She was not yet 13 when the Khmer Rouge seized power in Cambodia and ripped her family apart. The totalitarian regime sent her and four siblings to work camps, where they planted rice and dug irrigation canals from sunrise to sunset — each surviving on two ladles of rice gruel a day. One disappeared, never to be found.

Just a few months before the Khmer Rouge fell in January 1979, Lim’s father starved to death, among the nearly of Cambodians who perished from execution, forced labor, starvation or disease in less than four years.

For Lim, the indelible stamp of childhood anguish drove two of her life’s passions: serving people as a physician and cooking lavish feasts for friends and family — both of which she did until she died of covid-19 in January.

Within the week before her death at age 58, she treated dozens of patients who flooded the hospital during the deadly winter covid surge, while bringing home-cooked meals to the hospital for her fellow health care workers to enjoy during breaks.

“These experiences during the war made her humble and empathetic toward the people around her,” said Dr. Vidushi Sharma, who worked with Lim at Community Regional Medical Center in Fresno, California. “She always wanted to help them.”

Lim’s story is one of suffering and triumph.

During the Khmer Rouge’s brutal reign and the Cambodian civil war before it, Lim and her nine siblings attended school sporadically. The ravages of war forced the family first from its small town to the capital, Phnom Penh, and then into the countryside when the Khmer Rouge took power in 1975. As part of its vision to create a , the communist group split families and relocated residents to rural labor camps.

Lim survived the work camps because she was smart and resourceful, said her youngest brother, Rithy Lim, who also lives in Fresno. She dug ditches, hauled clay-like dirt on her back, built earthen dams in the middle of a river during monsoons — all with little food or rest, he said.

She also became a skillful hunter and fisher, and learned to identify plants that were safe to eat.

“You cannot imagine the horrible conditions,” he said. “Think of it as a place that you live like wild animals, and people tell you to work. There’s no paper, no pens. You sleep on the ground. We witnessed death of all sorts.”

Vietnamese troops liberated Cambodia from the Khmer Rouge in 1979. Later that year, Lim, her mother and siblings sneaked into Thailand. “The whole family walked through minefields,” Rithy Lim recalled. There, they waited and worked in refugee camps. At one camp, they met a dentist from California’s Central Valley who was on a medical mission.

When Lim and her family arrived in the U.S. in 1982, they landed in Georgia. But she and an older brother soon moved to the small town of Taft, California, about 45 minutes west of Bakersfield, at the invitation of the dentist they’d befriended at the Thai refugee camp.

When she hit the ground, the 4-foot-11 dynamo, then 19, was driven by “pure determination,” Rithy Lim said.

Within two years, Linath Lim learned English, earned her GED and graduated from Taft College — “boom, boom, boom,” her brother recalled. (She learned to make traditional, middle-America Thanksgiving dinners when she worked at the community college’s cafeteria, which she would later cook for scores of friends and family.)

She went on to attend Fresno State and then the Medical College of Pennsylvania, sleeping on friends’ couches, borrowing money from other Cambodian refugees and scraping by.

“Imagine not having any money, studying alone, sleeping in someone else’s living room,” Rithy Lim said.

Lim became an internal medicine doctor “because she always wanted to be really involved with a lot of patients,” Rithy Lim said. After her residency, she returned to the Central Valley to practice in hospitals and clinics in underserved communities, including Porterville and Stockton, where some of her patients were farmworkers and Cambodian refugees.

California has the largest Cambodian population in the country, with roughly 89,000 people of Cambodian descent in 2019, according to a Public Policy Institute of California analysis of data.

Twice, Lim joined the on weeklong volunteer trips to Cambodia, where she and other doctors treated hundreds of patients a day, said Dr. Song Tan, a Long Beach, California, pediatrician and founder of CHPAA.

“She was a kindhearted, very gentle person,” recalled Tan, who said he was the only member of his family to survive the Khmer Rouge. “She went beyond the call of duty to do special things for patients.”

Most recently, Lim worked the swing shift, 1 p.m. to 1 a.m., at Community Regional Medical Center. She admitted patients through the emergency room, where she was exposed to countless people with covid. She worked extra shifts during the pandemic, volunteering when the hospital was short-staffed, said Dr. Nahlla Dolle, an internist who also worked with Lim.

“She told me there were so many patients every day, and that they didn’t have enough beds and the patients had to wait in the hallway,” Tan said.

Colleagues said she was aware of the risks but loved her job. Lim, who was single and didn’t have kids, drew happiness from celebrating others’ joys. After getting home from work in the small hours, she slept for a bit, then got up to cook. Her specialties were Cambodian, Thai, Vietnamese and Italian food. She sometimes ordered a whole roasted pig that she transported to the hospital. Her memorable Thanksgiving dinners served 70 or more people.

“For any occasion that comes up — if it’s a birthday, if it’s a baby shower, if it’s Thanksgiving — she would cook, she would order food and bring everybody together,” Dolle said. “She loved to feed people because she experienced famine and lack of food.”

The week before she died, Lim cooked for her colleagues almost every day, and threw a baby shower for Sharma, complete with chicken calzones and blueberry cake.

“Every day, we were having lunch together,” Sharma said. “She did the shower, and then she’s gone.”

Lim, who had health problems including diabetes, had not been vaccinated.  Family and friends had urged her to take care of herself, and to check her blood sugar and take her medications. “She would care about everyone but herself,” Sharma said.

On Jan. 15, Lim told friends by phone that she was exhausted, achy and having trouble breathing. But she said that she would be fine, that she just needed to rest. Then she stopped responding to calls and texts.

When she didn’t show up for work a few days later, her brother went to check on her at home and found her on the couch, where she had died.

Now her brother and colleagues are haunted by what-ifs over the loss of a remarkable woman and doctor: What if I had checked on her sooner? What if she had been vaccinated? What if she had gotten care when she started feeling ill?

“To have someone who has been through all that in her childhood and then flourish as a physician, a human being, coming to a new country, learning English, going to school and college without having much financial support, it’s phenomenal,” Sharma said. “It’s unbelievable.”

This story is part of “Lost on the Frontline,” a project from  and Kaiser Health News that aims to document the lives of health care workers in the U.S. who die from COVID-19, and to investigate why so many are victims of the disease.

This story was produced by , which publishes , an editorially independent service of the .

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Y es hora de renovar su cobertura de salud. Pero en este caso Farrell, una ex trabajadora social de 54 años, sabe lo que hará.

“Estoy jubilada desde hace dos años y mis ahorros ya se esfumaron. Estoy llegando a mi límite”, dijo la residente de Murrieta, California.

Así que, a regañadientes, Farrell planea abandonar su plan de salud el próximo año que había impuesto la Ley del Cuidado de Salud a Bajo Precio (ACA).

