By Lindsay Kramer

 

Okay, I’ll admit it: I experience much difficulty treating opiate dependence. From heroin to OxyContin to Kratom, opiate abuse is alive and flailing in this field.

 

What I more specifically have a difficult time treating are the behaviors associated with opiate withdrawal: lack of motivation, constant discomfort, and hopelessness, to name a few. What this looks like in a treatment setting is resistance to treatment (resulting in early termination of treatment), pervasive irritability and affective lability, constant behavioral disruptions within the milieu, and sensationalizing the drug despite the consequences that have accompanied the addiction.

 

…if I don’t feel that I can always successfully treat the behaviors associated with the withdrawal from opiates, the best I can do is try to understand some of the components that make treatment… so difficult.-LINDSAY KRAMER

 

I notice that when we have a band of opiate addicts on the unit, the staff is working exponentially harder to manage these patients and to keep everyone on track than in comparison to when the milieu is lacking of this demographic. It’s said that the squeaky wheel gets the grease when it comes to attention focused on patients in treatment, and unfortunately, we often spend arguably too much time attempting to motivate patients to surrender to recovery when these “wheels” aren’t even motivated to be squeaky in the first place.

 

As I teach my patients to shift their unpleasant feelings toward someone to having compassion toward their difficulties that are impacting the relationship, so I must do with regard to understanding why opiate addicts struggle within treatment settings and within their overall recoveries. Therefore, if I don’t feel that I can always successfully treat the behaviors associated with the withdrawal from opiates, the best I can do is try to understand some of the components that make treatment for these addicts so difficult.

 

Motivation

To say that an opiate addict in early recovery isn’t motivated is absolutely inaccurate. They are motivated; it’s just a matter of what they are motivated toward. Due to the fact that the language of neuroscience is as foreign to me as is Cantonese, I will attempt to regurgitate this information as concisely as possible so that other laypeople like myself can understand it:

 

Person takes opiates. Opiates release chemicals that bind to the opioid receptors and produce a euphoric feeling. The euphoric feeling is better than the brain expects, so it releases the neurotransmitter dopamine to reward the user for the opiate use, which also causes the user to feel good. Dopamine is released within the prefrontal cortex and the nucleus accumbens, which both play a role in behavior and motivation. More opiates equal more euphoria, which produces more dopamine, which creates a behavioral motivation to continue to use in order to achieve the same effect. It’s a vicious cycle of using to feel good, and the good feelings leading back to using.

 

Here’s where it becomes more complicated.

With greater opiate use, the brain creates more opioid receptors in order to adapt to the presence of opioids, which in turn are constantly active and require more of the opiates in order to fill these receptors just to reach that same euphoric state. This is called “receptor upregulation.” Empty receptors also cause discomfort, which signals pain to the user, further perpetuating the craving for greater use in order to return to the euphoric, better-feeling state. While this is occurring, the brain is also more frequently releasing dopamine as the reward for the increased use, which is a key motivator in this process and has been determined to also be released prior to the use itself in order to jumpstart motivation for continued intake. (Read more about that here.) Simultaneously, as the brain senses the overload of dopamine due to the opiate use, it stops naturally-producing dopamine in order to balance out this new dynamic, but still craves the dopamine that is released by the opiate use. What we have now is a conditioned overload of opioid and dopamine processes, which embodies the addictive elements of tolerance, dependence, and craving.

 

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Source:

Recovery.org