Among the most abused drugs, opioids present the most significant challenge when it comes to addiction. Addiction to opioids causes a plethora of health, economic, and social problems. The drug draws its addictive characteristic from the fact that it influences the nervous system hence producing a feeling of pleasure and relief from pain. It is in this regard that physicians legitimately prescribe some opioids as a remedy to pain relief and pleasure. The addiction, however, causes a compulsive and powerful urge to continue using the drugs even if they are no longer medically required. According to statistics, about 2 million people abuse opioids yearly. In 2016 alone, overdose with opioids accounted to up to 20,000 deaths. Other than the addiction, opioids also possess a high rate of relapse. Studies have shown that the chances of relapse are high with particular research asserting that it can be as high as 91% (Chalana, Kundal, Gupta, & Malhari, 2016). Most fundamental to note is that the relapse occurs within the first few weeks to months after recovery. The treatment for opioids takes the shape of therapeutic medication and psychotherapy. With the opioid epidemic continuing to cause various medical, social, and economic problems to the addicted, ore focus needs to be put on the relapse cases to mitigate the reoccurrence of the problem associated with the drug abuse.
Opioids
Mechanism of Function
The understanding of the opioid drug addiction and relapse would only be useful if one appreciated the mechanism in which the drug uses to assert its action on the human body. Opioid receptors are found in the brain where the components of the drugs attach. After the attachment, signals are sent to the brain to block pain, enhance a slowed breathing, and cause a sense of calm. The body itself does not have the capacity to produce enough opioids to prevent chronic pain. Their ability to activate receptors draws from the fact that they mimic natural neurotransmitters. As such, it "confuses" the receptors allowing the drugs to interact with the body thus activating the nerve cells. However, this does not mean that the drug similarly activates the nerve cells as the natural neurotransmitters do. Therefore, the drug has a high potential of causing the transmission of abnormal messages throughout the network.
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The drug also targets the reward system found in the brain and causes an influx of the neurochemical dopamine. Dopamine is primarily found in brain areas that regulate emotion, movement, motivation, cognition, and pleasure. The overstimulation of the system, therefore, rewards natural behaviors leading to euphoric effects. It is therefore understandable why people would go on to misuse these drugs since they are after seeking such pleasurable feelings that come secondary to the stimulation of the reward system. As such, this explains the rationale behind the addiction to the drugs. The brain is created in such a way that individuals will repeat life-sustaining activities that promote pleasure or reward. The reward circuit, therefore, causes the brain to seek behaviors that cause such feelings continually.
Opioid Addiction
According to the National Institute of Health (NIH), opioids alter the chemistry of the brain leading to drug tolerance. It, therefore, means that with time, the dosage of opioids needs to be significantly increased for an individual to attain the desired effect. One of the reasons why relapse rates are high with the drug is due to its high dependence. Continuous abuse of the drug causes dependence, meaning that when individuals cease to take the drugs, they develop not only physical but also psychological problem of withdrawal. The person, therefore, develops several health conditions that might include anxiety, diarrhea, and muscle cramping. The NIH further states that “opioid addiction can cause life-threatening health problems, including the risk of overdose” (Chalana, Kundal, Gupta, & Malhari, 2016). The misuse of opioids continues to be a problem not only for the US but also the entire world. A study showed that in 2016, the drug resulted in the death of 20,000 people in the US alone.
The fact that the drugs are used in the treatment of pain or as an analgesic makes it prone to misuse and abuse. Some of the instances in which physicians can prescribe the drug include during injuries, toothaches, surgeries, and chronic conditions such as cancer. Signs of opioid abuse include poor coordination, drowsiness, nausea, constipation, and poor decision making among other symptoms. Individuals with addiction problems are therefore advised to seek prompt medication as a way of preventing adversities and complications.
Treatment of Opioid Addiction
As earlier noted, opioid addiction or opioid use disorder is a significant problem not only affecting the US but the world at large. Other than its effects on the brain, researchers have also noted that the drug increases the chances of an individual to acquire diseases such as Hepatitis and HIV/AIDS. However, there are a plethora of health interventions that could be used in the treatment of the addiction problem. Some of the common medications used include methadone, buprenorphine, and naltrexone. According to the National Institute of Drug Abuse, "once treatment is initiated, a buprenorphine/naloxone combination and an extended-release naltrexone formulation are similarly effective in treating opioid use disorder" (Naji et al., 2016). In a bid to acquire the best treatment results, medication should be administered along behavioral counseling in meeting the holistic approach known as the Medication Assisted Treatment (MAT). According to scientists, the MAT approach initiates a reduction in opioid use, overdose, criminal activities, and deaths resulting from its use (Tai, Saxon, & Ling, 2013).
