Diphenoxylate Addiction

The definition of addiction

Diphenoxylate is an opioid and is therefore inherently capable of producing addiction. High doses of diphenoxylate are associated with addiction. When given at therapeutic doses to treat acute or chronic diarrhea, diphenoxylate does not produce addiction. However, when an individual uses high doses diphenoxylate for recreational purposes, he may become addicted.

Addiction is a primary disease, which means it arises spontaneously and not as part of or as the result of any injury or condition. Addiction to opioids, such as diphenoxylate, is a chronic disease of the nervous system influenced by a variety of genetic, psychological, social and environmental factors. Addiction is characterized by impaired control over diphenoxylate use, compulsive use of opioids, continued use of drugs despite awareness of the harm and craving for opioids.

Addiction versus Dependency

Scientists describe physical dependence as "a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist." In simple terms, drug dependence is a state where a person's body adapts to the presence of a drug and needs to maintain a certain level of the drug in order to feel normal. Addiction is the compulsive use of a drug.

Addiction to and dependence on drugs are independent from one another: you can be addicted to something without being physically dependent on it and vice versa.

For example, you can be addicted to heroin without being physically dependent upon it; you can be physically dependent on blood pressure medications but not feel symptoms of addiction when you quit taking it. Both addiction and dependence cause physiologic changes in your body and brain but addiction and dependence manifest themselves in different ways.

Addiction: What Family Members Should Know

Scientists have not yet established the exact cause of drug dependence and addiction; researchers do think genetics play a role. Scientists at the American Society of Addiction Medicine state that genetic factors account for about half the likelihood that an individual will develop an addiction. Other environmental factors that can lead to addiction to diphenoxylate and other opioids are peer pressure, emotional distress, anxiety, depression and environmental stress contribute to dependence.

Family member should know that children who grow up in an environment where illicit drug use is acceptable are more likely to develop addictions. This is especially true for girls; women who grew up on homes where drug use was acceptable use drugs more frequently in adulthood than are females raised in homes where parents prohibited substance abuse.

Addiction Symptoms: Physical and Psychological

A person who is addicted to opioids such as diphenoxylate may display symptoms such as an inability to refrain from using diphenoxylate consistently and may be unable to control other behaviors. He may experience cravings from drugs or other intense reward experiences, such as engaging in criminal activity, gambling or high-adrenaline sports. He may not be able to recognize significant personal or relationship problems, such as abusive relationships or constantly fighting with someone they love. He may also display a dysfunctional emotional response such as inappropriate laughter or unprovoked outbursts of anger.

While addiction most notably causes psychological symptoms, addiction does cause the individual to experience physical symptoms as the result of his addictive behaviors. When a person is addicted to a substance such as diphenoxylate, he begins to care more for the opioid than for his own health. When an addicted person must choose between buying food and the diphenoxylate, he frequently chooses drugs over food. He also tends to sleep less and is more prone to illnesses than a person who does not abuse opioids. Physical symptoms of diphenoxylate addiction include nervousness, restlessness, changes in sleep patterns and changes in weight.

Addiction to drugs such as diphenoxylate causes actual changes in brain structure and function, especially in those areas of the brain associated with reward, including the nucleus accumbens, anterior cingulate cortex, basal forebrain and amygdala. Addiction also changes the way the brain remembers rewards so that diphenoxylate use becomes more rewarding than food, love or even sex.

Addiction and gender: how women and men are affected differently

Men and women come to drug use in different ways and experience drug addiction differently as well. In scientific studies, women seem more likely to abuse prescription drugs, such as diphenoxylate, whereas men prefer illicit drugs such as cocaine, marijuana and heroin. Women are also more likely to abuse multiple substances than are men. Men come to drug use through social circles, with friends turning them onto drugs at parties. Women often start drug use after a visit to a doctor. Physicians are more likely to prescribe mood-altering drugs to females than males because doctors seem to perceive a woman's complaints to be due to depression, nervousness or some other emotional problem rather than from a physical ailment. This is an especially important factor in diphenoxylate addiction because doctors prescribe diphenoxylate to reduce diarrhea associated with withdrawal from other drugs; a woman can potentially become addicted to diphenoxylate as part of her treatment for another addiction.

Addicted women are more likely to have a partner or spouse with an addiction, whereas men typically become addicted to drugs independent of their partner's drug use. Men are more likely to exhibit social disorders, like belonging to a gang or committing crimes. Men typically fund their addiction through criminal activity such as theft, robbery and cons. Addicted men are more likely to engage in drugs socially, as compared to women who tend to abuse drugs alone and in private.

Women engage in prostitution but generally fund their addictions through non-criminal activities. Females are more likely to experience mood disorders as part of their addiction than are males. Women with addiction tend to have distorted body images and therefore are at higher risk for developing concurrent eating disorders.

According to the 2002 National Survey on Drug Use and Health, women are less likely to report current drug abuse. Traditionally, men have higher rates for entry into treatment than women do, and men remain in treatment longer. Men also enjoy a better rehabilitation completion rates than women. Rehabilitation specialists attribute the differences to social stigmas, economic barriers and family responsibilities that prevent addicted women from seeking or completing treatment programs.

Signs of addiction: For those around

The people surrounding an individual with addiction to opioids such as diphenoxylate may notice changes in a person's behavior, thinking patterns and emotions. The person with the addiction may have difficulty interacting with others, including spouses, children, family members, co-workers, friends and members of the community, such as police officers. Addiction to drugs such as diphenoxylate changes an individual's executive functioning; these changes manifest themselves in problems with perception, learning, impulse control compulsivity and judgment. Addiction changes the way a person thinks, feels and behaves.

