H2400

Opioid Drug Abuse 1

Opioid Drug Abuse in North America

Braxton Bassie

Health 2400-001

Clemson University

Opioid Drug Abuse 2

HEALTH BEHAVIOR OF INTEREST

The health behavior of interest in regards to this literature review is the avoidance

of a prescription drug, or opioid addiction among medical patients and drug users.

According to a WHO report, opioid addictions can be defined as “a cluster of

physiological, behavioral, and cognitive phenomena in which the use of a substance or a

class of substances takes on a much higher priority for a given individual than other

behaviors that once had greater value” (WHO Report, 2015). While these drugs are very

effective in their designed medical purposes of pain relief, patients can often use them for

addictive purposes that are unintended by their providers (Kosten & George, 2002).

There are also many common misconceptions about opioid abuse that have made it

difficult to address this health behavior efficiently. For instance, a common view of the

North American population is that patients dealing with opioid abuse are the result of

them being “bad people,” however that’s simply not always the case as it has been proven

that opioid addictions can be the result of biological brain traits that make some

individuals more susceptible to addiction than others (Kosten & George, 2002).

Therefore, this literature review works in understanding behavioral influences like this.

When understanding the health determinants of opioid addiction public health

professionals can address the health behavior more clearly and work towards a solution

of preventing an opioid addictive behavior in present and future individuals (Rosenblum,

Marsch, Joseph, & Portenoy, 2009).

STATISTICS AND HEALTH OUTCOMES

The non-medial use of opioid pain-relievers has increased in prevalence over

recent years, as a recent report found that at least 2 million Americans had been using

Opioid Drug Abuse 3

opioids in an abusive manner (Stotts, Dodrill, & Kosten, 2010). Another study found

alarming opioid statistics as well, as in 2007 it was estimated 2.5 million people in the

United States aging from 12 years old and up had been ‘misusing’ new prescription drug

medications for non-medial purposes (Weiss, Potter, Copersino, Prather, Jacobs, Provst,

& Ling, 2011). The same study also explained that this has become a growing concern of

health professionals as 2.15 million of these opioid abusers were new abusers,

representing a very high number of new users when compared to past decades (Weiss,

Potter, Copersino, Prather, Jacobs, Provst, & Ling, 2011). Consequently, a growing

concern of health professionals has become opioid drug overdose. With growing rates in

opioid misuse, it appears to researchers that death rates due to opioids could greatly

increase (Stotts, Dodrill, & Kosten, 2010). In 2008, researchers found reports from the

Center for Disease Control and Prevention reporting 20,044 deaths had been due to

prescription drug overdose (Chakravarthy, Shah, & Lotfpour, 2012). Most of these

deaths were found to be unintentional and not the result of suicide. When comparing the

time periods between 1999 and 2008, overdose rates due to opioids had become four

times greater as the sales of opioids had become four times greater as well. This

correlation displayed to researchers a possible relationship between the selling of

prescription medication and overdose rates.

HEALTHY PEOPLE 2020

The reports made by Healthy People 2020 provide objectives that can serve as

templates of desired behavior for a population. These objectives are meant to be realistic

goals for the target population. In regards to opioid abuse in this literature review,

Healthy People 2020 set objectives in response to the trending negative health effects

Opioid Drug Abuse 4

opioids could have on the population (Health People 2020, 2014). A specific objective

that explains this issue and its need for improvement is objective SA-19, which states the

goal to “reduce the past-year nonmedical use of pain relivers.” Within this objective,

there are objectives SA-19.1 and SA 19.5 which state to “reduce the past-year

nonmedical use of pain relievers” and “reduce past-year nonmedical use of any

psychotherapeutic drug” respectively. SA-19.1 displays it’s importance in changing

behavior in the statistic that “4.8 percent of persons aged 12 years and older reported

nonmedical use of pain reliever in the past year in 2008.” SA-19.5 displays a similar

baseline but with a higher percentage of “6.1 percent of persons aged 12 years and older

reported nonmedical use of any psychotherapeutic drug in 2008.” The target goal for the

SA-19.5 objective is stated to be a 10 percent decrease in the number of individuals using

psychotherapeutic opioids non-medically. Substance abuse is not a new concern of

Healthy People initiatives but opioid abuse will likely increase in concern as its

prevalence continues to grow over the years (Chakravarthy, Shah, & Lotfpour, 2012).

