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Beating Your Drug or Alcohol Addiction
Author: JeffreyStuckert
Blog URL: http://www.wellnessweb.com/blogs/drugsalcohol
Tags: addiction, drug and alcohol addiction, substance abuse, rehab, drug and alcohol treatment
Description:
Tips for yourself or loved ones coping with an addiction or trying to help an addict.
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Seeking Drug and Alcohol Treatment for Employees
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If you currently know of or have known of an employee that needs drug and alcohol treatment, it is likely that you are frustrated. As an employer, you have a range of options available, but the action that many employers are likely to take is to fire the employee in question. Employers may think that is this the most practical and viable option. Dealing with employee drug or alcohol abuse seems troublesome, and hiring a new employee altogether seems as if it is the best choice for the company. But that choice may be wrong.

There are numerous reasons why employers may want to consider sending their employees to a drug and alcohol treatment center. Some of the reasons are practical - increased job satisfaction, or the use of less healthcare dollars - but other reasons may actually impact the company's financial situation. The cost of finding and training new employees is not inexpensive, and it may actually cost less to send your employee to a drug and alcohol treatment program rather than to find someone new. The following include some, but not all, of the reasons to send an employee to a drug and alcohol treatment program.

Employee Drug or Alcohol Abuse: Reasons to Finance Employee Treatment

  • Productivity. Employees who are sent to a drug and alcohol treatment program will experience a boost in productivity. Employee drug or alcohol abuse is detrimental to the company - he/she may not be productive at work because they may be experiencing symptoms of withdrawal, or they may be trying to recover from the night before. Either way, employees lacking treatment cannot focus on their tasks at hand, short-changing the employer and the company. Treatment is essential to this employee. Afterward, he/she will be more responsive to their superiors, and in general, he/she will be a healthier employee - physically and emotionally.
  • Job Satisfaction. If an employee suffering from drug or alcohol addiction is a supervisor in any regard, after treatment, the employees that they oversee will also experience increased job satisfaction. Employee drug abuse and alcohol addiction affects everyone in the workplace. It impacts many functional areas of the company, as the workplace is heavily impacted by negative attitudes. After treatment, the employee will be able to perform better at work, managing their workload and others more efficiently.
  • Company Loyalty. Employees who receive drug and alcohol treatment will be much less likely to injure the company in an inadvertent way, such as damaging the company's reputation. When employees are actively using, they are not good ambassadors for the company or the community. Interactions with clients and co-workers will suffer, and attendance may often be a problem. However, employees sent to get treatment will do and feel the opposite - they may experience feelings of greater loyalty towards a company willing to provide them with assistance and help while they are dealing with their disease, and will "pay" the employer back with increased productivity, a boost in work performance, and company loyalty.
  • Recovery Time. Employee drug or alcohol abuse is a problem that can be treated within a reasonable amount of time. In residential recovery, employees who receive alcohol and drug treatment will be expected to attend a treatment facility for four weeks, and can begin work again in six to eight weeks. This recovery time is relatively short, especially in comparison to medical leave for lengthy operational procedures. The recovery time is not extraordinary, and the benefits, overall, are great.
  • Re-training and Re-hiring Costs. The cost to find middle to high management is substantial, and a missing employee puts a burden on additional employees to perform extra duties until that position is filled. Oftentimes, financing these costs can be more expensive than the cost it takes to send an employee to drug and alcohol treatment. There are several different costs that employers can expect to pay for when losing and attempting to replace an employee.
    • Separation Costs: These costs may be the costs paid for exit interviews, administrative duties, separation/severance pay and unemployment compensation.
    • Vacancy Costs: These costs may include the costs paid to employees who work overtime to take over additional duties, or to find and hire a temporary employee to take over that specific employee's tasks.
    • Replacement Costs: These costs may include the cost of attracting applicants, entrance interviews, testing, medical exams and acquiring and disseminating information.
    • Training Costs: These costs may include formal or informal training costs, literature costs, technology costs, and time spent learning additional tasks.
  • Moral Duty. Sending an employee with a serious health issue to find drug and alcohol treatment is the right thing to do. Legally, companies are not allowed to fire employees due to serious health issues, such as cancer or heart health, but employers are much more willing to let employees go because of substance abuse or alcohol addiction - diseases which should be treated as physical and mental health issues that need to be addressed for the health of the employee.
Summary

Whether an employer chooses to send an employee to seek treatment is ultimately up to company, but there are numerous reasons - both for the sake of the employee and for the sake of the company - to send an employee to receive drug and alcohol treatment, rather than to wish them well and finance the costs of hiring someone new.

