The biology of addiction is complex

Published 3:44 pm Monday, March 13, 2017

Problems not just all in the brain, patients say

How does one progress from taking drugs for pain management, to full blow opioid addiction? The answer lies in the brain.

Opioids treat pain by binding to receptors in the brain. These same areas, however, are the ones stimulated by pleasurable activities like eating or sex, according to the National Center for Biotechnology Information at the National Institutes of Health. This, according to their data, results in a dump of dopamine into the brain, which triggers the feelings of euphoria associated with opioid use.

That euphoric effect is what ultimately leads to addiction. Your brain learns to associate the actions and rituals of drug use with that dopamine dump and feelings of euphoria, and that is why even after overcoming the physical dependence and going through terrible withdrawal symptoms, those who are addicted will often return to using. For some, there is also a genetic component, that makes them more predisposed to addictive behavior, but the changes that occur in the brain with repeated use can happen to anyone.

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This is the part of the illness that needs to be treated, and can only be treated with counseling, lifestyle changes, and in some cases psychiatric care.

But in order to effectively treat this, you need to understand the other impacts opioids have on the brain and the body.

Along with addiction comes tolerance and dependence.

Tolerance is the inability to achieve the same effect from the same dosage of the drug. Once a body builds up a tolerance to the drug, it takes a higher dosage to achieve the same euphoric effect that used to occur with use.

This is often when people begin doubling up on their prescription dosage and seek out more of the drug on the street. This is why they begin using the drugs in ways other than as prescribed.

This is why they eventually graduate to harder drugs.

Tolerance keeps escalating their usage, to where they will do things to support their habit that they never thought they would do.

But tolerance isn’t what keeps them using the drug when they want to stop though. That is dependence.

Dependence occurs when your body needs the drug just to avoid feeling the symptoms of withdrawal.

This is what happened to Patients Three and Four, two working class addicts seeking treatment at S.T.E.P.S of Recovery.

“People think the sickness is in your head,” explained Patient Three, an average looking woman in her mid 50s. “It’s not.”

Patient Three had been on Percocet long term for a shoulder injury and surgery. When she was taken off the prescription, she found that she was jittery, restless and irritable. Patient Four recognized it for what it was, immediately, and offered her half of one of his Oxycodone. She was reluctant, but took it anyway, and afterward she felt better. That was when she knew she was an addict, she said.

It may have been a surprise for her, but it wasn’t for her husband. Patient Four had been a functioning addict for years already.

“I’ve been an addict since ’93,” he said. “The doctor gave me Percocet for my back, that escalated to Oxycontin and then to heroin.”

While Patient Three said she eventually started snorting pills instead of taking them, and snorted heroin, she never used a needle. Patient Four, however, had no such compunctions.

“When you first started, once was good,” he said. “By the end, you’re doing it six or seven times a day.”

They eventually sought treatment after Patient Four overdosed, and are happy that they did.

“I don’t miss the drugs,” said Patient Three.

“I definitely don’t miss the sickness,” added Patient Four.

But they know that even if they use Suboxone to quell the physical withdrawal, the addiction will never fully go away. They have programmed their brains to associate these actions with pleasure, relief, and comfort.

That intense craving and compulsive use that indicates addiction, Dr. Nicholas Landry explained, is one reason that Suboxone treatment works best in conjunction with both counseling and a gradual step-down of the drugs dosage, so that the patient feels in control of when and how they let go of it. Even then, they aren’t cured.

“Addiction is a chronic, lifelong, genetic disease, with no cure,” Landry said. “All we can do is help them sober up, teach them coping, and avoid a relapse.”

Next week, we’ll look closer at the pharmacology of treatment, and how various drugs like Suboxone, Vivitrol and Naloxone work.