1. Opioid Addiction as a Social Work Challenge
Brianna Tiedeman
October 4th, 2015
Dr. James Forte

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Problem Identification
A common reason for residents desiring a new location is their drug-infested towns, cities,
and suburbs. They might hypothesize that a change of scenery will rid them from the
accessibility of drugs or the prevalence of using. But the unfortunate reality is that drug-use,
more specifically opiate addiction, is becoming a global crisis, and moving is not the answer; the
problem will reside wherever the people do.
Non-users, society as a whole, and professionals might question the temptation of opiates, the
effects of using, the addiction itself, the accessibility, and ultimately, the process of using. What
is it that hooks our demographics onto one of the sharpest in the tackle box? Research points to
economic, social, and political reasons for using, but it also points to possible and tested factors
like the orientation process to opiate use, evolutionary or biological factors, the conditioning
process, avoiding withdrawal, euphoria, craving, and a loss of control. (Alexander, B. K., &
Hadaway, P. F. 1982) (Lyvers, Bond,1998). A potential research question that stems from trying
to understand these trigger behaviors is what the most common triggers associated with opiate
addictions are and how can social workers intervene those specific precursors to using.
Importance of the Problem
In turn, while considering the social work field, the reasons for using are important to
research for prevention and intervention purposes. Social workers who work with addicts
function as micro, mezzo, and macro practice because of clinical work with individual users,
group education and counseling, and widespread intervention awareness practices such as
methadone programs and other detox methods (Frosch, D. L., Shoptaw, S., Nahom, D., & Jarvik,
M. E. 2000). The National Institute on Drug Abuse indicates that the addiction of opioids such as

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heroin, morphine, and prescription pain relievers causes devastating and rising consequences
(Volkow, 2014). These professionals estimate 26.4 to 36 million people worldwide abusing
opiates and unintentional overdose deaths more than quadrupling in only sixteen years.
Prevalence of the Problem
The aforementioned statistics were publicized in 2014, but opiate use and addiction dates back
to the very late 1800s and into the Civil War and is a growing disease, taking the lives of (Batki,
2005). Researchers believe that the roots of opioid addiction were planted in the battlefields
when military doctors prescribed soldiers morphine, opium, and heroin as pain, discomfort, and
stress relievers. “By 1900, an estimated 300,000 persons were opioid addicted in the United
States” (Batki, 2005, p.2). Prior to 1900, doctors introduced heroin as a cough suppressant in
1898, but the prescriptions turned into addictions as soon as the euphoric effect kicked in (Batki,
2005). This study classified males in their early twenties to be the most common users as the
addiction rates grew higher through to the twentieth century. As the millennium neared, the
Office of National Drug Control Policy estimated that 898,000 reported people in the U.S. used
heroin daily and by 2001, admission rates for addictions treatment doubled according to the
Substance Abuse and Mental Health Services Administration (Batki, 2005).
Impact of the problem
Just like the process of deciding to use opiates involves political, social, and economic
triggers, the consequences of using comes with its own trifecta costs. More recent research
indicates that those previous addiction rates increased since 2001 to 5.2 million in 2006 (Manag,
2009). Rates for 2015 would be incredibly higher but are not as accurate due to non-reporting
users; non-reporting could be attributed to penalties and charges intensifying and overdose

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prevalence rising, too. With rising numbers though comes more and more damages. Some of
these include the total cost of opiate prescription abuse totaling $8.6 billion for workplace,
healthcare, and criminal justice expenses and $16,000 of direct per capita annual health care
costs encompassing abusers of both prescription and non-prescription opiates (Manag, 2009).
More costs of opiate addictions, despite the monetary forms, weigh on community
reputations, users’ reputations, relationship reputations, and of course health reputations and
status. These sociocultural aspects of opiate abuse are becoming harder to control because of the
growing populations of addicts. “The costs to individuals and society for rehabilitation from the
myriad effects of substance use are almost incalculable and affect all life areas” (Lex, 1991,
p.33). Opiates foster negative effects on relationships like violence, miscommunication, and even
neglect. They also have negative effects on the female reproductive system, and they create even
more social stigmas on deviant behavior than society already faces (Lex, 1991).
Relevance to Social Work
Although psychological damage and reasoning falls under addicts’ health, the explanations
and theories of addiction triggers dominate the intentions of this paper and they transition into
the absolute relevance to social workers and their profession. According to the National
Association Social Workers’ Code of Ethics, the profession revolves around “a historic and
defining feature of social work is the profession’s focus on individual well-being in a social
context and the well-being of society. Fundamental to social work is attention to the
environmental forces that create, contribute to, and address problems in living” (National, 2008).
The environmental force in this case is addiction; this disease of the mind negatively contributes
to the well-being of the individuals affected and the well-being of society. Social workers are
feeling the effects of the opioid addiction phenomenon because of the growing populations of