About the Author

Dr. Jeffrey Stuckert, M.D. is an American Board of Emergency Medicine (ABEM) certified physician and has practiced clinical emergency medicine in Ohio for 29 years. He has practiced addiction medicine on a full time basis for the last two years, and currently serves as the CEO and Medical Director of The Ridge, a residential addiction treatment program and Northland, an outpatient treatment center near Cincinnati. Dr. Stuckert has served as Chairman and Medical Director of Emergency Medicine Departments of both the Christ Hospital and Deaconess Hospital for 22 of his 29 years, and has personally attended to more than 70,000 emergency-room patients. During his time as Medical Director, he supervised all clinical personnel and administrative operations of those divisions. This includes the supervision of over 100 emergency physicians, more than 100 emergency medicine residents and hundreds of nurses and ancillary staff. For more information about The Ridge, please visit www.theridgeohio.com, and for more information about Northland, visit www.northlandmbs.com.

09/26/2011 0 Comments | Add Comment
 
How is Suboxone Treatment Different than Drug Abuse?
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Physicians who treat opioid addiction also have the option of utilizing 'medication-assisted treatment', and the most common medications used in the treatment of opioid dependence today are methadone, naltrexone, and buprenorphine (Suboxone).

Most people cannot just walk away from opioid addiction. They need help to change their thinking, behavior, and environment. Unfortunately, "quitting cold turkey" has a poor success rate - fewer than 25% of patients are able to remain abstinent for a full year. This is where medication-assisted treatment options like methadone, naltrexone, and Suboxone benefit patients in staying sober while reducing the side effects of withdrawal and curbing cravings which can lead to relapse.

Methadone

Methadone is an opioid and has been the standard form of medication-assisted treatment for opioid addiction and dependence for more than 30 years. Methadone for the treatment of opioid dependence is only available from federally-regulated clinics which are few in number and unappealing for most patients. In addition, studies show that participation in a methadone program improves both physical and mental health, and decreases mortality (deaths) from opioid addiction. Like Suboxone, when taken properly, medication-assisted treatment with methadone suppresses opioid withdrawal, blocks the effects of other problem opioids and reduces cravings.

Naltrexone

Naltrexone is an opioid blocker that is also useful in the treatment of opioid addiction. Naltrexone blocks the euphoric and pain-relieving effects of heroin and most other opioids. This type of medication-assisted treatment does not have addictive properties, does not produce physical dependence, and tolerance does not develop. Unlike methadone or Suboxone, it has several disadvantages. It does not suppress withdrawal or cravings. Therefore, many patients are not motivated enough to take it on a regular basis. It cannot be started until a patient is off of all opioids for at least two weeks, though many patients are unable to maintain abstinence during that waiting period. Also, once patients have started on naltrexone the risk of overdose death is increased if relapse does occur.

Buprenorphine / Subutex / Suboxone

In 2002, the FDA approved the use of the unique opioid buprenorphine (Subutex, Suboxone) for the treatment of opioid addiction in the U.S. Buprenorphine has numerous advantages over methadone and naltrexone. As a medication-assisted treatment, it suppresses withdrawal symptoms and cravings for opioids, does not cause euphoria in the opioid-dependent patient, and it blocks the effects of the other (problem) opioids for at least 24 hours. Success rates, as measured by retention in treatment and one-year sobriety, have been reported as high as 40-60% in some studies. Treatment does not require participation in a highly-regulated federal program such as a methadone clinic. Since buprenorphine does not cause euphoria in patients with opioid addiction, its abuse potential is substantially lower than methadone.

What is Medication-Assisted Treatment?

Medication-assisted treatment for opioid dependence can include the use of buprenorphine (Suboxone) to complement the education, counseling and other support measures that focus on the behavioral aspects of opioid addiction. This medication can allow one to regain a normal state of mind - free of withdrawal, cravings and the drug-induced highs and lows of addiction. Medication-assisted treatment for opioid addiction and dependence is much like using medication to treat other chronic illnesses such as heart disease, asthma or diabetes. Taking medication for opioid addiction is NOT the same as substituting one addictive drug for another.

What is Suboxone and How Does it Work?

There are two medications combined in each dose of Suboxone. The most important ingredient is buprenorphine, which is classified as a 'partial opioid agonist', and the second is naloxone which is an 'opioid antagonist' or an opioid blocker.

What is a 'Partial Opioid Agonist'?

