Addiction: How Choices Turn To Disease

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**Editor’s note: The students of WOUB News’ Investigative Unit are looking into the heroin epidemic of Southeast Ohio. This article is the first in a series of stories chronicling the situation and what steps are being taken to combat it. Be sure to follow @WOUBNews on Twitter and “Like” our Facebook page to stay up-to-date with our stories.

No matter how addiction begins, officials and recovering addicts say the ability to control their use disappears once the disease takes over.

The American Society of Addiction Medicine’s latest report, out this year, defines it as “a primary, chronic and relapsing brain disease characterized by an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

In other words, local experts say addiction is a brain disease, not a failure in morality nor a behavioral problem.

“All of us have a normal level of how happy we are, or how many chemicals are running around in our brain,” said Dr. Melinda Ford, an Addiction Medicine physician who runs an addiction clinic in Athens, Ohio. “Once you’ve messed that up with the drugs, you’re going to feel horrible without them because you’re going to feel like everything is just missing.”

It’s important to note people do not use drugs with the intention of becoming addicts, as two recovering addicts told WOUB. Instead, people might start using drugs and soon– very soon– find themselves unable to stop.

“In the beginning, though, it is something you choose. I mean, the very first time you use you’re not an opiate addict, so you do have your choice,” said Jason Leach, who is in recovery through a program at the Athens County Prosecutor’s Office. “Then after a while… you get dependent on it.”

The director of the recovery program knows the choice has been taken away from those entering his office.

“Not one person has ever told me they want to be an addict,” said Reuben Kittle, a Diversion Director and Felony Investigator in the Athens County Prosecuting Attorney’s office. “It’s not about having fun, it’s not about getting high. It was literally about surviving the day.”

The recovery program uses Vivitrol for its medication-assisted treatment. Vivitrol is an injected drug which manages the cravings connected to addiction.

The deadliest dependency according to recent studies is heroin addiction. In a June 2016 National Heroin Threat Assessment Summary conducted by the Drug Enforcement Administration, America saw a 248% increase in drug poisoning deaths involving heroin from 2010 to 2014. Heroin overdose deaths now equate to 22%– about 10,500 per year– of overall drug overdose deaths per year.

Heroin’s effects on the user, though, can vary drastically, medical experts say.

“It’s going to be a little bit different depending on what they started with, as far as risks,” Dr. Ford said.“The brain response can be nothing more than sort of feeling like you’re sort of drugged out, or, for people who have a big genetic risk, they feel that this is the greatest experience they’ve ever had in their life– about 10 times stronger than how you would feel when you’re having sex.”

The genetic risks range from having a prolonged family history of addiction, having pre-existing conditions that make the user’s brain respond differently, to even stress.

“People who are under stress at the time the drug is introduced are much more likely to become addicted to it and to have that surge,” Dr. Ford adds. “It also depends on how addictive that first thing they use is. So, heroin is a bigger risk [compared to] alcohol because there’s not as big a rush of chemicals from that.”

Despite the dangers associated with heroin use, its use has increased. The Service Abuse and Mental Health Services Administration reports 435,000 people aged 12 or older were current heroin users in 2014– that’s the highest since 2002, when the administration began keeping record.

The risk differences are significant, with 23% of individuals who use heroin becoming addicted to it, surpassing the 17 percent who try cocaine, 15 percent who try alcohol and 9 percent who try marijuana.

Megan Clark, also a recovering heroin addict said, in her experience, heroin gets you higher than anything else.

“[The rush] is really hard to explain,” Clark says. “It’s like a warm blanket that covers your body. It just numbs you from everything. Even though you’re nodded out and probably sleeping… it’s just something that I liked, as an opiate addict.”

Dr. Ford attributes the rush to a chemical called dopamine.

“When that is flooded through the system, nothing can ever peak that high again. The brain starts to, over time, actually need the drug to even keep a normal level of dopamine,” she explains.

This is why, Ford says, addicts say they never reach the intensity of their first high ever again.

“Tolerance gets high real quick,” Clark says.

Leach agreed, saying the first few times a user takes heroin, they are typically cautious.

“The first, second, third time, you’ll use an amount and you’re like ‘Alright, I don’t wanna use no more than that ‘cause I don’t wanna overdo it.’ But then once you do it a couple times you’re like ‘well that ain’t workin’’ so you gotta do a little bit more.”