Esta , que puede ser de miles de dólares al año (y sigue vigente en 2018), fue una razón clave por la que Farrell, que se considera sana, mantuvo su cobertura.

Ahora se pregunta: ¿para qué conservarla?”. “No tengo ningún problema de salud importante y tengo muchas facturas que simplemente aparecieron. No puedo pagar más”.

Farrell es una de las millones de personas que, en todo el país, probablemente dejen de tener seguro de salud luego que una disposición de la administración republicana a partir de 2019.

La Oficina de Presupuesto del Congreso que la derogación de la multa haría que 4 millones de personas, a nivel nacional, abandonasen su seguro de salud el próximo año, o que no lo compren en primer lugar, y esta cifra alcanzaría a 13 millones para 2027.

Algunas personas que odiaron al Obamacare desde el principio dejarán su cobertura como una declaración política. Para personas como Farrell, es simplemente una cuestión de dinero.

La mujer contó que, desde que comenzó a comprar su propio seguro de salud a través del mercado en 2016, su prima mensual ha aumentado cerca de $200; y debe pagar el total porque no califica para recibir los subsidios que otorga ACA. Dijo que el año que viene su prima habría subido a alrededor de $600 por mes.

En 2019, planea pagar en efectivo por sus visitas al médico, un máximo de $80, y por cualquier medicamento que necesite, rezando por no tener un accidente de auto o una emergencia médica.

“Mucha gente está en esta situación”, dijo Miranda Dietz, autora principal de que proyecta cómo la eliminación de la multa afectará al mercado de seguros.

Las personas como Farrell, cuyos ingresos son demasiado altos para calificar para subsidios, son especialmente vulnerables, explicó Dietz, investigadora y asociada en políticas en el Centro para la Investigación y Educación Laboral de la Universidad de California-Berkeley. Estos consumidores deben pagar la totalidad de la prima.

Las primas, incluso para un plan de bronce con un deducible de más de $6,000, son enormes en algunos casos, agregó. “El estado ha hecho un gran trabajo implementando ACA”, dice, “pero todavía hay californianos para los cuales el seguro está fuera de su alcance”.

Según el estudio, hasta 450,000 californianos podrían no tener cobertura  en 2020 como resultado de la finalización de la multa, y hasta 790,000 más para 2023, lo que aumenta la tasa de falta de seguro del estado para residentes menores de 65 a 12.9%, según el estudio. El mercado individual sufriría las mayores pérdidas.

Covered California, el mercado estatal de seguros de salud, predice que la inscripción en el mercado individual, tanto dentro como fuera del intercambio, podría disminuir en un 12% el año próximo, dice el vocero de la agencia, James Scullary.

Los funcionarios del mercado también culpan a la derogación de la multa por un aumento promedio de 3.5% en las primas, ya que las personas saludables abandonarán el mercado, lo que resultará en un grupo de consumidores más enfermo y más costoso.

El seguro de salud puede ser difícil de costear, pero no tenerlo es una “mala apuesta”, afirmó Scullary. Hay que tener en cuenta: por ejemplo, solo en California, más de 22,000 beneficiarios de Covered California se quebraron, dislocaron o torcieron un brazo o un hombro en 2017, y a 50,000 se les diagnóstico, o fueron tratados, por cáncer.

“Sabemos que ninguna de esas personas comenzó el año pensando: ‘Este año me voy a romper el brazo’ o ‘Este es el año en que el que tendré cáncer ‘”, dijo.

Si estás considerando dejar tu plan de salud y estás arriesgándote a las devastadoras consecuencias financieras de un gasto médico inesperado, primero averigua si puedes reducir tu prima.

“Un gran error que comete mucha gente es darse por vencida y dejar su seguro si ha aumentado mucho”, dijo Donna Rosato, editora de Consumer Reports con sede en Nueva York, quien cubre problemas de costos de atención médica.

“Antes de hacer eso, investiga otras opciones”.

Lo más importante es buscar ayuda gratuita de un agente de seguros certificado, conocidos como navegadores. Puedes encontrar haciendo clic en la pestaña “Buscar ayuda” (Find Help) en el sitio web de .

A nivel nacional, puedes obtener ayuda en el sitio federal , en donde también puedes entrar al sitio de internet de tu estado, si es distinto del federal.

A continuación, puedes ver si calificas para más ayuda financiera. Por ejemplo, si está cerca del umbral para calificar para subsidios en los mercados de seguros establecidos por el Obamacare, aproximadamente $48,500 para una persona o $100,000 para una familia de cuatro este año, consulta a un asesor financiero sobre cómo ajustarlo, sugirió Rosato. Es posible que puedas contribuir a una cuenta IRA, al 401 (k) o una cuenta de ahorros de salud para reducir el total.

Más allá de eso, Rosato aconseja ser flexible y estar dispuesto a cambiar de plan. Considera diferentes niveles de cobertura, tanto por dentro como por fuera de los mercados de seguros. Si estás en un plan del nivel de plata (el segundo nivel más barato), puedes ahorrar dinero al comprar un plan del nivel de bronce, menos costoso, que tiene gastos de bolsillo más altos pero que te protegería en caso de una emergencia médica.

Este año, el médico de Farrell le dijo que estaba muy bien de salud. Aunque está nerviosa por no tener cobertura el próximo año, siente que no tiene otra opción. “Va a ser la primera vez en mi vida que no voy a tener seguro de salud”, dijo.

Esta historia fue producida por Kaiser Health News, que publica , un servicio de la .

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It’s also time to re-up her health coverage. But that’s where Farrell, a 54-year-old former social worker, is drawing the line.

“I’ve been retired two years and my savings is gone. I’m at my wit’s end,” says the Murrieta, Calif., resident.

So Farrell plans — reluctantly — to drop her health coverage next year because the for not having insurance is going away.

That — which can reach thousands of dollars annually — was a key reason that Farrell, who considers herself healthy, kept her coverage.

Now, “why do it?” she wonders. “I don’t have any major health issues and I’ve got a lot of bills that just popped up. I can’t afford to pay it anymore.”

Farrell is among millions of people likely to dump their health insurance because of a provision in last year’s Republican tax bill that , starting in 2019, by zeroing out the fines.

The Congressional Budget Office that the repeal of the penalty would move 4 million people to drop their health insurance next year — or not buy it in the first place — and 13 million in 2027.

Some people who hated Obamacare from the start will drop their coverage as a political statement. For people like Farrell, it’s simply an issue of affordability.

Since Farrell started buying her own insurance through the open market in 2016, her monthly premium has swelled by about $200, she says, and she bears the entire cost of her premium because she doesn’t qualify for federal ACA tax credits. Next year, she says, her premium would have jumped to about $600 a month.