A 'partial opioid agonist' like buprenorphine is an opioid that produces less of an effect than a full opioid when it attaches to an opioid receptor in the brain. Oxycodone, hydrocodone, morphine, heroin and methadone are examples of 'full opioid agonists'. For the sake of simplicity from this point on we will refer to buprenorphine (Suboxone) as a 'partial opioid' and all the problem opioids like oxycodone and heroin as 'full opioids'.

When a 'partial opioid' like Suboxone is taken, the person may feel a very slight pleasurable sensation, but most people report that they just feel "normal" or "more energized" during medication-assisted treatment. If they are having pain they will notice some partial pain relief.

People who are opioid dependent do NOT get a euphoric effect or feel high when they take buprenorphine properly. Buprenorphine tricks the brain into thinking that a full opioid like oxycodone or heroin is in the lock, and this suppresses the withdrawal symptoms and cravings associated with that problem opioid.

Buprenorphine is a long-acting form of medicated-assisted treatment, meaning that it gets 'stuck' in the brain's opiate receptors for about 24 hours. When buprenorphine is stuck in the receptor, the problem 'full opioids' can't get in. This gives the person with opioid addiction a 24-hour reprieve each time a dose of Suboxone is taken. If a full opioid is taken within 24 hours of Suboxone, then the patient will quickly discover that the full opioid is not working - they will not get high and will not get pain relief (if pain was the reason it was taken). This 24-hour reprieve gives the patient time to reconsider the wisdom of relapsing with a problem opioid while undergoing medication-assisted treatment.

Another benefit of buprenorphine in treating opioid addiction is something called the 'ceiling effect'. This means that taking more Suboxone than prescribed does not result in a full opioid effect. Taking extra Suboxone will not get the patient high. This is a distinct advantage over methadone. Patients can get high on methadone because it is a full opioid. The ceiling effect also helps if buprenorphine is taken in an overdose - there is less suppression of breathing than that resulting from a full opioid.

What is an 'Opioid Antagonist' (Opioid Blocker) and Why is it Added to Suboxone?

An opioid antagonist like naloxone is a medication-assisted treatment option for opioid addiction that also fits perfectly into opioid receptors in the brain. Naloxone is not absorbed into the bloodstream to any significant degree when Suboxone is taken correctly by allowing it to dissolve under the tongue. However, if a Suboxone tablet is crushed and then snorted or injected the naloxone component will travel rapidly to the brain and knock opioids already sitting there out of their receptors. This can trigger a rapid and quite severe withdrawal syndrome. Naloxone has been added to Suboxone for only one purpose - to discourage people from trying to snort or inject Suboxone.

How is Suboxone Taken as a Form of Medication-Assisted Treatment?

Because it is long-acting (24 hours or more) Suboxone only needs to be taken one time per day. It should be allowed to completely dissolve under the tongue. It comes in both a 2 mg and 8 mg tablet, and a 2 mg or 8 mg filmstrip. The filmstrip is now the preferred preparation because it has less potential for abuse by people with opioid addiction (it cannot be crushed), serial numbers on the filmstrip packs help prevent diversion (trafficking), and the strip dissolves more rapidly than the tablet.

Patients should not eat, drink or smoke for 30 minutes before their dose of Suboxone, or for 30 minutes after their dose of Suboxone. Food, beverages, and nicotine can block the absorption of Suboxone. Chewing or dipping tobacco can seriously impair the absorption of Suboxone and should be promptly discontinued by anybody going through medication-assisted treatment.

What is Recovery, and How Can Family and Loved Ones Help?

Put simply, recovery is restoring the life that was lost during active opioid addiction. As a complement to medication-assisted treatment, there are many ways that family and loved ones can help the person suffering from addiction. Family and significant other involvement is an important part of a recovery program. The following is a list of ten ways you can help:

  • Learning about the disease - the biology, psychology, and sociology of addiction.
  • Understanding that addiction is not a problem of poor will-power or poor self-control.
  • Understanding that this is a hereditary disease that results in long-term changes in the structure and function of the brain that lead to behaviors that are potentially fatal.
  • Learning about the behaviors that occur during addiction, why they occur, and how they can be changed.
  • Learning how living and social environments play a key role in triggers, cravings and relapse.
  • Learning how easily family members can get drawn unwittingly into supporting their loved one's addiction (co-dependency).
  • Encouraging and motivating your loved one to attend and complete treatment even when they don't feel like it.
  • Understanding that you cannot make the addict get better, but you are not helpless. You can make changes that promote recovery for your loved one, and for you.
  • Participating in support groups that help the family of the addict recover (such as Al-Anon or Nar-Anon).
  • Attending the family education sessions with your loved one.
About the Author

