Summary/Abstract

For a long time, society viewed addiction as a moral failing. The addict was seen as someone who simply lacked self-control. Today, thanks to new advances in brain imaging and other technologies, we know that addiction is a disease characterized by profound disruptions in particular routes — or circuits — in the brain. 

Content

Stas Novitsky thought moving 600 miles away would help him resist the urge to use heroin. It didn’t.

Part of him desperately wanted to stop using because it was messing up his life. But that was no match for the intense urge, the compulsion, the need to get high.

At one point, he was using alcohol, cocaine and heroin on a daily basis, he said. Even when, after a time in treatment, he stopped the first two, he couldn’t kick heroin, which is considered one of the most addictive substances there is.

“It was bad. I was living in ruins. I was couch surfing, staying with whoever trusted me at that moment, bouncing from place to place,” said Novitsky, 27, who grew up in western Henrico County. “I didn’t have any stable anything. A lot of my friends had died or gone to jail. The people I did spend time with, I don’t know why they helped me.”

Scientists say addiction is a disease, and that substances like heroin, cocaine and alcohol, in some ways, take the brain hostage.

Using imaging technology, researchers are able to see that areas of the brain show more neurotransmitter activity when an addict gets high. It’s the same system—the reward system—that’s gets activated during other pleasurable activities, such as eating and sex.

Based on that theory, every time Novitsky used heroin, his brain was flooded with a chemical called dopamine, making him feel good. His brain remembered that feeling and drove him to experience it again and again.

 ADDICTION IS UNPREDICTABLE

Not everyone who uses an illicit drug becomes addicted, but there is no sure way to predict who will or won’t.

“Addiction begins in the brain, and we have to think of it as a brain disorder,” said psychiatrist and addiction expert Charles O’Brien, one of the speakers last fall at a University of Richmond conference on addiction. “The reward system is the part of the brain that makes us feel good, that pretty much makes us feel like we’ve achieved something, and it gives us motivation. And it’s very important for formation of addictions.

“We are essentially going around our daily lives trying to achieve some activation of this system. In a very molecular way, we are trying to increase dopamine in our reward system,” said O’Brien, whose work helped lead to the drug naltrexone being used as a treatment for alcoholism.

People may start off using drugs just to see what it’s like, to experiment, said Robert Balster, a pharmacologist and addiction expert at Virginia Commonwealth University.

“As people keep using drugs, then the brain adapts,” said Balster. 

“It produces tolerance, or changes or adaptation in this brain reward system,” he said. “The pleasurable effects start to diminish. Now people are taking drugs in order to prevent feeling bad. It’s a different dynamic.

“As the addiction process goes along, mainly they are taking drugs to avoid getting sick from withdrawal.” 

One federal report estimates there are 2.1 million people in the U.S. addicted to prescription opioid pain medications and more than 460,000 addicted to heroin. 

‘I ALMOST DIED’

“I could still find drugs wherever I went,” Novitsky said. He was 24 years old and in the throes of addiction when he went to Boston in 2013 to live with a relative, thinking a change of scenery would help him get free of heroin. 

“As soon as I went to Boston, I found drugs within my first four hours of going into the city,” he said. 

Novitsky stayed in Boston for four months before returning to the Richmond area. He got a job through a temp agency working at a landfill, picking up trash that blew off trash piles. 

He worked to have money to buy drugs. That wasn’t always enough, so he turned to crime. He got busted on a petty larceny charge and was sentenced to three months in a Henrico jail.

Even behind bars, he managed to get drugs but got caught and was put in isolation.

“I detoxed cold turkey in the jail,” he said. 

The day he was freed, he went immediately to buy drugs, selling plasma, a component of blood, to get money. 

“I had obsessed about it the whole time I was incarcerated,” Novitsky said.

“I still had this desire to use,” he said. 

“I got high off of a point, which is a tenth of a gram. And I overdosed on it. My mom found me in my room that next morning. 

“When the paramedics arrived, I was down to four breaths a minute. 

“I almost died.” 

