Proposal

There is an opioid epidemic that is sweeping across America. It affects so many teens and
young adults and it is becoming a leading cause of death in todays society. Many families,
including mine, see the affects of addiction in a loved one, we watched the progression of
addiction in my brother until he overdosed and lost his life. When you see something like this its
very hard to say that it was a choice and that every addict just chooses to opt out into drugs.
There are so many layers of addiction including the way the brain functions and how that affects
the addictions. The biological factors of these addictions, especially opioid is what I am choosing
to research during my project. I want to learn whether how these factors can change the way we
view the treatment plan.

Summary
In todays society its hard to find a single school that doesnt participate in a D.A.R.E
type program. These programs are educational, warning children as young as kindergarten the
danger of using bad medicine. Every year during a D.A.R.E week, my little brothers
elementary school wears crazy sock, weird hats, and tacky clothes to lighten the spirit of their
week as they learn about taking medicine that isnt there and how peer pressure affects choices.
When I was a child I would laugh these weeks off, how could someone let themselves become
dependant or addicted to drugs? I thought it was completely mind over matter, you had to have
let yourself become addicted and you had to want to continue to use drugs, but through personal
experience and furthered education I have changed my view.
When I was seven years old I met my step brother Shane. He quickly became the coolest
(and only) teenager I knew. He and his friends would drive me and my sister around and take us
places. Stepsiblings was a term that we always hated, we were just siblings in our eyes, but two
years into knowing my brother I watch him. Shane became addicted to opioids and prescription
medicine. It changed him and because it was almost impossible for me to continue my previous
belief that it was a choice. I watched my brother struggle with his addiction for 5 years before he
lost his battle to an overdose in November of 2016. A lot of people I have talked to have a
similar story as me and it brings to question, why now? Why is this opioid crisis becoming a
national epidemic?
As I have learned more through my education, I have learned that there are many aspects
of biology and genetics that relate to the state of a persons mental health. I began to wonder why
most addicts started using when they are teens and how these substances change the pathways
and the genetic markers in cells. If these drugs are affecting the body in a hard science way,
why do we only treat them with psychology? The current treatment plan in America is mostly
still the same twelve steps that were invented in 1935 with some minor upgrades. Every year
there are constant improvements in medical health and if a doctor tried to cure a cold with
medical advice from 1935, they would lose their medical practice. This programs are failing and
how could we expect them to continue to work? I believe that if we spend more time looking at
 the genetic and epigenetic factors we could reverse and possibly put an end to addiction
altogether.

Main Theme Ted Talk by Ben The Relevance of Should The Opioid Hospitals Could Do More
Goldacre Auto-Biological Crisis Be Declared A For Survivors Of Opioid
Attributions for Mental National Emergency? Overdoses
Health

Biological All mental health, not

Factors of just addiction, is
Addiction caused by factors of
the brain like chemical
imbalance. The stigma
place on the mental
health that it is
controllable is a
perspective of the past
that needs to be change

The Modern New Jersey Governor 90 fatal overdoses each

Opioid Crisis Chris Christie releases a
report calling for the
president to call a State
of Emergency on the
Opioid Crisis This
would allow there to be
a decrease price in
Napoleon and other
overdose reversing
drugs.. There is some
issue that arise if they do
this. It could become
like the War on Drugs.
day. For every fatal OD
there are approximately
30 nonfatal ODs.
Finding a new way to
combat ODs in hospitals
is so very important.
Using Buprenorphine can
help hospitals in this
crisis.

Medical Ben Goldacre talks Naloxone is a drug that Even though we have
Contributions about the process of many view as a crutch. several drugs that have
publication of a trial in It reverses overdoses been proven in trials to
the medical field and and lessens dependence. help reverse overdoses the
how that can be is In Dr. Corey Waller numbers of fatal ODs are
extremely opinion these drugs are still rising.
bias.(Example- trial essential to saving the
published on lives of loved ones and
Nostradamus being should be widely
proven to tell the future, available.
but no trail for the
 disapproval for that.

