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Doctor: We need to understand how addiction affects brains

  • POTEE



Recorder Staff
Friday, September 15, 2017

GREENFIELD — There was a mix of lawyers, judges, probation officers — all sorts of officers of the court present, and they were asked a simple question to start: Anyone try to quit smoking?

A few people raised their hands.

“Remember how hard it was to try to quit smoking?” Dr. Ruth Potee followed up. Several nodded their heads.

The tone was set at the Franklin County Justice Center Friday afternoon — addiction is tough to beat.

Potee, a local specialist in the opioid epidemic, was delivering a training on the physiology of addiction for the Mass. Trial Court staff and Franklin County Bar Association, who regularly encounter people afflicted with addiction.

Franklin County Sheriff Christopher Donelan, and fellow member of the Opioid Task Force with Potee, delivered the afternoon’s introductions to the dozens present. He spoke of the challenges of dealing with people who are struggling with addiction, as the opioid crisis continues to plague the criminal justice system.

“They aren’t doing it because they’re weak,” Donelan said. “They aren’t doing it because they’re punks. They’re doing it because addiction is really hard and it changes the physiology of their brain.”

The sheriff plugged Potee’s training, which focused on understanding why dealing with addiction to opioids like heroin is so challenging for someone and how to best to get someone toward the right type of treatment.

“It’s going to change the way you do your job,” Donelan said in his introduction to the training. It’s going to change the way you see the men and women you work with, and I think you’ll enjoy your work more.

Professionals primarily from Franklin County, but also representing Hampden and Worcester counties learned how people with an addiction to heroin may not even be “chasing a high,” but rather just trying to “chase so that you feel normal.”

Potee tried to explain how dopamine receptors in the brain work. She told the basics: the body looks to survive by achieving pleasure and the dopamine receptors let your body know when it achieves a degree of pleasure. Eat a fresh, in-season peach? See a spike in dopamine. Complete a workout? See a greater spike in dopamine. Take heroin? See a spike so high that it’s off the charts from what is typically within a normal range, leaving you with such a potentially positive feeling.

The problem can then be when you try to detox, it can be extremely difficult, especially when your mind knows there’s a way to try to get back to that feeling.

“Who would tolerate that?” Potee said. “If you knew you could fix the way that felt, you would do it.”

With a spike in dopamine levels so high, among other effects caused by the opioids, the wiring of your brain is altered, a process that Potee said could take anywhere from 18 to 24 months to change back.

“It actually make sense to continue to use because you’re wicked sick,” Potee said. “It makes sense. The brain is on survival mode.”

But even when someone has been clean for a while, there can be a part in their brain with a strong preoccupation for the drug. At times, it’s very quiet, and then at other times, it can get quite loud, especially when something goes wrong in your life, like a fight with a significant other.

“The brain starts to spin,” Potee said.

She continued: “I just need you guys to remember this circuit of the brain. Because isn’t it frustrating when people who are doing well relapse?”

The law officials nodded, solemnly.

Except Potee added not to get hardened by these experiences that can make your work even harder. She said that it’s important to feel emotional by people’s struggles with drugs, because if you’re not, then you’re not listening.

“You know what it feels like to relapse?” Potee said. “You feel like a worthless human being. Not just others think that, but you think that about yourself.”

She spoke about the heavy feelings of depression and anxiety that people can feel when they relapse and while detoxing. She said anxiety is typically the worst in the first 30 to 60 days. Potee reminded people of the lack of mental health care in rural counties and then spoke about the increasing scarcity of psychiatrists in a field that she said is not seeing new, young blood.

Potee advocated for medically assisted treatment methods, like methadone and buprenorphine.

One innovative strategy coming soon, Potee said, is suboxone shots that could be coming into the toolbelt for health care providers in the next year.

And then she spoke about the importance of language.

“Be present and engaged,” Potee said. “Say, ‘I’m here for you when you want to get better.’”

She said people ought to drop “should” from their vocabulary because it’s not productive for someone suffering from addiction to hear.