Neuroscientist Maureen Boyle's relationship with her sister, who struggles with drug addiction, becomes even more complicated when she begins working on drug policy.

Maureen Boyle is the Chief of the Science Policy Branch at the National Institute on Drug Abuse or NIDA. She is a neuroscientist who has spent the last 7 years working on behavioral healthcare reform and drug policy. Prior to joining NIDA she was a AAAS Science and Technology Policy Fellow at the NIH Office of Behavioral and Social Sciences Research.  Before getting involved in policy she studied the biological basis of psychiatric and neurodevelopmental disorders. When she wants to get out of her brain she runs, does yoga, and tries to apply Pavlov's lessons to her bulldog puppy. 

This story originally aired on Aug. 4, 2017, in an episode titled “Epidemics.”

Story Transcript

The first time I smoked weed was with my older sister. When we were young, I was in awe of her. She was gorgeous. She was smart and insightful. She wasn’t just popular -- she was a leader of the popular girls and she always knew how to get exactly what she wanted. We used to go to this little store around the corner from our house and, with just a look, she could get the guys behind the counter to give her a free candy or soda.

She was always the fun and impulsive one. The first time my parents caught her getting drunk, she was only thirteen. By that time, more than a few of the bottles in our liquor cabinet had been topped off with water or iced tea.

She started staying out all night, partying with her friends, but that fun and impulsive side was only part of the picture. She started going through bouts of mania and depression. She started starving herself to stay thin. She was in and out of the mental health institutions, gathering up different diagnoses, bipolar disorder, OCD, panic disorder, anorexia, PTSD.

In college, she started dating a pharmacist and he basically gave her unlimited access to pills. I would go over to their apartment and there would be Costco-size bottles of Vicodin, Percocet, Xanax just sitting out on their shelves. For her, that eventually transitioned into heroin and crack. That’s when all the behaviors that you associate with addiction began, the lying, the stealing, the only showing up when she needed or wanted something.

There was one time she called my brother in the middle of the night begging for two hundred dollars to get her carpets cleaned. She went from this incredibly smart person to someone who couldn’t think of a better lie than a carpet emergency.

Our relationship took a lot of twists and turns over the years. At times, she could be the most thoughtful and pathetic person you know. She knows how to comfort you when you're in pain. She knows what to say to reassure you, to make you feel like you're loved, because she knows what it’s like to feel like you aren’t. But at other times, she could show a selfishness and an unconcern that was totally incompatible with the other side.

She used to smoke cigarettes incessantly. But my mom had bad asthma. She’d be upstairs in her room smoking out the window while our mother struggled to breathe downstairs. And she knew what she was doing. She knew that she was hurting our mom and she wouldn’t just go outside. For a long time, I couldn’t forgive her for it.

But as I got older and I understood her mental health problems better and the pain that she was in, we got close again. We were even roommates for a time in college, but she was at the height of her anorexia.

She was five-foot-five and got down to about eighty-five pounds. I'd come home and she’d recite for me the meager amount of food that she’d allowed herself to eat, the slices of cucumber, steamed green beans. And she’d show me how her size-zero jeans were starting to get baggy on her. And in the next sentence, she’d ask if she was fat. Every conversation centered around it. It felt like she needed constant reassurance -- reassurance that I loved her, reassurance that she was thin, reassurance that life was worth living. But no amount of it ever seemed to make a dent.

There was one time when I was cooking dinner when I realized that one of the good knives was missing. I asked her about it and she said that she had started sleeping with it in her bed in the hopes that she would wake up with the strength to do it. I was eighteen. I had no idea how to handle this. I was convinced I was going to wake up one morning to find her body, or that I'd get a phone call at work telling me she was dead.

I wish I could say that I was strong when she needed me the most, but I wasn’t. I started avoiding being home. I would leave first thing in the morning and come back just in time to go to bed. And all this time, all I wanted was to save her. I was convinced that if I could just come up with the right words, if I could just frame the right argument, she would understand that life wasn’t as bad or as hard as she thought it was. If I could just find the words that would resonate with her, she would stop hurting herself and she would get better. But I never found those words.

