This Is Your Brain on Opioids: Tips on Understanding Addiction and Recovery

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According to Neurologist and Addiction Medicine Specialist Dr. Russell Surasky, addiction is a complex, chronic disease with a lifelong risk of relapse. Fortunately, as we have developed an understanding of how opioids affect the brain, we have seen the introduction of treatments that can reverse the neurological damage and support a permanent recovery.

Dr. Russell Surasky

Understanding how opioids change the brain helps us understand why it is so challenging for an addict to simply stop using drugs.

Despite the broad reach of opioid addiction into every segment of the American population and its heartbreaking effects on individuals and families, most people know and understand little about how opioids wreak havoc on the brain and why the cycle of abuse is so hard to break. In 2014, almost 2.5 million Americans suffered from substance abuse disorders involving opioids, about 80% of them involving misuse and abuse of prescription pain relievers such as hydrocodone, oxycodone, morphine, codeine, and fentanyl, and about 20% involving the illegal drug, heroin.1 “Understanding how opioids change the brain helps us understand why it is so challenging for an addict to simply stop using drugs,” says neurologist and addiction medicine specialist Dr. Russell Surasky with Surasky Neurological Center for Addiction. “Addiction is not a moral failing. It is a complex, chronic disease with a lifelong risk of relapse. Fortunately, as we have developed an understanding of how opioids affect the brain, we have seen the introduction of treatments that can reverse the neurological damage and support a permanent recovery.”    

Dr. Surasky offers the following tips to help people understand more about opioids and what they do to the brain:

What are opioids?
The term “opioid” is generally used to refer to both drugs derived from the opium poppy, such as morphine, codeine, and heroin, and synthetic drugs that produce similar narcotic effects such as Oxycodone and Hydrocodone more popularly known as Percocet and Vicodin. Opiate receptors are found in the brain and spinal cord. They significantly reduce the sensation of pain but also play an enormous role in the way we feel mentally and emotionally. They cause an overall feeling of “well-being”. They significantly reduce symptoms such as depression and anxiety. Opiates also cause negative symptoms including drowsiness, nausea and constipation. The human body naturally produces its own substances (“endogenous opioids”) that act in similar ways to modulate pain and also regulate life-sustaining functions such as the need for food, water, and sex. Endogenous opioids trigger the brain's reward center to produce feelings of pleasure when these vital needs are satisfied. “Opioid drugs stimulate the reward system just as endogenous opioids do,” says Dr. Surasky. “They produce a euphoric effect and over time rewire the brain to pursue that effect as it does a basic life need, making the individual as powerless to resist the impulse to take more drugs as he or she is to resist the need for food and water.”

How do opioids act on the brain?
Opioids attach to proteins called “opioid receptors” located on nerve cells in the brain and stimulate them to flood the reward system with dopamine and other substances that reduce pain and produce pleasurable feelings. Opioid drugs act on the same receptors as our own endogenous opioids but their chemical composition may produce a more intense effect. “Opioids prescribed for pain are powerful aids in relieving suffering,” says Dr. Surasky, “but they have great potential for misuse and become dangerous and addictive when taken to excess or for non-medical purposes.” Drugs overstimulate the reward system, producing not just a calming, pleasurable feeling but the euphoria that characterizes opioid abuse. When the drug wears off it detaches from the receptors and the brain signals the need for another dose.

How can opioid addiction be successfully treated?
After as little as a few weeks of use, opiates 'hijack' the brain to the point that it needs the drug for survival and the compulsion to continue taking the drug becomes overwhelming. “Withdrawal and counseling aren't enough,” says Dr. Surasky. “Unless the neurological changes to the brain can be reversed, those cravings may persist for a lifetime. One of the newer and most effective treatments is Vivitrol®, an extended-release medication that is injected once a month and immediately stops cravings.” Vivitrol is a safe medication that that helps the brain to heal from the changes that have occurred during the drug use. Vivitrol itself is not an opioid, is not addictive and does not cause dependence. A patient who has been treated with Vivitrol and then takes opiates anyway will not feel high. Dr. Surasky states “people who are treated with Vivitrol but then take opiate drugs do not get sick or high, absolutely nothing will occur. Patients quickly learn that they might as well throw their money in the garbage before spending it on these drugs.” Treatment is individualized for each patient to ensure that the psychological and behavioral aspects of the disease have been adequately addressed and the individual has developed the life skills needed to remain drug free.

“Drug addiction destroys lives and families,” says Dr. Surasky. “Medication-assisted treatment can heal the brain by undoing the neurological damage opioids have inflicted and along with ongoing behavioral therapy offers patients a lifeline and the hope of a permanent recovery.”

1 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf

Vivitrol® is a registered trademark of Alkermes, Inc.

Russell Surasky, FAAN, ABAM, with Surasky Neurological Center for Addiction, is board certified in both neurology and addiction medicine, and is one of the few physicians with this combination of credentials. His primary focus in practice is addiction medicine. Utilizing unique medication protocols individualized to each patient, he provides specialized treatment for opiate, benzodiazepine, and alcohol addiction. http://www.drsurasky.com

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