Motivation and Reward
How does opioid addiction influence motivation over time? The brain plays a critical role in reward and motivation. Dopamine is a neurotransmitter linked to feelings of pleasure and satisfaction that acts to reinforce behaviors that lead to rewards, helping us remain motivated.1 You may find that your child loses motivation after detoxing from fentanyl. Opiates can damage this system by flooding our brains with dopamine when taken.
Over time, this can cause changes to how the brain processes reward and motivation, leading to addiction. Tolerance builds, meaning more opiates must be taken to achieve similar effects on reward pathways; at the same time, natural rewards become less satisfying due to desensitization. In the clinical setting, I have observed that younger patients may require months before their normal levels of motivation return due to the damage that fentanyl can cause to the reward system.
Opiate addiction often results in a cycle in which your child’s primary source of motivation becomes seeking more drugs rather than engaging in activities that would normally bring pleasure or fulfillment. You should be alert to the fact that drug abuse is often tied to deeper psychological issues such as depression, anxiety, or unresolved trauma that needs resolving.2 Drug dependency often begins as an initial source of relief or escape from physical pain, emotional distress, or psychological issues, but over time it can evolve into a compulsive and destructive pattern of substance use that significantly impacts health, relationships, and overall quality of life.
Over time, drugs can quickly become the focal point of an individual's life as they provide comfort and escape from difficult emotions. Once this occurs, users often prioritize finding and using the drug over other activities such as hobbies, schoolwork, relationships, or work - sometimes to the detriment of all these pursuits. As a parent, you should understand that prolonged drug use will cause destructive behaviors with severe repercussions for those involved.
It's important for you as parents to get your child evaluated and treated for substance abuse or addiction early on. This can help identify any related mental health issues and provide a personalized treatment plan that addresses both the addiction and any co-occurring psychiatric disorders. This approach can improve outcomes and reduce the potential long-term impact of substance abuse on your child's cognitive, emotional, and social development. Seeking early help can make a big difference in your child's recovery and future well-being.
How is the Trajectory from Adolescence to Adulthood Affected
Adolescent brains are still developing, making them highly susceptible to the changes caused by opiate use. If your child abuses opiates, their normal reward, and motivation system will become disrupted, leading them to experience feelings of pleasure when taking drugs rather than engaging in positive behavior. Continued use will lead them down the path toward addiction as well as cause long-term changes to brain processes related to the reward and motivation systems. Both my clinical experience and existing evidence suggest that routine opiate abuse and dependence will increase the likelihood that your child will experience more significant social and or psychological difficulties than their peers without such histories.3
Addressing Underlying Thoughts, Beliefs, and Behaviors
A variety of counseling approaches have been studied for recovery from opiate abuse/dependence during adolescence. You should seek recovery programs using cognitive behavioral therapy as an evidence-based therapeutic approach for substance abuse or addiction.
Cognitive behavioral therapy (CBT) emphasizes recognizing triggers for drug use and teaching skills for responding effectively.4 Medication-assisted therapies like buprenorphine and methadone coupled with CBT have been proven effective at decreasing cravings and withdrawal symptoms.5 This provider encourages peer support organizations like Narcotics Anonymous, which offers teenagers and young adults recovering from opioid dependency further options and assistance.6 We will delve further into treatment and recovery strategies in later posts.
Early Opiate Abuse Impacts Long-term Pain Control
Adolescents who use opiates run the risk of long-term health complications, including cognitive deficits, physical health issues, and mental health disorders. You should understand that opiate abuse experienced during adolescence can have lasting consequences when your child reaches middle age and experiences increasing discomfort associated with growing older.7 Opiate abuse experienced during youth can have devastating ramifications on how your child’s brain processes pain as they age further into adulthood.8 Adolescent opioid abuse and tolerance can alter how the brain processes pain signals, leading to decreased responsiveness to opioid medications later in life, even at higher dosage levels.9
Furthermore, many parents do not know that their children who have abused opioids during adolescence are at an increased risk of substance use disorder if exposed to them again later. Long-term consequences demonstrate why it is vitally important to identify and address opioid abuse among adolescents. Opioid receptors within the brain remember tolerance built up during teenage years by altering their structure or function over time.
Desensitization occurs when opioid receptors are exposed repeatedly. Over time, repeated exposure results in permanent changes within their receptors that will reduce their sensitivity to opioids.10 Repeated exposure leads to long-term changes within receptors that will become increasingly permanent over time.11
Permanency also means that even after individuals cease taking opioids, their reduced sensitivity could continue to make effective responses difficult. Therefore, as parents, you should seek out and provide treatment promptly to adolescents abusing opioids. These long-term changes emphasize why it is crucial for adolescents abusing opioids to seek professional assistance as soon as possible.
References
1. Cheng, Y., Winder-Rhodes, S., & Kalivas, P. W. (2017). Neuromodulatory systems and drug addiction: Focus on the dopaminergic system. Neuropsychopharmacology, 42(1), 18–26.
2. Deehan, G., Berridge, K., & Robinson, T. (2013). Reward systems and addiction: A neurobiological analysis of reward circuitry in drug dependence. Neuroscience & Biobehavioral Reviews, 37(8), 1690–1709.
3. Hoaken, P., & Stewart, S. H. (2003). Drugs of abuse and the elicitation of human aggressive behavior. Addictive Behaviors Reviews, 4(2), 115-129.
4. Chaplin, J., Windle, M., & Spear, L. (2017). Adolescent opioid use and misuse: Neurobiological implications for prevention and treatment. Neuroscience & Biobehavioral Reviews, 76, 162-174.
5. Ramesh, M., et al. (2019). Medication-assisted treatment for opioid disorder in adolescents and young adults: A systematic review and meta‐analysis. Addiction, 114(4): 640-649.
6. Rashid, H., et al. (2008). Peer support groups for substance misuse: a qualitative evaluation among members of Narcotics Anonymous from New Delhi, India. Social Science & Medicine, 66(2): 406-415.
7. Lai, T., et al. (2017). Long‐term health effects of early‐onset opioid use: a review. Addiction, 112(7): 1119-1135.
8. Hoaken, P., & Stewart, S. (2003). Opioid tolerance and sensitization in the central nervous system: Implications for substance abuse research and opioid analgesic therapy. CNS Drugs, 17(7), 473-490.
9. Lai, T., et al. (2017. Long‐term health effects of early‐onset opioid use: a review. Addiction, 112(7): 1119-1135.
10. Chaplin, J., Windle, M., & Spear, L. (2017). Adolescent opioid use and misuse: Neurobiological implications for prevention and treatment. Neuroscience & Biobehavioral Reviews, 76, 162-174.
11. Ramesh, M., et al. (2019). Medication-assisted treatment for opioid disorder in adolescents and young adults: A systematic review and meta‐analysis. Addiction, 114(4): 640-649.
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