EXPLORE THE IMPACTS
Opiates
Opiate use profoundly impacts the brain, body, and behavior, creating powerful cravings and physical dependence that are often misunderstood. These substances hijack the brain’s reward system, overriding empathy and self-control, while also masking emotional and social pain that the person may be unable to manage otherwise. Understanding how opiates affect the nervous system, behavior, and underlying trauma is essential for providing effective support. Compassionate interventions that address both the physical and emotional drivers of addiction, while building new coping skills, can help individuals safely regain control and reconnect with themselves and others.
Brain
Opiates increase dopamine in the brain by 400-600%. That is the good news and the bad news. The good news is that it is not enough to damage dopamine receptors. The bad news is since that is not enough to damage dopamine receptors, it tricks the brain stem into believing that you need that amount of dopamine to survive. One problem with that is that the brainstem is beneath the empathy center of the brain, which is housed in the limbic system. With you empathy center off line, you cannot think of anyone’s needs but your own no matter how much you love that person. This makes parents, or anyone charged with another’s care, extremely dangerous when they have cravings for opiates.
Body
Since opiates make the brian think it needs 400 - 600% more dopamine than is truly needed for survival, when it does not receive that amount, the brain literally thinks it is dying and creates all of the craving, cramping, sweating, and other nearly intolerable physical symptoms to drive you to do whatever you need to do to obtain the amount of dopamine it thinks it needs.
The painkilling effect of opiates work as well on emotional and social pain as they do on physical pain, which is what drives most people to them in the first place. It is not an accident that places with limited access to resources, social activities, safe housing, safe places to congregate, living wage jobs, and other social and economic limitations have the highest rates of opiate addiction. Shame releases the greatest amount of cortisol, a powerful stress hormone. This results in physical pain with no physical injury so no natural endorphins are there to decrease the social and emotional pain. Opiates work excellently for relieving that pain. The strong pain killing effect of opiates also decreases heart rate and lung capacity. This can result in death by overdose. The better the pain killing effect (or high) the closer the person is to death. The decrease in heart and lung capacity also results in something that is sometimes called, “the nods,” which is the person nodding off to sleep from drowsiness.
Behavioral Patterns
Stealing, selling of anything for money including one’s self unsafely, and one’s own children are not uncommon. People will engage in very unsafe actions to satisfy the cravings and ward off withdrawal. Eventually the withdrawal becomes so bad, people are working to avoid it more than obtain the high over time. It is important to remember that the part of the brain driving these cravings and withdrawal symptoms is the brain stem, which is beneath the empathy center, so even with the best of intentions that person will not have empathy for themselves or others. This makes them highly unsafe and unable to protect someone because they cannot put the needs of others ahead of their own.
Supports
Addiction treatment that includes volunteer work (the best way to obtain dopamine) and physical activity (the best way to obtain endorphins) will be helpful. It needs to also address the trauma that is driving the addiction.
As Gabor Maté says, “The question is not why the addiction? The question is why the pain?” The social and emotional pain driving the need for the pain killing medication needs to be addressed or you are asking someone to give up a coping strategy without eliminating their need for it.
When teaching new ways of being in the world and new ways of addressing cravings, it is crucial to use the 3Ps very concretely. The practice part must truly include actual practice of the new behavior, not just a discussion of it. The drive for the substance is in the lower regions of the brain that control procedural memory, which is memory based on action like riding a bike. To be effective, new behaviors must become procedural memories. Verbal or even picture memories cannot be accessed until procedural memory has been calmed, addressed, or replaced with a new way of doing things.
Addictions are addressing body memories (like trauma) not bad memories, which only exist in the cortex and not in the central nervous system (lower regions of the brain) where they are felt. Hence the drive for substance that decreases pain.