What causes addiction? A look at the science behind the cycle

Newsrooms across the commonwealth have spent years documenting the opioid crisis in their own communities. But now, in the special project State of Emergency: Searching for Solutions to Pennsylvania’s Opioids Crisis, we are marshalling resources to spotlight what Pennsylvanians are doing to try to reverse the soaring number of overdose deaths.

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After three years in recovery, getting high is still the first thing David Adamek thinks about when something goes wrong.

Despite all the good things now happening in his life, the voice in Adamek’s head still belongs to addiction.

According to the American Psychiatric Association’s most recent Diagnostic and Statistical Manual of Mental Disorders, addiction is a chronic brain disease marked by compulsive substance use and impaired behavior, including the ability to maintain relationships, take care of obligations at work, school or home, and to exert self-control. Relapse is part of the disease, as is recovery.

“There are many people that will say they tried (the opioid painkiller) Percocet, for example, and they could not stand the way it made them feel. But others will say things like, ‘The first time I took something I was in love.’ It’s that powerful,” said Dr. Michael Shore, the director of the American Society of Addiction Medicine region that includes Pennsylvania, New Jersey and Ohio.

Those people want to experience the feelings again and again, and they have a compulsive need to use more and more, regardless of the consequences, according to the National Institute of Drug Abuse.

“After a while, it doesn’t cause euphoria anymore,” Shore said. “They continue to use to feel normal, to avoid withdrawal.”

“It’s flu-like symptoms, but kind of feels worse,” Adamek explained. “Everything’s sore; you’re achy, your skin hurts. … Whatever is in your stomach comes out.”

People don’t want to experience that, so they seek out the substance again.

“You know if you go back to it you’ll feel better,” Adamek said. “You always think, just one more bag, or just one more pill, and everything will be better. Or you think you can wean yourself down.”

It becomes a cycle and gets worse over time, according to the 2016 Surgeon General’s Report on Alcohol, Drugs, and Health. It affects the prefrontal cortex, responsible for executive function such as decision-making, and it changes other parts of the brain as well.

“It becomes a major priority in your life,” Shore said. “Everything else becomes secondary.”

Adamek was prescribed opioid painkillers after he was shot in the hip 13 years ago during a tour of duty in Afghanistan with the U.S. Navy. When the prescription ran out, he said he began buying them illegally to avoid withdrawal and then in 2013 he began using heroin.

“I was able to keep my life — barely — together, pay the bills and stuff like that when I was on the pills,” the Delaware County native said. “Once I switched to heroin I didn’t care about anything. It didn’t matter. I didn’t care about the bills. I stole, pawned.”

Recovery is possible, Adamek stressed.

“Willpower can be what gets you into treatment. It can help you maintain your treatment, it can help you make changes in your life situation so you stay away from people and places where drugs are abused,” Shore said.

But willpower is not going to cure the disease, Shore said. Even those who have received treatment and achieved long-term recovery still can experience triggers and cravings that lead to a relapse.

Experts can’t tell exactly who will develop substance use disorder, but genetics and personal and family history increase risk.

Evan Resnikoff, chief of operations for Newtown Ambulance Squad and president of the Bucks County EMS Chiefs’ Association, has seen that the disease does not discriminate.

“It’s anybody; it’s in lower-income areas, it’s in higher-income areas,” he said. “We’ve been fortunate, we haven’t been called to a school around here for (an overdose), but it’s happened in other areas.”

 

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