Opioids and the Brain: Why There’s Still Hope for Recovery | AspenRidge

Opioids and the Brain: Why There’s Still Hope for Recovery

Remember those old “This is your brain on drugs” commercials. No? Am I dating myself here? Well, back in the 1980’s, The Partnership for a Drug-Free America had a HUGE campaign to fight drug addiction. As part of the campaign, they published all kinds of anti-drug commercials. The most famous one is a 10-second video of an egg frying in a pan. As the egg crackles and sizzles in a bed of hot oil, a man’s voice speaks narrates the image. “This is your brain on drugs,” he says in a stern voice.

It was definitely a memorable series of commercials. I’ll give them that. But it was in no way an accurate depiction of addiction. It was too sensational, too extreme, too absolute. An egg, after all, can’t be uncooked. Once someone cracks it open and drop it into a pan of hot oil, it will always be cooked. There will never be a point where it can be restored it back to its original condition. But when it comes to addiction, at least opioid addiction, the brain can be uncooked. The process can be reversed. Addicts can quit using and start living a healthy, productive life again. They just need to quit before things get dangerous. Addicts need to start reversing the process early on before the real damage starts to take effect. Yes, drugs like heroin and fentanyl can be brutally harmful to both the brain and body. They can affect the body in all kinds of ways and have long-lasting consequences in an addict’s life. However, drug addiction is not the be-all, end-all of their existence. In order to fight a strong fight against drug addiction, we need to educate addicts on how opioids actually affect the brain and body. 

How Opioid Addiction Really Works

We’re all familiar with the problem. Drugs like fentanyl, heroin, and oxycodone are killing tens of thousands of Americans every year. Current research shows that around 115 people die of an overdose every day. The National Institute on Drug Abuse estimates that more than half a million Americans are currently addicted to heroin. This stat doesn’t include the people addicted to prescription painkillers, either. It’s likely that most of us either know a victim of the crisis or are one ourselves. What most people don’t understand is how addiction actually functions. Most of us don’t understand why it’s so easy for someone to become addicted to heroin or pills. People can’t seem to grasp that addiction is both a physical and mental illness, which is why we hear so many say things like:

“If you really want to quit using heroin, why don’t you just stop?” …or… “Oxy addicts are in that position because they want to be…” …or, even worse… “If you die of fentanyl addiction, it’s your own fault…”

It’s phrases like these that reflect a popular misunderstanding of what addiction really is. 

Addiction is a Disease of the Brain and Body

“Today, we recognize addiction as a chronic disease that changes both brain structure and function. Just as cardiovascular disease damages the heart and diabetes impairs the pancreas, addiction hijacks the brain.” – Harvard Medical School Mental Health Newsletter

No one ever plans to become an addict. It can happen through any number of incidental circumstances. Some people start by taking oxycodone pills prescribed to them by a doctor and end up hooked before they know it. Others try Vicodin for fun but become chemically dependent in a matter of weeks. Whatever the circumstances, many people find themselves simply unable to manage a habit they never planned on having. Even when their quality of life starts to diminish, they’ll still continue to use their substance of choice. A newsletter published by Harvard Health Publishing out of Harvard University Medical School explains the condition in a very succinct manner. The newsletter states, “Addiction exerts a long and powerful influence on the brain that manifests in three distinct ways: craving for the object of addiction, loss of control over its use, and continued involvement with it despite adverse consequences.” The “loss of control” that the School describes is important to take note of. By taking over the brain and taking over its functionality, drugs like heroin are able to keep addicts coming back for more.

What Do Opioids Do to the Brain?

