If you’re here for the brain stuff, read on. If you missed part one, The Opioid Epidemic, and want to know how we got to where we are, click here.
A Chemical Reaction
All of the “good” and “bad” feelings you experience in your life are the result of chemicals being released in your brain. In order for a chemical release to occur, the body needs an agonist and a receptor. Think of agonists as keys and receptors as locks. Whenever you find a key that matches a lock, a door opens and chemicals are released, producing certain feelings.
You’ve probably heard of many agonists: endorphins, serotonin, epinephrine (adrenaline). These are known as “endogenous agonists” and occur naturally in your body under certain conditions, such as when you exercise or fall in love.
Let’s look at endorphins.
Urban Dictionary’s top definition for endorphins is more helpful for our purposes than Webster’s. It defines endorphins as, “The body’s natural opioids to make a person feel happy! Also to reduce pain.”
Our bodies’ opioids so mimic their external counterparts (opium, heroin, etc.) that the name “endorphin” literally translates to “endogenous morphine.” The happy feelings and pain reduction associated with both endogenous (developed internally) and exogenous opioids (developed externally) can largely be traced to the release of dopamine (more on this complex neurotransmitter later) they trigger.
The human body is smart, and the amount of dopamine and other chemicals that are released when a healthy person’s endogenous key turns a receptor’s lock are limited. But science is smart too, and we’re not always reliant on having a natural way to unlock doors. This can provide much needed relief when a person is suffering and our internal chemicals aren’t enough to take away the pain. In the absence of physical pain, it can trigger euphoria far greater than anything we’ve experienced naturally.
“Take the best orgasm you ever had, multiply it by a thousand and you’re still nowhere near it.” – Trainspotting
“You ever try Oxy?” John asks as he pulls a tiny round pill from his desk drawer.
“Like Percoset?” I say as he scrapes off the orange coating revealing the white insides.
“Nah, OxyContin. It’s way better than that other shit. Doesn’t have any of the filler stuff. Doctors only prescribe it to cancer patients.”
“Haven’t had it, but I’m down,” I say as John pulls out a credit card and cuts the pill in half. He starts to chop his up into a powder and I get a sick feeling in my stomach. “I’ll just swallow my half.”
“You sure? Hits you faster this way.”
I nod. He hands me my half of the pill. I swallow mine, he snorts his, and then heads to his room to get ready before we take off. By the time John returns to his living room 20 minutes later the couch beneath me has become a cloud and I’m floating across a sunlit sky overwhelmed by a sense of serenity that’s eluded me my entire life. It takes me a while to see him, but when I do I smile.
“You got anymore?” I say.
Reading those few paragraphs took slightly less time than it took me to go from a casual pill popper to an OxyContin-snorting soon-to-be full-fledged addict.
Why? Because it made me feel like this…
All my worries, gone. Replaced with a deep abiding calm and confidence I thought only existed in movie stars in Rolex ads. But this was real life. And life was finally good.
Most stories about addiction focus on the harrowing aspects of the disease. But I believe it’s important to tell the full story, good and bad. And one thing we often lose sight of is how much good there is before the bad. I imagine we’re afraid to talk about this because of what it might reveal about ourselves.
As humans, we’re inherently hedonistic, but we’re often led to believe that seeking worldly pleasures is a bad thing. It’s what leads to have unprotected sex, eat a third serving of dessert and drink too much on a night out. Even if you’re a nonbeliever and don’t consider these things sins, it’s hard for the guilt not to permeate your psyche in some way because it’s so prevalent in our culture. And so we feel ashamed of these cravings.
Luckily for us, there’s a great way to get rid of that shame when we’re feeling it…
- Ashamed about your lack of motivation? ADDERALL!
- Anxious about an upcoming presentation? XANAX!
- Afraid to talk to that stranger at the bar? ALCOHOL!
- Struggling to keep the party going? COCAINE!
- Depressed, isolated, lonely, and in pain? HEROIN!
Each of these drugs produce desirable feelings by affecting our brain chemistry in certain ways. And they continue to make us feel good for a long time as evidenced by the massive number of people taking them.
Opioids, in particular, have a high propensity for addiction because of how they work in the brain. The mu opioid receptor, which is responsible for all the desirable feelings you get from eating a delicious meal or having sex, is the same one activated after taking substances like oxycodone, heroin, or morphine. These pleasurable feelings often provide enough incentive for the recreational user to keep taking them. But the mu opioid receptor isn’t just responsible for the good feelings, it’s also the reason behind opioids addictive properties and what makes it impossible to create a morphine-like medication without a strong potential for addiction.
This wouldn’t be so worrisome if you could just continue taking the same amount of the drug that produced your initial high. This can easily occur with opioids, for while their ability to produce a seemingly endless supply of pleasurable feelings can be a needed reprieve or a fun night out in the short term, tolerance is quickly developed and often leads to addiction.
