Babies Can’t Be Addicted

“Babies Born Addicted,” “Addicted Babies,” “Babies with Addiction,” and similar headlines appear nearly daily in the media. This is because babies exhibit horrible withdrawal symptoms if they are born physically dependent on opioids, and it pulls at our heartstrings to see them suffer. But it misleads media consumers, policymakers, and family members into believing the newborns are addicted. They confuse signs of withdrawal with opioid addiction.

It is important to understand what addiction is and what it is not. Addiction is characterized by the 4 Cs: craving, loss of control in using the substance, compulsion to use the drug, and continued use despite harm. It is defined by volitional behaviors. Withdrawal can occur in people with addiction, but it is not evidence of the disease. Therefore, babies cannot be addicted because addiction requires a drug seeking behavior. Babies don’t seek a drug when they are born.

Even some physicians believe withdrawal is synonymous with addiction. To raise awareness, I often tweet to the journalists who make this mistake, “Babies cannot be born addicted. Please don’t label them.” Once, a journalist tweeted back and apologized for his mistake. He also thanked me for educating him. But this was the only time I received a response.

It’s possible that some journalists don’t know better, or they opt to call babies “addicted” because the sound bite will grab readers’, viewers’, and listeners’ attention. It is also possible that they have limited space or airtime, so they use “addicted babies” as a type of sloppy shorthand.

Some journalists probably know that babies who are exposed to opioids in the womb may be born with neonatal abstinence syndrome (NAS), but they may believe that NAS is just a technical term for addiction. They’re incorrect. NAS is withdrawal from, rather than addiction to, opioids.

Withdrawal Versus Addiction

In writing this blog, I googled the phrase “withdrawal and addiction.” Almost half of the resources I found used the two terms interchangeably. That’s astounding to me.

I once saw a middle-aged woman in my clinic who had been prescribed opioids for several months following major surgery. She was ready to discontinue her opioids. She tapered herself to a low dose, but was not able to discontinue it completely, because she experienced terrible withdrawal towards the end of the tapering process. Her doctor referred her to me with a diagnosis of addiction. However, she wasn’t addicted. She had no craving for the opioid, and she was not using the drug to get high or to chemically cope. She was not continuing to use the drug despite harm. She was trying to stop. She’d developed a physical dependence, similar to that of babies who are born physically dependent on opioids when their mothers are addicted to, or physically dependent on, opioids.

Some people believe that, when someone can’t stop taking a medication without difficulty, it must be a sign of addiction. That is not necessarily the case. Difficulty in tapering off non opioids can also occur. Signs of withdrawal—such as increased anxiety, nausea, vomiting, chills, and muscle aches—are not necessarily proof of addiction. But, if those symptoms occur in people who are using drugs for a non-medical purpose, then those signs could support a diagnosis of addiction.

It is important to understand the signs that someone might be experiencing an addiction to opioids, even if that person is in denial or tries to hide it. The first, and foremost, sign is that the drug is being used for a reason other than to relieve pain. Often, people will use an opioid because it gives them energy or makes them feel good. If a loved one is primarily using the opioid to feel good, instead of to relieve pain, it could be a sign of a problem. Going to more than one doctor to obtain prescriptions, or “doctor shopping,” is another sign that the person may have a serious problem. Certainly, if someone is frequently taking opioids that were not prescribed to them, that is a serious problem (it may not necessarily be proof of addiction, but it’s a sign of an issue that needs to be addressed immediately since street drugs might contain toxic substances, such as fentanyl).

Opioids should improve function and quality of life. If this is not happening, then taking opioids may be inappropriate and could be a sign of addiction.

The type of treatment depends on whether the diagnosis is withdrawal or addiction.

Treatment for Withdrawal or Addiction

People with withdrawal, regardless of whether it is associated with addiction, need a doctor’s care. If the withdrawal is due to physical dependence, the patient must be slowly tapered and often will require adjuvant medications to treat the withdrawal symptoms. This allows continual tapering with minimal to no side effects. Physicians experienced in treating withdrawal can make the tapering comfortable and successful.

However, if you think you or a loved one might have an addiction problem, seek advice from a physician who has experience with opioid addictions.

Most doctors do not know how to help people who are struggling with an addiction. It is not part of training for most physicians, so it is very important to find someone who is knowledgeable about, and experienced in, treating addictions. Inaction can lead to death. If you suspect a loved one has a problem with addiction, taking the action–seeking expert advice–is better than the alternative.