Opioid Addiction

What opioid use disorder is

Opioid use disorder (OUD) is a chronic, relapsing brain disease defined in the DSM-5 by a problematic pattern of opioid use causing clinically significant impairment or distress. Diagnosis requires meeting at least two of eleven criteria over a twelve-month period, grouped into four domains: impaired control over use, social impairment, risky use, and pharmacological changes such as tolerance and withdrawal. The severity of OUD is graded mild (2-3 criteria), moderate (4-5 criteria), or severe (6 or more), and treatment is matched to severity.

The opioid category includes prescription pain medications such as oxycodone (OxyContin, Percocet), hydrocodone (Vicodin), morphine, codeine, tramadol, and fentanyl; illicitly manufactured fentanyl and its analogues; and heroin. Opioids work by binding to mu-opioid receptors in the brain, producing pain relief, euphoria, and sedation. With repeated use, the brain reduces its own natural opioid production and the density of receptor sites, creating a cycle of tolerance, physical dependence, and withdrawal that makes stopping feel impossible without help.

Importantly, tolerance and physical dependence alone are not sufficient for a diagnosis of OUD. Many people on long-term prescribed opioids develop dependence without meeting the broader criteria for a use disorder. Conversely, opioid use disorder can develop in the absence of pronounced physical withdrawal in some cases. The National Institute on Drug Abuse (NIDA) and SAMHSA recognize OUD as a chronic brain disease that responds to medical treatment.

Why opioids are so dangerous right now

The opioid crisis that the Centers for Disease Control and Prevention (CDC) has tracked over two decades has entered its most deadly phase, driven primarily by illicitly manufactured fentanyl. Fentanyl is 50 to 100 times more potent than morphine and is now present in the majority of the illicit opioid supply, as well as in a growing proportion of stimulants, benzodiazepines, and counterfeit pills sold as everything from prescription oxycodone to Xanax. A person buying what they believe is a prescription painkiller may receive a counterfeit pill with a lethal fentanyl dose.

The second critical danger is tolerance loss after a period of abstinence. When someone stops using opioids, tolerance drops rapidly, sometimes within days. If they return to the same dose they were using before, the risk of fatal respiratory depression is dramatically elevated. This is why overdose deaths are disproportionately common shortly after people leave jail, hospital, or an inpatient program without adequate MAT and continued outpatient care.

Signs and symptoms of opioid use disorder

The behavioral and physical warning signs of OUD tend to appear and deepen together as dependence progresses. Recognizing them early in a loved one or in oneself creates the best opportunity for intervention before an overdose occurs.

• Using opioids in larger amounts or over a longer period than intended
• Persistent desire to cut down or stop, or multiple unsuccessful attempts to do so
• Spending significant time obtaining opioids, using them, or recovering from effects
• Strong cravings or urges to use that are difficult to resist
• Opioid use causing failure to meet major work, school, or family obligations
• Continued use despite the social or interpersonal problems it is causing
• Giving up or reducing important activities because of opioid use
• Using opioids in physically hazardous situations
• Continued use despite knowing it is causing a physical or psychological problem
• Tolerance: needing more to get the same effect
• Withdrawal symptoms when use is reduced or stopped: nausea, sweating, muscle aches, anxiety, insomnia
• Physical signs: drowsiness, nodding off, constricted pupils, slowed breathing

Opioid withdrawal: timeline and what to expect

Opioid withdrawal is genuinely miserable and is the primary driver of relapse in the absence of treatment. Although it is rarely fatal on its own, the combination of intense physical discomfort and overwhelming psychological distress makes unassisted withdrawal extraordinarily difficult. The fear of withdrawal is what keeps many people trapped in active use for far longer than they want to be.

For short-acting opioids such as heroin and oxycodone, withdrawal typically begins within eight to twenty-four hours of the last dose, peaks within thirty-six to seventy-two hours, and largely resolves within five to ten days. For longer-acting opioids such as methadone or extended-release formulations, onset may be delayed by one to three days, and the peak and resolution are correspondingly extended. Symptoms include muscle and bone aches, restless leg sensations, nausea, vomiting, diarrhea, sweating, chills, goosebumps, pupil dilation, anxiety, irritability, insomnia, and powerful cravings.

Post-acute withdrawal syndrome (PAWS) can extend for weeks to months after acute withdrawal resolves, with persistent low mood, sleep disruption, cognitive fog, and intermittent cravings that are a major relapse trigger in early recovery. Medication-assisted treatment addresses both acute and post-acute phases. This page is educational and is not dosing or medical advice.

Recognizing and responding to an opioid overdose

Opioid overdose is a medical emergency. Knowing how to recognize it and respond can save a life. The key signs are slow, shallow, or stopped breathing; blue or grayish discoloration of the lips or fingertips; unresponsiveness to voice or touch; and extremely constricted (pinpoint) pupils.

