Knowing the science behind addiction, does not accurately describe the intense despair of those who are living it.  Today we look at how people involved in substance abuse view their lives.  The following article consists entirely of quotes from online videos and books relating the experiences of those  in addiction; WARNING: May be too graphic for some readers. 
“Before my brother’s death I was just a normal kid, playing video games and sports. Going through the grief of my brother’s death, his friends told me, just take this drug and you won’t have to feel anything anymore.  When I took it I felt numb.  Any problem I had went away.  My addiction got worse, I stole more and hurt more people  I had no one.  I wasn’t even getting high at this point, I was just not being sick.  It cost me around $300 a day.  The mental addiction to this takes over your mind.  I had no choice, I just needed to feel ok.  And so that was the first time I tried heroin and there was no going back after that.  I ended up overdosing, almost dying only a few feet from where my brother was found dead.  It took four shots of Narcan to bring me back.”  (The Dark Path by Andrew D., Brendan P., Joshua M. in McDonald PA: from the operationprevention.org) 
“I saw myself as a pathetic creature, a fool, so completely obsessed with a stupid drug.  I was in trouble because my sickness called for a cure that only made it worse:  more ominous, more dangerous.  I was in trouble because, though I didn’t quite get it yet, some part of me would erode further every time I came into contact with opiates in the future.   My attraction would burgeon with alarming suddenness, my control would give way, and I would take risks that I couldn’t yet imagine.  Opioids made me feel safe and warm, cared for, soothed and  I would need them all the more to combat the shame and depression they themselves engendered.” Memoirs of an Addicted Brain
 “Drugs took my mind over and made me do things that I’d been brought up not to do.  It turned me into a monster.”
 “Drugs became my full time job.  The needle was my boss, a very demanding boss.  My whole day revolved around it.  It’s a never ending vicious cycle.  The same thing over and over and over.  You go to sleep doing it.  You wake up and are dope sick, so you got to do it all over again.  You got to at least do enough just to where you are not sick anymore.”
 “I stole checks from my grandma.  Anything that wasn’t nailed down I stole and pawned.  I stole my mom’s debit card.  Heroin cost me $300 a day.  You don’t think about anything.  You don’t think about the people you are hurting or the lies you tell.  You don’t think about getting arrested.  All you can think about is getting another fix.  I didn’t care what it was going to do to me later on, I just wanted the feeling of it right then and there.”
 “It’s not worth it.  And it will get you.  You are no different than anyone else.  It will destroy your life.  You will end up in jail or dead or in some institution for the rest of your life.”  Quotes above are from Chasing the dragon: The Life of an Opiate Addict:  justthinktwice.gov 
These testimonials give you a sense of the power of addiction and the difficulty of achieving recovery.  But there is hope.  Treatment works.  Recovery is possible.
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In these articles, we have presented a very neutral view of people involved in substance misuse/addiction,  but their families and the people around them will tell quite a different story.  They will tell you that the person addicted to a substance is not the person they used to be.  Things that interested them in pre-addiction days, no longer have any appeal.  Their loved one is consumed with obtaining drugs and maintaining the drug supply. Drugs overpower every other motivator in life: family, job, hobbies, work, even children. 
Brain research backs this up. “Drug addiction isn’t as simple as a person making bad choices. Rather, it reflects a disease of the very system that makes good choices possible.” Dr. Nora Volkow
In their  book, The Molecule of More: How a Single Chemical in Your Brain Drives Love, Sex and Creativity—And Will Determine the Fate of the Human Race (BenBella Books, 2018,) Daniel Lieberman and Michael Long describe the major role of dopamine in the chemistry of addiction.  They explain how the  dopamine desire circuit  is designed to promote behaviors that lead to survival with an eye on the future.  Dopamine urges you to possess and accumulate anything that might help keep you alive—whether you need it or like it—dopamine doesn’t care.  It makes us want it right now.
Dopamine activation in the desire circuit  triggers motivation, energy, enthusiasm, and hope.  It feels good.  Dopamine turns on the imagination, producing visions of a rosy future.  But, it is the salesman in no position to make the dreams come true, only making promises it cannot keep.
Addictive drugs hit the dopamine circuit with an intense chemical blast, hijacking the brain.  Nothing else can match it, stimulating  it far more intensely than natural rewards like food or sex. The substance misuser’s entire life becomes focused exclusively on the drug.  Drugs become the most important thing, overwhelming all other motivation and concerns.  From the outside it looks like substance misusers are making irrational choices, but their brains are telling them that their choices are perfectly logical.  The euphoria of drugs provides a bigger dopamine dose than just about any experience you can name.  Substance abusers take drugs until they pass out, get sick, or run out of money; the gnawing craving is never satisfied.
Many of the decisions that substance misusers make are impulsive, because they can only think of the  immediate pleasure, not long-term consequences.  Desire for dopamine overpowers the more rational parts of the brain, causing the user to feel  powerless to resist.  It’s as though their free will has been comprised by an overwhelming  urge for the  immediate pleasure of drugs.    Addiction is not a sign of weak character or lack of will power. Instead it is a vicious cycle of the desire circuits getting thrown into a pathological state, powerfully demanding more stimulation, consuming all attention and motivation, and profoundly influencing a person’s will.
