When it comes to sobriety, especially long term sobriety defined by abstinence periods measured in time frames of a year or more, the success rates of all forms of drug treatment tend to drop dramatically. This is particularly true of opioids, and there are physical reasons for this. All drugs of abuse, and many others as well, cause or can cause physical changes to the brain. Some may be permanent, at least to some degree, and contribute to the ongoing risk of relapse over time. If you’re asking yourself, “am I weak-willed if I use maintenance medications long term following a substance abuse treatment program?” the answer is no. Drug cravings driving the urge to use your drug of choice are not based on will power. They are based on changes in the brain and the subjective pleasurable effects of the drug of choice. These urges are also rooted in your genetic makeup, probably to a significant degree.
AA and NA
According to the 12 Steps of Alcoholics and Narcotics Anonymous, drug abuse contributes to and causes the user to lose control of their lives. No one would argue with that. However, AA and NA teach and believe that this loss of control is basically due to a lack of faith and belief in a Higher Power. It’s this Higher Power that you must allow to take control of your life and therefore your drug or alcohol abuse. There is nothing wrong with faith. There is nothing wrong with asking a higher power, whatever you conceive that to be, for help and spiritual guidance when you need it. The problem with this AA and NA philosophy comes with failing to recognize the proven physical factors that drive addiction. There are also emotional, psychological and environmental factors as well. It makes no sense to pretend like these things don’t exist. They certainly do.
Drugs produce pleasurable effects in some individuals. These effects are self-reinforcing. So why doesn’t everyone who takes an opioid or a snort of cocaine become addicted? The answer is very complex. Many people will like the effect but not necessarily seek it out. These people may lack the genetic predisposition for addiction. They may use a drug occasionally, perhaps if it happens to be around, but they won’t seek it out. Many people have taken prescribed opioids after surgery, for example, but they stop as soon as the pain subsides. No one knows for sure, but people who don’t become addicted to drugs even after taking them probably lack the genetic and environmental predisposition for drug abuse and addiction.
Genes and Addiction
Genes may determine the tendency for addiction at least half of the time. Environmental factors may determine much of the other half. If you have found yourself physically and psychologically addicted to a substance, it’s safe to assume that you have at least some of these factors working against you. It’s not your fault if you inherited faulty genes. No one is ever blamed for having genetic diseases like cystic fibrosis, hemophilia or Down syndrome, are they? Inherited genes that influence the tendency for addiction aren’t any different. You can’t change these genes. You can’t really fight them, either. Good or bad, they are part of who you are.
Drugs of abuse cause profound changes in the brain. Opioids cause a depletion of endorphins, natural feel-good and pain-relieving compounds produced by the normal brain. Narcotics also cause the brain to grow extra opioid pain receptor sites. Stimulants deplete the brain of dopamine, a drug necessary for feelings of reward and well-being. Low dopamine and serotonin levels are linked to depression. There is no way to know for sure what other kinds of changes, some of them perhaps permanent, that may occur in the brain due to repeated use of certain drugs.
After you complete substance abuse treatment, you may still have brain changes compelling you to use drugs. The tools you learned in rehab, while very useful in many ways, may not be enough to combat powerful drug cravings and urges originating from a physical cause. Maintenance medications help to relieve these urges and greatly increase your chances for sobriety. For example, buprenorphine, the synthetic opioid component of Suboxone, activates the brain’s opioid receptors just enough to suppress drug cravings and prevent opioid withdrawal symptoms. Relieved of the constant craving for opioids, you can focus on other parts of your life and take part in family and work life again. No one who uses maintenance medication is weak-willed for doing so. That’s a ridiculous fallacy.
Do you Need Help?
If you’re struggling with drug cravings and would like more information about substance abuse treatment or maintenance medication, we can help. Just call us anytime at 833-497-3812. Our trained, professional staff will be happy to answer all your questions and guide you to the best treatment options for you.