It used to be that quite a few different phrases were tossed around in drug rehab centers. People talked about whether a person suffered from drug abuse, tolerance, dependence, or addiction. There was a line drawn between opiate substance abuse vs. dependence. Then, in 2013, the Diagnostic and Statistical Manual of Mental Disorders—the fifth edition, mind you—did away with all those nifty phrases. There was no question of opiate substance abuse, tolerance, dependence, or addiction. It all fell under the general umbrella of substance use disorder.
Even so, the people who work in the field substance abuse treatment—or should we say treatment of substance use disorder—differentiate between various stages of addiction. Here’s a rundown just in case you or someone in your family is wondering if you’ve got a problem with opiate substance abuse.
Stages of Substance Use Disorder
Tolerance. Consider this the first level of misery, or whatever name you want to assign to the plague that opiate substance abuse will mean to your life. Tolerance happens when you first begin taking opiate pain pills and you notice that the same amount of pills doesn’t do the trick anymore. Maybe you have had a prescription for the pain pills, or maybe you just took a few from a family member’s prescription bottle because you thought they would mellow you out. Either way, suddenly you realize, with a sense of annoyance, that although you’ve taken the one or two pills that you usually take, you just don’t notice any effect. You have developed a tolerance for the medication and you will need to take more if you expect to re-experience that initial effect.
Dependence. You reach this level when your body begins to depend upon the stimulation of the prescription pain pills in order to produce the body’s natural level of endorphins. What happens is that the brain normally produces endorphins based on the pleasurable things you do during the day, including exercising, having a great meal, and even sex. But when you fall into the vicious cycle of opiate substance abuse, your brain is stimulated by the pain pills to generate endorphins, and so it stops producing these important biochemical on its own. Dependence is an actual “physiological state of adaptation to a substance,” according to the National Alliance of Advocates for Buprenorphine Treatment (NAABT). Your opiate substance abuse actually results in changes in the brain.
Addiction. When you develop a tolerance that leads to dependence and you experience withdrawal symptoms if you don’t take enough of the medication that you’re abusing, then you are on the edge of addiction. Addiction creates a full-fledged compulsion to continue the opiate substance abuse, even if you hate yourself for the negative behaviors that come with it. Taking Granny’s pain pills? It doesn’t matter. Spending the mortgage money on getting more pills? Nobody cares. Feeling sick as a dog—sick when you take the pills, and sick when you don’t? Oh, well.
That’s what addiction is: the descent into a syndrome that compels you to keep seeking out the medication no matter what the social, psychological, or physical consequences. It’s actually the medical diagnosis of addiction.
When you go past the normal interval of time without taking more of whatever it is you’re abusing, your body sends you signals. The same way that an alcoholic experiences a hangover, you will feel the horrible symptoms of withdrawal: You’ll be sweating, itching, aching, and irritable. Your eyes and your nose will run. Expect some abdominal cramps and diarrhea. Your body holds you hostage with its one persistent demand: More drugs—now.
The withdrawal symptoms dominate the person’s life. People addicted to opiates have described it as a hundred times worse than a hangover or the flu. They not only feel horrible and depressed, but they live in a constant state of denial. They don’t deny that they have a problem; rather, they deny that they have lost control of it. That implacable denial is a symptom of any addiction, whether it’s alcohol, opiate substance abuse, or gambling.
The Depression That Accompanies Opiate Substance Abuse
People who have gone beyond opiate substance abuse and are caught in the throes of addiction also suffer from depression. Some scientists believe that because the drugs are stimulating your brain to produce the endorphins you need in order to enjoy life, that your brain slows down or stops producing them naturally. In fact, some researchers believe that people who are more susceptible to addiction are those who naturally produce a low level of endorphins. The first time they experience the artificial endorphin stimulation from opiate substance abuse, the brains wants it again and again. This theory would also explain why addiction seems to run in families, if there is a genetic predisposition to produce low levels of endorphins.
It also explains why so many people who become addicted to alcohol, opiates, or other drugs suffer from depression, anxiety, and other emotional health disorders. The condition is reversible, however, given a sufficient period of time in treatment. Once someone stops doing their drug of choice and participates in individual or group counseling, their brain will gradually resume producing endorphins on its own. For the person who is chronically depressed or anxious, taking a class of medication called SSRIs may put them at a normal level of endorphin production without opiate substance abuse. SSRIs are selective serotonin reuptake inhibitors, and they keep the brain from reabsorbing the endorphins too quickly. Serotonin is one of several neurotransmitters that produce the endorphins you’ve just learned about.
There is Help
Both methadone and buprenorphine offer relief for the person suffering from opiate substance abuse. Both medications have a longer half-life than the pain pills or heroin that you’ve been using. They are available only if you’ve already tried and failed to quit using drugs without them. They allow you to maintain equilibrium throughout your entire day so that you can function effectively as a parent, spouse, employee, friend, and neighbor.
Many people opt for buprenorphine over methadone because methadone requires daily trips to the methadone program, while a prescription can be written for a month’s supply of buprenorphine. Also, buprenorphine is a partial opiate agonist, so there is a limit to the effects of the medication that a person can feel even if they try to abuse it.
You really need to sit down with a substance use disorder professional—a licensed, certified counselor—and talk openly about what drugs you’re using, how much, and how often. You need to be as open and honest as you can about the events going on in your life, including legal or financial woes. Only then can your counselor make an educated decision about the best level of treatment for your opiate substance abuse. Even if things seem hopeless now, just remember that your decision to get help will make a huge difference in the rest of your entire life. And you deserve it.