Main Theme Randomized controlled Biological David Sheff On New Findings on

trial of a computerized Contributions to Addiction: Prevention, Biological Factors
opioid overdose Addictions in Treatment And Staying
education intervention Adolescents and Predicting Addiction
Adults: Prevention, 'Clean' Relapse Vulnerability
Treatment and Policy
Implications And

Memoir of a Meth
Addiction from a Father
and a Son

Biological We have worked hard Most people who have an

Factors of to study and combat addiction have a low level
Addiction multiple addictions, but of grey matter in their
there is no change in brain and they have a
levels. Drugs actually increase activity in
are a form of caudate and dorsal
neurotransmitters that striatum region. This is
rewire. There is what controls stress, so
predisposing factors when a person is stress the
that cause a person to natural release of these
have an addictive hormones remind the
personally and these brain if the addiction and
are mostly found with that is where the need
the amount of grey come froms
matter in a brain, this
also connects it with
age.

The Modern This experiment shows This Author and father

Opioid Crisis that computerized of a recovered addict
education and speaks on a book he
naloxone training can wrote. David Sheff says
significantly decrease that addiction is one of
the rate of ODs in the the most complicated
opioid epidemic. diseases and it is a brain
Table four as an disease. In the interview
example. together they talk about
the personal story about
how Nic lost himself in
the Methantamine.

Medical Using drugs that inhibit

Contributions the mesolimbic
dopamine function help
addiction to drugs like
opioid, but are limited
when it comes to
addictions like
gambling. That says
there are more
underlying contributors
to addiction and it is
important to find these.

Literature Review
The modern day opioid crisis is sweeping across the nation and as it does it is capturing
the attention of many, creating a polarized spectrum of opinions. In 2015 there were more than
33,000 fatal overdoses in the United States, that is approximately 90 fatal overdoses each day
and for every one fatal overdose there are approximately 30 nonfatal overdoses. (Hsu 2017) In
2017 this crisis has reached a pinnacle point, so much so that New Jersey Governor Chris
Christie released a report calling for the president to call a State of Emergency on the opioid
crisis. This would allow there to be a decrease price in Naloxone and other overdose reversing
drugs making them widely available (Allen 2017). In an interview David Sheff on NPR speaks
on a book he wrote, David Sheff says that addiction is one of the most complicated diseases and
it is a brain disease. Together they talk about the personal story about how Nic lost himself in the
Methanamine (2013). With addiction rates rising now more than ever, many scientist are now
focusing their research efforts on pinpointing what factors contribute to addiction.
All mental health, not just addiction, is caused by many factors. Some of which can be
linked to neuroscience and the biology of the brain, as example chemical imbalance or genetic
variation (MacDuffie and Strauman 2017). The stigma placed on the mental health that it is
controllable is a perspective of the past that needs to be changed. Scientists have worked hard to
study and combat all addictions, but there is no change in levels. In the specific case of drug and
substance addiction, the substances actually change the neurochemistry essentially rewiring the
brain. There are predisposing factors that cause a person to have an addictive personality and
these are mostly found with the amount of grey matter in a brain, this also connects it with age.
This is why Dr. Potenza contributes addictions to the younger adolescent generations. Our grey
matter is still developing and we are also still using primary circuitry which when functioning in
parallel loops can cause impulsive behaviors such as addiction (2017). This primary circuitry
controls the bodys response to stress, so when a person is stress the natural release of these
hormones in these loop and remind the brain of the addiction causing the impulsive behavior
(Sinha 2011).
Learning more about the science behind addiction, pharmaceuticals have began
producing more drugs to combat addiction and overdoses. Naloxone and Buprenorphine are two
major drugs that help reverse the effects of overdoses and lessens dependences on opioid. Many
drugs like these people view as a crutch. It reverses overdoses and lessens dependence. In Dr.
Corey Waller opinion these drugs are essential to saving the lives of loved ones and should be
widely available (Allen 2017). Even though they help addicts, there is a lot more questions
about these drugs than answers. Ben Goldacre is a doctor who disagrees with the process of
medical journal publication (2011). He talks about the bias of publication, journals only publish
positive results which makes medicines seem better than they are. In relation to these drugs we
often question their effectiveness, we have several drugs that have been proven in trials to help
reverse overdoses and that are being used, but the numbers of fatal overdoses are still rising.
(Sinha 2011) Overall using drugs that inhibit the mesolimbic dopamine function help addiction
to drugs like opioid, but are limited when it comes to addictions like gambling. That says there
are more underlying contributors to addiction and it is important to find these as well so we can
better grasp the issue (Potenza 2017).