Relapse
Rationale for Relapse
Drug addiction can also be referred to as a relapsing disease because relapsing is a common phenomenon seen in individuals in recovery. The repeated use of a drug affects the reward system in the brain hence affecting an individual's level of self-control and the ability to resist craving temptations. People in recovery experience a continuous risk of relapse for a period that spans to years. With the evolution of the drug relapse concept, various complications have arisen in a bid to provide the most plausible definition. One of the most common controversies surrounding its meaning includes whether relapse is a process or an outcome. Through the lenses of healthcare, a relapsing patient is seen as an individual who has regained their initial state of sickness after a period of remission. Opioid is one of the drugs with the highest rates of relapse. Rakash, Ambekar, and Dayal (2016) asserted that recent research on relapse has shown that more than 85% of people relapse within the first year after treatment and return to abusing the drugs. Although this seems high, the rates of opioid are much higher and go up to 91% (Kadam et al. 2017). Researchers opine that the most critical period for recovery when dealing with an opioid is within the first few months (Hser et al. 2015). However, two instances primarily predispose an individual to relapse. The first instance is when the caregivers do not prioritize recovery. Secondly, the individual can also show reluctance to becoming sober.
A significant question that needs to be answered is why the rates of opioids seem to be higher than any other drug. As earlier mentioned, the primary way of action significantly influences this type of outcome. It impacts the Mesolimbic brain system hence affecting the reward system. Since it creates an intense feeling of pleasure, individuals can easily fall back and use it due to the cravings. The feeling can be so intense that individuals will not mind whether it leads them to more devastating conditions or not. Individuals that are more predisposed to relapsing include those who have used the drug for extended periods a factor that contributes to their addiction and dependency rates. After the relapse, addicts will experience a feeling of discouragement and shame. After periods of experiencing substance-free life characterized by sobriety, it is common that the person will feel ashamed and a failure once they relapse back to the initial state of drug abuse. It is therefore essential to note that just like the treatment for addiction, interventions targeting relapse must focus not only on the physical but also the psychological well-being of an individual.
An Effective Treatment Plan
According to the National Institute of Drug Abuse (NIDA), regaining a sober life is a journey that must be accompanied by the commitment to recovery (Kolodny et al. 2015). It is an endeavor that requires several stakeholders including the primary care provider, the relapsed addict, family members, and relapse support representatives among others. The first step towards recovery involves the creation of an effective relapse prevention plan. For a relapse prevention strategy to yield the maximum results, it must consist of four fundamental parts. The first step requires the individual to recognize the warning signs of relapse. The person must understand both their internal and external sources of the trigger (Kolodny et al. 2015). The internal factors include the feelings and thoughts that a person develops when abusing the opioids. On the other hand, the external factors include specific incidences or places that cause an individual to desire the drug. They include smells, sights, items, and sounds that create the cravings for the opioids. After identifying the warning signs, the next step is to develop a course of action once the identification has been done.
An individual will be required to identify some of the most coping skills or a robust support source in their endeavor to deal with their relapse. Some of the examples of the skills and practices that can keep an individual away from the use of the drugs at the time of need could encompass hobbies, skills, and activities that work to keep them out of any involvement with drug abuse. Thirdly, the plan must also include a platform for making a follow-up not only with treatment professionals but also support groups for psychotherapy. Individual or group therapies can act as a way of gaining comfort towards a life of freedom from drug abuse. The last step requires an individual to develop a recovery action plan. It is important to note that a feeling of emptiness and unhappiness is common as a person begins their sober life (Kolodny et al. 2015). The reason for this is that the individuals are yet to replace their previous drug life with another meaningful engagement. Therefore, there is a void left unfilled hence leading to depression and loneliness. In a bid to gain satisfaction from the newly acquired sober life, the person’s life must include a host of other activities that might compensate for the previously unhealthy life.
