opioid addiction is a chronic brain disease

Definition of Opioid Use Disorder

According to the American Society of Addiction Medicine, addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. Struggle and disorder are reflected by an individual pathologically pursuing reward and/or relief through substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, cravings, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. This chronic illness has a biological basis and does not indicate a moral failing or overarching lifestyle choice.

Symptoms and diagnosis of Opioid Use Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, the diagnosis of “opioid use disorder” can be applied to someone who uses opioid drugs and has at least two of the following symptoms within a 12 month period: 


1. Taking more opioid drugs than intended 

2. Wanting or trying to control opioid drug use without success

3. Spending a lot of time obtaining, taking, or recovering from the effects of opioid drugs     

4. Cravings opioids

5. Failing to carry out important roles at home, work or school because of opioid use 

6. Continuing to use opioids, despite use of the drug causing relationship or social problems 

7. Giving up or reducing other activities because of opioid use 

8. Using opioids even when it is physically unsafe 

9. Knowing that opioid use is causing a physical or psychological problem, but continuing to take the drug anyway 

10. Tolerance for opioids

11. Withdrawal symptoms when opioids are not taken

Why is addiction so difficult to treat?

Opioid tolerance, dependence, and addiction are all manifestations of brain changes resulting from chronic opioid abuse. The opioid abuser’s struggle for recovery is in great part, a struggle to overcome the effects of these physiological changes. Medications such as methadone and buprenorphine act on the same brain structures and processes as addictive opioids, but with protective or normalizing effects. Despite the effectiveness of medications, they must be used in conjunction with appropriate behavioral health therapies. At Durango Recovery Center, we recognize both the biological basis of addiction and each person’s unique sociocultural situation, and work to individualize treatment to each person. Our goal is to deliver compassionate, evidence-based care that improves quality of life and daily life functioning.   

Neurobiology of Addiction

Pleasure derived from the activation of the brain’s natural reward system through the use of opioid substances promotes continued drug use during the initial stages of opioid addiction. Subsequently, repeated exposure to opioid drugs induces the brain mechanisms of dependence, which leads to daily drug use to avert the unpleasant symptoms of drug withdrawal. Further prolonged use produces more long-lasting changes in the brain that may underlie the compulsive drug-seeking behavior and related adverse consequences that are the hallmarks of addiction.


There are three important classes of opioid receptors: 


1.  μ receptor or Mu receptors: Three subtypes: μ1, μ2 and μ3 receptors. Present in the brainstem and the thalamus, activation of these receptors can result in pain relief, sedation and euphoria as well as respiratory depression, constipation, and physical dependence.


2.  κ receptor or kappa receptor: Present in the limbic system. Activation of this receptor causes pain relief, sedation, loss of breath, and dependence.


3.  δ receptor or delta receptor: Widely distributed in the brain and also present in the spinal cord and digestive tract. Stimulation of this receptor leads to analgesic as well as antidepressant effects but may also cause respiratory depression.


Opioids target the brain's reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who misuse drugs; the desirability of these effects leads users to repeat the behavior. Our brains are wired to ensure that we will repeat life-sustaining activities by associating those activities with pleasure or reward. Whenever this reward circuit is activated, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again, without thinking about the effects. Because drugs of abuse stimulate the same circuit, we learn to abuse drugs in the same way. 

Harm Reduction

Because we at Durango Recovery Center bring the best available science to our treatment plans, we employ a harm-reduction approach to addiction treatment and lifelong recovery. Harm-reduction uses practical strategies to reduce the negative consequences of drug use.


Harm reduction focuses on minimizing the harm caused by the ways people use drugs. Harm can be physical, psychological, or social in nature, including the physical rituals of use, criminal or dangerous activities, and the deterioration of one’s former lifestyle and wellbeing. Injecting a drug such as heroin—especially on a daily basis—can damage veins and can even cause veins to collapse, compromising circulatory function. Injecting can also lead to the transmission of diseases, such as hepatitis and HIV, through sharing needles and equipment with other drug users. Re-using equipment, and injecting impure drugs can also lead to various kinds of infections and poisonings, which can be life-threatening. Another very real physical harm that can occur from opioid use is overdose. Once a dose of opioids has been taken, the body has to cope with the effects of the drug on the body, which can include slowing breathing and heart rate to the point where the person falls unconscious and may die. Because methadone and buprenorphine are given orally, these medications combat many of the negative side-effects and risks of illicit drug use, and are considered a form of harm reduction, and an integral component of successful opioid treatment and recovery.

Financial cost of the opioid crisis

 A 2011 study published in the journal Pain Medicine, estimated that healthcare costs related to prescription opioid abuse amounted to $25 billion dollars; cost to  the criminal justice system was estimated at $5.1 billion. The largest cost however, was to the workplace at $25.6 billion, in the form of lost earnings and employment.  


Sadly, these figures do not include the economic value of loss of life.  Accounting for the 42,249 opioid-related deaths in 2016 and multiplying those numbers by $5 million dollars—a figure commonly used by insurance companies to value a human life—loss of life alone, costs the economy an additional sum of $211 billion dollars a year.  Opioid prevention and treatment costs a fraction of these estimates.


The opioid crisis amounts to a total estimated societal cost of $237 billion dollars at current levels.  


Birnbaum, H., White, A., Schiller, M., Waldman, T., Cleveland, J. & Roland, C. (2011). Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States. Pain Medicine, 12, 657-667.    

