What’s the Difference between Dependence and a Substance Use Disorder?
In the midst of an opioid epidemic, chronic pain patients are feeling neglected and judged due to heightened restriction of opioid medication. No one undergoing chronic pain management starts out with the goal of becoming addicted to their pain medication; nevertheless it happens at least 10 percent of the time.
Because of recent changes, many chronic pain patients who are no longer receiving their prescriptions are left without the direction or tools necessary to manage their condition. Some are trying to discontinue the opioids, but are unable to because they had developed a physical dependence on their medications. Others turn to other drugs and alcohol to escape the physical and emotional suffering associated with living with chronic pain. Regardless of where patients fall on this spectrum, A Healing Place – The Estates has a solution to help even the most challenging of cases.
Discussing Misunderstood Terms
There are many misunderstood terms or definitions when it comes to discussing medication management problems for people who are using opioids for chronic pain management. Starting with appropriate medication use, physical dependence, tolerance, medication misuse, medication misuse or abuse, pseudoaddiction and finally a medication use disorder frequently called addiction.
In order to understand opioid dependence it is best to first understand tolerance. Tolerance is a state of adaption in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time. In other words, tolerance is experienced when someone first used two or three pills to get relief, and now it takes four or five. As one’s tolerance increases, so does your body’s dependence on the chemicals.
As the body is exposed to the opioid medication for a prolonged period of time, it becomes expectant to receive the medication on a regular basis. If the body does not get its regular dosage of medication, the individual will experience physical withdrawal symptoms. These are typically flu like symptoms such as nausea, sweating, severe aching sensations, overall discomfort, as well as medication cravings. Learn more about the dangers associated with opioid dependence here. This does not mean the person is necessarily abusing or “addicted” to their medication.
The term pseudoaddiction is fairly new to the addiction treatment field but has been used in pain management for quite a while now. The point to remember is that even though pseudoaddiction looks like addiction, it is actually caused by an undertreated or mistreated chronic pain condition. However, at A Healing Place, the treatment plan for pseudoaddiction and addiction is identical. The major danger of pseudoaddiction is that if it is not adequately addressed, it will turn into full blown addiction—sometimes quickly, sometimes slowly.
In 2004, the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine collaborated on defining pseudoaddiction: Behaviors that may occur when pain is undertreated. Patients with unrelieved pain may become focused on obtaining medications, may “clock watch,” and may otherwise seem inappropriately “drug seeking.” Even behaviors such as illicit drug use and deception can occur in the patient’s efforts to obtain relief.
As a patient builds tolerance and develops dependence to opioid medication, they may begin to exhibit what seem to be addictive behaviors. Some of these behaviors include
- “Clock watching”, or counting the hours to the next dose.
- Obtaining or demanding early prescription refills.
- Always having pain medication on hand, even if you are not experiencing pain.
- Feeling anxiety as medication becomes scarce.
- Finding or augmenting pain relief with illicit drugs or alcohol.
Although these behaviors may seem concerning, they are often displayed by individuals with an undertreated pain condition. This can be due to either developing a heightened tolerance from years of opioid use, or from relying exclusively on opioid medication as a symptom management tool. When an individual is able to find healthy, holistic, or non-pharmacological solutions to managing their chronic pain, these behaviors usually subside rather quickly. This is a key difference between addiction and pseudo addiction.
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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. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, 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 (believe it or not) is the shortened definition of addiction provided by the American Society of Addiction Medicine. As you can imagine, there is no single qualifying criteria to categorize someone as an addict. A Healing Place – The Estates believes this to be true as well. We also believe a less stigmatizing, and appropriate, term is substance use disorder.
While we are more than happy to help those who identify as addicts, our programs are appropriate for anyone struggling in managing their chronic pain with a history of opioid use. This includes medication management issues, opioid dependence, medication misuse or abuse, pseudo addiction and substance use disorders (addiction). To learn more about how A Healing Place – The Estates is changing lives, call our intake staff at 844-388-4100, or visit https://ahealingplacetheestates.com/programs/