Opioid Use Disorder
West Georgia Technical College
PSYC 1101 Introductory Psychology
Opioid Use Disorder
Opioid use disorder is a growing problem in the United States. Opioids are a class of narcotic drugs that reduce perception of pain by acting on endogenous pain receptors to induce feelings of euphoria, drowsiness, and mental confusion (Schuckit, 2016). Some such as hydrocodone, codeine and oxycodone are legal and are distributed by prescriptions from medical professionals (Mistry, 2014), while other opioids like heroin are classified as illegal and are obtained by drug dealers. Recent research estimates show that 1.9 million people struggled with addiction to prescription pain relievers in 2014, while more than half a million others were affected by heroin addiction (Substance Abuse and Mental Health Services Administration, 2018). More general estimates suggest that as many as 3 million people in the United States and more than 16 million worldwide have experienced an opioid use disorder at some point in their life (Schuckit, 2016).
Opioid use disorder is a type of addiction that creates considerable distress or impairment for the affected individual. The diagnosis is made if two or more of the following symptoms are present within a one year period: loss of control over quantity and duration of opioid use, inability to reduce, manage or satisfy the need to use opioids, excessive focus on maintaining access and supply, unable to meet the minimum needed to function as an employee, student, or in relationships. refusal to discontinue regardless of its effects on life, abandons responsibilities to self, relationships, career and other interests to continue use, disregard for the safety of self and others to ensure continued use, neglect of physical and mental health to maintain use of opioids, increased tolerance which causes loss of effect and/or increased dosage needed for the same effect, and withdrawal causing multiple detrimental physical effects following discontinuation of use (American Psychiatric Association, 2013).
Opioid use becomes all-consuming in the lives of individuals suffering from this disorder when their tolerance builds and they need ever increasing doses of the drug to achieve the desired high. When this level of addiction is active, the attainment and use of the drug becomes a primary daily activity of users. Individuals often resort to the use of illegitimate medical conditions in order to obtain prescriptions from multiple doctors. This compulsive behavior often leads to other illicit activities such as forgery, theft and drug-related crime (Schuckit, 2016). Additionally, healthcare workers involved with the improper distribution and misuse of prescription opioids encounter a myriad of other professional, ethical and legal issues. These compulsive and criminal behaviors associated with the individual’s drug use often cause serious impediments to relationships and employment (American Psychiatric Association, 2013).
Biological, psychological and sociocultural factors all play a role in the development and perpetuation of opioid use disorder. These factors along with appropriate treatment can greatly influence the success or failure of recovery and rehabilitation.
There are numerous biological explanations for opioid use disorder. Key among these are genetic factors, brain anatomy, interactions between opioids and opiate receptors, and stages of addiction.
Opioids work by binding to pain receptors in the and altering neural transmission of signals regulating the perception of pain. Opioid receptors are found to be “highly abundant in the amygdala, the nucleus accumbens (NAc), and the caudate putamen (CP)” (Mistry, 2014, p. 158). Opioids act by increasing the transmission of dopamine, which is the main neurotransmitter involved in feelings of pleasure and euphoria, as well as by reducing
the release of GABA, the inhibitory neurotransmitter. By reducing the amount of GABA, opioids increase the amount of dopamine available in the brain (Mistry, 2014). The amygdala and the hypothalamus help regulate mood and the perception of pain and pleasure. As opioids enter the amygdala and hypothalamus they act as agonists and bind to the opiate receptors. This binding allows the opioid to exert its pain-relieving and mood-altering effects, thus setting the stage for a cycle of abuse (Gruber, Silveri & Yurgelun-Todd, 2007). The process of addiction begins with the release of dopamine in the prefrontal cortex and amygdala, and the repeated release of dopamine caused by misuse of opioids further reinforces the addiction.
The role of genetics plays a critical role in the development of opioid use disorder. Family and twin studies show significant evidence for genetic factors that may increase the risk for developing an addiction to opiates. Specific genes that regulate dopamine transmission may be altered in individuals with opiate dependence, and those gene alterations may be inherited (Mistry, 2014). Other research has shown that a predisposition for compulsive and risk taking behaviors has a genetic basis. These behaviors are crucial for the establishment of substance use disorders (American Psychiatric Association, 2013).