Addiction to diphenoxylate alters the individual's behavior. He may excessively use drugs or alcohol or participate in compulsive behaviors, such as gambling, shopping, sex or eating disorders; he will engage in these behaviors with an ever-increasing intensity and frequency or more intense and frequent than he intends, even though he always says he is trying to quit or promises "this is the last time." He loses hours, days and weeks looking for diphenoxylate, using it or recovering from getting high. He continues to use diphenoxylate, even though he is aware of the consequences. He will grow less interested in things that do not involve getting high, even those things he used to love before he started using diphenoxylate. Everything he does results in getting high. Despite knowing the harm diphenoxylate is causing, he seems unable or unwilling to quit.

Diphenoxylate makes cognitive changes, or alters the way a person thinks. An individual who is addicted to diphenoxylate grows preoccupied with substance abuse; it is all she seems to think or talk about. She always talks about how great diphenoxylate is and dismisses the consequences and risks of diphenoxylate abuse. She may blame her problems, or even her diphenoxylate use, on other people instead of attributing her problems to her diphenoxylate abuse.

Diphenoxylate addiction makes changes to the brain; these changes manifest themselves as emotional issues. A person addicted to diphenoxylate may express or exhibit increase anxiety or emotional pain. A doctor might say the individual is suffering from dysphoria, the negative emotional opposite of euphoria. He may be more sensitive to stressors and say something like, "Everything seems more stressful right now." He may have trouble identifying his emotions or expressing his feelings to others.

Treatment options

It is vital to receive adequate and prompt treatment for diphenoxylate. The American Society of Addictive Medicine warns that addiction to this and other substances can cause "disability or premature death, especially when left untreated or treated inadequately." Rehabilitative experts agree that a person can best recover from addiction through a combination of self-management on the part of the addicted individual, mutual support from friends and family along with professional care provided by trained and certified professionals. Treatment options depend largely on the severity of addiction, the nature of the addictive substance along with economic and social factors.

The first stage of treatment always involves detoxification and dealing with withdrawal symptoms. The second phase of recovery focuses on behavioral therapy to help the individual adapt to life without drugs. Addiction makes changes to the brain that prevents effective behavioral therapy from taking place until the individual's body is clear from the effects of opioids such as diphenoxylate.

Due to social or economic factors, some individuals try detoxification alone, without the help of a medical professional. This is called self-detox, or going cold turkey. These people suffer through several days of overwhelming and demoralizing flu-like symptoms. Withdrawal symptoms frequently prevent a significant percentage of these individuals from making it all the way through detoxification without relapse. Complications, such as vomiting and aspirating the stomach contents into the lungs or dehydration from excessive sweating, vomiting and diarrhea, may cause long-term illness or death.

Some people use a homemade regimen of drugs to go through withdrawal at home. One such concoction is the Thomas Recipe, in which an individual takes Xanax, Klonopin, Ativan or Librium to reduce symptoms and cause sleep. He then takes consecutively smaller doses of these drugs each day to wean from that medication. The worst day for symptoms usually falls on or about the fourth day. Withdrawal symptoms should subside enough after five or more days to discontinue valium or other drugs. Imodium helps control diarrhea and L-Tyrosine eases agitation. Other supplements ease fatigue and depression while hot baths soothe body aches. These individuals face the same risk for illness or death associated with complications of self-detox. Furthermore, a person who has recently gone through detoxification is at a higher risk for taking an overdose than someone who has not lowered their tolerance by detoxifying their body. People who relapse may overdose on half the dose they used to take before detox.

Acute intoxication or overdose requires emergency, sometimes lifesaving treatment. Detoxification takes place in the emergency department, where doctors rapidly lower diphenoxylate levels by administering medications. Emergency staff members stand by, prepared to administer life-saving measures, along with intravenous fluid replacement and maintaining electrolyte balance.

Individuals who have not taken an overdose may opt for drug replacement therapy in an outpatient facility. During drug replacement therapy, or DRT, doctors prescribe methadone, Suboxone or buprenorphine to ease withdrawal symptoms associated with sudden cessation of diphenoxylate. To its benefit, DRT allows some patients to carry out their daily lives while engaging in recovery. Opponents say DRT is merely trading one addiction for another.

A person may choose inpatient care to address diphenoxylate addiction. During detoxification, physicians administer medications to lower diphenoxylate levels and drugs to ease withdrawal symptoms. In an ironic twist, physicians usually prescribe diphenoxylate to relieve diarrhea associated with opioid withdrawal. Rehabilitation professionals must substitute diphenoxylate with another anti-diarrheal during detoxification. Imodium is safer for these individuals but is less effective than diphenoxylate. Physicians monitor a patient's progress to avoid complications. Inpatient treatment is safer and reduces the duration and intensity of withdrawal symptoms. While the patient suffers less, she still struggles with the demoralizing aspects of withdrawal that complicate subsequent behavioral therapy treatments.

Rapid Detox is the newest, most humane method for detoxification as part of addiction treatment. During rapid detox, board certified anesthesiologists administer sedatives and anesthesia along with the standard detoxification and anti-withdrawal medications. The patient rests comfortably in a "twilight sleep" while doctors lower the level of diphenoxylate and battle withdrawal symptoms. When she awakens, she will have no recollection of the detoxification process and, therefore, be in a better frame of mind to participate in behavioral therapy. She may decide to enter a residential treatment program including personal, family and group counseling. These programs include behavior modification programs and provide peer support. Short-term residential programs may last only 28 days while extended programs may last six months to a year. Long-term recovery is promising for those who complete detoxification and rehabilitation programs.