Why Some People Become Addicted to Opioids While Others Don’t

Dr. Greg Amer, Fairview addiction medicine physician, explains why some people become addicted to opioids and offers tips on how to prevent developing an addiction.

As an addiction medicine physician and because of the current opioid crisis facing our nation, I’m often asked, “Why do some people become addicted to opioids while others don’t?"

Before I answer that, let’s first review what opioids are. Simply put, opioids include prescriptions like codeine, hydrocodone (Vicodin, Norco) or oxycodone (Oxycontin, Percocet), but they can also be illegal street drugs, including heroin. You can learn more about what opioids are in this blog post.

The answer to why some people become addicted and not others is quite simple: Addiction is a disease that some people have and others don’t, just like any other disease. It’s estimated that about 10-15 percent of our population are actively battling addiction or recovering from it.

If you don’t have it, it’s very unlikely you’ll form an addiction to opioids or any other addictive substance or behaviors. (However, it’s worth noting that it is possible for anyone, regardless of whether or not you have the disease, to become physically dependent on opioids, but that is different than addiction.)

So, how does one develop addiction? The disease is in a person’s genes. The makeup of the responsible gene(s) affects the receptors—the circuits and wires, in other words—in the person’s brain that cause him or her to react differently to addictive substances than a person without the disease. But beyond that, we—doctors and researchers—don’t know much about the cause. 

For a person with addiction, the disease is always present but only apparent when coupled with substance abuse or addictive behaviors. Currently, we don’t have a way to determine who has the disease and who doesn’t before a person shows symptoms of addiction. There are no blood tests or scans that we can run, but I hope and believe we will be able to do so someday.

Until then, I offer this advice:

  • Know your biological family history: The best indicator in determining if a person has the disease or not is family history. If there’s known addiction in the family—say your biological mother or father is an alcoholic—there’s a chance you too may have the disease, but it’s not a certainty; the more people in your family with the disease of addiction, the greater the risk you will inherit the disease. 
    • If addiction is present among your biological family members, proceed with caution when needing to take opioids, other addictive substances (e.g., alcohol, marijuana, Ambien, Valium, Xanax), or engaging in addictive activities like gambling.
  • Recognize how opioids make you feel: If you’ve taken opioids in the past or are now, notice how you felt/feel while taking them. Did they make your feel good (happy and/or relaxed in addition being pain free), or did they make you feel sick? Those who feel good while taking opioids may have the disease and must be very careful to take the prescription only as prescribed—certainly do not take more than prescribed or, better yet, avoid taking them at all, if possible. Talk to your doctor about alternatives.
  • Be honest: If you feel really good (beyond being pain free) while taking opioids, or you find you’re taking more than prescribed, tell your doctor right away. Ask for help. The earlier you and your doctor or care provider recognize that you may be developing an addiction, the better the intervention and chances of reversing the trend are. 
  • Avoid addictive substances and behaviors: If you have a history of addiction, avoid all addictive substances/activities for the rest of your life; the risk of relapse is very high. Remember, the disease is always present in your body even when you’re not symptomatic.

Knowing your family history, and being aware and honest about the way opioids make you feel, can play an enormous role in whether or not addiction becomes a problem.

If you have concerns about opioid use or addiction, talk to your doctor, or make an appointment with me by calling 612-273-6099.


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