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Signs of Dependence

Recognize some of the signs:

  • Needing to take more of the drug to get the same effect – or getting a lesser effect from the same amount of drug
  • Experiencing withdrawal symptoms when not using opioids, or taking opioids to relieve or avoid withdrawal symptoms
  • Taking larger amounts of opioids than planned or prescribed, and for longer periods of time
  • Cravings for opioids
  • Persistently wanting to quit, or trying unsuccessfully to quit
  • Spending a lot of time and effort to obtain, use, and recover from taking opioids
  • Giving up activities because of substance abuse
  • Continuing to use in spite of negative consequences
  • Failing to fulfill major obligations
  • Recurrent use in hazardous situations
  • Continued use despite social or interpersonal problems
  • Avoiding people or places that do not approve of you using drugs
  • Job or school is suffering
  • Life at home is extremely unhappy
  • You feel defensive, guilty, or ashamed
  • Have irrational or indefinable fears
  • Have you ever overdosed?
  • Do you ever question your own sanity?
Understanding Dependence

Opioid dependence is a disease in which there are biological or physical, psychological, and social changes. Some of the physical changes include the need for increasing amounts of opioid to produce the same effect, symptoms of withdrawal, feelings of craving, and changes in sleep patterns. Psychological components of opioid dependence include a reliance on heroin or other drugs to help you cope with everyday problems or inability to feel good or celebrate without using heroin or opioids. The social components of opioid dependence include less frequent contact with important people in your life, and an inability to participate in important events due to drug use. In extreme cases, there may even be criminal and legal implications

The hallmarks of opioid dependence are the continued use of drugs despite their negative affect, the need for increasing amounts of opioids to have the same effect and the development of withdrawal symptoms upon cessation.

There are a variety of factors than can contribute to the continued use of opioids. Among these are the use of heroin to escape from or cope with problems, the need to use increasing amounts of heroin to achieve the same effect, and the need for a “high.”

In 2002, more than 400,000 people ages 12 and over reported using heroin in the previous year. An estimated 3.7 million people reported having used heroin at some time in their lives.

Recently, inexpensive high-purity heroin has become more available. Rather than injecting, many new users are smoking or snorting heroin, with the misconception that these routes are less addictive. In addition, use among younger adults is growing rapidly.

Dependence vs Tolerance

Tolerance, physical dependence, and psychological dependence are related - but still distinct - conditions that are often confused with one another. Understanding the difference between these conditions is important because the treatment considerations can vary widely. Pain patients, in particular, may be interested to learn that the likelihood of their becoming opioid-dependent is relatively slim, even when opioid use leads to tolerance or physical dependence.

Tolerance: Over time, repeated use of an opioid causes certain receptors in the brain to become tolerant (ie, less responsive) to opioids - in other words, more of an opioid is needed to produce the same effect.

A physical dependence on opioids means that the brain has made so many changes in response to repeated opioid stimulation that it now actually needs opioids to function "normally."

Psychological dependence involves continued drug use for reasons other than tolerance and withdrawal, such as a desire to experience a drug's pleasurable effects. The hallmark of psychological dependence - compulsive drug seeking and use - stems in large part from intense opioid cravings caused by complex neurological changes.

Opioids and the Brain

Opioid dependence is a long-term medical condition that causes changes in the brain. According to the National Institute on Drug Abuse (NIDA), people believe at first that they can stop using drugs on their own. But after going through cycles of withdrawal and return to drug use, people begin to fear the withdrawal symptoms. They spend time making sure that they continue to keep a level of drug in their system in order to avoid the intense withdrawal symptoms.

The need to satisfy cravings or avoid withdrawal can be so intense that people who want to stop taking opioids find this difficult to do. Or, they may find themselves doing things they wouldn’t ordinarily do in order to obtain more of the drug they crave. For this reason, even though opioid dependence is a medical condition and not a moral failing, it can drive behavior.

Substances such as opioids that produce euphoria are considered to have high reinforcement potential, which increases the likelihood that they will be taken repeatedly or abused.

Importance of Counseling

Stopping the use of heroin or painkillers is an important step in the treatment of opioid dependence. However, it is only the first step - the next step is not starting again. Reducing the risk of relapse is actually something that opioid-dependent patients learn how to do.

Helping patients to develop the skills to avoid the triggers and situations that might put them at risk is one of the key functions of counseling during treatment.

Counseling has other benefits, too, such as:

  • Helping patients substitute positive behaviors for substance use
  • Helping patients work toward realizing their treatment goals
  • Providing support, encouragement, and hope

Numerous studies have shown that long-term treatment success (ie, stopping any use of drugs of abuse) is more likely when patients regularly participate in counseling as part of their opioid dependence treatment.

Meetings and Resource Links

Because it is impossible to take substances away from an addict without replacing that empty spot with something more powerful than the addiction itself, below is a list of links and resources to help you toward your goal of living drug free. It is important for you to know you are not alone!

Click here to download Facts for Patients in PDF form

NA or AA meetings are FREE and abundant wherever you live. Click here to find an AA meeting near you or click here to find an NA meeting.

Because addiction affects family and friends... Find an Al-Anon/Alateen meeting near you.

Learn more information about substance abuse at the National level at the National Institute on Drug Abuse