Tolerance

The struggle that Adam and Eve discovered in the garden, on that fateful day when they ate the apple, was that they learned about something they were never intended to know. Much like the Adam and Eve narrative, when we use opiates our brain learns about something it never knew existed, the increased capacity to experience higher levels of dopamine output. If that sounds too clinical for you then let me make it simple; they (opiate users) discovered a higher, more intense level of pleasure than they ever knew possible. It is so powerful in its reward that it almost immediately sets a new default for pleasure that the brain will always try to attain again.

Our brain is amazing. It is very plastic and adaptive. When it sets its “mind” on something it obsesses on it (cravings/urges) and if we surrender to those cravings we strengthen our connection to that which we are craving.

In the case of the opiate user our brains, the pathways that support the natural endorphin production work just fine but compared to the new superhighway of heroin/prescription narcotics it pales in comparison. The brain is flooded with significantly more endorphins and the brain has to create new pathways and places for them to land. This causes the brain to change and actually grow new endorphin landing sites, which in turn requires more of whatever it is that is flooding the brain with larger amounts of dopamine. Repeat the process. This is called tolerance and the brain is designed to make this happen.

Meanwhile, the old pathways that the naturally produced endorphins use to travel and growing old and less used. Imagine old rural county highways that are overgrown with grass, wore out and crumbled, with cracks and dirt beginning to cover them. They are becoming less traveled because of the nearby superhighway that is allowing more endorphins to travel at higher speeds to the reward center of the brain. In time, nothing will travel on those old roads and if they do it is likely to get lost along the way.

So, what use to give us pleasure; sex, food, relationships, work, recreation, movies, candy, etc. now pale in comparison and no longer deliver what it use to. Now, try to imagine that for a minute…nothing gives you pleasure except the medication your doctor prescribed you for your back pain. You quickly learn the only thing worth pursuing is the next fix, because, as well talk about next, withdrawal is so bad you’ll wish you were dead.

Withdrawal

You’ve been using these pills for several months now. They no longer work like the use to because you’ve developed a tolerance and your doctor is starting to become concerned about the frequency of which you ask for refills and is beginning to talk about not prescribing them anymore. You start to panic and begin visiting different urgent care centers hoping to score some Vicodin.

Instead, you decide to just stop taking the pills. They are costing a fortune and you don’t like the feeling of needing them just to help the kids get ready for school in the morning. So you just stop taking them one day.

REVOLT!

The brain has become dependent on the level of medication you’ve been giving it daily for the last nine months. It shut down its own production of natural endorphins and now relies on you to give it what it needs to function normally, to just get out of bed and not hurt. When the brain revolts like this it makes you feel deathly sick. It is reported that you feel like you’re dying but it never comes.

Common withdrawal symptoms are:

  • Sweating
  • Nausea
  • Muscle cramps
  • Diarrhea
  • Cold sweats/fever
  • Tremors
  • Pain
  • Depression
  • Possible seizures

Your stomach and digestive system has opiate receptors as well and since one of the side-effects of opiate use is constipation, diarrhea would result when in withdrawal. These symptoms are so severe that they would drive you to temporarily suspend your morality and do things you never imagined doing, such as; lying, cheating, stealing, manipulating, breaking the law, becoming violent, all to get money to get more opiates so you won’t be sick any longer. The criminal behavior often associated with drug use is typically a function of the drug use not a personality or character flaw. Stealing and selling possessions, lying or coercing others to get money is simply to not be sick any longer and so they can just get up and take care of their family, house, job, etc.

It is here that sympathies break down. When someone addicted to opiates begins to steal from a loved one we tend to become less empathetic. It’s important to remember at this time that your loved one is suffering from a brain altering dependency on an opiate. Nobody grows up hoping to become a heroin addict.

The brain is a fickle organ. It wants what it wants when it wants it and when it gets it over and over and over again it changes its neurological make-up to accommodate it. This is the nature of a brain disease/disorder that has biological, environmental, behaviors, cognitive, and personality variables influencing the outcome of dependency. At some point the person dependent on opiates loses their ability to choose. They MUST continue to use.

*in our next post we’ll explore the role of medications like methadone and suboxone in helping someone overcome opiate dependency.

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