WHY DOES OPIOID DEPENDENCE BECOME INTRACTABLE TO TREATMENT?
This important question can be answered only partially and tentatively. The conditions that contribute to the onset of opiod dependence also support the tendency to continued use. These, as previously noted, include chronic emotional distress, drug-using models, an available opioid drug, and withdrawal symptoms. Two other effects of the drug dependence probably contribute to relapse after treatment or incarceration. First, mild withdrawal symptoms such as muscular aching, insomnia, and irritability often persist for six months or longer after the last dose. These symptoms (called protracted withdrawal) are promptly relieved by an opioid drug, and they probably contribute to relapse after treatment. Second, the opioid user becomes conditioned to environmental conditions associated with withdrawal symptoms, so that after a period of abstinence, exposure to a conditioned stimulus will evoke withdrawal symptoms. This conditioned withdrawal probably contributes to relapse. Three other chang