INTRAPERSONAL FACTORS

Intrapersonal factors are the factors within an individual, which is why it is also

known as individual factors. As seen in this literature review, these factors are made up

mostly of a person’s attitudes and beliefs but can also include other factors such as

Psychological and Demographics/Socio-Economical Status.

Psychological Factors

There are a number of intrapersonal factors that can lead an individual to engage

in a negative behavior such as opioid abuse. Many of these intrapersonal factors are seen

as unavoidable as they are categorized as biological and seen as genetically predisposing

Opioid Drug Abuse 5

factors that cannot be influenced by an individual (Zaaijer & Bruijel, 2014). It may seem

that a patient’s abuse of prescription drugs is only the result of their poor behavior, but

this is not always true. According to biological research, humans have 50% more

susceptibility to addiction if they have genes that would promote an addictive behavior

(Ling, Mooney, & Hillhouse, 2014). This idea can be proven by studies done on

identical twins containing identical sets of genes. If one twin develops a particular drug

addiction, there is a 50% chance the other twin will develop a drug addiction as well

(Olson, Vernon, Harris, Aitken, & Jang, 2001). It has also been theorized that certain

individuals may be born lacking certain neurotransmitters, called dopamine, responsible

for the pleasure sensations in their brain. Due to this, these individuals are shown to have

a high likelihood to self-medicate themselves through the use of prescription drugs that

increase the levels of neurotransmitters they may be lacking (Dunn & Surratt, 2015).

This method of self-medication can be seen as a better option than the use of “hard

drugs,” but awareness of these issues and the fact opioids can be just as dangerous as

these “hard drugs” would greatly reduce this health risk according to researchers (Dunn

& Surratt, 2015).

KNOWLEDGE

According to Healthy People 2020, approximately 95% of people with substance

abuse issues like opioids are considered unaware that they have a problem (Healthy

People 2020, 2014). This lack of knowledge applies to the general population as well, as

research done on a variety of young and elderly individuals showed young patients

making knowledge-based mistakes on their medications 67% of the time and elderly

patients making mistakes 55% of the time (McCormack, Lawlor, & Dongeon, 1997).

Opioid Drug Abuse 6

Through this data researchers could conclude that more experienced users of opioid pain

medications still hadn’t received the knowledge necessary to behave appropriately. This

is a major issue, as it would be impossible for a patient to avoid a prescription drug

addiction if they didn’t know how to handle their medications properly. One way to

combat this is through the use of education-based programs explaining to the population

the effects of opioids. An example of this can be seen in a study done on Turkish

University students in the United States, who when educated about the power of

addiction had better attitudes in avoiding an addictive opioids behavior (Cirakoğlu,

2005). Research has also proved that knowledge-based problems have come from the

poor labeling on medications (McCormack, Lawlor, & Dongeon, 1997). Often times the

labeling is not very descriptive of what patients are supposed to be taking and the

quantity at which they are supposed to be taking it. This has the potential to lead to

serious problems when the patients do not have prior knowledge themselves.

Demographics (SES)

While the overdose of prescription medications has become a growing concern

over the years, the relationship between opioid overdose and demographics is a newer

concept to most health professionals. This can be seen in research done showing deaths

due to opioid overdose not being constant across demographic groups and areas, with

mortality rates of opioid overdose showing 5.9/100,000 in men and 3.7/100,000 in

women (Chakravarthy, Shah, & Lotfpour, 2012). These proportional rates allowed

researchers to find more accurate and reliable results as opposed to mortality incidence

rates, which wouldn’t account for varying population numbers. There is also a difference

between states, as opioid overdoses are shown to be more prevalent in states where the

Opioid Drug Abuse 7

non-medical use and sale of opioids is more prevalent (Chakravarthy, Shah, & Lotfpour,

2012). These researchers found that high overdose states include the top three being New

Mexico (27.0/100,000), West Virginia (25.8/100,000), and Nevada (19.6/100,000).

