Opiate Addiction

Opiate addiction is a growing problem in the United States. The Substance Abuse and Mental Health Services Administration reports the U.S. admission rate for opiates other than heroin skyrocketed by 414 percent between the years 1997 and 2007, from 7 people per 100,000 to 36 per 100,000. This rise in opiate abuse is due, in large part, to the fact that Americans take more opiates than another other nation on earth. Even though Americans represent only about 5 percent of global population, they consume 80 percent of the world's supply of opiates, according to the Institute of Addiction Medicine.

Opiates are a group of painkillers derived from the poppy plant, which contains natural opiates such as morphine and codeine. The poppy plant also contains other compounds, such as thebaine, from which semi-synthetic opiate drugs may be synthesized. Examples of semi-synthetic opiates include hydrocodone, oxycodone, hydromorphone and oxymorphone.

Opiates, sometimes called opioids, are a psychoactive drug frequently prescribed to relieve moderate to severe pain. Opiates are appealing to recreational drug users because of the euphoria these drugs produce.

Physicians typically prescribe oral opiates, to be taken by mouth, but many addicted individuals snort or inject opiates to heighten the drug's psychoactive effects.

The Definition of Addiction

The American Society of Addiction Medicine offers a detailed and complete definition of addiction. "Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors." "Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one's behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death."

Addiction versus Dependence

While many use the terms addiction and dependence interchangeably, these two conditions are separate and quite different from one another. The human body adapts to the presence of foreign substances, such as medicine or alcohol, by adjusting its chemistry so that the body can tolerate these substances and still function. The person may even grow tolerant to the substance, which means he must take increasingly higher doses to get the intended effect.

Sometimes the body grows dependent on these substances, so that the individual must continue to consume the substance in order to feel normal. If the level of this substance were to drop suddenly, his body would struggle to stabilize itself. The individual feels this battle for chemical stability through uncomfortable withdrawal symptoms.

Withdrawal symptoms, known in the medical world as opiate abstinence syndrome, often come in two waves several hours after the last dose. Early symptoms of withdrawal include:

  • Agitation
  • Anxiety
  • Insomnia
  • Muscle Aches
  • Runny nose
  • Sweating
  • Watery Eyes
  • Yawning

Later, the individual will experience symptoms including:

  • Abdominal Cramping
  • Diarrhea
  • Dilated Pupils
  • Goose Bumps
  • Nausea
  • Vomiting

Doctors diagnose an individual as being dependent on opiates if he suffers withdrawal symptoms after the level of opiates drop. A dependent person will feel withdrawal symptoms if he stops taking opiates or if he receives certain medications that rapidly reduce the level of opiates in his body, such as naloxone.

Addiction manifests itself through certain predictable behaviors, including craving and drug seeking.

While an individual could be both addicted and dependent upon opiates, addiction and dependence are separate conditions and independent of one another. A person can be dependent upon a substance but not be addicted to it, and vice versa. For example, an individual who depends on an anti-hypertensive will suffer high blood pressure if she does not take her medicine but she will not crave the drug. Conversely, an addicted person will crave cocaine if she runs out but she will not suffer physical withdrawal symptoms because cocaine does not cause dependence.

Addiction: What Family Members Should Know

Addiction is a disease, not a choice or a flaw in a person's moral character. Family members should know that an addicted person needs love and support for effective recovery to take place. It is also important for the family to recognize that they share the risk for addiction with their loved one.

While researchers are still searching for the exact cause of addiction, most specialists agree that genetics play a large role in the development of addiction. Those with a strong family history of addiction to alcohol or drugs face an increased risk for developing similar addictions.

Environmental factors also affect the development of addiction. Stresses within the home, such as financial or relationship trouble, increase the risk for substance abuse and addiction. Researchers are also discovering that addicted individuals may be hypersensitive to stress and that this hypersensitivity may be hereditary. Additionally, children learn how to cope with stress by watching their parents; an addicted parent passes poor coping skills to their children.

Addiction affects and endangers the entire family. Addiction causes a considerable amount of collateral damage to a family, including loss of income, child neglect, and illegal activity of illicit drug use within the home, arrest or even imprisonment.

Addiction: What Parents Should Know

Opiate addiction is a growing problem among teenagers and young adults in the United States. Parents should know the National Institute on Drug Abuse says that 3 percent of individuals between the ages of 12 and 17 reported taking prescription medications for non-medical use in the previous month. When asked how they got opiate painkillers without a prescription, more than half of 12th graders say they were given the drug or bought them from a friend or relative. The number of teens who purchased opiates through the internet was negligible.

Parents should look for warning signs including an unusual loss of interest in things that were once important. A child with an opiate addiction may suffer a sudden drop in performance in school, athletics or at an after-school job. A parent may notice a loss of motivation and energy. The child frequently sneaks away and is unable to come up with a reasonable explanation for her absence.

A child addicted to opiates must fund her addiction. Children and teenagers typically have relatively simple financial needs; parents should question a child who seems to have money problems. Parents should investigate any missing household items or lost money.

