Mental Health & Opioid Addiction

The United States is currently in the midst of an opioid epidemic. This class of drugs, which includes substances such as heroin and prescription painkillers, have contributed to over 67,000 overdose deaths in 2018 alone — and approximately 128 Americans die from opioid overdoses each day 1.

Opioids are highly addictive, have intense and often painful withdrawal symptoms, and place users at a high risk of death or relapse. In addition, opioid use disorder commonly co-occurs with other mental health conditions, including depression and suicidal ideation.

Here’s what you need to know about mental health and opiate addiction.

Table of Contents

What Are Opioids?

Opioids, also known as opiates, are a class of drugs derived from opium poppy seeds. These seeds contain substances such as morphine and codeine, which provide sedating, pain-relieving, and euphoric effects.

These drugs typically come in two forms: illegal derivatives and prescription painkillers. Opioids, regardless of their type, are highly addictive and dangerous in large doses. Misuse of opioids often leads to addiction, unpleasant withdrawal, and overdose death.

Heroin

Heroin is a semi-synthetic opioid that can be injected, smoked, or snorted. This drug is a Schedule I controlled substance in the United States, since heroin has no medical benefits, can be highly dangerous, and carries a high risk for opioid use disorder.

Heroin-involved overdose deaths have increased significantly across the United States, with 14,996 deaths in 2018 alone 2.

In addition to overdose risk, heroin can lead to:

  • Viral infections, like HIV/AIDS and Hepatitis C
  • Bacterial infections to the skin, bloodstream, and heart
  • Physical dependence
  • Tolerance, requiring more of the drug to achieve the same effect
  • Long-term neuronal and hormonal imbalances

Prescription Opioids

Prescription opioids are substances used to treat moderate to severe pain after a medical procedure, such as a major surgery or serious injury. Like all opioids, these drugs can be very addictive; in 2016, 11.5 million Americans reported misusing prescription opiates 3.

Patients can use a higher dose of the drug than prescribed, or take the drug solely to experience its euphoric effects. When the addiction progresses, they may use other people’s prescriptions once the medical reason for their own prescription is no longer valid.

Many doctors prescribe these painkillers to their patients, despite their highly addictive nature. In 2017 alone, doctors wrote over 191 million prescriptions for opiate painkillers to American patients 3.

Common prescription opioids include:

  • Codeine
  • Morphine
  • Oxycodone (OxyContin or Percocet)
  • Hydrocodone (Vicodin)
  • Oxymorphone (Opana)

Side effects of prescription opioid abuse include tolerance, physical dependence, depression, increased sensitivity to pain, and slowed breathing.

Fentanyl

Fentanyl is a synthetic prescription opioid that is highly dangerous in small quantities, contributing to over 31,000 overdose deaths in 2018 alone. Fentanyl was involved in 59% of opioid-related deaths in 2017, compared to 14.3% in 2010 4.

Fentanyl is particularly dangerous due to its potency. Often used to treat severe pain, fentanyl is 50 to 100 times more potent than morphine, and a fatal dose can be as little as 250 milligrams 4.

Many fentanyl-related overdose deaths involve fentanyl-laced drugs, such as heroin and cocaine, that the victim was unaware of when they purchased these substances. Other users take fentanyl willingly, since it is highly addictive.

What is Opioid Use Disorder?

When people develop a physical dependence on an opioid, they develop opioid use disorder (OUD). This condition is chronic and lifelong, and may lead to disability, death, and relapses if the patient decides to quit without seeking professional help.
You may have OUD if two or more of the following events have occurred within the past 12 months:
  • Taking larger amounts of the drug
  • Developing a tolerance for the drug
  • Taking the drug over a longer period of time
  • Unsuccessful efforts to reduce opioid use
  • Strong cravings for the opioids
  • Spending lots of time obtaining, using, or recovering from the drug
  • Experiencing issues at home, school, or work due to opioid use
  • Giving up activities due to opioid use
  • Experiencing withdrawal symptoms
  • Using opioids in hazardous situations
You can develop a physical dependence on opioids in as little as 4 to 8 weeks 5. This physical dependence can make it difficult — and even dangerous — to stop using the drug without professional help.
Opioid withdrawal symptoms can be very severe, and may include:
  • Generalized pain
  • Vomiting and nausea
  • Chills
  • Cramps
  • Diarrhea
  • Anxiety
  • Restlessness
  • Intense cravings

Withdrawal symptoms can develop within hours of a last dose, and because they are so severe, many people continue to misuse opioids in order to treat or avoid them.

OUD then begins a vicious cycle where you need more opioids to achieve the desired effect, experience worsening withdrawal symptoms over shorter periods of time, and continue to misuse these drugs on a regular basis.

If you believe you have OUD, seek professional treatment immediately. You will receive care designed to manage withdrawal symptoms and help you gain the tools necessary to recover from your condition.

Opioid Use Disorder and Mental Health

People who have opioid use disorder often also have a co-existing mental health condition, such as depression or anxiety. In fact, out of the 19.3 million adults who suffered from substance use disorder in 2018, 9.2 million also suffered from a co-occurring mental illness 6.

