The paper will introduce opiate addiction and explore its important aspects such its prescription, diagnostic criteria, etiology and opiate prevalence. The paper will also survey manifestation and course of opiate addiction and its differential diagnosis. The treatment of opiate addiction through self help and support groups will be explored in this paper. Assessment of the effectiveness of the available treatment methods will be discussed in detail.
The history of medical involvement in opiate addiction is depicted by political disagreements over deviance descriptions. According to Hunt, Milhet & Bergeron, the description of opiate abuse has differed from a late 19th century due to lack of concern as a societal problem to 20th century as a criminal offense of those use it (2011). Opiate addiction is pathological condition although in instances where opiates leads to addiction the amount of time involved cannot be simply predetermined (Hunt, Milhet & Bergeron, 2011).
Prescription Opiate Addiction
Worldwide there is a serious worry for opiate addiction and opiate overdose deaths. The United States Drug Enforcement Administration (DEA) defines drug abuse as the use of a Schedule II through Schedule V drug in a way or quantity that is incoherent with the medical or social pattern of culture (Lowinson, 2005). Schedule V drug refers to a class of drugs that have a small prospective for abuse or addiction. Opiate dependency in the addiction field is more than taking a large quantity of opiates. Lowinson (2005) says that a patient who takes a prescribed opiate on a regular basis may become physically dependant on the medication but is hardly an addict unless the patient’s behaviour meets the The Diagnostic and Statistical Manual for Mental Disorders (DSM) diagnostic criteria for opiate dependence (Hunt, Milhet & Bergeron, 2011).
Surveys have found fundamental increase in misuse of hydrocodone and oxycodone products. These are opiates and their availability has remained relatively stable from 1994 to 1999. Prescription opiate abuse relates to the inherent abuse liability of the prescribed opiate and its distraction from the intended route of distribution (Lowinson, 2005). Prescription opiate abuse is associated with certain pharmacologic properties. Opiates include morphine, heroin, codeine, meperidine, and hydromorphone. Heroin is available only unlawfully in the United States. Opiates are frequently used for pain control (Murphy & CowanBottom of Form, 2008)
The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM) delineates the diagnostic criteria for prescription opiate dependence and abuse. Opiate addiction is characterized by significant level of tolerance defined by the need for markedly increased quantities of opiate to attain intoxication or desired effect (DSM, 2000). For opiate dependence, tolerance is also defined by diminished effect with continued use of the same amount of opiate (DSM, 2000). Individuals also experience withdrawal which is marked by the typical withdrawal syndrome for opiates and remarkable withdrawal symptoms of dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea, diarrhea, yawning, fever, insomnia, gooseflesh, sweating (DSM, 2000).
Opiates are also taken to relieve or avoid withdrawal symptoms. The central feature of opiate diagnostic criteria is continued use of the drug despite persistent and recurrent social, occupational, psychological, or physical problems caused by the use of the drug (DSM, 2000). For opiate addiction to be diagnosed at least three signs must be present. Individual’s desire for the drug persists (Hunt, Milhet & Bergeron, 2011). The signs include craving for an opioid drug, rhinorrhea or sneezing, lacrimation, muscle aches or cramps, abdominal cramps and nausea or vomiting (DSM, 2000).
Opiate addiction is not restricted to low socioeconomic classes even though the prevalence of opiate dependence is greater in these groups than in higher socioeconomic classes (Sadock, Kaplan & Virginia, 2007). Sadock, Kaplan & Virginia (2007) noted that social factors associated with urban poverty possibly contribute to opiate dependence. Studies indicate that 50 percent of urban opiate users are children of single parents or divorced parents and are from families in which at least one other member has a substance related disorder (Sadock, Kaplan & Virginia, 2007). Children from such settings are at high risk for opiate dependence particularly if they also evidence behavioral in school or other signs of conduct disorder (Sadock, Kaplan & Virginia, 2007). Sadock, Kaplan & Virginia (2007) indicated that “some consistent behaviour patterns seem to be especially pronounced in adolescents with opiate dependence” (p. 445). Opiate addicted individuals experience behavioral powerlessness counteracted by disturbances in social and interpersonal relationships with peers maintained by mutual substance experiences (Sadock, Kaplan & Virginia, 2007).
