When Rachel Thaxton started taking lortabs at age 25, she felt like she found what had been missing all her life.
She had always felt inferior to people, like she couldn't look them in the eye. That all changed when she took the drug. They gave her a sort of self-worth.
"I don't know any other way to put it but that I fell in love," she said.
Dr. Carl "Rolly" Sullivan, vice chairman of WVU's School of Behavioral Medicine and Psychiatry, said the feeling Thaxton got from being on the drug is common. Many addicts have a similar story, he said.
"You'll hear that all the time that people didn't feel comfortable until they had that drug inside them," said Sullivan, who has run WVU's addiction program since 1985. Many addicts experience that at a young age, he said. "By the time I see them, they will do virtually anything to make sure they don't go without the drug."
Opioids are a form of medication that relieves pain. They include hydrocodone, oxycodone, codeine, morphine, heroin and related drugs, according to the National Institute on Drug Abuse. They enter the brain and are converted into morphine, which binds to molecules on cells known as opioid receptors. The receptors are located in parts of the brain and body that are involved in the perception of pain and reward. Opioid receptors are also in the brain stem, which controls blood pressure, arousal, respiration and other automatic processes critical for life.
Opioids have a beneficial effect at first - they diminish pain and provide a bit of euphoria, Sullivan said. They also make people drowsy and constipated, he said.
Intravenous heroin users say they feel a surge of euphoria and dry mouth, a warm flushing of the skin, heaviness of the extremities and clouded mental functioning. After the initial euphoria, the drug user goes into alternately wakeful and drowsy states, according to the Institute.
Over time - perhaps weeks, months or years, depending on a number of factors - the brain adapts to the amount of the drug a person takes.
"It doesn't matter if it's a legal drug from a doctor or heroin, they all work the same in the brain," Sullivan said. "The brain adapts to the large amounts of drugs. It becomes relatively immune to the effects of the drugs. So you have to take more of the drug to feel the same."
Studies have also shown that long-term heroin use may cause deterioration of the brain's white matter, which may affect decision-making abilities, the ability to regulate behavior and responses to stressful situations, according to the Institute.
For Thaxton, and many other users, resistance meant using harder and harder drugs: from lortab to Percocets to oxycontin, opanas to heroin.
"As the dependency built up, I needed more and wanted more," Thaxton said. "And then I don't just want it anymore - I had to have it."
The time it takes a drug user to become addicted varies, Sullivan said. As opposed to alcohol, which often takes years before an addiction develops, some people become addicted to opioids within weeks. The time it takes depends on their genetics, the amount they take and the drug's potency.
"We almost never saw a 19-year-old alcoholic and we see 19-year-old opioid addicts all the time," Sullivan said.
A person may not notice the symptoms of drug use while they're using, Sullivan said.
Overdose can be another physical effect of heroin. If person has too much of the drug, they become drowsy, fall asleep, slip into a coma and die, Sullivan said.
When a person starts to come off opioid use, "that is an extremely uncomfortable situation," Sullivan said. They're shaky, drenched in sweat and their nose runs constantly, he said.
"It looks like the worst case of the flu that anyone can go through," Sullivan said. "They're so sick, but if I gave them a dose of opioid, it would go away pretty quickly."
These flu-like symptoms last days to weeks depending on the drug.
"The thing that doesn't get better is the craving that will lead them back to using," Sullivan said.
Though she had tried before then, it wasn't until 2013 when Thaxton successfully got clean, she said. She had lived in a tent on the riverbank. She lost her job as a kindergarten teacher when she started to steal from her employer, she said. She's careful not to call it rock bottom, though; there's always lower a person can fall, she said.
In addition to the symptoms Sullivan described, Thaxton got intense leg cramps during her heroin withdrawals, she said.
"And there's not a lot of sleeping going on," she said. "I couldn't for weeks because of racing thoughts. The drugs have been removed but your mind is still going."
Joshua Brothers, 30, of Hurricane, was 56 days sober as of Friday. He's in treatment at a Prestera facility in Dunbar after his latest arrest, this time for credit card fraud. He described the withdrawals as "very intense." It starts with a feeling of tiredness and stomach sickness, he said. Withdrawals are worst on the third and fourth day, he said.
"You would rather step in front of an 18-wheeler or a train than go through it," he said. "Your head's going a hundred miles an hour [asking] 'what can you do to get dope?' " He didn't sleep for eight days, he said.
Fifty-six days is the longest Brothers had been sober since he was 16, he said. He said when he started shooting heroin he "fell in love" with it.
"It's a soul snatcher," Brothers said. "You don't care about anybody or anything. It's crazy the way it makes you feel. It's the best high there ever is. But sobriety's a lot better."
West Virginia is seeing is an increase in hepatitis due to intravenous drug use, Sullivan said. He's concerned that the number of HIV and AIDS cases will increase next.
"I can just feel that coming," Sullivan said. "...Some of the most severe complications are not the changes in the brain, it's the things that go along with doing the drugs."
Thaxton will be the program director for Recovery Point of Charleston when it opens (slated for late spring). Brothers, too, said he is committed to staying clean.
But even after a person recovers and isn't using anymore, addiction can last a lifetime. Sullivan compared it to an alcoholic who had been sober for a number of years. When he was in his 70s, he was having trouble sleeping and his physician advised him to have a glass of wine before bedtime. Not long after that, he was in a treatment facility for alcohol abuse, he said.
"To go back to recreational drug use is not advisable - ever," Sullivan said. "For the most part, if you're going to get sober or clean that's what you need to do."
Reach Lori Kersey at lori.kersey@wvgazettemail.com, 304-348-1240 or follow @LorikerseyWV on Twitter.