Dr. Jeffrey Stuckert, M.D. is an American Board of Emergency Medicine (ABEM) certified physician and has practiced clinical emergency medicine in Ohio for 29 years. He has practiced addiction medicine on a full time basis for the last two years, and currently serves as the CEO and Medical Director of Northland, an outpatient rehab clinic and The Ridge, an inpatient treatment center near Cincinnati. Dr. Stuckert has served as Chairman and Medical Director of Emergency Medicine Departments of both the Christ Hospital and Deaconess Hospital for 22 of his 29 years, and has personally attended to more than 70,000 emergency-room patients. During his time as Medical Director, he supervised all clinical personnel and administrative operations of those divisions. This includes the supervision of over 100 emergency physicians, more than 100 emergency medicine residents and hundreds of nurses and ancillary staff. For more information about Northland, please visit www.northlandmbs.com, and for more information about The Ridge, please visit www.theridgeohio.com.

07/25/2011 0 Comments | Add Comment
 
Opioid Dependence and Withdrawal
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A person is said to have physical opioid dependence if they have high 'tolerance' of opioids, meaning they need more of the opioid to get the desired effect. Opioid withdrawal symptoms occur when the substance is stopped. Most patients who seek treatment for opioid addiction also have some degree of physical dependence. However, physical opioid dependence alone is not sufficient to make a diagnosis of addiction. A person can be physically dependent - like a cancer patient might be when prescribed opioids for severe pain - and not be addicted. The term 'addiction' refers to certain behaviors.

What are the Symptoms of Opioid Withdrawal?

Opioid withdrawal can occur in both the addicted patient and the patient who has opioid dependence but is not experiencing total opioid addiction. When an opioid is stopped or the dose is suddenly reduced, both types of patients experience withdrawal symptoms - sweating, chills, muscle and joint pain, nausea, vomiting, diarrhea, restlessness and insomnia. 'Goosebumps', which commonly occur during opioid withdrawal, give rise to the term 'cold turkey'. Fear of these unpleasant and painful opioid withdrawal symptoms makes it difficult for the addict to stop using and begin the recovery process.

Who is Prone to Develop Opioid Dependence?

Although the specific causes vary from person to person, scientists believe that our heredity (our DNA) is the major factor in an individual's susceptibility to the development of the disease of addiction. We also know that psychological factors (feeling stressed, anxious or depressed) and our social environment also play important roles in the development of opioid addiction. The unpleasant effects of opioid withdrawal lead many users to continue abusing prescription or illegal opioids, leading to prolonged dependence.

Opioid abuse has risen dramatically in the United States over the past ten years. The National Institute of Drug Abuse (NIDA) reports that more than 5.2 million Americans misused a prescription painkiller in 2008 for non-medical reasons. Approximately 1 million people in the U.S. are addicted to heroin today. About 1 out of 8 people (13% of the population) who are exposed to a mood-altering substance that can cause an intense euphoric effect (like alcohol, opioids and other drugs of abuse) are prone to develop the behaviors of addiction with repeated use.

What Happens to the Brain in Addiction?

Opioid addiction is a disease of the brain. Repeated use of an opioid leading to opioid dependence causes long-term changes in both the structure (the architecture of the brain) and the way the brain functions (the biochemistry of the brain).

The most important structural or architectural change takes place in the circuitry of the brain - particularly in the wiring of the reward pathway. Our brains are wired to ensure that we will repeat life-sustaining activities - such as drinking water and eating food - by associating those activities with pleasure or reward. Whenever this reward circuit is activated, the brain records that experience making us likely to do it again. Memories that have an intense emotional component (like pleasure) may be permanently 'hard-wired'.

In the person with opioid dependence who is prone to opioid addiction, the excessive stimulation of the reward pathway by an opioid 'tricks' the brain into believing that an opioid is as necessary for survival as food and water. The effect of such a powerful reward motivates people to repeat that behavior again and again, even when it is clearly harmful to do so. This is why drug abuse is something the person prone to opioid addiction can learn to do very, very well.

Chemical changes also take place in the brain as it tries to adapt to the excessive stimulation of the reward pathway. During opioid dependence and opioid addiction, the brain tries to 'turn down the volume' and compensate for the vicious highs and lows that occur during repeated opioid use and opioid withdrawal by reducing the number of opioid receptors in the brain. This is what leads to tolerance in people with opioid addiction - more and more of the opioid is needed to achieve the same effect. The result is that eventually the addict may feel lifeless, depressed, and may be unable to enjoy activities that usually bring them pleasure. By the time most opioid addicts seek treatment they no longer get a euphoric effect from taking an opioid - they are taking opioids just to function normally.

