Modern medicine and medical professionals can do a lot of truly amazing things. There has never been a time in history where severe trauma can be so readily healed. But there are practical, real-world limits.
Medicine oftentimes takes a fully scientific approach to problems that can border on being obtuse. Humans are complex. We’re not thinking humanely when we say, “Oh, they’re depressed or anxious, so they just start taking drugs.” Or, “Oh, they’re genetically predisposed to mental disorders or drug use.”
The standard diagnostic and statistical manual definition of how people become addicted to drugs, specifically opioid addiction and similar painkillers often gets distilled to “dopamine”. As if substance abuse disorder can be blamed on something as simple as, “Cause it feels good”. This basic formula for opioid addiction and opioid dependence is too simple.
It is also unfair and inhumane to merely say, “There are multiple factors where people get addicted to dopamine and develop a drug tolerance and therefore take more and more.” Because the obvious question is: “Then how did they start? Why did they start?” And for some, “Why can’t they just stop?”
To help in our understanding of drug addiction, let’s understand these three questions.
How and why do people start taking opioid drugs and painkillers?
Let’s be clear: no one wants to become addicted to anything.
Gambling addicts don’t wake up one morning with the idea, “I think I’d like to develop a gambling habit” any more than people wake up and think, “I think I’ll develop a drug habit today.”
Multiple things can be true about substance abuse:
- In aggregate, we’re talking about broad generalizations, and there are always outliers from the statistical norms.
- Drug use, whether from heroin, painkillers, LSD, or any other drugs, can cause physical dependence and can result in a drug tolerance that can cause people to seek more.
- Medical professionals’ understanding of drug addiction is evolving, and there is a lot we still don’t know.
A more humane understanding of how and why people start taking prescription opioids, to name one of the most commonly abused drugs in America right now, requires we understand each individual, like these comments from a similar Reddit thread on how people became addicted to various substances:
“I’ve been around too many addicts, and almost 50% of them were functional people who were injured. They took the pain meds like the Dr. said but so many of them had persistent pain, the Dr. would give them higher dosages and eventually just cut them off.
It sucked, they first hit friends up asking if they had any pills, then local street dealers. Eventually, they ran out of money and found heroin and fentanyl.”
“I had a pretty lengthy stay in hospital, when i was released after nearly a month, i had a supply of pain meds. Eventually they ran out and it didn’t even occur to me at the time, but i started feeling awful, stomach cramps, diarrhea, shaking, unable to sleep etc etc.
Took like a week for the worst of the symptoms to go away, I’m actually glad that i didn’t recognize what was happening until it was all over, i think i may have went looking for more if i knew that’s what would make the pains stop.”
“I was in a pretty bad place in my mental health and ready to start experimenting with more than just cannabis and booze as a form of self medication. A buddy of mine offered me some morphine pills. We snorted them. Which isn’t something I ever ever ever thought I would do. It was the best I’ve ever felt in my life.
We laid on separate couches and watch[ed] some Discovery channel dinosaur documentary. I couldn’t move a muscle. It felt like pure bliss and serine peace. If I had just died right then I woulda been fine with it. Thankfully I didn’t, but I did get mildly addicted. We were smoking pills off of aluminum foil and being straight junkies for a bit. But nothing ever ever felt as good as that first time, and it comes with diminishing returns in general.”
These are just three instances. But the rationales are all very different. Your approach to understanding addiction changes when you know a person’s life.
- A hardworking, middle-aged industrial worker gets hit in the knee by a forklift and has to undergo surgery. Afterward, the doctor prescribes prescription opioids to treat pain.
- A mild-mannered Midwestern mom has chronic pain due to a crash C-section. As she ages, her body worsens from the impact of having her stomach ripped apart, so she talks to a doctor about pain relief. She prescribed opioids given the severity of the pain.
