Stop And Go
Updated: May 23, 2019
Down The Rabbit Hole of Addiction
It is part of our human nature to strive to make sense of the world we live in and our place in the world. We justify, explain and classify behaviors because of our need to make sense of those behaviors that cause us and our loved ones pain and distress. Sometimes, in that attempt we feel compelled to “pigeon hole” the problem. This fear and lack of knowledge has caused us in the Behavioral Health field to develop several models to understand the devastating causes of addiction. A popular “moral” model developed and assumed that addiction is a moral failing or flaw in a person’s character.
The moral model framed addiction as a result of human weakness—a defect in character. It did not recognize biological or genetic components to addiction and offered little compassion or understanding for those who displayed addictive behaviors. This model made the assumption that addiction is the result of poor choices. Addicts make these poor choices because of a lack of willpower or moral strength. If they will just stop, all will be well.
How is it that some people will transition from using or misusing alcohol or drugs on an occasional basis to a full-blown addiction that has the potential to ruin their relationships and their life as they know it?
Let me introduce you to David. David was in his 50’s and didn’t look the part. He had a great job, a loving wife and a happy family. But like an estimated six million Americans nationwide, he abused his prescription medication. As a successful college football player, David was exposed to a stock supply of Vicodin kept in the locker room for the athletes and given out for pain just by asking the college trainer. Exposed at a young age, he found that the Vicodin made his physical pain disappear along with the stress and anxiety of being a college student. Fast forward to David in his fifties, now experiencing chronic back and disc pain due, in large part to his injuries as a football player. Seeing well-respected doctors to treat his pain, he was given Percocet while his medical team figured out if surgery was necessary. It was decided that surgery was indeed the recommended course of treatment and David was prescribed Percocet to manage his pain after surgery. Soon he was taking one pill every two hours instead of every four to six hours as prescribed.
Because the medication was prescribed and David needed relief from his pain, he had no idea that he would become an addict.
Because the medication was prescribed and David needed relief from his pain, he had no idea that he would become an addict. Primed in his youth and with legitimate pain in his boomer years, David became an addict. Everyone addicted to pain medication has their own story, but all will agree that the journey to sobriety is long and painful.
Today, millions of Americans suffer with all kinds of physical concerns that cause them serious pain. They are in need of pain management to help them function and are often prescribed appropriate medications to help them cope and manage their condition. However, because these drugs are so powerful and the need so great, bodies can build up a tolerance for the medications. They need more of the drug to obtain the same effect. Eventually they can become overly dependent on these drugs, which can have a very negative effect on their quality of their life.
Scientific breakthroughs have dramatically transformed our understanding of substance use disorders and addiction. Over several decades, research has transformed our understanding of addiction and its effect on the brain. What an exciting time for us in the field of addiction. New models have evolved and opened the door to new ways of thinking about treatment and prevention of substance use disorders. We now have an evolving understanding of the neurobiological framework underlying substance abuse that explains the fact that changes in brain structure and function promote long-term addiction and contribute to relapse. This is the “stop and go” of addiction. What was once considered a moral failing or character flaw is now understood to be a chronic illness, similar to diabetes, hypertension or asthma. Like addiction, these diseases have both physical and behavioral components that wax and wane and can go into remission.
This new knowledge has opened the door to new ways of thinking about substance abuse and addiction. Over a period of time, we have a better understanding of the brain and substance abuse. However, many addicts still believe that their addiction is a social stigma, a failing on their part. This remains a great source of their shame and guilt. We, as a society must move away from the concept that addiction is a result of some moral failure or defect of character. This is not a disease of choice or moral failure. Even medical professionals often find it difficult to separate a person’s character from their addiction.
