Psychology Sociology

How Social Rejection Increases Opiate Addiction

"As far as your brain is concerned, a broken heart is not so different from a broken arm." —Naomi Eisenberger, PhD
Audio version available:

Social rejection is painful.

When we feel rejected, our self-worth is dealt a heavy blow. We lose a sense of security, a sense of belonging, and perhaps a sense that we matter.

At its most extreme, the pain from social rejection can lead to suicide, according to the interpersonal theory of suicide.

Although we know social rejection is painful, neuropsychological research has revealed how social rejection affects the same regions of the brain as physical pain, and therefore respond similarly to the affect of painkillers.

In the study, participants were given acetaminophen (commonly known as Tylenol), or a placebo pill. After three weeks of regular doses, those who received the drug reported lower levels of social pain, in addition to showing lower levels of pain in fMRI brain scans:

…acetaminophen reduced neural responses to social rejection in brain regions previously associated with distress caused by social pain and the affective component of physical pain…

These findings are particularly relevant given the recent opioid epidemic. Beyond over-prescription and their highly addictive properties, this drug of choice might also tell us something about the health of our social context.

Beyond coping with physical pain, individuals who feel rejected may be self-medicating with opioids to cope with social pain.

We can see this phenomenon in studies on populations with a heightened risk of opiate use: groups with low income, low education, those lacking permanent housing, those who are unmarried, recently released prison inmates, veterans, and LGBT groups.

Once someone begins experiencing an opiate addiction, they may then find themselves feeling even further rejected, especially if it results in heightened poverty. In turn, this perpetuates the downward spiral of self-medicating to further reduce the social pain, in addition to the physical pain of withdrawal.

Promoting social health means combating barriers to social integration. These barriers include stigma, prejudice, economic inequality, and lack of social programs/support for individuals undergoing major life transitions, as seen among veterans in transition to civilian life.

When treating and preventing opiate addiction, we need to be mindful of the social dimension of the issue, in addition to the biological and psychological.

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  1. The audio concerning veterans and LGBT was personal in that my nephew, an army veteran committed suicide by hanging in his barracks after returning from South Korea. He did stints in Afghanistan and possibly Iraq. My nephew was also openingly gay. The whole family found out of his death via his facebook page as my brother’s second wife kept seeing RIP comments to him.
    I read his last postings which stated feeling alienated with at that time there was a national fervor over not baking a wedding cake for a gay couple. My nephew stated in a post how he felt
    “This weekends lessons: Indiana has a lot in common with Louisville. And I am unfortunately a scorpion, while the people around me are frogs. I quit.” He took his life shortly after.

    I’m in a program for Homeless Vets and this program is circulating vets back into homelessness with unremarkable bureaucracy and sickening indifference to veterans needs. Between the VA and HUD, they’re creating all the ills of homelessness and more while increasing greater insecurity and less self dependency.

  2. I’m going to put my hand up and say I’m a somewhat recovered addict so I see two sides to the to opioid addiction coin. You’re now wondering what the “somewhat” is about after all you’re either a recovered addict or an addict, right? When it comes to pain management yeah nah there is always a slice of society who go about their day slowly exhausting every physical and mental resource they have just to function with a level of pain most healthy people can NEVER understand before they cave and take the bloody pain killer that contains opioids.

    From the age of 11 when I first got my period I started to suffer debilitating cluster migraines to the point I would be hospitalised with vomiting, light sensitivity and total incoherent speech patterns and let me tell you normal painkillers do shit all to help a migraine it literally feels like your brain is exploding. As I got older the migraines got worse to the point I thought it was perfectly normal to have a headache 24/7 and that 3 to 9 days per month vomiting my guts up, having memory issues and almost no ability to function was perfectly normal.

