Author: Jordana White

Opioid addiction is a type of substance use disorder.¹ While substance use disorders can manifest differently depending on a variety of factors—such as the substance being misused—clinicians use a set of common characteristics to diagnose substance use disorders. These characteristics can provide narcotics addiction warning signs.

In this article:

• What Is a Substance Use Disorder?
• 10 Signs of Opioid Addiction
• Diagnosing an Opioid Addiction
• Addressing an Opioid Addiction

What Is a Substance Use Disorder?

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V or DSM-5), substance use disorders (SUDs) are broken down into 10 different substance categories.

These classes of drugs include:¹

1. Alcohol
2. Caffeine
3. Cannabis
4. Hallucinogens
5. Inhalants
6. Opioids
7. Sedatives
8. Hypnotics
9. Stimulants
10. Tobacco

For each of these drug classes, the DSM-5 also identifies distinct narcotic addiction warning signs. Depending on how many of these signs of addiction you or your loved one displays, the substance use disorder diagnosis could be classified as mild, moderate, or severe.¹

Regardless of its degree, it’s important to get help for any signs of opioid addiction or other narcotics addiction. For this reason, understanding the characteristics of narcotics addiction can help you seek help or encourage your loved one to seek help that may keep a mild SUD from becoming severe.

10 Signs of Opioid Addiction

Opioids include the illegal drug heroin, synthetic opioids such as fentanyl, and prescription opioids, such as oxycodone, hydrocodone, codeine, morphine, and many others. Signs of opioid addiction or another substance abuse disorder include the following:

1. Hazardous Use

Using narcotics in hazardous ways can be indicative of an opioid addiction or other SUD. Hazardous use includes any use that endangers your physical health and safety. For example, driving with another person in the car while under the influence of opioids is hazardous use. Even if you have never overdosed, but have blacked out after taking opioids or other narcotics, this is considered hazardous use and may be a narcotics addiction warning sign.³

2. Social or Interpersonal Problems Related to Use

When use of opioids or other narcotics begins to interfere with relationships, this may be a sign of a SUD. These social problems can take on different forms. Your loved one may cancel your planned get-togethers to use narcotics or recover from narcotics use. Or you may find yourself spending less time with friends and family members to spend more time with people who also misuse narcotics. These may all be signs that your loved one has an addiction to narcotics. Keeping company with others who are also using drugs may be cause for additional concern because having a strong social network is important during recovery from narcotics addiction.⁴

3. Activities Given Up to Use

If you miss favorite activities or can no longer enjoy former hobbies due to narcotics use, that could indicate an opioid addiction or other SUD.¹

4. Neglecting Major Roles to Use Narcotics

If narcotics use results in missed deadlines at work or missed assignments at school, that may mean that substance use has progressed to a disorder. Even if you manage to complete tasks, but you cannot meet your former standards, this could also indicate an addiction to narcotics.¹

5. Withdrawal

If you experience withdrawal symptoms when you stop using narcotics, that may indicate opioid addiction or another SUD, particularly if those symptoms improve when you use more of the substance.¹ Withdrawal symptoms vary depending on the narcotic being misused.

Physical withdrawal symptoms may include: ⁵

• Aches and pains
• Loss of appetite
• Nausea
• Changes to sleeping patterns or inability to sleep
• Shaking
• Sweating and/or chills

Withdrawal can also cause psychological symptoms, including aggression, irritability, anxiety, and extreme unhappiness or negativity.⁵

6. Tolerance

A clinical tolerance to opioids or other narcotics occurs when you must use more of a substance to get the same effect. Many substances, such as opioids, change the way your brain chemistry works. Over time, brain cells containing opioid receptors become less responsive to stimulation from opioids. For that reason, higher doses become necessary to achieve the same effect. In time, an opioid addiction may develop.⁶ On its own, tolerance could be an indication of a SUD, but it is not the same as a SUD. However, having a physical tolerance to opioids or other narcotics may contribute to the development of the next DSM-5 sign of narcotics addiction.

