We often read about how to tell if we’re addicted to prescription painkillers and what to do if we are addicted. But what about the early signs – signs that could indicate the need to take action before we become dependent?

Few people wake up one morning suddenly addicted to prescription opiates. The process is typically more gradual, which means there are numerous opportunities for early intervention. Here are the earliest signs that your use of pain medication is beginning to cross the line into addiction:

#1 You’re starting to use your pain medication to feel better, not just to ease pain.

Most people who use prescription opiates have pain as a result of an accident, surgery, illness or other condition, and then take their medicine to relieve that pain. Those who become addicted have pain, take the medicine and find that they not only have less pain but they also feel better in other ways.

Perhaps it helps you sleep, energizes you, makes you feel more confident, or relieves stress or anxiety. When you take the medication, you may find that it numbs emotional pain, allows you to escape from difficult thoughts or feelings, or gives you a sense of pleasure.

A shift occurs where you’re no longer taking the medication because you’re in physical pain but because of the positive effects on your mood or outlook. You’re now taking the drug to get high.

 When a patient is in pain, doctors seek to provide relief. But sometimes that relief causes more problems than it solves.

The latest example making news is war veterans suffering from pain and co-occurring post-traumatic stress disorder who are being prescribed potent opiate painkillers. Even though it’s widely known that veterans with PTSD are at high risk for drug and alcohol abuse, a recent study in the Journal of the American Medical Association shows they’re twice as likely to get prescriptions for addictive painkillers as veterans with only physical pain.

Even more concerning, vets with active substance abuse problems were four times more likely to get addictive drugs than those without mental health issues.

Vets with PTSD who are prescribed these drugs are more likely to suffer drug overdoses, self-inflicted injuries and suicides, according to the study. In addition to their addictive potential, opiate drugs can actually exacerbate certain emotional problems and only slightly reduce or even worsen pain.

Side effects, tolerance and withdrawal symptoms can compromise the drugs’ pain-relieving effects. In a 2009 study of 1,843 workers with back injuries, researchers found that only 26 percent of the patients on opioid painkillers experienced pain relief, and only 16 percent experienced improvement in physical function.

Although often overlooked, emotional trauma lies at the heart of many types of addictions. Our recognition of trauma as a root cause of addiction isn’t new. Since the 1970s, treatment professionals have understood the role of trauma in the development of substance abuse disorders and relapse.

But in recent years, there has been a welcomed resurgence in awareness and treatment of trauma as a co-occurring disorder.

Research Links Addiction and Trauma

Last week, a study published in Alcoholism: Clinical & Experimental Research confirmed what many of us in the treatment field have long observed: A history of childhood neglect or sexual, physical or emotional abuse is common among people undergoing treatment for alcoholism and may be a factor in the development of alcohol use disorders.

Abuse was also linked to a higher risk of anxiety disorders, depression and suicide.

A growing body of research suggests that food can be as addictive as drugs like cocaine and nicotine. In addition to being unhealthy, processed, sugary, wheat-based,  fatty and salty, foods affect the reward circuitry in the brain, resulting in compulsive eating despite the well-known risks of heart disease, diabetes, high blood pressure, high cholesterol, cancer and other negative consequences.

Late Princeton psychologist Dr. Bartley Hoebel hypothesized that both drugs and sugar are governed by three characteristic phases of addiction: binge, withdrawal, and preoccupation. Like drugs, studies show that people can develop a tolerance to sugar, needing more and more to feel pleasure, and experience withdrawal-like symptoms when cut off from sugar. Interestingly, drugs we use to block opiate receptors in the brain, such as naltrexone and topiramate, also reduce cravings for fatty and sugary foods.

Other studies have revealed some interesting findings about food addiction:

• A Yale study found that the brain activity of women with three or more symptoms of food addiction who viewed images of and then drank a chocolate milkshake was similar to drug addicts. Just as drug addicts’ brains light up when viewing drugs or drug paraphernalia, food addicts’ brains light up in the areas governing pleasure and reward when looking at high-fat foods and show reduced activity in regions involved with self-control when actually consuming those foods.

In 2011 a group of physicians descended on Capitol Hill to ask congress to help them fight prescription drug abuse. How? Finally require all health care professionals get real training in prescribing addictive drugs, recognizing signs of addiction, and identifying problematic patterns of use.

Most physicians receive little or no training regarding substance abuse and the use of controlled substances that have the potential for addiction. While there are many doctors who prescribe these powerful drugs responsibly, and these drugs are often critically important when used as intended (usually very short-term use or on an as-needed basis), better education will help them recognize drug-seeking behavior and train them to evaluate and refer these patients to treatment the same way they do when they see high blood sugar or blood pressure.

In the field of addiction treatment, some of the most tragic stories are those of high-functioning addicts. The friends, neighbors, relatives and co-workers you look up to – envy even – for their beautiful homes, loving children and successful careers may be dealing with a secret addiction that is destroying them from the inside out.

How long do you think it would take to identify the signs of addiction in someone close to you? Most people assume they’d perceive a problem rather quickly, keeping an eye out for major life consequences such as job loss or destroyed relationships. But according to a 2007 study by the National Institute on Alcohol Abuse and Alcoholism, only 9 percent of alcoholics fit this stereotype.

The majority of addicts are high-functioning – high-power executives, surgeons in the operating room, successful professionals, hard-working stay-at-home moms and others you may not suspect even if you know them intimately over a long period of time.

High-functioning addicts are masters of disguise whose struggles with drugs and alcohol may go unnoticed for years, often with increasingly severe consequences. Here are a few ways to unmask the high-functioning addict in your life: