Hydrocodone Addiction

Hydrocodone is an opioid pain reliever, derived from the poppy plant and provides pain relief similar to that of morphine. Hydrocodone is the most frequently prescribed opioid in the United States with over 139 million prescriptions filled in 2010. That is enough hydrocodone to medicate every adult in the United States around the clock for one month. The U.S. Drug Enforcement Agency, or DEA, states that hydrocodone is associated with more drug abuse than any other opioid.

There are more than 200 products containing hydrocodone available in the United States. Hydrocodone is only available by prescription and always in combination with other pain relievers, such as acetaminophen or aspirin. Hydrocodone addiction increases the risk for side effects associated with hydrocodone, as well as raising the chances for adverse reactions and medical conditions caused by the added pain relievers.

Because of the euphoria hydrocodone produces, hydrocodone is associated with more drug abuse than any other opioid. The DEA says most illegal doses of hydrocodone started out as legally prescribed medication, a process known as diversion. Hydrocodone is the most widely diverted drug in the United States. Illicit hydrocodone users frequently combine this medication with alcohol, increasing the individual's risk for side effects such as toxicity, overdose and liver disease.

Potential for abuse, physical dependence or addiction are possible side effects associated with hydrocodone. The U.S. Drug Enforcement Agency, or DEA, classifies substances according to their associated potential for abuse. The DEA classifies hydrocodone as a Schedule II narcotic, which means it carries a high potential for abuse and mental or physical dependence.

According to the Centers for Disease Control and Prevention, or CDC, one in 20 Americans over the age of 12 years had used a prescription opioid in 2010 such as hydrocodone non-medically, which means they used the drug without a prescription or to get high.

The Definition of Addiction

Substance abuse may lead to physical dependence or addition, two independent medical conditions. Addition is a chronic, primary disease, which means it is a long-term illness, not caused by another condition. Addiction is a neurobiologic disease; it causes changes to the nervous system on a cellular level. Heredity, psychological, sociological and environmental factors influences the development of addition and can affect how addiction manifests itself. A person addicted to hydrocodone exhibits behaviors such as craving, impaired control over drug use and compulsive use despite being aware of the harm hydrocodone causes.

The Definition of Dependence

Physical dependence means the body needs a substance to feel normal; if the level of this substance drops below a certain level, the body struggles to regain chemical balance. Medical professionals diagnose a patient as being physically dependent on a substance if he suffers symptoms once levels of the drug decline in his system. This drop in hydrocodone is brought about by not taking the opioid or through the administration of certain drugs, such as naloxone.

Addiction versus Dependency

Drug dependence is a state where a person's body needs a drug in order to feel normal and addiction is the compulsive use of a drug. Addiction and dependence on drugs are separate and independent from one another: you can be addicted to something without being physically dependent on it and vice versa. For example, a person may need an anti-hypertensive drug to keep her blood pressure down; if she were to stop taking the drug, her body would struggle to maintain blood pressure but she would not feel cravings for the medicine.

Conversely, you can be addicted to cocaine without physical dependence. A person addicted to cocaine will crave more once he runs out, but the drop in cocaine levels will not disrupt his body chemistry.

Both addiction and dependence cause real changes in the brain and body but addiction and dependence manifest themselves in different ways.

Addiction: What Family Members Should Know

While scientists are still working to establish the exact cause of drug abuse and dependence, most agree that heredity plays a role. Other environmental factors are peer pressure, emotional distress, anxiety or depression and environmental stress contribute to dependence. These environmental factors can cause, as well as be the result of, addiction to hydrocodone.

Family members should know that hydrocodone addiction affects every member of the household. Researchers think that addiction is hereditary, passed from one generation to the next; young family members should recognize an increased risk for addiction if one or both parents suffer from addiction.

Scientists believe addiction is more likely in people who are hypersensitive to stress. Stressors within the household, like relationship or financial problems, increase the risk for addiction in hypersensitive individuals. Moreover, a child learns how to deal with stress by watching his parents; an addicted parent passes poor stress management skills to his child, especially if both the parent and child are hypersensitive to stress.

Hydrocodone addiction increases stress within the family, as the addicted person spends more of her time seeking, using and recovering from hydrocodone and less time fulfilling her responsibilities, such as work, raising children, paying bills or taking care of the household. Hydrocodone leaves a hole where a person used to be.

