By Terri Ogan
Dr. Daniel Alford, an associate professor of medicine at Boston University School of Medicine, and director of the Safe and Competent Opioid Prescribing Education (SCOPE) program, said that prescription drug addiction and overdoses have become so prevalent today because people have a false sense that this “remedy” is safer than illicit drugs, e.g., heroin and cocaine. But how do people get their hands on this drug that is thought to cure ailments but has become a killer?
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 55.7 percent of users got the drugs free from a friend or relative and 19.1 percent of users get the drugs from one doctor, 14.8 percent of users have bought or taken the drugs from a friend or relative and the remaining few obtained the drugs from a drug dealer, bought them on the internet, or got them from more than one doctor .
In the Q&A below, Alford explains what addiction really is, and talks about the demonic outcome that using these drugs can cause. He said that in order to understand prescription drug abuse, one must understand addiction.
A little bit about Dr. Daniel Alford’s work:
Alford wears many hats in the field of addiction and drug studies, and his passion to treat the disease is clear. At the Boston University School of Medicine he is currently an associate professor of medicine, and Director of the Safe and Competent Opioid Prescribing Education (SCOPE) program, among other things. He is also the medical director of the Boston Medical Center Office-Based Opioid Treatment program.
The focus of Alford’s clinical work, program development, teaching and research is the treatment of opioid dependence in primary care settings, as well as the interplay between pain and addiction and the safe and effective use of opioids in treating chronic pain.
What is addiction?
“There’s something in the brain called the reward pathway and it’s in the middle of the brain and it’s a system that uses dopamine as the transmitter. When the system gets stimulated you feel euphoric, you feel good, it’s a reward for stimulating that pathway. We have it there to reward life-sustaining species sustaining activities, so when you eat, it stimulates that pathway and you say, ‘Good, that feels good, I’ll eat again.’ When you have sex it stimulates that pathway.
“That same pathway gets stimulated when someone uses heroine, or OxyCodone, or methamphetamine, or cocaine, but it’s stimulated, 10, 20, 100 times what food or sex can do to that same pathway. What happens is, the body starts becoming tolerant to the effects of that, so you don’t feel as high the next time you use it so you need more. And over time, the body becomes physically dependent on that substance so when you don’t use it you feel sick. By the time it becomes a chronic disease, that is, a brain disease, people no longer are using to get high, but to feel normal. We know now with imaging of the brain, that the brain has changed. Those things that used to result in reward, like eating and sex and exercise, no longer make the person feel well anymore. They have a very difficult time tolerating stress, pain, they can’t sleep and this goes on for months, sometimes years, and we know the brain has changed.
“People used to think that you send someone who’s addicted to a detox and when they leave they’re all better, but they’re not all better. They relapse at rates of 80 and 90 percent. Why? Because the brain has changed.”
How long does it take for the brain to change?
“People develop tolerance to the substance pretty quickly within weeks. They develop physical dependence. If they stop using and they’ve been using everyday, they’ll go through withdrawals. That’s not addiction. That’s just a physical response to the substance and there are plenty of drugs, medications that I prescribe in primary care, that if they stop it abruptly, they go through withdrawals; medication for blood pressure, diabetes. So it’s not unique to the drugs that people use, it’s just a biological adaptation to the body. What is unique is what happens in the brain with these substances, because that’s where they act, they act in the reward pathway, exactly in the pathway that rewards us for things that are healthy.”
What would be some typical addictive behaviors for someone addicted to prescription drugs?
“When they don’t use they get sick and in the back of their mind they’re remembering how good it felt when they first used so they’re trying to chase that as well. It takes over their life so they’re not fulfilling social obligations, whether they’re in school, or working, or married, families. Their main focus, their main drive to stay alive, is to get this drug and they will do everything it takes to get that drug. They’ll commit crimes, they’ll steal from families and they will lie. They will do everything in order to get that substance and that’s part of the addiction. They become very skilled at getting that substance. Eventually they run out of money, they’re tired of being tired, they’re sick of feeling sick and they go to treatment and they are convinced that all they need is detox, that that’s going to be the cure and that’s not the cure and they relapse and go through the whole cycle again.”
If a parent or family member is noticing these addictive behaviors in a loved one, what is the first thing they should do?
“What doesn’t work is to say, ‘You’re going to kill yourself if you keep doing this, you have to stop, what are you doing? You’re smarter than this.’ That creates resistance. It’s the parent telling you don’t it and therefore you do it. You really need to build motivation in the people themself. I think it’s talking to the person, not preaching to them and getting into an open dialogue.
“If the person is killing themself and they’re at an immediate risk, you can actually involuntarily commit them for 30 days. You need to go to a judge and say the person is killing themself. That could buy time to continue the conversation and talk to them. There’s also this fine line between allowing them to stay in the house and use and kicking them out of the house, which is very hard to do and if you let them stay are you enabling them. I would say they could stay as long as they’re engaged in treatment.
“Families need to realize this is a lethal disease that people die from it everyday. There are two people that die everyday in Massachusetts from a drug overdose. It’s mostly prescription drugs now, but it wasn’t always like that. And families shouldn’t feel guilty about telling a loved one to leave the house if they’re not engaged in treatment because they’re not doing them any favors by keeping them in the house while they’re actively using.”
Addiction can be very hard to understand. What piece of advice you can give a family member dealing with a loved one struggling with addiction?
“Understanding that there is this change in the brain and that you’re not helping them getting into recovery and potentially survive if you’re letting them stay in the house while continuing to use. Allowing them to stay in the house when they’re actively engaged in treatment makes total sense and it’s great and it’s beautiful. As bad as it feels when someone dies, to realize that this is a really fatal disease for a lot of people.”