Even though opioid addiction has led to a crisis in the United States, dependence on the drug doesn’t happen spontaneously overnight. Like most addictions, opioid use disorder is the result of a long process of repeated substance abuse. Over time, the substance changes the way the body reacts to its presence. Addiction can look and feel differently for everyone, but the stages leading up to opioid addiction are relatively linear and follow the same progression. Although the duration of each stage and how quickly it progresses can differ depending on the individual, the type of opioid being abused, and the dosage, the stages leading up opioid addiction typically include:
Here’s what you need to know about opioids, the various stages of use, how they can lead to opioid addiction, and how professional rehabilitation programs treat opioid use disorder.
Opioids are powerful drugs used to relieve pain. Opioids come from the opium poppy plant. They can be naturally derived or synthetic, medically prescribed or illicit. Regardless of their type, all opioids bind to opioid receptors in the body and decrease the amount of pain signals the body sends to the brain. This is how they help relieve pain.
Doctors prescribe opioids to relieve acute and chronic pain. This means that opioids can be used to help toothaches, severe dental procedures, mild injuries, pain after surgery, and cancer pain. When used as prescribed, opioids are typically safe. But all opioids have a risk of abuse.
Some of the most commonly prescribed opioid painkillers include:
Heroin, the street drug, is an illegal opioid that people smoke to experience a euphoric high.
Whether individuals use medically prescribed opioids or an illegal opioid like heroin, initiation is always the first stage that leads to opioid addiction.
Initiation happens when an individual tries a substance for the first time. Since some opioids are legal and others are illegal, opioid initiation can happen medically or recreationally. When a patient takes prescription opioids for the first time, for example, they have been medically initiated to take opioids. Individuals using heroin for the first time experience recreational opioid initiation.
Opioid initiation can happen at any time during a person’s life, but the National Institute on Drug Abuse reports that the majority of people with an addiction tried their drug of choice before they were 18 years old and had a substance use disorder by the time they were 20.
But initiation doesn’t automatically mean someone will develop an addiction.
Just because someone takes a prescription opioid or uses heroin doesn’t mean that they will also develop an addiction. Some individuals consume opioids and stop using them with no problem. Usually, the decision to stop or continue using opioids depends on a wide range of factors, including:
When individuals do continue to take the drug, many find themselves regularly using their substance of choice, which is the next stage of opioid addiction.
In this stage, using opioids shifts from being a temporary prescription or recreational habit to a lifestyle. At this point, many individuals feel that life isn’t as comfortable or satisfying without opioids. They may also use opioids as a way of dealing with everyday life. Instead of using opioids periodically, the substance has become a normal part of their regular routine. They may not use opioids every day, but they have developed a pattern of use. This pattern can look differently based on the individual, but some common regular use patterns can include taking opioids:
Even though most individuals don’t use opioids every day during this stage, a regular pattern of use can become problematic and have a negative impact on an individual’s life. Addiction doesn’t typically happen in this stage, but individuals do tend to think about opioids more often at this point.
Prescription opioids are meant to be taken as directed by doctors. When individuals start taking opioid medications for reasons that aren’t consistent with legal or medical guidelines, they start misusing opioids. Opioid misuse can look different from person to person, but common examples include:
All of these types of misuse revolve around not following the doctor's instructions and can lead to adverse side effects. However, individuals who misuse opioids are not always looking to “get high.” According to the Food and Drug Administration (FDA), individuals misusing opioids are most often using the substances for purposes other than the intended use, but their primary focus isn’t to feel or experience euphoric effects.
Instead, individuals may start taking opioids to fall asleep, get rid of a headache, ease back pain, or relieve nausea. Although their intention isn’t to get high, the FDA recognizes these types of actions as drug misuse. This is because, even though the person is treating a medical need, they are not doing so according to the directions of their healthcare provider. Some individuals may give opioids to their friends for the same reasons.
With the help of a healthcare professional, many individuals can stop misusing opioids. However, some individuals who continue to misuse opioids end up abusing them.
