society families doctors
look at addicts in a very negative way
right as if almost they have control of
this and they're just being selfish and
they're just being nasty people
right but in a lot of ways there is a
very biological thing going on here that
is making it tremendously difficult to
stop
[Music]
number one i want i want the viewers to
understand the basics of what's
happening when you take an opioid in
your brain
i want the viewers to understand why
it's so addictive
and i want to make sense of the science
to take a little bit of the burden away
from the addict so let's go like
neuroscience 101 okay
the brain let's think of the brain as
like a computer but instead of silicone
chips
we have neurons and neurons are nerve
cells and there's billions of them in
our brain and they all communicate with
each other okay
neurons
have gaps so
in order to allow one neuron to
communicate with another neuron and to
do something in your brain it sends
signals like these are two neurons here
and here's the gap right in order to
send a signal from this neuron to this
neuron to make something happen
this one has to be activated by
something okay so let's say an opiate i
take an opiate
and this neuron has receptors on it
which are like let's picture a lock and
key
so we have a lock right here the opiate
is like a key it comes in and it goes
click and it opens something for this
neuron
now this neuron spits out
neurotransmitters
serotonin dopamine norepinephrine and
this ner this neuron goes oh okay i'm
going to do something with that now and
then communicates down the line that's
basic basic neuroscience that lock and
key turning on a neuron or turning off a
neuron to help it communicate with
others that's how our brain communicates
in an incredibly basic way
so
we talked a little bit about our bodies
have endogenous endorphins right
endogenous opiates and what that means
is
again that we have chemicals in our body
that make us feel good they allow us to
feel pleasure and fun and excitement
and satisfaction and a sense of reward
and happiness those are endorphins
so when we exercise or even when we're
stressed or if we fall in love
our endogenous opioids unlock that
little receptor and it spits out
neurotransmitters mostly like dopamine
in certain areas of the brain
and activates that feeling of happiness
and pleasure okay
so
now comes along this poppy plant that
makes this
opioid that looks very similar to what
we have in our bodies naturally except
it's much stronger much more potent
so
if i'm a person and i'm you know going
to take an opiate and i inject an opiate
and it goes through my vein up into my
brain
the lock and key it hits all of those
receptors and it turns on that
that neuron and that neuron fires and
the answer is immense pleasure and
euphoria and calm and relaxation and
love and warmth and all of these
positive feelings
that you had to exercise for or fall in
love to get right so now it's at your
fingertips this all sounds great to me
you got it and that's i'm so glad you
said that because so why is that bad
yeah right why is that bad let's just
all take opiates and be happy yeah
it was a really really important reason
and i used the term in previous episodes
i'm going to say it again because i
think it drives home an important point
that natural endorphin that unlocks this
neuron is like a tiny little whisper
when you get the opioid whether it's a
prescription or morphine or
heroin
it's like a loudspeaker it's so much
stronger it opens up all those receptors
and sends all these signals to the brain
now what it does is it works on an area
of the brain called the basal ganglia
right and that's like your reward sort
of pleasure basis for your brain so it
activates that
we've talked about the amygdala on some
of these med circle series and the
amygdala is that fear response and guess
what the opiates do to that they turn it
down i'm not scared everything's good
i'm going to turn down that fear
response so it activates the pleasure
centers it turns down your fear response
and then it also
it goes and activates your prefrontal
cortex which is your decision-making
ability and sort of bypasses that so you
don't really think too clearly you're
just thinking more basic like just i
just want pleasure
and reward
so now you're setting yourself up for
your brain goes wow that was
awesome and our brains are wired to feel
pleasure like evolutionarily if
something feels good we should probably
do it again right so the brain develops
connections now
to reinforce that so it develops
highways and connections that are more
direct and easier to get that
pleasurable response
and will tell parts of your brain
like the basal ganglia and the
prefrontal cortex to crave that again
you need to get that again you need to
get that again right so now you get this
craving to do it again
now let's throw something in the mix
that your brain does when it's flooded
with something
when your brain is flooded with
something that it doesn't really need or
that it senses is too much
also kind of says
oh
slow down what is this this is too much
so there's a theory called receptor down
regulation now let's just say and this
is incredibly simplistic okay right
let's just say that you have
100 locks all around
right
your brain goes i'm getting a whole lot
of keys
and they're all filling up and it's a
little much
so i'm going to take away some of those
locks
okay so what i need now are stronger
keys
to open those right to get the same
effect
and that is called tolerance and you're
