William C. Moyers
Beyond Addiction by William C. Moyers
Improving our understanding of alcohol and drug addiction
Help That Hinders
It's one of the sharpest contrasts of active addiction, when somebody under the influence cannot pull off the easiest of tasks and it's obvious to everyone. Or nobody sees what's happening because that person is deft at conniving, scheming or outmaneuvering the world on the way to another drink or drug.
This week, it's the experiences of the latter I find noteworthy.
The other day, I sat in on a session with drug addicts trying to stay clean, most of them hooked on the meds they got legally and, at least at the start, legitimately from doctors and dentists and therapists. Opiates for chronic old-age aches or acute post-surgery pain, benzodiazepines for mental health problems such as anxiety and sleep disorders, and even a medical marijuana-dependent breast cancer survivor who kept smoking the stuff long after she was declared cancer-free. (Yes, advocates of legalization, marijuana can be addictive to some users, no matter what you argue.)
Addiction was their common denominator. But here are other factors they share, in their own words:
"The doctor never told me hydrocodone is addictive." Sure, the warning label is explicit, but tiny print never resonates like a face-to-face conversation between doctor and patient.
"The pharmacist asked, 'Do you have any questions?' But what's there to ask? I figure that if the doctor prescribes it, then it must be safe. Besides, the side effects couldn't possibly be so bad as the pain I wanted to get rid of." Real pain is like real love; it can be blinding.
"I never imagined a new hip would lead me to rehab five months later."
Still, ignorance is not bliss any more than it is an excuse. In this group, everybody agreed that at some point, they had come to a realization that their pain had faded or their mental health issue was no more. Yet they continued to chase the effect to satisfy the craving for more.
"It reached a point where I had to have it because, well, I just couldn't imagine not having it. That's how good I felt under the influence."
"More and more, twice and then four times and even six times the prescribed doses, to get higher and higher, and I knew I'd built up a tolerance to the point I'd actually go into withdrawal after only a few days without the meds."
"One day, I read a story in the newspaper about the so-called opiate epidemic, and that's when it hit me.
"Wow, that's me. I'm a drug addict.'"
And this, from the woman who used medically prescribed marijuana to mitigate the effects of chemotherapy and radiation: "I survived cancer, only to become an addict."
So how did the people in this group keep feeding their addiction? By going back to the source, the doctors and nurse practitioners and psychologists (in some states, they can prescribe these drugs, too) trained to help heal but whose involvement was now only a hindrance because they were too busy to notice or were ignorant or pretended not to know that their patients were manipulating them and the truth as addicts learn to do and do so well.
"My dentist was on the cover of the annual Best Of magazine in 2013. That's how good she is. She has a reputation for happy patients. Pain makes patients unhappy. When I told her I was still hurting (two months after a pulled tooth and root canal), she kept me happy."
"The surgeon put in my new hip and was on to the next patient and the next patient after that and didn't have the time to pay attention every time I called his office complaining that it still hurt. He always just called in a refill."
"In my state, there's a prescription-monitoring database that docs can tap into to check how often and where I'm getting my meds filled. Ultimately, I was doctor shopping to get what I needed. Nobody was looking at my file; otherwise, someone would have figured it out."
Among the dozen or so addicts in this group, not one ended up in treatment because a doctor or dentist finally said no to more prescriptions. Not one hit bottom, either, as the result of a crime, a lost job or financial ruin. Nearly all of them managed to "function" under the influence, in some instances for years in the grips of their prescription medications. It was only when family members took notice and took action that the charades ceased and help ensued. "My mom said I stopped being the son she knew the day I broke my leg," said one patient. "It took her a while to connect the broken leg to the meds to the junkie I'd turned into."
Medical schools don't teach their students much about the symptoms of addiction. Perhaps families will.
August 23, 2014