    Then at 23 while at university the clinic doctor gave me a packet of Mersyndol an analgesic tablet which contains Panadol, Codeine and calmative, with the instructions of take 2 tablets every 4 to 6 hours and don’t take more than 8 per day. I was a little hastiest at first after all Codeine is an opioid and there is a history of alcoholism and drug addiction on both sides of my family so I was legitimately concerned about developing an addiction. However pain does very bad things to your neural pathways and you will literally do anything to make it stop, hell if they told me cutting my arm of would stop the migraines I would have voluntarily had my arm amputated.

    Oh my lord this drug was magic yes I still had a headache 24/7 but even on migraines days I could function because it deadened the pain enough for me to function normally. It also had this wonderful side effect of killing off my social anxiety and made having to deal with people something I could cope with. Best of all a month after I started taking it the Australian Government took it off the prescription only list and put it on the can be bought over the counter so I didn’t even need to go to the doctor to get a script I could walk into any chemist and buy it.

    Fast forward 20 years. I have completed 3 university degrees, travelled around Australia, travelled around the USA, Singapore and UK. Worked in some amazing jobs and had what would appear to be a highly successful life. All white popping 8 Mersyndol a day to function. I worked in both Defence and Mining which have heavy duty drug screening and the minute I said – “oh it’ll give a false positive I take Migraine medication” all was forgiven. I changed doctors several time and every time I was truthful about how much Mersyndol I took daily, the doctor would freak out and do blood test to check my liver function only because Mersyndol contains Paracetamol which can be toxic. Once I got the liver function is fine nothing else was ever mentioned about my pain killer addiction. I did at one point push to be sent to a neurologist to see what could be done about my migraines and after a zillion test got told nothing can be done it’s hormonal you’ll have them till you die, so just keep taking the pain killers.

    Then in 2016 when the doctor I was seeing decided that Mersyndol might not be strong enough and handed me a script with 5 repeats for Endone I went ENOUGH. And found a new doctor. My new doctor Dr SJ is brilliant and he like me was highly concerned about the cocktail of drugs I was now taking and the amount of pain killers I popped daily. He did something very radical and took me off all my drugs and every day for 2 weeks I went in daily to see him for a checkup. It sucked really really really sucked coming off a 20 year heavy duty Codeine addiction but I did it. However as was got things like my lung medication back on track, figured out I don’t need blood pressure medication just fluid retention meds something horrid happened. Mentally I fell apart and my anxiety went through the roof, my depression came back and my suicidal pop-up messages came back. Dr SJ really quickly realised that minus heavy doses of Codeine dulling my neural activity my brain was showing it’s true self and it was badly in need of help.

    Dr SJ sent me off to an amazing Psychiatrist Dr B who took his time because I’m a tough nut who is not good at showing vulnerability and my genius level IQ meant I could with some effort hide a huge amount of my issues. At first they thought I might be Bi-Polar II but that didn’t quite fit and the drugs made me worse not better. Bit more pocking and prodding and the “A HAH” moment happened of figuring out I’m Autistic (High Functioning) with Communication Difficulties/Socialisation Problems and co-morbid ADHD. 12 Months later and the right combo of drugs and therapy and my mental health is looking mostly stable.

    However I still get migraines, which when they hit require prescription meds and Mersyndol or a 3 or more days stay in hospital. In desperation I discussed with both Dr SJ and Dr B about trying body piecing and they both said it couldn’t hurt to try. So I went and had a Daith piercing done in my ear and it has help because instead of up to 5 days of 4 to 6 Mersyndol + 2 Immigrain (prescription med) a day while the cluster happens. I now get a 3 day cluster where 2 Mersyndol + 1 Immigrain a day works to control it enough to function.

    So back to the top of my story – I’m not a recovered opioid addict but I’m also probably not considered a full opioid addict, I’m that in-between addict who unless they can figure out a way to control my migraines will probably take Codeine based pain meds for the rest of my life. I’m not happy about this but I’m a realist and pain control is far less damaging than extreme pain.