In some cases, patients develop mental health issues due to their opioid use disorder. In other cases, patients develop an opioid use disorder to cope with symptoms of their mental illness.

Regardless of which came first, it is important to understand the symptoms of these mental health conditions and seek treatment as soon as possible.

Depression

Depression is a mood disorder characterized by intense feelings of sadness and a loss of interest in activities you once enjoyed.
Symptoms of depression include:
  • Sadness, emptiness, or hopelessness
  • Irritability and frustration
  • Difficulty sleeping
  • Loss of interest in normal activities
  • Anxiety and agitation
  • Difficulty concentrating or sleeping

This condition can increase your risk of developing opioid use disorder — people with depression who begin taking prescription opioids are two times more likely to develop OUD 7.

In addition, people who develop depression after using opioids for a long period of time may experience more severe depression symptoms than others. In fact, some patients develop depression symptoms after using prescription opioids in as little as one month 8.

This risk may occur for a number of reasons. Opiate use can induce symptoms of depression, such as social withdrawal and sleep disturbances. These substances also influence your brain chemistry, causing depression to develop over time.

In addition, you may reach for opioids to cope with symptoms of depression, using their euphoric effects to improve your mood. Over time, however, this abuse will only lead to worsening depression.

Anxiety Disorders

Anxiety disorders are mood disorders characterized by intense feelings of fear and panic, usually disproportionate to the actual threat.These conditions, which may include generalized anxiety disorder (GAD), panic disorder, and social anxiety, are common among American adults.
Symptoms of anxiety include:
  • Nervousness and restlessness
  • A sense of impending danger
  • Increased heart rate
  • Hyperventilation
  • Sweating, trembling, and weakness
  • Difficulty sleeping

Misusing opiates can both lead to the development of an anxiety disorder or an increase in the severity of your anxiety symptoms. Many anxiety patients with OUD use opioids to cope with their symptoms, which in turn can worsen the condition and restart the cycle of dependence.

People who suffer from long-term opioid use disorder are more likely to develop any anxiety disorder than people who do not use opioids 9. These drugs are capable of producing anxiety symptoms, which can occur during or after use.

Opioids can exacerbate current anxiety symptoms, leading to paranoia, agitation, and difficulty sleeping. Anxiety symptoms often appear during the withdrawal process as well, making it difficult to quit without professional treatment.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after you experience or witness a traumatic event. While we often associate this condition with military veterans, anyone can develop PTSD after any traumatic event, such as car accidents, assault, and near-death experiences.
Symptoms of PTSD include:
  • Recurrent, invasive memories
  • Flashbacks and nightmares
  • Avoiding people and situations related to the trauma
  • Difficulty maintaining relationships
  • Negative thoughts and emotional numbness
  • Irritability and aggression

Since PTSD is triggered by a traumatic event, opioid use does not directly cause this condition. However, 42% of people with PTSD are dependent on opioids, which suggests that many patients use these substances to cope with PTSD symptoms and avoid memories of the event 10.

In addition, dependence on opioids tends to place people in situations where traumatic events are likely to occur. For example, you may go to a dangerous part of your city to purchase drugs and increase your risk of falling victim to a violent crime. If you do not seek swift professional treatment after a traumatic event, you have a higher chance of developing PTSD.

Opioid Use Disorder and Suicide

Suicidal Ideation

Suicidal ideation involves thoughts, feelings, and actions that lead to you wanting to end your own life. Approximately 4% of American adults experience suicidal ideation each year 11.
Symptoms of suicidal ideation include:
  • Talking about suicide
  • Withdrawing from social contact
  • Mood swings
  • Feelings of hopelessness
  • Increased drug and alcohol use
  • Obtaining the means to take your own life
Suicidal ideation often occurs concurrently with other mental health conditions, including depression and PTSD. In addition, people who misuse opioids are at a high risk of suicidal ideation, attempts, and death.
Statistics on suicide related to opioid use:
  • 39% of overdose patients in emergency rooms reported wanting to die or not caring about the risks associated with opioid use 12.
  • Approximately 30% of overdose deaths may fit the description of suicide 13.
  • People who misuse prescription opioids are 40% to 60% more likely to have suicidal thoughts 14.
  • People with OUD are 13 times more likely to die from suicide than people without OUD 15.

Since opioid misuse often exacerbates or leads to the onset of mental health conditions, these drugs can increase the frequency of suicidal ideation as well. You may feel hopeless, unable to control your situation, and unsure how to break free from the cycle of opiate addiction.

Suicide is never the answer, even if it may seem like the only option. You can take steps to seek help, restore your quality of life, and begin enjoying the activities you once loved again.

If you believe you may attempt suicide, seek help immediately. Call 911 for emergency medical attention, or call the National Suicide Prevention Lifeline at 1-800-273-TALK.

Video: "You cannot divorce the suicide rate from the opiate overdose rate"

Listen to former congressman Patrick J. Kennedy passionately talk about the connection between suicide rates and opiate overdose rates.

He states that suicide numbers are “way under reported in this country,” and that “We’re in denial.”

Treatment

Many treatment options are available for people with OUD and co-occurring mental health conditions. These may include medication, pain management, and a variety of behavioral therapies.