To complicate matters further, the repeated use of an opioid has a profound impact on the intellectual portion of the human brain that is involved in judgment and decision making. Since this part of the brain is still developing in adolescence, opioid dependence leading to addiction which begins during the teen years is often more severe and more resistant to treatment. Unfortunately, the impairment in the thinking part of the brain - the part that serves as the 'brake pedal' for addiction - is so severe that the addict may flatly deny that they have a drug problem, try to justify their use to family and friends, or minimize the consequences of their behavior. A person with opioid addiction (and less often, opioid dependence) can find themselves saying or doing things they would never have believed themselves capable of - including lying to family members, stealing from loved ones, or even committing criminal acts - all in pursuit of the drug their brains are telling them they must have.

As a result of opioid dependence or opioid addiction, these changes in the structure and function of the brain result in powerful and long-lasting cravings for opioids. Cravings can last for months and even years after an addict has stopped using opioids, and has gone through the initial opioid withdrawal period. Persistent cravings explain why the relapse rate is so high with this disease. The need to satisfy cravings can be so intense that even people who try as hard as they can to remain abstinent find it difficult or impossible to do on their own.

Is Opioid Addiction Really a Disease?

Yes, opioid dependence can lead to opioid addiction, which is a chronic and progressive disease if untreated--just like heart disease, asthma and diabetes. These diseases have a lot in common with addiction--they are seen more frequently in those with a family history of the disease, they cause changes in the structure and function of a major organ system, they improve with behavior modification, they can be treated with medication, and they all require daily management. And like these other diseases, addiction is chronic - a condition for life, as there is no known cure. Fortunately, addiction can be managed, and a person suffering with opioid addiction can regain a healthy, productive life by seeking assistance with managed opioid withdrawal in an addiction treatment program.

The myth is that opioid addiction or opioid dependence is a result of poor will-power, a lack of self-control, or low moral standards. In reality, if it was that straightforward most people who are addicted would be able to stop using on their own. The changes in the structure and function of the brain are so powerful that stopping and remaining abstinent usually requires professional help.

How Serious is Opioid Dependence?

Opioid dependence is a behavior disorder that is potentially fatal. Sudden opioid withdrawal is an unpleasant experience, and many individuals continue to use opioids to avoid the negative physical effects. Individuals who use heroin intravenously are about 7 to 10 times more likely to die on any given day than someone of similar age who is not a user. Accidental overdoses are on the rise because the potency of street drugs like heroin are unpredictable from one dose to the next, and the potency continues to climb (7% purity in 1980 to 75% today). Overall, patients with opioid dependence die at a much higher rate than non-users from a number of medical complications. The incidence of Hepatitis C is on the rise due to the sharing of needles – even those that are supposedly 'recycled' and 'clean'. About 2% of those who are opioid-dependent die each year because they don't seek treatment or assistance for opioid withdrawal. The message here is that there is a good explanation for why we don't see a lot of old opioid addicts walking around.

About the Author

As an American Board of Emergency Medicine (ABEM) certified physician, Dr. Jeffrey Stuckert, M.D. has practiced clinical emergency medicine in Ohio for 29 years. He currently serves as the CEO and Medical Director of Northland, an outpatient drug and alcohol treatment center and The Ridge, an inpatient treatment center near Cincinnati, and has personally attended to more than 70,000 emergency-room patients. Dr. Stuckert has served as Chairman and Medical Director of Emergency Medicine Departments of both the Christ Hospital and Deaconess Hospital for 22 of his 29 years. Dr. Stuckert has practiced addiction medicine on a full time basis for the last two years. For more information about Northland, please visit www.northlandmbs.com, and for more information about The Ridge, please visit www.theridgeohio.com.

06/29/2011 0 Comments | Add Comment
 
Opioid Dependence and Withdrawal
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A person is said to have physical opioid dependence if they have high 'tolerance' of opioids, meaning they need more of the opioid to get the desired effect. Opioid withdrawal symptoms occur when the substance is stopped. Most patients who seek treatment for opioid addiction also have some degree of physical dependence. However, physical opioid dependence alone is not sufficient to make a diagnosis of addiction. A person can be physically dependent - like a cancer patient might be when prescribed opioids for severe pain - and not be addicted. The term 'addiction' refers to certain behaviors.

What are the Symptoms of Opioid Withdrawal?

