The basis of our life is that we are driven toward things that provide us pleasure and away from things that cause us harm. These can be realized or construed in multiple ways — something could bring an immediate feeling of pleasure or a slow return of satisfaction of achieving one’s goals; something could harm us immediately or be a feeling of more prolonged pain. The signals get twisted when what brings us pain or discomfort also is something from which we can derive pleasure. Examples abound including unhealthy relationships, difficult work situations and even drugs and alcohol. Only drugs and alcohol have an intense neurotransmitter surge which amplifies our results and our response to the use — only to also amplify the response of its absence.
When we speak of addiction, a person becomes isolated from the community and into a loop — of response to substance and of withdrawal — an intensification of pain — without it. The opiate receptors are prepared for heroin which elicits a strong, unnatural response. From the initial use to frequent use afterwards, the brain adjusts to the chemical by down-regulating, or reducing, its receptors. The person can no longer flood the dopamine centers for a pleasure response and can only slightly reproduce the initial by flooding it with higher levels — known as tolerance. A rat will continue to administer itself heroin if it can press a bar until it kills itself. This is exactly what occurs with drug abuse. A person will subject themselves to no community ties – homelessness – to subsist in the vicissitudes of addiction – and lose himself/herself in the exchange.
In the context of how we as humans function and how we all can derive great benefit from each other, a great message is found: that when humans work together, they are capable of doing more together than when they work as silos – and that we need each other as a community. Therein lies the framework of love and how it became reinforced in humans – reaping more benefit from working as a community – when mutually giving and depending on one another.
It is at the time of tolerance that an interesting phenomenon occurs. The opiate curve of euphoric response after heroin stimulus flips on its axis and becomes a curve of hyperalgesia, or intense pain, before opiate use to normalize the pain. In plain words, heroin or a pain medication actually begins to “induce” pain.
Heroin and meth addicts frequent the hospital and often require infectious diseases consultation for post-drug rendezvous infections, such as abscesses, septic pulmonary emboli and endocarditis (heart valve infections). It is common that when they are going through withdrawal, there is very little we can do for them — many will not let doctors or nurses lay a hand on them to examine them. I remember a time a user with a “fever of unknown origin was oblivious to a lower back abscess”, when he resisted an exam. I sit with many of them when there is greater calm after withdrawal. They become different – the deeper person that was hiding or captured in loop – starts awakening again. They are no longer an automaton to the drug.
Ok … here it gets more personal and may evoke emotions. Think of the times in your life when you have had challenges – pains of separation – maybe from a marriage or long-term relationship – when you felt judged harshly or ridiculed — when you injured yourself – maybe broke a bone. We often yearn for understanding and counsel during those darker times. However, in the brain of an addict, a thirst for the drug awakens again – as if a wolf-in-sheep’s clothing it taps on the door again.
Many may immediately react to someone who is in this “drug trap” as not being intelligent enough to realize. I sometimes catch it going through my mind when I see a smoker take a puff into his tracheostomy or an ex-addict clean for 2 years after being diagnosed with a life threatening condition and has heart valve surgery uses again after their mother dies. Why would they go back if something was so harmful and trapped them?
The answer is that with addiction there is no chance for reason. The brain uses the body in any way to “connect the dots”. It is because these cycles occur even before our cerebral cortex has a chance to interact with intelligent avoidance. The mesolimbic pathways (or rewards pathway) includes the nucleus accumbans which leads to dopamine transmission as it is activated after pleasure-generating activities like food, music, exercise — but it is amplified with drugs. Our senses send signals to this area for the experience of pleasure and link to our hippocampus for memories and amygdala for pleasure reminder. It goes to the allure of pleasures and pains – it goes to the fact that our brain forms loops or neural signals that link an image, a smell, a feeling with an action. If it fires, it wires — after being a usual coping pattern — the cravings come back during really high times (times of elation) and really low times (times of depression).
What is love? Is it an outpouring of dopamine, vasopressin and oxytocin that generates pleasure, bonding and belonging? These are some of the neurotransmitters involved. Maybe it is a pause – just enough to prevent relapse – just enough to prevent a first try. Love allows you look to take a look at the bigger picture – the future plans – and yourself in the context of a greater good? All successful rehab programs involve some form of group interaction: the addict – interacting with others to share their story and their past trauma.
These are things that I remind a user when they are withdrawing — the physical aspect will settle usually in 3 to 5 days – the aftermath is the prolonged psychological adjustment — a hole that is left. They may feel like they are looking into an abyss — re-living these experiences and feeling alone and isolated.
The deficiency of activity that occurs after chronic use of methamphetamine, for instance, gradually recovers through time. With that recovery, comes new wiring in the brain – there is an ability to experience pleasure naturally, the ability to form bonds and an increase in discipline. The brain is forever marred by the drug-loop – those wires reduce in firing but it will forever be a stress-coping option that the brain presents to the conscious state, as if our own brain is sabotaging us.
Recovery from traumatic experiences – recovery from drug abuse – recovery from death of a loved one – all represents times in which our brains are capable of changing of building new pathways – a phenomenon known as neuroplasticity. It is the same mechanism when someone who is blind, with an atrophic visual cortex, develops sensory improvement with hearing and depth perception and other senses. The brain changes – it grows to these pressures. So too does our brain change in the setting of recovery — a triumph.
Love fuels these efforts. The wires build as one learns that they can trust again – that they will not be thrown into pain of isolation or rejection. It reminds one that they are not alone – that they are not failures – that they can free their shame. The more that we love – the more we are capable of loving!
The message: We are not captive to our past, although it defines how who we are now – and we are not captive to some future fate – as we can address ourselves NOW to whom, the best of ourselves, we would dream to become. Love grows as one recovers and, in turn, we become better at loving others.
Attached is a link to a song — one that really fills my heart with joy as I think about how far I have come this year — in my efforts to become a bridge of love to others.
For more information regarding our emotions, David Staub has a great website with articles at 4SightModel.com