Heroin Addiction

• “In your mind, you can be O.K., you can just do one. But one is too many, and a thousand is never enough.” — Bruce Cherry, 58, Pennsylvania
• “In the beginning, it feels really good. You’re paying to get high. And toward the end, you’re feeling really stupid, because you’re paying not to be sick.” — Raj Mehta, 51, Michigan
• “Do not believe the hype. Do not believe your eyes. In the end, it’s not worth it.” — Jasmine Johnson, 29, Pennsylvania

A Visual Journey
Through Addiction

Why do people start taking opioids and why can’t they stop? Through interviews with users and experts, The New York Times created a visual representation of how these drugs can hijack the brain.

Written by SHREEYA SINHA illustrations by ZACH LIEBERMAN and LESLYE DAVIS

DECEMBER 18, 2018

The opioid epidemic is devastating America. Overdoses have passed car crashes and gun violence to become the leading cause of death for Americans under 55. The epidemic has killed more people than H.I.V. at the peak of that disease, and its death toll exceeds those of the wars in Vietnam and Iraq combined. Funerals for young people have become common. Every 11 minutes, another life is lost.

So why do so many people start using these drugs? Why don’t they stop?

Some people are more susceptible to addiction than others. But nobody is immune. For many, opioids like heroin entice by bestowing an immediate sense of tranquility, only to trap the user in a vicious cycle that essentially rewires the brain.

Getting hooked is nobody’s plan. Some turn to heroin because prescription painkillers are tough to get. Fentanyl, which is 50 times more potent than heroin, has snaked its way into other drugs like cocaine, Xanax and MDMA, widening the epidemic.

To understand what goes through the minds and bodies of opioid users, The New York Times spent months interviewing users, family members and addiction experts. Using their insights, we created a visual representation of how the strong lure of these powerful drugs can hijack the brain.

Dr. Pedro Mateu-Gelabert, one of the nation’s top opioid researchers, said this work brings “an emotional understanding” to the epidemic but “without glamorizing or oversimplifying.”

We invite you to share your experiences at the end of the page.

If you or someone you know is struggling with opioid addiction, call 1-800-662-HELP.

Stage 1 Gateway

“It’s like being hugged by Jesus.” — Amanda Ryan-Carr, 24, Pennsylvania

“I remember feeling like I was exhaling from holding my breath for my whole life. Just intense relief from suffering.” — Matt Statman, 48, Michigan

You naturally produce endorphins, the body’s own version of opioids, which act in the reward circuits of the brain to make you feel good after you work out, hug a friend or eat your favorite foods.

A drug like heroin creates a tidal wave in the reward circuits of the brain. To an outsider, it looks as though you have passed out. But on the inside you feel like a master of the universe, like you’re being “hugged by Jesus,” as one user said; there’s peace in your skin and not a single feeling of pain.

You may remember this exact moment for years to come: where you were, what you wore, what you saw and what you heard. You may chase this feeling for years.

As the high wears off, the brain regains its balance – but not for everyone. That’s the opioid trap for many people: In the beginning, no serious ill effects are apparent. But the brain rewires little by little with each use.

Stage 2 Tolerance

“It was like the high put on blinders to everything and made me not care about anything in the world, other than the heroin.” — Brandon N., 26, Pennsylvania

“Any time you start to feel like you’re getting antsy or anxious or a little stressed, your body says it knows exactly how to get out of this, and it’s telling you to just go get a little bit more of that heroin.” — Ivana Grahovac, 42, California

You’re chasing the siren of the first high by taking more. But even a thousand more doses will never bring back the experience of that first time.

The brain balances its own endorphins like a thermostat. When an external source keeps flooding the brain, it throws that system off.

Like other drugs, opioids produce a surge of dopamine, a chemical messenger that tells the brain that “taking this drug is good, repeat it.” The brain’s response to opioids and the surges in dopamine they cause can rewire circuits in the brain.

The brain’s response to these chemical changes make life difficult without the drug. Stress and irritability creep in, so you take more opioids to cope. Soon, nothing else in life provides any satisfaction.

The pleasure and reward cycles flip: You get less pleasure from the drug, but want it all the more. The more you seek and take the drug, the more the brain adapts to the drug and demands more.

Stage 3 Withdrawal

“It’s like a demon crawling out of you. You’d rather just die and be done with it than go through that.” — Jasmine Johnson, 29, Pennsylvania

“Everything hurts. It hurts to comb your hair. It hurts to shave. You have no energy. You feel weak. You feel a sense of desperation. You have constant impending doom and anxiety, because you realize that with one pack of dope you can change how you feel within a matter of 10 seconds.” — Raj Mehta, 51, Michigan

The final trap of addiction is laid when you muster the courage to stop. You may not even realize you are physically dependent until you experience withdrawal for the first time.

