Why Don't They just quit?

Dear Denise:

I know quite a few people who have gotten mixed up with opioids and have become addicted to either pills or heroin.  Many of them have lost a lot.  Some have lost their jobs, their families, their homes, their cars, almost everything.  This doesn’t seem to make much of an impression on them.  They continue to use.  Why is that?




Dear Megan:

I’ll try to explain what I’ve learned in an uncomplicated way.  It is a very complicated problem.  It is very frustrating to those who know and love these people suffering from opioid abuse.  I often hear “Why don’t they just quit?” which is what you are asking too.  I asked that too for a long time before I got an answer that at least made some sense. 

Most of what we know is about how these opioid drugs affect the brain.  This particular group of drugs act in the nervous system to produce pain relief and also pleasure.  Some familiar opioids are Oxycontin, codeine, morphine, Vicodin, and Percocet. Opioids change the chemistry of the brain and lead to drug tolerance. Over time of regular use the body needs more to get the same effect. When someone uses high doses of opioids every day for a few months there is a loss of these tiny structures in the brain called dendritic spines.  These structures help neurons to communicate with each other. Loss of these structures can lead to trouble reasoning and thinking through problems, and making decisions.  After using opioids for an extended period of time most people will become physically dependent but not addicted. (Dependence is when your body becomes accustomed to the use and when you stop taking the drug there are physical and psychological symptoms of withdrawal.)   A small percentage will become addicted and it overtakes their thoughts and actions in most moments and situations.  Opioid addiction often causes life threatening health problems including the risk of overdose.  Overdose occurs when high amounts of opioids are taken and cause respiratory distress that might lead to unconsciousness or death. 

So, we learn that opioids can take away the ability to make good decisions, attack problems logically, and reason.  Many times someone who is suffering from opioid abuse will argue quite vehemently about something that is totally incorrect but he really believes it and will stick to his argument.  It is because his brain is not working exactly right.  It is a disease of the brain. 

Opioid addiction can take over a person’s life.  As you have stated in your question, many people lose most of the things in their lives that they love the most but the drug takes over as a priority.  Getting high is all they think about. It is very difficult to enjoy anything that gave them pleasure before substance abuse.

It’s important to know that there are many variations in genes that contribute to the risk factors for becoming addicted or not.  Genetics, environment, and social interactions, and even certain personality traits contribute to whether someone will become addicted.  It’s really not a choice as most people believe.

As you can see, it is not as easy to “just quit” once the opioids have begun to play a part in how your brain works.  People may want to stop, return to what seems “normal”, enjoy what they previously enjoyed, but just can’t do it. 

Opioid addiction is here in Surry County in a big way.  Almost everyone knows and/or loves someone affected by this public health problem.  Surry County is learning about the best ways to reduce and limit the problem and help to heal our county.  It is a difficult task.

Thanks for your question.


Denise Krochta

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