In this post, we’ll explore the murky waters of opioid addiction. You’ve probably seen scary headlines on the topic for quite some time, pointing out that opioid overdose deaths are increasing. But how does opioid addiction differ from other addictions? Is it more dangerous? Find out in this concise guide. You’ll also learn how to identify signs of opioid abuse and overdose. You’ll gain insights into behavioral tells that can indicate that opioid addiction is setting in, too. Read on.
How Addictions Starts
The word addiction comes from the Latin root addictus. Addictus meant ‘enslaved by.’ This is quite apt.
Addiction is an extremely complex brain disease. An individual struggling with addiction will exhibit certain behavioral and physiological traits. As addiction takes hold, the addict will experience intense cravings for their drug of choice. They may also exhibit an inability to control their drug use, and if they lose access to their drug, they may engage in anti-social behaviors to get more.
One of the most common behavioral traits of addiction is that the addict will compulsively use their drug of choice despite negative consequences. They might lose their job, lose a relationship that was important to them or get in trouble with the law. But even though these events impact them negatively, using the drug remains their primary goal.
Managing an addiction is possible—even opioid addiction—but it’s important to understand that addiction itself is a chronic condition. Once you develop an addiction, you’ll need to manage that addiction for life. Understanding and accepting this is an important step in the recovery process.
Even in remission, when you’ve gotten control over the addiction and aren’t using, you may have to manage cravings. Learning to cope with these cravings on an ongoing basis is one of the major aims of drug addiction treatment.
What Causes Addiction?
It was once thought that addicts were simply lazy, or immoral, or weak. This is not the case. No one starts using drugs thinking, I sure hope I get addicted to this.
Addiction is not a moral failing, it’s a brain disease.
Some people are more susceptible to addiction than others. One reason for this is genetic predisposition. Growing up under the poverty line and/or experiencing any type of abuse in adolescence can also contribute to a desire to experiment with drugs.
Let’s briefly recap the hallmarks of addiction. Then we’ll explain what’s happening in the brain. In addiction, three things happen:
- Craving and withdrawal. The addict has intense cravings for the drug. These cravings start out as a mild inconvenience, but as they continue to abuse the drug, cravings become more intense. If they go more than a day without the drug, they experience withdrawal symptoms.
- Loss of control. The addict tells themselves they’ll stop using or will cut down their use, but they are unable to do so.
- Compulsive use. The addict will continue using even though doing so causes negative consequences.
Did you know?
At least 23-million Americans are addicted to alcohol or drugs. That’s almost 1 in 10 people.
Alcohol is by far the most commonly abused drug. After alcohol, the most commonly abused drugs are opioids, marijuana and cocaine.
In the 1930s, research into addiction began in earnest. But researchers then did not have the brain imaging technologies we have today. These researchers, while well intentioned, came to the erroneous conclusion that people struggling with addiction simply lacked the will to break their addiction. Consequently, addiction treatment involved providing addicts incentives to forgo drug use. But because addiction is a neurological process that starts in the brain, these techniques left a lot to be desired.
Today, scientists understand that addiction starts in the brain’s pleasure center. Pleasure is an important survival mechanism since it provides motivation to perform certain actions. For instance, we get hungry, so we eat, and as a reward, we experience pleasure. While many neurotransmitters are involved in this process, one in particular is important: dopamine.
But when you take a drug that has addictive potential, you force the brain to release a flood of dopamine—much more than it would ever release in ordinary day-to-day life.
This flood of dopamine affects an area of the brain called the nucleus accumbens in particular. This cluster of nerves located under the cerebral cortex becomes extremely active when you use drugs, and other areas of the brain take note. One of these, the hippocampus, creates short and long term memories in response to the over stimulation. These memories are also related to survival. In nature, it’s in the brain’s best interest to remember things that trigger a reaction like this, as it’s likely that the substance would aid in survival.
However, in the context of the modern world, this is not true. But the brain has no way to know that. Nevertheless, the brain has now created an association between the drug and intense dopamine release.
