The opioid epidemic has touched nearly every community in the United States, affecting individuals from all backgrounds and circumstances. While every person’s experience with opioid use is different, many find themselves caught in a cycle that becomes increasingly difficult to break over time. No two experiences are exactly the same, which is why treatment must be tailored to the individual.
Effective care goes beyond addressing the substance itself. It must address what the opioids were being used to manage in the first place. At Helios West Palm, our clinical staff helps clients understand the underlying reasons for opioid use and how to find a sustainable way to achieve long-term recovery through integrated treatment.
Opioid use disorder (OUD) is a chronic medical condition characterized by the problematic use of opioid medications in a manner that adversely impacts the user, often as an attempt to self-medicate.[1]
Opioids themselves are a class of drugs that includes both legal prescriptions like hydrocodone and oxycodone, as well as illicitly manufactured opioids like fentanyl and heroin that act on opioid receptors throughout the central nervous system, producing pain relief, euphoria, and sedation.[2]
OUD affects more than 2 million people and contributes significantly to drug overdose deaths in the US.[3]. According to the National Institute on Drug Abuse (NIDA) and multiple sources of public health data, opioid overdose remains a public health emergency due in large part because a significant portion of the drug supply now contains synthetic opioids like fentanyl, which is extremely potent and deadly.[4]
OUD is characterized by a lack of control over the use of opioid medications, continued use despite negative consequences, and withdrawal symptoms when use is stopped. Like other substance use disorders, it is classified as a chronic condition, requiring continual medical management and one that very frequently co-occurs with mental health conditions that also require treatment.[5]
Recognizing the symptoms of opioid dependence is an important first step in determining whether someone might benefit from professional help.
Common signs of opioid dependence include:
The range of symptoms related to OUD is considerable, and many people with OUD may have no obvious signs of addiction or may show only physical dependence without other diagnostic criteria for OUD. A comprehensive clinical evaluation is the best way to determine the level of services someone requires.
The short-term and long-term effects opioids have on physical and mental health are important contexts for understanding the clinical makeup of OUD. They include:
Short-term side effects
Long-term side effects of opioid use
The psychological and neurological side effects of chronic opioid use, particularly depression, anxiety, and anhedonia from dopamine depletion, are some of the most clinically important for patients who require dual diagnosis treatment.[7] For many people, the depression and anxiety compound long-standing mental health issues that were causing the opioid use in the first place. This creates a complex set of circumstances that requires careful, integrated psychiatric management.
The link between opioid addiction and mental health has been studied extensively in behavioral health. Many people with opioid use disorders also have co-occurring mental health issues, and many times the mental health issue existed before the substance use, creating a vulnerability to develop an opioid use disorder.[8]
Depression is the most prevalent condition that co-occurs with opioid use.[9] Opioids provide a very powerful means of relieving both emotional and physical pain, and for people suffering from untreated depression, it can seem to be the most effective treatment they have. Over time, the neurological changes from using opioids can deepen the underlying depression, creating a cycle that can be very difficult to break without treating both conditions.
PTSD and trauma are extremely common among people who use opioids.[10] Unresolved trauma, including childhood abuse, sexual trauma, and combat exposure, creates a significant amount of internal stress that can be temporarily relieved by using opioids. Without addressing the trauma in treatment, chances of sustained recovery are extremely unlikely.
Chronic pain and mental health have a deeply intertwined relationship. The relationship among physical pain, depression, PTSD, and opioid use is considered to be one of the most complicated in clinical medicine, mainly because the neurological pathways involved with pain, emotional distress, and opioid use all reinforce each other.[11] The full picture must be addressed to achieve effective treatment.
Anxiety disorders, bipolar disorder, ADHD, and personality disorders in patients with opioid use disorders are also very prevalent, and each contributes to the vulnerability that drives opioid use as a coping mechanism.[12]
Many patients who come to Helios West Palm follow a certain pattern. They have been detoxed from opioids, treated with medication-assisted treatment such as methadone, buprenorphine (Suboxone), or naltrexone (Vivitrol), and completed rehab or outpatient programs.
