The Addiction Paradox

By | July 31, 2017

The same reward circuits in our brains that we use for survival also leave humans perpetually vulnerable to addiction.

Our brains are wired for survival.

The human brain is finely tuned to seek out rewards like food, sex, and money, and to avoid painful experiences like being killed by dangerous predators, large and small.

Called the dopamine reward pathway, this brain feedback system provides the motivation to learn and repeat behaviors that give us pleasure, rewards, and safety:
 

Heroin, and synthetic opioids like Percocet, hydrocodone, and fentanyl essentially hijack the brain’s natural reward system.

Initial exposure to opiates can lead to intense urges to repeat the first experience, triggering an addiction cycle that is very difficult to break. (The same cycle is true for synthetic stimulants like methamphetamine, cocaine, MDMA, etc)

While there are multiple societal costs from addiction, the problem can be crystallized in a single graph.

Death Rates from Opioid Addiction Are Skyrocketing

Deaths from opioid overdose (both legal & illicit sources) is on track to eclipse 70,000 per year in the U.S., based on current trends:
 

It’s very possible that by 2020, opioid overdose deaths will be greater than deaths from vehicle accidents and firearms combined.

Update: The White House Commission on Combating Drug Addiction and the Opioid Crisis (The Opioid Commission) released on 7/31/2017 an interim report that recommends declaring a national state of emergency. If implemented, this could speed treatment and research initiatives.

The path from legal use of prescription pain medications to illicit use of pills, heroin, and fentanyl is a well-worn story that happens across every community and social class.

One example out of many is the fatal opioid overdose by the musician Prince in 2016. Prescribed pain medication after hip surgery in 2010, his need for opiates apparently escalated to the use of fentanyl, a narcotic that is 30 times more powerful than heroin.


New Approaches to Addiction are Needed

Prohibition and interdiction of addictive drugs tend to be stop-gap measures that lose effectiveness over time, especially if consumer demand for the drugs rise or simply remains stable.

There is no silver bullet to the problem. But understanding that addiction is deeply intertwined with the human biological drive for survival is a realistic place to start.

Objective education on the addictive potential of any drug, along with realistic alternatives to opioids for pain relief can begin to turn the tide and lower the demand side of the equation.

Some interesting research is being done to find effective, non-drug approaches to pain relief.

Chronic pain can cause a negative feedback loop with the brain, where the brain “learns” to expect a repetition of pain signals, whether or not the source of pain is still present.

Transcranial Brain Stimulation Devices – TMS, TDCS, TRNS are a class of devices that are being tested in clinical trials for a variety of pain management therapy approaches.