A Family-Friendly Guide to Understanding Opioid Use Disorder (OUD)
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An Introduction to Opioid Use Disorder
About the Author: Who Am I, and Why Am I Writing This?
What Are Opioids?
How Addiction Develops
Addiction vs. Dependence
What Influences the Risk of Addiction?
Conclusion: Addiction as a Hostage Situation
What Happens in the Brain and Body During Addiction
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If you or a loved one is struggling with opioid use and addiction, please call 6063934632 to schedule an assessment.
An Introduction to Opioid Use Disorder
If you are reading this, you or someone you love may be struggling with opioid use. I want you to know this first: you are not weak, broken, or beyond help.
Opioid addiction, clinically called Opioid Use Disorder (OUD), is one of the most misunderstood health conditions families face today. In the United States, millions of people live with OUD, and tens of thousands die each year from opioid overdoses, making it a leading cause of accidental death. It affects people of all ages, backgrounds, and walks of life. It often begins quietly, sometimes with a prescription meant to help pain, and can slowly take over before anyone realizes what is happening.
Understanding what opioid addiction actually is —not what we’ve been told or what stigma suggests— can help families recognize the signs early and approach their loved ones with understanding. My hope is that this guide helps you feel informed, supported, and less alone as you consider next steps.
Who Am I, and Why Am I Writing This?
My name is Dr. Rose Uradu, and I am an addiction medicine specialist. For many years, I have had the privilege of caring for thousands of people living with opioid use disorder; people just like you, your family members, your neighbors, and your coworkers. I have seen people at their lowest points and watched them rebuild meaningful, stable lives. I’ve also seen how shame, misinformation, and fear keep people from getting help far longer than they should. I’m writing this not to lecture you, but to sit with you with the goal to explain what is happening in the body and brain in a way that makes sense, and to remind you that recovery is possible. Help works. Treatment works. And people do get better.
What Are Opioids?
Your body has always had its own natural pain-relief system. It produces substances called endorphins, also known as endogenous opioids. These chemicals help manage pain, stress, and emotional distress and play an important role in survival and emotional balance.
The Endogenous Opioid System (EOS) keeps a careful balance between producing and breaking down these natural opioids. But sometimes, that system isn’t enough.
In cases of severe injury, surgery, or serious illness, natural opioids may not adequately control pain. This is where medicine stepped in.
By studying plants like opium and through laboratory science, external (exogenous) opioids were developed to treat severe pain. These include prescription medications such as hydrocodone, oxycodone, and morphine, as well as heroin and synthetic opioids like fentanyl.
How Addiction Develops
In addition to being effective pain controllers, synthetic opioids — especially at high doses — can also induce an extreme dopamine rush leading to an intense euphoric state, which some body types may adopt as a new normal and constantly aspire to replicate.
This bodily desire to replicate the dopamine high is called opioid “dependence.” - an opioid side effect.
Addiction vs. Dependence
This distinction is important.
Dependence: A physical adaptation where the body goes into withdrawal when the opioid is stopped. It requires a controlled opioid step-down to return to baseline.
Addiction (OUD):
While in withdrawal, how one goes about sourcing external opioids is the major distinction between opioid dependence and opioid addiction. In opioid addiction, the pursuit of opioids consumes the individual.
So, addiction is a chronic state of physical opioid dependence that includes behavioral changes including compulsive opioid use despite adverse physical, social, and legal consequences.
The difference is not whether someone’s body depends on opioids, but whether their life has become organized around pursuing them.
What Influences the Risk of Addiction?
Anyone who has taken opioids for a period of time can experience opioid dependency, but whether a person becomes addicted to opioids is determined by a complex interplay of genetic, environmental, and developmental factors.
Key Risk Factors:
Some factors that increase vulnerability include:
Genetics: An individual’s genes account for roughly half of their risk for addiction.
Environment: A person’s surroundings and life experiences significantly influence their risk.
Family and social environment: Lack of family support, a difficult home life, peer pressure, and association with others who use drugs increase risk.
Trauma and stress: A history of physical trauma or chronic pain can greatly increase vulnerability to later addiction.
Access and availability: Easy access to prescription opioids or illegal substances in one’s community is a contributing factor.
Socioeconomic factors: Living in poverty or chronic hopelessness can also increase risk.
Mental health conditions: People with untreated mental health disorders may use opioids to “self-medicate” and cope with painful feelings.
Development: The age at which a person begins using opioids is critical.
Method and duration of use: Taking opioids regularly, in higher doses, or for prolonged periods increases the risk of physical dependence and addiction.
What Happens in the Brain and Body During Addiction
Chronic exposure to external opioids signals the body to reduce or stop its own production of endogenous opioids.
Exposure to large quantities at a time causes the body to:
Withdraw some opioid receptors into the cell (internalization), and
Blunt others so they become less sensitive to opioids (desensitization).
By these two processes, there is an inverse proportion to the effect of opioids on the receptors: the more you use, the less euphoria one gets.
This protective adaptation is called opioid “tolerance.”
When the level of opioid-carrying receptors falls below a critical point, the body goes into a physical crisis called “withdrawal.” Withdrawal is usually very unpleasant and painful.
From then on, how to avoid going into withdrawal becomes the person’s main preoccupation. The state of constantly thinking of how to get and use drugs is described as “craving.”
At this time, the person no longer experiences any high, as all the drug does is return the EOS to the new baseline so the person feels “normal.”
To maintain this new “normal,” the brain rearranges its order of commands, prioritizing the obtaining of opioids over all other behavioral parameters like self-respect, aversion to legal problems, responsibility to others, relationships, etc.
This reset in the brain’s priorities explains why the addict continues to use drugs despite awareness that it often leads to other social, legal, and relationship problems.
Conclusion: Addiction as a Hostage Situation
For centuries, the general belief has been that addiction is a disorder of choice and lack of willpower to say no to drugs. Everyone wishes it were that simple. In my clinical experience, people with opioid use disorder wake up every morning hoping this will be day one of not using drugs and goes to bed in shame and frustration at the failure.
Science has shown that addiction hijacks the brain command center and holds it hostage.
The term 'addiction' stems from the Latin word addictere, which means 'enslaved by or bound to.' In Roman law it referred to a person who became enslaved or devoted through a court ruling. In Greek methodology, Addictus was the name of a freed slave who remained in his chains. In essence, a substance with addictive qualities turns an individual into an addict who becomes 'enslaved' to that substance or behavior, even when it causes significant harm.
As with every hostage situation, some captives may break out of captivity by themselves, while the majority may need a “SEAL Team Six” intervention.
We’ll talk more soon on the next blog.
Until then, stay safe