    From my point of view far less finger pointing and social outcry about “the opioid addicts” needs to happen and far more resources need to be channelled into things like Pain Management Clinics and Mental Health Diagnosis & Treatment. However experience has taught me that the morons making the decisions will make it harder to get opioids but not put in place funding for things like Addictions Centres, Pain Management Clinics or Mental Health Facilities, so the problems will continue. I’m also going to point out that on several occasions I reached out for help to Doctors with my genuine concern about my pain killer addiction and was told that the pills were not effecting my physical health so just keep taking them because controlling the pain was far more important than my concern that I might be an addict!

    1. Thanks for sharing this person experience! I am sorry to hear about the pain you have been going through for over twenty years. Chronic pain is a very real issue for many people who need access to long term prescriptions to manage the pain. In addition, you are right that this area requires support so that individuals like yourself can get access to the proper treatment.

  3. Steve,
    To answer your question, no, you don’t appear to be supporting opiates. I’ve been following this whole “opioid crisis,” including the history of opiates, generally, as well as the “War on Drugs” that the drugs seem to be winning. It’s an incredibly complicated issue, and I would contend we live in a medication-addicted society, with the pharmaceutical industry, the insurance industry, the government, and the medical establishment all colluding in creating and fostering addictions to pills and outside “help” for every problem.

    This goes beyond the scope of your article. More to the point, I wonder if the addictive crowd creates its own social circle, such that the addicted person finds companionship among other addicts. It’s the glue that makes Alcoholics Anonymous so powerful, I think, the sense of belonging to a group with a shared weakness.

    1. Thank you for this feedback! I started to wonder if it appeared that way after I received a few comments suggesting so. Also, I completely agree with your comment regarding the power of social belonging! This has been central to many of my articles, especially those regarding veterans in transition.

  4. Hi Steve,

    I’d be wary of putting too much faith in such article (research path). Mainly because there may be hidden “Variables”. Like how the patients are interacting with the nursing staff who are administering the “pain killers”…etc.

    And for my spin, I see pain as a motivational force in the sense that one should accept it, and realize that it is necessary for a guided change to occur if necessary (some people enjoy pain…masochism).

    I’d just be wary of applying cookie cutter treatments nowadays. Especially when it comes to mental/social health.

    1. Just to clarify, does this article seem to suggest treating social rejection with opiates? There seems to be a bit of misinterpretation since the purpose was to explore how social disintegration contributes to opiate addition. Any suggestions on how to clarify so this is more clear?

      1. Well the title of the actual blog post, and not the Url, is, “How Social Rejection Increases Opiate Addiction”. Thus from my background/backing it seems like a safe assumption that this message/blog post is about an increase usage of Opiates. The key word that seems to be the take away is (in my mind) “Increases”.

        Although, I can understand potential sources of confusion. I seem to know a few Sociologists, one who’s finishing/Finished(?) his doctorate from North Carolina-Chapel Hill (if that matters to you).

  5. I want to bring attention to one other fact, as it relates to the use and prescription of addictive medication types. Unfortunately, medications such as Opioids and Benzodiazepines can be highly addictive. Unfortunately, these are also covered by health insurances in the States. Where does the need to treat outweigh the consequences it creates. I know it is too much for just one article to explore, but I have seen much travesty caused by the medical institution’s need to “use treatment to help the sick according to my ability and judgment”? Food for thought.

    1. Thanks for the comment. I completely agree. The purpose of this article is not to recommend opiates for treating social rejection. Hopefully it didn’t come across that way. How did you interpret it? Also, how might you recommend changes so that it doesn’t give that impression? The purpose was to understand some of the social motivational behind opiate addiction and the downward spiral caused by social rejection.

      1. Hello Steve. It was only food for thought, further possible articles maybe. Unfortunately as a psychotherapist I see the use of highly addictive substances as the primary treatment modality for low level problems such as generalized anxiety and social anxiety. However, from experience, medication should be a last resort of treatment, not a first line of defense. Great article though.

        1. I agree. It’s sad to see how these substances are used for low level problems. Thanks for clarifying. I thought your original comment was a misinterpretation, but rereading it, I see how it was a suggestion to further explore this issue.