All of these treatment options helped stabilize the opioid use, but the depression, trauma, and mental illness that drove the opioid use in the first place were never adequately addressed. And because they didn’t receive treatment for those underlying conditions, the urge to return to opioid use continues.
These patients aren’t treatment failures. They just received interventions focused on the opioids, instead of the underlying cause. What these patients need isn’t another treatment option that focuses on addiction. They need care in a psychiatric setting where their primary diagnosis is treated, and their opioid use disorder is addressed within that clinical context.
Helios West Palm is not a detox center, a methadone clinic, or a primary treatment facility for addiction. For patients whose opioid use stems from underdiagnosed or undertreated mental illness, such as depression, PTSD, anxiety, or bipolar disorder, we provide an integrated, psychiatric-led residential treatment program that effectively treats the underlying condition as the primary diagnosis so you can get to the root of your issue and heal from the inside out.
For patients who require medical detox prior to admission, we will refer to outside medical providers. Our admissions department will help coordinate this transition as part of the intake process.
If you have received treatment for opiate addiction before, but found it didn’t address the full picture, then Helios West Palm may be your next step.
Reach out to our admissions team today; they are available round the clock to answer your questions, verify your insurance, and help you see what integrated treatment could look like for you.
People addicted to opiates exhibit physical withdrawal symptoms when they miss or decrease their dosage, build tolerance that requires increasing dosage to achieve the same effect, continue to use despite negative consequences, and experience intense cravings. The above characteristics represent a person who has a dependence on opiates, but do not by themselves indicate that the person has a substance use disorder. A thorough clinical assessment is required to identify the level of care needed in treating a person with an OUD or mental illness.
Yes. Evidence-based medication-assisted treatment, such as buprenorphine, methadone, or naltrexone, is available for treating OUD. Once a person is stable on MAT, they continue to receive appropriate medication under the supervision of the psychiatrist conducting their psychotherapy sessions as part of the comprehensive treatment of the mental health disorder.
The high incidence of relapse following opiate addiction treatment can often be attributed to the inability of the person to engage with their underlying issues, such as depression, PTSD, or anxiety. Addiction treatment is ineffective when it doesn’t address the issues causing the addiction. That is why Helios West Palm addresses the root causes and not just the symptoms.
Chronic pain, depression, PTSD, and OUD overlap in a common set of brain networks. Chronic pain causes depression, depression causes chronic pain, PTSD exacerbates chronic pain, and opiate use disorder produces more emotional and physical pain. Treatment for people suffering from several of these conditions should be coordinated within an integrated psychiatric and medical management program.
[1] Dydyk, A. M., Jain, N. K., & Gupta, M. (2023). Opioid use disorder. StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/n/statpearls/article-42233/
[2] National Institute on Drug Abuse. (2024, November 22). Opioids. https://nida.nih.gov/research-topics/opioids
[3] [4] [5] National Institute on Drug Abuse. (2024, August 21). Drug overdose deaths: Facts and figures. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates
[6] StatPearls Publishing. (2023). Opioid withdrawal. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK526012/
[7] Garfield, J. B. B., Cotton, S. M., & Lubman, D. I. (2020). Anhedonia as a key clinical feature in the maintenance and treatment of opioid use disorder. Clinical Psychology Review, 75, 101814. https://pmc.ncbi.nlm.nih.gov/articles/PMC7009780/
[8] [12] Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment for people with co-occurring disorders: Updated 2020 (Treatment Improvement Protocol Series, No. 42). National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK571022/
[9] Meredith, L. S., et al. (2021). Design of CLARO (Collaboration Leading to Addiction Treatment and Recovery from Other Stresses): A randomized trial of collaborative care for opioid use disorder and co-occurring depression and/or posttraumatic stress disorder. Contemporary Clinical Trials, 104, 106354. https://pmc.ncbi.nlm.nih.gov/articles/PMC8432760/
[10] National Institute on Drug Abuse. (2024, February 12). Trauma and stress. https://nida.nih.gov/research-topics/trauma-and-stress
[11] Substance Abuse and Mental Health Services Administration. (2020). Managing chronic pain in adults with or in recovery from substance use disorders (Treatment Improvement Protocol Series 54). https://www.ncbi.nlm.nih.gov/books/NBK92054/
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