It all starts with a remedy for pain relief, or in the pursuit of pleasure. Some people become dependent on narcotics to help with their back or neck pains, others turn to drugs for their euphoric effect. Pleasure or relief is what we are after. Some people climb mountains, ski, or eat excessively. Some drink coffee, eat chocolate, smoke cigarettes, drink alcohol, or do drugs. These all produce euphoria by turning on the reward activation system of the brain. This system sends increased dopamine into the frontal lobes of the brain and serotonin into the rest of the brain’s cortex. These chemicals make us feel good. The dopamine can inhibit the activity of our frontal lobes, which dampens our critical reasoning and judgment, resulting in feeling uninhibited.. We might dance, get silly, or do crazy things. Almost all drugs that are abused turn on this reward activation system and produce euphoria. The problem is that we cannot maintain this state and we feel bad afterwards.
THE ADDICTIVE PERSONALITY
Why are some people more prone to becoming addicted to narcotic drugs? Is it a part of their genetics or a particular set of personality traits that make an individual predisposed to addiction? People with substance dependency are frequently at a higher risk of becoming addicted to gambling, food, pornography, exercise, compulsive buying, and excessive cell phone and internet-computer use. What are the common traits between all addictions? Although, there may be some generalities in this list, the addictive personality usually displays signs of impulsive behavior, weak commitment to achievement of goals, sensitive to stress, lack self-esteem, seek peer-approval, extraversion, self-monitoring, and loneliness. Stress, depression, anxiety disorder, obsessive personality, and attention deficit disorder are all related to the addictive personality.
Chemically speaking, the opioid-dependent person has less dopamine release in the brain. This dopamine can be artificially created by narcotics, cocaine, nicotine, or alcohol. This delivers the feeling of well being or self-soothing in stressful situations.
REWARD ACTIVATION SYSTEM
The reward activation system is what keeps us happy. This is what keeps us feeling good. It does this by increasing dopamine into the frontal lobes of the brain and serotonin into the rest of the brain. The dopamine can inhibit activity in the frontal lobes and dampen our critical reasoning and judgment. A dopamine surge corresponds to a euphoric high. In short, our judgment might be impaired and we feel uninhibited. We might do risky or crazy things. We are in pursuit of turning on the reward activation system. Narcotics, as well as coffee, smoking, and alcohol can do this. The problem is that this state of euphoria can’t be maintained and we usually feel bad afterwards.
THE PAIN JUST KEEPS GETTING WORSE
Assuming that some people started using narcotics for a pain condition such as back or neck pain, the medication at first worked well in decreasing the pain. As tolerance to the narcotic occurs, more and more medication is needed to control the pain. After some time, attempts to decrease the medication, results in severe pain that was worse than the original condition. This is because withdrawal symptoms of severe body aches played on the overall condition. The answer was always, I need more medication from my doctor because the drugs are no longer working. When in fact, it’s the development of tolerance to the drug and not being able to obtain additional quantities, that results in withdrawal. This causes severe aches and pains. High opiate levels cause pain sensitivity to increase. Substance dependence, is a drug user’s compulsive need to us narcotics in order to function normally. When such substances are unobtainable, the user suffers from withdrawal symptoms. In opiate withdrawal, everything hurts. Even normal uninjured parts of the body hurt. This declines gradually over a 1-3 month period and the pain threshold comes back to normal. The important thing is to realize that there is a problem.
Adrenaline is a natural substance in the body that helps us cope with stress and increased activity. Opiates dampen this response to adrenaline. This may result in sleepiness. If there is enough opiates in the system, we stop breathing and die. This is known as overdose. The body adapts to opiates by increasing adrenaline levels. This helps prevent respiratory depression and makes the person more tolerant to higher doses. When the opiate is stopped, the high levels of adrenaline cause withdrawal symptoms as sweats, watery eyes, runny nose, yawning, muscle twitching, and irritability. There may even be a tendency for panic attacks.
THE BIG LIE
We assume that the drug effect is gone when the high goes away. The truth is that a drug induced high is followed by a low. With repeated use, the high weakens and the low gets stronger. A good example is cocaine. It gives you a brief “high” followed by a depressed state. Despite knowing that the drug is causing their bad feelings of withdrawal, pain and fatigue make people vulnerable to losing control. They go out to get more of the drug to fix the situation.. Thus begins an addiction. The person no longer has command or control over their use of the drug. The drug takes control, and all problems are interpreted as the result of too little or too much drug.
THE HIGH ALWAYS GOES AWAY
The high goes away and the user gradually settles down to just trying to “maintain” being normal and avoiding withdrawals “being sick”. The trick is to gradually wean off the opiates. Many addicts use alcohol to dampen withdrawal symptoms, and may settle into a life of alcoholism. Long acting mixed narcotics used for treating dependency, such as Suboxone, are helpful in the weaning process.
No method is perfect for treating addiction. Whether you use abstinence, Methadone or Buprenorphines (Suboxone, Subutex, or Zubsolv), the failure rate remains high. Being motivated helps improves the numbers. Buprenorphine activates opiate receptors only part way and stays for a long while. Other long acting opiates such as Methadone make it easier to avoid withdrawals, but tend to be abused and can result in overdosing. Suboxone has a ceiling effect. This makes it unlikely that an experienced opiate user will overdose. In fact, patients treated with Suboxone for over one year have a very low mortality rate. Using any more than 12-24 mg daily sublingual has no psychological benefit. Suboxone and Zubsolv are formulations of Buprenorphine plus Naloxone. They dampen the roller coaster on and off cycle of opiate addiction and blocks the craving associated with opiate withdrawal. With education, effective counseling, patients can be tapered slowly off Buprenorphines This should be the goal. A newer product such as Sublocade is an injectable form of Buprenorphine that lasts for months.
MORRIS JAGODOWICZ, M.D.