One 20mg pill split in two, each half taken a couple hours apart; that used to be enough to fuel the fun for an entire night. Now I’m sitting here with 80 milligrams of Oxy chopped up and spread out in a single line, bent over with a three-inch red plastic straw jammed up my nose, ready to inhale this entire motherfucking thing with a single snort.
Just to feel normal.
That’s how I felt when things started spinning out of control. I didn’t know how right I was. A wonderful paper titled “The Neurobiology of Opioid Dependence” confirms that, “Repeated exposure to escalating dosages of opioids alters the brain so that it functions more or less normally when the drugs are present and abnormally when they are not.”
Needing to take more of a drug to get the same effect as you previously got through smaller doses is known as tolerance. Dependence is developed when discontinuing the drug would lead to withdrawal symptoms. I was experiencing tolerance and had became dependent on higher and higher doses of the drug to feel normal, which were the only thing preventing my withdrawal.
The reason dependence develops is because an opiate addict’s body tries to protect itself by overproducing another chemical meant to counteract the opioids. This chemical, noradrenaline (adrenaline), is responsible for stimulating wakefulness, breathing, blood pressure, and general alertness; basically, all of the things that opioids suppress when they’re present in your body.
Because I’d unwittingly trained my body to expect high amounts of opioids at all times (it didn’t know they were unnatural), it not only stopped producing its own, but also began to release large amounts of noradrenaline in an attempt to maintain its normal functioning and minimize the analgesic effects I’d come to expect from OxyContin. Now, in the absence of the painkillers I was taking, I was overwhelmed by anxiety, insomnia, diarrhea, and constant pain, all consequences of having too much noradrenaline in your system.
At this point, I was no longer fooling myself. I needed opiates to feel normal.
I’m sitting in my bathtub, more raisin than human at this point. The scorching hot water that provided a moment’s relief from the pain I’ve been feeling for the past 24 hours does nothing for me at it’s current room temperature. I could crawl out of here, dry off and carry on with my life. But I’m too sad, too sore, and too stubborn to admit I need anyone else’s help.
At least I knew what to expect going in this time: The cold sweats, sleepless nights, aching body, diarrhea. The fact that I’m having trouble keeping down food came as a surprise, but I’m too depressed to be hungry. Meals are for people who still have hope and my only hope is that I won’t be hopeless forever.
It’s difficult to explain to someone who hasn’t experienced withdrawals what they actually feel like because most of the agony isn’t related to the physical sensations, albeit as terrible as they are.
Can’t eat. Can’t sleep. Agonizing pain. Heart racing. Mind racing. Constant shivering. Cold sweats. Goosebumps. Diarrhea. Vomiting. Minutes feel like days. Too tired to know if you’re dreaming or still awake. Punishing muscle aches and manic thoughts are your constant companions, each one screaming at you to take the pain away.
If you can get through 120 hours of that, then the hard part begins, because all that time dopamine was acting in front of the camera to make you feel good, it was also hard at work behind the scenes cementing the brain pathways that make changing habits so goddamn difficult.
At this point, if you’re confused about what dopamine actually is, you’re not alone. Luckily, the Internet exists, and in a superb Slate article (that you should absolutely read if you’ve made it this far), Bethany Brookshire explains the mechanisms of dopamine in depth, while also pointing out how it’s been labeled many different things in its quest to become the sexiest neurotransmitter on the market…
All abused drugs, from alcohol to cocaine to heroin, increase dopamine in this area in one way or another, and many people like to describe a spike in dopamine as “motivation” or “pleasure.” But that’s not quite it. Really, dopamine is signaling feedback for predicted rewards. If you, say, have learned to associate a cue (like a crack pipe) with a hit of crack, you will start getting increases in dopamine in the nucleus accumbens in response to the sight of the pipe, as your brain predicts the reward. But if you then don’t get your hit, well, then dopamine can decrease, and that’s not a good feeling.Bethany Brookshire (Slate)
Many seasoned addicts will tell you that the best high isn’t how you feel when you do the drug; it’s the way you feel just before. As Brookshire’s quote above illustrates, this is because dopamine isn’t just released when you ingest your drug of choice, it’s also released when your brain gets a signal and predicts it’s going to receive a reward. For Pavlov’s dog, the signal was the bell, and just like our canine friend our physiological functions don’t wait until the food is in our mouths to kick off.
Let’s say the signal we get is the smell of brownies…
If you’ve got the same sweet tooth I do, once that delicious scent hits your nose your brain starts releasing a large amount dopamine in anticipation of the reward. Now imagine that right after you smell the brownies you remember that you’ve decided to give up sugar for the month. Again, if you’re like me, you’ll initially feel devastated, then immediately start justifying all the reasons why a single brownie doesn’t break your diet.
