school grounds through a program that allows them to acquire it from the state at little to no cost. But it was clear to Peterson and other area high schoolers that having naloxone at school isn’t enough, especially in rural places.
“The teachers who are trained to use Narcan will not be at the parties where the students will be using the drugs,” he said.
And it isn’t enough to expect teens to keep it at home.
“It’s not going to be helpful if it’s in somebody’s house 20 minutes outside of town. It’s going to be helpful if it’s in their backpack always,” said Zoe Ramsey, another of McKinney’s friends and a senior at Animas High School.
“We were informed it was against the rules to carry naloxone, and especially to distribute it,” said Ilias “Leo” Stritikus, who graduated from Durango High School last year.
But students in the area, and their school administrators, were uncertain: Could students get in trouble for carrying the opioid antagonist in their backpacks, or if they distributed it to friends? And could a school or district be held liable if something went wrong?
He, along with Ramsey and Peterson, helped form the group Students Against Overdose. Together, they convinced Animas, which is a charter school, and the surrounding school district, to change policies. Now, with parental permission, and after going through training on how to administer it, students may carry naloxone on school grounds.
Durango School District 9-R spokesperson Karla Sluis said at least 45 students have completed the training.
School districts in other parts of the nation have also determined it’s important to clarify students’ ability to carry naloxone.
“We want to be a part of saving lives,” said Smita Malhotra, chief medical director for Los Angeles Unified School District in California.
Los Angeles County had one of the nation’s highest adolescent overdose death tallies of any U.S. county: From 2020 to 2022, 111 teens ages 14 to 18 died. One of them was a 15-year-old who died in a school bathroom of fentanyl poisoning. Malhotra’s district has since updated its policy on naloxone to permit students to carry and administer it.
“All students can carry naloxone in our school campuses without facing any discipline,” Malhotra said. She said the district is also doubling down on peer support and hosting educational sessions for families and students.
Montgomery County Public Schools in Maryland took a similar approach. School staff had to administer naloxone 18 times over the course of a school year, and five students died over the course of about one semester.
When the district held community forums on the issue, Patricia Kapunan, the district’s medical officer, said, “Students were very vocal about wanting access to naloxone. A student is very unlikely to carry something in their backpack which they think they might get in trouble for.”
So it, too, clarified its policy. While that was underway, local news reported that high school students found a teen passed out, with purple lips, in the bathroom of a McDonald’s down the street from their school, and used Narcan to revive them. It was during lunch on a school day.
“We can’t Narcan our way out of the opioid use crisis,” said Kapunan. “But it was critical to do it first. Just like knowing 911.”
Now, with the support of the district and county health department, students are training other students how to administer naloxone. Jackson Taylor, one of the student trainers, estimated they trained about 200 students over the course of three hours on a recent Saturday.
“It felt amazing, this footstep toward fixing the issue,” Taylor said.
Each trainee left with two doses of naloxone.
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Singledom & Healthy Longevity
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Statistically, those who live longest, do so in happy, fulfilling, committed relationships.
Note: happy, fulfilling, committed relationships. Less than that won’t do. Your insurance company might care about your marital status for its own sake, but your actual health doesn’t—it’s about the emotional safety and security that a good, healthy, happy, fulfilling relationship offers.
We wrote about this here:
Only One Kind Of Relationship Promotes Longevity This Much!
But that’s not the full story
For a start, while being in a happy fulfilling committed relationship statistically adds healthy life years, being in a relationship that falls short of those adjectives certainly does not. See also:
Relationships: When To Stick It Out & When To Call It Quits
But also, life satisfaction steadily improves with age, for single people (the results are more complicated for partnered people—probably because of the range of difference in quality of relationships). At least, this held true in this large (n=6,188) study of people aged 40–85 years:
❝With advancing age, partnership status became less predictive of loneliness and the satisfaction with being single increased. Among later-born cohorts, the association between partnership status and loneliness was less strong than among earlier-born cohorts. Later-born single people were more satisfied with being single than their earlier-born counterparts.❞
Note that this does mean that while life satisfaction indeed improves with age for single people, that’s a generalized trend, and the greatest life satisfaction within this set of singles comes hand-in-hand with being single by choice rather than by perceived obligation, i.e., those who are “single and not looking” will generally be the most content, and this contentedness will improve with age, but for those who are “single and looking”, in that case it’s the younger people who have it better, likely due to a greater sense of having plenty of time.
