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 Health & Beauty | October 2007 
And Then Comes Withdrawl
 Tara Brite - ASU Web Devil
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Millions of Americans have taken illegal drugs, and thousands will face the arduous process of withdrawal. ASU students are among those who have faced this trial.
Matt can't say exactly how his meth addiction started.
All he remembers is that he was in his freshman history class at Brophy College Preparatory in Phoenix. The class was watching "One Flew Over the Cuckoo's Nest."
"A guy handed [the meth] to me, because he was trying to quit. I was going to throw it out," Matt says. "I put it in my pocket, and the bag spilled. So I took it out, and I just did it on the desk."
Matt is just one of millions of teenagers who will take at least one illegal drug in their lifetimes. A 2004 report — the most recent available — from the Centers For Disease Control states that 7.9 percent of people over the age of 12 have used an illegal drug in the last month.
But as Matt and many others like him have found, it's not finding the drug or taking it that is difficult — it's the withdrawal.
Understanding addiction
In order to understand what happens to a person during withdrawal, one must understand addiction.
Jim Parker, executive director of the Do It Now Foundation, a non-profit publisher of drug abuse-related pamphlets, says all kinds of addictions start in the brain.
"The mechanism of addiction is pretty universal," he says. "The mechanisms of addiction involve the most primal circuits in the human brain. These are the circuits of pleasure and anticipating pleasure."
Parker says there are two key events that must occur for a person to become addicted to a substance.
The first, he says, is that the substance must be self-administered.
"If you're in a car wreck, you can be administered high levels of narcotics and slowly be tapered off of them," Parker says. "You don't have the severity of symptoms of addiction because you weren't doing it to yourself."
The second condition is that a person must be aware that the drug directly causes the effects he feels, Parker says.
If either of these two conditions is absent, a person won't become addicted, he says.
Another common thread that ties together all addictions — from gambling to narcotics — is the involvement of the brain's pleasure centers, Parker says.
An article published by the National Institute on Drug Abuse says that all drugs are aimed at the brain's reward system, and they flood the brain with dopamine — the chemical that produces feelings of pleasure. "[Dopamine] makes you feel good, aroused and ready to go," Parker says.
Matt understands this feeling precisely.
"Doing meth stimulates your reward complex," he says. "It's like working on a hard paper all week — that feeling you get when it's done."
When a person uses a substance for a long period of time, the neurons that produce dopamine can become impaired, and they appear to turn off. When this happens, the body stops producing dopamine because the drugs look and act just like it, Parker says.
"The trick is to find behavioral ways to turn them back on," he says. "But it's unclear whether that is always possible."
Some drugs, Parker says, can damage a person's neurotransmitter systems so badly that he may never be able to return to homeostasis, the body's normal state before the addiction.
Parker relates this to a thermostat in a house, which is a self-regulating system. This means that if you set the thermostat at 76 degrees, the air conditioner will automatically turn on when the temperature increases to 77 or 78 degrees. That is how a normal brain functions, monitoring its own internal temperature, he says.
"When drugs interfere, it's like setting the temperature to 66 [degrees]," Parker says. "Your air conditioner will run 24 hours a day until you forget that it's running. You don't notice it anymore."
"This is what happens when a person is addicted," he says. "They only notice when the air-conditioner is off. The immediate response is to turn on the air-conditioner. Can't sleep at night? Turn on the AC."
"It becomes the fundamental awareness at the center of all the other awarenesses that make up our lives," he adds. "Turn on the drug."
Physical dependence
Erin Shadle, an animal health student at Mesa Community College who used to attend ASU, knows what it's like to have drugs at the center of her life.
After nearly two years of sporadic hospital visits due to low blood counts, spleen removal and an attack of arthritis in her hip, Shadle, 22, says she was on a first-name basis with painkillers like Dilaudid, Vicodin, Percocet, Ambien and Demerol.
She had to leave her first semester at ASU early to get pins inserted into her hip, which were later removed because of an infection, she says. At the hospital, she was put on a lot of heavy painkillers, and she received oral medications to take home.
