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Opioid Use Disorder

Opioid Use Disorder is a new diagnosis introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is a combination of two previous diagnoses – Opioid Dependence and Opioid Abuse.

There are a variety of different opioid drugs, including street drugs such as heroin, and those used in healthcare settings such as methadone, morphine, codeine, oxycontin, etc. The most notorious type of opioid use disorder is of Heroin (10% of people aged 12-17 years old in the United States with opioid use disorder take heroin). The most common one is that of analgesic opioids.

 

The diagnosis of opioid use disorder is made when someone has been using opioid drugs and has at least two of the following symptoms within a 12 month period:

  • Abuse – Taking more than intended/prescribed.
  • Dependence – Wanting to control use without success.
  • Seeking – Spending a lot of time obtaining, taking, or recovering from the effects of opioid drugs.
  • Craving – Having a strong urge towards it.
  • Dysfunction – Failing to carry out important roles at home, work or school because of opioid use.
  • Neglect – Continuing to use opioids, despite the use of the drug causing relationship or social problems.
  • Preference – Giving up or reducing other activities because of opioid use.
  • Lack of concern – Using opioids even when it is physically and psychologically harmful.
  • Tolerance – Needing a higher dose for the same effect
  • Withdrawal – when opioids are not taken.

Chronic users can develop normal physical responses to prolonged drug exposure

Addictive disorders are primarily psychological in nature. Chronic users can develop normal physical responses to prolonged drug exposure, but that alone does not constitute an opioid use disorder if they have no cravings for the drug, no difficulty using appropriate dosages, and no lifestyle problems as a result of taking the drug. Using an illicit opioid drug such as heroin does not mean that the individual has an opioid use disorder unless they manifest signs of addiction. It is possible for heroin users to control their drug use, and show no psychological, physical or social signs of addiction. They do not qualify for this diagnosis as they are able to regulate their drug use, use safer methods of taking the drug, can stop when they need to, and keep their drug use from hurting their social life. These users who are able to control and manage their use tend to be more psychologically healthy and socially well-adjusted. Conversely, those who develop heroin use disorder often have very significant psychological problems, to begin with.

The most common way to screen substance abuse disorder is the CAGE questionnaire. If someone answers yes to any of these questions, they would undergo a more comprehensive assessment.

C – “cut down” – “Have you tried to cut down on your drinking or drug use, but couldn’t?”

A -“annoyed” – “Are family and friends annoyed about your drinking or drug use?”

G -“guilty” –  “Do you ever feel guilty about your drinking or drug use?”

E -“eye opener” – “Do you have a drink or use drugs as an ‘eye-opener” in the morning?

There are other more sophisticated tools, such as Opioid Risk Tool, which calculates the factors that place individuals at greater risk of having a substance use disorder, such as the past family and personal history of substance use, a history of childhood sexual abuse, age, and history of past or present psychological disorders, etc.

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