Paul

Paul* is a 29 year old advertising executive who was first prescribed medication for a relatively minor neck injury caused by a car accident. While hospitalized he was first treated with morphine and then was switched to Percocet. He left the hospital with a prescription for a week’s supply of pills.

The pills took away Paul’s pain. They made him feel calm and a little distant from his emotional pain, as well. Paul welcomed the relief from the emotional pain he was going through following the break-up of a serious relationship. It seemed to him the pills made him feel less lonely and needy. In addition, he found that the pills allowed him to feel more confident at work; he got more done, felt less stressed, and believed he functioned better.

Paul was upset when he finished his prescription. He called his doctor, telling her that he was still in pain. She prescribed more Percocet. She also let him know that if the pain continued any longer, she would prescribe Motrin. Paul felt elated that he could get more pills for now but also. decided he would stop taking them after this latest prescription was finished.

Two months later, Paul had to have oral surgery. All he could think about was how he’d now be able to get more Percocet. He found himself looking forward to, rather than dreading the surgery. After this newest prescription ran out, he began to devise aches and pains that would lead to more pills and was able to con several emergency room doctors into giving him further prescriptions.

Paul began to notice that the pills did not have quite the same effect. The initial euphoria he once felt was gone. He took more. He kept trying to “chase” that first high, but could not achieve it again.

A friend turned him on to Oxycontin. He loved the feeling the pills gave him and began to buy them from his friend. He no longer missed his ex so much. The pills made his emotional pain tolerable and filled the empty feeling he had inside.

Soon, he began to screw up at work. He was missing deadlines and no longer competed for the most prestigious and high-paying ads. Paul began to sink into a depression. His self-esteem plummeted because of his growing need for the drug and the extremes to which he would go to get it. He didn’t want to think about how his life was beginning to fall apart. He could not tolerate the negative feelings he was having. He began chewing the pills so he’d feel their effect sooner.

Paul sank further into a depression and believed that the only thing that made him feel better was to take more pills. His friend expressed concern that Paul was becoming too dependent on Oxycontin. He pointed out that the pills seemed to make Paul more depressed. He told Paul that he felt very uncomfortable supplying him with any more pills. Sensing that Paul needed help, he suggested going to an NA or AA meeting. Paul was angry that his connection to Oxycontin was going to be cut off. He thought his friend was overreacting. He was just using pills, not something dangerous like heroin or cocaine.

Paul realized, however, that he didn’t feel he could function without his pills. It was the only thing in his life he felt he could depend on. He began to chew them by the handful. One morning he woke up in a stranger’s apartment not knowing how he’d gotten there. He couldn’t remember anything. He called his friend who said he must have had a blackout and that he needed to get off the pills before he self-destructed any further. Paul finally agreed and went into an inpatient detox and rehab program.

He began to get in touch with the empty void the pills filled up. He felt a great deal of shame about becoming addicted to them. He also felt a great deal of remorse about the behaviors he engaged in to feed his addiction.

Shame and Guilt

Both shame and guilt are feelings that are very common to the experience of addiction. No one wants to be a drug addict. There is tremendous shame in having your life ruled by a vial of pills. There may also be a tremendous amount of shame and guilt about the type of behaviors you can become capable of engaging in to get drugs. The way one behaves on pills--falling down, slurring one’s words, blackouts--are all shameful experiences.

A person whose become addicted to prescription drugs may feel guilty about the way they have treated others, particularly those closest to them. There’s a great deal of guilt associated with lying and betraying the people they love.

Neither shame or guilt is conducive to getting the help that is needed. In fact, these feelings can be quite destructive. Shame can prevent you from getting treatment. Guilt can lead to all kinds of self-destructive behaviors that will interfere with sobriety. Bottom line: shame and guilt lower self-esteem and foster self-hatred.

Getting Help

There are many treatment facilities located throughout the country. Many insurance plans cover inpatient detox. Some insurance companies will pay for a week, maybe two. Some may pay for rehab as well. It’s important to get help and not to try to get off pills on your own. Some people may feel that they can’t afford to take a week or two out of their lives to spend in a treatment facility, detoxing. The demands of children, a job, school, or other responsibilities may make inpatient treatment seem like a luxury. It is not. It is unquestionably better to leave the routine responsibilities of your life for a week than it is to suffer the inevitable outcome of prolonged drug addiction.

Withdrawal

When an individual becomes physically dependent on painkillers or benzodiazepines, they should not just suddenly stop taking them. Stopping suddenly can cause seizures and possibly even death. The risk of a seizure is actually quite high. Dependency might be dealt with by tapering off the medication. Some people have been successful using this approach. Addicts have often found tapering to be unsuccessful because their addiction is both physical as well as psychological. If tapering is done inpatient, it has more of a chance of success.

Withdrawal symptoms can be, and often are, difficult. Benzodiazepines, for example, are stored in the tissues and fat cells. Getting the drug out of your bloodstream can take a long time. Drugs that go through the digestive tract are more quickly excreted.

Even when someone detoxes inpatient, the symptoms often feel unbearable. While the acute withdrawal symptoms generally last a couple of weeks, the prolonged withdrawal, called Post Acute Withdrawal Syndrome (PAWS) lingers. These symptoms have been known to last a year or longer.

In addition, the person who suffers from chronic pain may initially be in more pain than they were before they began to take painkillers. Painkillers and benzodiazapines repress the body’s natural production of dopamine and endorphins (the “pleasure center of the brain”) and take over their function. After the drug is detoxed, it takes some time before the body’s natural pain receptors “wake up” and begin to function normally again.

What other options does someone who suffers from chronic pain have? After becoming drug-free, this issue still needs to be addressed. Some people believe that they can never take prescription narcotics again and need to remain abstinent for life. Other methods of pain relief like meditation, breathing exercises, yoga, or biofeedback may provide some relief. For recovering addicts who need to be on narcotic painkillers, having someone else responsible for the medication may be a good idea.

Who's at Risk?

The elderly are particularly at risk; misuse of prescription medications may be the most common form of drug abuse among the elderly. According to the National Clearinghouse for Alcohol and Drug Information, as many as 17% of adults 60 and over abuse prescription drugs. While elderly people comprise just 13% of the population, this age group represents as much as 30% of the number of prescription drug abusers.

There is less likelihood that an elderly person will comply with the directions on the prescription bottle. There may be confusion regarding the dose or the frequency with which to take the medication, or difficulty reading the small print. Unintentional misuse can lead to addiction. Compounding this problem, many health care workers may prescribe an addictive substance to an elderly person more than they might to someone younger.

Another at-risk segment of the population is women. One reason is simply that women are more likely to go to the doctor when they are feeling anxious or in pain. Both women and men abuse prescription drugs at approximately the same rate, however, women are twice as likely to become addicted as men. Specifically, females between the ages of 12 to17 and 18 to 25 have shown the largest increase of prescription drug abuse over the past two decades (NIDA). In addition, young girls aged 12 to 14 report that painkillers and tranquilizers are one of the most popular drugs used to get high.

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