Opioid addiction is a well-known cause for concern across the country. Whether it’s unintended misuse of prescription drugs or illegal fentanyl, opioid use disorder can have devastating effects on individuals and their loved ones.
Alongside this substance use disorder, many people also experience mental health disorders such as anxiety and depression. The two conditions intertwine, and finding treatment for both can be challenging.
By understanding the connection between opioid addiction and mental health, patients, loved ones, and providers can find the best opioid addiction resources and treatment options in their community.
We’re living through an opioid epidemic in the United States, but many people don’t know opioid addiction symptoms or how opioid addiction starts. Understanding this disorder is vital to understanding its relationship with mental health.
Opioids are a class of drugs that include everything from hydrocodone to fentanyl. They work primarily by intercepting the pain signals between your body and brain, then releasing dopamine and making you feel better. Doctors regularly prescribe opioids for use after surgery or other major medical procedures. While using opioids, you may feel euphoria, reduced pain, and a slower heart rate and breathing.
Over time, your brain gets used to this new system and rewires its pain and pleasure connections. Your body might start producing less of its own dopamine, and you’ll find yourself needing higher and higher doses of opioids to get the same feelings. Addiction can happen rapidly, which is why following prescriptive orders exactly is so important.
While symptoms may vary from person to person, the “Diagnostic and Statistical Manual of Mental Disorders Fifth Edition” (DSM-5) says the following are common ways opioid use turns into addiction.
- Opioids taken longer than planned or in higher doses.
- Unsuccessful efforts to decrease use and/or lack of desire to do so.
- Excessive time spent finding, using, and recovering from the opioids.
- Strong cravings and desires.
- Continued use, despite known and experienced physical, mental, and emotional side effects.
- Continued use, despite seeing opioids contribute to social/interpersonal problems.
- High tolerance.
- Withdrawal symptoms when stopped.
Opioids and mental health
The link between opioid addiction and mental health is complex and multi-directional. In other words, there isn’t a straightforward way to connect the two. What’s clear from research, however, is that opioid addiction and mental health disorders often occur together in patients and can exacerbate the other’s symptoms. For example, 6% of adults with mental illness reported opioid misuse in the past year, compared with only 2.4% of adults with no mental illness. So why might this connection exist?
One path of connection between opioid addiction and mental health disorders is by viewing opioid use as a potential treatment for mental health. Research shows that adults with severe depression are 14.66 times more likely to misuse opioids than adults with no depression.
Patients with depression and anxiety may be trying to self-medicate and alleviate their symptoms. Anxiety sufferers, for instance, may use opioids to calm panic attacks and slow their heart rate and breathing. Those with chronic depression may have tried other medications and then turned to stronger options to deal with the side effects of their mental illness.
From another angle, opioid use may cause mental health struggles. When an opioid user experiences withdrawal symptoms, for example, the result is similar to the body’s response to an anxiety attack: jitters, sleeplessness, and a racing mind can all happen when the opioids leave a user’s system and the body floods itself with self-made feel-good chemicals.
Experiencing this kind of physical and mental anxiety repeatedly (as one would with repeated opioid use and withdrawal) can take a significant toll on mental health. Users might take even more opioids to counteract the process, creating a spiral of anxiety and addiction. Opioid users who recognize their addiction might, in turn, experience depression if they lack the resources to combat their condition.
Individuals struggling with mental health conditions alongside addiction have a dual diagnosis (or co-occurring disorders). The Substance Abuse and Mental Health Services Administration (SAMHSA) shares resources for providers regarding best practices in treatment: “Integrating both screening and treatment for mental and substance use disorders leads to a better quality of care and health outcomes for those living with co-occurring disorders by treating the whole person.”
Rather than a sequential model (treat either the substance use or the mental health condition, then the other later), this simultaneous treatment model is evidence-backed as the most effective. The SAMHSA Treatment Improvement Protocol offers guidance for providers on screening, assessing and treating patients with a dual diagnosis.
The most important consideration for patients with co-occurring disorders is to limit the barriers to receiving treatment. These obstacles can be physical, financial or mental. Getting patients in the door and ready to accept help is the goal.
Clinics that require a patient to be sober before receiving therapy for depression may be turning away people who have difficulty seeking help and are unlikely to try again. Similarly, finding two different providers and coordinating care is a hurdle preventing patients from seeking treatment.
Minnesota opioid resources
Providers and patients in Minnesota can get information about opioid treatment resources from Hennepin County’s Opioid Epidemic campaign. Working with community organizations to create culturally responsive solutions is one of the ways that Hennepin County has responded to the growing opioid epidemic.
By addressing opioid use from prevention through treatment, the team has made it easier for community members to treat opioid addiction alongside mental health disorders.
