Author: Anjali Talcherkar, PhD

Opioid addiction involves the use of prescription and non-prescription narcotics classified as Schedule II controlled substances by the Drug Enforcement Administration (DEA).¹ Opioid pain relievers are marketed as safe, but the safety of narcotics requires that you take them as prescribed and only for the time period recommended by your prescribing doctor.¹ Long-term narcotic use causes changes in the brain that can lead to opioid abuse and narcotic addiction.²

Signs and Symptoms of Opioid Addiction

According to the DEA, narcotics include opioids like oxycontin, heroin, and fentanyl. The Schedule II controlled substances classification indicates that these substances have a high potential for misuse, dependency, and addiction.¹

How does legitimate opioid use turn into opioid abuse? Opioids work by activating opioid receptors in the brain, producing feelings of euphoria or elation. You can become physically dependent on the neurological activation and pain reduction the narcotics produce and continue the cycle of misuse. A reported 21% to 29% of patients prescribed opioids for chronic pain misuse them.³

Common prescription and non-prescription narcotics include:^4,5

• Opium
• Heroin
• Codeine
• Oxycodone
• Hydrocodone
• Tramadol
• Morphine
• Hydromorphone
• Carfentanil
• Fentanyl

Research shows that people often start with oral use of opioids (pills). People who develop an addiction to narcotics may use methods of intake that introduce the substance into the body more quickly, such as smoking, snorting, and injecting. As a person’s tolerance increases, higher amounts or more potent forms of narcotics are needed to achieve desired effects.³ It is also not uncommon for people to mix narcotics with alcohol or other illicit drugs.

Once you become physically dependent on narcotics, you will experience unpleasant side effects if you go without the drug, otherwise known as withdrawal symptoms. Withdrawal symptoms can encourage the cycle of misuse even if you recognize harmful health consequences directly related to the narcotic. Experiencing withdrawal symptoms is one sign you may be addicted to narcotics.

Physiological withdrawal signs include:⁶

• Anxiety
• Restlessness
• Muscle aches or twitching
• Abdominal cramps
• Diarrhea
• Nausea
• A runny nose
• Fever
• Sweating
• Hot/cold flashes
• Yawning
• Shaking
• Vomiting
• Insomnia

If you continue using opioids, you may also notice negative impacts on your mental health. Mental and emotional symptoms of opioid addiction include:⁷

• Lack of interest in social activities
• Depression and suicidal ideation
• Preoccupation with taking narcotics
• High stress levels

The mental and emotional signs of opioid addiction may also become apparent in other areas of your life. Narcotic addiction can contribute to or cause: ⁷

• Financial hardship
• Interpersonal relationship problems
• Legal consequences

Often a person will stop using a prescription opioid, such as OxyContin, and then relapse to using the drug at the same dose. The body’s tolerance, however, will have reverted back to an earlier level, significantly increasing the risk of OxyContin overdose. Opioid overdose is life-threatening and may result in death or permanent injury. In 2019, 50,000 people in the U.S. died from opioid-involved overdoses.⁸

Diagnosis of Opioid Addiction

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), outlines 11 criteria that clinicians use to diagnose a narcotic addiction, clinically categorized as an opioid use disorder (OUD) or other substance use disorder (SUD).⁹ Two to three symptoms experienced in the last 12 months indicate a mild disorder; four to five symptoms indicate a moderate disorder; six or more of the following symptoms indicate a severe OUD:⁹

• You often take opioids in larger amounts or over a longer time than intended.
• You are unsuccessful in reducing or controlling your opioid use.
• You spend a great deal of time trying to obtain the narcotic, using it, or recovering from its effects.
• You have a craving, or a strong desire, to use opioids.
• Your opioid use is making it difficult to fulfill major obligations at work, school, or home.
• You have continued opioid use despite experiencing persistent or recurrent social or interpersonal problems caused or exacerbated by the narcotic’s effects.
• You give up or reduce important social, occupational, or recreational activities because of opioid use.
• You use opioids in situations in which it is physically hazardous to do so.
• You have continued to use opioids despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by narcotic abuse.
• You experience tolerance as defined by either 1) a need for increased amounts of opioids to achieve intoxication, pain relief, or another desired effect or 2) a diminished effect with continued use of the same amount of an opioid.
• You experience withdrawal as demonstrated by experiencing typical opioid withdrawal symptoms or needing to continue taking the drug or a closely related substance to relieve or avoid withdrawal symptoms.

If you recognize these criteria relating to your opioid use, seek help for opioid addiction. Remember that only a behavioral health professional with the appropriate credentials, such as a psychiatrist or psychotherapist specializing in addiction, can give you an official diagnosis. However, you do not need a diagnosed OUD to begin accessing some types of narcotic addiction treatment.

Treatment for Narcotic Addiction

Detoxification is often the first step in a treatment plan before addressing a person’s addiction to opioids.¹⁰ During detox, your doctor or clinician may prescribe medications to help reduce the severity of your withdrawal symptoms and manage the potentially dangerous physiological effects of stopping narcotics use.¹¹

Medication-assisted treatment (MAT) works by providing a substitute for the narcotic you are addicted to, so your body and brain can gradually adjust to the absence of the substance.¹² Medications can prevent or reduce the severity of withdrawal symptoms. Eventually, you will taper off these medications after your body readjusts and the narcotic is out of your system.¹⁰

Detoxification methods vary based on the narcotic and other factors. For example, if you misuse heroin, your care team may prescribe the synthetic opiate methadone, which is a longer-acting drug that can be taken orally or injected. The dose frequency is gradually reduced to about once a week. Clonidine, another detox medication, lowers blood pressure and is sometimes used to shorten the withdrawal time and relieve physical symptoms for people who are detoxing from heroin.

