While a basic understanding of the function of narcotics and their effect on the (normal) brain of a chronic user is simplistic when determining who is likely to abuse opiate medications and why they are in a particularly high risk group for opiate addiction, the truth is, of course, much deeper than that.
Historically, opiate addicts--those who abuse and become dependent on heroin and other other forms of opium including synthetic opiates, such as methadone--have been characterized primarily by their low functionality on the social spectrum. Stimulant addicts; those abusing cocaine, methamphetamine, amphetamine and other stimulant drugs are the "go-getters" of the addiction spectrum, as a general rule. Therefore, it is important to determine who is likely to become addicted to and dependent on opiates. This information can educate those in the medical field about who are more likely to use and abuse opiate medications.
By and large, there is a certain amount of truth in the theory that "B-type" personalities are those drawn to the opiate family of drugs. There is a certain tendency for opiate addicts to come from certain types of personality and character development patterns. The largest tendency for opiate addicts is those who suffer from disorders stemming from development of social anxieties or having difficulty with relationships, both personal and social. This group also has a low tendency toward regulation of affect, along with little or no development of psychosis. Another group predominantly tending to abuse opiates is those with a low threshold of reality-based cognitions, with impaired views of reality vs. fantasy regarding relationships. The third group is probably the most highly-functional of the three, socially and intellectually. They are somewhat disillusioned about reality ideation, but not psychologically impaired. They are somewhat, mildly depressed as a rule, but not clinically depressed or impaired. Many in this group function with a low energy for many years, with and without opiates.
In today's trend toward abusing prescription pain killers (synthetic opioids) the latter is probably the most frequently found group. While a certain amount of social functioning is present, due to the high cost of maintaining their addiction and the necessity for obtaining and maintaining numerous prescriptions, they are highest in likelihood of pulling this off. In astonishing numbers, we see them in hospitals, public sector jobs, and other places where drugs are part of the world they inhabit.
Heroin and other opiates are considered "street drugs." The groups using these substances are more traditionally recognized as the addicts who steal money and goods to pay for their drugs, rather than those who must maintain employment and insurance and who are more functional socially. This group is lower functioning and less likely to be involved in the workplace, unless it is on jobs where they have low productivity and poor attendance records.
Initially, opiates will have beneficial and highly pleasurable effects on the user. Dependence develops quickly because the drugs produce euphoric sensations that lead to more frequent use.. Dependence also develops due to the tolerance to specified amounts of the drug that develop rapidly with use. Because these are the drugs most frequently used for pain management, those with chronic pain symptoms and long-term and chronic pain are highly susceptible to addiction and more likely to go through symptoms of opiate withdrawal. Understanding the nature of those who are likely to become dependent on the drugs is important for monitoring patients on pain medication regimens for early signs of abuse. Figuring out what caused the addiction initially and figuring out other solutions is the first step toward opiate recovery.
Kelly McClanahan has an MSW in clinical social work, with a specialization in substance abuse treatment. Having worked in this field for over 20 years, she is currently working on her certification as an addictions' counselor.