Whereas the first time abusing illicit drugs or prescription pills may be a conscious decision, for one in every seven people, that decision turns into a mental impairment — substance use disorder.

Many people who suffer from substance use disorder with opioids began with a pain prescription at some point, but the addictive nature of the drugs led them to a point of dependency that many people cannot shake said Rep. Holly Rehder (R-Sikeston).

With one in seven people developing substance use disorder in their lifetime, only one in 10 of those individuals receive any type of treatment.

Substance use disorder is a medical illness that impairs health and function through the use of any substance in a manner, situation, amount or frequency that can cause harm to users or to those around them — and particularly for this investigation, opioids.

Someone with substance use disorder will show several symptoms uncharacteristic to their usual self. General indicators of substance use disorder include alienation; doing things to get the drug that the person wouldn’t normally do, such as stealing; spending money recklessly even when the money isn’t available to the; and constantly working to not get “sick” in relation to withdrawal symptoms.

According to the Surgeon General’s Report on Alcohol, Drugs and Health, substance use disorder is neurologically proven to be a mental disability. It states: “Well-supported evidence shows that addiction to alcohol or drugs is a chronic brain disease that has potential for recurrence and recovery.”

It describes the three areas of the brain most iconic when discussing the onset, development and maintenance of substance use disorder: the basal ganglia, the extended amygdala and the prefrontal cortex. Because of this, these areas enable triggers associated with substance-use to cue seeking of substance, reduce the sensitivity of brain systems that produce pleasure and reward to build up tolerance, and heighten activation of brain stress systems; and negatively affects the executive control systems of the brain.

According to the Missouri Intervention and Treatment Programs for Substance Use Disorder 2017 report, approximately 419,000 Missouri citizens struggle with substance use disorder. Of that number, 17,000 are between the ages of 12 and 17.

Breaking it down further: 795 pregnant women, 2,975 adolescents, 2,234 Missouri veterans, 19,624 community-supervised offenders, 2,228 homeless Missourians, 10,470 parents and 2,859 drug court participants received treatment for substance use disorder in FY 2016 (these numbers are not exclusive to opioid use and also include alternative drugs and alcohol abuse).

Substance use disorder treatment programs are funded by about $40.5 million in state general revenue, which generates an additional $64.4 million in matched federal funding including Medicaid and Substance Abuse Prevention and Treatment Block Grant

Southeast professor of social work Dana Branson describes substance use disorder as a continuum. She said addiction can be quantified, and from those classifications can assess the level of treatment necessary.

Through this data, Branson said some people are identifies as being more susceptible to form substance use disorder. Once these individuals begin drug use, their brains begin to alter and adapt to the drug.

“Different drugs manipulate different transmitters,” Branson said. “Dopamine is always involved and is that pleasure neurotransmitter. Those transmitters are the things that get out of whack, and any type of substance you put in your body is what it alters. That’s where addiction comes from.”

When taking opioids, the drug takes over a job the brain is generally supposed to do. Since it doesn’t have to produce specific neurotransmitters anymore, it stops. When the brain stops producing them, an individual becomes victim to substance use disorder.

Substance use disorder withdrawals begin when an individual stops using the drug on which they’ve grown dependent. The brain no longer has the neurotransmitters it relies on, and therefore must begin making them again.

“That’s why you have withdrawal symptoms,” Branson said. “It’s your body crying out for the stuff it got used to being put into.”

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“All addiction starts in the brain. It’s not an issue of morality, or somebody doesn't have enough will power; it is a simple issue of brain chemistry,” Branson said.

Rep. Holly Rehder (R-Sikeston) said she believes the number one initiative behind combating the opioid epidemic is reversing the negative stigma behind substance use disorder.

The Surgeon General’s Report on Alcohol, Drugs and Health gave recommendations on shifting social attitudes about substance misuse to attempt to successfully address the negative connotation accompanying substance use disorder. Their recommendations include adjusting the way individuals think and talk toward people with substance use disorder, to treat it like any other medical issue, and to provide high quality care for any individual suffering.

Rehder said she wants substance use disorder to be treated the same as any other mental impairment. She believes when it comes to smoking cigarettes and drinking, people generally don’t have the same negative reaction as they would if someone was addicted to opioids.

“Stigma really prevents a lot of people from reaching out for help. It keeps family members from understanding what’s going on and providing that help that they need,” Rehder said. “Remove the stigma so that people can be treated properly.”