Opioid Dependence and Opioid Addiction
In the context of drug treatment, we seem to understand that you can be opioid dependent without being opioid addicted (in, say, the case of a terminally ill cancer patient).
We seem to understand that opioid dependence and opioid addiction are directly linked.
But sometimes we forget – with the encouragement of insurance companies – that opioid addiction is still very much a problem even if we are no longer opioid dependent.
The person who is no longer opioid dependent -- as a result of successful detox – is still very much opioid addicted.
The journal Addiction Science and Clinical Practice defines dependence as the need to keep taking drugs to avoid the physical discomforts of withdrawal.
The journal defines addiction as abnormalities in the brain caused by past drug use that provoke intense craving and compulsive use; both the cravings and the compulsion to use can still be triggered -- even after successful detox -- by environmental triggers such as stress, old memories of pleasure, and psychological conditioning. The brain abnormalities that define addiction "can produce craving that leads to relapse months or years after the individual is no longer opioid dependent."
While both dependence and addiction are the result of abnormal changes in the brain caused by chronic opioid misuse, the symptoms of opioid dependence clear up within a few weeks of detox. The neurobiological impairments of opioid addiction are long-lasting and wide-ranging.
Prescribing the Right Course of Treatment
Opioid dependence can be successfully treated by short-term or acute care.
It’s the opioid addiction that requires long-term drug rehab and extended recovery care.
Experts in every realm of addiction science – medical, academic, and governmental – unanimously agree that recovery from drug addiction requires 90 days or more of residential, long-term recovery care. The brain requires 90 days or more to heal, to resolve the abnormalities caused by drug use, to learn to cope with the stress of everyday life and to withstand the cravings triggered by factors outside of the recovering person. The healing of addiction goes on long after the healing of dependence.
Based on standards of care established by health insurance providers, people addicted to opioids are prescribed a course of treatment suitable to the treatment of opioid dependence.
This is like going to the doctor with an ax in your skull and being offered an aspirin because your head hurts.
Until diagnosis and dose of treatment become aligned with both opioid dependence and opioid addiction, we will continue to hear about the remitting, relapsing nature of this chronic, life-long brain disease.