If you witness a suspected opioid overdose: call 911 immediately, administer naloxone (Narcan) if it is available, perform rescue breathing if you are trained to do so, and stay with the person until emergency responders arrive. Because illicit fentanyl is far more potent than heroin, multiple doses of naloxone may be needed. Many states, including New Jersey and North Carolina, have standing orders that make naloxone available at pharmacies without a prescription, and both states have Good Samaritan laws that provide legal protections for people who call for help during an overdose.

The Archangel Centers includes naloxone education, distribution guidance, and overdose response training in our opioid treatment programming. We also help clients and families build safety plans so that if relapse occurs, it does not become a fatality.

Medication-assisted treatment for opioid use disorder

Medication-assisted treatment (MAT) is the gold standard for opioid use disorder. Decades of research from NIDA, ASAM, and the Cochrane Collaboration consistently show that MAT combined with counseling reduces overdose deaths, reduces illicit opioid use, reduces criminal activity, improves social functioning, and supports long-term recovery far better than abstinence-only approaches. MAT is not trading one addiction for another. FDA-approved medications used at therapeutic doses stabilize brain chemistry without producing the cycle of impairment, craving, and harm that defines addiction.

Buprenorphine, available as Suboxone (buprenorphine/naloxone) sublingual film and as Sublocade (monthly injectable), is a partial opioid agonist that activates opioid receptors enough to suppress withdrawal and cravings without producing a significant high at prescribed doses. It has a ceiling effect that limits respiratory depression risk. Naltrexone, available as a daily oral tablet or as Vivitrol (monthly injectable), is a full opioid antagonist that blocks opioid receptors entirely, preventing any opioid from producing effect. It requires a period of complete abstinence before starting to avoid precipitating severe withdrawal. Methadone is a full opioid agonist available only through federally licensed opioid treatment programs (OTPs) and is not in The Archangel Centers' formulary. Both buprenorphine and naltrexone are available through our outpatient programs.

• Buprenorphine (Suboxone, Sublocade): partial agonist, suppresses withdrawal and cravings, ceiling effect limits overdose risk
• Naltrexone (Vivitrol): opioid antagonist, blocks effects of any opioid, requires 7-10 days of abstinence before starting
• Staying on MAT for an appropriate duration is the single strongest predictor of sustained recovery from OUD per ASAM and SAMHSA consensus
• MAT is endorsed by the American Society of Addiction Medicine, the American Medical Association, and the Surgeon General
• Medication duration is individualized; there is no universal timeline, and premature discontinuation carries elevated overdose risk

Therapy alongside medication-assisted treatment

Medication addresses the physical dimensions of opioid use disorder; therapy addresses the psychological and behavioral dimensions. Both are necessary for comprehensive treatment, and The Archangel Centers provides them together under one clinical team rather than as separate, disconnected programs.

Cognitive Behavioral Therapy (CBT) teaches clients to identify the thought patterns, emotional states, and situational triggers that lead to use and to build concrete skills for responding differently. Motivational Interviewing strengthens the client's own motivation and commitment to change. Dialectical Behavior Therapy (DBT) addresses the emotional regulation and distress tolerance deficits that frequently drive opioid use in clients with trauma histories or mood disorders. Trauma-informed care and EMDR address the underlying traumatic experiences that are highly prevalent in people with OUD. Relapse prevention planning, group therapy, and family therapy complete a comprehensive behavioral treatment approach.

Co-occurring conditions in opioid use disorder

Depression, anxiety disorders, PTSD, and chronic pain are extremely common co-occurring conditions in people with opioid use disorder. In many cases, opioid use began as an attempt to manage one of these conditions before it escalated into a disorder in its own right. Treating only the opioid use while leaving depression, trauma, or chronic pain unaddressed creates the conditions for relapse.

The Archangel Centers takes a dual diagnosis approach as the clinical standard, not the exception. Co-occurring mental health conditions are assessed using validated instruments including the PHQ-9 for depression, the GAD-7 for anxiety, and the Columbia Suicide Severity Rating Scale. Treatment addresses both the addiction and any co-occurring conditions in an integrated plan delivered by the same team.

What treatment looks like day to day

After a comprehensive intake assessment, each client at The Archangel Centers is placed at the level of care that matches their clinical needs: PHP, IOP, or standard outpatient. PHP clients attend programming five days a week and receive intensive group and individual therapy, psychiatric evaluation, and medication management. IOP clients attend three to four days per week and receive comparable therapy while maintaining daily responsibilities. All levels include individual therapy, group programming, medication management when appropriate, and regular reassessment.

In New Jersey and in North Carolina, our outpatient setting is designed to be comfortable and therapeutic rather than institutional. Clients move through levels of care at a pace set by their clinical progress, not an arbitrary calendar. Families are included in the process when the client consents and when family involvement supports recovery.