Treating prescription drug addiction
Ongoing or regular abuse of addictive prescription drugs can result in the development of a dependence upon that substance. More than just the physical dependence that can occur naturally through normal use of a prescribed substance, a prescription drug addiction can cause a number of negative changes to occur in the person’s life, including interpersonal problems, financial struggle, mental health issues, physical ailments, and a higher risk of death caused by overdose or accident under the influence. If the person is unable to stop on his own, treatment is recommended.
Prescription drug abuse is defined as any use of a drug available only by prescription that varies from the use instructions provided by the prescribing physician. Behaviors that are described as abuse of prescription drugs include:
- Using a prescription medication that was actually prescribed to someone else
- Using a prescription drug for the express purpose of getting high
- Taking a larger dose than prescribed or taking more doses than prescribed within a 24-hour period
- Crushing an extended-release pill and swallowing it
- Crushing any pill and snorting the resulting powder or dissolving the powder in water and injecting it
- Combining the use of the prescription drug with other substances including alcohol, marijuana, or other prescription medications in an effort to amplify its effect
- Depressants: When on high on depressants, users often feel less anxiety, a sense of sedation and/or feelings of well-being, and fewer inhibitions than when sober. They also experience a lesser ability to concentrate, confusion, diminished memory, and lack of coordination. Barbiturates like Nembutal and Phenobarbital, benzodiazepines like Valium and Xanax, and sleep medications like Ambien and Lunesta fall into this category.
- Opiate painkillers: Painkillers not only provide users with pain relief, but also with a euphoric high as well as sedation. Additionally, users experience confusion, intense sweating, weakness, dizziness, nausea, and more. Painkillers include OxyContin, Demerol, Percocet, Vicodin, and others.
- Stimulants: Increased focus, increased mental and physical energy, plus a euphoric high characterize the use of stimulant drugs. Amphetamines (e.g., Dexadrine, Adderall) and methamphetamine (e.g., Concerta, Ritalin) are classified as stimulants.
- Someone takes an addictive medication that is left over from someone else’s prescription in order to self-medicate a physical ailment like a headache
- A patient living with mental health issues attempts to treat his own symptoms by taking painkillers or benzos
- A person with heavy deadlines or expectations placed upon them (e.g., a student or young professional) takes stimulants to help her focus or accomplish a great amount of work in a short period of time without the need for sleep
- Someone with a prescription for an addictive medication feels that the prescribed dose is not working and takes more than prescribed or uses other drugs or alcohol to increase the effect
- Physical ailments: Depending upon the drug of choice, the physical results of long-term use may vary. For example, those who abuse prescription stimulants may experience heart problems including cardiovascular failure. No matter what the drug of choice, however, it can be particularly taxing on the person’s liver and/or kidneys to process large doses of prescription medications. Especially when the opiate drug is combined with acetaminophen, liver damage, liver disease, and/or liver failure may be more likely to develop. Additionally, if a woman is pregnant, large doses can contribute to miscarriage, low birth weight or premature birth, addiction in the baby, developmental problems, and learning or behavioral difficulties later in life.
- Complications of underlying mental health issues: Again, the type of prescription drug abused may impact the development of certain mental health issues. For example, abuse of stimulants can increase levels of anxiety, paranoia, hostile and/or erratic behavior, and psychosis. If an underlying mental health disorder is a part of a person’s experience, ongoing use of prescription medications can worsen the symptoms experienced and/or increase the number of episodes.
- Addiction: Ongoing and regular use of an addictive medication can very often lead to addiction, and addiction is a life-threatening disease. No part of a person’s life goes unharmed by addiction: relationships suffer, financial stability disintegrates, career and reputation disappear, and both mental and physical health problems slowly build with every passing day.
- Overdose: The risk of taking too much of the drug of choice or having the “normal” dose overwhelm the system is a daily risk when addiction is an issue and a risk even for those who simply experiment with these medications or use them recreationally. Even “seasoned” drug users will find that their tolerance fluctuates drastically as does the potency of the product they take if they buy any drugs – even pills – on the street. That is, last week’s dose that was sufficient to provide a high may be a deadly dose this week. Additionally, the risk of inadvertently taking too many pills, or experiencing overwhelming effects when the pills are mixed with alcohol, is a risk with addictive use of prescription medications as well.