Treatment
As opposed to addiction treatment, interventions for relapse are tailor-made to suit the demands of an individual. Different forms of therapies and care plans are created to ensure they meet the unique needs exhibited by a person. It is therefore imperative that "anyone who is seeking treatment after a relapse should get help from an addiction treatment center who has an individualized treatment plan made special for them" (Potter et al., 2015). Treatment centers are required to have a system of medication-assisted therapy (MAT). Tai, Saxon, & Ling, (2013) asserted that research has shown that MAT is currently the best approach to deal with future cases of relapse. According to statistics, MAT has shown to reduce addiction and relapsing rates in 62% of the cases that it was used. Just like in addiction treatment, the three primary drugs including naltrexone, buprenorphine, and methadone should be used as prescribed by the physician. It is important to note that a relapse is a form of treatment failure. Therefore, once the patient comes back for treatment, the initial drugs used in treatment can either be emphasized or changed altogether. Once the medications are started, they should be maintained for the foreseeable future. The treatment of relapse must occur on a daily basis. Failure to manage the condition daily means that it will easily come back.
As earlier intimated, research has shown that even with intensive care, the relapse rates are at a whopping 91%. Further studies have revealed that relapse rates drop by around 40 to 50% with strict medication (Rakash, Ambekar, & Dayal, 2016). For individuals discontinuing medication, the rates go back to 90% and above. Other than the identified medication, psychotherapy forms the basis of treatment when it comes to opioid addiction. As earlier stated, relapsing individuals will feel a sense of failure, shame, and guilt after going back to the use of drugs especially if they had put in intense work and dedication. Kampman & Jarvis, (2015) asserted that the psychotherapy treatment is sometimes referred to as the Relapse Prevention Therapy (RPT). Here, the drug users are encouraged to anticipate activities that might help them to overcome their urge to use the drugs. It further identifies some of the most common factors that might predispose an individual to go back to the drugs including boredom, hunger, anger, and loneliness among others (Naji et al., 2016). Once an individual notes and understands these, they can remain away from the drugs.
Through RPT, persons are shown how to put their conditions into the right perspective. As earlier mentioned, once a relapse occurs, the person might interpret this either as a failure or the inability to recover. However, such a false conclusion can leave the person with no option but to continue abusing the particular drug. Therefore, in this regard, the role of the RPT is to show the person that they need to improve their coping skills against opioid addiction. A person can also decide to engage in support groups where they will undergo psychotherapy with other individuals suffering from the same problem. Here, they will get an opportunity to assess their condition, make comparisons, and encourage one another towards achieving desirable outcomes.
Conclusion
With the opioid epidemic continuing to cause various medical, social, and economic problems to the addicted, more focus needs to be put on the relapse cases to mitigate the reoccurrence of the problems associated with the drug abuse. First, understanding the scientific background behind opioid addiction provides the rationale for the high prevalence of relapse. The drug targets the reward system of the brain thus causing episodes of pleasure. More significantly, it targets various receptors in the brain thus preventing pain. As such, the urge to continue using opioids even if one is treated is high. Treatment mechanisms utilize both medications and psychotherapy. Since the relapse rates are high, individuals are asked to enhance strict adherence to the therapy and seek medical centers that are best suited to respond to their particular needs. Most fundamentally, they should not misinterpret relapse as a failure but rather a new opportunity to develop life-long coping skills against the disease.
References
Chalana, H., Kundal, T., Gupta, V., & Malhari, A. S. (2016). Predictors of Relapse after Inpatient Opioid Detoxification during 1-Year Follow-Up. Journal of addiction, 2016.
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Kadam, M., Sinha, A., Nimkar, S., Matcheswalla, Y., & De Sousa, A. (2017). A Comparative Study of Factors Associated with Relapse in Alcohol Dependence and Opioid Dependence. Indian Journal of Psychological Medicine, 39(5), 627–633. https://doi.org/10.4103/IJPSYM.IJPSYMpass:[_]356_17
Kampman, K., & Jarvis, M. (2015). American Society of Addiction Medicine (ASAM) national practice guideline for the use of medications in the treatment of addiction involving opioid use. Journal of Addiction Medicine, 9(5), 358.
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