Tramadol Addiction

  • Generic Name or Active Ingridient: Tramadol

Addiction to opioids such as Tramadol is a fast-growing problem in the United States. The Substance Abuse and Mental Health Services Administration reports the U.S. admission rate for opioids other than heroin jumped up an astonishing 414 percent between 1997 and 2007. In 1997, about seven people in 100,000 were addicted to non-heroin opioids; in 2007, that number rose to 36 people per 100,000.

This rise in opioid abuse and subsequent addiction is largely because painkillers are readily available in the United States - Americans use more opioids 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 opioids, according to the Institute of Addiction Medicine.

The Definition of Addiction

The American Society of Addiction Medicine, or ASAM, 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."

This means that addiction is not the result of other diseases or medical conditions. Addiction is a long-term illness; recovery may take several years of intense treatment. Addiction is a disease that changes the cells of the central nervous system, or CNS, in a way that affects the way the brain works. Neurological changes alters the way a person thinks, feels and behaves.

ASAM goes on to state, "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

Tramadol use and abuse may lead to addiction or dependence. While some use the words addiction and dependence interchangeably, these two conditions are separate and quite different from one another.

The body adjusts to the presence of foreign substances such as Tramadol by adjusting its own chemical balance. With continued use, or use at high doses, the body becomes dependent on a certain level of Tramadol to feel "normal." If the level of Tramadol drops suddenly, the opioid-dependent body feels unpleasant, flu-like withdrawal symptoms.

Tramadol withdrawal symptoms are typical of opioid abstinence syndrome. Withdrawal symptoms include:

  • Abdominal Cramping
  • Diarrhea
  • Fever, Runny Nose or Sneezing
  • Goose Bumps and Abnormal Skin Sensations
  • Hot Sweats and Cold Sweats
  • Insomnia
  • Low Energy Level
  • Muscle Aches or Pains
  • Nausea or Vomiting
  • Pain
  • Rapid Heartbeat
  • Rigid Muscles
  • Runny Nose
  • Shivering, Tremors
  • Teary Eyes
  • Yawning

A person who is dependent on opioids will experience physical withdrawal symptoms when she runs out of Tramadol, while the addicted individual will express behavioral symptoms such as cravings and drug seeking.

Symptoms of Addiction include:

  • Inability to Consistently Abstain from Tramadol
  • Behavioral Control Problems
  • Cravings for Tramadol
  • Inability to Recognize Significant Problems with One's Own Behaviors and Interpersonal Relationships
  • Inappropriate Emotional Response

A person can be addicted to a substance and not dependent upon it, and vice versa. For example, a person may be dependent on an anti-hypertensive; if he stops taking his medication, his blood pressure rises but he will not feel cravings for the drug. Conversely, prolonged cocaine use may cause addiction but not dependence - the individual will crave cocaine if he stops taking it, but he will not suffer physical withdrawal symptoms.

Addiction: What Family Members Should Know

Addiction is a disease. It is not an indication of poor child rearing or weak moral character. As with any medical condition affecting the nervous system, your family member needs your support now more than ever.

Family members should know that heredity plays a role in the development of addiction to substances such as Tramadol. Your risk for addiction rises if other members of your family struggle with this disease.

Stress and Other Environmental Factors

Environmental factors also play a role. A stressful home or work life increases the risk for addictive behaviors in everyone in the relationship. Research shows some addicted individuals are hypersensitive to stress; addicted individuals may also have poor coping mechanisms, learned from parents and caregivers.

Environmental stresses increase the risk for addiction in every member of the household. Family members can work towards reducing stresses within the household to help the addicted individual and to decrease their own risks for developing addiction.

Addiction to Tramadol or other substances affects and endangers the entire family, not just the addicted individual. Addiction inflicts collateral damage on children, spouses, family members, friends and co-workers. Addiction diverts money from groceries, rent and childcare to the purchase of Tramadol. Children lose the guidance and intellectual support of a parent as she spends an increasing amount of time seeking Tramadol, getting high or recovering from drug abuse. Tramadol addiction prevents the worker from doing his job well, when he is able to show up at all. The addicted individual associates criminal drug dealers, endangering the safety of everyone in his household. Additionally, the family may have to pay for the inevitable legal and medical bills associated with Tramadol addiction.