Why are these drugs so addictive? What could be so great about them that someone would risk their life by taking them? Well, as the newsletter above points out, drugs can actually “hijack” the brain. They do so by tapping into the parts of the brain where pleasure comes from.   This is particularly true of opiates, which make us feel good by targeting the parts of the brain called “opioid receptors”. This video does a good job of explaining how certain drugs affect those receptors: https://www.youtube.com/watch?v=NDVV_M__CSI If someone hurts themselves (like breaking their arm in the way Susan did in the video), their body generates pain signals. These pain signals, called “neurons”, are sent straight to the brain. Pain is a way to let us know that we’re in a threatening situation, which is why those signals make it to the brain so quick. Now, drugs like opium, heroin and similar drugs block those pain transmitters from getting into the brain. Our brains usually regulate how many of these signals are able to pass through the brains barrier. When someone is high, though, they’re almost blocked out entirely. This is why they’re prescribed by doctors, used in surgeries and embraced by the medical community under certain circumstances. They’re really good for pain relief. As the video points out, they also do something else. When someone takes one of these drugs, it triggers an enormous rush of dopamine. Dopamine is a chemical that makes us feel good. Our body makes dopamine to remind us that certain activities are good for us. This pain-blocker-and-dopamine combo is the reason why these drugs make us feel so euphoric (at least the first few times we take them).

Why Are They So Addictive?

The problem with opioids is that they supply the brain with an unusually large rush of dopamine. And dopamine, as Nsikan Akpan calls in an article published on PBS.org, is a “pleasure highway”. These little transmitters are released whenever we eat something delicious, laugh with our friends, or go for a run. It’s produced in a region of the brain called the Ventral Tegmental Area, or VTA if that’s too much of a mouthful. Whenever someone feels like a million bucks, it’s because they have a fresh dose of dopamine ricocheting around in their brain. Their body recognized that they were doing something good and their VTA started producing dopamine to let them know that they should do it again. The cycle of “do something good, get rewarded with dopamine” is actually a mechanism the human body developed to keep doing the things that are integral to our survival. It’s part of a larger cycle that neuroscientists and psychologists call our “reward system”. “When [the brain] hears, ‘This pill feels good. Let’s do more,’ the mind begins to develop habits and cravings” – Nsikan Akpan, PBS.org So, when an addict takes heroin or some other similar drug, they actually hack into that reward system. Their VTA starts spitting out dopamine like a broken ATM machine. Essentially, they reward their brain with a ton of dopamine that they didn’t do anything to earn. This, along with the drug’s pain-killing properties, tricks the brain into thinking that it’s a healthy decision. “Both of these events reinforce the idea that opioids are rewarding,” says Akpan. The opioid receptors don’t understand the consequences of the drug, of course. They recognize the reward and start reminding the user to do it again. These little “reminders” are what we call cravings.

Cravings are Why We Get Hooked

“When the craving circuitry overwhelms the pleasure hot spots, addiction occurs, leading people to pursue a behavior or drug despite the consequences.” – Fran Smith, National Geographic

Opioid addiction is similar to every other addiction in that it’s born out of user’s continually satisfying their cravings. As Fran Smith writes in her article, “How Science is Unlocking the Secrets of Addiction”, published in National Geographic, “Some scientists believe that many allures of modern life—junk food, shopping, smartphones—are potentially addictive because of their powerful effects on the system, the circuitry underlying craving.” A main component of the “circuitry” she refers to is the midbrain. This region of the brain is the part that helps to keep us alive. It controls some of our most primitive functions such as eye movements and communication processing. If you hear a loud noise in your closet at night, your midbrain is the part that tells you to get the hell out of there. Once you’ve fed those opioid cravings for a while, though, your midbrain starts to think that those drugs are necessary for your survival. It starts to look for “triggers”, or events that spark the desire to use. These events could be anything, from being at a party to getting out of bed in the morning (in the case of severe addiction. These triggers develop over time. They’re programmed into your brain as events that require a dopamine jolt. “Through learning, the signals or remind cues for rewards come to provoke surges of dopamine,” Smith writes, “That’s why the aroma of snickerdoodles baking in the over, the ping of alert, or chatter spilling out the open door of a bar can yank a person’s attention and trigger cravings.” By the time those cues are in place, the entire reward system has become dependent on the drug. The addict’s tolerance increases over time and they need more and more to fulfill their cravings. This is where things can take a turn for the worse (if they haven’t already).

