Wasted days

The first time Rob Rosolanko, MSW ’12, took a sip of alcohol he was 14. He made himself a “bocce ball,” a mix of amaretto and orange juice that he’d seen his father drink. He remembers not really liking the taste, but he enjoyed the feeling alcohol gave him and how his anxiety disappeared.

“I just remember feeling that none of that stuff mattered anymore,” Rosolanko says.

At the time, his parents were going through a divorce, which left him confused and anxious. His family dealt with the changes and upheaval by not talking about it.

“We all just kind of pretended that it didn’t happen,” Rosolanko says. “It was right around that time that I had that first drink.”

That desire to erase bad feelings and replace them with euphoric ones followed him into his college years and, later, adulthood, fueling a long-term battle with alcohol, painkillers and heroin.

What Rosolanko didn’t know at 14, and scientists wouldn’t begin to understand for another 16 years, was that alcohol can cause serious and lasting damage to an adolescent’s developing brain. And the earlier the drinking begins, the more potential there is for developing a substance-use problem.

Rosolanko says he drank like any normal teenager and smoked pot occasionally, but it wasn’t until his first year of college that his drinking picked up. He drank more than others and didn’t know when to stop. He’d wake up with a hangover and self-medicate by drinking more. He was only drinking on weekends — but those weekends began on Wednesdays.

He says that alcoholism never seemed to affect his studies or work. In fact, he thrived. “I never really accepted the fact that I might be an alcoholic,” he says.

Adolescent brains are different

When adolescents drink alcohol, they are less likely to slur their words, grow sleepy or stagger. While they are more sensitive than adults to the rewards of drinking, they are less sensitive to the cues that it’s time to stop. That means they are more likely to drink an excessive, or even lethal, amount of alcohol.

This was a surprise to Linda Spear, distinguished professor of psychology, who had hypothesized that adolescents would be less sensitive to the rewarding aspects of alcohol — that they would need to seek out more alcohol to achieve the high. The hypothesis, published in 2000, was subsequently disproved by research from her group and others, and has helped change the way scientists look at alcohol’s effects on the adolescent brain.

“The important thing about a hypothesis isn’t that it’s right or wrong, it’s that it is testable and generates a lot of research. By those criteria, the hypothesis worked very well,” Spear says.

At ��������, about a dozen faculty members are now working to understand how alcohol and drugs of abuse change the way a brain is “wired.” Most of the research is on prenatal and adolescent alcohol exposure and the consequences that are carried into adulthood.

In one study of chronic drinking in adolescence, Spear reports that adult rats continue to act like adolescents in certain ways. “After adolescent alcohol exposure, these adults may continue to drink like adolescents in part because they’re less sensitive to feedback cues to moderate drinking, while being more sensitive to alcohol’s rewarding and social-facilitating effects.

“In a sense, they’ve been ‘adolescentized’ for life,” she says.

A way to kill the pain

Rosolanko spent his 20s in and out of the hospital every two to three years with acute pancreatitis, a painful inflammation of the pancreas, which can be caused by heavy alcohol consumption. Doctors told him he was too young to suffer from the disease. The possibility that he could be abusing alcohol never came up.

“All I heard was that I don’t have to worry about alcohol because I’m too young,” he says. “I’m indestructible. I can keep drinking.”

Around age 30, a severe pancreatitis attack introduced him to a new drug, Vicodin, to manage his pain. He popped two, then three, then four pills, impatiently trying to rid himself of the pain.

“All of a sudden, I just felt amazing,” he says. “From that point on, it took off. … Once I found the painkillers, the alcohol wasn’t necessary.”

Rosolanko started to abuse painkillers and would “doctor shop,” making up ailments to receive prescription drugs. When he ran out of doctors, he bought opiates online, sometimes spending as much as $400 for 100 pills, and took as many as 30 to 40 pills daily. Every time he tried to quit, the withdrawal symptoms were so severe he would continue to use the pills to avoid the pain.

“It feels like a really bad flu, where your whole body aches, and you’re hot and cold and sweat, and you can’t sit still,” he says of the withdrawal symptoms. “You feel like there are bugs in you. I was so scared about going into withdrawal that I kept finding means to get more.”