- A suburban teenager is out with friends when someone talks about how amazing they felt taking one of his dad’s pills leftover from a wisdom tooth extraction. Feeling glum from a series of bad grades and a bad breakup, they’re curious and take one of the morphine pills, “Just to see.”
The truth in opioid addiction in particular is that pain makes people do unusual or even unheard of things. Like people who can summon superhuman strength to lift a car off a child, do any of us really know what we’re capable of in every possible situation, circumstance, or event?
Why can’t people “just stop” drug abuse?
Any one who has tried to “just stop” checking their Instagram feed when they’re bored, or “just stop” drinking soda, or “just stop” smoking, or “just stop” eating sugary food and dessert as part of a healthy diet knows just how hard and vapid the “just stop” advice is.
If people could “just stop” any bad habit, vice, or “unproductive use of time,” every American would be lean, salad-eating machines that read books like The Odyssey for leisure. Those people exist, but they are rare, and to most of us, they are downright peculiar to the point of being weird.
Humans need decompression time. What used to be telling stories and dancing around fires for decompression has evolved into alcohol, cigarettes, junk food, Candy Crush, and binge-watching reality TV. These things are engineered to be addictive.
People can’t “just stop” drug use because drugs repeatedly alter our minds, produce a level of withdrawal symptoms that are far in excess what people are generally equipped to handle, and physical dependence, however they got there, are too much.
People do get out from under withdrawal symptoms and their addictions, just as millions of people do lose weight and get their diets under control. But the will, desire, and reasons for doing so are complex.
Who among us does not know someone who has tried and failed, tried and succeeded temporarily, or tried and tried and tried with little success in eliminating an addiction? We do not view these people as failures or unworthy of support. Instead, we recognize the risk factors they face and understand the good faith efforts as a part of a process of recovery.
If drug addiction is caused in part by health care providers, can’t health care providers “fix it” with addiction medicine?
The common thread among many (but not all) opioid overdose deaths and opioid abuse is it started with a medical provider’s prescription. Prescription opioids in the early 2000s were heavily marketed to doctors as a sustainable, addiction-free way to help people with severe pain.
If you’ve ever given birth, had a kidney stone, or endured a severe injury or dental procedure you know that pain relief can consume your every waking moment. Our bodies desperately seek to notify us of pain to get it to stop. Those shirts everyone wears at the gym that says “Pain is weakness leaving the body” fail to consider the mammoth differences between doing 100 burpees and 100 days of throbbing, deep-seated suffering from a car wreck injury.
Medical providers seeking to help patients with pain are following the cardinal rule of health care providers: first, do no harm. Ensure that the patient is comfortable. This is why your dentist doesn’t drill your teeth without significant topical numbing agents and nerve-blocking injections. But those are short-term effects that last for as long as the procedure. Not a long-term solution.
Because medical practices are just that — a practice — few suspected at the time that 8.6 million Americans would develop long-term substance use disorder.
Medicine is developing a better understanding of drug addiction, opioid addiction, opioid withdrawal symptoms, and addictive disorders. Medical providers, the National Institute on Drug Abuse, and the National Institutes of Health are understanding drug addiction, addiction psychiatry, and how other drugs can treat opioid addiction sustainably, particularly when combined with behavioral therapies.
But it took decades to get a nation of ordinary, everyday Americans addicted to painkillers. We have a long way to go to understanding how to prevent withdrawal symptoms and avoid them from the start. And we have a long way to go to helping people with genuine, long-term pain, like those battling cancers, severe back injury, and, yes, several mental traumas, like from assault, sexual abuse, and more, live productive, comfortable lives.
Watch how people become addicted to drugs and how disorder treatment works in The Addict’s Wake
The Addict’s Wake is an hour-long documentary showing the toll of opioid addiction and painkiller abuse in the Midwest.
Watch how drug abuse impacts small towns and how mental health services, courts, law enforcement, and front-line community leaders are working to reduce substance abuse disorder, opioid use, and understand this complex disease.
Special versions are available now, too, for law enforcement and classrooms.