But as the person continues to abuse the drug, the brain starts to consider the drug to be too much of a good thing. Repeated, intense dopamine release is not a natural state for the brain, so the brain begins to resist the effects of the drug. The result? You’ll have to take more and more of the drug to get the same high. Sound familiar?
This is known as tolerance.
If you persist through the tolerance phase, the brain may become dependent on the compound to tell it when to release dopamine. This is known as chemical dependence. It’s at this point that you’ll begin experiencing intense cravings for the drug. If you go 12 hours to a day without the drug, you’ll experience withdrawal symptoms.
The term ‘opioid’ is a blanket term denoting any drug derived from the poppy plant. All of the above applies to opioid addiction, but there are a few extra facts to be aware of.
#1 Opioids Are Frequently Prescribed to Treat Pain
Just because a medication is made available to you by a doctor does not mean it is not addictive. When it comes to prescription medications, patients have been known to put their guard down somewhat. You would never use heroin. But if your doctor prescribes Codeine, Opioid Pain Medication or Prescription Pain Medicine , you might use that. Yet all of these drugs have addictive potential.
#2 Opioid Addiction Can Sneak up on You
Many patients who’ve become addicted to opioids started taking more of their prescribed opioid than they were supposed to. They do this because they think that the drug is not working as intended. This is an understandable conclusion to come to, but what’s really happening here is the onset of tolerance. If you find that your prescription is no longer working as intended, it is vital that you talk to your doctor right away.
#3 Some Opioids are Deadly
It’s not that these opioids may be deadly, it’s that they can outright kill you—and quite easily. Fentanyl, for instance, is a synthetic opioid that is between 50-100 times more potent than Opioid Pain Medication. Some people who develop addiction to prescription opioids move on to heroin when their prescription runs out. But some drug dealers add fentanyl to their heroin to make it more addictive.
If the addict then takes a dose of heroin-laced fentanyl thinking it only contains heroin, they could easily overdose and die. The drug dealer mourns the loss of a customer and moves on to hooking others. But the addict’s family mourns the loss of a loved one.
Signs of Opioid Addiction
As with many other addictions, opioid addiction occurs in stages, and it leaves tell-tale signs. Of course, everyone is different, and the situation will vary from person to person. In general, however, opioid addiction has predictable physical and psychological signs.
As we hinted at earlier, the progression of prescription opioid addiction can be slower than other drugs, such as cocaine. This is in part due to the patient’s psychological dependence on the drug for pain relief. If the patient relies on opioids for basic day to day functioning, they may be in denial about their dependence on it. In general, there are a few signs to watch out for:
- Repeated efforts to take fewer opioids. You may try and fail to quit several times. Or you may take a lower dose for a while only to double up later on.
- A lot of time spent obtaining, using and recovering. You may find yourself hopping from doctor to doctor trying to get multiple prescriptions. This is always a red flag. Then, you may binge on the drug—known to some opioid addicts as blissing out—which can occur over several hours. You then need to spend the next day recovering from the drug to return to baseline functioning.
- Failing to fulfill obligations. You’re so preoccupied with your need to get access to opioids and to use them that you neglect obligations at work or school. You may let relationships slip away from you too. Getting high becomes a bigger and bigger priority.
- You’re aware of the risk of overdose, but you use anyway. You know that opioids can kill, and you know you’re at risk. But you also know that you can handle the risk. You know that you’ll never overdose. Such high confidence can often be a sign of denial and can indicate chemical dependence.
There are also several physical side effects of opioid abuse. Let’s take a look:
- Slurred speech
- Constricted pupils
- Infections, including increased risk of HIV and Hepatitis C
Did you know?
Opioid abuse is associated with higher suicide risk.
At any level of opioid abuse, overdose is a possibility.
Opioids depress the respiratory system, and at a high dose, this can have lethal consequences. Signs and symptoms of opioid overdose include:
- Shallow, slow breathing
- Clammy skin
- Coma or unresponsiveness
- Fluctuating or decreasing vital signs
- Bluish lips
The most common street opioid is heroin. As mentioned, the dose of heroin will vary from dealer to dealer. Consequently, it’s difficult for a user to know how strong a given dose might be. This uncertainty contributes to heroin’s overdose risk, which is considerable. Of course, the addition of fentanyl and other additives can increase overdose risk as well.