The phrase “accidental addict” explains the fact that over 12 million older adults suffer from some sort of chemical dependency in the nation. Shaky hands, memory lapses, long afternoon naps, and even incontinence. Are these signs of aging or something else? The fact is that many prescription drugs remain in household cabinets long after med management has completed. As innocent as that may seem, it opens the possibility for abuse by the patient or others. Patients will often tell me that they knew that they should have disposed of their medication but they thought that they should “hold on” to them in case they are needed in the future. Opiate abuse, and especially narcotic prescription drug abuse was deemed an epidemic by the Center for Disease Control in 2011. A widespread and life-threatening problem, it has killed countless people and is vastly under treated. Doctors routinely prescribe tranquilizers and pain medications for older adults and more than 25 million prescriptions are written every year. Prescription drug addiction is emerging second only to alcohol as the drug of abuse in the older population. Older adults are particularly vulnerable to the “accidental addict” phenomenon. One interesting paradox to their core value, respect for authority, is older adults do not question doctors prescriptions for addiction medications. Consequently, after developing addiction problems secondary to prescription medications, older adults are offended when they are referred to as addicts. To them, addict represents that criminalized younger group.
Prescription drug abuse is the Nation’s fastest-growing drug problem and the “Accidental Addict” can happen to all ages and in all lifestyles. In addition to older adults, the populations that seem to be at the highest risk for prescription drug abuse are women and youth. Prescription drug abuse is becoming the deadliest gateway drug for our young people today. Studies show that a large percentage of youth began by using prescription drugs non-medically for the first time. And with all gateway drugs, this can lead to a future risk of using more dangerous hard drugs.
The population entering the workforce — people 18 to 25 years old — are another one of the groups showing an increased rate of prescription drug use. One of the areas of greatest concern for the treatment world is the number of workers that are addicted to pain medications. The rate of increased prescription drug use has become a public health issue and a concern to employers. Results of the 2013 National Survey on Drug Use and Health showed that of the estimated 22.4 million current illicit drug users aged 18 or older in 2013, 15.4 million (68.9 percent) were employed either full or part time.
According to a National Survey on Drug Use and Health in 2009, more than 5 million Americans misused prescription painkillers in a one-month period. “Daily, 50 people in our nation die from unintentional prescription opioid overdoses and daily, 20 times that number are admitted to hospital emergency departments for opioid overdoses,” said John Eadie, director of the Prescription Monitoring Program Center of Excellence at Brandeis University. As outrageous as that sounds, a huge majority – more than 70% of those prescriptions were from friends and relatives.
After all, many times these drugs are prescribed for real pain and unfortunately, patients are not always good consumers
There are many reasons for the rapid and growing abuse of prescription drugs. One is how easily accessible the drugs are from doctors, family and friends. The other is the diminished perception of risk while taking these legal drugs. After all, many times these drugs are prescribed for real pain and unfortunately, patients are not always good consumers and, like older adults, do not question their doctors when addictive medications are prescribed. Doctors tell patients to “get ahead of the pain – if you wait, it will take longer to manage your pain.” So your brain sends a signal that the pain is coming and you need to be prepared. Better take another pill. And the cycle of abuse begins. These factors all add to the epidemic and deadly problem of prescription drug abuse in our Nation today.
Many medications are potent but they serve a purpose for relieving pain and suffering. Treating a person with chronic pain is especially challenging. The question I always ask myself when a chronic pain patient is coming into treatment is, “how can I help my patient manage their pain and still have a quality of life and good health?” An addiction to opioid painkillers is almost always a condition that sneaks up on a person. And before they know it, they are addicted. Almost every family is touched by the disease of addiction in one form or another, either with a relative or a friend.
There are many misconceptions about addiction and those who suffer from it. The 21st century addict is no longer the stereotype of a sad, lonely, loser junkie on the street but more likely to get a fix by abusing prescription drugs than from a needle. Addiction is a terminal illness. People can die from it, physically and psychologically. The physical death from addiction can be from an overdose or accident but in my experience the emotional and relational deaths can be even more devastating. Families become fractured, sometimes; beyond repair, with patients falling into a void so deep that they will despair of ever getting out.
As we saw from the story of David, the face of addiction comes in many forms and our Nation and the treatment world is beginning to realize that we have to create accessible and effective treatment for the millions of people in our society that suffer from it.
The crisis of prescription drug abuse will not go away without a call to action.
The negative consequences of drug abuse and addiction for individuals and for society cannot be ignored. According to the National Institute on Drug Abuse, substance abuse costs our Nation over $600 billion annually, including productivity and health and crime related costs. Treatment can help reduce these costs. Drug treatment is worth the cost.
