December 6, 2017

“Addiction” does not have a simple meaning. Addictions to different drugs, or “substances,” are called substance abuse disorders. When addictive substances like opioids are taken in excess, they can activate the brain’s reward system to produce feelings of pleasure, or a “high.” The body’s reward system is normally used to reinforce behaviors and produce memories. Opiate abuse activates this normal reward system so intensely that normal activities may be neglected and forgotten about in favor of the “high” of drug use. Over time, excessive opiate use can even change the brain’s reward system so that an addicted person becomes physically dependent on the drug. Opioid addiction involves using an opioid drug compulsively, and to be overwhelmingly involved in finding, getting, and using that drug. When reducing or stopping drug use, addicted persons often experience pain and other uncomfortable symptoms (called withdrawal). Addiction also usually involves some drug tolerance, or the need to take higher doses of a drug to feel the same effects. [1] All addictions, including opioid addiction, are brain disorders. Some people, based on their heredity and environment, are more vulnerable or more likely to become addicted. Addiction is not due to lack of will power, is not a moral failing, and is not done on purpose. Often an opioid addicted person resists treatment, but treatment options should be continuously encouraged. Relapse is also common, and indicates that more or different treatments are necessary. The DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders, used by psychiatrists nation-wide) organizes these problems with opioid use under the heading “Opioid Use Disorder.”[2]

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.