East Bay Addiction Crisis
A top doctor discusses the regional addiction crisis and the effect of opioids on your brain.
It’s 10:30 a.m. on a Monday morning, and Dr. Fred Von Stieff’s waiting room is packed with patients. They range in age from late twenties to senior citizens; some sit patiently and read People, while others sweat and twitch, as they wait to discuss their addiction issues with Von Stieff.
Von Stieff, the top “addictionologist” at John Muir Behavioral Health Center in Concord, has guided more than 30,000 detox cases in his career. He’s spent countless hours studying the brain’s reaction to drugs and alcohol. His 2012 book, Brain in Balance: Understanding the Genetics and Neurochemistry Behind Addiction and Sobriety, details Von Stieff’s research on how the brain reacts if you drink a glass of wine, smoke a joint, or swallow a Xanax or Vicodin tablet—and how your genetics can predispose you to addiction.
Today, Von Stieff is busier than he’s ever been during his 40 years at John Muir. Prescription opioid narcotic addiction has become an epidemic across the United States. Nationally, nearly 30,000 people died in 2014 from opioid overdose, and California leads the country with the highest mortality rate.
Diablo met with Von Stieff to talk about the opiate crisis, why addiction is so hard to beat, and when people should seek help.
Q: What led to your study of addiction and its relation to brain chemistry?
A: I’ve [worked] with chemical dependency since 1992. I’ve tried to understand why such intelligent people suffer from addiction. I had six Berkeley graduates and six Stanford graduates in my unit at one time, so I knew there was more to it than stupidity.
During the 1990s, we began to understand the workings of the brain. That was also the time that the computer industry was developing rapidly, [and] we knew the brain was much like a computer. Then, there was also the study of the genome, and we learned that genetics had something to do with [addiction, and] that alcoholism ran in families.
We took those parameters—genetics and the study of the brain—and put them all together. There are eight neurotransmitters in the brain [related to chemical dependency], and they run like a mechanical system—if one of these goes out, the [system] will not run. Brain chemistry is just as predictable as heart disease: A deficiency or irregularity in the brain will cause people to have psychiatric problems.
Q: How has the addiction problem escalated in recent years?
A: Twenty years ago, we had more alcohol, cocaine, methamphetamine, and some heroin [abuse]. But over the last several years, we have seen Vicodin come into play. Then, all of a sudden, there was a change to the [formula for Vicodin], and then they made OxyContin and oxycodone. It was a minor change, but it made the drug very euphoric. So, we have had this rush into opiates in the past few years.
Q: Opiate pain medications are the most prescribed drugs in the United States by far. Why have they become such a problem?
A: Opioids [trigger] this tremendous amount of dopamine [to be released in the brain], and they are so addictive. Also, there is [an incredible] amount of corruption in the pharmaceutical industry with these drugs. We saw that in 2004, when [they] pushed the Pain Act of California [allowing doctors to prescribe higher doses of opioids for severe chronic intractable pain], which was an open gate to the use of narcotics in California. People need to understand that [nearly] 90 percent of all the Vicodins, OxyContins, and other opiates produced worldwide are consumed in the United States.
Q: Are certain users more likely to become addicted?
A: Typically, people who have the genetic predisposition to alcoholism have deficiencies in their brain of dopamine [making them much more susceptible to opiate abuse]. These people are depressed, or they have a lot of anxiety. So, when they [turn to] opiates, it increases the dopamine in the lower part of the brain and calms them down. And the opiates are much more addictive than alcohol.
Q: If someone becomes addicted to opiates, what damage is done to the brain?
A: We know that these opiates hit different receptor sites in the brain. Those receptor sites are hit so hard that they start disappearing. You’ve changed the brain.
Your tolerance quickly increases when you use these drugs. (And the longer you use them, the more damage you do.) A silent injustice of the pharmaceutical industry—that they do not write on the prescription—is that these drugs will cause permanent damage to your opiate and pain control systems.
Q: Can someone who has become addicted to opiates kick the habit on his or her own?
A: It’s a very rough withdrawal but can be successful. But if someone is a genetic alcoholic, it is likely he or she will relapse with alcohol. There is only about a 13 percent success rate for self-withdrawal.
Q: What happens during opiate withdrawal?
A: [They will] have sweats, ache all over, [and experience] some diarrhea. [They] feel like [they] have a terrible flu-like syndrome that lasts for three or four days. After 28 days, they are going to feel better. The reason we have a 28-day program is that we know the brain begins to balance out in [that period of time].
Q: What advantages does a rehab program offer over cold turkey withdrawal?
A: This [rehab clinic] experience is an opportunity to get knowledge. It’s like any other education you get in school. You’re going to make fewer mistakes, and you’re going to have fewer relapses. You’re going to have less shame, and you’ll understand your behavior [while gathering] the mechanisms that you’ll need in the future, when you have to cope in a new environment without the drugs.
Q: What happens if people take pills again?
A: These brain receptor sites have memories like elephants. Within two or three days of using—even years after detoxing—users will be right back to where they were when they went into rehab.
