Steven D. Passik, Ph.D. explains the basics in painkiller addiction.

Q: I’m very concerned about painkiller addiction and becoming addicted to my painkiller. What signs should I watch out for?

A: You’re not alone in being afraid of addiction; many patients share your fear. That often means they don’t advocate for themselves strongly enough to ensure they get adequate medication to control their pain. Rest assured, that fear is often unfounded.

Let’s begin with what you shouldn’t worry about: Patients often confuse physical dependence and tolerance with addiction. It’s true that abruptly stopping medication can lead to withdrawal (which indicates dependence), but that is a physiological issue, not a psychological one and should not be confused with addiction. Withdrawal and dependence aren’t limited to opioids, either, and dependence can develop in several weeks, or even days. Dependence isn’t something to be concerned about; you simply need to ensure you have enough medication to control your pain, and if you do decide to stop, do so gradually. Tolerance, on the other hand, simply means that more medication might be needed that your body has built up a tolerance to a drug and/or a specific dose and you might need to increase your dosage or change drugs.

So what does addiction look like?

Look for the four C’s:

  • Cravings
    Compulsive use
  • Out-of-Control use
  • Continued use despite harm

Unlike dependence, addiction isn’t just physiological. It’s psychological as well. So if you feel like you’re losing control over your medications craving it between doses (and not simply for pain relief) and cannot stop overusing it despite the fact that it’s having negative consequences for you socially, physically or psychologically, then it’s definitely time to talk to your doctor.

Switching to another opioid might help, or you and your doctor and family might be able to try strategies to help you regain control over your medicine: for instance, having a family member hold and dispense your medications, or prescribing a small quantity at a time.


You should also know that 85% of addictions appear before the age of 35, so if you’re older and have never had a problem with drugs or alcohol, don’t have addiction in your family and do not have any major, untreated psychiatric problems (this might cause you to self-medicate), the likelihood that taking opioids for pain control will cause addiction is quite low. And if you do have a history of addiction, start by telling your physician.


There are many ways you can work together or with mental health professionals to allow you to take your medication in a way that eases your pain and still maintains your sobriety.

Steven D. Passik, Ph.D., associate attending psychologist, Memorial Sloan-Kettering Cancer Center, and associate professor of psychology, Cornell University Medical Center, New York


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