Opioid addictions appear to remain constant across all ages, including the elderly (Pierce,

Bird, Hickman, & Millar, 2015). Researchers who found this came to the conclusion that

opioid care must be consistently given across all ages in order to improve this health

behavior.

Attitudes and Beliefs

According to research, attitudes and beliefs can have a major influence on

individuals avoiding addictive opioid behaviors in the United States (Rastegar & Walley,

2013). These researchers were able to prove this by finding that patients who believe in

their own risk of prescription drug abuse are more likely to avoid overdose than those

who don’t take the issue seriously. Their attitudes also play a role in their behavior, as

individuals with the proper attitude of taking precautions on their medications were likely

to never form addictive behaviors in the first place. According to a population-based

study on 4,000 Canadian individuals, results showed a majority of individuals with

substance/behavioral addictions also had character flaws, which included negative

attitudes and beliefs about opioid abuse and their own susceptibilities to them (Thege,

Colman, & el-Guebaly, 2015).

SOCIAL FACTORS

Social influences play a major role in avoiding an addictive behavior, especially

when most addictions are sustained on a social level. In order to diagnose the process of

avoiding an addictive prescription drug behavior, one must understand how social factors

Opioid Drug Abuse 8

can cause and influence behavior certain factors. One example of this is seen in social

norms, which often create an environment of what behavior is normal and what behavior

is seen as the behavior of outcasts. These social factors include specifically social

interactions and healthcare influences.

Social Interactions

The importance of social interactions cannot be underestimated, as it influences

most individuals’ everyday life. This can be seen in the fact negative interpersonal

conflicts with family members and partnerships have proven to increase the likelihood of

opium addictions (Karow, 2008). Due to this, researchers of this finding state the

importance of emphasizing positive social interactions with addicted individuals and

individuals susceptible to addiction. Social interactions may also have the ability to

affect the life of an individual, as “subjects who report experiencing interpersonal abuse

also report higher rates of suicide” (Plane, 2007). Due to this, screening opioid-using

patients for interpersonal abuse is becoming more of a priority for public health

professionals (Karow, 2008). If negative social interactions surround an individual, it is

likely an individual will turn to a behavior of substance abuse as a means to cope with the

stress of reality (Plane, 2007).

Healthcare Influences

For medical providers, prescribing opioids to patients is no easy task as it can

greatly affect a patient’s behavior. This difficulty in prescribing is because while opioids

can be positive in that they can reduce pain, they can also unintentionally become

addictive for patients. Researchers have found that limiting doses will not reduce

addiction, so therefore the most modifiable factor of changing this addictive behavior is

Opioid Drug Abuse 9

through identification of what is best to prescribe (Rastegar & Walley, 2013). Research

has shown that those with a history of substance abuse are three times more likely to

develop an addiction to opioids as opposed to those without an addictive history (Dunn,

Rutter, Banta-Green, & Sullivan, 2010). Knowing this, the study stated that when

doctors are well aware their patients’ medical histories before prescribing opioids, they

can help their patients avoid negative addictive behaviors. Another way medical

providers can help their patients avoid an addictive behavior is through identifying

whether opioids are really needed to be prescribed to their patients. While it has been

found that opioids are certainly necessary for moderate to severe pain, an alternative of

non-steroidal anti-inflammatory medications have been found to be just as effective for

minor injuries or procedures (Singla, 2005).

OTHER INFLUENCIAL FACTORS

Organizations and Social Institutions

With many people spending most of their time in organizations and social

institutions, this level of influence on opioid addiction is significantly high. Some

organizations provide better care for opioid patients than others, as exhibited by a study

comparing the treatment between nonprofit, profit, and public organizations (Bachhuber,

2014). The study found nonprofit organizations to be more likely than the profit and

public organizations to treat all aspects of the individual. This way of treating a patient

based on their whole health was much more effective in them avoiding a behavior of

opioid addiction. Certain organizations have also had a lasting effect on behavior. An

example of this can be seen in the Clinical Trials Network of NIDA, which is one of the

first national- level studies done on the addiction to prescription pain medications

Opioid Drug Abuse 10

(Denisco, Chandler, & Compton, 2008). This organization was able to test the

effectiveness of semi-opioid drugs, such as buprenophrine/naloxone tablets, which were

found to be an alternative to opioid drugs. These drugs were found to be rather effective.

