What is it?
The current version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV-TR) defines opioid dependence as a syndrome characterized by a maladaptive pattern of opioid use, leading to clinically significant impairment or distress, as manifested by at least 3 of the following and occurring in a 12-month period.
- Tolerance (the need for increasing doses of medication to achieve the initial effect of the drug)
- Withdrawal symptoms (see opioid withdrawal)
- Use of opioids in larger amounts or for longer periods than intended
- Persistent desire or unsuccessful efforts to cut down or control opioid use
- Significant amounts of time spent in activities to obtain and use opioids
- Important social, occupational, or recreational activities are given up or reduced
- Continued opioid use despite knowledge of adverse consequences
Factors influencing the development of opioid dependance
Pharmacological factors contributing to opioid dependance can be much more prominent than with other types of drug use disorders. Opioids are very powerful reinforcing agents due to their euphoric effects and ability to reduce stress and anxiety, increase self esteem, and help coping with daily problems. It is for this reason that opioid dependance is often seen to develop as a result of self-medication. The rapid speed at which physical dependence develops combined with withdrawal symptoms upon abstinence are unique to opioid use and make abstaining from opioid use especially difficult.
One of the biggest contributing social factors is the widespread availability of opioid medications. This factor combined with the more acceptable social attitudes associated with prescription drug abuse has made experimentation easy. Except for the association between higher exposure to the drug and higher rates of addiction, the precise role of social factors in creating dependent and addictive behaviors is uncertain. It is interesting to note that while 20% of US soldiers in Vietnam from 1970-1972 became physically dependent on heroin, very few continued to use heroin in their civilian life.
On the psychological side of things, studies have shown that that well over half of opioid dependent patients also suffer from at least one severe psychiatric disorder. The results of study published in 2011 appear to show that preexisting mental health diagnoses increase the risk for long-term use of opioids among adolescents and young adults with chronic pain.
It has been determined that genetics can also play a role in increasing vulnerability for opioid dependence. Genetic factors affecting dopamine receptors/transporters, opioid receptors, serotonin receptors/transporters, proenkephalin, and catechol-O-methyltransferase (COMT) all appear to be associated with vulnerability to opioid dependence. Genetic research may be a key part in the development of medications used in the future for treatment of opioid dependence.
- ^ American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington DC: American Psychiatric Association. 2000. [Link]
- ^ Chen KW, Banducci A, Guller L, MacAtee RJ, Lavelle A, Daughters S, Lejuez CW. An examination of psychiatric comorbidities as a function of gender and substance type within an inpatient substance use treatment program. Drug and Alcohol Dependence Apr 2011; 118(2-3):92–9. [PubMed]
- ^ Richardson LP, Russo JE, Katon W, McCarty CA, Devries A, Edlund MJ, et al. Mental Health Disorders and Long-term Opioid Use Among Adolescents and Young Adults With Chronic Pain. Journal of Adolescent Health Jun 2012; 50(6):553-8. [PubMed]
- ^ Saxon AJ, Oreskovich MR, Brkanac Z. Genetic determinants of addiction to opioids and cocaine. Harvard Review of Psychiatry Jul-Aug 2005; 13(4):218-32. [PubMed]