Does Opioid Addiction Affect the Rest of the Body, Too?

Opiates don’t just affect the brain. They can have all kinds of effects on other organs, as well. According to a report published by the National Safety Council, some short and long-term side effects of these drugs can include: Gastrointestinal troubles: These drugs, particularly prescription pills, are known to cause all kinds of problems in the digestive system. They actually slow down your digestion process, which can lead to constipation, nausea and even bleeding in the colon. The Council’s report states that 14 out of every 1000 addicts experience severe GI bleeding. Impaired ability to recover: “Opioids following an injury delay recovery and increase the risk of permanent disability,” the report says. This is likely due to the fact that the body becomes preoccupied with processing the drugs and spends less time on treating injuries. Increased sensitivity to pain: When someone is under the influence of these drugs, their ability to feel pain is greatly reduced. That means that once they quit using, something as simple as a paper cut can feel a lot more painful. This is likely to diminish over time, but it can be very uncomfortable for a while. Diminished sexual functions: Heroin and other similar drugs can really mess with the endocrine system. This is the system that produces hormones. According to the Council’s report, 50% of all opioid addicts experience some kind of sexual dysfunction due to drug abuse. Respiratory depression: This is by far the most dangerous physical side effect. When the opioid receptors are flooded with dopamine, it triggers the central nervous system to slow down. As a result, an addict’s heart rate slows down. The lungs follow suit. Many addicts face lifelong lung problems after years of using. Unlike chemical dependency and other effects on the brain, some of these physical effects are long-lasting. Respiratory depression and GI bleeding, in particular, are very hard to reverse. 

A High Risk of Overdose

“Breathing delivers fresh oxygen to the body’s cells and eliminates carbon dioxide. Opioids can interfere with that life-sustaining process in multiple, dangerous ways.” – Laura Sanders, Science News

It should go without saying that an overdose is the biggest risk involved in taking opioids. In fact, more than 42,000 Americans die from one every year. These deaths aren’t just due to heroin, either. Roughly 40% of all overdose deaths are caused by prescription painkillers (fentanyl, oxycodone, hydrocodone, etc). The majority of these individuals actually die from respiratory failure (which is technically the cause of all overdose deaths). In her article “Opioids Kill: Here’s How an Overdose Shuts Down Your Body”, Laura Sanders writes, “Among the many rapid effects that opioids have on the body, one is particularly lethal: Breathing is restricted.” This restriction of the respiratory system, the author explains, is due to a number of different factors. For one, certain opioid receptors play a key role in breath regulation. When these receptors are blocked by chemicals, they don’t function properly anymore. Sanders writes, “Upon activating, the receptors change the behavior of cells in ways that can slow or even stop breathing.” The writer also points out that the carotid body, a group of cells that prompts us to expel CO2 when there’s too much in our system, is affected by drugs. “Opioids dampen these sensors and silence the body’s CO2 warning system,” she writes, “Emergency signals to increase breathing go unsent.” It’s crucial, therefore, that addicts get help for their problem. Addiction treatment is the only true way to reduce the risk of respiratory failure and overdose. 

Hyperalgesia Makes it Harder to Kick the Habit

Obviously, these drugs are highly addictive. Addicts get caught in the cycle of abuse for years on end. As long as the substance has a stronghold on their brain, their behavior and thought processes, the condition can be a big hurdle to climb over. There’s another, often overlooked aspect of these drugs that make them so difficult to kick. It’s called opioid-induced hyperalgesia. Hyperalgesia is the name of the condition that decreases your pain tolerance. It happens because, as you may remember, these drugs block your pain receptors. When you use heroin or another drug for a long time, your pain receptors change. Not needing to block pain signals, they become much weaker. The addict will experience much more pain than they would otherwise. Most researchers believe the hyperalgesia can only occur while drugs are still in the user’s system. However, the condition can still make it very difficult for a user to commit to quitting. Going through heroin withdrawals, after all, can be quite the painful process. When the symptoms of withdrawal are made worse by hyperalgesia, the addict might have a tough time getting through detox without giving up. 