Another organizational influence on opioid addiction is the American Medical

Association and NIH Pain Consortium, which includes over 500 medical professionals

and researchers that look to increase new innovations in preventing opioid addiction.

Researchers of these organizations have found that through organizational influences,

they were able to develop a newer-generation of opioid-free individuals.

Community-Based Relationships

Avoiding an addictive opioid behavior can be done through community-based

relationships, as seen in the way opioid dependent patients have shown movement

towards independence from prescription drugs when given community-based treatment

(Winstanely, 2014). More specific studies have found similar findings, with one example

being a study of an outpatient community setting involving relatives of opioid abusers

who are no longer addicted (Hasanović, Pajević, Kuldija, & Delić, 2012). The study

concluded that with a positive community setting and the avoidance of social exclusions

amongst peers, patients were able to come away with “clear minds.” This relationship

with one’s community contributes to a smoother re-socialization for patients trying to

avoid continuation of an opioid addictive behavior. Communities consisting of poor

relationships with one another have shown to have an increased likelihood of individuals

engaging in unhealthy behaviors such as addiction (Ghaffarinejad & Kerdegary, 2009).

The end result of these poor relationships within the community is an increased

prevalence of opioid dependence due to its availability in the community.


Physical Environment

Treatment for pain may not always be optimal across all populations, as the

access may vary from patient to patient (Lynch & Fischer, 2011). Due to these variables

such as extremely long wait times in places like Canada, the variance in access may

influence an individual’s behavior in obtaining opioids illegally. Researchers have found

that individuals who find opioids illegally are more likely to behave in addictive

behaviors when using them. Research has shown that lack of access is not a barrier in

users becoming addicted to opioids, as regardless of the persistent lack of access the rate

of prescription opioid abuse in the United States has continued to rise over the years of

1992-2007 (Katz, Adams, & Chilcoat, 2007).

Policy Factors

Over recent years, there has been evidence of a steady decline in federal funding

of opioid treatment programs (Frimpong, 2014). Researchers who found this trend due to

public policy also found an increase in opioid addiction, which led to their conclusion

that this lack of funding hurt the accessibility to find help for opioid abusers. Public

health professionals have since looked for policy factors to positively influence this

behavior. One example of this is the Drug Treatment Act of 2000, which enabled

qualified physicians to treat patients that had become opioid-dependent with alternative

medications, such as buprenophrine (Bonhomme, Shim, Goodren, Tyrus, & Rust, 2014).

This policy allowed physicians at the primary-care level to successfully diagnose and

treat opioid disorders. Researchers were also able to find that by establishing an

authorization process there could be a limit on the doses given to patients and the

consequent opportunity to begin a direct relationship with the pharmacy/prescriber and


the patient (Garcia, 2014). Another study supporting this finding as well, as researchers

stated policy mandating the collaboration between the prescriber and pharmacy would

also help the prescriber be aware of the exact toxicity of what drugs they are giving

(Cobaugh, 2014). This would consequently help prevent the unwanted behavior towards

prescription drug abuse that would now no longer be enabled by abusers.

Predisposing Factors

1. The confidence of individuals to say “No” to the non-medical use of opioids

would help them to become less likely to develop an abusive behavior (Walker,

2008).

2. Studies linking genetics to opioid addiction have shown that in identical twins, if

one twin develops a drug addiction there is a 50% chance the other twin will

develop the drug addiction as well (Olson, Vernon, Harris, Aitken, & Jang, 2001).

3. Individuals with character flaws have been shown to be at a greater risk of

substance abuse (Thege, Colman, & el-Guebaly, 2015).

4. Patients with a history of substance abuse and addiction are three times more

likely to develop an opioid addictive behavior (Dunn, 2010).

