Dependence vs. Addiction
Physical dependence occurs because of normal adaptations to chronic exposure to a drug and is not the same as addiction. Addiction, which can include physical dependence, is distinguished by compulsive drug seeking and use despite sometimes devastating consequences. Someone who is physically dependent on a medication will experience withdrawal symptoms when use of the drug is abruptly reduced or stopped. These symptoms can be mild or severe (depending on the drug) and can usually be managed or avoided by using a slow drug taper. Dependence is often accompanied by tolerance, or the need to take higher doses of a medication to get the same effect. When tolerance occurs, it can be difficult for a physician to evaluate whether a patient is developing a drug problem, or has a real need for higher doses to control their symptoms. For this reason, physicians need to be vigilant and attentive to their patients’ symptoms and level of functioning to treat them appropriately.
THE OPIOID EPIDEMIC
THE NATIONAL OPIOID CRISIS
According to the government’s Health and Human Services (HHS) website, more than 2 million Americans had an opiate use disorder in 2016, and over 17,000 people died from opiate-related deaths in 2017. A total of 70,000 died of overdoses related to all substances. In late 2017 HHS issued a public health alert to increase public awareness and guide individuals toward appropriate treatment. The U.S. has been in the midst of an opioid crisis that has been slowly building for the past decade.
Synthetic prescription opioids were initially said to be non-habit forming by the medical establishment and the pharmaceutical companies who manufactured the drugs. This has turned out to be false, as millions have found themselves psychologically and/or physically dependent on these medications.
In many instances, once the individual is unable to secure the prescription opioids legally they find no alternative but to turn to heroin or illicit sources for the opioids, increasing their exposure to fentanyl. Fentanyl is a synthetic opioid that is 50 times more potent than morphine and deadly when the user is unaware that the drug they purchased contains the drug.
HOW ADDICTION TO PRESCRIPTION DRUGS OCCURS
UNDERSTANDING THE NEUROSCIENCE
Prescription drug addiction directly impacts the opioid receptors in the brain, blocking the feelings of pain, and producing a euphoric, deeply relaxing state. The brain registers this pleasant state as a positive experience and one to be repeated, and thus the neural pathways and brain chemistry begins to become altered. Over time, increased tolerance to the drug leads to higher, more frequent dosing, and the brain stops producing dopamine as a result. Eventually, the individual becomes dependent on the prescription pills.
SIGNS OF ADDICTION
KNOW THE WARNING SIGNS OF ADDICTION
In addition to increased tolerance and subsequent higher or more frequent dosing of the prescription drug to get the desired affect, there are other signs that addiction or dependency is developing. These signs include:
- Obsessing over acquiring the drug, having enough pills on hand, looking forward to next dose
- Doctor shopping when primary doctor discontinues refills
- Buying prescription drugs from strangers or online
- Withdrawing socially from friends and family
- Stealing pills from friends and family
- Chronic constipation
- Increased anxiety
- Loss of interest in usual activities
- Decreased appetite
- Difficulty sleeping
- Experience withdrawal symptoms when attempting to quit or cut back
When these warning signs emerge it is essential to begin seeking professional treatment as early as possible, as allowing the addiction to take root makes recovery more challenging. Seek a comprehensive program that offers detox, evidence-based psychotherapy, and medication-assisted treatment (for prescription opioids).
DETOX AND WITHDRAWAL
THE FIRST PHASE OF RECOVERY
When the individual commences treatment, an outpatient program through a physician or outpatient detox facility may be feasible if the addiction is not severe and in its early stages. In most cases, however, a supervised detox process is recommended for prescription drug addiction prior to entering a residential treatment program. There are real risks involved during the detox phase so supervision is the treatment norm. In addition, without help to mitigate the highly unpleasant symptoms the addict may never complete detox and instead return to using the pills.
During detox the individual will experience withdrawal symptoms related to the type of prescription drug of abuse, as well as psychological symptoms. In most cases, an incremental tapering schedule will be initiated to help gradually reduce the amount of exposure to the drug. Medications can also be useful for helping alleviate many of the withdrawal symptoms, including the drug cravings.
COMPREHENSIVE TREATMENT FOR PRESCRIPTION DRUG ADDICTION
TREATMENT ELEMENTS FOR RECOVERY
Comprehensive treatment for a prescription drug addiction will include several treatment elements:
- Individual psychotherapy. During these one-on-one sessions the therapist will use cognitive behavioral therapy (CBT) to guide the client in identifying disordered thoughts and actions that have become patterns of the addiction. Creating new healthy thought and behavior patterns will help the individual avoid relapsing. In addition, underlying factors that might be driving the prescription pill addiction, such as using it to self-medicate a mood disorder or trauma, will be examined.
- Group counseling sessions. Group therapy provides the social support so helpful in early recovery. Members of the group, under the facilitation of a therapist, share their own experiences and offer mutual support, bonding with each other with the common goal of overcoming the prescription pill addiction.
- Couples or family counseling. Prescription drug addiction touches those closest to the individual in recovery. For this reason it is helpful for loved ones to engage in the recovery process as well, as this can help in healing the relationships. Family or couples counseling provides tools for a healthy family dynamic and can help loved ones avoid falling into codependency or enabling behaviors.
Treating prescription opioid addiction requires commitment, time, and patience for the individual to be able to overcome the powerful grip these drugs possess. Medication-assisted treatment (MAT) is now the standard of care for helping those who are battling a heroin or prescription pill addiction. Drugs such as naltrexone, buprenorphine, and Suboxone are commonly prescribed to ease withdrawals and curb opioid drug cravings during the latter phase of detox and into the first year of recovery. MAT is credited with helping to increase the odds of the individual attaining a sustained recovery, and may be continued long-term if indicated.
The medications attach to the opioid receptors in the brain, blocking the drug’s effects and eventually reducing the person’s desire to use the prescription drug. In addition to the MAT, it is essential that psychotherapy and additional ongoing engagement in recovery efforts are continued. While a physician will be closely monitoring individuals who are on MAT, the continuing care efforts will help reinforce the continuation of a sober lifestyle and provide additional sources of support.