Unlike misuse, opioid abuse usually happens for the sake of experiencing intense euphoria and pleasure. Often, individuals who abuse opioids don’t actually have a prescription for the drug they’re taking, but some do. Whether individuals have been prescribed opioids or not, the National Institute on Drug Abuse suggests that any individual taking opioids to get a pleasant or euphoric feeling are, in fact, abusing opioids. At this point, individuals aren’t looking to treat a specific ailment. Instead, they are mainly looking to get high. Unfortunately, opioid abuse can lead to severe adverse effects, tolerance, dependence, and, if left untreated, addiction.
Some of the most common adverse effects of opioid abuse include:
One of the most dangerous consequences of opioid abuse is tolerance.
Tolerance is an individual’s capacity to endure continued consumption of a particular substance. When individuals first start using opioids, the brain has to get used to the drug. Over time, the brain becomes accustomed to opioids. In fact, the brain adjusts to the presence of opioids so much that it actually changes as a result of their influence. Instead of functioning the way it used to before being introduced to opioids, the brain begins to function as though opioids were an essential part of its biochemical makeup. When this happens, the brain has developed a tolerance.
Once the brain develops a tolerance for opioids, the drug no longer has the same effect on the brain. Since the brain has become accustomed to the initial amount of opioids consumed, individuals need a higher dose to achieve the pain relief or high they initially experienced. At this stage, a doctor can increase the dose, change the regimen, or prescribe a different medication, but many individuals start to take more opioids on their own. Unfortunately, doing so often leads to dependence, the next stage leading up to opioid addiction.
When individuals become dependent on opioids, they need a consistent supply of the substance to feel “normal.” They feel this way because their brains and bodies have started to rely on opioids. Eventually, the brain starts to consider opioids a physical and psychological need. When this happens, if an individual abruptly stops or lessens the amount of opioids they use, the body will react negatively.
Typically, this adverse reaction includes symptoms of withdrawal. These symptoms usually vary from person to person, but can include:
Opioid withdrawal symptoms can be mild or severe, but in most cases, individuals choose to continue their use rather than seeking help. In this stage, individuals aren’t taking opioids to feel “high,” but in an attempt to keep their body from experiencing withdrawal symptoms.
Even though dependence isn’t the same as full-blown addiction, this stage can easily lead to addiction if individuals don’t seek professional help. Here’s how.
Dependence isn’t easy to overcome, but healthcare professionals can help. If you think you or an individual you know may be dependent on opioids, speak to a doctor. A healthcare professional can help individuals find alternative ways to treat their pain and overcome opioid dependence.
By the time individuals have reached full-blown opioid addiction, they compulsively use opioids despite negative consequences. Most likely, they’re not taking time to consider their actions. Most of their thoughts are focused on obtaining the next high. Their personality and behavior may have changed so much that family members and close friends may not even recognize them.
Individuals addicted to opioids will feel as if they can’t stop using the substance. They may have a desire to quit, but without professional help, will likely disappoint themselves and end up using opioids again. This happens because their brains have become hard-wired to seek out opioids.
In this stage, individuals’ brains have become hijacked by the reward system which is primarily focused on obtaining, experiencing, and maintaining pleasurable sensations. Because of this, individuals addicted to opioids may neglect their basic needs. Their grooming habits may diminish or disappear altogether. They may skip meals and avoid sleep. They might even neglect showing up to work. If they do show up to work, their performance might be so subpar that they lose their job, which can directly affect their living situation and quality of life. Being addicted to opioids can also negatively impact their mental health. They may appear overly depressed or anxious.
Other signs and symptoms of opioid addiction can include:
Being addicted to opioids can also cause a number of health problems, including:
Luckily, an addiction to opioids can be treated.
Here at Aftermath Treatment Center, we know that addiction doesn’t happen overnight. But we also know that evidence-based treatment programs like ours can help treat all stages of opioid use disorder. Opioids don’t have to continue to rule your life. We can help you regain control of your life. Let us help you get there. Contact us today to learn more about how we can help you begin, continue or start your journey toward a thriving, substance-free life.