Users aren’t always addicts

Dopamine helps regulate the brain’s reward and pleasure centers. At normal levels, dopamine helps motivate us to experience things that bring us pleasure, such as food or sex. Drugs of abuse flood the brain with dopamine, elevating pleasure to euphoria. With repeated drug use, the brain learns to reduce the release of dopamine, which then blunts the high. The “solution,” for an addict, is to take more drugs.

Yet, most people who drink to excess or use illicit drugs eventually stop on their own. “That tells us that, in many cases, the drug is not sufficient to ‘break’ the brain. Rather, it says that a subset of people is more vulnerable to the effects of the drug,” says J. David Jentsch, professor of psychology, who researches the genetics of impulsivity.

There are three significant factors that can affect a person’s vulnerability to addiction: genes, environment and development (i.e., age at first exposure). The deeper scientists delve into each of these areas, the more they are learning about how, when and why these vulnerabilities are triggered.

“It’s important for people to understand that addiction is a brain disease for which some people, for reasons outside of their control, are exceedingly vulnerable,” Jentsch says. “They make a choice, not unlike that made by many, to have a drink, puff on a cigarette or smoke some dope, and it’s only then that they figure out that they are different. They are trapped. It’s too late.”

Pressure pushes him over the line

Everyone else is smarter than me.

I’m way out of my league.

If they knew that I didn’t really know what the hell I was doing, they’d fire me.

Those thoughts occupied Rosolanko’s mind. Right around the time he started to abuse painkillers, he received a job promotion and relocated from Chicago to Dallas as marketing director for more than 300 Home Depot stores. He had just turned 30. It was a high-pressure, competitive job that required a lot of traveling.

“I was really not prepared for all of that. It was such a growth period with Home Depot that it was a lot of pressure to constantly perform and do well,” he says. “I was always kind of insecure; I think it was always there from when I was younger … not feeling good enough or that I fit in at all. And I think I tried to overcompensate with education and making sure I was at the top of the class and in the best job.”

That insecurity fueled his addiction. Whenever he tried to stop using, he imagined losing his confidence and worried that he couldn’t keep up the facade. Abusing drugs gave him confidence, he says.

“I started to think I was really good at my job,” he says. “Everything just felt better. Everything tasted better. It felt like when you’re remembering a really good childhood memory, and you’re just smiling to yourself. It’s very addictive, that feeling.”

When people take opiates, their tolerance rises quickly, Rosolanko says, which means they must take more drugs to receive the effects. To pay for his drug habit, he started stealing money from Home Depot around 2002. Within two years, he stole more than $400,000 from the company. Eventually, he switched to a drug that was stronger and cheaper: heroin.

A friend of a friend introduced him to a dealer. He sniffed it at first, then quickly graduated to shooting the drug intravenously. He remembers sitting in a car in a parking lot while his dealer inserted the needle in his arm.

“It took it to a whole new level,” he says. “I kept drawing new lines in the sand. I won’t do heroin. I won’t do heroin at work — and a couple of times I did. The shame, it kept the use going. I felt so bad about it and ashamed of myself that I would use to not feel the shame.”

Rosolanko describes his drug use as a whirlwind he couldn’t escape. During the height of his addiction, he says that only once could he recall questioning his behavior and the direction his life was going.

“I was driving somewhere, and I was at a stoplight, waiting for the light to change, and for some reason I was thinking about what was going on in my life and thinking ‘How did you get to this point?’ … ‘This is not who you are.’ I started to think about how it started with pain pills … and it was so uncomfortable that I stopped [thinking], and I never thought about it again.”

Doing time and taking stock

A bus, shotguns and barbed wire. That’s what Rosolanko remembers about the day he was transferred to his 27-month prison sentence for wire fraud. It was 2005. �������� a year before, Rosolanko’s world had begun to crumble. He got sloppy. The company became suspicious. He flew home to his native New Jersey and confessed his drug problem and embezzlement to his family. He checked himself into a mental-health and substance-abuse treatment center, hired a lawyer, admitted his crime and was sentenced to a medium-security prison.

For 16 months, he participated in the prison’s residential drug and alcohol program, followed by an additional 11 months in a federal halfway house. Prison kept him sober and made him recognize he was interested in social work.

“I realized I could use this experience as something positive and actually help people,” he says.

When he was released in 2006, he moved in with his girlfriend in ��������; they married a year later. By 2008, he was accepted into ��������’s Master of Social Work program.