Instead, she plans to pay cash for her doctor visits at about $80 a pop, and for any medications she might use — all the while praying that she doesn’t get into a car accident or have a medical emergency.

“It’s a situation that a lot of people find themselves in,” says Miranda Dietz, lead author of a that projects how ending the penalty will affect California.

People like Farrell whose incomes are too high to qualify for tax credits are especially vulnerable, says Dietz, a research and policy associate at the University of California-Berkeley Center for Labor Research and Education. They must pay the entire premium themselves.

Premiums, even for a bronze plan with a deductible of , are enormous in some cases, she says. “The state’s done a great job of implementing the ACA,” she says, “but there are still Californians who just find insurance out of reach.”

Up to 450,000 more Californians may be uninsured in 2020 as a result of the penalty ending, and up to 790,000 more by 2023, boosting the state’s uninsurance rate for residents under 65 to 12.9 percent, according to the study. The individual market would suffer the biggest losses.

Covered California, the state health insurance exchange, predicts that enrollment in the individual market — both on and off the exchange — could drop by 12 percent next year, says agency spokesman James Scullary.

Exchange officials also blame the end of the penalty for a average increase in premiums, because the departure of some healthy people from the market will lead to a sicker and costlier insurance pool.

Health insurance can be difficult to afford, but going without it is a “bad gamble,” Scullary says. Keep in mind: More than 22,000 Covered California enrollees broke, dislocated or sprained arms or shoulders in 2017, and 50,000 enrollees were either diagnosed with — or treated for — cancer, he explains.

“We know that none of those people began the year thinking, ‘This is when I’m going to break my arm,’ or ‘This is the year I get cancer,’” he says.

If you’re considering dropping your plan and risking the devastating financial consequences of an unexpected medical expense, check first to see if you can lower your premium.

“A big mistake for people is to look at the notice they get for their current health insurance and see it’s going up a lot and then throw up their hands and decide they’re going to go without,” says Donna Rosato, a New York-based editor at Consumer Reports who covers health care cost issues.

“Before you do that, look at other options.”

The most important thing to do is seek free help from a certified insurance agent or enrollment “navigator.” You can by clicking on the “Find Help” tab on Covered California’s website, .

Next, see if you can qualify for more financial aid. For instance, if is close to the threshold to qualify for tax credits through Covered California or another Obamacare insurance exchange — about $48,500 for an individual or $100,000 for a family of four this year — check with a financial professional about adjusting it, Rosato suggests. You might be able to contribute to an IRA, 401(k) or health savings account to lower the total, she says.

Beyond that, be flexible and willing to switch plans, she advises. Consider different coverage levels, both on and off health insurance exchanges. If you’re in a silver-level plan (the second-lowest tier), you might save money by purchasing a less expensive bronze-level plan that has higher out-of-pocket costs but would protect you in case of a medical emergency.

This year, Farrell got a clean bill of health from her doctor after a round of tests. She’s nervous about being without coverage next year, but feels she doesn’t have a choice.

“It’s going to be the first time in my life I’m not going to have insurance,” she says.

This story was produced by , which publishes , an editorially independent service of the .

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Eso fue un viernes, y la mujer atribuyó sus síntomas a los persistentes efectos de la anestesia. El sábado, la residente de San Marcos, California, se preguntó si había contraído una gripe mortal o una infección urinaria.

Al día siguiente, ya no pudo levantarse de la cama.

Para el lunes, era como si su cuerpo hubiera sido golpeado con un bate de béisbol, recordó. “Sentía como lo que imagino se siente al morir”, contó Damare, de 53 años, azafata retirada.

Esa noche, los médicos de la sala de emergencias le diagnosticaron una infección y por E. coli, una complicación . Los doctores le dijeron que la infección probablemente surgió de su colonoscopía.

“El médico de emergencias me dijo que, si hubiera esperado un día más, habría muerto”, dice.

Los médicos usan una variedad de instrumental médico reutilizable para mirar dentro del cuerpo, y pueden representar un riesgo mortal de infección si no se limpian adecuadamente.

Instrumentos complejos como los llamados , utilizados para inspeccionar y tratar problemas en la bilis y los conductos pancreáticos, se en los Estados Unidos desde 2013, incluidas tres en el Centro Médico Ronald Reagan de la Universidad de California en Los Ángeles (UCLA).

Pero instrumentos menos complejos también tienen riesgo de contaminación, y se utilizan en muchas más personas: cada año en el país, los médicos realizan más de y 7 millones de endoscopías del tracto gastrointestinal superior.

Dos estudios recientes subrayan la amenaza: un publicado en marzo encontró que el 71% de los instrumentos médicos reutilizables considerados aptos para el uso en pacientes en tres de los principales hospitales del país.

Luego, un estudio conocido en mayo concluyó que las tasas de infección después de una colonoscopía y una endoscopía del tracto gastrointestinal superior son mucho más altas de lo que se creía. Por ejemplo, la tasa de infección dentro de los siete días después de una colonoscopía de rutina en un centro de cirugía ambulatoria es de aproximadamente 1 en 1,000, determinó .

Antes se pensaba que era aproximadamente 1 en un millón.

Susan Hutfless, autora principal del estudio de mayo y profesora asistente en Johns Hopkins, dijo que estaba “muy sorprendida” por los hallazgos, y agregó que los pacientes deben comenzar a interrogar a los médicos sobre las opciones de tratamiento y la limpieza del instrumental.

Hutfless dijo que “cuánto más gente pregunte, más mejorará la limpieza”.

No importa qué procedimiento recomiende su médico, comience aplicando un análisis de riesgo-beneficio a su situación, dicen expertos.

En el caso de las colonoscopías, que pueden detectar cáncer de colon, muchos expertos creen que el beneficio supera el riesgo de infección.

“La salva vidas”, dijo el doctor James McKinnell, profesor asistente de enfermedades infecciosas en la UCLA y el instituto de investigación . “El beneficio es menos riesgo de muerte”.

Además, la mayoría de las infecciones relacionadas con estos instrumentos son tratables y de corta duración, agrega Sylvia García-Houchins, directora de control de infecciones de la Joint Commission, que acredita a muchos hospitales y centros de cirugía en el país.

Como parte de tus preguntas, considera discutir posibles alternativas con tu médico, aconsejó Lisa McGiffert, ex directora del Safe Patient Project de Consumers Union y actual miembro del . “Yo diría, ‘¿hay algún otro procedimiento que puedas identificar que no sea invasivo?'”

Si no es así, comienza a hacer preguntas.

En primer lugar, asegúrate que tu proveedor tenga buena reputación y experiencia. Pregunta cuántos procedimientos ha realizado. Si el tuyo es el primero, o está entre los primeros, considera ir a otra parte o pedir que alguien supervise el procedimiento.

