Medical Progress

Prescription Drug Abuse: Who Gets Addicted and Why?

Tips for Stress-Reduction Activities While You Stop Smoking

The American Cancer Society’s Quitline counselors and other smoking-cessation experts recommend a variety of techniques to help you quit smoking.

  • Deep breathing. Breathe in deeply, letting your stomach expand until your lungs are filled. Pause a minute. Then exhale fully. Pause a minute. Then take another deep breath in, hold a minute, then exhale. Continue with your eyes closed until you feel calm.
  • Guided imagery. “Imagine yourself in the situation that causes you the most difficulty, and picture all the strategies you’re going to use to address the situation without smoking,” says Trina Ita, the counseling supervisor for the American Cancer Society’s Quitline. “We call it a mental rehearsal.”
  • T’ai chi. This mind-body exercise combines deep breathing with postures that flow from one to the next through a series of slow, continuous movements. Researchers at the University of Miami are now studying its effectiveness as part of a smoking-cessation program.

There are other relaxation techniques, including yoga and meditation. The trick is to find a relaxation technique that you enjoy, and that fits into your life.

Finding and eating food, drinking water, having sex, caring for children: these and other activities necessary to survival cause the reward system to release a tiny dose of dopamine, a neurotransmitter. “It feels good, and so we’re likely to repeat that activity later on,” Levounis tells WebMD.

Repeat abuse of opioid drugs floods the system with dopamine, which contributes to the euphoric rush of prescription drug abuse. “From the brain’s perspective, this is something worth repeating,” says Levounis.

As an addiction-susceptible person uses opioids again and again, the reward system begins to wrongly learn these drugs are as essential to survival as food or water. Experts believe that the nerve cells of the brain actually undergo a change.

“They often can’t articulate it, because these brain areas are so far below conscious control,” says Saxon, “but on some level they truly believe that if they don’t get the drug, they’ll die.”

This explains the changes in behavior that go along with opioid addiction: neglecting responsibilities to family and friends, performing poorly at work, or losing interest in sex. “When these pathways get hijacked, the salience [importance] of everything else goes down,” explains Levounis, “and the person loses control of their life to their drug of abuse.”

Opioid Addiction: Hard to Predict

Everyone’s brain has a reward system, and millions of Americans use prescription pain pills — or even misuse them for a short time — without developing opioid addiction. What determines who becomes addicted, and who doesn’t?

Despite opioid drugs’ reputation as “happy pills,” not all people are wired to enjoy their effects. In many people, nausea and dizziness outweigh any euphoric rush from the drugs. “They don’t like it that much, and they have no interest in taking it again,” Jamison tells WebMD.

Even more people might experience pain pills like most people do alcohol. It’s something pleasurable in moderation, but they have no urge to overdo it.

But according to Saxon, about 5% to 10% of the population have brains that are already primed for addiction. “They take the drug and say, ‘Wow, that’s fantastic,'” he says. “They really want to feel that feeling again.” Soon, they seek further chances to use the drug, and increase the dose.

Can someone know if their brain is vulnerable to opioid addiction? Unfortunately, “there’s no blood test, no scan of the brain that can predict who will become addicted,” says Levounis. While certain genes have been associated with the risk for drug addiction, “no one gene is responsible,” Saxon says, “and we’re a long way off from genetic testing to identify people at risk.”

Still, certain factors are known to increase the risk for opioid addiction. Altogether, our genes account for 50% of the susceptibility to addiction. Studies of identical twins, who share the same genes, prove the link. If one identical twin develops a drug addiction, there’s about a 50% chance the other twin will, too.

That leaves half of the risk in the “environmental” category. “This includes everything from your social group, your economic status, your family environment, and probably most importantly, stressful events during childhood,” says Saxon.

Childhood trauma, like physical or sexual abuse, losing a parent at a young age, or witnessing violent acts create changes in the brain that last into adulthood. For reasons that aren’t clear, these people are more prone to prescription drug abuse.

The most obvious environmental factor, though, is simply being around opioid drugs. For example, two teenagers might both be predisposed to opioid addiction. If one goes to a high school where prescription drug abuse is considered “cool,” he might be more likely to use and become addicted. If the other teen is never exposed to opioid drugs, he may be more likely to stay clean.

Adults who have already abused other substances like alcohol or cocaine are more likely to fall victim to opioid addiction, as well. Smokers and young people are at higher risk, as well, according to Jamison.

People with co-existing mental health conditions like depression, anxiety, and bipolar disorder are more likely to abuse drugs in general. “These individuals are most likely self-medicating to try to feel better,” but in the process they raise their risk for opioid addiction, says Levounis.

The likelihood of serious opioid addiction also goes up depending on how long someone abuses the drug. Those who abuse prescription drugs for weeks have a better chance of overcoming drug addiction than people who abuse them continuously for years.

Opioid Dependence vs. Opioid Addiction

There’s an important difference between opioid dependence and opioid addiction. Anyone who takes opioid drugs for more than a few weeks will develop tolerance and some physical dependence on the drug. Usually, these people are on stable, generally lower doses of medication. If they stop suddenly, they have withdrawal symptoms (usually mild). The symptoms go away, the person is “detoxed,” and they go on with life. They don’t seek further chances to use the drug.

The person with opioid addiction abuses the drug to get high or to lessen anxiety. The repeated highs and rush of dopamine in the brain create the brain changes that lead to drug addiction. The high doses, and longer time of use, are also what make withdrawal symptoms such a horrible experience for addicts. The pleasure of getting high and the fear of withdrawal “rewire” the brain’s reward pathway, leading to compulsive drug seeking, craving, and continued use despite negative consequences.

Whether it’s a Vicodin addiction, morphine, heroin, Percocet, or OxyContin addiction, experts say the specific drug isn’t important. “All these drugs are opioids, and activate the same systems in the brain and the rest of the body. From a practical perspective, there really isn’t much difference between heroin addiction and addiction to any other opioid,” says Levounis.

Addiction Calls for Compassion, Not Condemnation

Whether or not someone is susceptible to opioid addiction depends on genes and early experiences. Studies have shown that when opiates are taken exactly as directed, they are safe, can manage pain effectively, and rarely cause addiction. When a person begins to experience signs of prescription pain medication abuse, he or she can avoid drug addiction — defined as the compulsive and uncontrolled use of drugs despite adverse consequences — by stopping use completely. But once true opioid addiction takes hold, the condition can be as firmly rooted as other chronic diseases like diabetes or high blood pressure, experts believe.

Even after breaking free from physical dependence through a detox program, most people with opioid addiction relapse. They may need long-term maintenance therapy with methadone or Suboxone (buprenorphine/naloxone) — weaker opioids that prevent craving and withdrawal — along with counseling to break the cycle of detox and relapse.

Because of the biological basis for opioid addiction, condemnation and criticism are counterproductive, experts say. Although people often act hurtfully in the grip of opioid addiction, support from family, friends, and doctors is essential to their recovery. “People recovering from opioid addiction are in the fight of their lives,” says Jamison. “They need all the help they can get.”

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