PATTERNS OF USE: ARE YOU A JUNKIE?

PATTERNS OF USE: ARE YOU A JUNKIE?

Many people use opiates occasionally for the high. They take a pill, drink cough syrup, or inject heroin or fentanyl, for example. Some people develop a habitual pattern of daily use that accelerates over a period of time and then stabilizes at a certain level. These people take opiates every few hours. After the first week or two, they are tolerant to many of the effects of the drug; every time the drug wears off, withdrawal signs begin and the cycle of use starts again.

What pattern of use defines an addict? Can a person be addicted after the first dose? The answer for opiates isn't very different from the answers for all of the other drugs we discuss. It is not determined by whether a user injects drugs, or uses them only on weekends, or has never shared a needle, or has ever blacked out. The answer is that he's addicted when he has lost control of use: when he must continue to pursue whatever pattern of use he has set. For some, this loss of control might come from taking oxycodone pills or smoking heroin; for others, injecting or snorting her­oin; and for still others, even drinking codeine-containing cough syrup.

Is a person an addict if he goes through withdrawal? Or, conversely, if he doesn't go through withdrawal, is he not a junkie? This is a common rule that many people use. As we have said, an opiate user will go through withdrawal if he has been taking the drug regularly enough that his body has adapted to it. This is a clear indication of tolerance. Usually, such adaptation means he is in a regular use pattern, but a user can be addicted before he has taken the drug long enough to show strong withdrawal signs. Conversely, a pattern of use might be compulsive but low, and the withdrawal might be so mild it isn't noticeable. Withdrawal happens also in patients who take opioids as prescribed for pain if they take the drug for a period of days or weeks. This doesn't mean they are addicts—just that their bodies have adapted to the opioids.

The National Institute on Drug Abuse has accumulated statistics about "addiction careers," or the typical drug-use pattern of people who are addicted to opiates. Usually, use begins with occasional experimentation and then gradually accelerates over a period of months to continuous administration at intervals of four to six hours. The surprising part about opiate addiction careers is that they often end. Many opiate users follow this pattern for about ten to fifteen years and then quit, often without pro­longed treatment. The reasons are not entirely clear but probably include a host of social and physical factors.