También puedes preguntarle a tu médico si conoce las tasas de infección de la instalación, dijo McGiffert, quien vive en Austin, Texas. “Si dicen que no, yo diría ‘¿Por qué no? ¿Por qué no haces un seguimiento de esto?'”

Si tu médico le da una tasa de infección, pero es confusa, recuerda: “Cuanto más cerca de cero, mejor”, dijo McGiffert.

Luego, pregunta sobre . McKinnell ofrece algunas preguntas: ¿limpias y reprocesas tus aparatos? ¿Los cuelgas para que se sequen en un lugar limpio? Cuando ya están limpios, ¿los revisas por señales de contaminación?

Sin profundizar en todos los detalles científicos, debes tener una idea general que el médico o la instalación tiene un proceso de limpieza establecido.

“Quiero saber que hay una persona que se dedica a limpiar el instrumental”, dijo García-Houchins.

También puedes investigar si un hospital o centro de cirugía en tu área utiliza endoscopios descartables, que son cada vez más aceptados y se están usando más.

En definitiva, confía en tu instinto.

“Si no te sientes cómodo y aparecen señales de alarma, debes cambiar de lugar”, dice García-Houchins. “Simplemente tienes que hacerlo”.

Damare está de acuerdo. Después de su ataque de sepsis en agosto de 2016, algo que, aseguró, le quitó la vida durante un año, no planea volver a hacerse una colonoscopía.

Si la haces, recuerda que tú, no el médico, está a cargo, aconsejó.

“Es tu vida”, advirtió. “Tienes que sentirte realmente bien con respecto a tu elección”.

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That was on a Friday, and she chalked up her symptoms to lingering effects of anesthesia. On Saturday, the San Marcos, Calif., woman wondered if she had contracted a killer flu or urinary tract infection.

The next day, she couldn’t get out of bed.

By Monday, it was almost as if her body had been beaten with a baseball bat, she recalls. “It felt like what you imagine dying feels like,” says Damare, 53, a retired flight attendant.

That night, emergency room doctors diagnosed her with a raging E. coli infection and , a potentially . Her doctors told her the infection likely stemmed from her colonoscopy, she says.

“The doctor in the ER told me that if I had waited one more day, I would have died,” she says.

Physicians use a variety of reusable medical scopes to peer into the body — and they can pose a deadly infection risk when not cleaned properly.

Complicated scopes called , used to in the bile and pancreatic ducts, to at least 35 deaths in the U.S. since 2013, including three at the UCLA Ronald Reagan Medical Center.

But less complex scopes also pose contamination risks — and they’re used on far more people: Each year in the United States, doctors perform colonoscopies and 7 million endoscopies of the upper GI tract.

Two recent studies underscore the threat: published in March found that 71 percent of reusable medical scopes deemed ready for use on patients for bacteria at three major U.S. hospitals.

Then a May study concluded that infection rates are far higher than previously believed after colonoscopies and upper GI endoscopies. For instance, the infection rate within seven days of a routine colonoscopy at an outpatient surgery center is roughly 1 in 1,000, the determined.

It was previously thought to be about 1 in a million.

Susan Hutfless, senior author of the May study and an assistant professor at Johns Hopkins, says she was “very surprised” by the findings, adding that patients must start grilling doctors about treatment options and the cleanliness of the scopes.

You shouldn’t do it as I did at my first colonoscopy in January: I was on the gurney, waiting to be rolled into the operating room when I asked the doctor, “Your scopes are clean, right?”

You can guess what he said.

I might have asked earlier but, as Hutfless says, “the more people ask, the more cleanliness will improve.”

No matter which scope procedure your doctor recommends, start by applying a risk-benefit analysis to your situation, experts say.

In the case of colonoscopies, which can detect colon cancer, many experts believe the benefit outweighs the risk of infection.

“ saves lives,” says Dr. James McKinnell, assistant professor of infectious disease at UCLA and the research institute. “The benefit is a reduction in the risk of death.”

Besides, most infections related to scopes are treatable and short-lived, adds Sylvia Garcia-Houchins, director of infection control for the , which accredits many U.S. hospitals and surgery centers.

As part of your deliberations, consider discussing potential alternatives with your doctor, says Lisa McGiffert, former director of Consumers Union’s Safe Patient Project and now a member of the . “I would say, ‘Is there another procedure that you could identify that’s not invasive?’”

If there isn’t, start asking questions.

First, make sure you’re seeing a reputable provider with lots of experience. Ask how many procedures he has performed. If yours is the first, or among the first few, consider going elsewhere or asking for someone to supervise the procedure.

You can also ask your doctor if she knows the facility’s infection rates, says McGiffert, who is based in Austin, Texas. “If they say no, I would say ‘Why not? Why aren’t you keeping track of this?’”

If your doctor gives you an infection rate but it’s confusing, remember: “The closer to zero the better,” McGiffert says.

Next, ask about . McKinnell offers some questions: Do you clean and reprocess your scopes? Do you hang them to dry in a place that is clean? After they’ve been cleaned, do you check them for contamination?

Without wading into every scientific detail, you want to get a general sense that the doctor or facility has an established cleaning process.

“I want to know there’s a person cleaning the scopes who’s dedicated to cleaning the scopes. If they are, they’ve got the system down pat,” Garcia-Houchins says.

You can also research whether a hospital or surgery center in your area uses single-use endoscopes, which are becoming more accepted and prevalent.

Ultimately, trust your gut.

“If you don’t feel comfortable and those alarms are going off, you need to stop the bus,” Garcia-Houchins says. “You just have to do it.”

Damare agrees. After her bout with sepsis in August 2016, which she says sucked the life out of her for a year, she doesn’t plan on getting a colonoscopy again.

But if you do, remember that you — not the doctor — are in charge, she advises.

“This is your whole life,” she cautions. “You have to feel really good about what your choice is.”

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A pesar de su amplia experiencia personal y profesional con adolescentes, la residente de Eagle Rock, California, admite que a menudo sus comportamientos la dejan perpleja.

“Incluso si tienes hijos normales, siempre te estás preguntando: ‘¿Es esto normal?'”, dijo O’Leary, de 61 años.

Los adolescentes pueden ser volátiles y temperamentales. Pueden poner a prueba tu paciencia, presionarte y dejarte cuestionando tu propia cordura, y la de ellos.

No estoy alucinando. Los problemas de salud mental son un problema serio y creciente: el suicidio entre adolescentes y adultos jóvenes desde la década de 1940. La tasa de niños de 12 a 17 años que tuvieron problemas de depresión clínica aumentó un 37% en una década, según un .

Y la esquizofrenia y otros trastornos psicóticos a menudo se manifiestan en la adolescencia.

De hecho, la mitad de todas las afecciones mentales surgen hacia los 14 años y las tres cuartas partes para los 24, explicó el doctor Steven Adelsheim, director del , que forma parte del departamento de psiquiatría de la universidad.

