Opioid Addiction

What is opioid use disorder?

Opioid use disorder (OUD) is a chronic medical condition defined by the DSM-5 as a problematic pattern of opioid use leading to significant impairment or distress, with at least two of eleven diagnostic criteria present in a twelve-month period. Those criteria include tolerance, withdrawal, taking opioids in larger amounts or for longer than intended, persistent desire or failed attempts to cut down, spending a great deal of time obtaining or using opioids, craving, and continued use despite negative consequences in relationships, health, work, or legal standing. Severity is mild (two to three criteria), moderate (four to five), or severe (six or more).

The opioid class includes a broad spectrum of substances. Natural opioids derive from the opium poppy, including morphine and codeine. Semi-synthetic opioids are chemically modified from natural opioids and include oxycodone (OxyContin, Percocet), hydrocodone (Vicodin), and hydromorphone (Dilaudid). Fully synthetic opioids are engineered from scratch, including fentanyl, tramadol, and methadone. Heroin is a semi-synthetic opioid derived from morphine. All work through the same basic mechanism and all carry dependence risk, though potency and speed of onset vary widely.

In New Jersey, the opioid crisis has been devastating across Monmouth County and the broader Shore region. Opioid overdose mortality remains a leading cause of unintentional injury death in the state. The contamination of the illicit supply with fentanyl has made all opioid use substantially more dangerous than it was a decade ago, including use that began with a legitimate prescription.

How opioid addiction develops

Opioids produce their effects by binding to opioid receptors in the brain, spinal cord, and throughout the body. In the brain, this triggers the release of dopamine in the reward circuit, producing analgesia and, at higher doses, euphoria. The initial experience of opioid use is often described as profound relief, as if everything difficult has temporarily gone away. That experience is what the brain records and seeks to repeat.

With repeated use, the brain adapts. It produces fewer of its own endorphins and down-regulates the number and sensitivity of opioid receptors. The person now needs opioids just to feel normal, a state called physical dependence. This is distinct from addiction but is often a component of it. Tolerance develops in parallel: the same dose produces diminishing effect, pushing the person toward higher doses to achieve the original result.

Opioid addiction frequently begins with a legitimate prescription. A back injury, a surgery, a dental procedure. The prescription is intended as short-term pain management, but the opioid receptors do not differentiate between therapeutic and non-therapeutic intent. Dependence can develop in as little as a few weeks of daily use. When the prescription ends, some people discover they cannot simply stop. Others transition to cheaper, more available illicit opioids. This pathway from prescription to street drug is well-documented and does not reflect moral failing; it reflects the pharmacology of the drug.

The psychological dimension of opioid addiction is equally important. Many people who develop OUD were already managing depression, anxiety, trauma, or chronic pain before opioids entered the picture. The drug worked, for a while. It numbed what hurt. The addiction is often, at its root, an attempted solution to unbearable internal experience.

Physical and psychological signs of opioid addiction

The signs of opioid use disorder span the physical, behavioral, and psychological. They often appear gradually, and family members are frequently the first to notice changes.

• Drowsiness, slowed movement, or 'nodding off' at unusual times
• Constricted (pinpoint) pupils
• Slurred speech or impaired coordination
• Withdrawal symptoms between doses: sweating, chills, nausea, muscle cramps, anxiety, insomnia
• Increasing doses, running out of prescriptions early, or seeking opioids from multiple sources
• Preoccupation with obtaining the next dose -- planning life around supply
• Social withdrawal, neglect of responsibilities and relationships
• Financial problems with unexplained sources of cash or missing money
• Track marks, abscesses, or other injection-related injuries
• Mood swings, irritability, or emotional flatness between doses

Opioid withdrawal: timeline and what to expect

Opioid withdrawal is intensely uncomfortable, which is one of the primary drivers of continued use. Understanding what to expect can reduce the fear that keeps people from seeking help.

The onset and duration of withdrawal depend on which opioid was used and for how long. Short-acting opioids like heroin, oxycodone, and illicit fentanyl produce withdrawal beginning within 8 to 24 hours of the last dose. Longer-acting opioids like methadone may not produce significant withdrawal for 24 to 48 hours.

Early symptoms (first 24 hours) include anxiety, restlessness, yawning, runny nose, muscle aches, and insomnia. Peak symptoms (24 to 72 hours) include severe muscle cramping, vomiting, diarrhea, chills and sweating, elevated heart rate and blood pressure, and intense cravings. The acute phase typically resolves within five to seven days for short-acting opioids.

Protracted withdrawal, also called post-acute withdrawal syndrome (PAWS), can persist for weeks to months. Symptoms include dysphoria, sleep disturbance, anxiety, and difficulty experiencing pleasure (anhedonia). This is one reason why medication-assisted treatment is so valuable: it stabilizes brain chemistry through the protracted recovery period rather than leaving the person to white-knuckle a state of chemical imbalance.

Opioid withdrawal is not typically medically life-threatening in otherwise healthy adults, but the severity and risk of relapse make medically supervised detox the strongly preferred option. Archangel coordinates with detox partners for clients who need supervised withdrawal management before stepping into our outpatient programs.

