Opioid use risk factors include:3, 5, 6, 7, 8, 9

• Exposure to abuse or trauma.
• Genetic predisposition to SUDs.
• High levels of stressors.
• The presence of co-occurring mental health issues such as anxiety or depression.
• Use of substances that started at an early age.
• Use of opioids for extended periods of time, even if prescribed by a doctor.
• Use of very strong opioids, which are more likely to cause euphoria or a “high.”

Statistics from a 2019 survey of Americans age 12 and over showed that in the last year:14

• 6 million people had an OUD.
• 4 million people had an addiction to prescription pain medication.
• 438,000 people had an addiction to heroin (more than double the number in 2002).

In the US, there were 70,630 deaths due to drug overdoses in 2019.17 Opioids were involved in 49,860 (70.6%) of these deaths.17 Nearly 73% of these deaths involved some type of synthetic opioids, such as fentanyl.17

Why Are Opioids Addictive?

Opioids are very addictive for a few reasons. When opioids are used, they relieve pain and can provide feelings of euphoria and relaxation, making it more likely that you’ll want to continue taking them.8, 9, 13, 16

Long-term effects of opioid addiction include changes in the brain that may affect judgment, behavior, and ability to make decisions and cope with stress, which can make it additionally difficult to stop using.9, 16

Certain problematic patterns of opioid use may also make the development of an opioid use disorder more likely. Misuse includes any illicit use but may also involve:

• Taking prescription opioids in larger doses than prescribed.
• Taking them more often than prescribed.
• Taking them when they haven’t been prescribed to you.
• Using them differently than how they were prescribed, such as by crushing pills and then snorting or injecting them.1, 2

Physical dependence can develop with continued use, no matter how opioids are used. When dependence develops, withdrawal symptoms may arise when use is stopped. These occur as a result of the body and brain becoming used to the presence of opioids in the system and relying on them to function normally.8

Opioid withdrawal can be extremely unpleasant, making it that much more challenging to stop using opioids without help.2, 3, 12

Physical dependence commonly occurs alongside tolerance.8 Tolerance develops as you become less sensitive to the effects of opioids and need to take larger amounts to achieve pain relief or a high.8, 9 Although tolerance may also develop when opioids are taken regularly for long periods of time as prescribed by a doctor, its presence can be another sign of addiction, as the increased opioid use that it prompts can escalate the development of compulsive patterns of use.7

Addiction is a disease that affects your thoughts and behaviors, leading to compulsive opioid use even after it has caused negative consequences in at least 1 area of your life.4, 7 Dependence and tolerance are included in the diagnostic criteria for addiction, but they do not alone explain why opioids are so addictive.7, 12

For instance, while tolerance and dependence may subside after you stop using opioids, addiction is a larger matter to address. Issues like ongoing cravings as well as unhealthy thoughts and behaviors surrounding opioids and their use may require additional treatment attention to best promote long-term recovery.1

Alcohol misuse and alcohol addiction are not the same thing. A person can misuse alcohol but not be addicted to alcohol. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol misuse refers to:1, 2

• Heavy drinking, meaning consuming 5 or more drinks on any day or 15 or more per week for men, or 4 or more on any day or 8 or more drinks per week for women.2
• Binge drinking, meaning a pattern of drinking alcohol that raises a person’s blood alcohol concentration (BAC) to 0.08% or higher. This generally means consuming 5 or more drinks for men or 4 or more for women, in about 2 hours.2
• High-intensity drinking, which means drinking 2 or more times the gender-specific thresholds for binge drinking. This typically involves around 10 or more standard drinks for men and 8 or more for women.2

These patterns of drinking can increase a person’s risk of developing an alcohol use disorder (AUD).3