Dr. Brad Lander, clinical director of addiction psychiatry at Ohio State University's Wexner Medical Center, uses a video of rats in a presentation. Rats are not people, Lander said, but the principle is the same: Addiction, without treatment, can kill.

These rats are addicts and will do anything to feed their habit.

They do that by tapping a tiny bar in their cage, which sends a signal to electrodes that were inserted into the part of the brain affected by drugs. Each tap brings a jolt of pleasure, a high of sorts.

Tap, tap, tap.

The rats tap the bar over and over. They don't stop to eat, drink, rest or even have sex. They continue to tap the bar and feed their addiction until they die.

Scientists made getting high even more challenging by forcing the rats to cross an electrified grid to get to the bar.

The result was the same: The addiction overwhelmed their survival instinct.

Dr. Brad Lander, clinical director of addiction psychiatry at Ohio State University's Wexner Medical Center, uses a video of these rats in a presentation.

Rats are not people, Lander said, but the principle is the same: Addiction, without treatment, can kill.

Lander's presentation, given earlier this year to a packed house of judges, law-enforcement officers and treatment professionals at a statewide opiate conference in Columbus, shines a light on the science of addiction.

Those who see it might never again say to an addicted family member, Why can't you just quit?

Lander shows how addiction makes fundamental chemical changes to a part of the brain called the nucleus accumbens, the pleasure center and reward circuit - the place where drug addiction lives.

That's why, Lander emphasizes, the addict in front of you is no longer your son or daughter. His or her brain has been substantively changed by addiction, whether it involves prescription painkillers, cocaine or heroin.

The addict's perception of the world is dramatically altered, much like that of the person who's had too many drinks at a party but insists that he or she is sober enough to drive home. It's obvious to other guests that that is not true, but that's not how the inebriated person sees the world.

"Our biggest problem is not them; it's ourselves," Lander said. "We want them to just quit, and they can't, so we become frustrated with how they behave.

"It helps when you realize the addict or the alcoholic is always doing the best they can. These aren't bad people. If they could do better, they would."

Addiction isa chronic disease

Lander has been refining his approach to the science of addiction for 25 years. What began as diagrams on a blackboard now incorporates photos, graphics and the rat video in a presentation he calls "Understanding Addiction: Squirrel Logic."

He said humans have what amounts to a squirrel brain inside their own brain.

"Your squirrel brain wants what it wants, when it wants it," he said. "It doesn't understand future. It doesn't understand consequences. It doesn't understand the impact of its behavior. It wants to run, it wants to jump, it wants to hit, it wants to scream."

While working at a veterans hospital, Lander grew to understand the incredible power of the brain.

"People would talk about feeling pain in a foot when they didn't even have a leg," he said. "The reality of the limb is in the brain, not in the limb itself.

"We think we control everything we do, but when you come down to the molecules, it's based on chemistry," Lander said. "Once you realize you are powerless over molecules and you are not the master of the universe, it's very freeing."

Your brain on drugs

The blood-brain barrier, which normally does a good job of screening out harmful toxins, allows tiny molecules of alcohol, marijuana, opiates and other drugs to slip into the brain.

There, drugs affect two chemical messengers: They produce a flood of dopamine, which generates a feeling of euphoria and inhibits the brain's ability to absorb serotonin, which helps control a wide range of emotions.

Even one dose of a drug affects the brain; continued use can produce devastating results.

"There's no such thing as a little cocaine or crack use," Lander said. "This is going to affect you for a significant period of time."

Memory is a victim

"What you see and what you believe is not necessarily what is going on out there," Lander said.

"Short-term memory is converted or 'downloaded' to long-term memory while we sleep. Since people using drugs don't sleep well or very long, their memory doesn't download. So when they say they don't remember what they did while they were high, they really don't remember."

Brain-scan images show shocking results. An energy scan of a brain shows a cratered surface after a single use of opiates; the brain of a long-term user is riddled with holes. Similarly, scans depicting overall brain activity show a significant drop with continued drug use. Frequently, the result is cognitive difficulties.

Although the brain eventually recovers after drug use stops - with the exception of alcohol abuse, which actually kills brain cells - perception, learning, impulse control and judgment are severely affected.

"The brain interprets drugs and alcohol as a new environment and begins to make changes in response," Lander said. "It disconnects and reconnects some nerve cells.

"The brain is now convinced it needs drugs the same way it needs food, water and sex."

Inside the addict's mind

M. Vanessa Eubanks knows that feeling too well.

The Columbus woman struggled with drug addition for three decades before kicking the habit for good 14 years ago. She abused marijuana, crack cocaine, acid, pills and psychedelic mushrooms.

She knows what it's like to visit the ATM a dozen times a day, vowing each time to take out just $20 for another score, only to return a few hours later.

"The drugs pervade who you are. ... If you're not getting high, you're thinking about how to get the money to get high. I have not run into a word that describes that unending desire."

Eubanks, 56, said she managed to get through high school, earn a bachelor's degree and spend eight years in the Air Force while living a double life as a drug addict.

After finally ending her habit by working with Narcotics Anonymous, Eubanks earned two master's degrees and became a motivational speaker. She works with the National Alliance on Mental Illness Ohio.

"When I'm talking with parents, I see the worry lines, the age lines, the betrayal lines on their face," she said. "They don't realize they're not talking to the son or the daughter they raised."

Eubanks said there are not enough rehab programs.

"We don't put enough emphasis on getting out of this trap. I would not wish addiction on my worst enemy."

There is hope

Orman Hall, director of the Governor's Cabinet Opiate Action Team, wants people to know that recovery is possible.

"The human brain is very malleable," Hall said. "As serious as the effects of someone engaging in addiction is, if we provide the right kind of environment and the right kind of treatment, many people show improvement."

That takes time.

"You can't expect someone who has serious addiction issues to profoundly change in a short period of time," Hall said. "In many instances, it's two steps forward and one step back. Relapse is a part of the process for most people."

Hall said he is optimistic that Ohio and other states will continue to work to end addiction.

"We'll get a handle on this because we have to," he said. "Sometimes problems have to get to a critical mass before we see fundamental change.

"I wouldn't expect to see this problem going away in the short term, but there are important signs we are making good progress."

A rocky path

The road to recovery is perilous. For one thing, recovering addicts are highly susceptible to pain, Lander said.

Normally, the brain creates endorphins to reduce the pain of an injury or illness. But opiates are much better at that, and over time, a drug user's brain stops making endorphins.

During recovery, "you take that away, (and) you've got some real pain to deal with," he said.

The impact of drugs is most critical in adolescents, whose brains are still developing, Lander said. Teenagers become addicted five times faster than someone 21 or older.

In the final analysis, the battle for recovery is between the two brains: the one that reasons, and the one that acts on impulse.

The key to treatment is making major changes to addicts' physical and mental states, Lander said. They need to sleep, keep their blood sugar under control, exercise and learn to relax or meditate.

It also helps to quit smoking, a tough task for someone trying to get over another stimulant. But smoking reduces the amount of serotonin the body produces, effectively doubling recovery time.

"My goal in treatment," Lander said, "is to make them bulletproof so there is nothing they can't deal with."

ajohnson@dispatch.com

@ohioaj