Q: Marijuana is a hot topic in our national medical conversation. Would you advise using marijuana to manage pain?
A: No. Opiates affect receptor sites, but [the THC in] marijuana does as well. It causes a significant disturbance. Once you start messing with your dopamine system, you want more because your tolerance goes up. How do you get more dopamine? You use more marijuana, more alcohol, more opiates.
Q: Are the issues in Contra Costa County any different from the national epidemic?
A: We have a tremendous amount of opiate addiction. [There is] drug trade from San Francisco and other places. Addictionologists are giving people [opiate treatment drugs like] Suboxone and Subutex, particularly [to those] who have overdosed and almost died. Unfortunately, some of these doctors make money dispensing drugs and overprescribe.
When these [addicts] get to their sixties and seventies, they are going to have unprecedented tolerance to narcotics when they need pain control. There is probably going to be a pain epidemic around the year 2050, because these people in their twenties are going to need to have surgeries, and there is not going to be any drug that will help them.
Q: Many Diablo readers are educated women living in communities such as Danville, Lafayette, Pleasanton, and Walnut Creek. What are the most common problems you see with this demographic?
A: [Some] of these women are somewhat depressed and having a tough time in life. They might have the genetic predisposition to addiction. It’s very easy for someone like this to use alcohol to try to treat her own depression instead of seeking advice.
[Alcohol] is very hard to control. And the most powerful antidepressant in the world is alcohol plus nicotine. People in that group can fall into trouble so easily because these drugs are so powerful—and, so available.
Q: If someone has gone from a glass of wine every week to drinking a few glasses every night, how can he or she recognize the problem? And what should he or she do about it?
A: The number one signal that you have a problem with alcohol or drugs is [your] family telling you that they see a problem, and you don’t do anything about it. When you keep doing it in spite of their concerns, that’s the indication.
Listen to the advice of your family: If you can’t correct yourself in a certain amount of time, then you [need to] seek help. You need to surrender and say, “I need advice and recommendation to be able to stop this before I have further consequences.”
For more information about Von Stieff’s studies, visit braininbalancebook.com.
A Survivor’s Story
A Diablo reader shares her experiences with addiction and recovery.
Diana sips some water and reflects on hitting rock bottom.
“I was wasting away in bed, with a bottle of wine and a bottle of pills on my nightstand,” says Diana (who requested her name be changed for privacy). “I had stopped eating and weighed under 100 pounds. I was dying. Somehow, I called my child and asked for a ride to the hospital.”
Sitting in a restaurant in Walnut Creek, the 64-year-old mom’s spiral into drugs and alcohol feels like a fever dream. The breadwinner of her family, she maintained a
sober lifestyle for most of her life (though she faced a higher risk because her mother died at age 52 of alcohol and prescription pill abuse), running a small business in Lamorinda while raising three kids.
As her kids got older, Diana started drinking wine socially, then daily. “I wasn’t getting fall-down drunk, but I was having wine every night,” she says. “Sometimes a couple of glasses.”
In 2011, Diana endured several family challenges. She started seeing a psychiatrist who suggested antianxiety medications such as Xanax and lorazepam.
The drugs did little to relieve Diana’s stress, but she put her faith in the psychiatrist and the prescriptions. She took the meds as advised, only to feel more out of sorts. That’s when she started mixing wine with her prescriptions to take the edge off. An unexpected surgery came with an OxyContin prescription. All of these addictive drugs were prescribed by her doctors, who failed to mention the addictive part.
Her waking life became a nightmare. Diana would black out for hours at a time, sometimes forgetting how she had gotten home or where she had been. As the blackouts grew longer, Diana avoided social functions. “I didn’t think I could speak in complete sentences or get [my] words to come out in the right order,” she says.
Ashamed and terrified, Diana isolated herself in her bedroom during the day, with her pill bottle and wine glass. Finally, when she hit rock bottom, she asked for help, and her child drove her to the detox clinic at John Muir Behavioral Health Center. Diana remembers the uncontrollable shaking and Von Stieff’s visits a few times each day during her time in detox. “There’s no question he saved my life,” she says.
After six days of detox, Diana began going to meetings and classes in Von Stieff’s 28-day program. She was surprised to find that the
other 35 people in her detox group were much like her:
They were successful business owners, professionals, and community leaders. She got to know a mom from a neighboring town
who became addicted to opiate painkillers after a complicated pregnancy, then turned to heroin when she could not get enough pills to feed her habit.
After completing the 28-day program, Diana moved into a sober living home and attended AA meetings. That was just over two years ago, and she hasn’t had a drink or taken a pill since. Some of the others from her detox group haven’t been as fortunate. Last year, Diana went to the funeral of another friend from the program, a nurse who relapsed on opiate pills.
“I don’t understand why I’ve been able to not take a drink and she couldn’t do it,” says Diana.
Diana knows she can never take another drink or pill again, or she’ll wind up right back in that desperate fever dream. And she’s OK with that. Living life one day at a time isn’t so bad.