I was saddened this week to read of the coroner’s verdict on the death of Cory Monteith.  The 31-year-old talented actor and performer had been plagued by substance abuse problems long before his Hollywood days and had voluntarily checked himself into rehab in March where he completed a 30-day program.

Heroin and alcohol – a potentially lethal mix

Over the past two decades I have visited high schools and colleges to talk on how addictive drugs including heroin and alcohol affect the brain and it still amazes me how little the general public understand how these potentially lethal drugs work.

The post mortem showed the Cory’s death was due to a combination of heroin and alcohol intake. Both heroin and alcohol have similar effects on the brain. They both elevate mood, lower heart rate and put your brain into a sleepy inattentive state.  Heroin and alcohol are what’s called narcotics (i.e. sleep inducers) and sometimes called nervous system depressants – not to be confused with a depressed mood but relating as to how these drugs act to silence (i.e. depress) activity in the nervous system.  It is no coincidence then that a street name for heroin is dope. Once in the brain, heroin is converted to morphine by enzymes and the morphine binds to opiate receptors in certain areas of the brain. Alcohol in contrast, acts in a less specific way by making neurons ‘leaky’.  Both drugs are highly addictive and to make matters worse, at high enough doses they  both can act as anaesthetics – drugs that switch off important nervous functions in the brain stem – like for instance, respiration (breathing) and it was the combined effect of both of these drugs  in slowing and eventually stopping breathing which was why Cory died.

Many addiction experts were not surprised

It is clear from reading newspaper reports that although Cory Monteith’s friends and loved ones are deeply shocked by the revelations of the inquest many addiction experts were not surprised.  Corey struggled with drugs since he was 13 – so long in fact that his chronic addiction was hardwired into his brain. Thus, 30 days in rehab was not enough time to get to the root cause of the addiction especially if there were any underlying psychiatric issues. Brain rewiring for chronic addiction usually takes between 90 and 120 days to be effective.  Alarm bells should also have rung after he was released from rehab when he went on vacation to Mexico.  A vacation was a huge post-rehab mistake as a structured, supportive environment is so important to grow, maintain and strengthen the new brain connections.

What is tolerance and how did it kill Cory?

Not everyone who takes heroin and alcohol together dies; so what is so special about Cory’s situation? Cory died because of a brain phenomenon called tolerance. When drugs such as heroin are used repeatedly over time, tolerance may develop.  Tolerance occurs when the person no longer responds to the drug in the way that person initially responded.  Stated another way, it takes a higher dose of the drug to achieve the same level of response achieved initially.  So for example, in the case of heroin, morphine and alcohol tolerance develops rapidly to the effects of the drug.  The development of tolerance is not addiction, although many drugs that produce tolerance also have addictive potential.  Tolerance to drugs can be produced by several different mechanisms, but in the case of heroin, morphine and alcohol tolerance develops at the level of biochemical reactions mainly within the liver whereby  enzymes adapt so that the drug can no longer cause changes in brain cell firing. Thus, the effect of a given dose of heroin, morphine and/or alcohol is diminished.

A decrease in tolerance after rehab put Cory’s brain at risk

During the 30 days in rehab Cory’s body gradually rid itself of drugs and tolerance also gradually faded. The reasons why Cory’s death occurred shortly after his release from rehab was because of a large decrease in tolerance that his body experienced after that period of abstinence. Thus, when Cory returned to using, he ran the risk of experiencing a far more extreme reaction to the same drug doses that he was once accustomed to using.

It is particularly sad that our memories of this genuinely loved and popular person may be tarnished by the revelation. I would urge people not to let this be the case, and to remember Corey for his talent and not the sordid nature of his death.

Drug taking as a way of coping

I do think however that Cory’s death might not be in vain if it opens up a debate on how we as a society deal with stress. We have heard that Cory had a history of chronic addiction and we are led to surmise that alcohol and drug taking was his way of coping. In this he is not alone. As the world economy continues on its downward slide, and unemployment and financial worries beset us, are we going to turn more and more to these quick fixes to handle our dis-stress?

Probably the most important lesson to be taken from Cory’s death is the realization that the stresses of life and how we manage them IS the difference between life and death. I look forward to developing this theme in greater detail including drug-free tips on how the avoid worry and stress in future posts, but in the meantime, my deepest sympathy goes to Cory’s loved ones at this difficult time.