Contributed by Staff Member of Timberline Knolls
Opioids are effective pain relievers. Yet, they can also lead to dependence or addiction. At the same time, patients with mental health issues are more vulnerable to become dependent on opioids. Alternately, long-term use of opioids can also heighten the risk of developing a mental health problem.
Understanding Opioid Addiction
Opioids are a class of substances that include the illicit drug heroin, as well as prescription pain relievers, such as oxycodone, morphine, fentanyl, hydrocodone, codeine, and others. Doctors typically prescribe opioids to relieve pain resulting from a surgery or an injury.
Opioids substances function by interacting with the opioid receptors on the brain and nervous system, which relieves pain and induces pleasurable effects. This effect can become highly addictive, influencing a susceptible individual toward substance abuse.
According to the American Society of Addiction Medicine (ASAM), opioid addiction is driving the drug overdose epidemic in the United States, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015 alone. In 2017, doctors in the United States wrote more than 191 million prescriptions for these drugs.
Of the 20.5 million Americans, 12 years or older, that had a substance use disorder in 2015, 2 million of these were related to prescription pain relievers and 591,000 had a substance use disorder involving heroin.
Opioids and Mental Health Disorders
Substance abuse disorders and addiction are characterized as primary, chronic and relapsing brain diseases. The nature of addiction can cause abusers to experience one or more symptoms of another mental illness, just as mental illnesses can lead to drug abuse. For example, a person who is experiencing chronic depression may turn to mind-altering substances as a means to help cope with emotional distress.
Patients with a mental health condition such as depression or anxiety are more likely to get opioid prescriptions and exposed to a greater risk of developing a dependence on these drugs. Even though 16 percent of Americans have mental health disorders, they receive more than half of all opioid prescriptions.
People with mood and anxiety disorders are twice as likely to use these drugs as compared to mentally sound individuals. They’re also more than three times as likely to misuse opioids.
Having a mental health disorder also raises the odds of staying on opioids long-term. Adults with mood disorders are twice as likely to take these drugs for long periods as those with no mental illnesses.
A reverse relationship also exists. Evidence suggests that opioid use can contribute to mental health problems.
A 2016 study in the Annals of Family Medicine found that about 10 percent of people prescribed opioids developed depression after a month of taking the drugs. The longer they used opioids, the greater their risk of depression grew.
Understanding the Connection Between Drugs & Mental Illness
It is important to understand that both mental illnesses and drug use disorders, like an opioid addiction, are caused by overlapping factors, such as exposure to stress and/or trauma, underlying brain deficits, genetic predisposition, and more.
While addicts will display a higher rate of mental illness comorbidity, opiate addicts may experience more severe effects from mental illness as a result of the effects caused by their drug of choice. Some of the most common mental illnesses that are comorbid with opioid addiction include, but are not limited to:
- Anxiety/Panic Disorders
- Post-traumatic Stress Disorder
- Sleep Disorders
- Bipolar Disorder (Manic Depression)
- Adult Attention Deficit Hyperactivity Disorder
There are several possible reasons for this connection. Self-medication to escape symptoms of mental health issues and pain being a common symptom are important reasons to consider. Opioids may also not work well in people with mental illness causing patients to take increasingly greater doses. Furthermore, people with mental illness may have genes that can predispose them to greater risk of addiction. Trauma can also contribute to both mental illness and opioid addiction.
Getting Help for Substance Abuse & Mental Illness
Mental illness on its own warrants comprehensive and extensive treatment, and when comorbid with opioid addiction, all-encompassing treatment is needed to adequately address the complex issues involved. In many cases, a person suffering from an opioid addiction may enter addiction treatment without awareness of a co-occurring mental illness, like depression or anxiety.
Thorough screening in addiction treatment programs by specialized professionals can help identify any other illnesses in addition to the substance abuse and need to be prioritized for successful and sustainable recovery.
Ideally, an individual should receive simultaneous treatment for both the opioid addiction and mental illness, including psychotherapy, support groups, detox, pharmacotherapy and more to deliver the best possible chances of successful recovery.
: Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1
: Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51). Retrieved from http://www.samhsa.gov/data/.
: National Institute on Drug Abuse. (2015). Drugs of Abuse: Opioids. Bethesda, MD: National Institute on Drug Abuse. Available at http://www.drugabuse.gov/drugs-abuse/opioids.
: American Society of Addiction Medicine. (2011). Public Policy Statement: Definition of Addiction. Chevy Chase, MD: American Society of Addiction Medicine. Available at http://www.asam.org/docs/publicypolicy-statements/1definition_of_addiction_long_4-11.pdf?sfvrsn=2.
: Centers for Disease Control and Prevention. (2014). Opioid Painkiller Prescribing, Where You Live Makes a Difference. Atlanta, GA: Centers for Disease Control and Prevention. Available at http://www.cdc.gov/vitalsigns/opioid-prescribing/.
Thank you to Timberline Knolls for providing this article.
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The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Addiction Hope understand that addictions result from a combination of environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on July 23, 2019
Originally published April 19, 2017. Current version updated with statistics, recent research & video.
Published on AddictionHope.com