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addicts as aforementioned. Examining the triggers and affiliated relationships to addiction helps
foreshadow how social workers are involved.
One trigger indicated by the Experimental and Clinical Pharmacology journal is that of
tobacco. “Although there may be differing factors to account for dependence on different
substances, there remain important interactions among them. A body of work is accumulating to
explain the extent to which nicotine and other substances share similar brain pathways” (Frosch,
2000, p.9). The study concludes that the relationship between the tobacco phenomena and opiate
abusing is deepened by the amount of tobacco an addict uses in conjunction with his or her
opiate use. If a tobacco user quit smoking tobacco in any form, the cessation would likely extend
to other drug use, such as more opiates (Frosh, 2000). Though opioids have many other triggers
for use, using other drugs is a very common theme. Addicts’ minds function through sedatives
and a sedative, is a sedative, is a sedative. Most often if an addict quits one substance, they will
substitute or replace their drug of choice with another. The gateway drug theory is not always
representative, but in an addicts case who uses multiple substances to achieve a high, gateway
drugs are a very real occurrence. Either way, users are still using, no matter what the substance.
Other forms of triggers or indicators of opioid addiction occur because of the lack of
euphoria, in other words withdrawal symptoms. However, researchers believe that addicts do not
use to alleviate withdrawal symptoms, but instead they think that using will help them even
though the vicious cycle of withdrawal will start again if they use, regardless. “If addictive
behavior results from enduring drug-induced changes in the physical brain, all drug addictions
can be meaningfully regarded as reflecting a physical process irrespective of the presence or
absence of autonomic withdrawal changes” (Lyvers, 1998). In an addicts mind, they use to avoid
the horrible aftermath of using, but the brain is tricking them because the side effects are re-

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occurring (Alexander, 1982). “The drug habit has apparently taken on a life of its own, so that
the subjective consequences of drug ingestion, good or bad, are no longer important” (Lyvers,
1998, p.57).
Other drug-use and withdrawal avoidance, despite cognitive willpower, are just two of many
triggers associated with abusing opioids; however, more triggers and theories collaboratively
explain why addicts use as well. One example of a dual reason for using is the exposure
orientation versus the adaptive orientation (Alexander, 1982). Exposure orientation explains
addiction as a condition that occurs when the drug use “engenders a powerful tendency toward
compulsive use.” The drug itself is seen as the cause of addiction. Adaptive orientation explains
it as an attempt to “cope with chronic distress or trauma through habitual drug use” (Alexander,
1982, p. 367). Adaptive theory indicates that the drug is not the problem, but rather the trauma
causes the drug use is the problem. In addition to the exposure and adaptive theories, the
sociological orientation is yet another feasible theory explaining triggers for use. “Opiate
addiction is seen as imposed on addicts by their peer groups…typically gangs, deviant student
cliques, or friendship groups (Alexander, 1982, p. 369). These groups usually make it clear to
new members that drug-addiction is a common thread. A couple last theories and triggers of
opiate abuse include metabolism and conditioning. Metabolic theory explains that opiates alter
the metabolism and make frequent ingestion physiologically necessary for the addict (Alexander,
1982). This theory supports a physical dependence. Conditioning theories originate from a more
psychological perspective, indicating that opiates are positive reinforcements and make users
believe that the benefits outweigh the withdrawal and future consequences. Conditioning also
indicates that avoidance-learning could also occur if a user postpones withdrawal symptoms by
continuing to use, similar to the withdrawal-avoidance theory (Alexander, 1982).

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How Social Work Aligns
Triggers and theories that explain why addicts use are either physical or mental handicaps and
these addicts need intervention before overdose. This realization is where social workers come
in. The code of ethics, again, says that the profession aims to address the environments of clients
in order to better their lifestyles and improve their well-being. Social workers can help to
alleviate the frequency of these triggers and theories for using by developing treatment plans and
helping their clients stick to the goals associated with those plans. This primarily involves
changing the environments they currently function in. Social works can refer clients to or suggest
to them community resources such as methadone programs, detox centers, in-patient treatment,
group counseling, narcotics anonymous, peer-support, and even more, after they have evaluated
the people, places, and things that are already in their lives. Addiction recovery often takes years
to commit to and even decades to complete successfully. To stop using drugs is easy, but to stay
stopped is, for some, impossible. In turn, social workers are there as a resource by aiding these
individuals along their journey and contributing to the betterment of society overall.

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References
Appendix A
Alexander, B. K., & Hadaway, P. F. (1982). Opiate addiction: The case for an adaptive
orientation. Psychological Bulletin, 92(2), 367-381.
Batki, S. (2005). History of Medication-Assisted Treatment for Opioid Addiction. In
Medication-assisted treatment for opioid addiction in opioid treatment programs ((1)
ed., Vol. 43, p. Ch.2). Rockville, MD: U.S. Dept. of Health and Human Services,
Substance Abuse and Mental Health Services Administration, Center for Substance
Abuse Treatment.
Frosch, D. L., Shoptaw, S., Nahom, D., & Jarvik, M. E. (2000). Associations between tobacco
smoking and illicit drug use among methadone-maintained opiate-dependent
individuals. Experimental And Clinical Psychopharmacology, 8(1), 97-103.
Lex, B. W. (1991). Some gender differences in alcohol and polysubstance users. Health
Psychology, 10(2), 121-132.
Lyvers, M. Bond, U. (1998). Drug addiction as a physical disease: The role of physical
dependence and other chronic drug-induced neurophysiological changes in compulsive
drug self-administration. Experimental And Clinical Psychopharmacology, 6(1), 107-
125.
Manag, J. (2009). Economic burden of prescription opioid misuse and abuse. U.S. National
Library of Medicine. 7(1), 556-62
National Association of Social Workers. (approved 1996, revised 2008). Code of Ethics of the
National Association of Social Workers. Washington, DC: Author.

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Volkow, N, (2014). America's Addiction to Opioids: Heroin and Prescription Drug Abuse. The
science of drug abuse & addiction. National Institute of Drug Abuse, Testimony to
Congress 1, 1-14.