Opioids, and other substances such as alcohol, have an immediate impact on an individual’s brain when taken. Those feelings are so intense and immediate that you can’t get them through normal pleasurable activities. In the case of prescription pain medications, relief from the pain a person is feeling is just as rewarding as the euphoria experienced by others.
No matter the reason for taking an opioid, recreational or medical, more of it will be needed over time to get the same effect. This fact is the beginning of the chemical cycle in the brain which causes physical addiction.
1. Opioids attach to receptors in the brain that are normally activated by naturally occurring neurotransmitters that relieve pain, reduce anxiety and produce feelings of calm. Neurotransmitters are simply chemicals that carry messages in the brain.
Opioids closely mimic naturally occurring chemicals, so the body allows them to attach to receptors and activate them.
2. Once the opioid has attached to the brain’s receptors, the normal messages being sent are disrupted. A number of different responses are then initiated in various parts of the brain.
Neurotransmitters are released that are typically produced in response to pleasurable activities such as exercise, sex or eating. In addition to chemical responses, opioids impact basic survival functions such as breathing, heart rate and sleep patterns.
3. Very quickly, the brain adjusts to the surges in chemicals and the “new” messages being carried by neurotransmitters.
In response, it produces less of these chemicals naturally in response to the activities that have triggered their release before introducing a drug.
4. Once the body has adjusted, unless an opioid is present, the individual is left with a feeling of both physical discomfort and psychological irritability known as withdrawal.
Withdrawal symptoms can begin occurring just days or weeks after the drug is first used.
5. At this point the brain has become dependent on the opioids and requires more of them to maintain its overall well-being.
Beyond producing a feeling of euphoria, the body simply needs the opioids to prevent severe, debilitating withdrawal symptoms.
Many individuals struggling with the disease of addition began to use opioids or other drugs in response to negative situations or feelings for which they don’t have a solution. This can include child hood traumas, tragic life events or simply a feeling of not belonging or being comfortable with yourself. In addition, many people experience the difficulties of depression and anxiety all the time, not just in response to a specific event or issue.
Any of these factors can lead to a person’s dependence on opioids and other substances to help alleviate their negative feelings. Opioids can lessen the effects of sadness, worry, fear, shame, anger or any other emotion a person doesn’t feel equipped to handle. Just like our brain begins to adapt to, and then expect, the presence of drugs to be okay, so do our emotions.
When faced with these things, individuals begin to use the drug to “numb” their feelings or be the “solution” to their problems which may seem overwhelming and impossible to solve. However, almost certainly, that individual will also begin to recognize that the drugs have failed to solve their problems and instead have begun to cause them. At that point, they may wish to stop, but are unable to. Both the physical nature of the disease as well as the reliance on drugs as a solution to their problems will make it difficult to stop without help.
Signs & Symptoms
of Opioid Addiction
It can often be difficult to know if someone is misusing prescription pain medication or an illegal substance such as heroin or fentanyl. This is particularly challenging if they have been prescribed medication for an injury or illness, and the medication is taken to provide relief from valid pain.
Those using prescription medication to provide pain relief may build up a tolerance, reducing its effectiveness and causing some of these physical symptoms to occur. In response, more and more of the medication must be taken to experience that relief. An opioid addiction can form as a result of more frequent use related to this increased tolerance.
As a person continues to use opioids, whether for recreational or medical purposes, the same changes to their brain chemistry occur. Someone with an opioid addiction will show similar physical and psychological symptoms regardless of their initial reason for use. There are some tell-tale physical and behavioral signs that a person is misusing opioids which can help themselves and their loved ones know that they may need help.
Physical Signs of Opioid Addiction
These common physical signs of opioid use or addiction are present when a person has recently used opioids, but are likely to become more common as a side effect of long-term use as well.
- Sedation, drowsiness, lack of energy
- Nodding off or losing consciousness intermittently
- Narrowed pupils
- Slowed, shallow breathing
- Itching or constant scratching
- Lack of coordination
- Nausea, vomiting
- “Track marks” or scars from intravenous use in arms, hands, legs, feet or groin
Behavioral Signs of Opioid Addiction
When an individual is misusing opioids, there are typically significant changes to their behavior and moods. Each person is unique, but some or all of the following signs will likely be noticeable.
- Noticeable elation or euphoria
- Sudden, dramatic mood swings
- Avoiding social situations, isolation
- Dishonesty, secrecy
- Sudden financial problems, seeking quick cash
- Issues with work, family and friends
- Legal issues, arrests
- Inability to fulfill commitments
- Changes in habits or routines
- Using more medication than prescribed
- “Doctor shopping” or visiting multiple doctors to obtain prescriptions for opioids.
How Health Professionals Diagnose Opiate Addiction
When diagnosing opioid addiction, medical professionals use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. The DSM-5 lists 11 official symptoms of opiate addiction. Under these criteria, the person must experience two or more of the 11 signs within the previous year. These symptoms include:
- Using opioids for longer or in larger amounts than directed: In most cases, opioids should serve as a short-term treatment for pain. Extended use of the drug may indicate misuse when combined with other signs of opiate addiction.
- Inability to control opioid use: A person with an addiction can also have difficulty reducing or quitting their opioid use, even when they want to stop. Some people develop opioid addictions due to genetic, psychological or environmental factors that make them more susceptible.
- Excess time spent on opioid use and related activities: When addiction leads to increased use, it can also cause the person to dedicate more time and effort to opioid-related activities. They may spend excess money and time using and obtaining opiates.
- Strong urges to use opioids: Ongoing opioid use can make a person physically dependent on the drug. This effect results in cravings and withdrawal symptoms that encourage them to seek out more opiates.
- Difficulty completing obligations at work, home or school: The physical effects of addiction, including sleep and energy issues, can interfere with daily obligations. A person with an opioid addiction may have reduced performance in these areas.
- Continued opioid use despite interpersonal problems: Opioid addiction can lead to interpersonal problems. Someone with an addiction may become unusually confrontational when approached about their use.
- Withdrawal from activities: When someone develops an opioid addiction, they may begin to withdraw from activities that they used to love. They often have more difficulty with overall function and dedicate more time to opioids than their previous hobbies.
- Hazardous behavior linked to opioid use: Some people with opioid addiction perform risky behaviors while under the influence. These harmful activities include reckless driving or having unsafe sex.
- Ongoing use despite resulting mental health symptoms: In people who have mental health conditions, opioid use can make their symptoms worse. Someone with an opiate addiction may continue using them even when they know that it exacerbates their symptoms.
- Increasing tolerance to opioids: As someone keeps using opioids, they often need more of the drug to get the same effects. This increased tolerance can indicate the development of an addiction.
- Evident withdrawal symptoms: When opioids wear off, they can cause uncomfortable withdrawal symptoms such as sweating and mood changes. These effects can become more prevalent in someone with opiate addiction.