For that matter, gender plays a role; this large survey of singles found that (despite the popular old pop-up ads advising that “older women in your area are looking to date”), in reality older single women were the least likely to actively look for a partner:
See: A Profile Of Single Americans
…which also shows that about half of single Americans are “not looking”, and of those who are, about half are open to a serious relationship, though this is more common under the age of 40, while being over the age of 40 sees more people looking only for something casual.
Take-away from this section: being single only decreases life satisfaction if one doesn’t enjoy being single, and even then, and increases it if one does enjoy being single.
But that’s about life satisfaction, not longevity
We found no studies specifically into longevity of singledom, only the implications that may be drawn from the longevity of partnered people.
However, there is a lot of research that shows it’s not being single that kills, it’s being socially isolated. It’s a function of neurodegeneration from a lack of conversation, and it’s a function of what happens when someone slips in the shower and is found a week later. Things like that.
For example: Is Living Alone “Aging Alone”? Solitary Living, Network Types, and Well-Being
What if you are alone and don’t want to be?
We’ve not, at time of writing, written dating advice in our Psychology Sunday section, but this writer’s advice is: don’t even try.
That’s not nihilism or even cynicism, by the way; it’s actually a kind of optimism. The trick is just to let them come to you.
(sample size of one here, but this writer has never looked for a relationship in her life, they’ve always just found me, and now that I’m widowed and intend to remain single, I still get offers—and no, I’m not a supermodel, nor rich, nor anything like that)
Simply: instead of trying to find a partner, just work on expanding your social relationships in general (which is much easier, because the process is something you can control, whereas the outcome of trying to find a suitable partner is not), and if someone who’s right for you comes along, great! If not, then well, at least you have a flock of friends now, and who knows what new unexpected romance may lie around the corner.
As for how to do that,
How To Beat Loneliness & Isolation
Take care!
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How Gluconolactone Restores Immune Regulation In Lupus
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Let’s be clear up front: this will not cure lupus.
However, it will interrupt the pathology of lupus in such a way as to, as the title says, restore immune regulation—so that your body stops attacking itself, or at the very least, attacks itself significantly less.
What is gluconolactone anyway?
Gluconolactone (also called glucono-δ-lactone) an oxidized derivative of glucose, when glucose is exposed to oxygen and a certain enzyme (glucose oxidase). It’s used in various food-related fermentation processes, and also helps such foods to have a tangy flavor.
It’s also known as E575, showing that E-numbers need not always be scary 🙂
How does it work?
First, a recap on how lupus works: lupus is an autoimmune disease where the immune system attacks its own tissues, causing inflammation and organ damage (to oversimplify it in very few words).
Next, how lupus is currently treated: mostly with immunosuppressant drugs, which reduce symptoms but have significant side effects, not least of all the fact that your immune system will be suppressed, leaving you vulnerable to infections, cancer, aging, and the like. So, there’s really a “damned if you do, damned if you don’t” aspect here (because untreated lupus will run your immune system into the ground with its chronic inflammation, which will also leave you vulnerable to the aforementioned things).
See also: How to Prevent (or Reduce) Inflammation
Now, how gluconolactone works: it increases the number of regulatory T-cells (also called “Tregs” by scientists who don’t want to have to say/write “regulatory T-cells” many times per day), which are the ones that tell the rest of your immune system what not to attack. It also inhibits pro-inflammatory T-helper-cells that are otherwise involved in autoimmune dysfunction.
Where is the science for this?
It’s a shiny new paper that covers three angles:
- In lupus-suffering mouse in vivo studies, it improved Treg function and reduced inflammatory skin rashes
- In human cell culture in vitro studies (with cell cultures from human lupus patients), it bolstered Treg count and improved immune regulation
- In human patient in vivo studies, a gluconolactone cream controlled skin inflammation and improved the clinical and histologic appearance of the skin lesions within 2 weeks
❝These results suggest that gluconolactone could be a targeted treatment option with fewer side effects for autoimmune diseases such as lupus.