- Medical emergency or death due to accident: Just as prescription drug abuse can overwhelm the body and cause overdose, it can also cause a range of potentially deadly medical emergencies or an accident that results in medical emergency or death. Operating a vehicle while under the influence of prescription medication is not recommended; neither is caring for small children or elderly dependents when abusing drugs and/or alcohol. Too often, devastating mistakes can result in the hospitalization or death of the user or someone else.
- Side effects: The combination of substances can sometimes add up to uncomfortable physical symptoms, including nausea and vomiting, lack of coordination, headaches, and more.
- Medical emergency: Some medications in combination with alcohol or other drugs can make it difficult to breathe, cause internal bleeding, or trigger a cardiac event.
- Rendering ineffective: Prescription medications are prescribed to help treat an ongoing or underlying condition, and the use of other drugs or alcohol can, in some cases, render these medications ineffective or even harmful and toxic to the body.
It’s difficult to gauge what exactly will happen when combining multiple drugs and/or alcohol at once; because it can be so damaging to the body, it is recommended to avoid doing so at all costs. Patients who are prescribed multiple medications, especially if they get prescriptions from more than one doctor, are encouraged to double-check the list of what they are taking with their pharmacist.
- The drug the person is taking
- Other drugs being taken
- Body weight
- Underlying medical conditions
As a rule, extended-release versions of prescription painkillers, for example, are generally prescribed so that the new pill does not overlap with the last pill. Thus, if the patient is told to take an extended-release pill once each morning then it is expected that, for the most part, the last pill has been processed out of her system. Depending upon the factors listed above, however, the last pill may or may not be completely out of the person’s system by the time she takes the next pill. For this reason, it is important to check with the doctor to determine whether or not it is appropriate to take a medication late if a dose is missed or if it is better to wait until the next usual dosing time.
- Medical detox to address withdrawal symptoms
- Co-occurring treatment for underlying mental health disorders or symptoms
- A personalized treatment plan for the recovering individual that includes a range of traditional, alternative, and holistic therapy options
- Family support and education
- Aftercare support and care
If you fear that your loved ones will reject or judge you, consider inviting them to a session with a substance abuse counselor or a 12-step meeting. Educating your loved ones about the realities of addiction may make them more receptive and supportive. Having the support of professionals and peers will also help you stick with your convictions about recovery.
- Drug detox. Detox, short for “detoxification,” is the first phase in most drug treatment programs. During the detox phase, the addict is monitored by clinical personnel while he or she goes through withdrawal from drugs. Medications, nutritional supplementation, and fluid replacement may be provided to relieve withdrawal symptoms. At the same time, counseling is provided to encourage the patient to move forward to the next phase of rehabilitation.
- Substance abuse therapy. Therapy is one of the cornerstones of addiction treatment. Individual, group, and family therapy help the addict and his or her loved ones understand the nature and causes of addiction. Therapy teaches the addict the coping strategies and life skills that she or he needs to live a productive, sober life in the community. For individuals with a co-occurring mental illness, intensive psychotherapy can also address psychiatric symptoms.
- Addiction medications. If used properly under a professional’s care, anti-addiction medication can be one of the most powerful recovery tools for an individual struggling with drug abuse. These medications can help reduce withdrawal symptoms, make cravings more manageable, and reduce the urge to start using again.
- Inpatient treatment. Inpatient or residential treatment provides intensive therapy, 24-hour monitoring, and a full spectrum of rehab services for patients who need structure and supervision in the early stage of recovery. Inpatient facilities include hospitals, mental health facilities, and residential treatment centers. Patients live full-time at the center so they can focus exclusively on the healing process without the stressors or distractions of everyday life.
- Outpatient treatment. Outpatient therapy is ideal for those who have completed a residential treatment program. Via consistent meetings with a therapist on a regular basis, recovering addicts can maintain the gains they’ve made in residential care. For addicts who suffer from less severe or short-term addictions, outpatient treatment may be sufficient care in place of inpatient rehab. If an addict is opting for outpatient treatment from the start, it’s important that they have a strong support system at home.
