Opioid Addiction Develops And Perpetuates From A Carefully Arranged Interplay Of Six Factors

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Opioid addiction develops and perpetuates from a carefully arranged interplay of six factors: 1. Pleasure 2. Reinforcement 3. Tolerance 4. Withdrawal 5. Cravings 6. Social, medical, or legal problems Addiction typically develops when all six factors follow their natural course. These six elements form the basis of what I call the “Addiction Jigsaw Puzzle.” Let’s look at each of these six factors in the order they usually develop. PLEASURE It is human nature, often unconsciously driven, to choose pleasurable activities over less enjoyable or painful ones. For example, good-tasting food loaded with fat, salt and calories may win over healthier choices blander in taste, lower in salt, and lower in calories. However, pleasure can have a…show more content…
As the person uses more of the opioid for pleasure, there is a greater likelihood that the next phase, tolerance, will develop. Reinforcement is the second piece of the Addiction Jigsaw Puzzle. TOLERANCE Tolerance plays perhaps the most important role in promoting addiction. When we use a medication to treat an illness, a specific dose should produce the same response dose after dose. However, that is not true for opioids. With repeated use, opioids become less effective at relieving pain and producing pleasure. We call this phenomenon tolerance. As tolerance rises, so does the need for more of the opioid to produce the effects experienced at lower doses. Eventually, the person may consume astronomical amounts of opioids to satisfy the increase in tolerance. As an example, I treated a young man consuming over 1000 mg of morphine daily. For reference, the usual starting dose of morphine is 30-60 mg daily. He was fully alert without a hint of fatigue, unsteadiness in his gait or incoherence in his speech. That same dose in a person without built-up tolerance would easily be fatal. Tolerance is the third and the most critical piece of the Addiction Jigsaw Puzzle. WITHDRAWAL SYMPTOMS AND CRAVINGS Whereas tolerance is the most important factor promoting addiction, withdrawal symptoms and cravings are the most important factors perpetuating addiction. At high tolerance, suddenly stopping or even reducing the amount of opioid a person uses produces
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