Disclaimer: This post discusses topics related to drug use and addiction. I encourage you to recognize and respect your limitations in consuming sensitive content.

Opioids are a class of drugs that include heroin, synthetic opioids (e.g., fentanyl), and prescription pain-killers (e.g., oxycodone, hydrocodone, codeine, morphine). Side note: The term “opiate” technically refers to drugs that are naturally found in the opium plant (e.g., morphine, codeine), and “opioid” refers to synthetic drugs that are chemically similar to opiates (e.g., oxycodone, hydrocodone). However, the terms tend to be used interchangeably.

Having worked in an opioid treatment program that provided daily methadone treatment, the topic of this post is one that’s close to my heart. I spent a long time thinking about which story to share with you. Ultimately, I couldn’t choose.

It’s my privilege to discuss the following topics:

1. The “opioid epidemic”
2. Effects of opioids & common precursors to addiction
3. Medication-assisted treatment (MAT)
4. Methadone: how it works
5. Lessons learned as a counselor

I hope this post provides you with a sense of what individuals who struggle with opioid dependence may experience.

What is the “Opioid Epidemic”?

You’ve probably heard of the “opioid crisis” or “opioid epidemic.” What do these terms actually mean? Well, in the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to opioid pain relievers. Consequently, healthcare providers began prescribing them at greater rates. This led to widespread misuse of both prescription and non-prescription opioids before it was clear that these medications could be highly addictive.

Catastrophic consequences of the opioid epidemic have included overdoses and the rising occurrence of newborns experiencing withdrawal syndrome due to opioid use during pregnancy. Opioids were involved in 47,600 overdose deaths in 2017 (67.8% of all drug overdose deaths) (1).

Opiates and the Brain

Both humans and animals have opiate receptors in the brain. Our brains have these receptor sites because of endogenous, or internal, opioids (i.e., enkephalins and endorphins) that produce responses in the body that are similar to those of opiate drugs.

Opiates drugs bind to receptors and block the perception of pain. They can cause feelings of well-being, and can also cause side effects such as nausea, confusion, and drowsiness. Additionally, opiates can lead to feelings of euphoria. Though they’re often effective in treating pain, people can eventually develop a tolerance as they require higher doses over time to achieve the same effects.

Opiate Withdrawal

Opiate withdrawal has been described as similar to severe flu-like symptoms that can include anxiety, muscle aches, irritability, insomnia, runny nose, nausea, vomiting, and abdominal cramping. Many people find that they soon begin using opiates daily to mitigate withdrawal symptoms and be able to “function” each day. A common misconception about people addicted to opiates is that their use is completely motivated by a desire to get “high.” Once an individual becomes addicted to opiates, the physical, psychological, and emotional dependence begins a destructive cycle of daily use to feel “normal” and “okay.”

Precipitants of Addiction

Addiction can happen to anyone — and, yes, that also includes you and me. However, certain factors can make one more vulnerable to drug addiction. While these vary in each individual, the following are precipitants of addiction that I noticed in many of my clients:

Opioid Prescriptions

This is a big one. The most overwhelming precipitant of opioid addiction that I noticed was an initial prescription for opioids. Whether it was for a back surgery, surgery for a torn ACL, or surgery following a car accident — on all occasions my clients were prescribed opioids to treat their severe pain. Some people became dependent on opioids right away and some developed a dependence later in life. In the face of the opioid crisis, I imagine that researchers will race to discover pain-management strategies that are effective yet non-addictive. Side note: While opioids can be highly addictive, not everyone who uses them will become addicted to them. Each person’s biology and predisposing factors are unique.

Mental Illness

Mental illness (e.g., PTSD, anxiety, depression, bipolar disorder, etc.) can also make one more vulnerable to substance abuse in an attempt to self-medicate symptoms. As opioids can temporarily numb one’s physical and emotional experience, individuals who wish to escape their psychological pain can quickly become addicted to them. Additionally, previous posts in this series (i.e., topics related to depressants, stimulants, and hallucinogens) explore the interaction between mental illness and self-medication through substance abuse.

Trauma

Also pertaining to one’s mental health, I often heard horrific stories of childhood trauma that manifested in repressed pain that my clients sought to self-medicate as adults. As stigma surrounding mental health has only begun to diminish, there are many who carry around trauma that they’ve never spoken about though it has significantly affected them. It’s important that we ask about how people are really feeling, what they’ve been struggling with, and how they’ve been coping with their pain.

