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Dr. Tammy Anderson
By Jamie Ducharme August 7, 2018
More than a week after she was hospitalized for an apparent drug overdose, singer Demi Lovato has been released from Los Angeles’ Cedars-Sinai Medical Center and is speaking out about the enduring struggle of addiction and relapse — an often dangerous cycle that can end in tragedy for many people who struggle with substance use.
“I have always been transparent about my journey with
addiction. What I’ve learned is that this illness is not something that
disappears or fades with time,” Lovato, who had been sober prior to the incident, wrote in a statement Sunday. “It is something I must continue to overcome and have not done yet.”
Relapses — like the one Lovato experienced, according to People — are common. The National Institute on Drug Abuse warns that,
while 40% to 60% of people with a substance abuse disorder relapse at
some point, making it a normal part of addiction recovery, “it can be
very dangerous — even deadly.”
A number of risk factors make relapses so perilous,
says Dr. Richard Blondell, vice chair of addiction medicine at the
University of Buffalo’s Jacobs School of Medicine and Biomedical
Sciences. But the major culprit is often losing tolerance, he says.
“When a relapse occurs, someone may take a dose that
they think is going to be effective — and it may even be half of what
they were taking before — but because they’ve lost their tolerance,
those tend to be lethal,” Blondell says.
To understand why a changing tolerance is so dangerous, it helps to
understand how tolerance develops in the first place. Though its impact
is wide-ranging, affecting the way everything from a person’s heart to
their pupils responds to a drug, tolerance begins in the brain, Blondell
“In all brain cells, there’s a mixture of receptors.
Some stimulate the nerve cell; some inhibit the function of the nerve
cell. As you take a drug, that disrupts that normal balance, and the
brain tries to then reestablish that normal balance,” Blondell says.
“These drugs become incorporated in the brain function, so the brain
compensates for the effects of the drugs by changing what it does
Over time, the brain gets good at making these kinds
of adjustments, and a typical dose of a drug stops having the effect it
once did. As they adapt, a user will need larger and larger doses to get
the same high. And as they increase these doses over time, tolerance
continues to mount.
When someone stops taking drugs, however, the brain goes back to its
usual ways fairly quickly, and tolerance dissipates. Even a relatively
short period of sobriety may be enough to wipe someone’s neurological
slate clean, putting them at risk of taking a stronger-than-intended hit
if their substance use disorder returns, Blondell says.
Dosing can be particularly complicated depending on
the drug involved, Blondell adds. (The drug or drugs Lovato may have
taken remain unclear.) In general, because of their strength, it’s
easier to overdose on opioids than it is cocaine or alcohol, he says.
But potent synthetic opioids have further complicated the issue. While a
heroin user may be able to visually assess the strength of a dose
fairly well, he or she can’t always tell whether the substance was cut
with something like fentanyl.
“A standard dose of fentanyl might be about two or three grains of
salt, and a lethal dose might be six to seven grains of salt,” Blondell
says. “When that’s mixed up with powdered milk and sold in a little bag,
you can’t tell what’s a lethal dose just by looking at it.”
Tammy Anderson, a professor of sociology at the
University of Delaware who specializes in substance use, adds that the
social factors surrounding a relapse matter, too. Many people who see a
recurrence of substance use disorder begin using again because of
changes in their social group or environment, or because they’ve
reverted to the conditions under which they once used drugs or alcohol.
All of these changes, Anderson says, can lead people to use dangerous
amounts of a drug.
If there’s any silver lining to Lovato’s situation,
Anderson says, it’s that her transparency about her relapse, addiction
and recovery could help increase public compassion and decrease stigma
around addiction issues.
“This will increase awareness and it’ll raise
compassion, and that is a good thing,” Anderson says. “The opioid
epidemic can hit anybody.”
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