I see a lot of Chronic Illness patients in my private practice because I specialize in working with individuals that are struggling with Depression. When an individual discovers that they have a chronic illness that will cause pain, fatigue, and will most likely never go away, patients tend to become very depressed. That’s when I get the call.Usually, because the word is out – I have multiple chronic illnesses and get it.
Many doctors that treat chronic illness/chronic pain often tend to under medicate. This is for many reasons: some MD’s are afraid of losing their license (I’d like to hope that wasn’t the ONLY reason), some don’t believe that the patient is really in THAT much pain. Some are afraid that the patient might become addicted to the medication. And that is the one I want to discuss today.
Addiction. Dependency. What do they mean and how are they different?
Researchers suggest that Addiction is a biological and psychological condition where a person exhibits compulsive behavior to satisfy their craving for the drug. Repeated use changes the reward pathways to the brain. Chronic use can lead to a tolerance to the drug. The individual then needs more and more to get the same amount of high. And that is the key word. High.
Usually if someone is looking for a quick high, they may have a problem. Most patients in pain aren’t looking for a high. They are looking for a REDUCTION IN PAIN/SYMPTOMS, and preferably without a high. They don’t want to trade being in bed because they can’t move because of the pain, with being in bed drooling because of the loopy feeling their pain medication created. They want an IMPROVEMENT in quality of life.
Bingo – another difference. QUALITY OF LIFE. A drug addict continually uses the drug despite negative effects and consequences. (decreased quality of life).
An individual that takes medication for pain because s/he needs it, but only takes it as often as the script is written may become physically dependent. If they suddenly stop the medication does their body react? YES! Of course. But this doesn’t mean they need a 12-step program.
If you have a chronic illness that has no cure ( Arthritis, Lupus, Fibromyalgia, MS, nerve pain, to name a few) and you are looking at the rest of your life suffering in pain that the average person could not tolerate for a month and you are staring down FOREVER it makes sense that if your specialist said, “Here, take this every 4 hours and you will have a lot of your life back.” Maybe not 100% improvement but 70 or 80% looks pretty good when you are in bed every day, at the end of your physical and emotional rope.
Now, even if you take the exact dosage decided by your doctor you will possibly become dependent. Dependency is a physical state that occurs when the lack of the drug creates a reaction in your body. NOT a craving for the HIGH you experience when taking the drug, but a physical reaction such as nausea, the shakes, etc. What is occurring is that the body has become so used to the medication that it has noticed that you aren’t taking it and begins to withdraw.
Up until now we are only looking at opiates. But are there other drugs you might be taking that could cause a dependency? Oh yes. How about Beta Blockers. If you are on them for a while, then forget to refill that script your body withdraws (high blood pressure, increased heart rate). Are you on Avandia? Yep, you are probably dependent. Stop it and your blood sugar sky-rockets and that can’t feel good.
So what is the bottom line. We can get to it by looking at a few basic questions, WHY are you taking the drug (to get high, or to “fix” a problem or eliminate a symptom?). If you are seeking the high or euphoria that you get from the drug then we are probably looking at the addiction word.
Another issue that is very important is the word STIGMA. Stigma by doctors who don’t want to be known as a doctor that prescribes “those”drugs. Stigma by society that is misinformed about diseases, pain, and the “A” word. Stigma by patients who won’t take medications because they haven’t been well-informed by their doctors, or are afraid what their pharmacist, friends, family or spouse will think.
If you (or “your friend”) have drug seeking behavior consider an intervention. But if Aunt Lucy has severe Rheumatoid Arthritis and Lupus, can’t get out of the bed because of the pain, don’t drag her to an AA meeting. Do some research about chronic pain, print it out and give it to her. Then go with her to see her Rheumatologist and ask about a two-pronged way of dealing with her situation: Disease Management and Pain Management. If they won’t write the script , ask if they will send you (or Aunt Lucy) to a Pain Clinic that isn’t afraid of the DEA sneaking in the middle of the night to snatch up their license.
Chronic pain patients can suffer from Depression, Suicidal Ideation, and severe loss of self-esteem. They can’t make plans because they don’t know how to except on a day-to-day basis. They isolate (no one wants to hear how they REALLY feel). They are humiliated if they aren’t able to work, or can’t physically pick up their kids. They become irritable, exhausted, and often can’t concentrate or cope with even the little bumps in life. They no longer have the disease, they ARE the disease.
So after you get the pain medication script, consider finding a great therapist that understands chronic illness. And the difference between being dependent on those pain pills and being addicted.