The abuse of and dependence on prescription painkillers has reached epidemic proportions in the United States and around the world. According to federal U.S. data, an estimated 2.1 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers in 2012.1 According to the U.S. Centers for Disease Control and Statistics, 78 Americans die every day from an opioid-related overdose, including both prescription medications and illicit opioids such as heroin.2 Opioid narcotics are a class of pain-relieving medications that includes morphine, codeine (Tylenol-3), hydrocodone (Vicodin, Lortab), and oxycodone (OxyContin, Percocet). While these medications are effective at reducing pain, people can become physically dependent on these drugs, even when following prescribed use. Overcoming opioid dependence and addiction is difficult. However, there are multiple treatment strategies available, and psychologists are a valuable part of the treatment team.
Understanding opioid physical dependenceOpioids are very effective at relieving pain, particularly the short-term pain associated with injuries or post-surgical pain. However, opioids are not as effective for treating chronic pain. When taken long-term, people often begin to develop a tolerance to the medications. Tolerance means they need to increase their doses to achieve pain relief. People who develop tolerance might also notice symptoms of withdrawal when they do not take the medication. Opioid withdrawal symptoms can range from mild to severe, and include runny nose and eyes, nausea, diarrhea, hot/cold flashes, goosebumps, muscle aches and pains, insomnia, excessive yawning, anxiety and agitation. You can become physically dependent on opioids even when using your medications as prescribed. If you notice signs of dependence, it’s a good idea to speak with your physician or a pain medicine specialist. They can help you minimize the chance of developing an opioid use disorder.
Understanding opioid use disorderOpioid use disorder, also known as opioid addiction, is characterized by the misuse of opioid medications with the intention of getting high or avoiding withdrawal symptoms. Signs that someone might be abusing or misusing opioids include:
- Taking more than the prescribed dose.
- Taking other opioid medications because you’ve run out of your prescribed medication.
- Taking the medication for reasons other than prescribed.
- Feeling that the medication reduces your day-to-day functioning.
- Prioritizing the medication over participation in activities at work, school or home.
- Running out of medications before your next refill.
- Experiencing a positive emotional feeling or high from the medications.
- Lying or stealing to obtain medication or paying cash for medication that was not prescribed to you.
- Trading medications with others.
- Going to the ER in non-emergency situations or going to less-than-reputable pain clinics to obtain medication.
- Continuing to take the medication even when it causes increasing physical or psychological problems.
- Continuing to take the medication even when it causes problems between you and your family or friends.
Treating opioid use disordersNumerous treatment options are available for opioid use disorders. These include:
Medication-assisted treatment.In some cases, healthcare professionals provide medication to help alleviate withdrawal symptoms, reduce cravings or treat overdose. Some medicines can be taken for an extended period of time, or tapered off gradually. Others are designed for short-term use or to treat a person who has overdosed. The three medications typically used to treat an opioid use disorder are methadone, buprenorphine and naltrexone.
Residential (inpatient) treatments.Some inpatient treatments are brief, hospital-based programs that provide a safe place to go through the detoxification process when you stop taking opioids. Others are longer, more comprehensive programs that typically offer counseling to help reduce the risk of relapse.
Individual psychotherapy.People struggling with addiction often benefit from meeting with a psychologist one-on-one. Psychologists are professionals with training to help people learn to cope more effectively with life issues and mental health problems. They can help with a number of the challenges common to people with opioid use disorders.
- Managing pain. Many people begin taking opioids because they are living with pain. Chronic pain is physically and emotionally difficult to manage. Psychologists can help people learn strategies to moderate pain, function well despite pain, improve sleep and achieve a better overall quality of life.
- Treating other disorders. Many people who misuse drugs have other mental health disorders such as anxiety, depression or post-traumatic stress disorder (PTSD). Psychologists can help patients overcome or manage those conditions.
- Addressing drug use disorder. Psychologists can help patients understand the reasons they might have started misusing drugs and identify common triggers that drive them to continue misusing them. They can also help patients develop strategies to change or avoid the places and experiences that might act as triggers. Psychologists can also help people develop skills to help them feel more in control of their lives and decisions.
How psychologists help with opioid use disorderPsychologists draw from a variety of techniques to help patients achieve their goals. Some common approaches used with people suffering from chronic pain and/or drug abuse disorders include:
- Cognitive behavioral therapy (CBT) is a type of therapy in which patients learn to identify and manage negative thought and behavior patterns that can contribute to their drug use disorder. CBT helps patients identify negative thinking, change inaccurate beliefs, change unhelpful behaviors, and interact with others in more positive ways.
- Motivational interviewing is a type of therapy in which psychologists use nonjudgmental, nonconfrontational interviews with patients to help them feel comfortable discussing their drug use behaviors and inspire them to want to change.
- Mindfulness-based stress reduction (MBSR) is a therapeutic intervention that teaches people the principles of mindfulness, the ability to tune into the body’s thoughts, feelings and behaviors in the present moment. The goal of mindfulness and MBSR is to create greater awareness of the ways that unconscious thoughts and behaviors might be affecting the body and undermining emotional and physical health.
This article was reprinted with permission by the American Psychological Association (APA).
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