One Addict’s Story

“We are not narcissistic hedonists. When we hurt you we hurt too. We do these things not because we want to do them, but because we have to survive.” – Sam Snodgrass, Huffington Post

Behavioral pharmacology and HuffPo contributor Sam Snodgrass’ story entitled “What It Feels Like to Have an Opioid Addiction” serves as a reminder of the horrors of drug abuse. A personal recollection of his own experience, it also reiterates the fact that life doesn’t have to end with addiction. Snodgrass was a heroin user who picked up the habit during his early 20’s, although it took him a while to use so much that he became addicted. Throughout his entire college career, which started with a B.A in psychology and ended with a Ph.D in biopsychology, he used regularly. “In April of 1989 I got into a bottle of methadone hydrochloride from the behavioral pharmacology lab and the whole time I was shooting that methadone I told myself that I wouldn’t stop,” he recounts, “I believed that. Until I couldn’t.” Sam’s addiction, as he writes in the article, lasted for more than two decades. “The last year and a half of my addiction I was homeless,” he says,”[I was] living on the streets and sleeping on the ground, homeless shelters and people’s floors.” It wasn’t until 2011 that Sam was able to kick the habit. 22 years of this man’s life were spent using drugs and actively seeking them out. “Please understand I’m not trying to excuse our behavior. I am, though, trying to help you see why we do these things” Sam’s story does an excellent job of articulating what it feels like to struggle with a drug problem. “Let’s say that you haven’t had anything to eat for three or four days. Your starving,” he writes, “You would be needing, craving food. This craving that you feel is the brain’s mechanism that drives you to survive. Its purpose is to make everything else fall away and to force you to focus solely on acquiring what you have to have to live.” Following the analogy, he unpacks how this change in brain chemistry causes addicts to do dangerous, irrational things. “This craving for food is measured in days. Our craving for opioids is measured in hours,” he says, “Four to five hours after our last use we begin to starve…Everything but our need for these opioids falls away.” Ultimately, however, Sam’s story goes to show that addicts can have a second chance. Their brains don’t always fry like eggs in a pan. If they’re lucky enough to make it out alive, they can go on to pursue great things. Today, Sam sits on the board of directors for Broken No More, an organization that provides support and education for addicts.

There is Still Hope: Recovering from Opiate Addiction

“Recovery from addiction involves willpower, certainly, but it is not enough to ‘just say no’…” – Harvard Mental Health Letter

The Harvard Mental Health Letter, published by Harvard Medical School, dispenses of the myth that “just say no’ is a viable way to quit using. “Instead, people typically use multiple strategies—including psychotherapy, medication, and self-care—as they try to break the grip of an addiction,” the letter states. Here at AspenRidge North, we believe the same thing. In order for an addict to overcome the grip that drugs have over their brain, they need to approach the process holistically. Whether through medical detox, inpatient or outpatient rehab, or even just therapy, professional treatment will give the addict a better chance of getting (and staying) clean. Quitting cold turkey is NOT the way to go. According to the California Society of Addiction Medicine, those who try to quit on their own are far less likely to make it through detox without relapsing. 

