National Opioid and Substance Awareness Day - FAQs about Substance Treatment

By Abby Burd, LCSW, full time Mental Health Counselor 

September is National Recovery Month. September 21st will also be the first annual National Opioid and Substance Awareness Day. I thought I'd answer some common questions about substance abuse treatment and opioids in particular.

What does the word "substance" refer to?

In this context, "substance" refers to alcohol and drugs that can be misused, abused, or cause addiction/dependence. 

What are "opioids?"

Opioids are a class of drugs, including Heroin and painkillers like Fentanyl, OxyContin, Codeine, Vicodin, Hydrocodone, Methadone, etc. Painkillers could be prescribed by a doctor for a legitimate reason and still lead to problems. Other times they are purchased illegally. 

Opioids are known for causing both psychological addiction as well as physical dependence and tolerance.

Does taking opioids once mean you become addicted?

No. Individuals respond differently, and we don't fully know why, although genetics may play a role. In my own experience, I took one Vicodin after having my wisdom teeth removed and got so sick I've avoided all painkillers since. Others find them useful tools to manage pain during their life but don't particularly feel "high," euphoric, or a need to continue taking them for an extended period. Still others find that opioids indeed soothe physical pain and additionally, provide a "numb," happy feeling. They may find this effect helps them cope with stressful life situations... at least in the short term. Still some others will try them and immediately say, "What is that? I want more!"

What does "chasing the dragon" mean?

Sadly, opioids are not a reliable high. Those that enjoy it the first time they use it describe "chasing" that high and never enjoying it as much afterwards. Subsequent use becomes more a need to avoid feeling sick from withdrawal than achieving the pleasure of the first high. 

Opioids, like other substances, also create "tolerance" which means you need to use more and more each time to approach the positive feelings of the first use. Many say that recreating the first high is unachievable altogether. Using more and more creates the risk of overdose. 

What is overdose?

Simply defined, overdose is an excessive or dangerous amount of a drug. Colloquially, it is used to refer to death by overdose, also abbreviated "OD." Some may accidentally OD as a result of tolerance and chasing an unachievable, pleasurable high. Others may have stopped use for a while, then relapsed and miscalculated their tolerance and took more than they should have. 

What should you do if you think someone may have overdosed?

Call emergency response, such as 911, immediately. Most first responders carry a drug called naloxone (Narcan), that can be life saving if used in time. 

What are withdrawals?

Regular use of opioids creates a physical dependence that may include anxiety, agitation, sweating, body aches, nausea, vomiting, and diarrhea when there is a lapse between doses. Many describe it as feeling like you have the flu plus a panic attack (not pleasant!). One important thing to know is that opioid withdrawal is NOT life threatening, although many people may experience the fear of dying when in active withdrawal. 

What about withdrawal from other substances?

Withdrawal from heavy alcohol use or benzodiazepines (anxiety medications like Xanax, Valium, Klonopin, Ativan, etc.) can, in fact, be life threatening. Serious complications, like seizures and cardiac events are possible. It is very important to have a doctor supervise discontinuation of these substances. This is sometimes referred to as "detoxing," especially when done quickly, whereas "tapering" is when a doctor assigns a schedule to slowly reduce and eventually eliminate the dosage.

What is "medication-assisted treatment (MAT)?" 

MAT involves the use of medications, under the supervision of a specially trained and certified doctor, to either ease withdrawal and/or prevent relapse. For opiates, medications a doctor may suggest include Suboxone (buprenorphine and naloxone) or Methadone. Please note that some also abuse these medications, so they should never be taken unless under the direction of a qualified doctor, nor should they be taken on a "creative" schedule. 

Isn't taking a one drug to get off a another drug just substituting addictions?

Great question. For those self-medicating, it can be. The main point of medication-assisted treatment is to use doctor-supervised medicine combined with therapy and recovery support to make major lifestyle changes. Once the conditions and life circumstances underlying addiction are addressed, an individual may be in a better place to taper off the support medication. 

What are "co-occurring disorders" or "dual diagnoses?"

These terms refer to the understanding that many people who may misuse substances are also struggling with other mental health concerns, like depression, anxiety, bipolar disorder, PTSD, or psychosis. Only focusing treatment one one side or the other (the addiction or the mental health) won't effectively help. Successfully growing out of addiction often includes learning alternative coping skills for the underlying reasons or conditions that drove a person to become substance dependent in the first place. 

Does everyone who struggles with substance use have to go to rehab?

Nope! There are many different levels of treatment! Many people do quite fine just talking to a therapist once a week. Others decide they would like something more intensive. Here are some common treatment options, roughly in order of intensity:

• Peer support: Meetings run by others who have experienced addiction but may not be professionals. Examples are SMART Recovery, Alcoholic's Anonymous (AA), and Narcotics Anonymous (NA).
• Outpatient therapy: Meeting regularly with a mental health counselor, like coming to us in Health Services once a week for an hour.
• Outpatient therapy plus medication: Adding to the above a psychiatrist or addictionologist to your team who can prescribe support medications or create a tapering schedule.  
• Intensive Outpatient Therapy (IOP): A comprehensive program that meets multiple times a week (often 3-5x) for 2-4 hours/day, and includes group therapy and medication
• Partial Hospitalization: Services such as IOP, but for more hours/days, while still sleeping at home.
• Detox: This may happen in a hospital or residential program, and is medically supervised, and focused on immediate safety and comfort.
• Residential treatment: A comprehensive program which includes living at the facility, lasting anywhere from a few days to a few months.

Not sure where to start?

Start with an appointment in Health Services! A counselor can help you sort out what you are looking for and make referrals if you need a higher level of care. 

Note: If you think you need immediate assistance, don't wait for us to respond. Instead call 911, go to the nearest ER, or call the San Diego Access and Crisis Line at 888-724-7240.

MiraCosta College Health Services also sponsors anonymous, online screenings. Click here to access all of our mental health screenings and select "Worried about opioid use."