“Addiction” is an umbrella term for many kinds of conditions characterized by compulsive, difficult to control and repetitive behaviors that cause harmful consequences. In clinical practice, this term is not used often because it is not specific and does not describe these conditions as a complex and chronic brain disease. The clinical term used is Substance Use Disorders (and more specifically, alcohol use disorder, opioid use disorder, etc.).
Substances of abuse activate the circuit in the brain that is associated with processing rewards, and cause the subjective feeling of euphoria, or a “high.”. When a substance like opioids activates the reward circuit and decouples it from any relevant external stimuli, eventually the behavior of taking opioids becomes reinforcing itself. Furthermore, when patients use opioids daily for many weeks they become physically dependent on the drug. As a result, when they abruptly stop taking the drug several symptoms emerge that are unrelated to the reward circuit, such as increasing heart rate, sweatiness and intense craving. These symptoms are called withdrawal. Many people who develop opioid use disorder also develop a phenomenon called tolerance, where they need to take higher doses of opioids to feel the same effects.
In order to qualify for a diagnosis of opioid use disorder, not only do individuals use need to use opioids compulsively, but they would also have to be spending significant amount of time in finding, getting, and using opioids, or that the use of opioids causes significant dysfunction in fulfilling major social or vocational obligations, or that opioid use causes physical or psychological harm.
All substance use disorders, including opioid use disorder, are brain disorders. Some people, because of a complex combination of genetic and environmental factors, are more vulnerable in developing a substance use disorder when exposed to substances of abuse. Substance use disorders are not caused by a lack of will power and is not a moral failing. On the other hand, encouraging and motivating patients to engage in treatment is important: enhancing personal agency is a key aspect in recovery. Even when patients feel ambivalence or resist treatment, ongoing encouragement and enhancement of personal agency are associated with better outcome.
Relapse in substance use disorder is common, and it is important to discuss with treatment providers further strategies in preventing future relapse. It is important to avoid therapeutic nihilsm when relapse occurs—everyone can change and each at their own pace.
Table 2. Opioid Use Disorder: Symptoms and Severity
| Opioid Use Disorder: Symptoms |
|---|
| An opioid use disorder is defined as a problematic pattern of opioid use that leads to serious impairment or distress. |
| Doctors use a specific set of criteria to determine if a person has a substance use problem. To be diagnosed with an opioid use disorder, a person must have 2 or more of the following symptoms within a 12-month period of time. |
| An opioid use disorder may be mild, moderate, or severe: Mild: 2-3 symptoms Moderate: 4-5 symptoms Severe: 6+ symptoms |
| Loss of Control | ||
|---|---|---|
| 1 | Substance taken in larger amounts or for a longer time than intended | “I didn’t mean to start using so much.” |
| 2 | Persistent desire or unsuccessful effort to cut down or control use of a substance | “I’ve tried to stop a few times before, but I start using this drug again every time.” |
| 3 | Great deal of time spent obtaining, using, or recovering from substance use | “Everything I do revolves around using this drug.” (In severe cases, most/all of a person’s daily activities may revolve around substance use.) |
| 4 | Craving (a strong desire or urge) to use opioids | “I wanted to use so badly, I couldn’t think of anything thing else.” |
| Social Problems | ||
| 5 | Continued opioid use that causes failures to fulfill major obligations at work, school, or home | “I keep having trouble at work/ have lost the trust of friends and family because of using this drug.” |
| 6 | Continued opioid use despite causing recurrent social or personal problems | “I can’t stop using, even though it’s causing problems with my friends/family/boss/landlord.” |
| 7 | Important social, occupational, or recreational activities are reduced because of opioid use | “I’ve stopped seeing my friends and family, and have given up my favorite hobby because of drugs.” |
| Risky Use | ||
| 8 | Recurrent opioid use in dangerous situations | “I keep doing things that I know are risky and dangerous to buy or use this drug.” |
| 9 | Continued opioid use despite related physical or psychological problems | “I know that using this drug causes me to feel badly/ messes with my mind, but I still use anyway.” |
| Pharmacological Problems | ||
| 10 | Tolerance (the need to take higher doses of a drug to feel the same effects, or a reduced effect from the same amount) | “I have to take more and more of the drug to feel the same high.” |
| 11 | Withdrawal (the experience of pain or other uncomfortable symptoms in the absence of a drug) | “When I stop using the drug for a while, I’m in a lot of pain.” |
| Source: American Psychiatric Association. (2013). Substance Use Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. |
[1] Kreek, M. J. (2008). Neurobiology of Opiates and Opioids. In M Galanter & H Kleber (Ed.), Textbook of Substance Abuse and Treatment (4th ed.) Arlington, VA: American Psychiatric Publishing.
[2] American Psychiatric Association. (2013). Opioid Use Disorder. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