Furthermore, an individual may endanger his family through hydrocodone addiction. Using hydrocodone without a prescription is illegal. The addicted person risks going to jail, losing time from work and incurring fines and legal fees.

Children who grow up in an environment where illicit drug use is acceptable are more likely to develop addictions. A child will adopt a parent's positive attitude toward drug abuse and be more likely to abuse drugs when he is older. Furthermore, a child who grows up in a household where drug use is tolerable faces little to no parental resistance or punishment when he begins to abuse drugs.

Having hydrocodone or other opioids in the house, whether illegally or by prescription, increases the risk for drug abuse by another member of the family simply because the drug is easily available. Keeping opioids in the house also makes the household a target for drug trafficking or theft.

Caring for a Family Member with an Addiction

Hydrocodone addiction is extremely difficult for every member of the family but it is important to remember that the addicted person needs compassion now more than ever if recovery is going to take place. The family should develop a plan to help the addicted individual, with every member of the family participating in the recovery effort. The family should meet frequently, with or without the addicted individual, to help one another deal with the stress and emotional drain of addiction.

Each member of the household can make a commitment to take good care of the addicted individual, himself and the rest of the family. Develop plans to share household chores, childcare and financial responsibilities. Work as a group so that no one individual carries the burden of hydrocodone addiction.

It is okay to learn about addiction by visiting websites, asking questions and seeking referrals from other people who have supported a loved one battling this disease.

Family members should know that it is okay to talk about addiction. Family members should communicate between themselves, even before the addicted person is ready to talk about his disease. Start a conversation with another member of the household; sharing common emotions and experiences can unite family members and help them forge a common, well-planned path to recovery. The support and guidance of a strong family unit is a powerful influence over hydrocodone addiction. Counseling can help family members open lines of communication between themselves and the addicted individual.

Addiction alters pathways in the brain, and these changes frequently cause the addicted individual to resist talking about his disease. The addicted person will likely be very resistant to talk about substance abuse. He will voice feelings of anger and betrayal at first, and will probably refuse treatment. Despite passionate protests from the addicted individual, it is imperative that family members continue to urge professional treatment.

Signs of addiction: For those around

Features of addiction include changes in a person's behavior, thinking patterns, emotions and interactions with others. Family members, co-workers, friends and members of the community may notice an abrupt or slow, subtle change in the individual addicted to hydrocodone. Addiction changes an individual's executive functioning, or the way a person thinks. These alterations cause the person to have trouble perceiving, learning, controlling impulses and making sound decisions.

A friend or co-worker may notice changes in a person addicted to hydrocodone, including:

  • Excessive Hydrocodone Prescriptions for Self and/or Family
  • Frequent Emotional Crisis
  • Prioritizing Activities Involving Hydrocodone
  • Arguments or Violent Outbursts
  • Withdrawal from Relationships, Family or Friends
  • Child Neglect
  • Abnormal, Illegal or Anti-Social Actions
  • Separation or Divorce
  • Unexplained Absences from Home
  • Legal Trouble
  • Neglect of Social Commitments
  • Unpredictable Behavior such as Inappropriate Spending

Addiction Symptoms: Physical and Psychological

Hydrocodone addiction makes changes to the brain and body in a way that causes specific physical and psychological symptoms.

Physical symptoms of drug addiction include:

  • Unexplained Weight Gain or Weight Loss
  • A Change in Sleep Patterns
  • Deteriorating Physical Appearance - Looks Sickly
  • Nagging Cough
  • Diminished Hygiene Care
  • Body or Clothing May Have an Unusual Odor
  • Bloodshot Eyes with Large or Small Pupils
  • Tremors
  • Slurred Speech
  •  

Psychological symptoms of addiction to hydrocodone include:

  • Inability to Abstain Consistently.
  • Impairment in Behavioral Control.
  • Cravings for Drugs or Intense Reward Experiences.
  • Diminished Capacity to Recognize Significant Personal or Relationship Problems.
  • Dysfunctional Emotional Response.