Interviews

For my first interview I chose to interview Dr Sharon Bullock. She has earned her PhD in
Molecular and Cellular Pathology at the University of North Carolina at Chapel Hill and a BS in
Zoology at North Carolina State University. She currently teaches in the biology department at
the University of North Carolina at Charlotte.

1) There is a wide debate of "nature versus nurture" when discussing topics like addiction, do
you believe that there is one correct side or is it a blend of both? Why?
Blend, yes there are gene that predispose people to addictive behaviors. Looking at this topic in
wide ranges. Both sides have argument the model is typically twins that are separated at birth.
You can then pinpoint the difference. In these studies there is a genetic factor to the addiction
phenotype. Both twins often would have an addiction even if they aren't together. Also
connection with cancer oncogenes, but without the factors to trigger the gene you will not be
affected.

2) While studying the human genome, scientists have found very subtle variations in each
person's genome that are referred to as single-nucleotide polymorphisms or SNPs and within the
population of addicts there are more SNPs than in the general population. How could one single
and subtle change affect a person's susceptibility to a disease?
One change could affect the function of a protein related to the metabolism of a drug or alcohol,
now that one change can change the function. The SNP could relate to an enzyme and then affect
the processing of a drug.
3) Substance addictions create both a physical and mental dependence in the person, but in other
addictions, such as gambling and pornography, there is no physical addiction. Would you
personally classify these addictions the same generally category of addiction or is there a
spectrum of addiction?
I believe there is a spectrum. I think that addiction phenotype has both a physical and mental
component. Like in pornagraphy there is both a mental and physical aspects. Mental effects in
the nervous systems due to drugs, and the whole behavior set pattern control the addiction as
well. Creating patterns in their life, rehabs pull addicts out of their environment and they dont
know how to act when they go back.

4) Epigenetics is a relatively new field of biology being studied. Some scientist have found that
substance addiction causes genes to coil around histones, if this is true how could we change the
current treatment plans to better address addiction? Or could we?
Yes they are looking at the difference. They are looking for the addiction genes they are
currently looking at a population with phenotype and the people that looking for the people who
dont show vs the people who do. The differences are being identified and trying to be used. The
treatments are looking towards look for the biochemical pathway that causes the epigenetic
change. Could we block it? Or could we reduce it?

5) Have you known someone in your life who struggled with addiction? If so how has it changed
your preconceived opinions about addiction and the current treatment options? If not how would
you describe your feelings on addicts and the current treatment options?
We can all say we know people with addictions. My own preconceived opinion was that it was
devastating. I stayed clear of it, I dont smoke because I saw my mother smokes. She had to stop
due to an allergy to smoke she had to stop because of a health issue. My first grade teacher
would smoke while we worked on papers. Trying or risk it with social risk. Its bad , dont do it.
People who see it can either be propelled towards or completely against it. We could do more for
addicts through support early on. Education could be better for the younger generation, more
variety on plans for education. Kids dont listen to adults in a lecture setting. Supporting all
aspects of addiction, the family including. The research is not nearly finished yet. More research
is needed.

For my second interview I talked to my mother, Nancie Mandeville. She lost her 23 year old
stepson to an opioid overdose in November of 2016. She raised Shane from when he was 15
years old to 23 and he became addicted to opioids at age 18.