A los padres, muchas veces les resulta difícil distinguir las señales de una enfermedad mental de lo que es el comportamiento típicamente errático de un adolescente.

Cuando el hijo de O’Leary, Isaac, ahora de 23 años, era adolescente, tuvo dos altercados con la policía, una vez por organizar una fiesta salvaje mientras su madre estaba ausente, y otra vez cuando él y un amigo se subieron al tejado y comenzaron a dispararse con escopetas de aire comprimido.

O’Leary no le dio importancia a esos incidentes, pensando que eran cosas de adolescentes. Pero comenzó a preocuparse cuando, en medio de su proceso de divorcio, notó que Isaac se comportaba de manera inusual. Se quejaba de dolores de estómago y acumulaba ausencias a la escuela.

Fue entonces cuando decidió que era hora que la familia visitara a un terapeuta. “Se trataba de entender lo que era normal para mis hijos”, explica.

O’Leary tenía razón. Los expertos dicen que el primer paso para reconocer una posible enfermedad mental en los hijos es conocer sus hábitos y patrones, detectar cuándo se desvían de ellos, y crear un entorno en el que se sientan cómodos hablando con los padres.

En lugar de pedirle a tu hijo que hable, comparte con él una actividad que le brinde la oportunidad de abrirse: cocinar la cena juntos, pasear al perro, dar un paseo, dijo Tara Niendam, profesora asociada de psiquiatría en la Universidad de California-Davis.

“Solo quieres saber cómo les está yendo como persona. ¿Cómo van las cosas en la escuela? ¿Cómo están los amigos? ¿Cómo están durmiendo?”, explicó.

Como parte de este proceso de acercamiento al adolescente, controla y limita su actividad en las redes sociales, aconsejó la doctora Amy Barnhorst, vicepresidenta de salud mental comunitaria en el departamento de psiquiatría de UC-Davis.

“Las redes sociales nos ofrecen una ventana importante sobre lo que está sucediendo en la vida de los adolescentes”, aseguró Barnhorst.

Una vez que te familiarices con las rutinas de tu hijo, será más fácil detectar señales de enfermedad mental, como los cambios persistentes en la vida cotidiana que duran más de una o dos semanas.

Presta atención a las interrupciones en el sueño, el apetito, las calificaciones, el peso, las amistades, e incluso la higiene.

Tal vez tu hijo esté pasando más tiempo solo en su habitación. Quizás tu hija, que siempre cuida su apariencia, deja de usar maquillaje y no se ducha.

“Es cuando ves a los niños alejarse de todas las esferas de sus vidas”, dijo Barnhorst. “Están teniendo problemas académicos, con la familia, con los amigos, con sus actividades”.

Básicamente, toma nota cuando “hay muchos cambios y caos” en sus vidas, agregó.

Recuerda que estás buscando cambios en muchos aspectos de la vida de tu hijo que duran semanas, no la típica tristeza temporal que acompaña a una ruptura amorosa o la mala contestación cuando le exiges que ordene su habitación.

Si tu hijo todavía tiene los mismos amigos y participa en las mismas actividades, el comportamiento desagradable “no es necesariamente algo de lo que preocuparse”, explicó Barnhorst. “Eso podría ser solo adolescentes pasando por la crisis del crecimiento”.

Pero algunos cambios de comportamiento podrían indicar un problema más profundo. Por ejemplo, los adolescentes con depresión pueden estar más irritables de lo normal. Pueden enfurecerse con los amigos o incluso con el perro, aseguró Adelsheim.

“Los jóvenes hablarán de tener mecha corta, de su mal genio”, señala Adelsheim. “Las cosas que normalmente no les molestarían les molestan”.

Cuando te preocupe que el comportamiento de tu hijo pueda indicar algo más serio, ofrécele amor y apoyo, y busca ayuda, dicen los expertos.

(Y evita frases como “¿Qué pasa contigo?” y “ya acaba con eso”, aconsejó Niendam).

Si tu hijo amenaza con suicidarse, o si crees que está en peligro inminente, llévalo a la sala de emergencias.

Si no hay peligro inmediato, comienza con el pediatra o el médico de atención primaria. En algunos casos, podrán abordar el problema directamente o podrán derivarlo a un especialista en salud mental.

Aquí es donde podrían complicarse las cosas.

Es posible que deba esperar mucho por una cita, especialmente si vives en un área rural, y es posible que muchos no acepten pacientes nuevos. Barnhorst sugiere llamar a tu seguro de salud y pedir una lista de terapeutas, psicólogos y psiquiatras dentro de la red. Llama, y espera lo mejor.

“Uno de los problemas más graves que tenemos en este país en el frente de la salud mental es la falta de acceso a la atención”, dice el doctor Victor Schwartz, director médico de , una organización con sede en Nueva York que trabaja para prevenir suicidios en adolescentes y adultos jóvenes. “No hemos formado suficientes profesionales. No están distribuidos lo suficientemente bien a lo largo de todo el país”.

Otra opción, dijo, es consultar con las universidades cercanas para ver si tienen clínicas de salud mental con estudiantes en prácticas que atienden pacientes.

Mientras buscas ayuda médica, no olvides ponerte en contacto con la escuela de tu hijo, que puede hacer arreglos tales como ofrecerte tiempo libre para las pruebas, dice Niendam.

También sugiere conectarse con grupos de apoyo. “Si te sientes abrumado, puedes conocer a otros padres que hayan pasado por situaciones similares, y pedirles consejo”, sugiere.

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Despite her extensive personal and professional experience with teens, the Eagle Rock, Calif., resident admits she’s often perplexed by their behavior.

“Even if you have normal kids, you’re constantly questioning, ‘Is this normal?’” says O’Leary, 61.

Teenagers can be volatile and moody. They can test your patience, push your buttons and leave you questioning your sanity — and theirs.

I’m not being flip. Mental health challenges are a serious — and growing — problem for teenagers: Teen and young-adult suicide has since the 1940s. The rate of 12- to 17-year-olds who struggled with clinical depression increased by 37 percent in a decade, according to a recent .

And schizophrenia and other psychotic disorders often manifest themselves in adolescence.

In fact, half of all mental health conditions emerge by age 14, and three-quarters by 24, says Dr. Steven Adelsheim, director of the , part of the university’s psychiatry department.

For parents, it’s often hard to separate the warning signs of mental illness from typically erratic teenage behavior.

When O’Leary’s son, Isaac, now 23, was a teen, he had two run-ins with police — once for hosting a wild party while his mom was away, and again when he and a friend climbed up on the roof and challenged each other to shoot BB guns.