Caring for a Family Member with an Addiction

Caring for a family member with an opiate addiction is not easy but a strong family unit is vital to recovery from addiction. Because researchers think the roots of addiction are genetic and environmental, it is important to remember that those same factors may lead other family members to addiction. Families can identify and address environmental stresses within the home, such as resolving relationship problems or reassigning workloads. Addiction affects the entire family, so each family member will benefit by recovery efforts as well.

Family members should work as a team to provide a network of support for the addicted individual in such a way that no one person will carry the entire burden of addiction. This team should meet often and assign responsibilities to each teammate. For example, grandparents can take over childcare for an addicted parent while an aunt grocery shops and cooks for the family. Children and siblings participate by doing minor household chores and staying out of trouble at school.

Family members can develop a "care plan" designed to encourage the addicted individual to seek and complete recovery. This care plan may include looking for detoxification and rehabilitation facilities, deciding who will take over the addicted person's responsibilities while they are in rehab, rides to doctor's appointments and so forth.

The family should meet often to discuss progress. The addicted person does not have to participate at first; in fact, addiction makes changes to the brain that causes the individual to feel very private and defensive about his disease. The individual should be allowed to opt out of these meetings, but because addiction effects everyone, the family has a right to talk about the problem and seek solutions.

Family members play a critical role in recovery in that they encourage the addicted individual to seek and complete treatment. It is common for the family to have located the facility where the addicted individual eventually seeks treatment.

Do not let your loved one hit rock bottom. Addiction causes collateral damage and health hazards that can be avoided through early treatment. It is possible to arrest the disease's progress at any time.

Recovery often begins when the individual recognizes the problems addiction causes. Sometimes family members shield the addicted individual from the consequences of his actions either because they feel sorry for their loved one or because they are ashamed of them. Each family member must examine how she enables the addicted individual by preventing him from feeling the consequences of his action. While it is not necessary to "throw a person under the bus" by calling the police or kicking the person out of the home, an addicted individual must understand the damage his disease has caused his family.

Family members walk a fine line between shielding the individual from his addiction and supporting him in his recovery. The treatment and recovery experience works best when the individual feels physically, emotionally and spiritually safe in his home environment. Family members should recognize addiction as a disease and avoid blaming the individual for his illness.

Addiction has a negative effect but recovery can have a positive effect on a family. Working as a team brings families closer together. Taking on new responsibilities can bring out hidden talent and confidence in every member of the family, especially younger children. Families can identify and address household stresses to aid in recovery, reduce the risk for future addictions and generally bring peace and happiness to the home.

Signs of Addiction

Opiate addiction makes neurological changes that manifest themselves in a variety of ways. These changes to the nervous system affect the way a person behaves, thinks and feels. A doctor looks for these behavioral, cognitive and emotional changes when she diagnoses someone with an opiate addiction.

Behavioral:

A person addicted to opiates uses these drugs more often and in higher quantities than he intends, even while he promises to quit or control his behavior. Each time he uses opiates, he swears it will be his last. He tries to quit several times but ultimately seems unwilling or unable to control his opiate use.

He loses an increasing amount of time looking for, using and recovering from opiate use. This eventually cuts into the time he usually devotes to work, relationships, family or school. The addicted individual will continue to use opiates, despite the harm it causes to his health or to his relationship with the important people in his life. Soon, he will not care about the things he used to love most, like his hobbies, work or family. Addiction rewires the brain's reward circuit so that nothing seems as rewarding to the individual as opiates.

Cognitive:

The addicted individual becomes preoccupied with opiates, increasingly ignoring everything else in life. Addiction causes her to have an incorrect assessment regarding the relative benefits and risks associated with opiates; she will overplay the benefits and discount the risks. Soon, she will begin to blame everyone and everything else for her problems, rather than recognizing the harm opiate addiction causes.

Emotional:

Opiate addiction causes emotional changes, including increased anxiety, dysphoria and emotional pain. Addiction increases the individual's sensitivity to stress; frequently, the addicted individual says he needs opiates because "things seem more stressful." Addiction makes it difficult to identify one's feelings or to distinguish between emotions from other bodily sensations. An addicted person sometimes has trouble describing her feelings, a condition known as alexithymia.

Symptoms of Addiction

Opiate addiction is associated with a variety of physical and psychological symptoms.

Physical 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

Doctors diagnose opiate addiction by identifying certain psychological symptoms characteristic of addiction. 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.

This means the individual seems unable to stop using opiates. He may be unable to control his behavior in other ways, frequently acting out or engaging in other criminal or antisocial behavior. He craves drugs or other activities that promise intense rewards, such as risky sexual adventures, driving fast or gambling with large sums of cash. As his disease progresses, the addicted individual seems unaware of things going terribly wrong in his personal or professional life. He may display inappropriate emotional responses to the events surrounding him, such as laughing during a somber event or becoming enraged during a birthday party.