Vivitrol Could Be Your Best Treatment Option

Over the past few years, there’s been a lot of chatter in the treatment industry around addiction-ending drugs. Some experts believe that there will be a medication capable of curing addiction on the market in the near future. We could only hope so. In the meantime, however, there are a few drugs that can help addicts to fight off cravings while they get sober. Naltrexone (sold commercially as Vivitrol) is one such drug. Essentially, the drug helps the addict to get clean by eliminating their ability to get high. If the addict does choose to use illicit drugs, they won’t be able to feel the effects. In an article published in The Pacific Standard, Walter Armstrong explains, “Vivitrol/naltrexone works in a straightforward way: It blocks the brain’s opiate receptors, stopping opiate triggers like alcohol, heroin, and painkillers such as Oxycontin.” Vivitrol is considered to be a major innovation in the industry because no other substance has quite the same effect. Opioid Replacement Therapy medications, such as Subutex, have been around for years, but they don’t work the same. These drugs, as their name suggests, treat opioid addiction by replacing one substance with another. “My life is all for the better” -Wanda, former opioid addict on Vivitrol Naltrexone, on the other hand, is not a replacement for anything. It’s simply a way for addicts to force themselves into recovery. The drug is administered once per month and lasts for a full 28-day period. During that time, the addict needs to abstain from using (overdosing on H is still possible but they just won’t feel the high). Remember, part of getting clean is reprogramming the brain. In order for an addict to get sober, they must keep opioids out of their system long enough for their brain to adjust. Naltrexone is currently the best way for addicts to give their brain a break while it adjusts to having no drugs in it. Looking for Vivitrol Services? AspenRidge North can help. Click to learn more. Worried about the cost? Most insurance plans cover Naltrexone prescriptions. Verify your insurance plan.

The Brain in Recovery: Life After Addiction

“We used to think that the brain, once damaged could not repair itself. Breakthroughs in neuroscience have shown that this is not true.” – Dr. Constance Scharff, Psychology Today

The human brain’s best quality is its durability. These things are built to last. They have a quality that scientists refer to as “neuroplasticity”. This means that the brain can remold and rewire itself after neural damage occurs. In her article “Neuroplasticity and Addiction Recovery” published in Psychology Today, Dr. Constance Scharff says, “Though individual neurons might be damaged beyond repair, the brain attempts to heal itself when damaged by making new connections or new neural pathways as workarounds for the damage.” Opioid addiction itself, she explains, is considered to be a “neuroplastic event”. When someone develops a drug habit, their brain warps and reshapes itself to accommodate that habit. New neural pathways are created, new messages are sent to and from the brain and the addict finds themselves experiencing endless cravings. “Recovery doesn’t remove the addictive thought process; it just gives the addict an opportunity to change behaviors.” – Dr. Constance Scharff, Psychology Today As long as the addict doesn’t do too much damage (i.e physical damage due to car accidents, etc), though, this process can always be reversed. “In treatment, we can retain the brain, that is developing a new pathway that supports recovery,” Dr. Scharff says, “With intensive psychotherapy and other holistic interventions, we strengthen the new ‘recovery loop’ within the brain.” It’s not easy for addicts to create (and maintain) this “recovery loop”. Just because someone gets clean doesn’t mean that they’ll be able to stay that way. Anyone who’s ever battled drug addiction knows that triggers can show up anywhere and a relapse is always one hit away. The best rehab programs are the ones that help addicts to prepare for when those triggers rear their ugly heads. “You may not have been to your college campus in twenty years, but within minutes of arrival for a visit, it will become familiar to you—your old haunts, how to get around,” she says, “Addiction is no different. Recovery doesn’t remove the addictive thought process; it just gives the addict an opportunity to change behaviors.”

A Holistic Approach to Rehabilitation

Dr. Scharff believes that the brain must be fully “integrated” if an addict is going to stay clean in the long run. Opioid addiction can have all kinds of strange effects on the brain and its thought processes. As she explains, the key to recovery is reversing those effects and developing healthier ways of thinking. “Integration means health and wholeness,” she says, “The brain wants all its disparate parts to work together. It is designed for you to feel whole and happy.” She says that strong, supportive relationships can be a crucial component to a healthy recovery. Not only do they provide the addict with a natural source of dopamine, but they also help the addict to reconnect with the world. Reconnection is important for newly-sober addicts, as a life of drug abuse can be very isolating. 

Are Opioids Having a Negative Effect on Your Brain?

If you or a loved one are currently addicted to heroin or prescription meds, we’d love to talk. AspenRidge North can provide the supportive network you need to beat your addiction. We offer some of the highest-quality addiction treatment available in the United States and we’d be happy to help you get clean. Give us a call today. A member of our staff can help to diagnose your problem and provide information on treatment options. 

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