Medication

One of the main benefits of receiving treatment at a rehabilitation facility is access to medications designed to reduce your withdrawal symptoms and your dependence on opiates. Opioid withdrawal can be painful and unpleasant, and your medical team will supervise you during detoxification.
Your doctor may prescribe a number of medications to combat OUD, including:
  • Buprenorphine-naloxone
  • Buprenorphine hydrochloride
  • Methadone
  • Naltrexone

These medications help diminish cravings, blocks receptors from producing feelings of pleasure when using opioids, and detoxifies your body from opioids, helping you stay on the path to recovery.

If you have a co-occurring mental health condition, your doctor will prescribe compatible drugs that can help safely manage your symptoms. Some of these medications may also be used to treat OUD.

Behavioral Therapies

In addition to medication counseling, behavioral counseling is a very effective treatment option for co-occurring mental health and substance use disorders. At rehabilitation facilities, these counseling sessions are designed to address OUD as well as specific comorbid mental health conditions.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a common treatment option that involves walking through harmful beliefs and unhealthy coping mechanisms, and developing the skills you need to overcome your condition.

CBT is one of the most effective therapy options for people with anxiety and mood disorders, as well as people who struggle with substance abuse. During a CBT session, you will engage in a structured conversation with a trained counselor, who will in turn help you understand your negative thinking patterns and actively work to help you combat them.

CBT may help manage many mental health disorders, including:

  • Depression
  • Anxiety
  • PTSD
  • Obsessive compulsive disorder
  • Substance use disorder
  • Schizophrenia

Exposure Therapy

Exposure therapy is a treatment option for people with certain anxiety and trauma-related disorders, such as phobias and PTSD. During this option, a trained counselor will expose you to a situation, event, object, or memory that may trigger your symptoms.

The purpose of exposure therapy is to desensitize your response to these triggers, helping you gain control over your responses and re-engage in the activities you once loved. As a result, you may see reduced or eliminated symptoms and an array of skills to combat triggers once you finish treatment.

Seeking Safety

Seeking Safety is a treatment program designed to target trauma-related disorders and substance use disorders at the same time. During this program, patients will develop coping skills to manage their trauma symptoms and stay on the path to sobriety.

Unlike exposure therapy, Seeking Safety is focused on the present and the future, rather than the past trauma itself. During this treatment program, you will be asked what safety would look like in your life. After identifying this vision, the program will teach you the coping skills necessary to achieve safety in your daily life.

Dialectical Behavioral Therapy​

Dialectical behavioral therapy (DBT) is a treatment option for people who suffer from self-harm behaviors, which may include drug use, suicidal ideation, or cutting. The purpose of DBT is to help you develop healthy responses to stress, improve relationships, and regulate your emotions.

A DBT session is very similar to CBT. You may participate in DBT in a group, where you will learn behavioral skills in a classroom setting, or individually, where a counselor will walk you through a structured conversation. At the end of your program, you will have challenged and changed negative thinking patterns, and can apply the strategies you learned to daily situations.

Alternative Pain Management

Many people misuse prescription opioids originally prescribed for chronic pain, which can be difficult to treat and manage alone. If you are struggling with prescription opioid addiction, your doctor will work with you to identify alternative pain management options for your condition.
These may include:
  • Tricyclic antidepressants
  • Gabapentinoids
  • Acetaminophen
  • Nonsteroidal anti-inflammatory medications
  • Physical therapy
  • Relaxation training

Prevention

OUD is a complex disorder, as are mental health conditions. However, there are a few steps you can take to prevent opioid dependence — either before it begins or before relapse.
For prescription opioids, follow these tips:
  • Always follow your doctor’s instructions when taking prescription opioids. Never take these drugs more often or in greater amounts than prescribed.
  • If you experience any side effects while taking prescription opioids, speak to your doctor.
  • If you have a family history of drug addiction or you believe you may become addicted to prescription opioids, ask your doctor for pain management alternatives.
  • Do not share or sell your prescription opioids, and keep these prescriptions in a safe, secure place out of reach from other people.
  • If you have leftover prescription opioids, flush them down the toilet or use a community drug take-back program. Do not keep these pills.
For heroin dependence, the only true prevention method is to avoid the substance altogether. If you are experiencing heroin addiction, seek professional treatment as soon as possible.
After treatment, follow these tips to prevent relapse:
  • Join a sobriety support group in your community.
  • Avoid places where heroin use is common.
  • Avoid former friends and acquaintances who use heroin.
  • Practice your coping skills.
  • Identify and communicate with a sponsor.
  • Continue working with your treatment provider.
For heroin dependence, the only true prevention method is to avoid the substance altogether. If you are experiencing heroin addiction, seek professional treatment as soon as possible.

Seek Professional Help Today

While these prevention tips are helpful, opiate addiction is difficult to stop once it has begun. Seeking professional treatment from a rehabilitation facility or clinic that specializes in OUD can help you safely detox from these substances.

If you are struggling with opiate addiction, don’t wait to seek help. Visit a treatment facility to receive the counseling and medication you need to develop healthy coping skills, manage your symptoms, and stay on the path to full recovery.

References & Resources