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Intense, overwhelming cravings that dominate attention and decision-making Dramatic mood swings tied to the opioid use cycle: euphoria during use, irritability and dysphoria between doses Emotional blunting or inability to experience pleasure from activities that previously brought satisfaction (anhedonia) Anxiety, agitation, or panic when access to opioids is threatened or uncertain Cognitive impairment, difficulty concentrating, and impaired memory from long-term use Deep shame, guilt, and self-loathing, often driving further use to escape negative feelings Denial about the severity of use despite mounting evidence to the contrary When opioid use disorder occurs alongside anxiety, depression, PTSD, or other mental health conditions, each disorder worsens the other