There are several psychological influences firstly, stress as part of everyone’s daily life can lead to individuals using opioids to control stress and relax (Al’absi, 2007). Stress is highly associated with increased use of opioid drugs. Research suggests that the presence of chronic stress from areas such as relationships troubles and work-related problems can cause an increased vulnerability to the use of opioids and therefore addiction (Sinha, 2008).
The presence of adverse childhood experiences (ACEs) is also a risk factor for opioid use and addiction. ACEs are events that happened in childhood as parental neglect or abuse that lead to further psychological consequences in later adulthood. There is a correlation between ACEs being present and health-harming behavior to cope with posttraumatic stress disorder (PTSD) (Donkin and Allen, 2015). Likewise, PTSD is not just from childhood experiences that can be a risk factor that leads someone to become dependent on an opioid drug. In the scenario, there is mention of the patient being an amputee. If this patient was a veteran and had developed PTSD then negative alterations in mood, cognition, intrusive thinking, and dreams (Paulson and Krippner, 2007) may have led this patient to be on methadone as an alternative(López-Martínez et al., 2019).
The opioid is being used in an unhealthy coping strategy to manage thoughts and feelings that have derived directly from PTSD (López-Martínez et al., 2019). As a whole, PTSD is highly prevalent among individuals who use heroin incidence from the US and Australia shows PTSD is most prevalent in opiate users compared to users of any other drug class (Mills et al., 2007). PTSD is not only drawn from the military but from other factors e.g. ACEs, witnessing a trauma event, serious assault, or rape.
Chronic pain is another risk factor. It is estimated that opioid prescribing has doubled in the period 1998 to 2018 for chronic pain management. Currently, there is no guidelines from The National Institute for Health and Care Excellence (NICE, 2018) about the effectiveness of opioids and chronic pain and the Royal College of Anaesthetists (RCoA) have stated a clear risk of harm to patients who are prescribed opioid drugs to manage pain effectively in the long term(FoPM, 2018). The patient may have started to use an opioid to cope with pain from an earlier injury in the army perhaps.
Critically, RCoA state that opioids are good management for acute pain and pain at a palliative level however, on the whole, only a small percentage of patients would benefit from long-term prescribing of opioids as chronic pain is complex in nature (FoPM, 2018). Critically, Rosenblum on the other hand states opioids is among the most effective medications for moderate to severe pain. Several medical professional organizations acknowledge reports of satisfactory reductions in pain over time. Rosenblum, et al. 2008).
There is clear evidence suggesting chronic use of opioids is dangerous and can lead to increased dependence, addictions, and an array of other medical complications (Taylor, 2015).
The presence of ACE’s, stress, chronic pain, and PTSD all have a substantial risk of using opioid drugs.
There are several psychological consequences once an individual engages in the use of opioid drugs (Brinksman, 2018). In brief, the scope and severity of the consequences range drastically. Psychologically, there is evidence that the link between taking opioids and having an exacerbation of mental health conditions e.g. depression and anxiety can worsen these conditions as opioids can interference with the brain’s neurotransmitters which blocks and presents the normal function of the central nervous system. Opioid use can also create further mental health problems such as delusions, hallucinations, and paranoia (Sullivan et al., 2006). The main reason for this is the dependency many people taking opioids experience.
Chronically, the consequences of taking opioids in the long term can change the brain itself. Long-term use of heroin can change the structure and physiological aspect of the brain. Heroin for example is linked to causing brain damage similar to Alzheimer’s disease where a build-up of proteins causes nerve cell damage (Haley, 2009).
Social influencers such as existing poverty, peer pressure, and social isolation can all have an impact on the likelihood of an individual starting to take an opioid. Recent statistics show that around 24.6% of opioid overdose deaths were living in poverty (Altekruse et al., 2020) and that. Individuals who are at risk or are living in poverty are at risk of engaging in opioid use.
Moreover, young people and adolescence are also at high risk of being socially pressured into taking opioid drugs. One study in the US suggests have taken a form of opioid in their younger adult life. Pressure around having to fit in alongside issues of own self-esteem can interlink and cause a deadly combination to the start of opioid addiction. Furthermore, the likelihood is also increased if individuals are socially isolated from others and use substances to make friends or pass time (Romanowicz et al., 2019).
Financially there is also a risk to individuals. This is usually after addiction has started. However, is there influence beforehand. For example, individuals in financial problems or bankruptcy are at risk of starting to misuse substances harmful to their health. Individuals living in poverty, therefore, are also at risk of developing the need to cope and are at risk of opioid use. Influences such as inadequate housing, poor education, and social opportunities can make an individual more likely to become deprived and live in poverty.
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