Recovery from alcoholism and other drug addiction often calls for breaking through layers of denial and shame. But people who face the task of recovery along with a diagnosis of cancer deal with an immediate threat to their sobriety.

"When people hear the word ‘cancer,' there's kind of an assumption that it's a death sentence," says Dr. Marvin Seppala, chief medical officer for the Hazelden Foundation. "That's not the case, since so many cancers are treatable nowadays. Yet there's still a chance that people in the midst of addiction treatment might say to themselves: ‘Why bother to get clean and sober? I'm not going to go through with it because I've got cancer.' "

Studies suggest that rates of substance abuse in people with cancer are lower than in the general population. However, these figures are difficult to interpret. They could simply mean that people in cancer treatment routinely hide their problems with alcohol and other drugs.

Secrecy is just one problem. "If you're in the midst of an active addiction, you'll also be undermining any kind of healing process related to cancer," Seppala says. "And there's always the question of whether some of the addictive drugs will interfere with medications used to treat cancer."

In addition, a record of substance abuse can strain the human relationships that underlie cancer treatment. If doctors and nurses suspect that their cancer patients are lying about drug use, they may doubt anything that these patients say about their health.

People with cancer might sense this mistrust, doubt the goodwill of their health care team, and decide not to follow through with their cancer treatments. When this happens, prescriptions go unfilled, medical appointments are missed, and people with cancer can get sicker or die earlier.

A report on substance abuse issues from the National Cancer Institute underscores these problems. It also suggests ways to help people face cancer and abstain from alcohol and illicit drugs at the same time:

Gather facts without judgment. When taking a health history, doctors and nurses sometimes avoid questions about alcohol and other drug use. They may feel awkward about raising the issue, or simply assume that they'll never get honest answers. This assumption undermines cancer treatment. When health professionals ask about drug use with a non-judgmental attitude, people with cancer are more likely to speak candidly.

Involve a multidisciplinary health care team. Treatment for people with cancer and addiction should involve specialists in mental health and addiction medicine. Many people with a history of substance abuse--including those with cancer--also struggle with anxiety, depression, or personality disorders.

Treat pain with an accurate understanding of addiction. People can become physically dependent on opioid drugs such as codeine and oxycodone (OxyContin) that are used to treat cancer pain. This means that withdrawal symptoms will occur if the drugs are suddenly stopped. In this context, however, physical dependence and addiction are not the same. Addiction refers to the compulsive use of drugs for reasons other than pain control. Careful treatment planning can relieve withdrawal without triggering such use.

Current treatments also offer many options for treating cancer pain without drugs. Examples are acupuncture, acupressure, biofeedback, chiropractic treatment, osteopathic medicine, massage therapy, and meditation.

Set realistic treatment goals. There's a saying among members of Alcoholics Anonymous: "Getting clean and sober is simple--just change everything about your life and do it now." This slogan reminds us that recovery from addiction requires a transformation in thinking and behavior, which calls for decades of sustained effort. The risk of relapse is high, especially with the added stress of a cancer diagnosis.

Cancer specialists need to be realistic about this fact. Treatment planning for people in recovery should set up a structure for preventing relapse--and dealing with it openly if it does occur.

For more on this topic, visit the National Cancer Institute Web site at http://www.cancer.gov/ and click on "Cancer Topics" and "Coping with Cancer."

--Published January 9, 2006