5. Healthy People 2020 states that approximately 95% of people do not have the

knowledge that they have an opioid addiction (Healthy People 2020, 2014).

Enabling Factors

1. The increased awareness of doctors to see addiction likelihood in their patients

could severely decrease opioid addiction (Rastegar, 2014). Merely limiting doses

would not enable individuals to avoid an addictive behavior.


2. Instead of using opioids, doctors could prescribe non-steroidal, anti-inflammatory

medications for minor injuries. (Singla, 2005).

3. Public Policy that has brought a steady decline in federal funding of opioid

treatment programs has made it harder for addicts to seek help (Frimpong, 2014).

4. Continued care and monitoring of all ages of opioid patients, including the

elderly, will improve overall health (Pierce, Bird, Hickman, & Millar, 2015).

Reinforcing Factors

1. Community-based treatment programs have been shown to assist patients working

towards prescription drug independence (Winstanely, 2014).

2. Strong relationships with community and family members can help individuals

that are recovering from opioid addiction to reach re-socialization and gain more

stability in their lives (Winstanely, 2014).

3. Health providers that are non-profit organizations are likely to treat all aspects of

the individual, improving both their addictive help and holistic health (Garcia,

2014).

4. Relationships between patients and their doctors/prescribers of opioids can often

benefit both parties in achieving safe behavioral use (Garcia, 2014).

5. Since research has proven opioid addicted individuals wish to be socially

interactive with their environment, it is therefore important for these individuals

to receive positive social interactions from those around them (Arab, Kohan,

Ranjbar, & Arab, 2014).


Interactions

Predisposing, enabling, and reinforcing are all factors that can interact with one another

in order to influence the behaviors of individuals. Predisposing factors may include the

knowledge, attitude, beliefs, and skills of an individual. These are factors that are within

an individual and are seen as more straightforward factors that can explain why

individuals engage in certain behaviors. Enabling factors are the factors that allow for

access and availability in behavior, such as school and educational programs that allow


for individuals to gain knowledge in their behaviors. This can be seen in the way some

individual groups may have more access to prescription drugs than other group.

Reinforcing factors are the factors that come from social influences and can be seen as

what sustains behavioral change. Examples of this could be seen in relationships with

family, peers, and health providers that influence individuals in engaging or not engaging

in an opioid addictive behavior.

TRANSTHEORETICAL MODEL

The Transtheoretical Model, or Stage of Change model, is a model that is

commonly used for explaining addiction. The model is particularly helpful in

understanding drug addiction as it comes to opioid abuse in this literature review. The

Transtheoretical model generally consists of four main constructs: Stages of change, self-

efficacy, decisional balance, and processes of change. The Cochrane Database System:

Stage-based interventions for opioid cessation uses the stages of change and separates

behavioral change into categories of pre-contemplation, contemplation, preparation,

action, maintenance, and termination (Cahill, Lancaster, & Green, 2010). These levels of

behavior change in this study were able to help those tailoring interventions understand

where the individual’s motivations were and how to direct their motivatio ns towards the

desired behavior of a non-medical, opioid-free lifestyle. Researchers of this study found

that at the stages of preparation to termination, self-help interventions and counseling

were most effective in helping an individual avoid the continuation of an opioid addicted

lifestyle. When dealing with individuals at their specific stage of change, the study found

influencing individuals to behave opioid-free was not dependent on the medium it was

done. In other words, interventions could be done through telephone counseling,


interactive computer programs, or through physicians/lay supports and be equally as

effective on the individual. The relationships between the stages of change showed that

preparation and action stages were found to be equally useful stages in giving opioid

users quitting advice and encouragement, however, additional research found that there

was very little difference between the contemplation and preparation stages in these same

individuals (Callaghan, 2006).

Other constructs of decisional balance and self-efficacy of the Transtheoretical

Model were mainly excluded from the research, as its main focus was the stages of

change. However, for self-efficacy it was clear the article found individuals with high

confidence that they could quit an addictive opioid behavior very effective in doing so.

This had to be taken into account when understanding an individual’s confidence that

they could overcome the temptation of going back to an addictive opioid behavior.

