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The science of addiction

A look at dependence, tolerance, withdrawal and other aspects of addiction

By Daniel Dunkle | Jun 21, 2010

Addiction to prescription painkillers or street drugs such as heroin is a chronic disease for which there is no cure, according to drug counselors.

For most drug users, fighting addiction and finding recovery is a lifelong battle.

Opiates and opioids are among the most addictive drugs in existence. Opiates are natural painkillers derived from opium or the poppy plant. Opioids include natural and synthetic painkillers. Drugs that fall into these categories include heroin, methadone, OxyContin, oxycodone, Vicodin, Percocet and morphine.

Dependence

A user can develop a physical dependence on these drugs within about three weeks.

“The fact of the matter is that anybody who’s taking even prescribed opiates for 30 days or more, if it’s much of a prescription, they’re going to be dependent,” said Mike Franklin, clinical director of the Turning Tide treatment clinic in Rockland. “They’re going to be physiologically dependent on the medication and they will experience withdrawals coming off of it.”

Licensed drug counselor Wesley Hohfeld of Eureka Counseling Services in Rockland offered an example of how someone can become dependent on drugs. He said a local fisherman might pull a muscle while working on the water. His doctor prescribes Vicodin and tells the fisherman to stay home and rest for 10 days. When the fisherman takes the medication, he feels better, so he goes right back to work.

Now, because he shouldn’t be straining that muscle, he really injures himself with a ruptured disk. This requires more pain medication and surgery. Then the patient ends up having trouble getting off the prescription drugs.

In many other cases, Hohfeld said, people start as teenagers experimenting with alcohol and marijuana before progressing to opiates or cocaine.

Withdrawal

Once they become physically dependent on drugs, users will experience withdrawal if they try to stop using the drugs. Withdrawal from opioids can cause diarrhea, cramps, shakes, sweating, sleeplessness and flu-like symptoms lasting up to 10 days.

People often continue using problem drugs because they cannot tolerate the pain and sickness caused by withdrawal.

Long-term use of heroin or prescription drugs alters the brain’s chemistry.

Opioids mimic endorphins, which are natural chemical messengers in the brain. Endorphins are secretions that have a pain-relieving effect. The opioids that enter the brain are similar in shape to endorphins and, like a key that fits in a lock, they fit into the circuits for pleasure in the brain.

The theory is that the body slows production of natural endorphins in opioid users, figuring it already has plenty of them coming from the opioid drugs. When the person stops using drugs, there are not enough endorphins to keep the addict’s mood stable, and depression takes over.

“So even though you’re not using anymore, you still can’t get your life back together because you feel like you can’t do anything,” said Kristan Hilchey, a Turning Tide patient who struggled with OxyContin addiction. “It’s like you’re still obsessed. You’re still depressed. You’re still sick every day. It’s impossible. It’s like being on chemo and trying to live your life.”

She takes methadone to treat her addiction and said she will probably have to use the drug for the rest of her life. Advocates of methadone treatment argue that once a doctor stabilizes the dosage, methadone does not cause a high or impair the user, but it does prevent drug craving and withdrawal symptoms, allowing the addict to live a normal life.

Methadone is a synthetic opioid that has been used for many years in treating addiction, but remains controversial. Critics argue it is just substituting one drug for another.

Craving

Craving is the overwhelming desire of the addict for the drug. Addicts become obsessed with seeking their drug of choice and find it difficult to focus on anything else.

Tolerance

Drug addicts develop a tolerance to opioids over time. This means they have to take more of the drug in order to get high.

This can create a danger for the addict. Take, for example, a man addicted to heroin. If he stays off the drug for a year and then takes the same dose he was taking 12 months before, he could suffer a fatal overdose. His body can no longer handle the same dose he was taking when he was using the drug regularly.

Addicts increase their dosages, trying to achieve a better high. This is why people sometimes describe addicts as “chasing their first high.” Their first drug experience is sometimes more pleasurable than later ones due to tolerance they have built up.

Detoxification

An addict can go to the Penobscot Bay Medical Center Psychiatric and Addiction Recovery Center in Rockport for detoxification. This is the process of going through withdrawal under a doctor’s care and staying off drugs long enough that they are completely out of the body.

Prescription pills versus heroin

When looking at the use of opioids, there has been a shift in recent years from street drugs to prescription drugs. State officials said about 90 percent of the drug-related deaths in Maine are caused by prescription drugs rather than street drugs such as heroin.

Maine Drug Enforcement Agency Director Roy McKinney said people erroneously believe there is less risk in using prescription pills than recreational drugs. “They think it’s medicine, it must be safe,” he said.

Without a doctor’s supervision, the use of prescription drugs can be dangerous, because addicts take the wrong amount of the drug or change the way it is administered to boost the high. For example, addicts will crush OxyContin pills and snort or inject the medication to defeat the drug’s slow-release feature.

The use of prescription medications can lead to heroin use. Someone can become addicted first to prescription opioids and then shift to heroin because it is much cheaper.

No one sets out to be an intravenous drug user, but the misuse of prescription medications can start a person on that road. A prescription opiate addict can use heroin or any other opioid to avoid painful withdrawals.

As with any opiate or opioid, the greatest danger with heroin is accidental overdose. Opioids are central nervous system depressants that slow breathing and heartbeat. Unlike pill users, heroin addicts often have to guess what dose they should take to get high.

Drug dealers frequently mix heroin with other, sometimes toxic, substances so they can sell more and make more money. If addicts assume the heroin has been cut with something else, and it is really closer to 100 percent pure, they risk taking too much and overdosing.

Injecting drugs and sharing needles increases the risk of HIV or hepatitis C. Even with clean needles, there is a danger of getting germs that live on the surface of the skin into the blood stream, leading to serious infections.

The danger of mixing drugs

Experts warn that mixing drugs is another danger.

Medications that treat anxiety such as benzodiazepines can be lethal in combination with methadone if a doctor is not directing the dosage and aware of all the drugs the person is using. (See related story on methadone treatment.)

In addition, experts warn that alcohol should not be mixed with any drug.

Franklin said mixing stimulants with depressants is also dangerous.

“When I was using cocaine, I used alcohol to take the edge off the buzz, and to come down off of it,” Franklin said. “When you mix a stimulant and a depressant, you’re jerking your system two different ways.”

Another common mixture of stimulants and depressants is the “speed ball,” which combines heroin and cocaine.

“If you’re using cocaine on top of your methadone, I call it a dry speed ball,” Franklin said.

Experts agree that most people cannot successfully battle their addiction alone. Addiction is an incurable disease and people need professional counseling and support to achieve recovery.

This article is not intended to provide medical advice. Anyone who has questions about how drugs might affect them, or the substances or medications they are using, should consult a doctor.

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