Is opioid addiction a mental illness? Yes. It’s a brain disease caused by changes in the brain that occur from opioid abuse. However, opioid addiction can also be at least partially caused by an underlying mental condition like depression, anxiety or PTSD. Someone addicted to opioids doesn’t necessarily have a concurrent mental condition, but there is a high chance that they do.
What is Addiction?
In simple terms, addiction is using a substance for non-medical reasons even when this substance is clearly damaging to the person’s body and relationships. Physical dependence on a drug is not in itself an indicator of addiction. Anyone who takes opioids on a daily basis for any length of time will become physically dependent on the drug. It’s unavoidable, because it’s just how opioids work in the body. Addiction is different. It’s physical dependence, yes, but that’s only part of it. The part that makes it addiction and not just physical dependence is the compulsion to continue using the drug no matter what and for non-medical reasons.
Someone who is addicted will show drug-seeking behaviors like raising their dose, trying to get more pills, asking for refills early and visiting more than one doctor to get more. An addicted person cannot stop or control their drug usage. They can’t taper their dose alone. If the drug is around, they will use it until it’s gone.
Someone who is physically dependent but not addicted will typically follow their doctor’s directions. They don’t take more than is prescribed and do not run out early. They can quit when they want to and also taper their dose if they want to. There is no psychological component. They’re not using the drug to cope with life or to soothe emotional pain. They are taking it for physical pain to have a better quality of life.
How Does Addiction Happen?
Opioids work in the brain by binding to and activating cell receptor sites called mu, delta and kappa. It’s the mu site that is most associated with pain relief, sedation, overdose and addiction. When opioids are taken daily over a period of time, several things happen. The receptors become less sensitive to the opioid, and the brain actually grows more receptor sites to cope with the influx of outside opioids. The brain also stops producing its own opioids called endorphins. These are necessary for normal mood and to experience pleasure. They’re also necessary to control pain in the body from everyday living. The outside opioids have taken over these functions, so the body stops producing its own endorphins, because it doesn’t have to.
The liver also starts to manufacture enzymes that break down the opioid faster and faster. This means that less and less of the drug reaches the brain. This contributes to tolerance, which is the need to take more and more of a drug to get the same effect.
It’s all a constellation of effects that leads to eventual brain changes that lead to addiction in susceptible individuals. The addicted brain can no longer function without the presence of the drug.
Genes, Environment and Addiction
Genes may play a role in addiction at least half of the time. 50 percent of anyone’s risk for addiction may directly be related to their genetic makeup. The other half of the risk factor is environmental and possibly other causes not yet well understood. However, neither of these factors mean that someone will absolutely become addicted at some point. Each can modify and influence the other. There is also the question of exposure. No matter how genetically inclined someone might be for addiction, if they never take the addictive substance, they will not become addicted.
Someone who grew up in a house where addictive behavior was common may be at greater risk for addiction, but if they don’t also have the genetic predisposition for it, it may never happen.
What is Mental Illness Anyway?
According to the American Psychiatric Association, mental illness is a health condition involving changes in thinking, cognition, emotion and behavior or any combination of these. There is usually some distress and difficulty in coping with life. Examples given are dementia, depression, bipolar disorder, PTSD, autism, OCD and schizophrenia. These are very different conditions with highly varying levels of functionality. However, opioid addiction, as well as all addictions, fit the basic American Psychiatric Association definition. All cause changes in thinking, emotion and behavior at least to some degree.
Are you Struggling with Substance Abuse?
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