I was still her nerdy little sister, and I went off to grad school to study the neurobiology of mental illness. I was fascinated by how this mass of cells within our skulls could produce these sentient, introspective beings with such complicated and often inscrutable emotions and behaviors.

One day in my first year, I was in the lab, mid experiment, pipette in hand, and my phone rang. I glanced over and saw that it was my mom. My heart dropped. My mom doesn’t call. Ever. She emails.

So I ripped off my gloves, grabbed my phone, ran into the hallway. I was shaking by the time I answered. Then she tells me that she's redoing her will. She wants to send me some papers for me to sign. She heard the tears in my voice as soon as I replied. She knew exactly what I'd been thinking because it was what we were all thinking, all the time. She didn’t call again without emailing first.

A few years ago, I moved away from the lab bench and into policy, where I’m still working on mental health and addiction issues. Just about every day, I tell people how addiction is a brain disorder, how drugs flood the reward circuit with dopamine. This is the same circuit that reinforces natural rewards. Food, sex, love. But drugs activate it much more powerfully. And the brain likes to maintain a level of balance so when you repeatedly hyper-activate that circuit, it compensates to turn the volume down. What that means is when you stop taking the drug it’s still on low so you don’t experience the same level of pleasure from the natural rewards.

And similar things are happening to different circuits throughout the brain that are affected by drugs, circuits that control your stress response, pain, learning and memory, impulse control, decision making. Some of these are primal circuits. So someone with an addiction basically learns incorrectly, but powerfully, that their survival depends on those drugs.

So put yourself into the brain of someone with an opioid addiction. You want to stop, but as soon as you do you start to experience withdrawal. You're nauseous, you're shaking and sweating. Your head hurts, your body hurts, your joints, your bones. You have vomiting, diarrhea. It feels like the worst flu you've ever had. Your stress response is out of control and you know that the only thing that’s going to make it better is if you just take that drug.

Imagine at the same time that the circuits that help you prioritize your long-range decisions, your long-range goals, are diminished. Can you maintain your recovery? What if you also have PTSD or bipolar disorder? What if you're living in poverty? And even if you do stop using drugs, you don’t see a realistic way to rebuild your life.

On your worst days when you're stressed, exhausted, overworked, do you always live up to the goals that you set for yourself to eat right, to exercise, to walk your puppy? Do your better instincts win day after day, week after week, month after month? When I think about my sister through this lens, I have incredible sympathy for her. But the reality, on a face-to-face with her. is so much harder than this.

She lies. She doesn’t take responsibility for her actions. She doesn’t contribute to society. All that the science tells us doesn’t tell us how to actually have a relationship with someone in the throes of an addiction. When she lies, should I pretend that I believe her? Should I call her out on it, knowing it’s just going to start a big fight? Should I ignore it and move on? How can you have a relationship without trust? Without reciprocity?

Family relationships are always complicated. If my sister were here today, she would tell you that I’m not supportive enough. She blames me and the rest of my family for her illnesses. She thinks that if we could just trust her more, if we could just support her unconditionally, she could get better. But I don't know how to pretend to trust. I don't know how to pretend I don't see the lies.

A good friend of mine in recovery from addiction once told me that the best thing that family members can do is to distance with love, to show empathy and compassion without supporting the behavior. But anyone who’s ever done this knows how incredibly difficult it is, and every single member of our family has a different definition for what it means.

I wish I had good answers to these questions. I wish I had something to tell the family members that came to me how to rebuild their families. But in life, just like with science, we often don’t get complete answers to the big questions. We keep asking and looking and finding small pieces to the puzzle, and that’s what I try to do.

As I was writing this story, it brought me right back to that place of believing maybe I could find the right words. Maybe I could find words that would resonate with my sister, words that would save her. Hopelessness has been a refuge for me for a really long time. And even just a sliver of hope, that I don’t really even believe in, opened up this stuff, the pain that I’m usually really good at pretending isn’t there.

I don't know if I'll ever have a normal relationship with my sister, but I hope that she knows that even though I hold myself at a distance, I do it with love and with the hope that one day we can have the kind of relationship or accept each other despite our flaws without having to pretend they're not there.

Thank you.