The bottom line: Heroin and other opioids are the most commonly reported drugs in overdose deaths.
Opioid Addiction Treatment
The good news is, there are more options in opioid addiction treatment than there are for other addictions. This is partially because opioids have been used as medicine for a long time, and the drug’s function in the body is well understood. There are several medications that can help with opioid withdrawal symptoms. Among these are:
- This is a weak synthetic opioid that can help fulfill the brain’s acquired need for other opioids. It can reduce cravings and withdrawal symptoms both. In addition, because it’s an opioid agonist, it can block the effects of illicit opioids.
- This is a combination of buprenorphine and naloxone. Like Opioid Maintenance Medication, it can reduce withdrawal symptoms.
- Vivitrol. This is an extended-release medication that a doctor or other medical professional will inject into your arm. It blocks opioid cravings.
The availability of these medications means that the prognosis can be quite positive. However, medications alone are not enough to maintain sobriety. Addiction is a chronic condition, and you’ll have to learn to manage cravings on your own at some point.
For this, your best option is an accredited rehabilitation center.
A quality rehab center can help you learn how to manage cravings on a day-to-day basis using strategies like:
- Cognitive behavioral therapy. Learn to identify and nullify thought distortions that drive you to use. A thought distortion is an irrational pattern of thought that often causes you to feel stressed. Thought distortions can make you want to use, and you must learn to manage them as they arise. Examples include all or nothing thinking and minimizing the negative.
- Contingency Management. The focus of CM is on preventing relapse and encouraging adherence to 12-step programs. CM relies on the concept of operant conditioning. Because the brain exhibits neuroplasticity, you can learn new responses to cravings. Instead of giving in to the craving, you’ll learn to do something else instead. When you do this successfully, you’ll get a reward.
- Motivational Interviewing. MI gives you control over your addiction. You’ll create your own long-term treatment plan—still with the aid and guidance of a professional—and you’ll hold yourself accountable for following through. With motivational interviewing, you can become reacquainted with yourself and your strongest, deepest reasons to remain sober.
When to Seek Help
Opioids have become much more important to you than they were before. You think about using opioids quite often, perhaps more than you think about food or sex.
Check for this right now. Go ahead and think about how often you’re taking opioids, but also think about how often you’re not doing things you used to care about. What has fallen out of your life? Hobbies? People?
You take opioids much more than you used to, and you have all manner of justifications for this. Maybe your pain reliever isn’t working as well as it used to. Maybe you like how it makes you feel. Whatever the reason, you’re taking a higher dose than you used to—without your doctor’s blessing.
This pattern can be summed up by the thought, Just a little bit more.
You feel uncomfortable, anxious or paranoid if you can’t use opioids. If your supply runs low or is threatened, you feel threatened. The stronger you react when your use is questioned or threatened, the more likely it is that you’re addicted.
The common denominator here is that you react. You don’t question why you’re reacting this way, you just react. If someone said you could no longer eat, you would react negatively to that. You react the same way to being told you can no longer take opioids. But food is necessary for survival. Opioids are not.
Similarly, you’ve tried to cut down or stop, but you can’t.
Has your opioid habit disrupted your life? Have you lost a job or failed a class? Have you lost contact with friends or family?
# 5 Negotiation
Do you haggle with yourself? Do you tell yourself that you can take another pill this time, but next time you’ll take half a pill, or none? Do you make deals with yourself to justify overuse in the present, promising to cut back in future? This is a sure sign that addiction is forming, and it’s always a red flag.
Please don’t hesitate to seek help. No, detox is not fun. Yes, withdrawal is unpleasant. Sure, going over your past traumas with a therapist can feel intrusive. But gaining control over your addiction is important. It’s one of the most important things you’ll ever do. Don’t wait. Get help now.