Substance abuse and addiction most often begin with a prescription. According to the Centers for Disease Control and Prevention (CDC), prescription opioid misuse places an estimated $78.5 million economic burden on the United States each year.

About 21-29% of patients prescribed opioids for chronic pain will misuse them, and eight to twelve percent of those prescribed opioids for chronic pain will develop an opioid use disorder. Preventing addiction to prescription opioids is critical for healthcare professionals who prescribe them, and those taking prescription opioids must be aware of signs of addiction.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) establishes the criteria for substance abuse disorders, which include:

1. Using the substance in higher doses or for longer periods of time than you should
2. Wanting to quit but being unable to
3. Spending a large quantity of time getting, using, and recovering from using the substance
4. Cravings and urges to use the substance
5. Being unable to complete tasks at work, home, or school because of substance use
6. Continual usage despite it causing negative ramifications in your work, school, or personal life
7. Repeatedly using the substance, even when it places you in danger
8. Giving up important social, occupational, or recreational activities because of substance abuse
9. Continuing to use the substance despite having another medical condition that the substance can exacerbate
10. Increased tolerance to the substance, which leads to needing more of the substance to get the desired effect
11. Developing withdrawal symptoms

These addiction criteria often present themselves in three main categories that can easily be remembered by the “Three C’s:”

Control: Patient has lost control and will try to obtain more opioids because they consumed their allotted amount too quickly by engaging in activities such as:

• Reporting lost or stolen medication
• Calling for early refills
• Obtaining opioids from other sources
  • This may include illegal drug trade
• Presenting withdrawal symptoms

Craving: Patient remains focused on opioids as their only treatment option by engaging in behaviors such as:

• Recurring requests for more opioids – sometimes more of the same opioid they already take or by asking for different opioids
• Reporting increased sensations of pain or frequency of pain despite no progression of their medical condition
• Dismissive of non-opioid based treatments

Consequences of use: Patients continually engage in the aforementioned activities despite any negative consequences or risks associated with their actions.

The symptoms and behaviors associated with addiction and substance abuse disorders vary from person to person. Some may only show some of the eleven criteria for addiction and substance abuse, while others will show all of them.