Hydromorphone Addiction

The definition of addiction

Substance abuse may lead to physical dependence or addition, two independent medical conditions. Addiction to hydromorphone or other substances is a chronic, primary condition, which means addiction is not caused by other illnesses and that the individual will need to participate in long-term treatment. Addiction is a neurobiological disorder - it affects the cells of the central nervous system. Genetic, psychological, social, and environmental factors influence the development of hydromorphone addiction and these factors influence the ways addiction affects each person.

While some individuals may become addicted to hydromorphone after using this opioid to treat severe pain associated with cancer or another serious disease, most become addicted after using hydromorphone recreationally or without a prescription to treat another illness.

Abusing hydromorphone for non-medical purposes, either to get high or to treat a condition without a prescription, increases the risk for addiction to hydromorphone. Hydromorphone addiction is characterized by behaviors including one or more of the following: being unable to control hydromorphone use, compulsive use, continued use despite harm, and craving for hydromorphone.

Addiction is closely associated with dependence on a substance such as hydromorphone, but there are distinct differences between being addicted to a drug and being dependent upon it.

The Definition of Dependence

Physical dependence on hydromorphone means the body needs this opioid to feel normal. If the level of hydromorphone drops below a certain level, the body struggles to regain chemical balance. The individual feels this battle for chemical balance through uncomfortable, flu-like withdrawal symptoms.

Medical professionals say a patient is physically dependent on hydromorphone if he suffers symptoms once levels of this opioid decline in his system. This drop in hydromorphone levels happen by not taking the opioid or through the administration of certain drugs, such as naloxone.

Addiction versus Dependency

Dependence on hydromorphone is a state where a person's body needs hydromorphone in order to feel normal; in contrast, addiction is the compulsive use of this powerful opioid.

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, an individual may need an anti-hypertensive drug to keep his blood pressure down; if he were to stop taking the drug or take a drug that countered the effect of the blood pressure medication, his body would struggle to maintain blood pressure but he would not feel cravings for the medicine.

Conversely, you can be addicted to cocaine without being physical dependent upon it. A person addicted to cocaine will crave more once she runs out, but the drop in cocaine levels will not disrupt her body chemistry and cause flu-like withdrawal symptoms.

Both addiction and dependence cause real changes in the brain and body but addiction and dependence to hydromorphone manifest themselves in different ways. Addiction and dependence each have a profound effect on friends and family who love and rely on the individual battling hydromorphone abuse.

Addiction: What Family Members Should Know

Researchers are still working to establish the exact cause of drug abuse and dependence but most agree that heredity plays an important role in the development of addiction to hydromorphone or other substances. Environmental factors, such as peer pressure, emotional distress, anxiety or depression and environmental stress contribute to dependence on opioids such as hydromorphone. These environmental factors can cause, as well as be the result of, addiction to opioids.

Family members should know that addiction to hydromorphone affects every member of the household, especially if they are related to the individual struggling with addiction. Researchers think that addiction is genetic, 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 think addiction to substances such as hydromorphone is more likely in people who are hypersensitive to stress. Everyday stressors within the household, like financial or relationship problems, raise 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. This is especially true if both the parent and child are hypersensitive to stress.

Hydromorphone addiction increases stress within the family unit, as the addicted person spends an increasing amount of time looking for, using and recovering from hydromorphone. As a result, he spends less time fulfilling his responsibilities, such as earning money, raising children, paying bills or taking care of the household.

Addiction to hydromorphone is expensive: according to the DEA, one hydromorphone tablet costs between $5 and $100, depending on the region. Staying high on hydromorphone takes money away from the family's grocery budget, medical expenses, rent and other household needs. In challenging economic times, most families cannot afford the expense of hydromorphone addiction.

Furthermore, an individual may endanger his family through addiction to hydromorphone. Using hydromorphone without a prescription is illegal and could result in a prison sentence, time lost from work, fines and legal fees. A child with at least one parent incarcerated on drug charges faces an especially stressful home environment, increasing his chance for drug addiction later in life.

Children who grow up in households where illicit drug use is acceptable are more likely to develop addictions than are children raised in homes where illegal drug users faced punishment. A child will adopt a parent's positive attitude toward drug abuse and be more likely to imitate his parents' drug use when he is older. It is also likely that a child who grows up in a drug-friendly environment faces little to no parental resistance or punishment when he begins to abuse hydromorphone.

All families should remember to throw away hydromorphone or other opioid painkillers when they no longer need them; this goes for families with or without a family member battling an addiction. Having hydromorphone or other opioids in the house, whether illegally or by prescription, increases the risk for drug abuse for every member of the household simply because the drug is easily available. Additionally, an individual with a hydromorphone addiction is more likely to abuse another family member's drugs because they are so easily available in the home. Keeping opioids in the home also makes the household a target for drug trafficking or theft.

