ST. LOUIS — This West County man loved tasting new foods and cooking at home, and when he wasn’t cooking, he enjoyed his favorite late-night television show. If you couldn’t find him indulging in these two hobbies at home, you’d find him in nearby woods absorbing the world around him.
Then-34-year-old Michael Oppenheim, a former resident of the City of Des Peres, found pleasure in these mundane things. He also had interests in graphic design and nursing. But he struggled with depression and anxiety, his younger brother, Steve Oppenheim, said.
He started sipping cough syrup at 15 or 16 years old and inhaling compressed air filled with household cleaners to get high, self-medicate and cope.
The Oppenheim family didn't become aware of Michael's coping mechanism until he was 20 years old. His use had started earlier than they’d realized, Steve said.
The family pediatrician warned them when Michael was just a small boy. They told his parents that he had an “addictive personality” because Michael had an unhealthy relationship with food. Steve said he agreed.
“Our pediatrician told him, 'When you're older, you're going to have opportunities to do drugs. It's a really bad idea for you to try that,'" Steve said.
By his mid-20s, Michael started using heroin.
Michael struggled with his career pursuits because he used heroin and could not remain employed. There were lots of moments of sobriety, most of which weren't very long. Michael started moving around a bit for employment and rehab. He lived in Chicago, Houston and then returned to St. Louis County.
He didn’t always complete the rehab programs he signed up for, Steve said.
“He got kicked out, then he'd have to figure out a place to go," he said. "He would get caught doing drugs during his programs and (they) were ‘one strike and you're out.’"
Michael continued to go in and out of rehab for most of his life.
“Bad things got worse. (Drugs) made it so that he was not able to follow the path he wanted to," Steve said.
He was homeless several times.
The Oppenheim family then allowed Michael to stay with them in St. Louis County. Soon, they became aware that Michael’s coping mechanism had escalated into heroin addiction.
They sought to intervene.
“We sat down and told him, ‘This is how it's hurting us. We want you to have a healthy, happy (and) long life. We don't think that that is going to happen if you keep down this path,'” Steve said.
Michael would “grudgingly” reenter rehab again but he wasn’t fully ready to quit.
The family tried to support him as best they could, Steve said. It's really hard to know where the line was between supporting Michael and enabling him.
During Michael's stay at his parent's home, the family contemplated whether to continue letting him stay or not.
“I don't want to speak on behalf of my parents, but I can't imagine they were easy decisions to make,” Steve said. “It's complicated, difficult, too emotional and confusing. We tried to let him know that he was loved and given opportunities to get better."
Michael sought help to curb his heroin use but continued despite the negative consequences.
Difference between addiction and dependence
A leader in addiction science and research within the Department of Psychological Sciences at the University of Missouri-St. Louis described this as addiction.
Dr. Rachel Winograd, associate professor at the University of Missouri-St. Louis and director of the addiction science team within the Missouri Institute of Mental Health, said addiction refers to the continued use of a substance despite the negative consequences it could cause, including withdrawal symptoms.
Imagine the first time you sipped a cup of coffee.
You began to drink it every day and then one day, you couldn't afford it anymore. Rather than buying it at the store, you bought some on the street. But, with cash, you stole from your grandmother. She called the police and they took you into custody.
You have destroyed your relationship with your grandmother and want to stop drinking coffee. But, you get a painful headache when you try and stop. To avoid that migraine, you would rather steal from your grandmother again.
Not only are you trying to avoid that headache but also get the same sensation you received during the first sip.
“These are all consequences that mean your caffeine habit is impacting your life, so you meet the criteria for addiction,” Winograd said.
This condition is different from dependence, however.
If you like to drink coffee every morning and you “need it,” because your body has become accustomed to receiving caffeine, then Winograd has bad news for you. You depend on caffeine.
The difference between dependence and addiction on coffee is whether or not you continue use despite the negative consequences outlined in the first scenario.
The Biopsychosocial Model
Winograd said dependence refers to a physiological phenomenon. The physiological phenomenon of dependence is a combination of the physical and psychological contributors associated with each person.
Because of biological risk factors, which are genetic components such as hereditary disorders that run in families, some people are more or less likely to substance misuse based on their biological predisposition, according to Winograd.
Some people have various psychological precursors, which reveal how they might decide to cope with stress or trauma, according to Winograd. These precursors can determine whether they are more or less likely to have negative consequences from substance use or not.
The social element refers to their environmental upbringing, how they were raised and under what societal or cultural circumstances, Winograd said.
She also said environmental factors can reveal whether they faced circumstances such as discrimination, adversity or oppression.
The physical factor is described as a particularly pleasurable or euphoric response, which would make the drug increasingly tempting to keep using, she said.
Michael died from an overdose in December 2019 and shortly after, heroin became obsolete.
Experts said that fentanyl began to poison the street supply in 2016, and highly addictive opioids hit in 2018.
Winograd doesn’t necessarily agree that heroin is gone because of fentanyl though. Heroin has "longer legs" than fentanyl.
Although the institute saw a large decrease in overdose deaths in St. Louis County last year, for the first time in many years, it's “really hard to say when you're just looking at death data.”
She said we have to be very careful not to make too many broad, sweeping statements. She said that our drug supply has continued to “get more and more toxic and less and less predictable.”
Winograd said she doesn’t agree that someone could have an “addictive personality."
“That's a myth. It's not a matter of a moral weakness or a lack of willpower. It's all much more nuanced and complicated than either of those,” she said.
In the next part on this series, we review the history of fentanyl and opiates in the United States. Over the years, fentanyl's original purpose has traveled from legal pathways onto dangerous streets. Part 2 will be published next week.