Pain insists on being attended to and pain medications can play a real role in pain management for some patients. Because prescription drugs can vary widely in their purposes and side effects; there are no clear-cut signs that prove addiction. However, medication is not the only form of treatment for pain and as providers, we need to find and implement alternative methods for pain relief. By treating the whole person, we must look at Alternative Therapies that encompass a variety of disciplines. Some of these disciplines might include acupuncture, sensory integration techniques, stress management techniques, chiropractic treatment, yoga, biofeedback, aromatherapy, relaxation, herbal remedies, massage and many others. This complementary use of alternative treatments along with medication management and cognitive therapy has been shown to reduce associated health and social costs by far more than the cost of treatment.
Thankfully, we have come far in recognizing that our moral classifications were too rigid and our explanations were just not right. Addiction is not just a result of “moral failings” or a lack of discipline. We have an evolving understanding of substance use disorders and the roller coaster that all addicts and their families experience.
The belief that an addict must reach rock bottom before they can get any help is completely inaccurate. The fact is that the earlier we can get an addict into treatment, the better chance we have of helping them. Families, loved ones, employers, health care professionals and the legal system can and should require the addict to get treatment for their addiction.
Recovery is multidimensional and an ongoing process. Different factors facilitate recovery, protective factors and risk factors. These factors occur at all levels: individual, family, work, and community levels and cause the “stop and go” effects that all addicts experience.
As much as I detest too much government involvement in our lives, Congress must get more involved by passing laws to assist with our public safety. The passage of two important pieces of legislation has been helpful to make mental health and substance abuse coverage more affordable and accessible for individuals and families.
The Mental Health Parity and Addiction Equity Act of 2008 was signed into law by President George W. Bush and requires parity of mental health benefits with medical and surgical benefits with respect to the lifetime and annual dollar limits under a group health plan. Prior to the Mental Health Parity Act, insurers were not required to cover mental health care benefits which meant that access to treatment was limited. The importance of this act is that it expands coverage of mental health and substance use disorder providing more Americans with timely and accessible access to treatment.
With the inevitable passage of the Affordable Care Act, we, in the treatment world, were hoping for even more of an emphasis on the ability for people to get effective substance abuse and mental health treatment. We have a new administration and we remain hopeful that there will be an increased focus on substance abuse and mental health treatment for 2017.
Increased federal government initiatives are a good start but parents, patients, healthcare providers and manufacturers all play a critical role in preventing prescription drug abuse.
I have written much on how to maintain peace and stability and “future proof” our lives to withstand the inevitable storms of change that we encounter every day. The same applies to “future proofing” ourselves and our loved ones against the devastating disease of addiction. It is no longer alcohol or the isolated use of drugs but the complicated interaction of substances for pain management that has caused us to look at addiction with an entirely different perspective.
There is no other terminal illness that is more treatable than addiction. Only the person using alcohol or drugs can make the decision to get help but we as a society can help create the conditions that will make that decision possible. I know that by treating the social, psychological, psychiatric and physiological factors that are part of every addiction we can “future proof “ ourselves and our loved ones, giving them the best possible chance for the quality of life we all deserve.
As health care providers, we are constantly collaborating with our colleagues in the treatment world so that we have evidence based best practices and insurance approved targeted recommendations. We must look at and treat the whole patient in order to get successful outcomes, using a wide range of proven treatment methods. What that means is that we, as health care providers, will continue to develop an integrated approach that explores the relationship between mental health and physical conditions. We will move closer to providing effective treatment and support for all those that suffer from the devastating disease of addiction.
By combining these two elements, we can greatly improve the success rate of treatment and improve the overall quality of life for our patients by freeing them from both their addiction and the pain that helped lead them to it. There are millions of people living successful, full lives in recovery. This is a disease that has hope and a solution, and the solution is treatment.
Dr. Maryann Rosenthal has specialized in the treatment of addiction and mental health for more than 25 years. She has a unique background and career working in both the business and clinical sectors of health care with extensive experience in the field of chemical dependency and recovery, as well as the assessment, education, and management of chronic pain and addiction. An internationally known speaker and author of Be A Parent, Not A Pushover, Dr. Rosenthal has consulted throughout America, Australia, Europe, and Asia on family dynamics and life achievement issues. She has been published in numerous magazines and has collaborated on many books.
Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
National Institute on Drug Abuse: July, 2014.