Environmental Instability

In the case of homelessness, one is highly susceptible to engage in risky behaviors (e.g., selling drugs, using drugs, prostitution) as a means to survive. I worked with clients who became homeless and fell into a world of addiction on the streets In the same vein, many of my clients became homeless after becoming addicted to opiates, and then found it incredibly difficult to maintain sobriety as they were constantly surrounded by drugs.

Medication-Assisted Treatment (MAT)

Medication-assisted treatment, or “MAT,” is the use of medications in combination with counseling and behavioral therapies to treat substance use disorders. There are three drugs approved by the FDA for the treatment of opioid dependence: buprenorphine, methadone, and naltrexone.

Stigma associated with MAT is based on the notion that it “substitutes one drug for another.” For example, twelve-step programs (e.g., AA, NA) tend to look down upon those on MAT as they’re not seen as “completely” sober. This can deter individuals on MAT to seek out support in the recovery community. In reality, MAT can relieve withdrawal symptoms and psychological cravings that inhibit individuals from breaking the cycle of addiction.

Methadone Treatment: How it Works

Methadone “tricks” the brain into thinking it’s still getting opiates that it’s become dependent on. When used as prescribed, methadone mitigates withdrawal symptoms and does not cause one to feel “high.”  People may be on methadone for weeks, months, years, or a lifetime. When they wean from methadone depends on factors such as their biology, environmental stability, and psychological readiness to cope with potential cravings and triggers for drug use.

Daily Doses

Methadone is a medication that must be taken daily. As it’s highly regulated by the government to avoid abuse, overdose, and diversion, clinics dispense it to clients in person. Methadone clinics can open as early as 5am to accommodate people who need to get dosed before they go to work or school. It is typically administered in a liquid or wafer form. Once clients establish stable sobriety, they may become eligible for “take-homes,” or take-home doses of methadone for certain days of the week.

Individual & Group Therapy

Mandated with methadone use is individual and group therapy. Depending on the treatment facility, the frequency of these requirements may vary. As a counselor, I met with most of my clients on a weekly basis. I enjoyed individual therapy with my clients as it gave us an opportunity to build rapport over time, and provided a safe space in which clients were able to be vulnerable.

Leading groups was more challenging as one group often contained people in various phases of recovery. Due to inconsistent attendance and friction between group members, I sometimes questioned whether my clients were benefiting from the groups. However, there were moments of group cohesiveness, and I realized that “my” group had nothing to do with me at all. When members were vulnerable with each other they were able to form a sense of community —something incredibly important for people in recovery.

Lessons Learned as a Counselor

Working in a methadone clinic taught me a lot, to say the least. Here are my biggest takeaways from working with my clients:

Addiction is a relapsing disease.

Addiction is not a disease that can be “cured.” You may have heard people say that they’ve been “in recovery” for many years. They still identify with being “in recovery,” even if they’ve been sober for decades, because sobriety is a choice they make everyday. This choice might include MAT, maintaining their mental and emotional health, addressing their triggers for use, etc. I’ve had many clients who were caught in the cycle of treatment, relapse, and sometimes even overdose. I quickly learned that my clients’ relapses did not indicate a failure in themselves, nor did it indicate a failure on my part as their counselor.

My job is not to change people.

I learned to loosen my grip and accept that my work as a counselor is to support others as they fight their own battles. It was difficult, at times, to maintain emotional boundaries and not become overly-invested in my clients’ sobriety and decisions — especially when one of their goals was to re-earn custody of their children. Sometimes I’d feel frustrated by my clients, the treatment system, and my limited role in the scheme of it all. Over time, I saw that I must accept people for who they are, whatever stage of life they’re in, and not act on the urge to “change” anything about them.

My most powerful tools are empathy and compassion.

I worked with clients on identifying their “triggers” for substance use, creating helpful coping skills, exploring underlying mental health issues, and processing the disappointment of relapses. Ultimately, I found that the most meaningful interactions with clients were born from authentic expressions of empathy and compassion toward them. There is nothing more impactful than feeling seen by another individual. I often underestimate the power of simply feeling others’ emotions with them, and turning toward them with gentleness, acceptance, and non-judgment.

Thank You

I appreciate you taking the time to read this post and other posts in my series of Untold Stories of Addiction. It’s truly been an honor to work with the clients whose stories I’ve shared. I’m privileged that my field of work teaches me so much about the human condition and challenges me to know myself on a deeper level as I counsel others. In the face of addiction and mental illness in our society today, it’s imperative that you and I do what we can — even if that just means maintaining a compassionate and non-judgmental perspective.

References

1. Centers for Disease Control and Prevention (2019, June 27). Drug Overdose Deaths. Retrieved from https://www.cdc.gov/drugoverdose/data/statedeaths.html