Addiction causes changes in brain structure and function, especially in those areas of the brain associated with reward. Addiction changes the way the brain remembers rewards, causing an individual to incorrectly associated hydrocodone with a rewarding experience. This incorrect reward pattern alters an individual's behavior, shifting away from activities previously viewed as pleasurable and towards behaviors that result in hydrocodone abuse.

Addiction and gender: how women and men are affected differently

Results from the 2010 National Survey on Drug Use and Health show the rate for illicit drug use in people over the age of 12 years to be higher in males than females. Females between the ages of 12 and 17 years, however, were more likely to abuse pain relievers than males of the same age.

Many studies reveal women are more likely to abuse prescription drugs such as hydrocodone and are more likely to abuse multiple substances than are males. Women who abuse drugs are more likely to come from homes where illicit drug use was acceptable. Addicted women are more likely to have a partner or spouse with an addiction.

Males and females express hydrocodone addiction differently; addicted men are more public than addicted women are. Men are more likely to exhibit social disorders and engage in criminal activity, such as belonging to gangs or dealing drugs. Addicted men are more likely to engage in drugs with others in a party environment, whereas an addicted woman tends to abuse drugs alone, in the privacy of her own home.

Men are more likely to admit to drug abuse than are women, according to the 2002 National Survey on Drug Use and Health. Historically, women have a lower rate for entry into treatment, staying in treatment and completing treatment than men. Social stigmas, economic barriers and family responsibilities prevent addicted women from seeking or completing treatment programs at the same rate as men.

Behavioral, Cognitive and Emotional Changes

Addiction to hydrocodone changes the way a person behaves, thinks and feels. These changes may come about abruptly or slowly and may last long after the individual has stopped using hydrocodone, increasing the risk for relapse after substance abuse treatment.

A person with an addiction may take higher doses of hydrocodone more frequently than he intends, even though he promises to control his behavior in the future. He loses days or weeks pursuing, using or recovering from hydrocodone. Increasingly, he loses interest in things he used to be passionate about; eventually, he only cares about hydrocodone. He continues to use hydrocodone, even though he understands the damage it causes. It may seem that he lacks the interest or ability to quit using hydrocodone.

Hydrocodone addiction changes the way a person thinks. She becomes preoccupied with hydrocodone. Her views of the benefits and risks of hydrocodone shift, so that she eventually becomes blind to the dangers of opioid abuse. She may blame all her problems on other people or events rather than as a predictable consequence of hydrocodone abuse.

Addiction manifests itself through emotional changes. An individual addicted to hydrocodone experiences increased anxiety, sadness and emotional pain. Addiction increases sensitivity to stress, especially in those individuals who are hypersensitive to stress.

Treatment options

The American Society of Addictive Medicine warns that addiction can cause "disability or premature death, especially when left untreated or treated inadequately." Nearly 15,000 people die in the United States each year from overdoses on prescription painkillers such as hydrocodone. Many more suffer physical, emotional, social, economic and criminal affects from hydrocodone addiction.

According to the National Institute on Drug Abuse, more than 23 million people in the United States over the age of 12-years needed treatment for alcohol or substance abuse in 2010; of these, only about 11 percent received treatment at a specialty facility. Just over 5 percent of admissions to publicly funded substance abuse programs were for treatment of opioid abuse.

Many individuals try to quit hydrocodone alone, without the help of medicine to reduce withdrawal symptoms. This is known as self-detoxification, or "going cold turkey." Uncomfortable withdrawal symptoms, such as diarrhea, abdominal pain, cold sweats and muscle pain can last for several days to two weeks. Without proper medical assistance, the addicted individual may face complications. For example, he may vomit and inhale stomach contents, a complication known as aspiration. He also faces dangerous dehydration from excessive vomiting and diarrhea. Complications and overpowering symptoms of withdrawal cause many people who attempt self-detox to go back to hydrocodone abuse.

Other people reduce the withdrawal symptoms during self-detoxification by using a variety of products. Once such remedy is The Thomas Recipe, in which a person takes Xanax or some other medication to reduce anxiety and induce sleep, anti-diarrhea medication, plus vitamins and supplements to ease muscle aches and fatigue. While this may reduce withdrawal symptoms, the individual may suffer dangerous complications. Furthermore, self-detoxification addresses only the physical dependency of hydrocodone abuse; self-detox does not address the behavioral aspects of hydrocodone addiction, increasing the risk for relapse.