The prevalence of opiate addiction is determined by several factors. The first one is availability of the drugs. This implies that the greater the availability, the greater frequency of addiction (Souhami & Moxham, 2002). The second factor is the accessibility of the drug. This explains the virtual commonness of drug addiction amongst doctors and nurses and in big cities and coastal areas in a certain state or country (Souhami & Moxham, 2002). Souhami & Moxham (2002) noted that the most important cause of opiate addiction is its availability.
Availability of opiates means that susceptible individual expose themselves to the drug, either because they inhabit a subculture in which drug taking is prevalent, or because they are psychologically susceptible owing to family difficulties, dejection or boredom (Souhami & Moxham, 2002). Murphy & CowanBottom of Form (2008) says that opiate use and abuse are common in the United States. Prevalence for heroin dependence is about 0.1 percent, and prescription pain reliever dependence is about 0.6 percent. People who use opiates recreationally become addicted (Murphy & CowanBottom of Form, 2008).
Manifestation and Course of Addiction
Pharmacological features of opiates tolerance and withdrawal syndrome ensure the establishment of a habit, and as well as physiological factors that enable people to maintain the addiction and make rehabilitation difficult (Souhami & Moxham, 2002). Souhami & Moxham (2002) indicated that “it is possible that individuals susceptible to addiction may genetically be deficient in endorphins and hence opiate hungry” (pg. 243). Opiates reduce the amount and effects of other cerebral neurotransmitters such as acetycholine (Souhami & Moxham, 2002).
In their research, Souhami & Moxham (2002) also articulated that cerebral neurotransmitters has led to the super sensitivity theory of withdrawal syndrome, which postulates that addicted individuals have reduced amounts of transmitter reaching postsynaptic receptors. Halting opiates results in a sudden increase in transmitter and stimulation of the already supersensitive receptor. Continued use of opiates causes long term transformations in the brain that can be successfully treated with prescriptions (Fulco, Liverman & Earley, 1995).
Opiate withdrawal occurs when an individual with a chronic opiate addict abruptly stops or dramatically reduces opiate use. Miller & Gold (2011) says that although abandonment from opiates causes bodily discomfort, it is not life threatening. Miller & Gold (2011) established that “the most general treatment for opiate withdrawal is methadone alternative; in which methadone is replaced with the drug for the addicted person and then slowly reduced once the patient is soothed” (p. 102). Since methadone has a longer half-life than other opiates, the withdrawal and threats of difficulties are reduced, creating a smoother treatment. Furthermore, methadone can be orally given since it is a long-acting agent (Miller & Gold, 2011).
The DSM differential diagnosis
Differential diagnosis enables a clinician or practitioner to characterize a disorder from another disorder that has similar features and criteria. The diagnosis of opiate addiction is generally obvious after a careful history of mental status and physical examinations (DSM, 2000). Opiate addiction is characterized by difficulties in solving problems, focusing on reading and writing and understanding what others say DSM (2000). The symptoms of opiate-related disorders are equivalent to the substance use disorders of Nicotine dependence, Nicotine Withdrawal, Cocaine Intoxication and Amphetamine or Phencyclidine Intoxication. DSM (2000) noted that opiate addicted patients like mental disorder victims experience a maladaptive pattern of drug use leading to clinically important distress.
Opiate dependence is illustrated by the incapacity to stop taking opiate drugs or medications (Junig, 2008). Opiate addicts have a fascination to use opiate prescription that persists even after months or years, when withdrawal has long passed (Junig, 2008). Junig (2008) noted that opiate addiction is infuriating to the individual addicted and to his or her loved ones. Life for an opiate addict revolves around the drug because the addict is preoccupied with finding the subsequent prescription so as to evade becoming dope sick (Junig, 2008). Stine & Kosten (1997) noted that there are two imperative characteristics of opiate dependence which include; easiness, regarded as a deteriorating drug effect after frequent administration and reliance exposed by a withdrawal condition after immediate discontinuation of opiate exposure. Opiates cause both bodily and psychosomatic dependence (Stine & Kosten, 1997).
Subsequently, regular prescription of opiates, going over a long period of time forms a physiological need for its sustained use (Lindesmith, 2008). Lindesmith (2008) established that “when regular use is bunged, a number of worrying symptoms materialize, rising in sternness in quantity to the period of dependence and depending upon the amount and regularity of the dosage” (p. 28). Researchers say that sustained use of opiates leads to an episodic, synthetically produced gloominess and distress which fades away instantaneously upon reiteration of the dosage. Within a period of three weeks of daily use, the moderation symptoms apparently increase at faster tempo and swiftly become very harsh and even treacherous (Lindesmith, 2008).