Opioid withdrawal can occur in both the addicted patient and the patient who has opioid dependence but is not experiencing total opioid addiction. When an opioid is stopped or the dose is suddenly reduced, both types of patients experience withdrawal symptoms - sweating, chills, muscle and joint pain, nausea, vomiting, diarrhea, restlessness and insomnia. 'Goosebumps', which commonly occur during opioid withdrawal, give rise to the term 'cold turkey'. Fear of these unpleasant and painful opioid withdrawal symptoms makes it difficult for the addict to stop using and begin the recovery process.

Who is Prone to Develop Opioid Dependence?

Although the specific causes vary from person to person, scientists believe that our heredity (our DNA) is the major factor in an individual's susceptibility to the development of the disease of addiction. We also know that psychological factors (feeling stressed, anxious or depressed) and our social environment also play important roles in the development of opioid addiction. The unpleasant effects of opioid withdrawal lead many users to continue abusing prescription or illegal opioids, leading to prolonged dependence.

Opioid abuse has risen dramatically in the United States over the past ten years. The National Institute of Drug Abuse (NIDA) reports that more than 5.2 million Americans misused a prescription painkiller in 2008 for non-medical reasons. Approximately 1 million people in the U.S. are addicted to heroin today. About 1 out of 8 people (13% of the population) who are exposed to a mood-altering substance that can cause an intense euphoric effect (like alcohol, opioids and other drugs of abuse) are prone to develop the behaviors of addiction with repeated use.

What Happens to the Brain in Addiction?

Opioid addiction is a disease of the brain. Repeated use of an opioid leading to opioid dependence causes long-term changes in both the structure (the architecture of the brain) and the way the brain functions (the biochemistry of the brain).

The most important structural or architectural change takes place in the circuitry of the brain - particularly in the wiring of the reward pathway. Our brains are wired to ensure that we will repeat life-sustaining activities - such as drinking water and eating food - by associating those activities with pleasure or reward. Whenever this reward circuit is activated, the brain records that experience making us likely to do it again. Memories that have an intense emotional component (like pleasure) may be permanently 'hard-wired'.

In the person with opioid dependence who is prone to opioid addiction, the excessive stimulation of the reward pathway by an opioid 'tricks' the brain into believing that an opioid is as necessary for survival as food and water. The effect of such a powerful reward motivates people to repeat that behavior again and again, even when it is clearly harmful to do so. This is why drug abuse is something the person prone to opioid addiction can learn to do very, very well.

Chemical changes also take place in the brain as it tries to adapt to the excessive stimulation of the reward pathway. During opioid dependence and opioid addiction, the brain tries to 'turn down the volume' and compensate for the vicious highs and lows that occur during repeated opioid use and opioid withdrawal by reducing the number of opioid receptors in the brain. This is what leads to tolerance in people with opioid addiction - more and more of the opioid is needed to achieve the same effect. The result is that eventually the addict may feel lifeless, depressed, and may be unable to enjoy activities that usually bring them pleasure. By the time most opioid addicts seek treatment they no longer get a euphoric effect from taking an opioid - they are taking opioids just to function normally.

To complicate matters further, the repeated use of an opioid has a profound impact on the intellectual portion of the human brain that is involved in judgment and decision making. Since this part of the brain is still developing in adolescence, opioid dependence leading to addiction which begins during the teen years is often more severe and more resistant to treatment. Unfortunately, the impairment in the thinking part of the brain - the part that serves as the 'brake pedal' for addiction - is so severe that the addict may flatly deny that they have a drug problem, try to justify their use to family and friends, or minimize the consequences of their behavior. A person with opioid addiction (and less often, opioid dependence) can find themselves saying or doing things they would never have believed themselves capable of - including lying to family members, stealing from loved ones, or even committing criminal acts - all in pursuit of the drug their brains are telling them they must have.

As a result of opioid dependence or opioid addiction, these changes in the structure and function of the brain result in powerful and long-lasting cravings for opioids. Cravings can last for months and even years after an addict has stopped using opioids, and has gone through the initial opioid withdrawal period. Persistent cravings explain why the relapse rate is so high with this disease. The need to satisfy cravings can be so intense that even people who try as hard as they can to remain abstinent find it difficult or impossible to do on their own.

Is Opioid Addiction Really a Disease?