Caring for a Family Member with an Addiction

Addiction is challenging to every member of the family but it is important to remember that the person battling addiction to hydromorphone needs the love, support and compassion of a family now more than ever. Addiction is an illness and, like other illnesses, recovery relies heavily on the family's emotional support. The family can work as a unit to help the addicted individual, with every member of the family participating in the recovery effort.

Family member should know 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 counseling and group therapy, whether in internet chatrooms or in person, gives every member of the household the tools he needs to make a commitment to take good care of the addicted individual, himself and the rest of the family. Plan to share household chores, childcare and tending financial responsibilities with other members of the household. Develop a network of family members so that no one individual carries the burden of opioid addiction.

Talking about addiction is an important part of recovery from hydromorphone addiction, even if communications do not include the addicted individual. 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 family should meet frequently, with or without the addicted individual, to help one another deal with the stress and emotional drain of addiction. Counseling can help family members open lines of communication between themselves and the addicted individual.

The support and guidance of a strong family unit is a powerful influence over opioid addiction. Families may gather to perform an intervention, urging the individual to seek help with his hydromorphone addiction. Each member of the family should consistently deliver a message of love and support.

Addiction alters pathways in the brain, and these changes frequently cause the addicted individual to resist talking about his problem with hydromorphone. When a united family unit confronts him in an intervention, or he first hears suggestions to seek treatment, he will voice feelings of anger and betrayal. He will probably refuse treatment for several weeks, months or even years. Despite passionate protests from the addicted individual, it is imperative that family members continue to urge professional treatment: addiction to hydromorphone is a serious medical condition.

Signs of addiction: For those around

Addiction to hydromorphone affects everyone, including co-workers, friends and neighbors. Hydromorphone addiction changes a person's behavior, thinking patterns, emotions and interactions with others. Co-workers, friends, neighbors and members of the community may notice an abrupt or slow, subtle change in the individual struggling with hydromorphone addiction

Addiction to hydromorphone and other substances 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. Eventually, this breakdown in executive function affects the individual's performance at work, during recreational activities and in his intimate or casual relationships. A co-worker, friend or neighbor should know that this breakdown is due to hydromorphone addiction and not the result of a character flaw such as laziness or disrespect.

Hydromorphone addiction alters brain structure and function, especially in those areas of the brain associated with reward. The disease changes the way the brain remembers rewards, causing an individual to incorrectly associated opioids with a higher level of reward than with food, companionship, success or other normally rewarding experiences. This incorrect reward pattern alters an individual's behavior, shifting away from activities previously viewed as pleasurable and towards behaviors that result in opioid abuse.

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

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

Addiction Symptoms: Physical and Psychological

The disease of addiction makes changes to the brain and body in a way that causes specific physical and psychological symptoms. Not every person displays all the physical and psychological symptoms. Some symptoms may be more severe than others are, depending on individual circumstances, such as length and severity of addiction, number of substances abused and other factors.

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
  •  

The psychological symptoms of hydromorphone may be more difficult to identify and typically last longer than the physical symptoms. Without treatment, the psychological symptoms of hydromorphone addiction causes dangerous relapse to opioid abuse. Psychological symptoms of addiction to opioids 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.

Behavioral, Cognitive and Emotional Changes

Addiction to opioids changes the way a person behaves, thinks and feels. These changes may come about suddenly or slowly. These behavioral, cognitive and emotional changes may last long after the individual has stopped using opioids, increasing the risk for relapse after the physical effects of hydromorphone addiction have subsided.

A person with an addiction may take higher doses of hydromorphone that he intends, or uses this opioid more frequently than he realizes. He may promises to control his behavior in the future, even while he is pursuing or using hydromorphone. He loses days or weeks looking for, abusing or recovering from hydromorphone use. Increasingly, he loses passion for things he used to care for; eventually, he only shows interest in hydromorphone. He continues to abuse opioids, even though he says he understands the damage it causes. It may seem that he lacks the interest or ability to quit using hydromorphone.

Addiction to hydromorphone changes the way a person thinks. She becomes preoccupied with hydromorphone and eventually can think of nothing else. Her views regarding the benefits and risks of opioids shift; eventually she becomes blind to the dangers of hydromorphone She may blame all her problems on other people or events rather than as a predictable consequence of hydromorphone abuse.

Hydromorphone changes the way a person feels. Instead of relieving them, addiction causes increased anxiety, sadness and emotional pain. Addiction to opioid such as hydromorphone increases sensitivity to stress, especially in those individuals who are hypersensitive to stress.