Addiction: What Parents Should Know

Prescription painkillers such as Tramadol are increasing attractive to teenagers and young adults because these drugs are widely available. Teenagers get opioids from the family medicine cabinet, from friends or relatives. Because they are legal, there is less of a social stigma attached to abusing opioids such as Tramadol than there is to marijuana or heroin.

Parents should look for warning signs including:

  • Unusual loss of interest in things that once were important
  • Drop in academic performance
  • Loss of motivation or energy
  • Finds ways to sneak off
  • Money issues
  • Items missing from the home

Caring for a Family Member with an Addiction

Family members should work together to develop a treatment plan. The family unit can act as a network to support both the addicted individual and each other. Each member of the family participates according to his age and abilities. For example, a grandparent might take over some of the childcare, a younger child can do some light housework and an older child can run errands.

This type of teamwork can happen only after the family begins to communicate about addiction. This communication can occur between just two individuals, but it works best if the whole family is involved. Try holding family meetings to discuss Tramadol addiction and treatment.

The addicted person does not have to participate at first; he may be reluctant to talk about his illness at first. He may even become angry when he learns the family wants to become involved in his addiction. Anger and resentment will fade with time, as the addicted individual breaks free from the cycle of addiction and can see the love and support of his family clearly.

Addiction has a negative effect but recovery can have a positive effect on a family. Addiction and recovery is very difficult but this type of challenge often brings family members closer together. Working as a team, the family resolves issues that put them all at risk for developing addictions.

Family members play a critical role in recovery from Tramadol addiction. It is quite common for the family to have chosen the treatment facility the addicted individual eventually attends. Family members are frequently the first to encourage the addicted individual to seek and complete treatment for his Tramadol addiction.

A person does not have to hit rock bottom before seeking treatment. Rock bottom can be a lengthy prison sentence, overdose, divorce, unemployment, homelessness or even death. These terrible consequences of addiction put recovery even further out of reach.

It is possible to arrest the disease's progress at any time. Like many medical conditions, recovery from addiction may be easier with early treatment, before it can make lasting changes to the nervous system.

Recovery often begins when the individual recognizes the problems her addiction causes, such as loss of income or failing in personal responsibilities. The first reaction of a family member is often to cushion the addicted individual from the consequences of her addiction, enabling her to continue her addictive behaviors. While it is often difficult to tell the difference, family members should seek to support a loved one without enabling her.

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.

Signs of Addiction

Tramadol addiction changes the way a person thinks, feels and behaves. These cognitive, emotional and behavioral changes vary between individuals.

Behavioral, Cognitive and Emotional Changes

Behavioral:

An addicted person uses Tramadol excessively, at higher doses and more frequently than he intends. He may voice a persistent desire to control his behavior, even while taking more Tramadol. He may attempt to quit Tramadol several times but seem unwilling or unable to quit Tramadol for good.

An addicted individual will lose a great amount of time looking for Tramadol, getting high or recovering from drug abuse. His drug addiction will have a profoundly negative impact on his ability to work or engage in normal relationships with a spouse, parent or child.

The addicted person continues to abuse Tramadol, despite the negative impact it has on his life. With continued use, addiction changes the reward circuitry in the individual's brain; he loses interest in things he used to love. Soon, all he will care about it Tramadol.

Cognitive:

The addicted person becomes preoccupied with Tramadol - it is all she can think of. Her view of Tramadol's relative benefits and risks shift so that she mistakenly thinks Tramadol cures all ills and does no harm. She may hold the inaccurate belief that all her problems are due to other people or causes, and not as a predictable consequence of addiction.

