When people use the powerful opioid, they actually rewire their brains — short-circuiting their pleasure and reward centers, making heroin their greatest pleasure.
To treat heroin addicts, medical professionals have to address not only a rewired brain, but a raft of social, psychological and spiritual problems that heroin users have acquired through their addiction.
"It is so complicated because the disease is so complicated," said Dr. Jennifer Michaels, who treats patients through the Pittsfield-based Brien Center for Mental Health and Substance Abuse Services.
Michaels and other doctors say heroin affects the primitive center of the brain, where we learn that social interaction, love and sex are pleasurable.
In a non-addict, spending time with a loved one will trigger the release of dopamine — the chemical that makes us feel good.
In an addict, heroin hijacks that reward system so that nothing is as pleasurable as the drug. Where sex might register a five on the reward scale, Michaels said, heroin would be a 50.
As a result, the addict's life becomes solely about getting and using heroin. To the non-addict, this behavior — choosing to spend time with a drug dealer instead of one's children, or stealing from a parent to buy drugs — seems illogical, but for the
Studies show that the same part of the brain that tells us we need salt or water is the same area that directs an addict toward his or her craving for heroin, according to Dr. Alex Sabo, chairman of Berkshire Medical Center's Department of Psychiatry and Behavorial Sciences.
To deal with such a strong addiction, Sabo said, professionals have to address an addict's mental, biological, social and spiritual needs, and essentially "rewire their brain back to what it is meant to be."
It isn't an easy task, according to Francesca Speicher-Cote of Keenan House, a substance abuse treatment center in Pittsfield.
"There's no other disease we treat with such pessimism," she said. "This is a chronic lifetime illness. There is no way I can say this person is going to make it and this person won't."
Someone using heroin or any of the many pills that are its chemical cousins — including OxyContin, Hydrocodone and Percocet — build up a tolerance. It takes more of the narcotic to produce a pleasurable effect, and not having enough leads to symptoms of withdrawal, often described as like having the flu 10 times over, with aches, vomiting, diarrhea and feelings of hot and cold.
Addicts find an ever-shrinking window between the amount of drugs it takes to satisfy their tolerance level and the amount it takes to overdose, said Donald Scherling, who heads the McGee Unit of Berkshire Medical Center, the only inpatient substance abuse treatment facility in Berkshire County.
Scherling said 40 percent of those in drug rehab in Berkshire County in 2004 were there for opioid abuse. The figure was up from 10 percent in 2002.
People trying to quit opioids for the first time are usually urged to attempt it without any medication. That means gradually tapering the amount of the drugs they take until they quit entirely. It also means participating in counseling and 12-step programs such as Narcotics Anonymous.
Other addicts will go into inpatient detoxification, such as the one at McGee.
There, heroin is replaced by methadone, a long-acting opioid that works on the same receptors in the brain. The methadone dose is low, however, and reduced every day, so the patient still suffers through much of the pain of withdrawal. To ease that, many patients are prescribed Clonidine, a blood pressure medication that blocks the production of adrenaline, which causes many of the withdrawal symptoms.
After six days of detox, patients are discharged. But their return to the real world is seldom easy; many arrived homeless or become homeless because they don't want to return to the house where they were using drugs.
Until four years ago, patients graduated from the detox program into a six- to 10-day inpatient stay that gave them a chance to stabilize before they were released. Because of cuts in the state budget, that program was eliminated.
Now, Scherling said, the McGee Unit tries to place patients in residential facilities where they may not have medical care but at least have access to group therapy and counseling.
But there is more demand for those beds than there is supply, he said, and it often is difficult to find a place for recovering addicts to go after they are discharged. Many, he said, end up back on the street, where their chances for success are greatly reduced.
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