Opioid-Related Disorders (Heroin, Oxycontin®, Vicodin® and other pain medications)
A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.Opioid use disorder (e.g., heroin, Oxycontin®, Vicodin®)
The diagnostic criteria for a substance use disorder were previously reviewed. These criteria apply to opioid use disorders.
The terms opioid and opiate are very similar. Opiate drugs are naturally derived from the opium poppy plant. Opioids include opiates but also a wide variety of synthetic drugs made in a laboratory. Therefore, DSM-5 uses the word opioid as this is the more inclusive term. Both types produce a similar effect on the body.
There are many different opioid drugs. The most common opioids are opium, morphine, heroin, codeine, methadone, oxycodone, fentanyl, and buprenorphine. Street names for heroin include China white, black tar, horse, smack, chiva, junk, and dope. People also abuse prescription pain medications such as Oxycontin® and Vicodin®. Opioids are can be taken orally by mouth, or by injection into veins. In some cases, opioids are smoked or snorted. We call these different methods of use, routes of administration. Many people mistakenly believe they aren't "addicts" because they "only" snort, smoke, or swallow these drugs. Opioid use can easily escalate to addiction regardless of the route of administration.
Opioids can be obtained by prescription from a physician, as many of these drugs have a legitimate use in severe pain management. Usually this requires faking or exaggerating symptoms, such as back pain. Opioids can also be obtained from the illegal market. Just as alcohol problems are an occupational risk for bartenders, opioid use is a risk for medical personnel who have ready access to opiates.
Opioid addiction may be evident when its use interferes with personal responsibilities or safety. In more severe cases, opioid addiction is characterized by excessive and compulsive drug use. These substances often lead to tolerance and withdrawal.
Opioid Withdrawal (e.g., heroin, Oxycontin®, Vicodin®)
Opioid withdrawal occurs after the cessation (or significant reduction) of heavy and prolonged use. The speed and severity of withdrawal largely depend on the half-life of the drug. The half-life of a drug refers to how quickly your body can clear the drug from your system. Drugs that remain in your system a long time have a long half-life. These are called long-acting drugs. Drugs are cleared fairly quickly have a short half-life. These drugs are called short-acting drugs. For short-acting opioids such as heroin, withdrawal symptoms begin within 6-12 hours after the last dose and last for 5-7 days. For long-acting opioids, withdrawal symptoms may take several days to emerge and may last for several weeks, but with less intense symptoms.
Opioid withdrawal is often very uncomfortable. Withdrawal symptoms may include anxiety; restlessness; irritability; muscle aches; depressed mood; nausea/vomiting/diarrhea; sweating/fever; yawning; cravings; and difficulty sleeping. While highly uncomfortable, opiate withdrawal is usually not life threatening. However, opiate use itself can be fatal.
Effects of Opiates: Opioid Intoxication (e.g., heroin, Oxycontin®, Vicodin®)
Opioid intoxication can be extremely dangerous. The various symptoms include: mood swings (usually an elevated mood followed by a flattened demeanor); impaired judgment/attention/memory; change in pupil size; slurred speech; drowsiness; hallucinations; and even coma. Those who use opioids intravenously may have visible "track marks" at injection sites. Because needles require a prescription, many IV drug users re-use and share unsterile needles. As a result, they are at risk for acquiring hepatitis, tuberculosis, and HIV. The death rate for people who overuse opioids is high. Death may occur because of overdoses, accidents, medical complications, and violent injuries associated with obtaining the drugs. If a pregnant woman is a heavy user of opioids, her newborn may have a severe withdrawal syndrome.
Resources
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Articles
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What is Addiction?
- Introduction to What is An Addiction
- Definition of Addiction
- Definiton of Addiction Continued
- The Addiction Definition Compared to Other Addiction Terms
- How Do I Know if I Have An Addiction?
- Why Don't They Just Stop? Addiction and the Loss of Control
- Is Alcoholism a Disease?
- Addiction Statistics: How Big of a Problem Is It?
- A Brief History of Alcoholism
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What Causes Addiction?
- Introduction to Causes of Addiction
- The Many Causes of Addiction and Bio-Psych-Social-Spiritual Model
- Biological Causes of Addiction
- Disease Model of Addiction and Recovery Implications
- Evolutionary Model of Addiction and Recovery Implications
- Psychological Causes of Addiction
- Learning Theory of Addiction and Recovery Implications:
- Social Learning Theory of Addiction and Recovery Implications
- Cognitive (Expectancy) Theory of Addiction and Recovery Implications
- Educational Model of Addiction and Recovery Implications
- Developmental Model of Addiction and Recovery Implications
- Sociological Causes of Addiction and the Temperance Model
- General Systems Theory of Addiction and Recovery Implications
- Sociocultural Model of Addiction and Recovery Implications
- Public Health Model of Addiction and Recovery Implications
- Moral and Spiritual Causes of Addiction
- Addiction and Personal Responsibility: A Fundamental Conflict
- Personal Responsibility and Locus of Control
- Controversies in the Addiction Field: Change Versus Acceptance
- Conflict between 12-Step Anonymous Groups and Science: A Historical Perspective
- Conflict between 12-Step Anonymous Groups and Science Continued
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How Do You Get Addicted?