Emotional:

Increased anxiety, dysphoria and emotional pain;

Increased sensitivity to stressors associated with the recruitment of brain stress systems, such that "things seem more stressful" as a result; and

Difficulty in identifying feelings, distinguishing between feelings and the bodily sensations of emotional arousal, and describing feelings to other people (sometimes referred to as alexithymia).

Symptoms of Addiction

Symptoms of addiction can be obvious or subtle.

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

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.

Gender Differences

Twice as many men as women abuse drugs are be dependent upon illicit substances such as marijuana, heroin or cocaine, according to the 2010 National Survey on Drug Use and Health. Fewer females abuse illegal drugs: In 2010, 5.9 percent of females reported using illicit drugs, as compared to 11.6 percent of males.

While fewer women abuse illicit substances such cocaine or heroin, women are more likely to use prescription drugs, such as Tramadol, non-medically. Females are also more apt to abuse multiple substances, often mixing Tramadol with alcohol, marijuana or other opioids.

Men engage in Tramadol addiction differently than women do. Men tend to abuse drugs in social settings, while women abuse substances at home alone. Women with Tramadol addiction or other substance abuse problems have few or no significant friendships, whereas addicted men have wide social circles. This could be a reflection of stronger social stigmas against addicted women as compared to the tolerant attitude society has towards addicted men.

Studies suggest physicians prescribe mood-altering drugs more frequently to female alcoholics than to male alcoholics because the healthcare providers attribute the cause of the female's condition to be rooted in depression, anxiety or some other emotional difficulty. As a result, women are more likely to combine prescription psychoactive drugs, like morphine, with alcohol or illegal drugs.

Women seem to judge illegal drug use more harshly than males, and this social stigma deters many women from using illicit substances at the same rate as males. However, there is less of a stigma against prescription drug abuse.

Cause of Gender Differences

Adult female drug abusers often grow up in families where one or more family members struggled with drug or alcohol addictions. Women who carried too much responsibility in the home as a child face an increased risk for developing an addiction later in life. Addicted women also report more family disruption when they were growing up than males do. Women with addictions are frequently in relationships with a partner who also has a substance abuse problem.

Women are more likely to name a difficult relationship or disturbing experience as the cause of addiction to substances. Women seem more likely to hold genetics, family history or environmental stress responsible for their drug abuse problems.

Females tend to have co-existing psychological problems such as a poor body image or eating disorders and are more likely to have attempted suicide than men are. In general, women who are addicted to substances such as Tramadol have lower expectations for their lives, less education, fewer marketable skills and less job experience than males.

Females start treatment more frequently than males do but females do not finish as often. Women must overcome additional barriers, such as being able to afford treatment and social stigmas against addicted women. Many mothers fighting addiction have trouble finding someone to take care of their children while they seek help.

Treatment Options

The American Society of Addictive Medicine warns that addiction to substances such as Tramadol 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 opioids to non-toxic levels. An individual going through the Tramadol detoxification process typically experiences five or more days of intense physical withdrawal symptoms as his body adjusts to the lack of opioids.

Rehabilitative treatment focuses on the cognitive and behavioral aspects of Tramadol addiction. This phase of treatment usually includes behavior modification along with individual, group and family counseling to help the individual learn how to live without Tramadol.

Detoxification

Some addicted individuals attempt self-detoxification to free themselves from Tramadol. Self-detoxification is the process of going through withdrawal alone, without the help of trained professionals or medicines to ease withdrawal symptoms.

Profoundly strong withdrawal symptoms usually cause these addicted individuals to relapse back to Tramadol use.

Other people develop a homemade treatment plan to ease the detoxification process. One such home remedy is the Thomas Recipe, in which individuals use medicine such as Xanax to ease anxiety, anti-diarrhea medications, vitamins and hot baths to reduce overpowering symptoms of withdrawal. Detoxification takes five or more days, with the worst symptoms occurring on or about the fourth day. While the Thomas Recipe relieves the physical symptoms of withdrawal, it does not address the psychological symptoms that cause many people to relapse.