The devastation comes from the quick drop in dopamine and the justifications resonate because each one releases a little more dopamine back into your system as you get closer to convincing yourself to eat the brownie. Now imagine you’ve battled back and forth with your hangry mind and resolved to have “just one,” and then you walk into the kitchen to find this…
That crushing feeling you get is in response to the rapid decrease in dopamine when you realize that the signal (smell of brownies) predicting your reward (the happy chemicals released when you eat a brownie) was in fact a dustbin of disappointment. Now, you’re not only feeling crummy (no pun intended), but also obsessing about brownies. At this point, most of us would resolve to go to the store and grab something chocolate-y to satisfy our cravings. Who knew what we were really searching for was dopamine and not dessert?
Because addicts set their entire lives up to enable their addiction, the whole world smells like a brownie. The table where you used to snort the pills. A twenty dollar bill. Your cereal spoon. A bathroom stall. God forbid you had the misfortune to have a partner or friend that partook in drugs with you. Once sober, their presence reminds you of a needle ready to take your pain away the moment you relent.
The biggest bitch of all is there’s no real timeline for how long these psychological cravings will last. If you’ve ever tried to eat healthier, how long did it take until you slipped up and went back to your old habits? Did you ever get over your cravings, or do they still come back from time to time?
Those cravings were in response to the anticipation of the natural amounts of opioids your body would produce. With heroin or OxyContin, addicts are battling against a predicted reward a million times more miraculous than any salted caramel cookie ever could be. But giving in for them doesn’t mean loosening their belt by another notch.
It means death or rehab. And over the past decade it’s increasingly become the former (see statistics in Part One – The Opioid Epidemic).
In her heartbreaking memoir about her brother Harris’s struggle with heroin addiction, Stephanie Wittels Wachs recounts a text message conversation where he talks about making the switch from OxyContin to heroin.
When you understand the progression of addiction and the physical and psychological hold opiates take on you, it becomes easier to see how the decision to switch to heroin could be as practical as, “It’s cheap and pills are hard to come by.”
At the time of his addiction, Harris Wittels was a writer-producer on the hit show, Parks & Rec, and was in the middle of creating another show with Aziz Ansari that would eventually become Master of None.
To everyone else, he was living the American Dream.
A regular on the podcast circuit, Harris was interviewed on You Made It Weird with Pete Holmes in November of 2014. During the interview, he shared his struggles with heroin addiction and recovery. The conversation is equal parts harrowing and hilarious. I highly recommend listening to it for anyone who wants insights into the mind of an addict.
What Pete and the listeners didn’t know was that Harris’s recovery wasn’t going so well. Stephanie recounts her feelings about listening to her brother on the podcast saying, “While I applauded his candor and could see from Twitter that he was inspiring the masses, it was infuriating to hear him talk about his sobriety when I know he was using again. The whole thing made me sick.”
Harris had become part of the 90% of opiate addicts that relapse. Still, he assured his sister it was a temporary slip up and that he was back to being clean and sober.
During a standup at The Meltdown a few months later, Harris once again spoke of being sober and said he was in “a good place.” Fellow comedian and friend Steve Agee, who was in the audience, tweeted one of Harris’s lines from the show…
He wouldn’t have to go on trying to avoid thinking about death much longer. Hours after the show, sitting on his couch in his Los Angeles home, Harris Wittels died. The cause of death was listed as “acute heroin intoxication.” He was 30 years old.
It wasn’t long before the tributes poured in from fans and friends. Here’s how some of his peers referred to him…
- “The funniest person I ever met.” – Amy Poehler
- “He was so loveable even when saying the most disgusting things.” – Aziz Ansari
- “One of those golden boys who everything went right for.” – Scott Aukerman, creator of Comedy Bang! Bang!
- “Basically the funniest person I ever met.” – Alan Yang, co-creator of Master of None
- “The smartest thing I ever did was hire Harris, and the second smartest thing I did was realize how much I had to learn from him.” – Sarah Silverman
One of the most painful parts of addiction is that the addict is unable to derive any joy from these “stupid, human interactions” that mean so much to those around them.
Harris is not an anomaly. He’s your best friend, brother, next-door neighbor, the guy you pass on the street each day to work. You’d never know they’re an addict by looking at them, and they’d never tell you.
Which is why us addicts need to tell our stories (you can read mine here). By keeping them secret we remain complicit in maintaining the illusion that this type of thing can only happen to those types of people. But by telling them, we de-stigmatize the notion that addicts are weak-willed, hopeless junkies just looking to get high.
Stories Make Us Stronger
“Sometimes you can only find Heaven by slowly backing away from Hell.” – Carrie Fisher
When I was at the depths of my addiction it was an old Internet chat room for heroin and OxyContin addicts that helped me pull through. I remember pasting quotes throughout my room from people who’d made it out the other side. They were the only thing I had left to cling to when I’d justified every other reason to use again.
Now, there are communities on sites like Reddit where people share stories of success and commiserate their failures. Posts like The Suffering of Addiction allow addicts to realize they’re not alone and there are countless inspirational posts letting those still at the depths of their addiction know that it does get better. And sometimes that’s all it takes to make it through another moment of suffering until things start to feel a little better.