Medication-assisted treatment: Suboxone, Sublocade, and Vivitrol

Medication-assisted treatment is the gold standard for opioid use disorder. Research consistently shows that MAT reduces illicit opioid use, cuts overdose mortality, improves treatment retention, and supports social and occupational recovery. Three medications have FDA approval for OUD:

Buprenorphine (Suboxone, Sublocade): Buprenorphine is a partial opioid agonist that binds tightly to opioid receptors, blocking the euphoric effect of other opioids while eliminating withdrawal symptoms and cravings. Suboxone is a sublingual film combining buprenorphine with naloxone (to deter injection misuse). Taken once daily, it stabilizes brain chemistry and allows people to function fully. Sublocade is a monthly injectable formulation of buprenorphine, eliminating daily dosing and reducing diversion risk. Buprenorphine can be prescribed in an outpatient clinical setting, which makes it accessible and highly compatible with our PHP and IOP programs.

Methadone: A full opioid agonist with a long half-life, methadone eliminates withdrawal and cravings through a different pharmacological mechanism than buprenorphine. It requires daily dispensing from a federally licensed opioid treatment program (OTP). It is highly effective for people with severe, long-standing OUD who have not responded to buprenorphine.

Naltrexone (Vivitrol): An opioid receptor antagonist that completely blocks opioid effects. Vivitrol is a monthly injection, removing the daily compliance burden. It cannot be started until the person has been fully opioid-free for 7 to 14 days (depending on which opioid was used) because it will precipitate immediate, severe withdrawal in a person who is still physically dependent. Vivitrol is a strong option for highly motivated clients, those in recovery programs that prefer a non-opioid medication, and those returning from incarceration.

Naloxone (Narcan): Not a treatment medication in the ongoing sense, but every person with OUD and every family member should have naloxone available. It reverses opioid overdose within minutes. In New Jersey, it is available without a prescription at most pharmacies.

MAT is not a replacement addiction. The medications are regulated, dosed therapeutically, and used as part of a comprehensive treatment plan that includes behavioral therapy. The goal is full recovery: returning to work, rebuilding relationships, and living without the chaos of active addiction.

Co-occurring mental health and opioid addiction

The majority of people with opioid use disorder also meet criteria for at least one co-occurring mental health condition. Depression, anxiety disorders, and post-traumatic stress disorder (PTSD) are the most prevalent. Attention deficit hyperactivity disorder (ADHD), bipolar disorder, and personality disorders are also common.

In many cases, mental health symptoms preceded the opioid use, and the drug was consciously or unconsciously recruited to manage what felt unmanageable. Treating the addiction without addressing the underlying condition leaves the root cause untouched. At Archangel, dual-diagnosis assessment is part of the intake process, and treatment plans integrate mental health care from the beginning.

Trauma is particularly significant in this population. Adverse childhood experiences, abuse histories, military trauma, and grief are widely prevalent among people seeking opioid treatment. Trauma-informed care practices, including trauma-focused CBT and EMDR when indicated, are part of the clinical toolkit at Archangel.

Opioid treatment at The Archangel Centers: Monmouth County and the Jersey Shore

Archangel Behavioral Health is a licensed outpatient addiction treatment provider at 44 Apple St STE 3, Tinton Falls, NJ. We serve Monmouth County and the Jersey Shore, with clients from Red Bank, Long Branch, Asbury Park, Neptune, Eatontown, Freehold, and surrounding communities.

Our PHP (Partial Hospitalization Program) provides intensive daily structure for clients transitioning from detox or stepping down from inpatient care. IOP (Intensive Outpatient Program) meets three or more days per week and is the core level of care for most people beginning recovery from opioid use disorder. Standard outpatient follow-up supports clients in stable recovery.

We integrate MAT with behavioral therapy. Clients on buprenorphine or Vivitrol see prescribers within our network and receive therapy alongside medication management. Group therapy, individual counseling, psychoeducation, family therapy, and relapse prevention are all components of care.

New Jersey Medicaid and most commercial insurance plans cover our levels of care. We verify benefits before admission so clients know exactly what to expect.

Recovery from opioid addiction: what it actually looks like

Recovery is not a single event. It is a process, and it takes time. The first weeks and months are the hardest: brain chemistry is still recalibrating, cravings are strongest, and the social and environmental triggers that shaped the addiction are still present. A structured treatment program provides accountability, community, and clinical support through that period.

With time in treatment, the picture changes. Cravings become less frequent and less intense. Sleep improves. Cognitive function returns. Relationships stabilize. Work becomes possible again. People in long-term MAT-assisted recovery report quality of life comparable to the general population.

The Archangel Centers were founded on the belief that recovery is real and it is for everyone. Mike Sorrentino's own recovery story, and the stories of everyone on our team, are proof of what is possible. If you are in Monmouth County, Red Bank, or anywhere along the Shore and you are ready to start, or ready to help someone you love start, our team is here to talk.