“The view that drug use is a moral choice is pervasive, pernicious, and wrong. So are the corresponding beliefs about the addicted — that they are weak, selfish, and dissolute; if they weren’t, when their excessive drug-taking and drinking began to harm them, they’d stop. The reality is far different. Using drugs or not isn’t about willpower or character. Most problematic drug use is related to stress, trauma, genetic predisposition, mild or serious mental illness, use at an early age, or some combination of those. Even in their relentless destruction and self-destruction, the addicted aren’t bad people. They’re gravely ill, afflicted with a chronic, progressive, and often terminal disease.” — excerpt from "Clean: Overcoming Addiction and Ending America’s Greatest Tragedy" by David Sheff
After last month’s introduction to the HEALing Communities Study, a multi-year, multi-state research study to reduce opioid overdose deaths through the implementation of evidence-based practices, I’d like to address some misconceptions and myths about what happens to the body and brain of someone who suffers from substance use disorder, and why quitting is so hard.
Misconception No. 1: Addiction is a moral failure.
Reality: Addiction is a chronic disease that alters brain function.
Our brains are wired to seek rewards. The reward pathway in the brain is controlled by the chemical messenger dopamine. It tells the brain to pay attention to what just happened, and that it’s worth getting more of. Dopamine is released by endorphins, or when we encounter anything pleasurable or exciting. Drugs are among the most powerful experiences a brain can have and can push dopamine levels 10 times higher than normal. Extended drug use alters the connections between brain cells, creating memories of euphoria and triggering fierce cravings. The same can happen with gambling or eating; it can become addictive and difficult to self-regulate the desire. Drugs overwhelm the brain with dopamine, which makes the body decrease its production to the point where it can’t even produce enough dopamine to get you out of bed. Scans of brains exposed to drugs shower fewer dopamine receptors, which means the brain is starving for dopamine, our motivational drive. If we tell someone who is struggling with drugs to just get motivated to stop, we are essentially telling them to magically produce more dopamine. The good news is that scans also show that dopamine receptors reduced by addictive drugs can come back with recovery. In essence, people struggling with addiction are not weak, they are ill.
Misconception No. 2: Adolescents want to get high.
Reality: Adolescents are developmentally primed to use substances.
People die from opioid poisoning. In fact, over 130 people die from it in this country every…
Over 90% of addiction cases start before the age of 21, when the brain is still forming. Why is that? Turns out it has something to do with how the brain matures. While by age 10-12, a child’s brain size is that of an adult, the brain matures much slower. During adolescent and young adult years, the prefrontal cortex — which is responsible for executive function and decision making — is not yet fully developed. They are still in the developmental stage of seeking highly stimulating and rewarding activities, and are only partially deterred by risk and harm factors. The most effective way to achieve highly rewarding stimulation that adolescents seek is through drugs, which explains why most substance abuse starts in adolescence, with the largest percentage (20%) between the age of 16 and 20.
Misconception No. 3: Locking them up will set them straight.
Reality: Addiction is not a criminal problem; it is a health problem.
Trends are shifting as more and more policymakers and people in criminal justice realize that the war on drugs did not deliver the desired results, and we can’t arrest our way out of a health crisis. Addiction and the associated cravings put the body into survival mode. People with substance use disorder are not choosing to get high anymore; it’s the fear of withdrawal that is bigger than losing one’s job, family or life, which may help us understand why they steal and lie to get money to buy more drugs. Incarcerating people with substance use disorder and often other disorders related to mental illness presents a high risk for gaps in care during incarceration and a high risk of death upon release (13 times higher within two weeks of release). Diversion to problem-solving treatment courts has shown improvements in remission and recovery for illness and substance use disorder, and improved linkage to services. Medications for addiction treatment in jails and prisons and coordinated re-entry efforts are on the rise to address these health issues and help to reduce criminal recidivism.
Misconception No. 4: They can quit if they really want to.
Reality: Addiction can be treated, but not necessarily cured.
Chronic drug abuse is associated with a reduction in gray matter in the brain in the prefrontal cortex, which is crucial to making the right decisions at the right time. The lower the gray matter, the more the decision-making is impaired, which leads to a decreased ability to control your behavior. For that reason, people with a substance use disorder fight a very hard battle. It’s not about mustering enough willpower to quit, but taking the first step to seek help and get treatment. Just like with any other chronic disease, such as diabetes, hypertension or asthma, relapses can be expected to happen and are not a sign of weakness or failure. Quitting is hard, staying sober is harder. A combination of evidence-based treatment practices coupled with behavioral interventions to address the underlying issues or other disorders can help to restore the reward pathways in the brain away from substances over time.
Monika Salvage works for the Cayuga County Mental Health Department as the project manager for the HEALing Communities Study, a multi-year, multi-state research study to reduce opioid overdose deaths through the implementation of evidence-based practices. If you are interested in learning more or getting involved, call (315) 253-1522 or email email@example.com.
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