Prescription Opioid Abuse and Dependence: Assessment Strategies for Counselors.

A dramatic increase in the nonmedical use of prescription opioids (also known as analgesics, narcotics, and painkillers) has occurred over the past 10 years. In 2002, an estimated 29.6 million Americans reported having used prescription opioids for nonmedical purposes in their lifetime (National Institute on Drug Abuse [NIDA], 2004). These numbers seem to be increasing at alarming rates. NIDA data, for example, have indicated that "an analysis of data from 11 states that used detailed drug codes showed that narcotic painkiller admissions increased 129 percent from 1992 to 1997. During that time period, admission for oxycodone abuse increased 1,267 percent" (pp. 92-93). NIDA data have also indicated that opioids are the most commonly prescribed type of prescription medication used for nonmedical or recreational purposes. Although rates of abuse of and dependence on prescription opioids seem to be similar for men and women, individuals with psychological disorders typically present with higher rates than are seen in the general population (NIDA; Reiger et al., 1990). In an effort to better prepare physicians to treat patients who are abusing or dependent on prescription opioids, Isaacson, Hopper, Alford, and Parran (2005) recently published a series of helpful guidelines. They provided a categorical overview intended to assist medical professionals in understanding risk factors, red flags, and prevention strategies related to the increasing national problem of opioid abuse and dependence. In this review, we discuss that article and examine the overlapping role of the professional counselor in the identification and assessment of prescription opioid abuse and dependence. * Article Review: Introduction In their recent article "Prescription Drug Use and Abuse: Risk Factors, Red Flags, and Prevention Strategies" Isaacson et al. (2005) provided an overview of pertinent concepts and legal issues related to the escalating problem of prescription opioid abuse and dependence in the United States. This information was written with the intent of assisting the physician in identifying patients who are at greatest risk of developing problematic opioid use patterns. Isaacson et al. also provided a series of strategies designed to help physicians prevent prescription opioid abuse and dependence as well as steps for intervening with patients who may already be dependent on such substances. The first section of this article provides an overview of these guidelines from the perspective of the physician. In the second section, we provide a review of pertinent literature concerning counselors' shared role in understanding and identifying these issues so that counselors might assist in incorporating effective mental health prevention and intervention strategies. * Implications for Physicians Dependence, Tolerance, and Levels of Abuse By definition, a person is considered physically dependent on a substance if withdrawal symptoms appear after he or she suddenly discontinues use of the substance. Tolerance is a different condition wherein the person must continue to take higher dosages of the drug to achieve desired effects. This may be the result of the body's increased efficiency in metabolizing the drug or the addition of more drug receptor sites. It is not uncommon, however, for a person to develop drug dependence and tolerance after long-term use of certain medications prescribed by well-meaning physicians (Isaacson et al., 2005). In simple terms, patients use prescription drugs either correctly or incorrectly. To help physicians establish an accurate portrayal of a patient's opioid use patterns, Isaacson et al. (2005) outlined four common levels of use and misuse regarding prescription opioids. The first level, appropriate use, involves the use of a prescription drug exactly as it was originally prescribed. The second level, drug misuse or inappropriate use, is defined as use of a prescription drug at higher doses or for purposes other than those for which it was originally prescribed. …