Gender Differences

The 2010 National Survey on Drug Use and Health reveal gender differences in opiate addiction. For example, more males than females over the age of 12 years use illicit drugs. 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 show women are more likely than are men to abuse prescription painkillers such as opiates. Males and females express their addiction to opiates; addicted women are more private about their drug use and disease than are men. Males addicted to opiates are more likely to abuse drugs with others in a party environment. In contrast, an addicted woman usually abuses opiates in the privacy of her own home, away from others. Men are more likely to exhibit social disorders and engage in criminal activity, such as belonging to gangs or dealing drugs while addicted women sometimes participate in prostitution or petty theft to support her addiction.

Women are less likely to admit to drug use when compared to men, according to the 2002 National Survey on Drug Use and Health. Social stigmas, economic barriers and family responsibilities prevent addicted women from seeking or completing treatment programs at the same rate as men.

Treatment Options

The American Society of Addictive Medicine warns that addiction can cause "disability or premature death, especially when left untreated or treated inadequately."

Treatment consists of two phases: detoxification and rehabilitation. Detoxification is the process of lowering the level of opiates in the body. A person going through the detoxification process typically experiences five or more days of intense withdrawal symptoms as his body adjusts to the lack of opiates.

Rehabilitation addresses the cognitive and behavioral aspects of opiate addiction. This phase of treatment usually includes behavior modification and counseling to help the individual learn how to live without opiates.

Detoxification

There are many reasons people avoid opiate detoxification, including fear of overpowering withdrawal symptoms that drive even the most determined and self-disciplined individuals back to opiate abuse. Many people worry about the social stigma associated with drug addiction, and fear that entering a rehabilitation clinic will reveal their secret to friends, family and co-workers. Others cannot afford to spend days or weeks away from their jobs, so they attempt self-detoxification at home, without the help of medical professionals.

Self-detoxification, or going "cold turkey," is a grueling and time-consuming approach to quitting opiate addiction. Cold turkey refers to the addicted person's skin as he goes through withdrawal: cold, clammy, pale with goose bumps, much like a plucked turkey. With no medications to ease withdrawal symptoms, self-detoxification takes five or more days, with the worst day occurring on or about the fourth day. Without trained medical personnel to monitor him, the individual may suffer serious complications, including vomiting and inhaling the stomach contents in an condition known as aspiration, or dehydration caused by excessive vomiting and diarrhea.

Some individuals attempt to ease detoxification with a homemade treatment plan including medications to relieve specific withdrawal symptoms. One such plan is the Thomas Recipe. The individual takes Xanax or some other medication to ease anxiety and insomnia, two very unpleasant symptoms that makes the detoxification process seem especially long and grueling. The Thomas Recipe also calls medicine to ease diarrhea, muscle aches and fatigue.

While the Thomas Recipe and self-detoxification address the physical aspects of opiate dependence, they do not correct the neurological changes in the brain that characterize addiction. Without adequate treatment, the behavioral aspects of addiction will bring the individual back to opiate abuse soon after he has gone through detoxification.

Relapse is the primary complication of detoxification and relapse can be deadly. An individual who has recently detoxified his body has lowered his body's tolerance to opiates. Because of this lowered tolerance, he can overdose on a smaller amount of opiates than he used to take before detoxification. Many individuals who go through detox are unaware of their lowered tolerance and put themselves at great risk for overdose upon relapse.

Overdose is a serious medical emergency, claiming the lives of more Americans each year. There was a 63 percent increase in the number of deaths in the United States associated with opiate use during the 5-year period between 1999 and 2004. Physicians treat opiate overdose by administering naloxone, which drops opiates to safe levels very quickly. Nurses monitor patients for dangerous complications, such as aspiration and dehydration, and take appropriate action. Once the patient is in stable condition, she may participate in rehabilitation and counseling to address her addictive behaviors.

Patients who are in otherwise stable condition may skip the detoxification phase and move directly to rehabilitation through Drug Replacement Therapy, or DRT. Replacement drugs block the effects of opiates while still maintaining a level of opiates in the system, so that a person does not get high nor does he suffer withdrawal symptoms.

Methadone is perhaps the most famous form of DRT, but many patients now use Suboxone or buprenorphine to block the effects of opiates. DRT drugs last longer than heroin or other opiates and an individual may remain on DRT for many years. After the individual changes the behaviors associated with addiction, he weans himself from the replacement drug. Harvard Medical School cites estimates that 25 percent of methadone DRT patients eventually abstain, another 25 percent continues to take the drug and 50 percent go on and off methadone.

DRT is one form of Medically-Assisted Treatment, or MAT. During MAT, doctors prescribe medications that ease withdrawal symptoms to improve a patient's chance for recovery and for survival. MAT also increases retention in treatment plans. MAT decreases intravenous opiate use, which lowers an individual's risk for diseases such as hepatitis and HIV. Lowered drug use also decreases the risk for involvement in criminal activities and increases employment attendance. MAT improves birth outcomes for pregnant women battling opiate addiction.

Standard Detoxification is one type of MAT. During standard inpatient detoxification, doctors administer naloxone and other medications to reduce opiate levels, along with drugs to relieve ensuing withdrawal symptoms. Nurses monitor the patient for complications. While standard detoxification eases the physical discomfort of withdrawal and shortens the detoxification process somewhat, patients still battle the demoralizing psychological aspects of opiate withdrawal that can lead to relapse.