Yes, opioid dependence can lead to opioid addiction, which is a chronic and progressive disease if untreated--just like heart disease, asthma and diabetes. These diseases have a lot in common with addiction--they are seen more frequently in those with a family history of the disease, they cause changes in the structure and function of a major organ system, they improve with behavior modification, they can be treated with medication, and they all require daily management. And like these other diseases, addiction is chronic - a condition for life, as there is no known cure. Fortunately, addiction can be managed, and a person suffering with opioid addiction can regain a healthy, productive life by seeking assistance with managed opioid withdrawal in an addiction treatment program.

The myth is that opioid addiction or opioid dependence is a result of poor will-power, a lack of self-control, or low moral standards. In reality, if it was that straightforward most people who are addicted would be able to stop using on their own. The changes in the structure and function of the brain are so powerful that stopping and remaining abstinent usually requires professional help.

How Serious is Opioid Dependence?

Opioid dependence is a behavior disorder that is potentially fatal. Sudden opioid withdrawal is an unpleasant experience, and many individuals continue to use opioids to avoid the negative physical effects. Individuals who use heroin intravenously are about 7 to 10 times more likely to die on any given day than someone of similar age who is not a user. Accidental overdoses are on the rise because the potency of street drugs like heroin are unpredictable from one dose to the next, and the potency continues to climb (7% purity in 1980 to 75% today). Overall, patients with opioid dependence die at a much higher rate than non-users from a number of medical complications. The incidence of Hepatitis C is on the rise due to the sharing of needles – even those that are supposedly 'recycled' and 'clean'. About 2% of those who are opioid-dependent die each year because they don't seek treatment or assistance for opioid withdrawal. The message here is that there is a good explanation for why we don't see a lot of old opioid addicts walking around.

About the Author

As an American Board of Emergency Medicine (ABEM) certified physician, Dr. Jeffrey Stuckert, M.D. has practiced clinical emergency medicine in Ohio for 29 years. He currently serves as the CEO and Medical Director of Northland, an outpatient drug and alcohol treatment center and The Ridge, an inpatient treatment center near Cincinnati, and has personally attended to more than 70,000 emergency-room patients. Dr. Stuckert has served as Chairman and Medical Director of Emergency Medicine Departments of both the Christ Hospital and Deaconess Hospital for 22 of his 29 years. Dr. Stuckert has practiced addiction medicine on a full time basis for the last two years. For more information about Northland, please visit www.northlandmbs.com, and for more information about The Ridge, please visit www.theridgeohio.com.

06/29/2011 0 Comments | Add Comment
 
What is Opioid Addiction?
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To first understand opioid addiction, you must first understand what opioids are. The term opioid refers to any drug or chemical that attaches (like a key fits into a lock) to sites in the brain called opioid receptors. The human body makes its own opioids (called endorphins) but the opioids we are concerned with when we talk about opioid addiction are those that are manufactured in a laboratory or made by plants. For instance, morphine and codeine are found in the extract (the opium) of seeds from the poppy plant, and this opium is processed into heroin. Most prescription painkillers like oxycodone, hydrocodone, and hydromorphone are synthesized in the laboratory. When a person becomes dependent upon these drugs, they need opioid addiction treatment.

What are Common Types of Opioids?

Opioids may be prescribed legally by doctors (for pain, cough suppression or opioid dependence) or they may be taken illegally for their mood-altering effects--euphoria, sedation, "to feel better", or for some, opioids are taken "just to feel normal". Not everyone who takes an opioid is at risk for dependence requiring opioid addiction treatment, but these drugs are commonly abused.

Examples of prescribed medications that sometimes lead to opioid addiction, but that can also help patients battle other types of substance abuse include:

  • Codeine--the opioid in Tylenol #3, Fiorinal or Fiorecet #3, and in some cough syrups.
  • Hydrocodone--the opioid in Vicodin, Lortab, and Lorcet.
  • Oxycodone--the opioid in Percodan, Percocet and OxyContin.
  • Hydromorphone--the opioid in Dilaudid.
  • Oxymorphone--the opioid in Opana.
  • Meperidine--the opioid in Demerol.
  • Morphine--the opioid in MS Contin, Kadian and MSIR.
  • Fentanyl--the opioid in Duragesic.
  • Tramadol--the opioid in Ultram.
  • Methadone--the opioid in Dolophine.
  • Buprenorphine--the opioid in Suboxone.
Although not entirely accurate, the terms opiate and narcotic are generally used interchangeably with the term opioid.

