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

1498 WordsJul 31, 20166 Pages
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 support 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. 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 downside. Using our example…show more content…
REINFORCEMENT Should the person experiencing pleasure repeat the behavior to re-experience the pleasure, reinforcement sets in—that is, the more you do it, the more you want to do it. It’s analogous to a roller coaster ride at an amusement park. Those who enjoy the ride will want to repeat the ride over and over for the thrill of it produces. But for opioids, the person is digging a deep hole. As the person uses more of the opioid, there is a greater likelihood that the next phase, tolerance, will develop. Reinforcement is the second critical 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 repeat use, opioids become less effective both 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 more than 1000 mg of morphine daily. For reference, the usual starting dose of morphine is 30-60 mg daily. Yet, 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
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