Gluconolactone acts like a ‘power food’ for regulatory T cells—a real win-win situation for immune regulation❞
~ Dr. Antonios Kolios
You can find the paper itself here:
Where can I get gluconolactone?
At the moment, this is still in the clinical trials phase, so it’s not something you can get a prescription for yet, alas.
But definitely keep an eye out for it!
We would hypothesize that eating foods fermented with E575 (it’s sometimes used in feta cheese, hence today’s featured image, and it’s also often used as a pickling agent) may well help, but that’s just our hypothesis as it isn’t what was tested in the above studies.
Want to learn more?
In the meantime, if you’d like to learn more about lupus, we recommend this very comprehensive book:
*The “et al.” are: Jemima Albayda, MD; Divya Angra, MD; Alan N. Baer, MD; Sasha Bernatsky, MD, PhD; George Bertsias, MD, PhD; Ashira D. Blazer, MD; Ian Bruce, MD; Jill Buyon, MD; Yashaar Chaichian, MD; Maria Chou, MD; Sharon Christie, Esq; Angelique N. Collamer, MD; Ashté Collins, MD; Caitlin O. Cruz, MD; Mark M. Cruz, MD; Dana DiRenzo, MD; Jess D. Edison, MD; Titilola Falasinnu, PhD; Andrea Fava, MD; Cheri Frey, MD; Neda F. Gould, PhD; Nishant Gupta, MD; Sarthak Gupta, MD; Sarfaraz Hasni, MD; David Hunt, MD; Mariana J. Kaplan, MD; Alfred Kim, MD; Deborah Lyu Kim, DO; Rukmini Konatalapalli, MD; Fotios Koumpouras, MD; Vasileios C. Kyttaris, MD; Jerik Leung, MPH; Hector A. Medina, MD; Timothy Niewold, MD; Julie Nusbaum, MD; Ginette Okoye, MD; Sarah L. Patterson, MD; Ziv Paz, MD; Darryn Potosky, MD; Rachel C. Robbins, MD; Neha S. Shah, MD; Matthew A. Sherman, MD; Yevgeniy Sheyn, MD; Julia F. Simard, ScD; Jonathan Solomon, MD; Rodger Stitt, MD; George Stojan, MD; Sangeeta Sule, MD; Barbara Taylor, CPPM, CRHC; George Tsokos, MD; Ian Ward, MD; Emma Weeding, MD; Arthur Weinstein, MD; Sean A. Whelton, MD
The reason we mention this is to render it clear that this isn’t one man’s opinions (as happens with many books about certain topics), but rather, a panel of that many doctors all agreeing that this is correct and good, evidence-based, up-to-date (as of the publication of this latest revised edition) information.
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Infections, Heart Failure, & More
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Some health news to round off the week:
The Infection That Leads To Heart Failure
It’s long been held that, for example, flossing reduces heart disease risk, with the hypothesis being that if plaque bacteria enter the blood stream, well, that’s an even worse place for plaque bacteria to be. Now, with much more data, attention has turned to
- actual infections, and
- actual heart failure
Way to up the ante! And, it holds true regardless of what kind of infection. So, you might think that a UTI, for example, is surely “downstream” and should not affect the heart, but it does. Because of this, researchers currently believe that it is not the infection itself, so much as the body’s inflammation response to infection, that leads to the heart failure. Which is reasonable, because, for example, atherosclerosis is made mostly not of cholesterol itself, but rather mostly of dead immune cells that got stuck in the cholesterol.
Moreover, it’s not so much about the acute inflammatory response (which is almost always a good thing, circumstantially), but rather that after cases where an infection managed to take hold, the immune system can then often stay on high alert for many years alter. Long COVID is an obvious recent example of this, but it’s hardly a new phenomenon; see for example post-polio syndrome, and consider how many more such post-infection maladies are likely to exist that never got a name because they flew under the radar or got diagnosed as fibromyalgia or something (fibromyalgia is a common diagnosis doctors give when they acknowledge something’s wrong, and it causes pain and exhaustion, but they don’t know what, and it appears to be stable—so while it can be helpful to put a name to the collection of symptoms, it’s a non-diagnosis diagnosis on the doctors’ part. It’s saying “I diagnose you with hurty tiredness”).