Opiate drugs can simultaneously interrelate with major types of receptors in the brain and act as an agonist (Fulco, Liverman & Earley, 1995). The prejudiced outcomes of opiates are arbitrated through activities at mu opioid receptors, and intrusion with actions at these receptors causes a rational plan for coming up with medications for opiate dependence (Fulco, Liverman & Earley, 1995).
Studies show that among the numerous effects of opiate drugs on neurons are alterations in gene expression. The modifications in gene expression are identified as significant in this type of dependence because of its steady and progressive expansion and the perseverance of many of its characteristics long after discontinuation of drug exposure (Fulco, Liverman & Earley, 1995). In addition, opiates can manage some transcription features that are significant in neuronal gene expression.
The idea of narcotics anonymous self-help group is a traditional and a valued approach of treatment to many drug addiction problems (Ghodse, 2010). Narcotics Anonymous is a support group for individuals suffering from drug addiction. Narcotics anonymous (NA) self help groups is a group of individuals with comparable problems who meet together willingly to help themselves. Opiate self help groups help individuals become ascetic (Ghodse, 2010). Ghodse (2010) says that “there is an underlying philosophy that it is impossible for an individual to overcome opiate addiction alone, but that this can be achieved with the help of the group” (p. 173). Self help groups also provide mutual aid of people helping each other by offering companionship and sharing universal experiences (Ghodse, 2010).
Ghodse (2010) indicated that self help groups provide group support, social recognition and social personality for individuals who may have become very isolated because of their drug problem. Opiate addicts in established groups have access to a wide range of experience and build up skills and knowledge that may be genuine and realistic help to those trying to manage with opiate addiction (Miller & Gold, 2011). Since those who able to cope with abstinent continue to attend the group for a while, new members are able to meet and identify with such people (Ghodse, 2010). These groups provide a life-long supportive program for sustained recovery. This is because opiate dependence is a chronic disorder in which there are many reversions (StellmaTop of Form. 1998).
Self help groups are open to everyone with any type of drug problem and the only prerequisite for membership is the aspiration to stop using drugs (Ghodse, 2010). The approach of self help groups is based on the idea of addiction as a spiritual and therapeutic disease that can be prohibited but never cured. Opiates addicts follow the twelve steps stipulated in NA and AA programme for attaining abstinence (Ghodse, 2010). Ghodse (2010) indicated that “the twelve traditions of AA and NA safeguard the freedom of the group by outlining the principles that guide its organization and administration” (pg. 174). The groups are autonomous, self supporting and decline outside contributions (Ghodse, 2010).
The members of opiate dependence self help groups attend meetings recurrently (Ghodse, 2010). Ghodse (2010) noted that “during the meetings there is often a discussion based on the Twelve Steps and huge amount of emphasis is placed on complete openness and honesty with other members of the group” (pg. 174). As an approach towards individual’s recovery, the single shared common issue creates a strong bond between the members (Ghodse, 2010). New members of the group are encouraged to look for a sponsor within the group, a particular person to turn to during incidents of great need. The mandate of being a sponsor can be rewarding for the person concerned (Ghodse, 2010).
Support groups differ from self help groups in the way they are organized and run (Ghodse, 2010). Support groups offer the third form of opiate addiction treatment. Ghodse (2010) noted that “support groups are run by a professional but they offer similar caring and non-critical environment” (pg. 175). The support groups play a fundamental role to individuals who are parents and they and their children have exceptional needs which can be taken care of to some extent in an informal group setting. For opiate addicts support groups assist in mutual support between the members by providing them with a time and place to meet (Ghodse, 2010). Ghodse (2010) indicated that for addicts who are parenting, support groups gives them a chance whereby they can chat about general child-care matters and important aspects of bringing up their families. Opiate dependence parents need this support but they may be reluctant to attend an ordinary playgroup because of anxiety about their drug problem (Ghodse, 2010).
