The Accidental Addict

Not Everyone Looks Like an “Addict”

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 augured 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.

How Did David Become an Accidental 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 get clean is long and painful. 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.

Juan Harris, MBA, MS, ICADC, one of the country’s leading experts on older adults and addiction, talks about this as a hidden epidemic, a widespread and life-threatening problem that is not widely known and is vastly undertreated. 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. Mr. Harris states that “Because of the values they espouse: honesty, committed work ethic, responsibility, integrity, and respect for authority, older adults have the best results of any age group in terms of responding to treatment.”

The Accidental Addict Can Be Any Age

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 o ended when they are referred to as addicts. To them, the addict represents that criminalized younger group.

Today, millions of Americans suffer from 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 their need so great, their bodies can build up a tolerance for the medications. They then need more of the drug to obtain the same effect. Eventually, they can become overly dependent on these drugs, causing a downward spiral of use and abuse.

…Because our bodies can build up a tolerance, greater and greater amounts of these powerful drugs are needed to obtain the same effect. Eventually, people can become overly dependent on these drugs, which can have a very negative effect on their quality of life. Prescription drug abuse is the Nation’s fastest-growing drug problem and the “Accidental Addict” that Mr. Harris describes 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.

18-25 Year-Olds

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 2009 National Survey on Drug Use and Health showed that of the estimated 19.3 million illicit drug users who were 18 or older at the time of the survey, 66.6% 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. 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.”

How Opioid Addiction Works

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.

According to the Drug Abuse Warning Network, from 1994 to 2001, emergency room visits for narcotic prescription pain relievers increased for oxycodone 352%, methadone 230%, morphine 210%, and hydrocodone 131%. These statistics are appalling and as a society, we must start changing our beliefs and attitudes or we will continue to lose more loved ones to this disease. There are many misconceptions about addiction and those who suffer from it.

The 21st Century Accidental Addict

The 21st-century addict is no longer the stereotype of a sad, lonely, loser junkie on the street but more likely to get a x 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 an accessible and effective treatment for the millions of people in our society that suffer from it. 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 end 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 complimentary 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.

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. 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.

Government Offers Treatment For the Accidental Addict

Families, loved ones, employers, health care professionals, and the legal system can and should require the addict to get treatment for their addiction. “…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, are hoping for even more of an emphasis on the ability for people to get effective substance abuse and mental health treatment.

Return Unused Drugs

Related to the specific issue of prescription drug abuse, the DEA has organized two national prescription drug take-back days to collect unused or expired medications. To date, Americans have turned in 188 tons of unused or expired drugs at various sites across the country. 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.