1) There is a wide debate of "nature versus nurture" when discussing topics like addiction, do
you believe that there is one correct side or is it a blend of both? Why?
I believe it to be a blend of both "nature versus nurture". Chemical dependency appears to have
a predisposition in some families, but I often wonder how much of that is actually more
environmentally related (my father was a drunk, his father etc) because families have grown up
with the expectation of facing these problems rather than a true biological alteration. I also see
traumatic experiences as "tipping points" for those who face addiction. Children may be raised
in families that have generations of addicts without becoming addicted themselves, rather
choosing to use their exposure as a momentum to avoid addiction. Others may experience a
deep trauma that pushes them into addictive behaviors as they simply do not have the coping
mechanisms for dealing with their trauma.

2) Did you have any preconceived notions of addiction? How did knowing someone with an
addiction change your opinions?
Yes like most people who have only a light acquaintance with addiction I always thought it
would be "those people", troubled families, degenerate types that battled addiction. My own
personal exposure to addiction was with alcoholic grandparents and I saw their poverty and lack
of education as the reason for their drinking. Later in life I learned that my grandfather has
suffered from PTSD from serving in WWII and used alcohol as a means of coping. I think my
grandmother found drinking with him easier than being sober around someone suffering from
PTSD. When I married my husband and became the stepmother to a teenage son battling drug
addiction I fell into the roll of thinking.. "those people" again. It was easier to blame the choices
of his Mother's lifestyle, her erratic and often violent outburst personality, as well as my own
husband's inability to "see" his son's addiction as the causes of our son's addiction. In truth it
was most likely a combination of generationally being raised around addiction (multiple family
members on both sides battled alcohol addiction and drug addiction) which lent to his being
desensitized (perception of normal behavior) and a traumatic experience (my husband's
diagnosis as terminal) that triggered his initial addiction issues. The years we had Shane in our
life gave me the gift of seeing addicts as people. Viewing lives that have been broken, but are
still beautiful. I will always be thankful for this gift because I can now see the potential in those
that I meet who are fighting addiction, see them as who they were, who they are and who they
can be. I hope that in time our family will find some way to help individuals and their families
who are battling addiction

3) Do you believe addiction is preventable? Why?

Yes but it will require work at the foundational level of our society where we work to instill
family values again. Where we raise children who learn how to cope with life when it gives
presents traumatic experiences or even what used to be everyday experiences that we no longer
seem capable of dealing with. We need to support the family at it's core, provide resources that
build strong marriages, parenting skills things that have been lost in our society. This is a long
term means of preventing addiction. Get down to the roots of why we choose behaviors that
eliminate our pain.. teach our youth that life will always have challenge some far worse than
what we can imagine but there is always a way to get through without numbing ourselves to the
pain.
4) How could we improve the current treatment plans in America?
Stop band-aiding addicts. Look at what programs are having true success. Faith based
programs and programs that teach true life skills, survival type programs that have a
disciplinary approach. Learning how to equip people with structure so that they can live in the
world without falling back into what has become their only means of coping. The majority of
addiction programs out there today are nothing more than income generators for
pharmaceutical industries, health insurance companies and the big businesses that have
developed out of this crisis (rehab centers and sober living homes). They are nothing more than
a revolving door that perpetuates the cycle of addiction in order to continue the revenue stream
created by "treating" addiction.

5) Substance addictions create both a physical and mental dependence in the person, but in other
addictions, such as addictions and pornography, there is no physical addiction. Would you
personally classify these addictions the same generally category of addiction or is there a
spectrum of addiction?
I would completely disagree with the statement that pornography doesn't create a physical
addiction. All addiction is the choice of a substance or stimulus that creates a reaction within
the addict. They are either numbing or stimulating in effect. Pornography creates a physical
addiction that results in the addict being unable to experience sexual intimacy without
pornography being involved. Their body becomes desensitized to normal physical stimulus and
is unable to respond appropriately without the exposure to the visual addiction. I believe all
addiction has a physical and mental component whether it be from a substance or behavior.
What I have been learning is that opioid addiction however is something that physically is nearly
impossible to break within the human body according what I have read in the medical field.
That said I am skeptical as is it just another means to create revenue with the creation of
synthetic substitutes such as suboxone? I personally have become jaded by what we walked
through with our son Shane and realizing just how big the business of "treating" addiction has
become.
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