In spite of these neurological changes, treatment works, and recovery is possible.  People do recover from the snares of addiction with treatment and support.

Last time, we discussed the policies at the state and national level that are creating positive change related to substance abuse.  In addition to those discussed last week, Indiana has also implemented these legislative and policy changes.
Aaron’s Law was passed in 2015, allowing Hoosiers to obtain a prescription for Naloxone if they believe someone they know is at risk of an opioid overdose. This was recently updated to allow individuals to purchase Narcan without a prescription at pharmacies.  Some Medicaid and private insurance companies may pay for Narcan.  Check with your insurance provider.
Indiana's Aaron's Law also contains Good Samaritan provisions that offer some legal protections to individuals who administer Narcan and call 911 at the scene of an overdose.  Grants are available to county health departments to provide training and increase the availability of Narcan to law enforcement and families with loved ones involved in substance abuse. The White County Health Department is participating in this grant program, providing training and Narcan to the White County sheriff’s department.
Removing unused opioid prescriptions is another important step in combating the opioid crisis. As mentioned in previous articles, the White County Sheriff and Monticello Police Department have drug take back containers that are available 24/7 for the safe disposal of unused medications.  They do not take sharps, syringes or liquids.
Indiana Medicaid and HIPP are increasing coverage of MAT for substance and alcohol abuse allowing more people to access these services.
In White County, the United Council on Opioids (UCO) was developed to coordinate efforts and services centered around opioid and substance abuse.  The UCO includes more than seventy community members who are actively engaged in creating solutions to the local substance abuse crisis .  These members are working in emergency medicine, law enforcement, health care, education, the judicial system, probation, mental health care, city government, health navigation, peer recovery, or are families of those involved in substance abuse, those in recovery,  community agencies, health department,  treatment and interested citizens.
The UCO has three task force groups;  prevention, treatment, and recovery.  Each group has specific action oriented short-, mid-, and long-term goals.  They are achieving their goals and making a difference in our community.  They have completed a working directory of treatment and recovery support services, and obtained funding for a billboard campaign to promote prevention and awareness of substance abuse.  They are working on prevention activities for local schools and protocols for helping people transition from jail, hospitalization, and treatment into long term recovery.  In conjunction with these efforts, White County was selected to be a part of the North Central Quick Response Team, which begin services in September.
Exciting things are happening nationally and locally to combat the opioid crisis.

In previous articles we discussed how the  current opioid crisis did not happen overnight.  A series of events, perceptions and policies brought us to this place where Americans are more likely to die of an overdose than a  car accident.  The death toll is equivalent to a fully loaded 737 falling from the sky and killing everyone on board 365 days a year. https://www.clarionledger.com/story/news/2018/01/26/opioid-epidemic-solutions-naloxone-overprescribing-overdose-deaths/964288001/.   As a local school counselor asked in the face of this crisis: “What can we do to make a difference?​”  The good news is exciting things are beginning to happen nationally, at a state level, and locally.
Development in brain research began exploring the effects of substance abuse on the structure and wiring of the brain.  Scientists have learned how substances such as opioids change the chemistry of brain synapses, creating a chemical desire for the drug.  Drug use changes the areas of the brain related to  motivation, problem solving, and impulse control.  This better understanding of how addiction affects the brain is aiding in the development of evidence-based treatment options.
On a policy level, many things are happening to decrease the negative impacts of substance use in Indiana. The INSPECT prescription monitoring system keeps track of the number of opioid prescriptions written by doctors and filled by patients.  Just the awareness that someone is watching, has led to a 35% decrease in the number of opioid prescriptions doctors have written since 2013. https://www.ibj.com/articles/74228-report-indiana-opioid-prescriptions-down-35-since-2013
Narcan is saving lives.  Narcan is an opioid overdose reversing agent.  If used within six minutes of an opioid overdose, restore breathing and prevent death.  As the mother of an addicted child said, “Dead people don’t enter recovery.”  Narcan is now available without a prescription and can be purchased at local pharmacies.  Many health departments can provide it free to families of those involved in substance use disorder.  With the prevalence of fentanyl, some say that it is prudent for families with a loved one using any illicit drugs to have Narcan on hand.
 There are more and more opioid treatment centers opening around the state.  In 2018, there were 18 opioid treatment programs in Indiana.  By 2020, ten additional sites will open. Governor Holcomb’s goal is to have an opioid treatment program within an hour’s drive of every Hoosier.
In addition to reducing the number of opioid prescriptions written, another positive response is the number of drug take-back containers and programs. Over 50% of people who misuse substances get them from the medicine cabinets of friends and family. Here in White County, there are drug take back containers in the lobbies of the Monticello City Police as well as the White County Sheriff’s Department.
Indiana Medicaid/HIPP is providing coverage for substance abuse treatment and MAT (medication assisted treatment, providing more access to those in need of services.
Probably, most importantly, people are becoming educated about opioids, addiction and treatment.  Public opinion is beginning to accept the disease model of addiction, understanding how brain chemistry and changes influence behavior in addiction.