Comment; Great illustration of the origin of addiction in the brain!
By Jennifer Zampogna
New estimates from the Centers for Disease Control indicate 74,000 Americans died from drug overdoses in 2017, a 10 percent increase over 2016.
Responding to the epidemic, Pennsylvania has made commendable efforts to increase the availability and use of naloxone to reverse opioid overdoses.
The widespread use of naloxone is a linchpin to an emerging decline in overdose deaths in well-equipped communities. In the past four years, Pennsylvania police officers have saved more than 7,600 lives by administering this life-saving medicine. Emergency medical personnel have revived thousands more.
First responders often receive repeated overdose calls for the same address or person. Understandably, this may lead to frustration with the seemingly endless cycle of addiction and apparent unwillingness of many overdose survivors to accept desperately needed treatment. Empathy for those with substance use disorders may diminish over time, often leading to compassion fatigue.
As both a physician and a person in long term recovery from an opioid use disorder, I have perspective as a care provider and as someone whose rational brain was hijacked by this progressive disease. I speak from painful experience when I say I truly believed my use of prescription painkillers was under control, even when it became glaringly obvious to others that it was not.
Eventually, I came to realize that all the medical training in the world could not have prepared me for the battle I faced.
As a physician, it was important to understand what happened to my brain. What compelled me to act in ways incompatible with my values, to lie to others and myself? Why did I have zero insight into my behaviors and their consequences?Why was my thinking so distorted? Why couldn’t I just stop?
Scientific research provides many answers to these questions and suggests why someone who is revived multiple times with naloxone—facing death repeatedly—refuses interventions and continues the harmful use of drugs.
In the brain, directly above our eyes, the frontal lobe controls our executive functioning. This includes rational, logical thinking and decision-making in line with our goals and values, as well as considering consequences and controlling social behavior.
Compare this to the more primitive middle portion of the brain where our survival (fight-or-flight), emotional and reward systems reside.
This part of the brain evolved early in human development to keep us safe from ancient predators. It instinctively and instantaneously revs up the body, compelling us to flee as fast as we can from a serious threat. We don’t think about it; we just run. If we wait until the rational frontal lobe assesses the threat, we could certainly become a lion’s lunch.
The brain’s rational, critically-thinking frontal lobe and its emotional, fight-or-flight mid-brain communicate constantly. When they’re in balance, the frontal lobe acts as the brake pedal for impulses, while the mid-brain acts as the gas pedal, propelling us to act on fears and perceived threats.
A new Centers for Disease Control report paints a sobering picture of America’s drug abuse epidemic.
As a substance use disorder progresses, this delicate brain balance is lost, and communication between these two parts of the brain is significantly impaired. The rational frontal brain can no longer manage the impulsive mid-brain. The result is all “go” and no “stop.”
For people with an advanced substance use disorder, anything or anyone that comes between them and their substance of choice is perceived as the lion—an imminent threat.
The midbrain takes over as the analytic frontal lobe goes offline, and impulsive, irrational behavior can ensue. This often results in denial,ambivalence to or refusal of treatment and even aggression toward first responders.
Consider this: Why do lifeguards in training learn defensive maneuvers? Because a drowning person deprived of oxygen will claw his or her way over the rescuer with a singleness of purpose: to reach the surface for life-sustaining oxygen. It’s not personal; it’s an understandable human instinct.
When opioids become people’s oxygen, much like the drowning person, they will do whatever necessary to get the desperately needed substance, leading to sustained addiction.
My own desperation, negative consequences and ultimate hopelessness brought me to a breaking point, until I finally became willing to seek help.
In treatment, the opioids were purged from my system, and my rational brain started coming back online. I was able to gain insight into my addiction and begin my journey in recovery. The persistent compassion and encouragement of family and friends was vital to this process.
I understand why people, particularly first responders and health care professionals, may develop compassion fatigue during this opioid epidemic.
Still, I encourage them to consider the science—the “why” of addiction—when interacting with someone struggling with a substance use disorder. They make an impact every time they respond to an overdose call or interact with an overdose survivor. Their words and body language matter.
For people with a substance use disorder, disparaging words only compound their overwhelming shame and hopelessness; compassionate words plant a seed of hope that can blossom into long-term recovery.
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