Decisional balance was a factor in this model by the way the support and encouragement

of outside influences was effective, whether this was done over the phone or in person.

Without individuals experiencing a form of outside support to end an opioid abusive

behavior, the cons of quitting were generally greater than the pros of quitting and the

behavior was ultimately not changed.

INFORMATION MOTIVATION BEHAVIRORAL SKILLS MODEL

Similar to the Trantheoretical Model, the Information Motivation Behavioral

Skills Model, or IMB model, is another model that can be useful in explaining drug

addictive behaviors. As mentioned in the name, the constructs of this model include

information, motivation, and behavioral skills. Thirty-five current or former drug users

were tested on these constructs by ten clinical counselors in Substance Use Misuse:


Determining Cessation Related Information, Motivation, and Behavioral Skills among

Opiate Dependent Smokers Users in Methadone Treatment (Coooperman, Richter,

Bernstein, Steinberg, & Williams, 2015). At the information construct, determining the

individual’s knowledge of opioid health effects and the relationship between quitting and

relapse was tested. Motivation was tested by questions related to obtaining opioids and

the cost of them as well as whether individuals had the belief using opioids non-

medically was the same as using drugs. Behavioral skills were tested by an individual’s

skills to cope with emotions, find social support, their ability to adhere to

pharmacotherapy, and ultimately terminate an addictive behavior. Skills were very

essential in an individual’s ability to quit an opioid addiction as they generally

determined the final behavior.

Much of the results of these constructs varied between individuals and their

population groups, furthermore proving that opioid cessation is highly individualized

between people and their respective populations. However, all constructs proved to be

important to an individual’s behavior in opioid cessation as the IMB Model was still very

effective. This could be seen in the way behavior was changed significantly when the

constructs could identify the information, motivation, and skill of an individual correctly.

Consequently, work could be done to improve these constructs efficiently. As suggested

by the research, an example of this would be an individual lacking knowledge but with

high motivation and skill being identified and consequently gaining the knowledge

needed to change their opioid addicted behavior.

INTERVENTIONS


Interventions for individuals involved in prescription medications can be very

effective when they are targeting the individual in the correct way. These correctly

focused interventions can be centered around individuals anywhere from those severely

abusing opioids to individuals taking opioids for a short duration with susceptibility to

addictive behavior. However, determining which intervention-based strategy to conduct

is not always easy, as determining the characteristics of an individual can be difficult to

quantify (Cahill, Lancaster, & Green, 2010). Research has shown different interventions

are more effective depending upon whom the individual is. Luckily, recent research has

improved the lack in understanding in what intervention strategy to use as displayed by

community-based interventions, for example. This community level of the Social-

Ecological Model has shown to be very effective in helping individuals recover from an

opioid-abuse type of lifestyle (Winstanely, 2014). Through interventions that bring about

the support of the community as a reinforcing factor, re-socialization becomes a powerful

factor in the individual’s behavior. The individual is now seen differently, but in a

positive way, from those close to the individual such as family and friends. Through this

type of intervention, accountability comes from more than just a small group as the once

opioid addicted individual has a lesser chance of relapsing back to previous ways than

ever before. Another reinforcing factor that must be considered when tailoring an

effective intervention is the relationship an individual has between their provider and

prescriber. It should become a priority to make these relationships strong as it has been

proven that these relationships can really help the patient from behaving in an unwanted

addictive pattern (Garcia, 2014).


The predisposing factors of an individual’s behavior can be very important in

changing their behavior effectively. This intrapersonal level of the social ecological

model shows that factors such as character flaws, history of abuse, and low confidence

can all be worked on specifically by the intervention, as research has shown that having

these types of issues increases the chance of opioid abuse (Rastegar, 2013). Once the

predisposing issues have been identified, work can be done in order to change the

individual’s issues in a positive manner. Knowledge has also been proven to be a

problem with opioid addiction, as many opioid addictions have been proven to come

from individuals with very little knowledge of their addiction (Dunn, 2010). According

to researchers, using educational-based interventions must become a priority in order to

improve the health of these individuals suffering prescription-drug addictions.