There might be crippling pain, vomiting, insomnia, spasms, hot and cold flashes, goosebumps, congestion and tears. All this on top of debilitating anxiety and depression. You might feel like you’re having the worst flu of your life, or like a demon is crawling out of your skin.

This misery could last for weeks.

Dying from withdrawal is uncommon, but it doesn’t feel that way at the time. These harsh symptoms can make quitting seem impossible.

Stage 4 Addiction

“It’s like a time bomb. You’ve got 24 hours to get heroin, or you’re going to be really sick. You wake up, and your whole life is just based around it.” — Raj Mehta, 51, Michigan

“I felt like all my relationships were very surface-level, and really I was holding people hostage. No one was really my friend. I just wanted to take things from them.” — Mandy McCandless, 23, Pennsylvania

“I would see an old lady on a Mac and would think, ‘I could grab her pocketbook for cash.’ That was probably the beginning of the end.” — Jim Pietrowski, 57, Pennsylvania

The brain screams for more. Scoring the next fix feels like a race against the clock of withdrawal. You may feel like only a fix can save you. It makes no sense, but this compulsion takes over all logic, judgment and self-interest. You may do things you never thought you could.

Sell your body. Abandon your child. Steal from your mother. You might lose your job. Lose your home. Lose your loved ones. In this sad stage, families are torn apart.

Sharing needles can make things even worse, and bring about hepatitis and H.I.V.

A shadow of your former self lives in shame.

You’re now addicted to opioids and you no longer take the drug to get high, but to escape feeling low. The brain has adopted a new form of compulsion that can reassert itself even after years of sobriety.

Stage 5 Treatment

“My brain felt like it was rewired. My body, mind and soul. It's a day at a time. I can do anything for a day. Once I bought into that and made some other friends, things started to change for me.” — Jim Pietrowski, 57, Pennsylvania

“There was a push factor, which was the misery and the self-hatred and the depression and the cops, and then there was a pull factor, which was this amazing hope from this community of people who I knew understood me in a way nobody else in the world could.” — Matt Statman, 48, Michigan

You hit rock bottom, perhaps after a run-in with the law. You fear withdrawal. You dread confronting why you started and who you have become. Willpower alone may not be enough, and quitting cold turkey could increase the risk of overdose.

You may not have access to treatment. You may not be able to afford it. Or you’ve heard that quitting is impossible and that taking medication to help is simply swapping one drug for another.

Treatment centers that promote abstinence are at odds with the medical standard of care — long-term use of medications, like buprenorphine, methadone and naltrexone. But only about 25 percent of outpatient centers provide them.

These medications soften the cravings without causing euphoria. They help reset the brain’s thermostat, so it can stop thinking about opioids 24/7 and the hard work of recovery can begin.

Every person is different, and underlying issues, such as mental health problems, can affect a treatment plan. But therapy and community help increase the chances you stick with it.

Stage 6 Relapse

“A lot of times in your addiction, things are getting better. You see a light at the end of the tunnel. And it ends up being the freight train coming at you.” — Jasmine Johnson, 29, Pennsylvania

“That old impulse comes back, that old habituated response, which is: ‘This is hard. You’re going to fail. Don’t even try to get well. You’re just going to end up back in it. So just go get high right now.’” — Ivana Grahovac, 42, California

Relapse is a normal part of recovery, but it also brings dangers. After abstaining from the drug, your tolerance decreases even if the cravings remain intense. The same amount of the drug that you took before can result in overdose, especially if it’s laced with fentanyl or mixed with benzodiazepines and alcohol.

In an overdose, your body is unable to handle the drug and your breathing slows or stops.

Seventy-seven percent of opioid overdose deaths occur outside medical settings, and more than half occur at home. This year, the surgeon general advised Americans to carry naloxone, a life-saving medication to resuscitate victims.

Once revived, you may feel anger and shame, or face stigma and judgment, which can fuel the cycle.

For the families of those who are addicted, life has become a rollercoaster ride.

Stage 7 Recovery

“Colors get brighter and smells are more intense and emotions just are much more powerful, because opiates numb them.” — Dove Henry, 26, Montana

“I didn’t have interests or hobbies or anything. So finding what I really liked doing was really beneficial to me. Because if you don’t have fun, then you’re not going to stay sober.” — Rebecca Ronning, 24, Minnesota

“From now on, I have to guard my sobriety with my life, because my life depends on it.” — Ivana Grahovac, 42, California

Recovery is complicated and takes time, but it’s not impossible.

Experts say treatment could require six months to 20 years. One expert says the average person could relapse four or five times over eight years to achieve a single year of sobriety.

Some people may have to remain on medications indefinitely; for others, a doctor may taper them off. But doctors don’t know when the brain has reset itself and is no longer at high risk for substance use.

