The heroin nightmare

I have met a lot of drug dealers in the federal prison where I serve. Many of them were alcohol and/or drug addicts as well. Some of them stole food from the dining hall, fermented it in the lockers in their cells and made a rank brew they drank and sold to other inmates. My fellow volunteers and I would learn of this when one of our regulars didn’t show up for program. “Oh, he’s in SHU–got caught for making alcohol.”

It wasn’t until I began teaching at the local county jail, however, that I encountered the real, ongoing power of addiction. The majority of county jail inmates who took my forgiveness class were in on charges related to alcohol or drug addiction. They were caught stealing or forging checks to get the money to buy drugs. They were serving 90 days for a DUI. Or, quite commonly, they failed a drug or alcohol urine test resulting in a parole violation.

Of all the street drugs implicated, heroin was always at the top of the list. A word I heard quite often from them was “relapsed.” Some of them had been in rehab more than once. Every one of them had also relapsed. The jailhouse door is clearly a revolving one.

If you’ve watched the news, you have, no doubt, seen at least one story on the heroin epidemic, especially the one sweeping through rural America. (Pike County, where I live, is about as rural as it gets). The stories are heart-wrenching. And for those of us who have no history at all of drug use, they are puzzling, if not confounding.

“What is it with these people?” some of us are inclined to ask. Surely there’s some moral flaw in them, some character defect that they just haven’t worked hard enough to overcome.

The explanations just aren’t that simple, as I am increasingly becoming aware. People first use an addictive substance for lots of different reasons. For some, it is valid physical pain and a doctor’s prescription of an opioid, such as Oxycontin. For others, it might be the influence of peers and the interest in trying something stronger than marijuana. Apparently, a fair number of people turn to heroin when they can no longer obtain the prescription opioid to which they had slowly become addicted.

What some opioid addicts quickly discover is that an opioid not only addresses physical pain quite effectively, but it also brings amazing relief to emotional pain (or perhaps more accurately, “psycho-spiritual” pain).

This doesn’t have anything to do with moral failings or character defects. It really has to do with brain circuitry. At the risk of a making a vast oversimplification, I’ll put it this way: Some people come out of childhood and into adolescence and adulthood pre-wired for addiction. This is not to say they are destined to become addicts; it is to say that under the right circumstances the likelihood is higher.

Medical research confirms that childhood brain development can be adversely affected by a high-stress environment. The “stress” hormone, cortisol, is helpful during a stressful time of short and limited duration. In a constantly stressful environment, cortisol hinders normal healthy brain development by damaging the mid-brain dopamine system. Dopamine is often called the “pleasure hormone” because it lubricates the “pleasure pathways” in the brain. Cortisol damages the dopamine receptors in the brain.

Drugs such as cocaine and crystal meth stimulate dopamine production, causing an intensely pleasurable effect in the brain. Regular use of these drugs, however, inhibit the brain’s own development of dopamine, creating a vicious cycle. The more one uses a stimulant drug, the more it damages normal brain dopamine function, thus creating the need and desire for more of the stimulant drug. This is the chemistry of addiction.

The other primary hormones implicated in addiction are the brain’s “natural narcotics” — endorphins. Endorphins soothe pain, both physical and emotional. To be more specific, endorphins influence mood changes, physical activity, and sleep and regulate blood pressure, heart rate, breathing, bowel movements, and body temperature. They even help modulate the immune system. Thomas De Quincey described the effect of endorphins as “composing what has been agitated” and “concentrating what has been distracted.”

When the body’s endorphins are not up to the task of soothing intense physical pain, physicians have always turned to narcotics such as morphine and, more recently, a host of opioid pills marketed under a variety of names, to help their patients. Those who use opioids initially to address physical pain quickly find out how effective they are at addressing psycho-spiritual pain. It is easy to understand how addiction begins and why it is so difficult to break.

In a video I use in classes on forgiveness, a woman who affirms that “forgiveness saved my life” described her childhood as “total chaos.” She mentions alcoholic parents and childhood sexual abuse by an uncle. When I ask how many participants in my class would describe their childhood as “total chaos,” the majority of hands always are raised.

This helps me understand the origins of drug addiction, at least for some. Even a seemingly harmless curiosity can lead someone to experiment with a substance that, to their surprise, they find to be amazingly effective in dulling pain or creating a pleasurable sensation that, because of interrupted brain development, they find so satisfying that they choose to return to it, time and time again.

While the news stories (see below) about the opioid epidemic do a very good job of describing the nightmare of heroin addiction, they rarely touch on the chemistry or neurobiology of addiction. When I began to understand this, it made a difference in how I looked at the men with whom I work and how I approached the teaching of forgiveness.

I have come to believe that psycho-spiritual woundedness is deeply complicit in addiction. Unless addicts can find genuine healing, the lure of short-term pain relief through drugs and alcohol will be too strong to resist. The trouble with genuine healing is that it’s very hard work. Even occasional miracles from God do not reduce the necessity of hard work and perseverance on the part of those struggling with addictions.

The Washington Post has published several very good articles in a series chronicling the addiction-related ills afflicting vast numbers of Americans. Here are two:

‘How’s Amanda?’ A Story of Truth, Lies and an American Addiction

The Lonely Road of Staying Clean: In a town where pills are currency, opioid addicts have few options

A sobering view of the opioid epidemic appeared on Frontline and can be found here:

Chasing Heroin

2 thoughts on “The heroin nightmare

  1. I concur with this objective analysis that the roots of addiction start and are often carried forward over generations. When you mentioned “adversely affected by a high stressed environment”, this is very much the cauldron of taking what already may be a genetic predisposition to addiction and acerbating that disposition in the very ways you clearly describe. A baby, on through a toddler and into early childhood, has no means or self-efficacy in choosing what environment it finds itself placed into, or the caregivers that control that environment. While this is a fundamental truth for all children, the heart breaking reality is that too many children begin life in circumstances that make their odds of escaping the negative neural wiring this kind of environment creates slim indeed. Rural America has been stricken by the employment shifts brought on by globalization and technology, but the harder truth is that “high stressed environments” can be found throughout our demographics.

    Chaos is the perfect word for describing the inner experience of a person caught in addiction. The temporary emotional reprieve from the psycho-spiriutal pain and trauma that ingesting drugs gives only further inflicts physical trauma making poor wiring worse is hard to come to grips with, but you’ve described that vicious cycle well. Who would want to live in a world where there is no hope of escaping years of ravaging, destructive fear for which the person actually had no choice as a child simply trying to survive? That the Gospel focuses directly on healing & Kingdom proclamation, it was for healing this hopelessness that Jesus came into the world.

    Forgiveness is a powerful first step in learning realty testing and to accept one’s self as “damaged goods” with the same deep compassion with which Jesus holds the prisoners you’ve described (and all of us with our mini-addictions – after all, who’s kidding who, when we say we are without the sin of some form of addiction) in His heart.

    • I appreciate your comment, especially how you expanded on what I wrote. All of us who are Christian and care about the wounded walking among us wonder how the gospel speaks to persons in such pain. We have to wonder, too, what our churches–not to mention us as individuals–could be doing to minister God’s healing love.

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