Addiction and gender: how women and men are affected differently

The 2010 National Survey on Drug Use and Health show more males over the age of 12 use illicit drugs than females of the same age. Females between the ages of 12 and 17 years, however, were more likely to abuse pain relievers such as hydromorphone than males in the same age group.

Approximately 3 million Americans used an illicit substance for the first time in 2010; 52 percent of new users were women. According to survey studies, women are more likely to abuse prescription drugs such as hydromorphone and are more likely to abuse multiple substances than are males. Female drug abusers 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 than are men with addictions.

Males and females express opioid addiction differently; men are more sociable addicts than addicted women are. Men are more likely to exhibit social disorders, such as gang violence 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.

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 this opioid. Many more suffer physical, emotional, social, economic and criminal affects from addiction to opioids such as hydromorphone.

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 abuse of opioids such as hydromorphone.

Many individuals try to quit hydromorphone alone, without the help of medicine to reduce withdrawal symptoms or trained professionals to attend to the psychological aspects or complications associated with withdrawal. This is known as self-detoxification, or "going cold turkey." The phrase "cold turkey" refers to the cold, clammy, pale and bumpy appearance of addict's skin during withdrawal - it resembles the skin of a plucked turkey.

Uncomfortable physical symptoms of hydromorphone withdrawal, such as diarrhea, abdominal pain, cold sweats and muscle pain can last for several days to two weeks, with the worst symptoms occurring on or about the fourth day. Without proper medical assistance, the addicted individual may face serious complications. For example, he may vomit and inhale stomach contents, a complication known as aspiration. Excessive vomiting and diarrhea may cause dangerous dehydration. Complications and overpowering symptoms of withdrawal cause many people who attempt self-detox to go back to opioid abuse.

Other people reduce the physical symptoms of hydromorphone withdrawal by using a variety of products. Once such self-detoxification treatment plant is The Thomas Recipe, in which a person takes Xanax or some other medication to reduce anxiety and induce sleep, along with anti-diarrhea medication, vitamins and supplements to ease muscle aches and fatigue.

While this may reduce physical symptoms of withdrawal from hydromorphone, the individual may suffer dangerous complications. Furthermore, self-detoxification addresses only the physical dependency of opioid abuse; self-detox does not address the behavioral, cognitive or emotional aspects of opioid addiction. Addiction and the grueling process of hydromorphone withdrawal, coupled with the social stigmas of addiction, increase the individual's risk for relapse.

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

Hydromorphone overdose requires emergency, sometimes lifesaving treatment. Doctors administer naloxone and other medications to reduce the amount of hydromorphone in a patient's body to safe levels quickly. Once the individual has completed the detoxification and withdrawal process, she may participate in behavioral therapy to address the emotional and behavioral aspects of hydromorphone addiction.

Medication-Assisted Treatment, or MAT, refers to any substance abuse treatment plan that includes pharmacological intervention, including drug replacement treatment or standard detoxification. According to the Substance Abuse and Mental Health Services Administration, medication-assisted treatment:

  • 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 opioids and other drugs to address the resulting symptoms of withdrawal. Medical personnel 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.

Outpatient drug replacement therapy, or DRT, is a good solution for a few individuals. During DRT, physicians prescribe drugs such as methadone, Suboxone or buprenorphine, which bind to the same opioid receptors within the body as opioids do. This reduces withdrawal symptoms. Replacement drugs are longer lasting than opioids and do not produce the euphoric effects. This allows the individual to "bypass" the detoxification and withdrawal process and participate in treatment without a hospital stay. After the individual learns how to live without hydromorphone, 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.

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

Both pharmacological and behavioral treatments work to restore normalcy to those brain function and behavior. A person may overcome his addiction to hydromorphone using only medical treatment or behavioral modification, but combining medical treatment and counseling offers the best hope for recovery. Behavioral therapy can take place at an inpatient or outpatient facility, depending on the individual's needs and the severity of his addiction. Behavioral modification treatments aim at improving employment rates, reducing relapse and lessening side effects associated with opioid addiction.

After successful detoxification or drug replacement therapy, patients participate in drug rehabilitation treatments offering behavior modification techniques designed to change the behaviors that caused physical dependence or address environmental factors that led to the initial dependence on drugs. 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 addiction to opioids such as hydromorphone. One type of therapy, 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. This type of therapy restores the individual's psychological reward system to the way it was prior to addiction to hydromorphone.

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

Long-term recovery from opioid 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 opioid addiction. These programs include behavior modification programs and provide peer support.