Brian Flynn, director of admissions and student services in the Department of Social Work, has known Rosolanko since he was admitted to the program. Flynn says Rosolanko always struck him as bright, insightful, compassionate and highly committed to issues of social justice.

“Like most of our students, Rob flourished while with us,” Flynn says. “Our graduate program is rigorous, and the profession of social work demands passion, integrity, intellect and resourcefulness. These are all abilities Rob excels at.”

But Rosolanko’s past continued to haunt him. He had been clean for seven years when he started to suffer back pain in 2011, and his doctor prescribed him pain medication.

“And all of a sudden I had that feeling again, and it scared the hell out of me,” he says. “Then I went back and got some more. … I was already working in the field as a counselor, but the guilt and everything started coming back.”

It frightened him that he would still turn to drugs after all he had been through. He temporarily left the field and returned to rehab, this time at Geisinger Marworth Alcohol and Chemical Dependency Treatment Center in Waverly, Pa.

“That was the turning point,” he says. “My problem wasn’t drugs; my problem was me. I needed to work on me. That’s what recovery is all about: how to live and be happy without having to take any substance … to make you feel better.”

In treatment, he saw for the first time that addiction is a disease, and he was challenged to be honest about his past and get to the root of his dependency. Now he understands the source of his insecurity and anxiety and has learned to accept and love who he is.

“I learned that one of the reasons I ‘used’ was because I was so uncomfortable being me,” he says. “Something happened when I was there. It changed. And I was done. It just felt so good that I could finally let go and take care of me. It was so freeing.”

Finding the right treatment

Addiction is a disease of the brain, not a failure of morals, and that fact is helping change ideas about treatment. The development of evidence-based practices — behavioral or medical interventions based on research, clinical expertise and a patient’s circumstances — means treatments can be better tailored to meet individual needs, according to the National Institute on Drug Abuse. And that is critical to achieving recovery.

One example is motivational interviewing. Nadine Mastroleo, assistant professor in the PhD program in the College of Community and Public Affairs, specializes in brief drug and alcohol interventions. She uses motivational interviewing to help people understand how their drug and alcohol use is getting in the way of their relationships, well-being and goals.

“It’s important, as therapists, that we are not telling them what to do, but steering them toward self-actualization and recognizing how substance use is interfering with their goals,” says Mastroleo, who has worked as a counselor.

Therapists ask open-ended questions, provide affirmations and request client permission before giving advice.

“It seems so simple on the surface, but you would be surprised how many people don’t realize how substances are negatively affecting their lives and the lives of those around them,” she says. “I believe people have the inherent strength and ability to make changes. My job is to help them make connections between their behavior and the negative outcomes associated with that behavior.”

It’s “not rocket science,” she says, but she believes there’s an art to being an effective motivational interviewer.

Last year, she co-authored a paper about the use of software to code conversations between therapists and clients to detect which interactions were most beneficial in minimizing client harm. She trains other therapists, social workers, doctors and nurses in motivational interviewing, borrowing from techniques she’s found to be successful through her research.

“I became a researcher to teach and discover new methods of treatment — and there’s no immediate gratification in this field,” she says. “But when you’re doing a motivational interview and you see the light bulb go off in someone — that’s what makes it all worth it.”

Sharing a story, sharing help

Today, Rosolanko is the outpatient clinical program director at Syracuse Behavioral Healthcare in Syracuse, N.Y., where he helps others struggling with alcohol and other substance-use disorders. Life, he says, is fantastic. A year ago, he found the courage to finally tell his family about his heroin addiction, which he had always kept secret. He then shared his story with hundreds of people at a meeting on heroin use in the Southern Tier in January 2016. The experience felt both satisfying and terrifying, he says. But in telling his story, his wish is that others suffering from the disease will see promise, and that people will be exposed to the facts and reject some of the assumptions about addiction; it doesn’t just happen to those living under bridges, he says. Addicts are housewives, lawyers, executives, people like Rosolanko.

“There are plenty of people out there exactly like me who were able to put their lives back together and create an entirely new life,” he says. “What works against this field is the stigma against addiction. Even if you have all the education about how it’s hereditary and it’s a disease, there’s a lack of understanding about it.”

–Diana Bean ’81 and Natalie Murphy ’14 contributed to this story.