7. Using Larger Amounts or Spending Much More Time Using Narcotics

Spending increasing amounts of time using or recovering from the effects of using opioids can be one of the signs of opioid addiction. In this time, the dose used may also increase, which can also indicate a SUD.¹

8. Repeated Attempts to Control Use or Quit

Maybe you or your loved one has tried to cut back on or quit their opioid use or other narcotic use, but those attempts have been unsuccessful. This could indicate an opioid addiction or other SUD since relapses and an inability to find sobriety without professional treatment are common narcotics addiction warning signs.²

9. Physical or Psychological Problems Related to Narcotics Use

If you or your loved one’s opioid or other narcotic use triggers known physical health problems, but these issues do not alter the substance misuse, this may be a sign of a SUD. Mental health problems, such as depression or anxiety, may also be related to narcotics use.⁵

10. Substance Cravings

If you or your loved one has an opioid addiction or other SUD, physical cravings to use the substance may make it harder to stop using it. Cravings can make the desire to use opioids feel similar to the needs to eat, drink water, and sleep throughout the day, making it difficult to stay focused on recovery.²

Diagnosing an Opioid Addiction

Clinically, substance use disorders can only be diagnosed if two or more signs of opioid addiction or narcotics addiction warning signs are present within the span of a year.¹ After passing that milestone, the disorder can be classified as mild, moderate, or severe. If you or your loved one shows two or three characteristics of addiction, the disorder would be considered mild. Showing four or five addiction warning signs indicates a moderate SUD. Showing six or more warning signs could suggest the SUD is severe.¹

Additionally, substance-induced disorders can occur. These are conditions such as intoxication, withdrawal, and certain mental health disorders. While some—such as withdrawal—are also indications of a SUD, these are medical concerns that may need to be addressed separately.⁵

Doctors may identify substance-induced mental disorders if your loved one is now living with certain mental health conditions that they did not struggle with before using narcotics.

Examples of narcotics-induced mental health disorders include:⁵

• Certain psychotic disorders
• Bipolar disorder and related conditions
• Depressive disorders
• Anxiety disorders
• Obsessive-compulsive disorder (OCD) and related conditions
• Sleep disorders
• Sexual dysfunction
• Changes to neurocognitive function

Using certain narcotics increases the risk for substance-induced disorders. If your loved one uses psychoactive or hallucinogenic narcotics, their ability to manage stress could also change or become compromised.⁵ Marijuana misuse, particularly in young adults, increases the risk of developing psychosis, schizophrenia, or schizophreniform psychosis later in life in ultra high-risk populations.⁷

Addressing an Opioid Addiction

The initial diagnosis of an opioid addiction or other substance use disorder is not necessarily a permanent classification. Following diagnosis, you or your loved one can seek treatment for opioid addiction and narcotics misuse.¹

In treatment, clinicians can note that the SUD is “in early remission,” “in sustained remission,” “on maintenance therapy,” or “in a controlled environment.”² While SUDs are not curable, they are highly treatable, with many individuals finding sustainable sobriety with appropriate treatment.²

Have you noticed warning signs of opioid addiction in your own life or in the life of a friend or family member? Help is available. Call 800-934-1582(Who Answers?) today.

References

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders—DSM 5. American Psychiatric Association.
2. Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. (2013). DSM-5 criteria for substance use disorders: Recommendations and rationale. American Journal of Psychiatry, 170(8), 834–851.
3. American Psychiatric Association. (2013). Substance-Related and Addictive Disorders.
4. Pettersen, H., Landheim, A., Skeie, I., Biong, S., Brodahl, M., Oute, J., & Davidson, L. (2019). How social relationships influence substance use disorder recovery: a collaborative narrative study. Substance Abuse: Research and Treatment, 13, 1178221819833379.
5. McLellan, A. T. (2017). Substance misuse and substance use disorders: Why do they matter in healthcare? Transactions of the American Clinical and Climatological Association, 128, 112-130.
6. Kosten, T. R., & George, T. P. (2002). The neurobiology of opioid dependence: implications for treatment. Science & Practice Perspectives, 1(1), 13-20.
7. Shrivastava, A., Johnston, M., Terpstra, K., & Bureau, Y. (2014). Cannabis and psychosis: Neurobiology. Indian Journal of Psychiatry, 56(1), 8-16.