- Introduction to How Do You Get Addicted?
- The Biology of Addiction and Recovery
- How Does Addiction Affect the Brain?
- Addiction Changes the Brain's Chemistry
- Addiction Changes the Brain's Communication Pathways
- Addiction Changes Brain Structures and Their Functioning
- Impaired Decision-making, Impulsivity, and Compulsivity: Addictions' Effect on the Cerebral Cortex
- Drug Seeking and Cravings: Addictions' Effect on the Brain's Reward System
- Habit Formation, Craving, Withdrawal, and Relapse Triggers: Addictions' Effect on the Amygdala
- Stress Regulation and Withdrawal: Addictions' Effect on the Hypothalamus
- The Good News: The Brain Also Helps to Reverse Addiction
- The Psychology of Addiction and Recovery
- Learning Theory and Addiction
- Classical Conditioning and Addiction
- Operant Conditioning and Addiction
- Social Learning Theory and Addiction
- Cognitive Theory and Addiction (Thoughts, Beliefs, Expectations)
- Cognitive Theory and Addiction Continued
- Cognitive-Behavioral Therapy: Improving Coping Skills
- Addiction and Other Psychological Disorders
- Developmental Theory and Addiction
- Recovery from Addiction: The Psychology of Motivation and Change
- Addiction: Social and Cultural Influences
- Addiction and Sociological Influences: Culture and Ethnicity
- Recovery from Addiction: Becoming Aware of Cultural Influences
- Recovery from Addiction: The Powerful Influence of Families
- Recovery from Addiction: Social Support
- The Spirituality of Addiction & Recovery
- The Spirituality of Addiction & Recovery Continued
- Incorporating Spirituality into Recovery from Addiction
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Signs and Symptoms of Addiction
- How Do You Know If You Have An Addiction?
- The Diagnostic Criteria for Substance Use Disorders (Addiction)
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- Alcohol-Related Disorders
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Treatment for Addiction
- Treatment for Addiction
- Natural Recovery: Recovery from Addiction Without Treatment
- Natural Recovery Continued
- Choosing An Effective Treatment Approach: Evidenced-Based Practices
- What Makes An Addictions Treatment Effective?
- Biological Approaches to Addiction Treatment: Medications
- The Role of Medication in Addictions Treatment
- Pharmacologic Medications for Addictions Treatment
- Pharmacologic Medications for Addictions Treatment: Part II
- Psychological Approaches to Addiction Treatment
- Motivation for Change: The Stages of Change Model
- Motivation for Change Continued
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- Relapse Prevention Therapy
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- What The Pros Know: The Practical Recovery Model
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- The Social Support Approach to Addictions Recovery: Recovery Support Groups
- Self-Empowering Support Groups for Addiction Recovery: Smart Recovery
- Moderation Management
- Women for Sobriety
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- Summary of Self-Empowering Support Groups
- Spiritual Approaches to Addiction Recovery
- 12-Step Support Groups: Groups That End With "Anonymous"
- 12-Step Support Groups: Part II
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- Expanding Addiction Treatment Choices in the United States
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Videos
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- How to Tell if a Loved One is Abusing Opioids
- Why Addiction is a “Disease” and Why Is It Important
- NIDA Emerging Drugs-Methylone and Molly
- Designed to Drink? The Genetics of Alcoholism
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- Why are Drugs So Hard To Quit
- Anyone Can Become Addicted to Drugs
- Substance Use: Addiction Theories New Treatments and the Role of Doctoring in Society
- The Impact of Changing Social Behaviors on Teen Drug Use
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- Cannabis Effects on Driving Performance
- Epidemiology of Tobacco Use
- Addiction: Learning to Forget
- Addiction: What Can I Do About It?
- Addiction: Treat It Like a Disease
- Addiction: What Is It?
- One in 4 People Prescribed Opioids Progresses to Longer-Term Prescriptions
- NIDA’s Dr. Phil Skolnick discusses intranasal naloxone
- "Eyes On" Research in Drugged Driving
- How Will Anti-Drug Vaccines Be Used? An Interview With Dr. Thomas Kosten
- Opioid Use in Pregnancy: A Community’s Approach
- Naloxone Rescue Kits
- Living Without Fear
- What You Need to Know About Internet Addiction
- Hooked, Hacked, Hijacked: Reclaim Your Brain from Addictive Living
- The Neuroscience of Internet Addiction
- Internet Addiction: Signs You Need to Shut Down
- What the Internet is Doing to Our Brains
- Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment
- The Reward Circuit: How the Brain Responds to Cocaine
- The Reward Circuit: How the Brain Responds to Methamphetamine
- The Reward Circuit: How the Brain Responds to Marijuana
- The Reward Circuit: How the Brain Responds to Natural Rewards and Drugs
- Mindfulness-Based Relapse Prevention (MBRP) for Addictions Video (vol. 1)
- Mindfulness-Based Relapse Prevention for Addictions (vol. 2)
- Prescription Opioid Misuse
- Substance Use Disorders/Addictions - Clinical Overview
- Addiction in the Elderly
- Teenagers, ADHD, and Substance Abuse
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