Teresa Alvarado has seen the effects of substance abuse first-hand. In her role at Lubbock County VOICES Coalition, a nonprofit group that works to reduce and prevent drug use and abuse in young people, she says treating the brain disease takes a village, and curbing underage drinking is the place to start.

“They start using alcohol, then they graduate to using and abusing different kinds of drugs,” Alvarado said.

“When you’re using a drug just to feel normal, that’s when you know addiction has started,” she explained.

Texas lawmakers are looking for connections between substance abuse and mental health in the state. In a Tuesday hearing, experts weighed in on how the national painkiller epidemic ties to Texas.

Cynthia Humphrey, executive director of the Association of Substance Abuse Programs, said that of the top 25 cities with the highest drug overdose numbers, four are in Texas: Amarillo, Midland, Longview and Texarkana. Humphrey said after testifying that the death toll is staggering.

“Each drug kind of has its own set of peculiarities that we have to address, but at the bottom line at all of these is addiction,” Humphreys explained.

Sharon Brigner serves as deputy vice president for state policy for the Pharmaceutical Research and Manufacturers of America (PhRMA). While Brigner, a registered nurse, said there is no “one size fits all [approach] for any state, any city,” the chairman of the state House’s Opioids and Substance Abuse select committee said treatment and prevention will need a multi-pronged approach.

“I am confident that we can do some proactive things, take some steps at the prescriber level, distributor level, obviously the manufacturing level,” Rep. Four Price, R-Amarillo, said.

At a tax reform roundtable with business owners in Amarillo, Sen. John Cornyn said Tuesday addicts need more support.

“Some of what we need to do is restore people’s confidence in the future and not sort of retreat into this idea of self-medication that creates so much heartache for so many people and so many problems in our society,” Cornyn said. “We’re trying to help people break that cycle of addiction.”

As the opioid conversation continues to be a priority for President Donald Trump, his administration is working to install a temporary memorial in Washington to remember those who died at the hands of prescription drugs.

The White House, along with the National Parks Service, will host the National Safety Council’s opioid memorial on the Ellipse in President’s Park, Press Secretary Sarah Huckabee Sanders said during Tuesday’s daily press briefing.

“Within the exhibit 22,000 engraved pills display the faces of Americans tragically lost to prescription drug overdose,” Sanders added. Sanders said the exhibit aims to “educate visitors on the devastating impact of the opioid crisis,” and will be open to the public April 12-18.

Nationally, different organizations partner with local law enforcement to host Drug Take Back Day. On April 28, people across the country can safely turn in old prescription pills to authorities and learn about medication use.

Alvarado said Texas is ahead of the curve, sharing that the problem is worse in other states, but Commander Karen Hearod, a licensed clinical social worker overseeing Texas for the Substance Abuse and Mental Health Services Administration, said staying ahead is crucial.

“It prepares us if we do have Fentanyl coming Texas’ way, how can we get our treatment in place, and then how can we look at our infrastructure for all substance use disorder,” Hearod said.

El Paso Democrat Rep. Joe Moody said lawmakers made strides in this work, “not just last session, but building through a lot of work that has been done over the last decade.” He said he hoped the work continued by the committee would be the “next extension” of the groundwork laid down.

Tuesday’s hearing was one of four planned meetings for the committee, which will then prepare a report in time for the 86th Legislature in January.