The Accidental Addict

When most people hear about OxyContin or other prescription opiods, they immediately think “addiction.” This is deceiving, because these medications play a role in pain management for some patients. Physical dependency on narcotic painkillers can be experienced by anyone who has taken them for pain management longer than several weeks, and when use is stopped, people may experience the discomfort of physical withdrawal. The disease of addiction has more than just a physical dependency component, affecting all aspects of health and daily life.

Addiction to substances including prescription painkillers has social, physiological, psychiatric and physiological factors. And addiction to opiod painkillers is almost always a condition that sneaks up on the sufferer. Most don’t realize they are addicted.

If a physician has prescribed psychotropic medications, including painkillers to you on a long-term basis, you may assume this is appropriate. The reality is that long-term use of opiod narcotics, which include the trade names OxyContin, Percocet, Vicoden, Lorcet, Tramodol and Percodan, can create a tolerance that requires a higher dosage to manage pain. A person’s sensitivity may even increase, a condition called hyperalgesia. Other psychotropic medication abuse includes depressants used to treat anxiety and stimulants for the treatment of ADHD and obesity. During treatment assessment at Hanley Center we see a high percentage of dual diagnosis, including depression, with those patients who suffer from addictive medication dependency.

Sometimes people mistake physical withdrawal symptoms from medications for a continuation of pain symptoms, so they continue to seek pain medication. When dependency becomes addiction, people are caught in the throes of extreme behavior. Doctor shopping can become as time consuming as a part time job, as the addict desperately seeks a wider circumference of doctors to prescribe medications. Others may even seek out surgery for their perceived pain just so they can get access to narcotic medications.

Common symptoms of opiod medication addiction include blackouts and inability to get to work on time or at all, other additive behaviors, emotional upheavals and mood swings, interpersonal problems, isolation and the disruption of daily life in myriad of ways. Often those who abuse painkillers seek other psychotropic medications for sleep disorders, depression and anxiety. If they are doctor shopping, the physician or psychiatrist may not realize the other drugs being taken in this potentially dangerous mix. Alcohol is sometimes added to create an unwittingly deadly cocktail.

A significantly risky phenomenon that has emerged around the country is the pain management clinic. Pain medication is the stock and trade of many of these clinics, and for Americans who subscribe to the quick fix theory of everything, this sounds like the ticket. Successful long term chronic pain management is more complex, and requires the active participation of the individual.

Don’t ignore your pain

If you experience pain, don’t ignore it. Effective pain treatment needs to address the pain source, the patient’s medical history and history of substance use or abuse, the level of pain and how long the pain has persisted. The physiological and psychological reality is that the longer the pain exists untreated, the more likely it will become chronic pain. The body’s neurological processes can actually create a memory of pain in the central nervous system.

What will your options be in pain treatment? Will surgery be necessary or will you engage in a course of physical therapy? If surgery, have you had similar surgeries before? Will you follow up with physical therapy and prescribed exercises? I know of knee surgeries, for example, that most likely would have been successful had the patient actually done the recommended painful but effective physical exercises post-surgery. Do you want to play tennis again?

Reaching for a goal may not include conquering the slopes after a multi-fracture accident, but it may mean being able to walk the dog for a mile or two.

A multidisciplinary pain treatment approach is most effective because it treats the whole person, psychologically and physically. There are effective newer medications that are non-addictive, but are slower acting. These were often developed to treat other conditions such has depression and seizures, such as Duloxetine (Cymbalta), an antidepressant. Nonsteroidal drugs, such as over-the-counter or prescription Tylenol, aspirin or naproxen, such as Aleve, and prescription Naprosyn may be recommended.

Lifestyle changes are often key in pain management and recovery, such as weight loss and dietary changes, consistent sleep patterns smoking cessation and exercise. There really isn’t a quick fix, but an integrated approach. Mind-body exercises such as yoga are popular, and the meditative Tai Chi are disciplines that have now been widely adopted in the U.S.

When medication use becomes abuse

The disease of medication addiction is debilitating. Many addicts attempt to detox by themselves, only to turn to the psychotropic medication again. “Cold turkey” withdrawal after long-term use of an opiod drug is severe, with symptoms such as cramping, nausea, vomiting, diarrhea, and dizziness, and can be dangerous if not medically supervised.

There are many detox clinics that assure a quick turn-around and recovery form addiction, but this disease is multi-faceted. Just as the treatment of pain should be multi-disciplinary, holistic addiction treatment is most effective as well, including close medical supervision. Assessment and treatment plans include wellness, physical, mental and spiritual components, and individually appropriate integrative and expressive therapies. The role of the family, support groups and often continuing care play a role in relapse prevention and successful recovery.

Dr. Barbara Krantz is a noted board-certified addictionologist and the Chief Medical Officer at Hanley center, http://www.hanleycenter.org Hanley Center is a renowned treatment center in West Palm Beach, Florida that specializes in age and gender specific treatment for men and women. Its personalized, holistic therapy programs are rooted in the Twelve Step Philosophy, with care plans that include interactive and expressive therapies, and that address the whole person, spiritually, physically, medically and emotionally.