O’Leary dismissed those incidents as teenage pranks. But she did start to worry when she was in the midst of divorce proceedings with her then-husband and noticed that Isaac started exhibiting some unusual behavior. He complained of stomachaches and racked up absences from school.

That’s when she decided it was time for the family to see a therapist. “It’s a question of what’s normal for my kids,” she explains.

O’Leary is right. Mental health experts say the first step in recognizing possible mental illness in your children is to know their habits and patterns — to spot when they deviate from them — and to create an environment in which they feel comfortable talking with you.

Instead of asking your teen to talk, share an activity that will give your child the chance to open up: Cook dinner together, walk the dog, take a drive, says Tara Niendam, an associate professor in psychiatry at the University of California-Davis.

“You just want to know how they’re doing as a person. How are things going at school? How are their friends? How are they sleeping?” she explains.

As part of getting to know your teen, monitor and limit your child’s social media activity, says Dr. Amy Barnhorst, vice chair for community mental health in the UC-Davis psychiatry department.

“Social media gives us this important window into what’s going on in teenagers’ lives,” she says.

Once you know your child’s baseline, you’ll be more attuned to signs of mental illness: persistent changes in your child’s everyday life that last more than a week or two.

Be aware of disruptions in sleep, appetite, grades, weight, friendships — even hygiene.

Maybe your son is spending even more time alone in his room. Perhaps your daughter, who is particular about her appearance, stops wearing makeup and isn’t showering.

“It’s really when you see kids falling off the curve in every sphere of their lives,” Barnhorst says. “They’re having problems with their academics, problems with their family, problems with their friends, problems with their activities.”

Essentially, take note when “there’s a lot of shifting and chaos” in their lives, she adds.

Remember, you’re looking for changes in many aspects of your child’s life that last for a few weeks, not the typical — but temporary — sadness that comes with a breakup or the unfortunate mouthing off you get when you ask your kid to clean his room.

If your child still has the same friends and is participating in the same activities, unpleasant behavior “is not necessarily something to worry about,” Barnhorst says. “That could just be teenagers going through growing pains.”

But some behavioral changes could indicate a deeper problem. For instance, teenagers with depression may be more irritable than usual, Adelsheim says. They might snap at friends or even the family dog, he says.

“Young people will talk about their fuse being shorter than normal,” Adelsheim says. “Things that normally wouldn’t bother them do bother them.”

When you become worried that your child’s behavior may indicate something more serious, offer your child love and support — and seek help, experts say.

(And avoid phrases like “What’s wrong with you?” and “Snap out of it” when talking with your kids, Niendam advises.)

If your child threatens suicide, or you think he’s in imminent danger, take him to the emergency room.

If there’s no immediate danger, start with your child’s pediatrician or primary care physician. In some cases, the pediatrician will be able to address the problem directly — or may refer you to a mental health specialist.

This is where it could get tricky.

You may face a long wait for a specialist — especially if you live in a rural area — and may find that many aren’t accepting new patients. Barnhorst suggests calling your health insurance plan and asking for a list of in-network therapists, psychologists and psychiatrists. Then hit the phone and hope for the best.

“One of the most serious problems we have in this country on the mental health front is the lack of access to care,” says Dr. Victor Schwartz, chief medical officer of , a New York-based organization that works to prevent suicides in teens and young adults. “We haven’t trained enough professionals. They’re not distributed well enough across the country.”

Another option, he says, is to check with nearby universities to see if they have mental health clinics that train students and see patients.

While you’re seeking medical help, don’t forget to contact your child’s school, which may be able to make accommodations such as offering your child extra time for testing, Niendam says.

She also suggests connecting with your local chapter of (namica.org), a grass-roots organization of people whose lives have been affected by serious mental illness.

“If you’re struggling, you can meet other parents and ask their advice,” she says.

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“I got beat up really badly out there,” says Hogden, 62. “It’s not a safe place for women.”

She landed in the hospital and then in a boarding home for adults with mental illness. But her big break came when she started volunteering for a mental health program called the , run by Alameda County.

Participants, who offer each other support, also advise the county’s behavioral health division on how to better meet consumers’ needs. The county has adopted some of the group’s recommendations, Hogden says.

“People rallied around me when I was unstable and struggling with my mental health,” Hogden recalls.

She didn’t know at the time that the program was paid for by the state’s (MHSA). But after two years as a volunteer, she became a paid staffer and learned that the program wouldn’t exist without that funding.

“I wouldn’t be where I’m at in my wellness and recovery had it not been for the Mental Health Services Act,” Hogden says.

In 2004, Californians approved the act, originally known as Proposition 63, which imposes a 1 percent tax on personal income over $1 million to help counties expand mental health care services.

The tax has raised billions, and Gov. Jerry Brown expects it will bring in in the coming fiscal year.

“Counties were able to take Mental Health Services Act dollars and either revamp existing programs or completely create new programs that didn’t exist at all,” says James Wagner, deputy director of Alameda County Behavioral Health Care Services.

The act has been “wildly successful” at improving the ability of counties to respond to the mental health needs of their residents, he says.

But counties and the state have faced criticism from the , an independent state oversight agency, and others for their implementation of the law. In February, accused counties of hoarding the mental health money — and the state of failing to ensure the money was being spent.

Still, there’s no question “these programs have helped hundreds of thousands of people,” says Heidi Strunk, president of the .

across the state lists page after page of offerings that address homelessness, suicide, caregivers, veterans, children and dozens of other topics and populations, including scholarships for college students pursuing degrees in mental health.

But what’s available — and to whom — depends on your county. For instance, most programs are for low-income residents, but that’s not true across the board. Unfortunately for consumers, researching county programs and determining whether you or your loved ones qualify may not be easy.

“It’s so hard for individuals and families to know what kind of services are available, especially because there’s no statewide standard,” says Jessica Cruz, CEO of , an advocacy group for individuals, and their families, who have been affected by serious mental illness.

“Access is an issue,” Cruz says. “There’s not one singular place to look and see what’s available.”

Strunk’s coalition is advocating for a statewide, interactive map that will allow you to click on your county and see its Mental Health Services Act programs. NAMI California, which compiled the statewide, is working on an update, but that won’t be out until this summer, Cruz says. (Check NAMI California’s website at for the update.)

“We’re still trying to resolve issues with how to get information to the public,” Strunk says.

Until there’s a central information source, you will have to use your research skills, plus a little telephone work.

To get started, Strunk suggests Googling your county’s name and the term “.” Then call that person. You can also find your county’s MHSA plan online.

Some counties have that will help connect you with appropriate programs based on your needs. (In Orange County, for example, it’s 855-625-4657. In Alameda County, dial 800-491-9099. Riverside County residents can call 800-706-7500.)

“Each county webpage looks different,” Strunk warns. “Some counties have super user-friendly landing pages, for some counties it’s buried, and some you can’t find at all.”