Models explaining health behavior can be used as a valuable tool in tailoring

interventions. The Transtheoretical Model is an example of this, as research done by

Cochrane Database System: Stage-based interventions for opioid cessation proved that

interventions done over the telephone or computer programs were equally effective

(Cahill, Lancaster, & Green, 2010). Knowing this, intervention strategies can be

improved in other ways and not so much on the medium of which they are done. The

Information Motivation Behavior Skills Model is another model that can be used to

improve intervention strategies as it mostly tests the motivations of individuals based on

their skills. According to Substance Use Misuse: Determining Cessation Related

Information, Motivation, and Behavioral Skills among Opiate Dependent Smokers Users

in Methadone Treatment, improving the skills of an individual are essential in allowing

them to change an opioid addicted behavior (Coooperman, Richter, Bernstein, Steinberg,


& Williams, 2015). This could certainly be seen as an enabling factor that must be

improved in the individuals of future interventions.

CONCLUSION

The abuse of prescription drugs, particularly opioids, has increased in prevalence

over recent years. Due to this, opioid abuse has consequently become more of a concern

for health professionals. This can be seen in the initiatives made by Healthy People

2020, which state the objectives to reduce the non-medical use of opioid drugs. Although

research has been done to understand why individuals behave in addictive patterns, there

are still opportunities for more research to be done. Improving the environments that

prevent an addictive behavior from happening and promoting interventions that are

tailored to changing addictive behaviors are dependent upon continued research of this

behavior.


Resources

Arab, M., Kohan, M., Ranjbar, H., & Arab, N. (2014, February 3). Quality of life, social

desirability and their relationship in opium addicted persons in southeast

of Iran. Retrieved March 7, 2015, from

http://www.ncbi.nlm.nih.gov/pubmed/24762351

Bachhuber, M. (2014, May 5). Profiting and providing less care: Comprehensive services

at for-profit, nonprofit, and public opioid treatment programs in the United

States. Retrieved February 14, 2015, from


Bonhomme, J., Shim, R., Gooden, R., Tyus, D., & Rust, G. (2014, May 30). Opioid

Addiction and Abuse in Primary Care Practice: A Comparison of

Methadone and Buprenorphine as Treatment Options. Retrieved April 17,

2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039205/

Cahill, K., Lancaster, T., & Green, N. (2010, November 15). Stage-based interventions

for opioid cessation. Retrieved March 28, 2015, from


Callaghan, R. (2006, August 31). The relation between processes-of-change and stage-

transition in smoking behavior: A two-year longitudinal test of the

Transtheoretical Model. Retrieved March 29, 2015, from


Chakravarthy, B., Shah, S., & Lotfipour, S. (2012, November 1). Prescription Drug

Monitoring Programs and Other Interventions to Combat Prescription


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039205/



Opioid Abuse. Retrieved April 7, 2015, from


Cirakoğlu, O. (2005, January 11). Perception of drug addiction among Turkish university

students: Causes, cures, and attitudes. Retrieved March 7, 2015, from


Cobaugh, D. (2014, September 15). The opioid abuse and misuse epidemic: Implications

for pharmacists in hospitals and health systems. Retrieved February 14,

2015, from http://www.ncbi.nlm.nih.gov/pubmed/25174015

Cooperman, N., Richter, K., Bernstein, S., Steinberg, M., Williams, J. (2015, January 5).

Determining Cessation Related Information, Motivation, and Behavioral

Skills among Opiate Dependent Smokers Users in Methadone Treatment.

Retrieved March 26, 2015, from


Dart, R., & Surratt, H. (2015, January 1). Trends in opioid analgesic abuse and mortality

in the United States. Retrieved April 7, 2015, from


Denisco, R., Chandler, R., & Compton, W. (2008, October 5). Addressing the

Intersecting Problems of Opioid Misuse and Chronic Pain Treatment.

Retrieved April 18, 2015, from

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3349281

Dunn, D., Rutter, Banta-Green, & Sullivan. (2010, January 19). Opiod prescriptions for

chronic overdose, a cohort study. Retrieved January 28, 2015.