The take-away from all this? Avoid infections, for your heart’s sake, and if you do get an infection, take it seriously even if it’s minor. The safe amount of infection is “no infection”.
Read in full: Study uncovers new link between infections and heart failure
Cold Water Immersion: Hot Or Not?
The evidence is clear for some benefits; for others, not so much:
- It’s great (if you’re already in fair health, and definitely not if you have a heart condition) to improve circulation and stress response
- There may be some benefits to immune function, but however reasonable the hypothesis, actual evidence is thin on the ground
- The oft-hyped mood benefits are a) marginal b) short-lived, with benefits fading after 3 months of regular cold baths/showers/etc
Read in full: The big chill: Is cold-water immersion good for our health?
Related: Ice Baths: To Dip Or Not To Dip?
The Unspoken Trials Of Going To The Gym (While Being A Woman)
Public health decision-makers often think that getting people to go to the gym more is a matter of public information, or perhaps branding. Some who have their thinking heads on might even realize that there may be economic factors for many. But for women, there’s an additional factor—or rather, an additionally prominent factor. The study we’ll link started with this observation (please read it in the voice of your favorite nature documentary narrator):
❝Despite an increase in gym memberships, women are less active than men and little is known about the barriers women face when navigating gym spaces.❞
What then, of these shy, elusive creatures that make up a mere 51% of the world’s population?
A medium-sized (n=279) study of women, of whom 84% being current gym-goers, reported often feeling “judged for their appearance or performance, as well as having to fight for space in the gym and to be taken seriously, while navigating harassment and unsolicited comments from men”
Even gym attire becomes an issue:
❝Aligning with previous literature, women often chose attire based on comfort and functionality. However, their choices were also influenced by comparisons with others or fear of judgement for wearing non-branded attire or looking too put together. Many women also chose gym attire to hide perceived problem areas or avoid appearance concerns, including visible sweat stains.❞
…which main seem silly; you’re at the gym, of course you’re going to sweat, but if you’re the only one with visible sweat stains, then there can be social consequences (bad ones).
Similarly, there’s a “damned if you do; damned if you don’t” when it comes to working out while fat—on the one hand, society conflates fatness with laziness; on the other, it can be extra intimidating to be the only fat person in a gym full of people who look like they’re going to audition for a superhero movie.
❝In the gym, just like in other areas of life, women often feel stuck between being seen as ‘too much’ and ‘not enough’, dealing with judgement about how they look, how they perform, and even how much space they take up. Even though the pressure to be super thin is decreasing, the growing focus on being muscular and athletic is creating new challenges. It is pushing unrealistic standards that can negatively affect women’s body image and overall well-being.❞
Writer’s note: I live a few minutes walk from my nearest gym, and I work out at home instead. This way, if I want to do yoga in my pajamas, I can. If I want to use my treadmill naked and watch my T+A bounce in the mirror, I can. If I want to lift weights in the dress I happened to be wearing, I can. Alas that I can’t swim at home!
Read in full: Women face multiple barriers while exercising in gyms
Related: Body Image Dissatisfaction/Appreciation Across The Ages
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NADᐩ Against Aging
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Nicotinamide adenine dinucleotide, or “NAD” to its friends, is a coenzyme produced in the human body (amongst other places), and it is critical for cellular energy metabolism, but there’s more to it than that.
Today we’ll be looking mostly at NAD+, of which the + indicates the positive formal charge of one of its nitrogen atoms. We won’t get too much into the chemistry of this, but we will mention that it’s a cofactor with NADH—the former accepting electrons and the latter donating electrons.
Both NAD+ and NADH are critical to good health, but we’re going to focus on NAD+ for the simple reason that it gets depleted with aging.
Note: it gets depleted with aging.
Chronological age is not so important here, but there is a direct relationship between biological aging and NAD+ depletion.
For example, healthy centenarians tend not to have depleted NAD+ levels. Further, its depletion (in those in whom it is depleted) is then a causal factor for many age-related diseases:
❝Remarkably, ageing is accompanied by a gradual decline in tissue and cellular NAD+ levels in multiple model organisms, including rodents and humans.