The psychological factors leading to the initiation of opioid use disorder vary greatly. Stress, previous traumatic events, compulsive and risk taking behaviors all contribute to this disorder (Substance Abuse and Mental Health Services Administration, 2018). There seems to be a link between how the brain processes physical pain and emotional pain, and those who have struggled with pain caused by a medical condition may be at greater risk for opioid addiction. In one study, patients with a chronic illness who experienced negative emotions like sadness or anxiety reported self-medicating with opioids when they had received a legal
prescription for the drugs (McMains, 2017). People who have experienced an intensely stressful life event and those who have been diagnosed with depressive disorder are also at greater risk for developing opioid use disorders (Substance Abuse and Mental Health Services Administration, 2018), and adolescent use of marijuana or narcotics also increases susceptibility to opioid dependence (Mistry, 2014). Opioid use disorder greatly increases the risk of suicide for individuals with major depression (American Psychiatric Association, 2013).
The sociocultural influences on opioid use disorder cannot be underestimated. According to research, the most prominent factors leading to the development of this disorder are race, gender, availability of opioids and age. The Diagnostic and Statistical Manual states that the largest percentage of individuals suffering from this disorder are Caucasian women with easy access to prescription opioids (American Psychiatric Association, 2013). Furthermore it appears that older white females are particularly prone to the misuse of opioid drugs. These patients normally present with legitimate medical conditions requiring pain management. The patients follow the prescribed course of treatment, unaware of the addictive properties of opioid pain medications. This compliance along with readily available prescription drugs ultimately leads to the development of opioid use disorder (Webster, 2012). Since 1999, the death rate caused by opioid overdose has increased dramatically, with more than 17,000 deaths attributed to opioid use in 2011 (Substance Abuse and Mental Health Services Administration, 2018).
Numerous treatment options exist for individuals suffering from opioid use disorder, which include pharmacological and psychosocial methods. Pharmacological treatments involve the use of medications and consist of management and maintenance therapies. Management
treatment plans are designed to assist in the control of complications arising from opioid withdrawal. Medications such as clonidine and naltrexone are administered to alleviate symptoms and aid in detoxification. This type of program also helps the individual enter into a long-term recovery program (Mistry, 2014). Maintenance treatment programs are intended for individuals with a long-term history of opioid use. Agonist opioid medications such as methadone or buprenorphine are given to stabilize the patient and assist in their transition to a more complete rehabilitation program (Kleber et al., 2006).
Psychosocial treatments are intended to quell the use of opioids through the modification of compulsive behaviors and enhanced motivation. In addition, learned coping skills and improvement of social interaction skills are goals of this form of therapy (Schuckit, 2016). Two examples within the realm of psychosocial therapy are motivational enhancement therapy and social skills training. Motivational enhancement therapy involves the use of a combination of psychotherapeutic techniques. This form of therapy involves empathetic questioning to ascertain an individual’s goals and attitudes towards drug use behaviors. The therapist then listens intently to the individual’s answers in an attempt to inspire a discontinuation of opioid use. Social skills training focuses on the development and reacquisition of social and communication skills. An individual with an opioid use disorder often has poor or severely inadequate social and communication skills. Improvements in communication, listening, body language and adaptability to new situations are goals of this modality. Results have been mostly positive when used as part of a more complete rehabilitation program (Kleber et al., 2006).
The serious ramifications of opioid use disorder affect not only the individual but society as a whole. An understanding of associated biological, psychological and sociocultural factors
assist in the diagnosis and prevention of this disorder. In addition, awareness of available pharmacological and psychosocial treatments aids in recovery and rehabilitation. This understanding and awareness is essential in combating the proliferation of opioid use disorder.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing
Gruber, S. A., Silveri, M. M., & Yurgelun-Todd, D. (2007). Neuropsychological consequences of opiate use. Neuropsychology Review, 17(3), 299-315. doi:http://dx.doi.org/10.1007/s11065-007-9041-y
Kleber, H. D., Weiss, R. D., Anton, R. F., Rounsaville, B. J., George, T. P., American Psychiatric Association Steering Committee on Practice Guidelines. (2006). PART A: Treatment recommendations for patients with substance use disorders. The American Journal of Psychiatry, 163(8), 5-82. Retrieved from ? url=http://search.proquest.com/docview/220505197?accountid=15019
McMains, V. (2017, November 27). ‘Negative Emotions’ Linked to Higher Rates of Opioid Use in Sickle Cell Disease. Johns Hopkins Medicine. Retrieved from
Mistry, C. J. (2014). Genetics of Opioid Dependence: A Review of the Genetic Contribution to Opioid Dependence. . Current Psychiatry Reviews, 156-67. doi:http://doi.org/10.2174/1573400510666140320000928
Schuckit, M. A. (2016). Treatment of Opioid Use Disorders. New England Journal of Medicine, 357-68.
Substance Abuse and Mental Health Services Administration. (2018, March 14 ). Retrieved from Substance Use Disorders:
Webster, P. C. (2012). Medically induced addiction reaching alarming levels.
Canadian Medical Association Journal, 184(3), 285-6. Retrieved from