Relapse is the largest complication associated with quitting hydrocodone. An individual who has recently gone through detoxification is at a greater risk for overdose, as detoxification lowers the body's tolerance to hydrocodone. He can accidently overdose on a lower dose than he used to take before detoxification.

Overdose requires emergency, sometimes lifesaving treatment. Doctors administer naloxone and other medications to reduce hydrocodone to safe levels quickly. Once the patient has completed the withdrawal process, she may participate in behavioral therapy as an inpatient or outpatient.

Some individuals participate in outpatient drug replacement therapy, or DRT. During DRT, physicians prescribe drugs such as methadone, Suboxone or buprenorphine. These drugs bind to the same opioid receptors within the body as hydrocodone does; this reduces withdrawal symptoms. These drugs are longer lasting than hydrocodone and do not produce the euphoric effects, allowing the individual to participate in treatment without a hospital stay. After the individual changes the behaviors associated with addiction, he weans himself from the replacement drug. Supporters of DRT recognize the flexibility of outpatient treatment while opponents say it is merely trading one addiction for another.

Medication-Assisted Treatment, or MAT, refers to any substance abuse treatment plan that includes pharmacological intervention. According to the Substance Abuse and Mental Health Services Administration, or SAMSA, this intervention:

  • Improves Survival
  • Increase Retention in Treatment
  • Decreases Illicit Opiate Use
  • Decreases The Risk for Hepatitis and HIV
  • Decreases Criminal Activities
  • Increases Employment
  • Improves Birth Outcomes for Pregnant Women Battling Addiction

Inpatient MAT programs focus on using medicine to ease withdrawal and facilitate detoxification. During detoxification, physicians administer some medications to decrease the level of hydrocodone and other drugs to address the resulting symptoms of withdrawal. Medical staff watch for dangerous complications, such as dehydration or aspiration, and take appropriate measures. While detox eases the physical aspects of addiction, individuals must still endure the demoralizing process of detoxification.

Rapid detox is the most humane method of detoxification. During rapid detox, board-certified anesthesiologists administer standard detoxification and anti-withdrawal medications alongside anesthesia and sedatives so that the patient rests in a comfortable "twilight sleep." When the patient awakens, he will have no recollection of the grueling and demoralizing detoxification and withdrawal period and can move onto the rehabilitation process.

Rehabilitation

Although medical treatment and behavioral modification are independently useful, addressing both the physical and behavioral aspects of hydrocodone addiction offer the best hope for recovery. Behavioral therapy may take place at an inpatient or outpatient facility. To offer the best chance of success, it is important to match the type of facility to the individual's personal needs. Both pharmacological and behavioral treatments work to restore normalcy to those brain function and behavior. These treatments also aim at improving employment rates, reducing relapse and lessening side effects associated with hydrocodone addiction.

After successful detoxification or drug replacement therapy, patients may participate in drug rehabilitation treatments offering behavior modification techniques designed to change the behaviors that caused physical dependence or improve the environmental factors that led to the initial dependence on drugs and reduce the risk for relapse. Rehabilitation may be inpatient or outpatient, and programs can be as short as 28 days or as long as 6 months or a year.

New behavioral therapies show particular promise in the treatment of hydrocodone addiction. Contingency management therapy is a voucher system in which a patient earns points for negative drug tests. He may redeem these points for items that enhance a healthy lifestyle.

Cognitive-behavioral interventions modify a patient's expectations and behaviors related to hydrocodone addiction and give him new tools to deal with stresses that may cause relapse.

Long-term recovery from hydrocodone withdrawal depends on success during both the detoxification and rehabilitation phases. A significant number of individuals suffer relapse, especially those who engage in self-detoxification or do not participate in rehabilitation.

The American Society of Addictive Medicine states that recovery from addiction is "best achieved through a combination of self-management, mutual support, and professional care provided by trained and certified professionals." Rehabilitation can take place in an outpatient clinic, or at a short-term or long-term residential facility. Professional treatment programs include personal, family and group counseling; each addresses a specific aspect of hydrocodone addiction. These programs include behavior modification programs and provide peer support.