What is addiction treatment?

Addiction Treatment at Durango Recovery Center

  • An opioid addiction treatment center is a facility that specializes in helping clients overcome opioid addiction.  According to the National Institute on Drug Abuse, approximately 20% of all drug treatment admissions are opiate/opioid related. 

What are Opioids?


Opioids include illegal drugs such as heroin, as well as prescription medications used to treat pain including: 

  • morphine
  • codeine
  • oxycodone (OxyContin®, Percodan®, Percocet®)
  • hydrocodone (Vicodin®, Lortab®, Norco®)
  • fentanyl (Duragesic®, Fentora®) 
  • hydromorphone (Dilaudid®, Exalgo®)

What type of treatment is right for me?

When looking at treatment options for opioid addiction, the first choice to make is whether to go to an outpatient or inpatient recovery center. Outpatient opioid treatment programs offer many of the same services as inpatient programs, but patients do not stay at the facility. In general, outpatient opioid treatment programs are better suited for those whose addictions are less established, as well as those who are not able to leave home for some reason. Inpatient opioid treatment facilities offer residential care and all residents live on site. The facility takes care of all needs, including room, board, behavioral health therapy, medication, adjunct therapy and treatment for potential co-occurring disorders. Inpatient recovery treatment is recommended for those who have struggled with opioid addiction for a long time, those who have relapsed several times, or those with a dual diagnosis (people with a mental health condition as well as opioid addiction issues).

How much does it cost to go to an opioid treatment facility?

According to Centers for Disease Control counts, in 2016 a total 63,600 people died from overdose in the United States, with 42,249 individuals from opioid substances alone; this staggering number outpaces American deaths from breast cancer each year by over 1,000 individuals. Unfortunately, surveying trends in use and related deaths, this number is unlikely to reverse any time soon. 


Particularly when looking at attending a private facility, a common concern is the cost of treatment and perceived barriers to access. Do not let the price tag dissuade you from attending an opioid addiction treatment center. Treatment saves lives! Many opioid addiction treatment centers accept insurance or work with insurance companies to help assure adequate treatment for the patient and reimbursement. This is particularly true since the Affordable Care Act stipulates that certain health plans must cover benefits that include treatment for substance abuse. Even facilities that do not take insurance often have financing options to make paying for life-saving treatment easier. Please refer to our admissions page for more information.

What should I expect?

At Durango Recovery Center, we treat clients in four phases:

  1. Intake
  2. Induction into medication assisted treatment
  3. Behavioral health therapy and maintenance
  4. Recovery including ongoing self-care and support

Intake


During intake, clinical staff ask questions to get a better understanding of the patient's situation and whether they are a good fit for the treatment center. Practitioners usually get a family history (including history of addiction), more information on the person's situation (how long they've been using their drug of choice, progression, etc.), and payment information. Federal law requires all treatment centers to keep patient information confidential.  Stays of 60 to 90 days are often the recommended best course of treatment.


Induction

  

Due to the specific nature of opioid and other substance use addictions, treatment centers specializing in treatment of these disorders are specially equipped to help ease a client’s experience of withdrawal by providing a substitute drug. When someone uses an opioid like OxyContin, Vicodin, or heroin for an extended period of time, the body adjusts to a “new normal.” The drug becomes physiologically required in order to function properly; once the drug is removed, the body goes into withdrawal. Without proper care, withdrawal can be painful. With the right care, it can be a much more comfortable process. Medication assisted treatment utilizes medication to ease withdrawal and aid in the overall recovery process. Methadone is used primarily for those struggling with heroin addiction. Some recovering from heroin addiction continue to take methadone for months or even years after stabilization. Buprenorphine is another medication for treating addiction to prescription opioids. Naltrexone can be used to curb both opioid and alcohol cravings. Research indicates use of these medications for an extended period of time produces longer recovery and better outcomes. This type of intervention is called maintenance therapy.


Behavioral Health Therapy

In some cases, drug addiction began in part as an attempt to self-medicate—to treat oneself for escape of pain or overwhelm in life. Recovery, including addiction therapy, is in part about validating one’s original suffering, learning to cope, and moving beyond the need for opioids or other substances to numb emotional or psychological pain. We offer a combination of individual and group therapy. We also offer family therapy. 


Therapy is helpful in learning to healthfully address everyday life issues such as:

  • Learning how to productively work through intense emotion and thought patterns, and learning how to become more resourceful and resilient in the process
  • Working through past trauma or distress
  • Learning how to identify addiction triggers and what to do when these triggers arise
  • Support in establishing a healthy new life, and healthy thought and emotional patterns
  • Working to establish a thriving lifestyle and supports as the ideal way to ensure sobriety

What happens after treatment?

Leaving Durango Recovery Center is not the "end" of recovery. Like many things, staying sober is an ongoing commitment. Following treatment, some people may choose to live in a sober living environment for a period of time, such as transitional housing. The most important thing in recovery, is to determine what works for a specific individual, and then commit. Opioid and substance use addiction can destroy lives. Addiction treatment however, can be extremely effective and help participants end substance abuse for good. Many people go through recovery and go on to live productive, fulfilling, and happy lives. Making the choice to end addiction is courageous. It is also the start of a new life--one based on greater self-awareness and an expanded sense of support, community, and possibility.