Listed below are three medications that have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of drug addiction:
- Methadone is a synthetic opioid that has been prescribed since the 1960s as a form of treatment for heroin addiction. When taken in small, controlled doses, methadone allows heroin addicts to withdraw gradually and to maintain a drug-free life.
- In 2002, the FDA approved buprenorphine for the treatment of opioid addiction. Buprenorphine is a semi-synthetic opioid that is prescribed to help addicts manage their cravings and reduce the need for opiates. Buprenorphine is sold under a number of brand names, including Suboxone, Butrans, and Buprenex.
- Naltrexone was approved by the FDA in 1994 for the treatment of alcoholism; however, it is currently prescribed for the treatment of opioid addiction. Sold in oral or injectable forms (ReVia and Vivitrol), naltrexone can help block the effects of opioids on the brain, making it less pleasurable to use these powerful drugs. Naltrexone is prescribed for opiate users who have been through the withdrawal phase and who are motivated to stick to a recovery program.
Other medications are prescribed to help manage the pain, muscle spasms, nausea, and anxiety of drug withdrawal. When they are used as part of a comprehensive recovery plan, these medications can make withdrawal more tolerable, increasing the chances that the patient will progress to the next stage of recovery.
Addiction is a chronic disease, and relapse is one of its major symptoms. It’s important for a recovering addict to realize that relapse is the rule rather than the exception. Relapse prevention therapy can help addicts learn how to avoid lapses, or how to minimize the severity of a relapse if they do slip. The sooner you seek help after a relapse, the sooner you’ll get back on track with your recovery program.
Recovery rates are higher for patients who have access to aftercare support after they are discharged from treatment. Aftercare services include case management, alumni groups, community referrals, counseling services, sober housing, medication management, and more. These services provide a source of stability and support for recovering addicts during the vulnerable transitional period from drug treatment back to the community.
A longitudinal study of drug-dependent individuals who participated in a six-month aftercare program showed that participants were less likely to relapse into drug or alcohol use. This study, published in Addictive Behaviors, indicates that the support, information, and coping strategies gained from aftercare play a big part in the success of a recovery program.
Treatment statistics and research
- The 2010 National Survey on Drug Use and Health (NSDUH) determined that about 2.4 million Americans had used a prescription medication non-medically within the year prior to the survey – an average of 6,600 new users every day. More than 50 percent of these new users were female, and about 33 percent were between the ages of 12 and 17.
- More males than females abuse prescription drugs in every age group except the 12-17 group.
- The Drug Abuse Warning Network (DAWN) observes emergency room visits in different parts of the country, and they found that about 1 million ER trips in 2009 were related to prescription drug abuse. About 343,000 of these visits were caused by the use of prescription painkillers, more than twice the rate reported five years earlier. Similarly, the rate of ER visits caused by stimulant medications was twice as high at 22,000 visits, and the number of ER trips for depressants was also twice as high at 363,000. More than half of all these emergency room visits involved the use of more than one drug.
- According to a report from the Substance Abuse and Mental Health Services Administration (SAMHSA), people between the ages of 12 and 49 who used prescription painkillers non-medically were 19 times more likely to initiate heroin use than their peers who did not use painkillers. Additionally, about 80 percent of new heroin users reported non-medical use of prescription pain relievers.
- The Centers for Disease Control (CDC) reports that about 15,000 Americans die due to painkiller overdose every year. They also report that in 2010, about 1 in 20 people over the age of 12 in the US reported past year non-medical use of prescription painkillers, and that enough prescription painkillers were prescribed in 2010 to keep every American medicated 24 hours a day for a month.
- The National Institute on Drug Abuse (NIDA) found that teen prescription drug abuse is not only common but also reckless. They found that about one out of eight high school seniors reported non-medical use of prescription painkillers between 2002 and 2006, and 70 percent of that number combined their use of prescription drugs with other illicit drugs including marijuana (58.5 percent), alcohol (52.1 percent), cocaine (10.6 percent), tranquilizers (10.3 percent), and amphetamines (9.5 percent). Additionally, teens who reported abusing prescription drugs were eight times more likely to report abusing marijuana and four times more likely to report having been drunk more than 10 times.
Prescribing physicians and pharmacists are in a unique position to identify signs of prescription drug abuse and addiction in patients. With access to a statewide drug database, they can check in and see if patients are getting multiple addictive prescriptions from different doctors or altering their prescription to get larger amounts or quantities of pills.