  6. Society is falling down a rabbit hole with all the bullying and terrible things that happen to children/others in schools and on social media. The cruelty is astonishing. But with what’s going on in Washington, hatred, cruelty, and bullying seems to be the rule of the day. Let’s not forget insanity. Nightmare. I don’t see things getting better when the KKK is in the white house and on the streets and on campus. Hate and brutality in every form seems to be coming from everywhere. I think it’s to show us just how truly disgusting and horrific human beings are/can be. It’s like a wake up call to show us that we can’t ignore the violence, hatred, prejudice, sexism, homophobia, agism, racism…well you know what I mean. Orwell is screaming, “I TOLD YOU THIS WOULD HAPPEN!” Now we have to fight a government who has all the weapons and doesn’t think twice about killing it’s own citizens. So, um, don’t see kindness and compassion or the end to bullying coming anytime soon except from individuals and all the love in the world can’t stop the pain of someone who is terrified to go to school everyday. Nope…even drugs won’t take away that kind of fear.

    The solution is to change society and not have low income people, not have uneducated people, not have people in prisons because of their color and income, the answer is to STOP BULLYING in schools with HARSH consequences because last time I looked, that was not happening. We also need to teach kids to SUPPORT EACH OTHER and stand TOGETHER against bullies. We don’t teach that. We teach fear because fear makes people easier to control. Society doesn’t want people who can think for themselves. They don’t want citizens standing together…but that’s exactly what we have to teach children to do from the very beginning. If a bully comes up to someone, other kids should immediately go to his aid and stare the bully down. THAT’S how you start to end bullying. By standing up for each other. Rejection is also taught. Everything is taught. If we want change…we have to teach different things. Change the brainwashing/conditioning and you change the culture because that’s what we are…brainwashed and conditioned. Well, not all of us, of course. Those who refuse to shut up and sit down are labeled trouble makers, Behavior Disordered, uncooperative, American terrorists, you know what I’m saying. The government shivers and wants those who fail to be conditioned to be destroyed or dead. Those who refuse to be bullied are the artists, the creative thinkers and they are a DANGER to the status quo. That’s what we need to teach. “HOW TO BE A DANGER TO THE STATUS QUO 101.” That’s what I taught. QUESTION AUTHORITY AND FIGHT BACK. Then there is no bullying or rejection because you’re tough and can take care of yourself. WE NEED TO TEACH THAT and stop following the stupid rules. Worked for me. I’ve never been rejected in my entire life. Not once. Not EVER. I’ve stood up to teachers, politicians, people screaming at me from picket lines, from everyone, including a judge. Don’t care. I’m tougher than all of them and when we teach kids to be tough they won’t be afraid either and our society will be made up of strong individuals who don’t have to cower and hide in fear, because that’s what they have been taught to do. No one saves kids who are bullied in school because our culture wants them to be that way. They are grooming them for citizenship.

    We are controlled first by labels/name calling, which escalates to minor violence/bullying, then moves up to more forceful violence, then beatings, then arrests and then death. We know that’s the way society controls the masses. The laws change accordingly.

    In every single country the first to be arrested are the artists. Artists have the power to INFORM and they must be stopped. Creative people, thinkers, are dangerous to the state. It’s simple. Raise kids differently. Actually have the guts to do something to the bullies to stop them. Teach kids to stand together against things that are WRONG! Teach kids not to put up with things, or take the garbage that comes their way, to stand together to fight the things that are WRONG. Then you won’t need medication at all. You just teach them to be brave. Even if they’re terrified, you teach them to stand up and face whatever it is and BE BRAVE. Nothing can stand against people like that. Nothing. FEAR is the problem. FEAR. Teach people how to overcome FEAR and you teach them to be brave.

    1. Thank you for another passionate response! I agree that the issues need to be changed on the social level. Just to get some feedback, does this article seem to be suggesting the use of opiates or other medications?

    1. Love Gabor Mate, a fellow Canadian. Thanks for sharing! Also, in doing the literature review for this article, I came across those studies on Tylenol and empathy! Fascinating topic.

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