Family Issues #6

From a drug rehab website, I learned    

• “dinosaur” is someone in his 40’s or 50’s who uses heroin   
• “criss-crossing” is setting up a line of heroin next to a line of cocaine and, through a straw in each nostril, snorting half of each line, then switching and snorting the other half lines
• “goat” is heroin
• “white mosquito” is cocaine

Very creative language, but what does that have to do with family issues and pain??  Well, today’s topic is, Are you worried your loved one will get addicted to medication?

On Fridays, I’ve been having a series of posts about family issues and your pain. Pain conditions affect not only you, but also your family… your husband or wife… your children… your Mom and Dad… even your friends.

These posts are excerpts from a handout for family members (and friends) of patients with pain that I’ve written with a colleague, Dr. David Kannerstein, who is the lead author.  These excerpts are reprinted with permission from Practical Pain Management, 2007, Vol 7, 48-52.  We’ve written this handout to provide information for family members and to help them with what they’re going through.

You’re invited to copy these posts and discuss them with your loved ones.  If you’d like a copy of the complete handout, information is available at the end of today’s post.

Many patients with pain as well as their families worry about addiction to medication.  Much, although not all, of this concern is the result of confusion about the meaning of terms like “addiction,” “dependency,” and “tolerance.”  The American Pain Society defines these terms as:

• Addiction is a disease, with genetic, psychological, social, and environmental factors influencing its development and symptoms.  It consists of behaviors such as poor control over drug use, compulsive use, continued use despite harm, and craving.
• Physical Dependence is when the body gets used to a certain medication or drug, and withdrawal symptoms occur when the drug is stopped or decreased in dose.
• Tolerance means that the body gets less effect from a certain dose of a medication or drug, or needs a higher dosage to get the same effect.

In other words, addiction always involves abuse of a substance.  Physical dependence and tolerance do not.  If your loved one uses narcotics or benzodiazepines (e.g. Ativan or Klonopin) regularly, they may become physically dependent and may develop tolerance for them.  By themselves, these aren’t signs of addiction.

If your loved one is not abusing the medication, notice whether or not the medication is improving his functioning.  Can he do more?  Is her mood better?  And is his pain less?  These are signs of appropriate use of medication.

Patients who are not getting adequate relief may complain and ask for more medication – this may look like the behavior of an addict.  However, this is called “pseudo-addiction.”  So how can you tell real addiction?  Does your loved one, to get more medicaiton than is prescribed:

• repeatedly says she’s lost prescriptions
• get the same medication prescribed by different doctors
• get prescriptions filled at different pharmacies
• get medication off the streets

These may be signs of addiction and need to be discussed with the doctor.

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Next Friday… Family Issues #7: What Helps in Addition to Medication?

You’re welcome to copy this handout from this site, with a notation that it’s from www.howtocopewithpain.org.  For a copy of the complete handout, you can contact my co-author Dr. David Kannerstein at dkanner@comcast.net.  David Kannerstein is a psychologist in private practice with Margolis Berman Byrne Health Psychology in Philadelphia and SRI Psychological Services in Jenkintown, PA.  He specializes in helping individuals and their families manage chronic pain.