Factors like health insurance, housing and income can determine how long you remain on medication. Like a child, you also need to learn new behaviors and rebuild your life. It’s a journey to accept, control and heal the feelings that led to addiction.

Only one in five people who need treatment for drug use actually receive care, and only about half of those are given medication, experts say. Those given medications rarely receive them for long enough.

This article was taken from the New York Times on December 23.  Having seen how heroin can affect the person and the family close up, I felt compelled to copy this article in its entirety, in the hopes that some of you will read it.  Heroin is unlike other drugs, as it rewires your brain.  We have an epidemic in this country, and no solution in sight.  We all the rehab centers we have, no one has really figured out how to treat heroin addiction.  Hopefully this article will give you a better understanding.

Family Secrets: We All Have Them

When I started to write this blog, I thought I would focus on how families have become more transparent, more open, in the discussion of family secrets.  I thought that years ago, family secrets were kept hidden, never to be reveled, or else discovered upon the death of the person keeping the secret.  Now, I think this is still the case.

I guess there are big family secrets and little family secrets.  A big family secret is when it is discovered that the deceased had another family, another wife, and several other children, that no one ever knew of.  My friend went to the funeral of her first husband.  He had three children with his first wife.  At the funeral, my friend saw one of the mourners who looked just like her.  It was her half sister from another family, someone she knew nothing about.  Wow, while married to my friend she had fathered other children, and no one knew about them until his funeral.  What a shocker!

We used to have a box at Hollywood Park, and became very friendly with the older couple who sat next to us.  We learned through the years, that the man had fathered another child, with a woman who was a family friend.  The child was always thought to belong to the woman and her husband, but in fact, our friend was the real father.  I knew the boy when he was an adult in his 20's.  He knew who his real father was, but the secret was kept from the father's wife.

Things like mental illness, pregnancy out of wedlock, alcholism or drug abuse, and abortion, are family secrets that are often not revealed, unless by accident.  More and more the stigma of these situations are becoming more understandable, and are being revealed.  People now realize everyone has family secrets, and keeping them locked away is hard.

I'm reading a book  called Annie's Ghosts, about a family secret.  A son has researched his family history to find out why his mother always called herself an only child, when in fact she had a younger sister, with birth deformities and mental illness, who lived to be 52, and neither he nor any of his three other siblings new about sister Annie.  It's very interesting, and it shows that usually secrets cannot be kept forever.  Something happens to reveal them, and often the hurt that is caused is greater than if the secret had been told in the first place.

Eloise Psychiatric Hospital:1832-1982

I'm reading a book about a family secret, and it got me interested in Eloise Psychiatric Hospital, the place where the family member spent much of her life hidden from the rest of the world.  I realize after learning about Eloise, that it wasn't the only mass facility in America in the mid 20th century, where people were housed, often for life for various forms of mental illness, deformity, blindness and deafness.  In other words, asylums were where families (with approval from doctors) put less than perfect children.

Eloise Psychiatric Hospital opened in 1839.  At that time it was a medical facility for sick patients.  It was a poor house at this time, but quickly became an asylum and medical hospital.  At it's peak, it housed over 10,000 people.  It was located just outside of Detroit, Michagan.  It was so big that it had it's own postal code.  It grew all it's own food, had a bakery, slaughterhouse for pork and beef, it's own fire and police department.  There were thousands of people who worked there, not only as hospital employees, but raising and cooking food for the thousands of people that had to be fed every day.  It was probably no better or worse than similar asylums in California, New York and Illinois, because psychiatric medicine was really in it's infancy.  They used such archaic (today) methods as insulin and Metrazol shock therapy to treat patients.  They had chains and metal cuffs anchored on walls to control patients.  It must have been a horrific life for the residents.

The strides in mental health in the past century have been huge.  We now understand that many of the patients at Eloise and other similar facilities, did not belong there.  People who are blind or deaf or have physical deformities, live productive lives in their communities today.  Those with mental retardation also fit well into our society.  There is a place for psychiatric hospitals, but generally only for short term treatment, not life.  Mental health has come a long way.  The stigma of mental health is slowly being erased.  Thank goodness.

Three Cheers For Costco

I always liked Costco, but now I love them.  Costco recently said they will no longer carry Roundup in its stores, or any other product containing glyphoste.  Glyphoste is the active ingredient in Roundup.  It is carcenogenic, causing liver and other cancers and  endocrine disrupting.  It is great at killing weeds, but at what cost?

The use of glyphosate has skyrocketed around the globe.  Study after study has proven that this weed killer is also a people killer.  It causes liver damage and cancer.  Still, it is the 2nd best selling herbicide in the U.S. for lawn and garden.  Scotts Miracle Gro has a lucrative contract with Monsanto, which gives them exclusive rights to market Roundup in North America and much of Europe.  Scotts distributes over $154 million of Roundup to retail giants, including Amazon, Home Depot, Loewes, and Walmart.