Overdose

The greatest risk to recovery is relapse to Tramadol use, potentially resulting in fatal overdose. Detoxification reduces a person's tolerance to opioids; there is a great risk for overdose immediately after relapse. A person can overdose on a smaller dose of Tramadol after detoxification that he used to take before going through withdrawal.

Overdose is a serious, life threatening medical emergency. If you think you or someone you know has overdosed on Tramadol or any other medication, contact poison control center at 1-800-222-1222 or go to the nearest hospital, emergency department, urgent care clinic, doctor's office or fire department. Call an ambulance if it is the quickest way to get the patient to the hospital.

Overdose symptoms include:

  • Extreme Drowsiness
  • Pinpoint Pupils
  • Nausea
  • Vomiting
  • Diarrhea
  • Confusion
  • Ringing in the Ears
  • Cold, Clammy Skin
  • Muscle Weakness
  • Fainting
  • Weak Pulse
  • Slow Heart Rate
  • Coma
  • Blue Lips
  • Shallow Breathing or No Breathing

Emergency department personnel will administer naloxone or other drugs to drop Tramadol to non-toxic levels quickly. Doctors and nurses will establish an airway to help the patient breathe and pump excess Tramadol from the stomach. They will also perform other emergency, life-saving treatments such as CPR as necessary to counteract toxic levels of Tramadol.

Once the patient is out of danger, he may participate in behavioral modification to learn how to live without Tramadol.

Drug Replacement Therapy

If an individual is not in mortal danger of overdose, she may choose to participate in drug replacement therapy, known as DRT. Methadone, buprenorphine and Suboxone are different types of DRT.

Replacement drugs reduce the withdrawal symptoms associated with Tramadol but do not get the individual high. This allows some people to put off the detoxification process and start with behavior modification therapy.

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 type of Medically-Assisted Treatment, or MAT, in which physicians administer drugs to lower opioid levels in the body and reduce withdrawal symptoms. Research shows MAT has many benefits, such as:

  • Improved Survival Rates
  • Increased Retention in Treatment
  • Decreased Illicit Opioid Use
  • Decreased Risk for Hepatitis and HIV
  • Decreased Criminal Activities
  • Increased Employment
  • Improved Birth Outcomes for Pregnant Women Battling Addiction

Standard Detoxification is another type of MAT. During standard inpatient detoxification, doctors administer naloxone to lower opioid levels along with other medications to reduce withdrawal symptoms. While standard detoxification reduces severity and duration of withdrawal symptoms somewhat, the patient must still endure the demoralizing and debilitating psychological symptoms that accompany detoxification.

Rapid Detox is the most humane and efficient way to detoxify the body from Tramadol. During rapid detox, board certified anesthesiologists administer sedatives and anesthesia alongside the usual detoxification medications. The patient dozes in a comfortable "twilight sleep" and awakens refreshed, unaware of the grueling detoxification process and unaffected by psychological withdrawal symptoms.

Rehabilitation

Successful recovery includes rehabilitation and behavior modification. Tramadol addiction is a complex but treatable disease that affects brain function and behavior. Individual, family and group counseling, along with other behavioral therapy, are the most commonly used forms of drug abuse treatment. While no single treatment is appropriate for everyone, treatment needs to be readily available to be effective.

Treatment programs should perform an initial assessment for the presence of HIV/ AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.

The most effective treatment attends to multiple needs of the individual, and not just his drug abuse. Many drug-addicted individuals also have other mental disorders.

Medications are an important element of treatment for many patients, especially when MAT is combined with counseling and other behavioral therapies. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.

It is critical that the individual remains in treatment for an adequate amount of time. Counselors and physicians should continually assess and modify the individual's treatment and services plan to meet his ever-changing needs. Rehabilitation specialists must continually monitor a patient for drug use during treatment, as lapses during treatment do occur.

Treatment for Tramadol addiction does not need to be voluntary to be effective. According to NIDA, those under legal coercion tend to remain in treatment longer than and do better than those not under pressure. People would rather stay in treatment than go to jail.