This decline in NAD+ levels is linked causally to numerous ageing-associated diseases, including cognitive decline, cancer, metabolic disease, sarcopenia and frailty.
Many of these ageing-associated diseases can be slowed down and even reversed by restoring NAD+ levels.❞
~ Dr. Rosalba Perrone et al.
Read in full: NAD+ metabolism and its roles in cellular processes during ageing
As for restoring those NADᐩ levels, that does help in interventional trials, whether by supplementing directly, or with NAD precursors*:
❝NAD+ levels steadily decline with age, resulting in altered metabolism and increased disease susceptibility.
Restoration of NAD+ levels in old or diseased animals can promote health and extend lifespan, prompting a search for safe and efficacious NAD-boosting molecules that hold the promise of increasing the body’s resilience, not just to one disease, but to many, thereby extending healthy human lifespan.❞
~ Dr. David Sinclair et al.
Read more: Therapeutic Potential of NAD-Boosting Molecules: The In Vivo Evidence
*There are actually also other NAD-boosting molecules besides NAD itself and its precursors. For example, the liver will not produce NADᐩ unless it has aminocarboxymuconate-semialdehyde decarboxylase (or “ACMSD”, to its friends), which limits the production of NADᐩ. Why, you ask? The theory is that it is a kind of evolutionary conservativism, much like not lighting a fire without the ability to put it out. In any case, taking ACMSD-blockers will thus result in an increased endogenous production of NADᐩ.
You can read about this here:
De novo NAD+ synthesis enhances mitochondrial function and improves health
Nor is taking supplements or drugs the only way to get more of it; there’s an enzyme nicotinamide phosphoribosyltransferase (“NAMPT”, to its friends) involved in the synthesis of NADᐩ, and exercise boosts levels by 127% (i.e., it more than doubles the levels), based on a modest three-week exercise bike regimen:
Skeletal muscle NAMPT is induced by exercise in humans
And to underline that point, another study found that resistance training (so, a different kind of exercise from that of the previous study) boosts levels of NADᐩ itself by the same 127%:
One way to get more out of NADᐩ
We’ll get straight to the point: it works very well paired with a senolytic agent, i.e. something that kills aging cells so that they get recycled sooner:
NAD+, Senolytics, or Pyruvate for Healthy Aging?
To read more about senolytics, check out:
Fisetin: The Anti-Aging Assassin
Want to try some?
We don’t sell it, but here for your convenience is an example product on Amazon 😎
Enjoy!
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For Seniors With Hoarding Disorder, a Support Group Helps Confront Stigma and Isolation
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A dozen people seated around folding tables clap heartily for a beaming woman: She’s donated two 13-gallon garbage bags full of clothes, including several Christmas sweaters and a couple of pantsuits, to a Presbyterian church.
A closet cleanout might not seem a significant accomplishment. But as the people in this Sunday-night class can attest, getting rid of stuff is agonizing for those with hoarding disorder.
People with the diagnosis accumulate an excessive volume of things such as household goods, craft supplies, even pets. In extreme cases, their homes become so crammed that moving between rooms is possible only via narrow pathways.
These unsafe conditions can also lead to strained relationships.
“I’ve had a few relatives and friends that have condemned me, and it doesn’t help,” said Bernadette, a Pennsylvania woman in her early 70s who has struggled with hoarding since retiring and no longer allows guests in her home.
People who hoard are often stigmatized as lazy or dirty. NPR, Spotlight PA, and KFF Health News agreed to use only the first names of people with hoarding disorder interviewed for this article because they fear personal and professional repercussions if their condition is made public.
As baby boomers age into the group most affected by hoarding disorder, the psychiatric condition is a growing public health concern. Effective treatments are scarce. And because hoarding can require expensive interventions that drain municipal resources, more funding and expertise is needed to support those with the diagnosis before the issue grows into a crisis.
For Bernadette, the 16-week course is helping her turn over a new leaf.
The program doubles as a support group and is provided through Fight the Blight. The Westmoreland County, Pennsylvania, organization started offering the course at a local Masonic temple after founder Matt Williams realized the area lacked hoarding-specific mental health services.