MHSA programs primarily serve recipients of Medi-Cal, California’s version of the federal Medicaid program for low-income residents, and uninsured people with serious mental illnesses. But there are also services for a broader range of the population.

About of Mental Health Services Act dollars are earmarked for “prevention and early intervention,” and these are more likely to serve a wider cross section of people.

Sharon Ishikawa, Orange County’s Mental Health Services Act coordinator, points to as one example. The program provides counseling, vocational support and other services to people — and their families — who are confronting challenges related to sexual orientation and gender identity.

“It is open to anybody with or without insurance,” says Dawn Smith, a program manager who oversees several of the county’s MHSA-funded services. “They might have a really high deductible and don’t have a way to pay that or they might not be able to afford the copay.”

But the majority of participants are uninsured, Smith says.

NAMI, which has chapters across the state, operates some MHSA-funded programs on behalf of counties, and eligibility is not based on insurance status, Cruz says.

“For us, anybody’s eligible. Anybody can come to a family-to-family class. Anybody can come to a support group. You don’t have to be referred by the county,” she explains.

NAMI Orange County runs the MHSA-funded program, says Diana Fernandez, one of the peer mentors.

The program is for people, regardless of income, who have a family member or friend who is struggling with mental illness, a learning disorder or a behavioral problem. Participants can have a one-hour phone call each week for up to 12 weeks with peer mentors who have had personal experience finding help for themselves or loved ones, Fernandez explains.

Fernandez has five children, and two have struggled with dyslexia and attention deficit hyperactivity disorder (ADHD).

Last week, Fernandez spoke with a man who told her he felt suicidal. She stayed on the phone and connected him with the county’s crisis assessment team, then waited until she knew he was on his way to the hospital.

That situation was unusual, she says. More typically, Fernandez helps parents of children who are struggling in school, or caregivers who are emotionally and physically spent.

“We assure clients that they are normal and typical for what they’re going through,” she says. “That gives them a feeling of hope they may not have had before.”

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Si tú mismo o un ser querido quiere vencer una adicción a los opioides, primero asegúrate de tener un suministro práctico de , un medicamento que puede revertir una sobredosis y salvarte la vida.

“Los amigos y las familias deben guardar el naloxone”, dijo el doctor David Kan, especialista en medicina de adicciones de Walnut Creek, quien es presidente de la . “Las personas que usan opioides también deberían tenerlos a mano”.

Más de murieron por sobredosis de opioides en 2016, víctimas de una crisis impulsada por el aumento de un poderoso opioide sintético llamado , que es que la heroína. Las estrellas del rock y tenían fentanilo en sus sistemas cuando murieron.

Las personas pueden volverse adictas a los opiáceos a través del uso a largo plazo, o el mal uso, de los analgésicos recetados. En la mayoría de los casos, eso conduce al , según el Instituto Nacional sobre el Abuso de Drogas.

Si estás listo para enfrentar tu propia adicción, o la de un ser querido, debes saber que tal vez al principio no tengas éxito. Probablemente no podrás lograrlo sin ayuda externa o medicamentos. Y seguramente tendrás que tomar esos medicamentos durante años, o por el resto de tu vida.

“Superar una adicción a las drogas es un proceso. Habrá altibajos”, dijo Patt Denning, directora de servicios clínicos y capacitación en en San Francisco y Oakland.

Es por eso que Denning y otros sugieren que comiences teniendo el naloxone a mano, lo que puede ayudarte a mantenerte vivo durante el proceso.

El año pasado, en San Francisco, alrededor de 1,200 sobredosis potencialmente mortales se lograron revertir gracias a personas que no eran profesionales de salud y que administraron naloxone, dijo Kan.

El naloxone, que se puede administrar como un aerosol nasal o en forma inyectable, está disponible sin receta médica en . Pregúntale a tu farmacéutico si tiene el medicamento. Denning dijo que los programas de intercambio de jeringas también lo ofrecen sin cargo, al igual que algunas clínicas de salud pública.

La rehabilitación sola no funciona

Las personas adictas a los opioides enfrentan asombrosas tasas de recaída del 80% al 90% dentro de los primeros 90 días si intentan una rehabilitación a corto plazo o programas de desintoxicación que eliminen las drogas sin la ayuda de medicamentos, dijo Richard Rawson, profesor emérito de UCLA.

Rawson advierte que la rehabilitación también puede aumentar el riesgo de una sobredosis, porque la tolerancia del organismo a los opioides es menor después que se deja de consumirlos.

“Si sales de rehabilitación y tomas la misma dosis que solías tomar, no solo te vas a drogar, vas a estar muerto”, enfatizó.

En lugar de tratar la adicción a los opioides como una enfermedad curable, él y otros expertos lo comparan con las afecciones crónicas, como la diabetes, que requieren un tratamiento continuo.

“Esto no va a ser una sola visita”. Si se sufre de un trastorno adictivo, será por el resto de la vida “, dijo el doctor Stuart Gitlow, especialista en adicciones de la ciudad de Nueva York, quien es ex presidente de la .

Las enfermedades crónicas generalmente requieren de medicamentos. Rawson y otros señalan dos en particular que pueden ayudar a quebrar la adicción: y .

Hay un estigma injustificado asociado a estas drogas, junto con la creencia que “simplemente estás cambiando una adicción por otra”, dijo Kan.

Si bien estos medicamentos son opioides, controlan el ansia y la abstinencia, y ayudan a prevenir el comportamiento compulsivo y peligroso que con frecuencia se asocia a la adicción.

También reducen las posibilidades de sobredosis, dijo Rawson. Y protegen de otros riesgos que acompañan a la adicción a los opioides, como la exposición a infecciones transmitidas por sangre al compartir agujas, incluidos el VIH y la hepatitis C.

Estos medicamentos ayudan a que la persona se sienta “lo suficientemente cómoda físicamente” para enfrentar los problemas detrás de la adicción, desde la ansiedad y la depresión hasta el trastorno de estrés postraumático, agregó Denning.

El gobierno federal está de acuerdo.

“Abundantes datos científicos muestran que el uso a largo plazo de medicamentos de mantenimiento reduce con éxito el consumo de sustancias, el riesgo de recaída y sobredosis, el comportamiento criminal asociado y la transmisión de enfermedades infecciosas, y ayuda a los pacientes a recuperar una vida saludable y funcional”, según el informe 2016 del Cirujano General sobre .

Para obtener metadona, debes visitar una clínica regida por reglas estatales y federales.

“Estas clínicas no son particularmente amigables para el paciente. Tienes que ir todos los días. No puedes viajar”, dijo Denning. “Se apoderan de tu vida”.

La buprenorfina, por otro lado, puede obtenerse de varios médicos, incluidos los de atención primaria, que se hayan capacitado y hayan recibido aprobación federal.

