Most people who take prescribed opioid drugs do not become addicted. According to a review by Dr. Kevin Vowles et al. at the University of New Mexico(quoted in the April 2017 APA “Monitor on Psychology”), only 8 to 12 percent of patients who took opioids for chronic pain became addicted. Most opioid-related deaths occur when these drugs are combined with other substances. The review points out that the majority of people who develop opioid disorders begin by taking drugs prescribed for someone else.

This suggests that the central issue for the 8 to 12 percent who become addicted is not the substance or its availability from physicians who prescribe all too liberally.  The crucial matter is the pre-existing personality of the addict. Shouldn’t the focus be not mainly on the drug but rather on understanding what motivates the addict as he seeks the drug?

One might say that it is obvious that people become addicted to opioids because they seek relief from  chronic pain. So what differentiates people who become addicted in their quest to ease pain versus those who develop other methods to deal with chronic pain and do not become addicted?

In treatment, the focus needs to be first on safety and detoxification, then abstinence. However, if treatment is ultimately to be successful, attention must be paid to the basic personality of the user. A focus should be on cognitive processes (“thinking errors”) that give rise to opioid addiction

Some patients with chronic pain reject out of hand any treatments that do not guarantee them that they can obtain more of the drug. They refuse to consider psychological interventions, biofeedback, relaxation training, or stress management. All they desire is more and more of the drug. And if they cannot have access to it legitimately (by prescription), they go to the streets searching for opioids including heroin. 

Is it not likely that a significant number of cases of opioid addiction represents the tip of an iceberg of massive irresponsibility, and, in many instances, criminality? Over many years, I have interviewed individuals who were functioning irresponsibly before they ever became addicted. Now addicted, they will go to any lengths to obtain the drugs they want – lie, steal, etc.

The above has nothing to do with blame – blaming the user, the substance itself, or the prescriber. Rather, it is an attempt to identify the core problem.

Your thoughts? I invite commentary thoughts.

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