Frimpong, J. (2014, June 6). Determinants of the availability of hepatitis C testing

services in opioid treatment programs: Results from a national study.

Retrieved February 14, 2015, from


Garcia, M. (2014, May 20). Implementation of an opioid management initiative by a state

Medicaid program. Retrieved February 14, 2015, from


Ghaffarinejad, A., & Kerdegary, M. (2009). Relationship of Opioid Dependence and

Positive and Negative Symptoms in Schizophrenic Patients. Retrieved

March 18, 2015, from


Hasanović, M., Pajević, I., Kuldija, A., & Delić, A. (2012, October 24). Medically

assisted treatment for opiate addiction--suboxone method as prevention of

social exclusion of youth--Tuzla model. Retrieved April 18, 2015, from


Karrow, A. (2008, January 7). Association of personality disorders, family conflicts and

treatment with quality of life in opiate addiction. Retrieved February 1,


Katz, N., Adams, E., & Chillcoat, H. (2007, October 8). Challenges in the development

of prescription opioid abuse-deterrent formulations. Retrieved February

18, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/17885342





Kosten, T., & George, T. (2002, July 1). The Neurobiology of Opioid Dependence:

Implications for Treatment. Retrieved April 14, 2015, from


Ling, W., Mooney, L., & Hillhouse, M. (2014, September 22). Prescription opioid abuse,

pain and addiction: Clinical issues and implications. Retrieved April 20,

2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170948/

Lynch, M., & Fischer, B. (2011, November 11). Prescription opioid abuse: What is the

real problem and how do we fix it? Retrieved April 18, 2015, from


McCormack, P., Lawlor, R., & Donegan, C. (1997, February 5). Knowledge and attitudes

to prescribed drugs in young and elderly patients. Retrieved February 17,


Plane, M., Fleming, M., & Balousek, S. (2007, September 22). Prevalence of

interpersonal abuse in primary care patients prescribed opioids for chronic

pain. Retrieved February 1, 2015, from


Rastegar, D., & Walley, A. (2013, October 28). Preventing Prescription Opioid Overdose

Deaths. Retrieved January 29, 2015, from


Rosenblum, A., Marsch, L., Joseph, H., & Portenoy, R. (2009, July 16). Opioids and the

Treatment of Chronic Pain: Controversies, Current Status, and Future

Directions. Retrieved April 15, 2015, from








Stotts, A., Dodrill, C., & Kosten, T. (2010, August 1). Opioid Dependence Treatment:

Options In Pharmacotherapy. Retrieved February 10, 2015, from

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874458/#R1

Thege, K., Colman, I., & El-Guebaly, N. (2015, March). Social judgments of behavioral

versus substance-related addictions: A population-based study. Retrieved

April 19, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/25462650

USDHHS. (2014). Substance Abuse. Retrieved April 19, 2015, from

http://www.healthypeople.gov/2020/topics-objectives/topic/substance-

abuse/objectives

Walley, A., Xuan, Z., Hackman, H., Quinn, E., & Doe-Simkins, M. (2013, January 30).

Opioid overdose rates and implementation of overdose education and

nasal

Weiss, R., Potter, J., Copersino, M., Prather, K., Jacobs, P., Provost, S., . . . Ling, W.

(2011, March 1). Conducting Clinical Research with Prescription Opioid

Dependence: Defining the Population. Retrieved April 5, 2015, from


Winstanley, E. (2014, January 1). Improving treatment for opioid dependence: A

perspective from the Ohio Valley node of the NIDA Clinical Trials

Network. Retrieved February 14, 2015, from


World Health Organization. (2015). Substance abuse. Retrieved April 1, 2015, from

http://www.who.int/topics/substance_abuse/en

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874458/#R1


http://www.healthypeople.gov/2020/topics-objectives/topic/substance-abuse/objectives

http://www.healthypeople.gov/2020/topics-objectives/topic/substance-abuse/objectives




Zaaijer, E., & Bruijel, J. (2014, December 1). Personality as a risk factor for illicit opioid

use and a protective factor for illicit opioid dependence. Retrieved April

17, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/25454407


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