Opiod Use Disorder

Substance use disorders are among the most common and devastating health problems in the United States and globally. Opioid use disorder affects approximately 2 million people in the U.S., and over 10 million people misused opioids in 2018. Opioids are drugs that can be either natural or synthetic and have potent pain-relieving effects by acting on a specific part of the brain. They come in several forms, such as medications that can be prescribed (for example, oxycodone, morphine), heroin, and fentanyl. Although opioids play a role in pain management, they can also be misused. This means taking opioids differently than prescribed (for example, more often or at greater doses) or without a prescription. Beginning in the late 1990s, there was a rapid increase in the misuse of opioids, number of people suffering from opioid use disorder, and opioid overdose deaths in the U.S. As a result, the U.S. declared the opioid epidemic a public health crisis in 2017. Importantly, there are effective treatments for opioid use disorder, with three FDA-approved medications available that reduce opioid use and help to prevent overdose death. When used in combination with medication, cognitive behavioral therapy (CBT) can help people to recover from opioid use disorder.

Opioid Use Disorder

Characteristics

Opioid use disorder is defined by regular use of opioids and at least two of the following symptoms: (1) taking more opioids than one wanted, or intended to; (2) having trouble cutting down on opioid use; (3) spending a lot of time getting, using, or recovering from the effects of opioids; (4) experiencing craving or urges to use opioids; (5) having trouble with work, school, home, family, or other relationships because of opioid use; (6) using opioids in dangerous situations (like while driving); (7) needing increasingly more opioids than one to get the same effect (tolerance); (8) continuing to use opioids even though they make a physical or psychological problem worse; (9) experiencing withdrawal symptoms from opioids. Withdrawal symptoms for opioids usually feel flu-like: diarrhea, vomiting, nausea, weakness, sweating, anxiety, aches and pains, and restlessness are a few of the common symptoms. In fact, these withdrawal symptoms are so unpleasant that many people with opioid use disorder continue to take opioids just to avoid the withdrawal symptoms.

Treatment

Opioid use disorder can be fatal. Over 46,800 people died of opioid overdose in the U.S. in 2019 alone. There are effective treatments for opioid use disorder. The most effective treatment for opioid use disorder is medication, combined with counseling or other support. There are three medications approved for the treatment of opioid use disorder: methadone, buprenorphine, and naltrexone. These medications help people to recover from opioid use disorder and reduce the risk of overdose death. CBT is often an important part of treatment and is especially beneficial for people who are also struggling with chronic pain or psychological disorders (such as depression or anxiety). CBT for substance use disorders can be delivered in a group or individual format. Some of the strategies used in CBT for substance use disorders include:

• providing education about substance use disorders and the effects of drugs on the body and brain;
• working with people and their families to identify alternatives to drug use;
• reducing exposure to “high risk” situations for drug use;
• providing incentives, or rewards, for abstaining from drugs;
• teaching individuals how to identify the “triggers” that create craving and urges to use drugs;
• training in skills to help manage triggers, like problem-solving and coping skills;
• increasing structure and valued activities;
• providing tools for thinking in more helpful ways when experiencing urges to use drugs; and
• providing general strategies for coping with difficult situations.

Because chronic pain is highly common in people with opioid use disorder, CBT can also be useful for helping people to manage their pain. CBT can also be used to help with psychological symptoms and disorders, such as anxiety and depression, which are also common in people with opioid use disorder. People with opioid use disorder can also benefit from engagement of family or other important people in their treatment and the use of mutual help or other recovery supports.