We all seek relief from pain, but how does relief become dependence? Following her own recovery, behavioural neuroscientist Judith Grisel has spent her career exploring the causes of addiction – and how our own brains can ultimately work against us.

The Galloping Cure has its World Premiere at Edinburgh International Festival Sun 9 – Wed 12 Aug. A bold new opera for the opioid age, The Galloping Cure is an allegory for a crisis that has become a worldwide epidemic. 

Dream Weavers: A Closer Look at the Opioid Crisis 

Around the globe, more than 10,000 people lose their lives every day from excessive use of mind-altering chemicals, accounting for about a quarter of all deaths. If we are not victims ourselves, we all know someone struggling with a merciless compulsion to remodel their reality by altering brain function. 

In Europe, more than a million years of potential life are lost annually to illicit drug use. The burden from alcohol alone is at least four-five times higher, accounting for more than 5% of all deaths. Along this sinkhole of a path are rippling costs in lost hope, dignity, relationships, money, family and societal structure, and community resources. 

Never Enough

Although human beings have been using substances to polish reality for tens of thousands of years, the rising incidence of disordered drug use is the likely result of better access and growing angst. Addictive drugs make us feel better fast, and ready access to such an array of potent chemicals initially feels like a shortcut to a fulfilled life – but ultimately hollows it out.

Rather than providing a shortcut, regular drug use turns out to be a dead-end, because the brain adapts by producing the exact opposite states as those we are aiming to achieve. This fundamental principle of neuroscience, that ‘what goes up must come down’ traps people into using – not to feel good (which becomes less and less possible) – but in order to not feel so bad. 

A Love Story

Early on, opiates provide perfect contentment – nothing remotely sinister. Using is easy and fun, and also simpler than hanging with a good friend. It feels so harmless in fact, that you barely notice the extra bit of comfort they provide after a rough day. As time goes by, you’d likely not realise that your existence has narrowed, or that you’ve grown more eager for the end of your shift. By the time you’re living mostly for the bottle, or the vapour, or the needle, it’s too late to turn back.

This pattern is all too plain to see. As Billie Holiday noted toward the end of her short life: 'If you think dope is for kicks and for thrills, you’re out of your mind. There are more kicks to be had in a good case of paralytic polio or living in an iron lung.' 

Drug of Choice

Many people begin their addiction in a doctor's office. Among women who are most likely to take these medications (partly because they are biologically more likely to experience pain) the first decade of the 21st century saw a 400% increase in lethal overdoses. Even living through a near-death experience usually isn’t enough to get someone to stop using; it merely delays the next crisis while governments, healthcare providers and family members shake their heads in dismay.

For users experiencing the bony clutch of opiate addiction tightening around their throats, the grip still seems so much better than no drug at all. This is because withdrawing is brutal. And just this way a habit is born, and round and round you go, not stopping because it would be too awful, even though the joy is entirely gone. The tragedy of addiction is enacted thousands of times a day, all over the world: the addict lives in a state of hopeless monotony but can’t see a way out. 

Yin and Yang

From a neuroscience perspective, the appeal of opiate drugs is easy to understand. The large class of narcotics, from heroin, fentanyl, and oxycodone to their less potent counterparts like tramadol, codeine and now kratom, all work by mimicking endorphins (endogenous morphine-like substances), the body's natural painkillers. Our brains manufacture an incredibly rich and varied pharmacopeia of these natural opioids, more than a dozen unique chemicals that play a critical role in our survival. This family of peptides facilitates bonding and attachment, helps us cope with stress, and most notably, reduces pain. Without these neurotransmitters, getting through a day would be even more challenging and prickly than it already is.

So, most of us can be thankful for our endogenous pharmacy, making life a little gentler and kinder. But in regular users, the brain changes to counteract the effects of their habit. As a result, the natural system goes silent, and even wickedly potent street drugs barely do the trick. Addicts can administer upwards of 150 times the dose that would be lethal to naive users and, even so, feel only 'right' but not really high. 

Paying the Piper

This tolerance means you need more, and more often. Bottoming out is even worse, as your body and mind are overcome with suffering – all as a result of the nervous system’s profound adaptation. Naturally, these adaptations produce craving, because anything is better than the excruciating state of abstinence.

In principle, moments of superb contentment from any addictive substance will require an equal and opposite experience of distress. The benefit of euphoria or escape creates a debt of dysphoria and riveting awareness. Any attempt to avoid this unpleasant state by taking more of the drug only increases what is owed. 

A Will and a Way

An adaptive brain leads to substance dependence, but the brain can also change toward recovery. Humans have a hundred billion neurons in their brains – about as many as there are stars in a galaxy – with an even more astronomical number of synapses through which these cells interact. 

They are all exquisitely tuned to appreciate and learn from our experiences with each other and the natural world, through connections, communication, our senses, poetry, music and dance and the world of ideas. These are the places to turn our attention when hoping to arrest the downward spiral of addiction, because they are considerably more proximal to a cure than anything to be found in another bottle or pill.