going to hear that term in addiction
that is physiologic tolerance tolerance
means
i took
one bag of heroin
last week but this week if i take one
bag of heroin
i don't feel anything i need to take two
and that's because of that receptor down
regulation so your brain is trying to
protect you it's trying to protect you
saying i gotta take more of these away
because you're overdoing it on these
opioids it's trying to balance itself
out the scientific term for that is
homeostasis right that's the big word
that just basically says trying to
balance things out what are you doing
slow down yeah but at the same time
the very basic primitive part of your
brain
is saying i need more i need more i need
more i need more now let's couple this
with someone that is going through a
difficult time in their life
so now let's create the perfect storm we
just gave your brain a dose of the best
euphoria it's ever felt
and we just created a reward circuit to
crave that substance again
and
let's
create a down regulation where you need
more to feel that again and now you're
in a bad place in your life where you
don't feel good to begin with
so you're going to crave it even more
you're going to need more and
all of a sudden you realize that
not only do i need more to get that same
feeling
but when you stop because of these
neurological changes that have happened
physiologically in your brain
when you stop
you get physically sick and that's
called withdrawal
so we just basically in a very
simplistic fashion discuss tolerance and
withdrawal and that's what happens when
you use substances so so the take-home
points are opiates bind to opiate
receptors
the lock-in key yep the opiate is the
key is the key right the lock is the
receptor and when you're taking it on
the outside you're activating your
neurons to talk to each other in a
fashion that creates euphoria and reward
and a pleasant feeling
the more you take the more you need to
get that same feeling because of down
regulation homeostasis and when you stop
because of those neuronal changes you're
going to become physically ill and
that's withdrawal and
what's happening too is that and this is
really sad this this to me is
tremendously difficult for addicts to
deal with and this is why stopping is so
hard the neuroscience behind it
is that
when you are flooding your body
with that protective opiate which is a
natural pain reliever
your body becomes more sensitive to pain
when you don't have it
[Music]
so
if you're an opiate addict
and you don't have that opiate
things hurt so much more a little ache
and pain that i might have in my knee
right now that's just a nuisance is
going to be a painful throb
when i don't have the opiate my shirt
instead of feeling like a nice piece of
linen is going to feel like sandpaper
when i don't have that opiate in there
so your skin and your senses become more
sensitive
which puts you in a very difficult
position right so all of those things
are stacking the odds against you that
you're going to be able to stop this
i have excessive pain i feel physically
sick when i stop my brain is
rewired to crave this
right
so all of these things are sort of
stacking those chips against you making
it incredibly difficult to stop
so when we talk about treatment
and detox
the viewers hopefully will understand a
little bit more of what we're trying to
achieve with detoxification yeah so
detoxification is sort of preventing
that physiologic response in the brain
for all of that physical discomfort
right to make that transition easier
right okay and i hope i made that as
simple as i could oh it was incredibly
clear and very simple i think that gives
that gives
people who might be using drugs and
understanding of what's going on in
their body and maybe even more
importantly it gives people who know
somebody who's using drugs a better
understanding of what they're going
through these are things out of their
control
taking drugs while on the surface looks
like a very selfish behavior and perhaps
you could argue it is
there are things out of their control
that's causing this behavior to reoccur
they are basically
rewiring their brain
to become selfish and focused on getting
that next fix so they rewired their
brain
there's they're circumventing the parts
of the brain that is reasonable
and says wait a minute what you're doing
is not a good idea it's not safe this is
dangerous you're circumventing that
because your brain wants that
wants that receptor to be filled that's
all it cares about in a very primitive
way
so
when your loved one is stealing money
out of your pocketbook or purse your
wallet to go get a fix
we take it personally like how could you
steal for me this is horrible and it is
horrible yeah
but it's this primitive drive right
that your reason is just out the window
your sort of ability to reason and make
sense of things out the window so you
really are rewiring your brain to not be
a very likable person yeah which is why
it's so hard you know to deal with
addicts as family members and loved ones
thank you for explaining that we are
going to have more from dr sportelli and
opioid addiction in our next episode
thanks for watching check out the links
below for more information on how to
access this full series and subscribe to
our youtube channel to watch new mental
health videos every week did you like
what you heard in this video if you want
to ask a med circle doctor a question
directly you can learn how by visiting
the links in the description below
[Music]