Types of Opioid Treatment

Following detox, you may choose to enter a long-care inpatient facility or an outpatient program. Entering a treatment program may be necessary to sustain long-term recovery. Licensed residential treatment facilities offer 24-hour structured and intensive care, including safe housing and medical attention. Both residential rehab centers and outpatient programs may use various therapeutic approaches to help you maintain recovery after treatment.¹³

Inpatient and outpatient rehabs offer a range of care with specific treatments tailored to the individual, which is most effective in treating addiction.¹³ Inpatient rehab can last from 30 days to 12 months. Outpatient programs allow participants to live at home and attend sessions, usually starting with multiple visits per week, tapering down to fewer hours per week to sustain recovery.¹³

Some programs accept insurance and some are state-funded so that you can find free or partially paid programs. Both inpatient and outpatient care usually provide counseling and other forms of behavioral therapy. Standard therapy and treatment plans are often modified according to the patient’s changing needs and may include:¹³

• Therapeutic communities—Highly structured programs in which patients remain at a restricted residence, typically for 30 days to 1 year
• Shorter-term residential treatment—Programs focused on detoxification and providing initial intensive counseling and preparation for treatment in a community-based setting
• Cognitive-behavioral therapy (CBT)—A form of counseling that helps individuals recognize, avoid, and cope with situations where they are most likely to use drugs
• Family group therapy—Interactive therapy developed for adolescents and young adults with drug misuse problems and their families
• Motivational interviewing—A type of therapy that works with a person’s readiness to change their behavior and enter treatment
• Motivational incentives (contingency management)—A method that uses positive reinforcement to encourage abstinence from drugs
• Counseling—Private, one-on-one sessions with a certified alcohol/drug counselor or therapist at a residential or outpatient treatment center

In addition, alternative therapies, such as yoga, meditation, and mindfulness-based interventions have been shown to be beneficial natural therapies to supplement treatment.^{14, 15, 17}

Aftercare and Ongoing Support

After a period of time in a treatment program, you may want to continue with an aftercare plan to keep your recovery strong and stay connected to your community of support.

Aftercare planning occurs as you transition out of a residential treatment program. Team members and medical staff work collaboratively to assess your needs to develop an ongoing treatment regimen upon discharge from your program.

Examples of aftercare services that some rehab facilities provide include:¹⁷

• Sober living homes
• Follow-up therapy
• Recovery coaching
• Sober companions
• Medical evaluations
• Alumni support groups
• Assistance finding recovery support groups like Narcotics Anonymous (NA), SMART Recovery, or Women for Recovery

Many people will continue to attend NA meetings after rehab, some for life. These groups provide a community of peer support with accountability to sustain recovery.¹⁸ Twelve-step and other recovery support groups are available throughout the U.S. and online, making them very accessible and cost-effective.

If you or someone you know is struggling with narcotic addiction, help is available. Call 800-934-1582(Who Answers?)

References

1. United States Drug Enforcement Administration. Drug scheduling.
2. National Institute on Drug Abuse. Mind matters: the body’s response to opioids. NIDA for Teens.
3. National Institute on Drug Abuse. Opioid Overdose Crisis.
4. Centers for Disease Control and Prevention. Prescription opioids.
5. Centers for Disease Control and Prevention. Opioid basics.
6. Sullivan, M., (2014). Management of Opioid Withdrawal and Overdose. Columbia University/New York State Psychiatric Institute.
7. American Society of Anesthesiologists. (2021). Opioid abuse.
8. Centers for Disease Control and Prevention. Drug overdose: synthetic opioid overdose.
9. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition).
10. Harvard Health Publishing. (2021). Treating opiate addiction, Part I: Detoxification and maintenance.
11. National Institute on Drug Abuse. (2018, June 27). Medications to Treat Opioid Use Disorder Research Report.
12. National Institute on Drug Abuse. (2020). Principles of drug addiction treatment: A research-based guide (Third Edition).
13. National Institute on Drug Abuse. (2019). Treatment approaches for drug addiction.
14. Lutz, D., Gipson, D., Robinson, D.  (2019). Yoga as an adjunct for treatment of substance abuse. Practice Innovations, 4(1), 13-27.
15. Garland, E., Hudak, J., Hanley, A., & Nakamura, Y. (2020). Mindfulness-oriented recovery enhancement reduces opioid dose in primary care by strengthening autonomic regulation during meditation. American Psychologist, 75(6), 840-852).
16. Priddy, S., Howard, M., Hanley, A., Riguino, M., Friberg-Felsted, K., & Garland, E. (2018). Mindfulness meditation in the treatment of substance use disorders and preventing future relapse: neurocognitive mechanisms and clinical implications. Substance Abuse and Rehabilitation, 9, 103-114.
17. Center for Substance Abuse Treatment. (2006). Chapter 3. Intensive Outpatient Treatment and the Continuum of Care. Treatment Improvement Protocols No. 47 Substance abuse: Clinical Issues in Intensive Outpatient Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration.
18. Donovan, D., Ingalsbe, M., Benbow, J., & Daley, D. (2013, August 26) 12-step interventions and mutual support programs for substance use disorders: an overview. Social Work in Public Health, 28(0), 313-332.

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