How do we get retailers to stop carrying Roundup?  Call the corporate offices of large retailers and ask that this dangerous weedkiller NOT be on the shelves.  Make sure that your local HOA does not use the product.  It can sicken dogs as well, who may ingest the product as they take a walk.  We got rid of it in my community several years ago.  It's all about money for big corporations like Monsanto and Scotts.  If law suits are kept to a minimum, they will continue to sell the product, but if settlements like the recent DeWayne Johnson case in California, where Johnson was awarded $289 million for wrongful death, corporations are going to pay attention.  A few settlements like this should discourage them from continuing to sell Roundup.

We know that it's all about money for most of corporate America, but hats off to Costo and their leadership, for doing the right thing.  How does a company in good conscience sell a product that they know can cause death?  Costco has done what's right, and hopefully others will follow suit.

William: One of the Lucky Ones

I was walking Pepper early one morning, when I came upon a woman and her cute little white poodle mix, whom I had never seen before.  She told me she and her husband had been living in Brazil until recently, and adopted William in Brazil just a month ago, and brought him with them when they returned to the U.S.  Here are a few details regarding how they came to adopt William.

Every year when the summer season begins in Brazil, around early December, many residents close up their homes and either travel or live in a summer home somewhere else.  Apparently the pets that they have cared for are disposable, because tens of thousands of dogs and cats are abandoned each year when summer comes.  They are either thrown out of car windows or abandoned when the family moves.  I could not believe this story, but the woman confirmed it to be true.  She had never heard of it either, but said that everyone living there seemed to know about it.  When she heard about this problem, she went to the local shelter and adopted William, who had recently been abandoned.

We've all heard of the thousands of street kids in Brazil, but I did not know of the up to 150,000 stray and unwanted cats and dogs roaming the streets of Rio de Janeiro, many of them sick or injured.  When my neighbor adopted William, he was emaciated and near death.  Today he is a happy, healthy dog.

There is a great deal of cruelty to these innocent creatures, with many dogs being poisoned, beaten, denied medical treatment and intentionally run over.  Animals are ruthlessly killed in municipal shelters and there are no public policies to ensure them any kind of humane treatment.  No spay and neuter centers are available, and the laws are insufficient to guarantee their lives and dignity.  Stray dogs live near trash piles, tear up bags containing discarded food, and are a health and safety  hazard, yet the government does little to control the situation.

Fortunately there are a number of rescue organizations that have stepped in to help, yet it is a drop in the bucket.  With 150,000 stray animals on the streets of Rio, much more must be done.  It seems that an inexpensive spay and neuter program would be a good start.  I have no answers, but thought you should know about this terrible animal crisis.

The Rise of the Golden Jackal

The species arrived at the southern edge of Central and Eastern Europe about 8,000 years ago, and started to expand slowly in the 19th century.  The current boom began in the 1950's and has accelerated over the past 20 years.  Jackals now vastly outnumber the wolves in Europe.  Jackals total as many as 117,000, compared to only about 17,000 wolves.  Their abundance creates problems for sheep farmers and ecology.

Jackals are one of the least studied canine predators.  They are family based packs, but the groups tend to be smaller than wolves or coyotes, only four to six animals in a pack.  A monogamous pair of jackals form the core of a pack.  Bulgaria now has the largest population of Jackals, but they are abundant in Greece, Slovenia, Croatia, Hungary, Romania, Ukraine, Austria and Italy.  Jackal scouts have been found all over Western Europe, including Denmark.

Scientists believe that jackals began to move north because wolves were targeted for eradication, especially in the Balkans.  Jackal expansion is similar to, but more surprising than the spread of coyotes in North America.

A large group of scientists is now studying the golden jackal, and trying to determine where they will go next, and how their migration and expansion will affect the region.  We'll just watch and wait.

Top Environmental Issue Facing Our Planet

We constantly hear that climate change is the single most critical issue facing our planet today, and there's much to support that opinion.  However, many experts feel there is an even more pressing environmental issue, and that is population, or should I say, overpopulation.

The population of the planet has tripled in the past 60 years, going from over 2 billion to over 7 billion.  This puts a strain on everything in the environment, from land and water, to food.  Several decades ago there was a big push to limit population growth in developing nations.  Birth control was encouraged, smaller families were too.  You don't hear much talk about world population as a problem today, but it is.  We need to get back to reducing family size, especially in developing nations where family resources are scarce.  There is so much poverty and famine worldwide.  Part of the problem is that we are not producing enough food in areas that have the largest growth in population.  Our planet faces so many environmental issues right now, and controlling population is a top priority.