‘you can’t just turn it off’ 

Anything that activates that reward system can be addictive, O’Brien said at the UR conference on addiction. Gambling is classified as a behavioral addiction in the American Psychiatric Association’s manual of psychiatric disorders. 

“Gambling causes very intense activation of the reward system,” O’Brien said. Plus there is “tremendous relapse, tremendous loss of willpower, which is another cardinal symptom of addiction. Because once it becomes learned, you can’t just turn it off. The drug, the behavior, becomes the director of what’s going on in your life.”

There is something about the adolescent’s still-developing brain that may open the window to addiction even wider, which is why prevention efforts focus on getting teens to just say no. 

“Sometime in my senior year, I started experimenting with drugs, partly to fit in and partly because the people I idolized were heavy drug users,” said Novitsky, who was sophomore class president and a captain of the soccer team at his high school.

Marjorie Yates, also in long-term recovery, said she too started experimenting with drugs and alcohol as a teen. By age 17, she was drinking every day, she said.

“As soon as I experienced the release and the euphoria that came from alcohol and drugs, back then I never wanted to be without them,” said Yates, who is acting director of the nonprofit Substance Abuse & Addiction Recovery Alliance of Virginia, which offers programs and resources for people in recovery. 

“It was the only medicine God gave me. That’s how I looked at it,” said Yates, 55, who has been in recovery since March 2005.

At the Substance Abuse & Addiction Recovery Alliance office in Richmond, recovery classes are held daily, and a bank of computers along a wall are available to clients to use for job searches. 

Yates advocates for more funding for treatment so that when addicts call or show up at publicly funded community services boards or such agencies as the Alliance for help, they are not put on a waiting list and told to come back in weeks or months. Recently, the Obama administration’s proposed budget for fiscal 2017 included $1 billion in new funding over two years to expand access to treatment for prescription drug abuse and heroin use. 

“What is particularly exciting is Obama’s designation of $920 million to help states provide medication-assisted treatment,” said Yates. 

“I see opiate addicts every day. People want help. It’s not available unless you have a lot of money and good insurance,” Yates said. “We need free, accessible treatment for people.” 

RESETTING THE BRAIN

Environment matters in addiction, but so do genes. How much the tendency to become addicted is inherited is not known. 

As a clinician, psychiatrist Martin Buxton said he is hard-pressed to find someone he is treating for addiction who cannot identify other family members with the problem.

But part of the challenge of teasing out the genetic link is that “sometimes you have a child of an alcoholic who says, ‘I’m never going to drink.’ They never develop or manifest addiction problems. ... They carry their addictive propensity quietly, unnoticed,” Buxton said. 

Families with a history of addiction should talk about it, but many keep it a secret, he said. 

“Part of the public health intervention would be to have families talk about the predilection for addiction like we talk about predilection for diabetes and heart disease and those things,” Buxton said. “You are not going to be able to stop it necessarily; this is what is so painful to parents. ... But at least plant that notion that other kids are going to be using, most of them will be OK, but in our family this is how we get into trouble.”

Can you reset the addicted —the hijacked—brain back to normal? 

“You can, but it takes a lot of work. But you have to get your life in order,” Buxton said.

“You have to understand what recovery is,” he said. “You have to figure out what your triggers are. You have to figure out what the risk places are for you. You’ve got to straighten out your personal life. Those are all stresses that will push you back towards addiction. What you are doing is you are buying safe time.” 

Relapse can occur days, weeks, months or years after sobriety. 

At the McShin Foundation, a nonprofit recovery program in Henrico, Novitsky tries to be an example and guide. After he got out of jail and the overdose in January 2014, he was presented with options—go into treatment or go back to jail on charges of possession of heroin and drug paraphernalia. 

He went to Florida for treatment. When he returned to the Richmond area, he started living at a McShin Foundation recovery house. He began running recovery groups, which developed into what he is doing now at McShin, working with youths in high school and college. He has been in recovery since May 2014. 

“Now that I am in recovery and helping kids to not make a mistake, I pretty much live and breathe recovery,” Novitsky said. 

“Addiction can affect anybody. ... There is not just one reason. There are lots of reasons.”