More than a week after she was hospitalized for an apparent drug overdose, the singer Demi Lovato has been released from the Los Angeles Cedars-Sinai Medical Center and talks about the persistent struggle for abuse and relapse – a often dangerous bicycle that can end in tragedy for many people struggling with substance use.
“I’ve always been transparent about my journey with addiction. What I’ve learned is that this disease is not something that disappears or fades over time,” promised to be sober before the incident, wrote in a statement Sunday. “It’s something I have to keep overcoming and have not done yet.”
Relapse – like Lovato experienced according to People ̵
1; are common. The National Drug Abuse Institute warns that while 40% to 60% of people with reduced drug addiction return at a certain time, which makes it a common part of drug reclamation, “it can be very dangerous – even fatal”.
A number of risk factors make recurrence so dangerous, says Dr Richard Blondell, Vice President of Addiction Medicine at the University of Buffalo’s Jacobs School of Medicine and Biomedical Sciences. But the big offender often loses tolerance, he says.
“When a relapse occurs, someone can take a dose that they think is effective – and that may even be half of what they took before – but because you’ve lost their tolerance, they tend to be deadly,” Blondell says. .
In order to understand why a change of tolerance is so dangerous, it helps to understand how tolerance develops in the first place. Although its impact is wide and affects how everything from a person’s heart to their students responds to a drug, tolerance begins in the brain, Blondell explains.
“In all brain cells there is a mixture of receptors. Some stimulate the nerve cell; some inhibit the function of the nerve cell. When taking a drug, it interferes with the normal balance, and the brain then tries to restore the normal balance, says Blondell. “These drugs are integrated into the brain function, so the brain compensates for the effects of the drug by changing what it does elsewhere.”
Over time, the brain becomes good for making such adjustments and a typical dose of a drug stops having the effect it once did. When they adapt, a user needs larger and larger doses to get the same high. And when they increase these doses over time, the tolerance continues to be mounted.
When someone stops taking drugs, the brain returns to its usual way quite quickly, and tolerance disappears. Even a relatively short period of sobriety may be enough to dry someone’s neurological slate clean, which means they risk taking a stronger than intended if their substance use recovers, “Blondell says.
Dosage may be particularly complicated depending on the drug involved, Blondell adds. (The drug or drugs Lovato may have been found to be unclear.) Generally, because of its strength, it is easier to overdose opioids than it is cocaine or alcohol, he says. But heavy synthetic opioids have an additional complicated problem. While a heroin user may visually assess the strength of a dose quite well, he or she can not always tell if the substance is cut off by something like fentanyl.
“A standard dose of fentanyl can be about two or three kinds of salt and a fatal dose may be six to seven salt grains,” Blondell says. “When mixed with milk and sold in a small bag, you can not tell what is a lethal dose just by looking at it.”
Tammy Anderson, a professor of sociology at Delaware University specializing in substance use, adds that the social factors surrounding a recurrence case also. Many who see a return of reduced drug addiction start using again because of changes in their social group or environment, or because they have restored the conditions under which they once used drugs or alcohol. All of these changes, says Anderson, can lead people to use dangerous amounts of a drug.
If there is any silver lining in the Lovato situation, Anderson says that it is her transparency about her relapse, addiction and recovery can help increase compassion and reduce stigma about substance abuse problems.
“This will raise awareness and it will increase compassion, and that’s good,” says Anderson. “The opioid epidemic can beat someone.”