Fight the Blight uses a curriculum based on cognitive behavioral therapy to help participants build awareness of what fuels their hoarding. People learn to be more thoughtful about what they purchase and save, and they create strategies so that decluttering doesn’t become overwhelming.
Perhaps more importantly, attendees say they’ve formed a community knitted together through the shared experience of a psychiatric illness that comes with high rates of social isolation and depression.
“You get friendship,” said Sanford, a classmate of Bernadette’s.
After a lifetime of judgment, these friendships have become an integral part of the changes that might help participants eventually clear out the clutter.
Clutter Catches Up to Baby Boomers
Studies have estimated that hoarding disorder affects around 2.5% of the general population — a higher rate than schizophrenia.
The mental illness was previously considered a subtype of obsessive-compulsive disorder, but in 2013 it was given its own diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5.
The biological and environmental factors that may drive hoarding are not well understood. Symptoms usually appear during the teenage years and tend to be more severe among older adults with the disorder. That’s partly because they have had more time to acquire things, said Kiara Timpano, a University of Miami psychology professor.
“All of a sudden you have to downsize this huge home with all the stuff and so it puts pressures on individuals,” she said. In Bernadette’s case, her clutter includes a collection of VHS tapes, and spices in her kitchen that she said date back to the Clinton administration.
But it’s more than just having decades to stockpile possessions; the urge to accumulate strengthens with age, according to Catherine Ayers, a psychiatry professor at the University of California-San Diego.
Researchers are working to discern why. Ayers and Timpano theorize that age-related cognitive changes — particularly in the frontal lobe, which regulates impulsivity and problem-solving — might exacerbate the disorder.
“It is the only mental health disorder, besides dementia, that increases in prevalence and severity with age,” Ayers said.
As the U.S. population ages, hoarding presents a growing public health concern: Some 1 in 5 U.S. residents are baby boomers, all of whom will be 65 or older by 2030.
This population shift will require the federal government to address hoarding disorder, among other age-related issues that it has not previously prioritized, according to a July report by the Democratic staff of the U.S. Senate Special Committee on Aging, chaired then by former Sen. Bob Casey (D-Pa.).
Health Hazards of Hoarding
Clutter creates physical risks. A cramped and disorderly home is especially dangerous for older adults because the risk of falling and breaking a bone increases with age. And having too many things in one space can be a fire hazard.
Last year, the National Fallen Firefighters Foundation wrote to the Senate committee’s leadership that “hoarding conditions are among the most dangerous conditions the fire service can encounter.” The group also said that cluttered homes delay emergency care and increase the likelihood of a first responder being injured on a call.
The Bucks County Board of Commissioners in Pennsylvania told Casey that hoarding-related mold and insects can spread to adjacent households, endangering the health of neighbors.
Due to these safety concerns, it might be tempting for a family member or public health agency to quickly empty someone’s home in one fell swoop.
That can backfire, Timpano said, as it fails to address people’s underlying issues and can be traumatic.
“It can really disrupt the trust and make it even less likely that the individual is willing to seek help in the future,” she said.
It’s more effective, Timpano said, to help people build internal motivation to change and help them identify goals to manage their hoarding.
For example, at the Fight the Blight class, a woman named Diane told the group she wanted a cleaner home so she could invite people over and not feel embarrassed.
Sanford said he is learning to keep his documents and record collection more organized.
Bernadette wants to declutter her bedroom so she can start sleeping in it again. Also, she’s glad she cleared enough space on the first floor for her cat to play.
“Because now he’s got all this room,” she said, “he goes after his tail like a crazy person.”
Ultimately, the home of someone with hoarding disorder might always be a bit cluttered, and that’s OK. The goal of treatment is to make the space healthy and safe, Timpano said, not to earn Marie Kondo’s approval.
Lack of Treatment Leaves Few Options
A 2020 study found that hoarding correlates with homelessness, and those with the disorder are more likely to be evicted.
Housing advocates argue that under the Fair Housing Act, tenants with the diagnosis are entitled to reasonable accommodation. This might include allowing someone time to declutter a home and seek therapy before forcing them to leave their home.
