Opiate Addiction and the Brain
As human beings we have a long history of using opiates, such as morphine. And if a person gains unlimited access to opiates, they can easily and quickly become tolerant and addicted to it. The drugs have an intense effect on the human brain. Prescription opiates are after all intentionally designed and created to make a person feel good within a short period of time. The drugs increase the level of dopamine released in the brain and copy the effects of endogenous opioids. More often than not, people who have taken opiates with consistency often have difficulty feeling normal without taking the drugs and little or no knowledge of what really happens with opiate addiction and the brain.
Endorphins and Dopamine
Our brains produce a natural morphine known as endorphins. They stimulate the opioid receptors to lift our mood when we are under stress; helping us feel more motivated and relieving pain when there is an injury. These hormones are produced during excitement, exercise, feeling loved, orgasm, pain, or even eating spicy food.
The production of endorphins also leads to the discharge of dopamine, which is the chemical that activates the reward system of our brain. Dopamine acts as natural “go system” that helps humans pursue stuff that we need to survive. Our brain also has a “stop system” found in the prefrontal cortex at the front of our brain. It helps us determine the consequences of our impulses. When a person is addicted to opiates, the “go system” of the brain acts on its own, and the “stop system” can no longer control it.
Some Examples of Opioids
Codeine – ingredient found in many cough syrups
Hydrocodone – Vicodin, Lortab or Lorcet
Oxycodone – Percocet, OxyContin or Percodan
Hydromorphone – Dilaudid
Morphine – MSContin, MSIR, Avinza or Kadian
Propoxyphene – Darvocet or Darvon
Fentanyl – Duragesic
What Opiates do to a Person’s Brain?
Opiate drugs activate the dopamine pathway (also known as the reward pathway) that sends out a rush of pleasure chemicals to the brain. When talking about opiate addiction and the brain, opiates are much more stimulating than natural endorphins, which is partly why they are so addictive. Once a person uses opiates, the brain stops creating natural endorphins because the body thinks that there are already enough levels of it in the brain. Within six to 12 months of using opiate drugs, the cells that produce endorphins can be significantly reduced in size and even die off.
One of the most commonly abused illegal opiate drugs is heroin. When it is injected into a vein, heroin reaches the brain within 15 to 20 seconds. It then binds itself to the opiate receptors found in the different parts of the brain that include, you guessed it; the reward pathway. When the receptors in the reward pathway are activated, the person feels a brief and very intense rush of euphoria. This is followed by several hours of what many report as a “contented and relaxed” state. This feeling of euphoria is what draws people back to opiates again and again.
The effects of opiates are similar to the ones from naturally occurring opioid peptides. When used for medical purposes, opiates can stop diarrhea, depress breathing, and relieve pain. They come with side effects that include vomiting and nausea. But when used in large doses, they can make breathing shallow or even make it stop altogether. Thousands of opiate addicts have died due to overdose. And mixing alcohol with opiates only increases the risk of death.
Opiate Addiction and the Brain vs. Opiate Dependence
Dependence happens due to the normal adaptations to prolonged exposure to opiates. Do not confuse the term dependence with addiction – they are not the same. Dependence is a physical condition. Addiction is described to be the compulsive seeking (psychological) and use of the drug that results in deadly consequences. Addiction usually includes some type of dependence (physical) as well.
Another way to understand it is this: dependence is typically acute and holds the potential to be resolved or cured. Addiction on the other hand can be acute or in remission – but it is always chronic and life long (i.e. it is not cured or removed). This is why we say a clean/sober person is “in recovery” and not that they are “recovered”.
A person who is dependent on opiates will experience some type of withdrawal symptoms when the use of the drug is suddenly stopped or reduced. The symptoms can be mild to severe. Withdrawal symptom includes flu-like discomfort, stomach cramps, unpleasant mood, diarrhea, and severe muscle pain, just to name a few. The withdrawal symptoms are most commonly managed medically through the use of a slow drug taper.
Dependence & Tolerance
Dependence is often accompanied by tolerance, which is the need to take higher doses of the drug in order to get the same effect. Once a person experiences tolerance, it can be difficult for the health care provider to evaluate whether the patient has a drug problem or if there is really a need for higher doses to control one’s symptoms. This is the reason physicians are attentive and vigilant to their patients’ symptoms, as well as the level of functioning to provide them with the most accurate information needed to prescribe the appropriate treatment.
Connection of Opiate Addiction and Brain Damage
While it has already established that opiate overdose can result to slow breathing, its effects on brain function are still being studied by researchers. Depressed respiration can affect the oxygen level in the brain. Researchers are still trying to determine the long-term effects of opiate addiction on the brain. Previous studies have shown that there is some deterioration of the white matter among heroin users that affect their ability to respond during stress situations, regulate behavior, as well as their decision-making abilities.