“La belleza de la buprenorfina es que se puede recetar como cualquier medicamento en un consultorio médico”, agregó.

Para encontrar un médico que recete buprenorfina, puedes ir al sitio web de la Administración de Servicios de Abuso de Sustancias y Salud Mental en www.samhsa.gov y hacer clic en el enlace “Buscar ayuda y tratamiento” en la página de inicio. Puedes buscar por estado y código postal.

Aunque puedes recibir atención de tu médico de atención primaria, Gitlow recomienda que también se consulte a un especialista en adicciones.

Para buscar un especialista visita el sitio web de la Academia Estadounidense de Psiquiatría de Adicciones en www.aaap.org y haz clic en la pestaña “Recursos para pacientes”, en la página de inicio.

Después de comenzar la medicación

Una vez que los pacientes comienzan con uno de los medicamentos, no está claro por cuánto tiempo deberían usarlos, es una pregunta que merece más investigación, dijo Rawson.

“Mientras más tiempo las personas permanecen en tratamiento, menor es la tasa de mortalidad y más pueden funcionar”, destacó.

Kan y otros especialistas en adicciones generalmente no fomentan el tratamiento solo con medicamentos, sin importar cuánto tiempo se permanezca en él. Vincular la medicación con terapia u otro tipo de apoyo, incluidos los programas de 12 pasos como , puede reducir aún más las tasas de recaída, expresaron.

Los grupos de y también pueden ser recursos útiles para las familias, agregó Kan.

“Yo aliento a todos a seguir los 12 pasos. No lo considero un tratamiento per se. Es como apoyo mutuo”, finalizó.

Esta historia fue producida por Kaiser Health News, que publica , un servicio de la .

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If you or a loved one wants to beat an opioid addiction, first make sure you have a handy supply of , a medication that can reverse an overdose and save your life.

“Friends and families need to keep naloxone with them,” says Dr. David Kan, an addiction medicine specialist in Walnut Creek who is president of the . “People using opioids should keep it with them, too.”

Americans died from opioid overdoses in 2016, victims of a crisis that’s being fueled by the rise of a powerful synthetic opioid called , which is more potent than heroin. Rock stars and had fentanyl in their systems when they died.

People can become addicted to opioids through long-term use, or misuse, of prescription painkillers. In most cases, that , according to the National Institute on Drug Abuse.

If you’re ready to address your own addiction, or that of a loved one, know that you may not succeed — at first. You probably won’t be able to do it without outside help or medications. And you’ll probably have to take those medications for years — or the rest of your life.

“Getting over a drug addiction is a process. There are going to be ups and downs,” says Patt Denning, director of clinical services and training at the in San Francisco and Oakland. “We need to hang with people while they’re struggling. It might take awhile.”

That’s why Denning and others suggest you start with having naloxone on hand, which can help you stay alive through the process.

Last year in San Francisco, about 1,200 potentially fatal overdoses were reversed by regular folks administering naloxone, not doctors, police or paramedics, Kan says.

Naloxone, which can be administered as a nasal spray or injection, is available without a prescription in , including California. Ask your pharmacy if it stocks the drug. Needle exchange programs also offer the medication at no charge, Denning says, as do some public health clinics.

Rehab Alone Doesn’t Work

People addicted to opioids face staggering relapse rates of 80 to 90 percent within 90 days if they try short-term rehab or detox programs that wean them off the drugs without assistance from medications, says Richard Rawson, a UCLA psychiatry professor emeritus.

Rawson warns that rehab can also increase the risk of an overdose, because your body’s tolerance to opioids is lower after you withdraw from them.

“If you leave rehab and take the same dose you used to take, you’re not just going to get high, you’re going to be dead,” he says.

Instead of treating opioid addiction like a curable illness, he and other experts liken it to lifelong, chronic conditions such as diabetes that require ongoing management.

“This isn’t going to be one visit. If you have an addictive disorder, this is going to be the rest of your life,” says Dr. Stuart Gitlow, an addiction specialist in New York City who is past president of the .

Chronic illnesses often require medication. Rawson and others point to two drugs in particular that may help break your addiction: and .

There is some unwarranted stigma attached to these drugs, along with a belief that “you’re just exchanging one addiction for another,” Kan says.

While these medications are actually opioids themselves, they control craving and withdrawal — and help prevent the compulsive and dangerous behavior often associated with addiction.

They also reduce your chances of an overdose, Rawson says. And they protect you from other risks that come with opioid addiction, such as exposure to blood-borne infections from sharing needles, including HIV and hepatitis C.

Essentially, the medications make you “comfortable enough physically” to confront the issues behind your addiction, from anxiety and depression to post-traumatic stress disorder, Denning says.

The federal government agrees.

“Abundant scientific data show that long-term use of maintenance medications successfully reduces substance use, risk of relapse and overdose, associated criminal behavior, and transmission of infectious disease, as well as helps patients return to a healthy, functional life,” according to the Surgeon General’s 2016 .

To obtain methadone, you must visit a clinic governed by state and federal rules.

“These clinics are not particularly patient-friendly. You have to go every day. You can’t travel,” Denning says. “It takes over your life.”

Buprenorphine, on the other hand, can be obtained from doctors, including primary care physicians, who have undergone training and received federal approval.

“The beauty of buprenorphine is it can be prescribed like any medication out of a doctor’s office,” Denning says.

To , go to the Substance Abuse and Mental Health Services Administration website at and click on the “Find Help & Treatment” link from the home page. You can search by state and ZIP code.

Though you can receive care from your primary care physician, Gitlow recommends that you also consult with an addiction specialist.

In California, the California Society of Addiction Medicine’s website at and clicking on the “Physician Locator” tab.

If you do not live in California, check the American Academy of Addiction Psychiatry’s website at and click on the “” tab on the home page.

After You Start The Medication …

Once patients start one of the medications, it’s not clear how long they should stay on — a question that deserves further research, Rawson says.

“The longer people stay on treatment, the lower the death rate is and the more they’re able to function,” he says.

Often patients face pressure from family members, who badger them to get off the medications even though it would be better for them to stay on them, Kan says.

“We don’t say to patients who suffer from diabetes … ‘Have you changed your diet enough so you can get off insulin?’” he says.

Kan and other addiction specialists generally don’t encourage medication treatment alone, no matter how long you stay on it. Pairing the medication with therapy or other support, including 12-step programs such as , can reduce relapse rates further, they say.

and groups also can be helpful resources for families, Kan adds.

“12-step is something I encourage for everybody. I don’t consider it a treatment, per se. It’s like mutual support,” he says.

Questions for Emily: AskEmily@kff.org

°ä±ô¾±³¦°ìÌý to read previous Ask Emily columns.

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