During that time, Shadle says she took 20 milligrams of Vicodin every four to six hours, which added up to 60 pills in five days.
Shadle recalls going on vacation to Cancun, where she was able to walk around but says she was in constant pain.
"I just accepted that was the way my life was — taking pain pills and in pain," she says.
The next year, Shadle's hip had deteriorated due to arthritis, and she received a hip replacement — and more painkillers.
"I went through [the painkillers] pretty quickly," she says. "I didn't overuse it, but I mastered the idea of pain prevention rather than pain relief."
With all her medications, Shadle says she was afraid of becoming addicted. "The heady feeling you get when you take it is enjoyable, but it's not why I took it," she says. "Part of me was afraid that when I got off it, things would go wrong."
Though Shadle never considered herself addicted to painkillers, she says she experienced some symptoms of withdrawal. She suffered from sleeplessness, restless leg syndrome (a creeping feeling in the legs) and extreme pain.
"When you're taking that much pain medication on a regular basis, you hit your elbow, and it doesn't hurt. You stub your toe, and you can't feel it," she says. "And when you go off it, all these things you haven't felt in months, they just hurt so bad."
"I don't think I had withdrawal the way some people do, but I was physically dependent on it."
Withdrawal and relapse
Parker says physical dependence — like Shadle's — often differs slightly from addiction to narcotics. While Shadle's dependence on painkillers was to keep her from feeling the pain in her hip, other addictions, like Matt's to meth, can have a different set of withdrawal symptoms.
"Since the drugs are so powerful and focused around the physiological effects, they have more physiological consequences that are aversive to people who are addicted," Parker says.
Drugs like meth have their greatest effect in the pleasure receptors of the brain. Overcoming that impairment to the dopaminergic neurons is what recovery from addictions is about, Parker says. And that can take several attempts.
According to National Institute of Drug Abuse, nearly 60 percent of drug addicts relapse.
Matt tried to quit his meth addiction three times before he was successful.
The first time was a couple of months into his sophomore year of high school. Matt went through a detoxification program and drug counseling at St. Luke's Medical Center. Going off the drug was tough, he says.
"It's like the most severe hangover you can have — constantly," Matt says. "You feel a complete dissatisfaction with life."
This dissatisfaction comes from the lack of that extra dopamine-like chemical in one's brain, Parker says. Matt says his first withdrawal was the exact opposite of that I-just-completed-something-important feeling, "but with a headache, throwing up and physical pain."
Three days after his month-long stint at St. Luke's, Matt was back on meth. "I jumped right back into the habit," he says.
At the end of his sophomore year, Matt was back in rehab, this time in the suicide ward of the Scottsdale Banner Behavioral Health Hospital.
After experiencing the same withdrawal symptoms over again, he was released, and he immediately began doing meth again — but this time he did more of it.
"I started doing it every day and two to three heavy binges each week," he says.
Finally, Matt was admitted into Casa by the Sea, a treatment center located in Mexico, about 50 miles south of San Diego, he says.
Matt says at the facility they were forced to wear the same clothes and shave their heads, and they aren't allowed to speak unless spoken to. "They strip you of your identity," he says. Matt spent three months at Casa by the Sea, but "most people are there for years," he says.
Though Casa by the Sea was shut down by Mexican authorities in 2004 for "immigration issues," according to an NBC San Diego article, Matt says it did what it took for him to quit meth.
"They scared me straight," he says.
Matt suffered many common symptoms of meth withdrawal, including pain, depression and sleeplessness.
"After I came off meth I was tired all the time," he says. "The feeling is really hard to describe. There's a feeling in your veins, like there's too much sober in them. You're empty."
After spending 90 days in Casa by the Sea, Matt returned to Arizona and attended his senior year of high school, where he earned a President's Scholarship to ASU.
He still thinks about meth, but he says he wouldn't do it again.
"I don't want to do it again. Well, you always want to," he says. "But I don't see it ever happening."
tara.brite@asu.edu |
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