Therapy treatment options
The therapies and treatment options that will best serve a person attempting recovery from prescription drug dependence will vary from person to person. Some factors taken into consideration by a therapeutic team when creating a unique treatment plan designed to help the individual to not only overcome drug dependence but also to thrive in recovery include:
- Drug of choice and the amount of the dose at the time of detox
- Co-occurring mental health disorders that also require treatment
- Underlying medical issues or injury
- Co-occurring learning or behavioral disorders
- Personal goals for early recovery and beyond
- Family situation
- Personal challenges
- Legal matters and obligations
There are a number of evidence-based treatment options for helping someone to overcome prescription drug addiction, and depending upon the factors above, any combination of the following may be appropriate:
- Medicated detox: For those living with opiate dependence, treatment using a medication like buprenorphine or methadone will help them to stop taking their pill of choice immediately and begin a slow and controlled step-down process that will allow them to avoid the bulk of withdrawal symptoms that usually accompany opiate detox.
- Medical detox: For opiate addicts who do not utilize a medicated detox and for benzodiazepine addicts for whom there is no such option, a medical detox can connect them with the medical care and treatment they need to manage the first weeks of recovery without their drug of choice. Stimulant addicts rarely require medical detox unless there are other issues present; however, medical stabilization may be required if psychosis is initially an issue.
- Personal therapy: Meeting regularly with a therapist will enable the individual to periodically assess his progress in each treatment chosen and provide him with the opportunity to potentially change direction or try something new as he accomplishes his goals. Additionally, the private nature of individual therapy allows the individual the safety to begin the work of treatment for underlying trauma and/or other challenges in recovery as they arise.
- Group therapy: Meeting regularly with peers to discuss a recovery topic, to tackle a common challenge facing everyone in the group, or to learn more about addiction and treatment allows individuals to grow in recovery while also connecting with others socially and building a support system.
- 12-step meetings: These meetings offer peer support, guidance, and a forum to discuss current issues, making them excellent sources of healing for patients. Connecting with others in a safe space can aid individuals in learning how to communicate with one other in a way that is healthy and positive. Additionally, there is great benefit not only from learning from the mistakes and successes of others as they share but also in having the opportunity to give back and help others in the same way.
- Relapse prevention: Identifying potential triggers for relapse and creating an actionable plan to implement when faced with those triggers put recovering individuals in the power position, making it clear that they are no longer victims of addiction.
- Holistic therapies: A range of therapies exist to support those in recovery in improving their mental health and physical wellness while also connecting with others in a positive way and decreasing their overall levels of stress. Some examples include acupuncture, massage and bodywork, acupressure, aromatherapy, yoga, meditation, and tai chi.
- Alternative therapies: A number of non-traditional therapies may help individuals to experience a “breakthrough” and make connections psychologically that are difficult to verbalize. These include art therapy, outdoor and adventure therapy, and equine-assisted therapy, among others. Additionally, many alternative therapies help individuals to address concrete issues in their lives that will help them to find sober life easier to navigate. Some examples include nutritional counseling, job skills training, parenting classes, and life coaching.
- Aftercare support: Though it is critical to undergo a comprehensive medical detox and therapeutic program in order to stabilize in recovery, few addicts will remain clean and sober for the long-term without ongoing therapeutic and peer support. An aftercare plan should begin before an individual leaves treatment and include as many therapeutic options as time and finances will allow as the person begins the work of rebuilding a life without drugs.
It’s important to note that those who are living with a mental health disorder as well as a substance abuse disorder must get treatment for both issues simultaneously. Both treatment plans should be comprehensive and provide the medication, therapeutic support, and aftercare necessary to manage symptoms for the long-term. Without comprehensive mental health treatment, few people will be able to remain drug-free for long.
If you believe that your loved one is living with prescription drug dependence, early intervention and treatment are recommended. The sooner your loved one stops abusing prescription drugs, the sooner he can avoid the risk of overdose and/or deadly accident as well as the host of complications that come with ongoing drug abuse.
Learn more about the comprehensive addiction treatment programs that we offer here at The Recovery Village today. Contact us at the phone number listed above now for more information.