The great majority of illicitly used prescription opioids are not obtained from drug dealers. Family and friends are now the greatest source of illicit prescription opioids, and the majority of these opioids are obtained from one physician--not from "doctor shopping". More than 90% of the world's opium and heroin supply comes from Afghanistan and Southeast Asia. 'Black tar' heroin comes primarily from Mexico. Opioids are the most powerful known pain relievers, sometimes leading to opioid addiction requiring treatment. The use and abuse of opioids dates back to antiquity. The pain relieving and euphoric effects of opioids were known to Sumerians (4000 B.C.) and Egyptians (2000 B.C.).

What Happens When an Opioid is Taken?

When an opioid is taken into the body by any route (by mouth, nasally, smoking or injecting) it enters the blood stream and travels to the brain. When it attaches to an opioid receptor in the brain, our perception of pain is reduced (if we have pain) and we feel sedated. Most people also feel at least a mild pleasurable sensation, or a sense of well-being when opioid receptors are stimulated. Some report feeling more energized or motivated after taking opioids. A few experience unpleasant side effects such as nausea, vomiting or irritability. Unfortunately, those who are prone to develop an opioid addiction seem to experience an intense euphoric or pleasurable feeling when they take an opioid - leading to prolonged dependence requiring opioid addiction treatment.

An opioid seems to do something for their mood that it does not do for most people. Their experience with an opioid is quite different than it is for the person who is not prone to develop an opioid addiction. Drugs of abuse (like opioids, cocaine and alcohol) are addictive for the susceptible person because repeated use of those substances--in an effort to reproduce that intense euphoric feeling--results in long-term changes in the structure and the function of the brain. These changes in the brain start to drive their behavior, and when someone is suffering from opioid addiction, they want the drug even when the drug no longer provides pleasure.

Opioids that can be snorted, inhaled or injected reach the brain in a high concentration rapidly and result in an even more intense high, or a "rush". As a result, drugs that can be abused by these routes are often more appealing to the person seeking euphoria, and are therefore more addictive for the susceptible person.

What is Opioid Dependence? Is it the Same as Opioid Addiction?

Yes - opioid dependence and opioid addiction mean the same thing. Opioid dependence is a disease affecting the brain that involves both a physical and a psychological need for an opioid, and requires opioid addiction treatment. An individual is considered "dependent" or "addicted" when he or she exhibits this behavior--compulsive use despite obvious harm. The addicted person can't seem to stop using opioids even when it is obvious to himself or herself and others that he or she should stop. The two major signs of opioid addiction are cravings--an intense and overwhelming desire for a drug--and a loss of control--it becomes harder and harder to say no to using a drug, or controlling the amount used, and thus use becomes compulsive. Behaviors which signal a need for opioid addiction treatment include:

  • Denial that a problem exists, or minimizing the severity of the problem.
  • Impaired control over use--using more than planned.
  • A lot of time is spent obtaining, using or recovering from using opioids.
  • Important obligations like school, work, or childcare are reduced for the sake of use.
  • Multiple prior unsuccessful attempts to quit, or a persistent desire to quit.
  • Continued use despite obvious harm to one's health, job, finances or family.
What is Physical Dependence?

A person is said to have "physical dependence" on opioids if they have high "tolerance", meaning more of the substance is needed to get the same effect, and they get withdrawal symptoms if the substance is stopped. Most patients who seek opioid addiction treatment also have some degree of physical dependence. However, physical dependence alone is not sufficient to make a diagnosis of addiction. A person can be physically dependent--such as a cancer patient might be who is prescribed opioids for severe pain--and not be addicted. Again, addiction refers to certain behaviors.

Patients who are being treated for chronic pain can develop what we call "pseudo addiction". They may start to exhibit some of the same behaviors we see with addiction when they don't get adequate pain relief. When their pain is controlled, the behaviors that we associate with opioid addiction disappear. They do not need opioid addiction treatment. They need better pain management.

About the Author

As an American Board of Emergency Medicine (ABEM) certified physician, Dr. Jeffrey Stuckert, M.D. has practiced clinical emergency medicine in Ohio for 29 years. He currently serves as the Medical Director of Northland, an outpatient drug and alcohol treatment center near Cincinnati, and has personally attended to more than 70,000 emergency-room patients. Dr. Stuckert has served as Chairman and Medical Director of Emergency Medicine Departments of both the Christ Hospital and Deaconess Hospital for 22 of his 29 years, supervising all clinical personnel and administrative operations of those divisions. This includes the supervision of over 100 emergency physicians, more than 100 emergency medicine residents and hundreds of nurses and ancillary staff. Dr. Stuckert has practiced addiction medicine on a full time basis for the last year. For more information about Northland, please visit www.northlandmbs.com.

06/06/2011 0 Comments | Add Comment
 
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