- Society, families, doctors, look at addicts in a very negative way. 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. (upbeat sting) Number one, 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 wanna 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 neuro-transmitters, serotonin, dopamine, norepinephrine. And this neuron goes, oh, okay, I'm gonna 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. - [Kyle] 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 neuro-transmitters,
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 gonna 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 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. - I'm telling you.
- It sounds wonderful. - You got it. And that's... I'm so glad you said that
because, so why is that bad? Right? Why is that bad? Let's just all take opiates and be happy. - Yeah. - There was a really,
really important reason. And I used the term in previous episodes. I'm gonna say it again 'cause 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 through 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 a pleasure basis for your brain, so it activates that. We've talked about the amygdala on some of these MedCircle 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 gonna 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, whoa, slow down. What is this? This is too much. So there's a theory called
receptor downregulation. 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 gonna take away
some of those locks. So what I need now are stronger keys to open those to get the same effect and that is called tolerance. And you're gonna 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 downregulation. - So your brain is trying to protect you. - It's trying to protect you. - It's saying, guy, I gotta
take more of these away, cause you're overdoing
it on these opioids. - Exactly. 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 downregulation 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. You're gonna crave even
more, you're gonna 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, discussed tolerance and withdrawal. And that's what happens
when you use substances. So, the take home points are, opiates bind to opiate
receptors, the lock and key. - Yup.
- [Doctor] The opiate... - Is the key.
- [Doctor] Is the key. - Right. - [Doctor] 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 gonna become physically
ill and that's withdrawal. And what's happening too, is
that, and this is really sad. 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. 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 gonna be a painful throb
when I don't have the opiate. My shirt, instead of feeling
like a nice piece of linen, is gonna 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 gonna 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 viewer hopefully will understand a little bit more of what
we're trying to achieve with detoxification. - [Kyle] Yeah. - So detoxification is sort of preventing that physiologic response in the brain for all of that physical discomfort. - 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 people
who might be using drugs an 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, reoccur, reoccur. - They are basically rewiring their brain to become selfish and focused
on getting that next fix. So they rewired their brain. 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 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 pocket book or purse or wallet to go get a fix, we take it personally. Like, how could you steal from me? This is horrible. And it is horrible. - Yeah. - But it's this primitive drive. - [Kyle] Right? - That your reason is just out the window. Your, sort of, ability to reason and make sense of things
is out the window. So you really are rewiring your brain to not be a very likable person, which is why it's so hard,
you know, to deal with that. (indistinct) family
members and loved ones. - Thank you for explaining that. We're gonna 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 wanna ask a MedCircle doctor a question directly, you can. Learn how by visiting the links in the description below. (upbeat sting)
