This article is part of WCPO's Heroin Project: How Do We Respond?
Perilou Goddard is a professor of psychological science at Northern Kentucky University.
Our community continues to be devastated by the epidemic of heroin and other powerful opioid drugs like illicit fentanyl. Families are torn apart, young lives once full of promise end in death or disease.
We search for answers, from tougher penalties for those who sell opioids illegally to expanded access to medication-assisted treatment. Our quest is hampered by the deep stigma attached to opioid use disorder, which, like other forms of substance use disorders, is treated like a choice rather than a disease.
Many members of the public focus on the fact that people who use heroin or other opioid drugs choose to do so, and most of the time, they are correct when they’re talking about the initial use of the drug. But this scenario is too simple.
Scientific research shows us that many influences determine whether the initial drug use ends after a few experimentations or develops into a full-blown substance use disorder. One of the most important factors is whether people have other sources of satisfaction and happiness in their lives when the initial experimentation takes place.
While it’s true that addiction can strike both rich and poor, the odds of experimentation turning into addiction are higher when people have few other sources of pleasure in their lives. It’s no accident that the current opioid epidemic began in economically depressed rural and Rust Belt regions where educational opportunities and jobs were scarce.
Another major factor is our genetic make-up: about 50 percent of the risk for addiction is programmed into our biology from the time we are conceived.
Our genetic risk for addiction combines with our environment to increase or decrease the likelihood that we’ll develop a substance use disorder. Experiencing adverse childhood experiences before age 18 is one of the most powerful environmental risk factors. According to the CDC, facing abuse, neglect, loss of a parent through divorce, death, or incarceration, or witnessing domestic violence, increases the risk of addiction and many other forms of chronic disease.
Scientists have discovered a dose-response relationship between adverse childhood experiences and later diseases: The more such experiences children have faced, the greater their risk for developing chronic diseases in adulthood, including substance use disorders.
Simply being in one’s teens or early 20s when the initial experimentation takes place is another powerful risk factor. Scientists now know that the prefrontal cortex, the part of the brain that helps us exercise good judgment and avoid risky behaviors, is not fully developed until we reach our mid-20s.
So, although the decision to try heroin or other dangerous opioids seems like a simple matter of choice, many elements that strongly influence the decision and its ultimate consequences are out of our control.
Young people aren’t responsible for their genes, economic opportunities, adverse childhood experiences, or the fact that their brains aren’t mature yet. Understanding the impact of these factors will help us see more clearly that addiction is a complex, chronic disease and not just a matter of bad choices.