“One of the worst health epidemics facing this country is the belief that successful pain management actually means the absence of any pain at all.”
BW Carrettin, 2003
Getting Off Opiates
Once a person stops using opiates, the natural chemical system of the body can’t turn on right away. It has already been damaged, and it will take a while to recover. The person will go through severe withdrawal that can last up to a week. Then the person will also undergo a long process called post-acute withdrawal syndrome that can last several months or even years.
When the person is suffering from withdrawal, they are typically depressed and with no motivation to do anything. Removing opiates from their system will suddenly bring lots of pain because there is no base level of endorphin found in their system. Professional treatment centers who specialize in opiate detox can help the withdrawal experience be much more comfortable.
Treatment for Opiate Addiction in Houston, Texas
Opioid addiction is a chronic disease, like diabetes or heart disease, and like all chronic diseases it is a medical condition for life. While it can be managed and kept in remission – it cannot be cured and will not go away. However, a person with an addiction can regain a healthy, active and productive life.
There had been a lot of growth and improvement in the field of addiction treatment and one aspect of that is medication-assisted treatment or MAT. Because of a lack of up-to-date training, antiquated ideas about addiction and a general ignorance of neurology and physiology – many people, even those in the addiction treatment field, find the idea of medication-assisted treatment to be controversial. This is sad and detracts from the core intention of recovery work.
It’s important to know that the overall goal of medication-assisted treatment is to help someone begin to recover from addiction. These medications, prescribed and monitored responsibly, do NOT replace one addictive substance with another. They provide a safe and controlled level of medication to overcome the use of a problem opioid. Medication-assisted treatment only works if all three of it’s equally important parts are upheld: medication (monitored and taken as prescribed), counseling (with a seasoned professional who specializes in addiction) and community support (recovery meetings as well as family and friends)
Medically Assisted Treatment (MAT)
In the past, the standard treatment for opiate addiction involved the use of methadone. (Even in the face of better options methadone is still widely used today for treatment of opiate addiction.) Methadone is a long-acting opioid that is used to keep the withdrawal symptoms at bay. It also controls the craving and relapse of the patient. Whether methadone treatment is actually an effective tool for rehabilitation remains a subject of great controversy.
Another medication used in the rehabilitation of opiate addicts is Buprenorphine. It contains a partial agonist opiate, has a weaker effect on the receptors in the brain than some newer medications and has a limited high, which some health care providers believe can deter the addict from abusing the medication. This medication is also surrounded by controversy – some have suggested it is due to improper use, others suggest negligent monitoring by treating physicians.
Naltrexone and Naloxone are used as antagonists at opioid receptors to block the pleasurable effects of the opiates. These do not contain opiates nor do they produce a high. When coupled with counseling or other therapeutic treatments these blockers have more recently been reported to help people quit their opiate addiction. There is an intramuscular injection (IM) version called Vivitrol which lasts approximately 30 days and has been reported to successfully block highs and help to control not only opiate cravings but alcohol as well.
Succeeding in Recovery from Opiate Addiction
For addiction recovery to be successful over a lifetime requires a great deal of desire, commitment, persistence, humility and support. One of the most widely available community-based support organizations is 12 Step with meetings across the globe and in nearly every city in the United States. Churches, community centers and many other venues are also available depending on your area.
A seasoned and experienced counselor who specializes in chemical addiction can also help the recovering addict through the challenges that arise in the recovery process. If the counselor is also licensed and experienced in mental health, they can also assist with issues such grief, anxiety or relationship conflicts that may come up during treatment and recovery. Counseling or psychotherapy is helpful not just for the addict but also for the partners, friends and family who love them.
Breathe. You Can Do This.
Change is hard and for many it can also be a bit scary. Patience and compassion, but not coddling or excusing, is necessary. Learning how to set good boundaries – new boundaries – is important for everyone involved. Remember – getting better doesn’t mean back to how things were. It will never be the same way it was in the past. That was the past. But it can be better, more than better. It can be really good.
If you or someone you know is struggling with opiates, or any drug or alcohol, reach out and get help. A better life is possible and attainable. I’ve worked in this arena for a long time and I’d like to help you.
Stop. Take a moment. Breathe.
You CAN do this.
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Ben Carrettin is a Nationally Board Certified Counselor (NCC), Licensed Professional Counselor-Supervisor (LPC-S) and Licensed Chemical Dependency Counselor (LCDC). He is the owner of Practice Improvement Resources, LLC; a private business which offers an array of specialized counseling, evidenced-based clinical consultation, Critical Incident Stress Management (CISM) and targeted ESI-based services to individuals and businesses.
Opiate Addiction and the Brain