But as outlined in the Senate aging committee’s report, a lack of resources limits efforts to carry out these accommodations.
Hoarding is difficult to treat. In a 2018 study led by Ayers, the UCSD psychiatrist, researchers found that people coping with hoarding need to be highly motivated and often require substantial support to remain engaged with their therapy.
The challenge of sticking with a treatment plan is exacerbated by a shortage of clinicians with necessary expertise, said Janet Spinelli, the co-chair of Rhode Island’s hoarding task force.
Could Changes to Federal Policy Help?
Casey, the former Pennsylvania senator, advocated for more education and technical assistance for hoarding disorder.
In September, he called for the Substance Abuse and Mental Health Services Administration to develop training, assistance, and guidance for communities and clinicians. He also said the Centers for Medicare & Medicaid Services should explore ways to cover evidence-based treatments and services for hoarding.
This might include increased Medicare funding for mobile crisis services to go to people’s homes, which is one way to connect someone to therapy, Spinelli said.
Another strategy would involve allowing Medicaid and Medicare to reimburse community health workers who assist patients with light cleaning and organizing; research has found that many who hoard struggle with categorization tasks.
Williams, of Fight the Blight, agrees that in addition to more mental health support, taxpayer-funded services are needed to help people address their clutter.
When someone in the group reaches a point of wanting to declutter their home, Fight the Blight helps them start the process of cleaning, removing, and organizing.
The service is free to those earning less than 150% of the federal poverty level. People making above that threshold can pay for assistance on a sliding scale; the cost varies also depending on the size of a property and severity of the hoarding.
Also, Spinelli thinks Medicaid and Medicare should fund more peer-support specialists for hoarding disorder. These mental health workers draw on their own life experiences to help people with similar diagnoses. For example, peer counselors could lead classes like Fight the Blight’s.
Bernadette and Sanford say courses like the one they enrolled in should be available all over the U.S.
To those just starting to address their own hoarding, Sanford advises patience and persistence.
“Even if it’s a little job here, a little job there,” he said, “that all adds up.”
This article is from a partnership that includes Spotlight PA, NPR, and KFF Health News.
Spotlight PA is an independent, nonpartisan, and nonprofit newsroom producing investigative and public-service journalism that holds power to account and drives positive change in Pennsylvania. Sign up for its free newsletters.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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Gut-Positive Pot Noodles
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Everything we consume either improves our health a little or worsens it. Pot noodles aren’t generally the healthiest foods, but these ones sure are! There’s quite a range of fiber in this, including the soluble fiber of the noodles themselves (which are, in fact, mostly fiber and water). As a bonus, the glucomannan in the noodles promotes feelings of fullness, notwithstanding its negligible carb count. Of course, the protein in the edamame beans also counts for satiety!
You will need
- ½ cup konjac noodles (also called shirataki), tossed in 1 tsp avocado oil (or sesame oil, if you don’t have avocado)
- 2 oz mangetout, thinly sliced
- 1 oz edamame beans
- ¼ carrot, grated
- 2 baby sweetcorn, cut in half lengthways
- 1 scallion, finely diced
- 1 heaped tsp crunchy peanut butter (omit if allergic)
- 1 tsp miso paste
- 1 tsp chili oil
- 1 tsp black pepper, coarse ground
- 1 tsp peeled-and-grated ginger
Method
(we suggest you read everything at least once before doing anything)
1) Layer a heat-resistant jar (mason jars are usually quite resistant to temperature changes) with the noodles and vegetables.
2) Combine the peanut butter, miso paste, and chili oil, black pepper, and ginger in a small bowl. Pour this dressing over the layered vegetables and noodles, and screw the lid on. Refrigerate until needed.
3) Add hot water to the jar and stir, to serve. If you prefer the vegetables to be more cooked, you can microwave (without the lid!) for a minute or two.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Making Friends With Your Gut (You Can Thank Us Later)
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- 10 Ways To Balance Blood Sugars ← today’s recipe makes a perfect high-fiber, low-carb starter, per the hacks here
- Capsaicin For Weight Loss And Against Inflammation
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Ginger Does A Lot More Than You Think
Take care!
Don’t Forget…
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