Support groups are accommodating to those who have just come off opiates and who are still at risk of going back to opiate use (Ghodse, 2010). Ghodse (2010) established that “those who are near the end of a detoxification programme for example taking less than 10-15 mg methadone daily may also attend self help group” (pg. 196). Support groups are regularly organized as part of the total programme of services of an expert clinic. They are also organized by voluntary agencies as one component of community response to opiate abuse problem (Ghodse, 2010).
Support groups should use Yalom’s principles were leaders learn the maintenance of stable groups, culture building and the use of the here and now group leadership skills (Haight & Gibson, 2005). Haight & Gibson (2005) noted that Yalom’s principles help group leaders to carry out subgroupings, resolving crises in the groups, social reinforcement and act as transitional objects in the support groups. T
Narcotics Anonymous Experience
I attended a Narcotics Anonymous (NA) meeting so as to learn what actually goes on in such meetings. The group is well directed by a leader who ensures that no one is placed out of their profundity without intending to do so themselves. The meetings run for 60 to 90 minutes. In each meeting one of the twelve steps is read and discussed. They usually start with a word of prayer from the group leader and then afterwards Chapter 2 of the AA Big Book is read. The topics of discussion include the twelve steps and traditions of AA. Majority of the group affiliates are enthusiastically willing to read this narrative. Everyone is encouraged to get a sponsor to stand behind him or her. For example, with the analysis of the sponsor story we examined the significance of identifying a sponsor for constant support. After reading, the group member discussed about her understanding of how he or she used her sponsor over the last week.
After the introduction, the group leader asked if there were newcomers or members attending the meeting for the second time. At the same time a list was passed around for anyone who intends to be contacted over the week or wanted to be a sponsor. Afterwards, one group member narrated his opiate addiction tale. The meeting was then opened for general discussion among the members. All members reviewed their weekly progress according to set procedure. During this time other group members were discouraged from commenting on the individual check-in report. The group leader made brief summary comments that recognized and positively reinforced behavioral changes that established that the group members was making an effort to achieve moderation and stability.
After the break, the group members were asked to list common early warning signs of dejection, obsession and opiate addiction setbacks. Members were requested to bring in their daily symptom monitoring calculator to share what they noted about their symptoms and if they found it supportive. The whole procedure included five steps. The first step involved 15 minutes of the check-in procedure. The second step involved 5 minutes of the review of last week’s group topic and reading personal signals and early warning signs of trouble. The third step included the review of the last week’s skill practice questions on the first handout. Step four involved discussion of avoidance of high-risk situations and skills to refuse opiates if offered. The fifth step involved reviewing the skill practice for the next group and asking all members to keep developing and practicing their refusal skills.
When I attended the Narcotics Anonymous (NA) group meeting I acknowledged that people experience problems while overcoming opiate addiction. This approach of treatment is good because it encourages meeting other people with similar problems helps them to realize that they are not alone (Mueser, Noordsy & Drake, 2003).This models the experience of opiate addiction, resulting in social validation and acceptance of the members who attend. I realized that many people benefited from sponsorship (Mueser, Noordsy & Drake, 2003). This is because new members in the group choose a mentor with some experience, from whom he or she could learn and receive individual support. Sponsors helped new members both within and outside the group meetings.
In my view Narcotics Anonymous (NA) group meetings give members the chance to understand the treatment procedures and information that we obtain from books, libraries, internet and medical personnel. This is a big opportunity to confront, in a secure setting, all those detrimental opinion that we have cultivated for so long, and to generate new skills that overrun those delusions from the past. While attending the Narcotics Anonymous (NA) group meeting I noted that for people who were receiving professional care for their opiate addiction complications, self help groups are useful adjunct to their treatment (Mueser, Noordsy & Drake, 2003). Self help groups promote diverse membership in that people from all walks of life attend these groups, so that a person can usually find someone with who to identify with.
From the literature review it can be noted that self help and support groups play a fundamental role in the recovery of opiate addiction. The effectiveness of self help and support groups in the treatment and recovery of addicted individuals has been evaluated. It was found out that many people (35-65 percent) drop out in the first few months. Ghodse (2010) noted that those people who remain in the groups become active members. Ghodse (2010) commented that “65- 70 percent improve to some extent, taking opiates less than formerly or not at all” (pg. 176). Treatment of opiate addicts is effective because during its administration it starts with a thorough assessment and detoxification if it is required. During the treatment period, patients participate in NA self help groups while in the primary stage of treatment and continue to do so when discharged to after care.