HealthScouter Drug Addiction Patient Advocate
HealthScouter.com - Equity Press
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Purchasing this book entitles you to free updates at www.healthscouter.com/Addiction
Edited By: Katrina Robinson
Includes Addiction from Wikipedia http://en.wikipedia.org/wiki/Addiction
HealthScouter Drug Addiction: Drug Addiction Treatment and Signs of Addiction (HealthScouter Drug Addiction)
ISBN: 978-1-60332-106-3
Smashwords Edition
Edited Components are Copyright (c) 2009 Equity Press
Permission is granted to copy, distribute and/or modify this document under the terms of the GNU Free Documentation License, Version 1.2 or any later version published by the Free Software Foundation; with no Invariant Sections, no Front-Cover Texts, and no Back-Cover Texts. A copy of the license is included in the section entitled "GNU Free Documentation License".
HealthScouter and Equity Press do not provide medical advice. The contents of this book are for informational purposes only and are not intended to substitute for professional medical advice, diagnosis or treatment. Always seek advice from a qualified physician or health care professional about any medical concern, and do not disregard professional medical advice because of anything you may read in this book or on a HealthScouter web site. The views of individuals quoted in this book are not necessarily those of HealthScouter or Equity Press.
Equity Press does not endorse any company or product, and listing on the HealthScouter web site is not linked to corporate sponsorship. We do not make a claim to being comprehensive or up to date. If you would like to recommend information to include in this book, please contact us – we would be very happy to hear from you.
Addiction and drug control legislation
The physiological basis of drug addiction
Individual mechanisms of effect
Theories about causes for epidemic outbreak of addiction
GNU Free Documentation License
References - Addiction Recovery Groups
Dear Reader,
I like to think of myself as a polite, well-reasoned person. I rarely speak out or complain. When a waitress spills something on me, or if my meal is cold—or if I’m overcharged—I generally try to be as polite as possible. I don’t like to make very many waves. I often secretly hope that the manager will hear about my predicament and come out and offer me a free meal, or something similar. I generally hope that my polite and respectful demeanor pays off. And it does happen from time to time. You know, I think many people are brought up to believe that this is just ood manners. It’s how you’re supposed to behave. And if you knew me personally, I think you’d agree that I’m generally pretty reserved. Of course my wife may raise an objection or two (!), but I really believe that it’s important to treat others as you would like to be treated. We’re talking about the golden rule here—it works well and it applies to almost every life circumstance. But I have to admit that when it comes to my health, or the health of someone I care about—all bets are off. I want to know what’s going on—when, why, where, and how. And I make these feelings known. I tend to get downright assertive. It’s just something I feel very strongly about. And I feel that when you are in a hospital, or if you’re brushing up against the healthcare system, that you should feel the same way. It’s unfamiliar turf, and the professionals who work in this system often take advantage of their positions. They may use some jargon to hide the whole truth— or they may say something without checking to make sure you understand completely. They may present the options that are best for them, perhaps the most profitable or convenient. Now I’m not saying this goes on everywhere. There are many professionals in the business of health who go out of their way to make sure you have the best care. And I’m not suggesting that you should become a bully, or purposefully
annoying—absolutely not. But I am suggesting that I think it’s OK for you to step outside of your typicalcomfort zone, and put on your patient advocate hat.Because you, the patient or patient advocate, care the most about your care—not the medical system or healthcare providers.
HealthScouter was created to help patients become better advocates for their own medical care. Because when it comes to your healthcare, the stakes are high. There are none higher. And healthcare is one area where consumers (us, the sick people) are notoriously unaware of their options. And that’s why I’m publishing these books. To help you understand your options, and to help you get the best care possible. I want to help you become a better advocate for yourself and for your loved ones.
It’s my sincere hope that you can take this book with you to the hospital, to be read in the waiting room or by the bedside—and when you see a relevant patient comment you can use this book to ask questions of your health care providers. My advice: Ask lots of questions! Providers are busy people who generally go about their business with little questioning, delivering care as they see fit—making quick decisions—and again, nobody is going to care as much about your health as you. So now, more than ever, you need tools at your disposal to get the best care possible. One of the tools at your disposal is this HealthScouter book and the material within. You need to be armed with questions, and you need to ask questions all of them time. And so the difficult part is now to understand the right questions to ask.
That brings me to an explanation of how these books are structured. HealthScouter books include a number of what we call patient comments. These patient comments are summaries of what people have experienced. They’re first hand accounts of what you may expect. These experiences effectively help you “catch up,” and understand what outcomes are possible. They expose you to the treatments are available, and provide insight as to potential outcomes. They help you understand what other people are doing. So if you find yourself stuck feeling like you’re receiving substandard medical care—or if you need a push to broach the subject, you can take this book to your provider and say, “Hey, I read here that another patient had this treatment—is that an option for me? If not, Why?” I believe that other peoples’ experience is the most valuable way for you to formulate and build a list of good questions for your healthcare providers. That notion is at the core of the HealthScouter philosophy.
So HealthScouter, by providing patient comments about a particular medical condition, will help expose you to what other people have experienced about a particular medical problem. If you know what other people have experienced, you can better understand what your options are. You’ll be better informed and you’ll have some questions to ask—it’ll be like you’ve had access to dozens of other people who have gone through the same thing you’re going through. And so armed, maybe you’ll be able to move through your condition and get back on the road to health, and
maybe you’ll be able to do this with more grace than I have. And that is my sincere wish. It’s also my wish that perhaps when a doctor or nurse sees this little blue book, that they’ll think twice
about the care they’re about to provide—knowing that the owner is a little bit better prepared, a little bit better armed—and yes, maybe even downright assertive.
I hope this book helps.
Yours truly,
Jim Stewart
San Diego, California
The purpose of HealthScouter is to help you understand your medical condition as quickly and easily as possible. We believe this can best be accomplished by reading about other people and their
experiences negotiating their health and care. We try to leave out complicated medical jargon. And we’ve spent a considerable amount of time structuring this book so that it’s easy to use. It’s important to know that this is not the sort of book you read from beginning to end. Of course you may do so, but this book is more meaningful if you flip through quickly and scan for applicable material. Again, it’s all about the patient commentary: The darkly shaded comments indicate one patient initiating a new discussion, and the light or clear comments are other comments associated with that same condition. So you should begin by looking for information from other patients who are experiencing the same aspect of the same medical condition that you studying. You can do this quickly by scanning through the book, focusing on the dark shaded comment boxes.
By scanning the patient comments you’ll find information about various aspects of a condition, all grouped together, in an easy-to-read format. In this way you can immediately begin reading about other patients and their experiences with your particular medical condition – and you can benefit immediately from their experiences.
The term addiction is used in many contexts to describe an obsession, compulsion, or excessive psychological dependence, such as: drug addiction (e.g. alcoholism), video game addiction, crime, money, work addiction, compulsive overeating, problem gambling, computer addiction, nicotine addiction, pornography addiction, etc.
In medical terminology, an addiction is a chronic neurobiological disorder that has genetic, psychosocial, and environmental dimensions and is characterized by one of the following: the continued use of a substance despite its detrimental effects, impaired control over the use of a drug (compulsive behavior), and preoccupation with a drug's use for non-therapeutic purposes (i.e. craving the drug).[1] Addiction is often accompanied by the presence of deviant behaviors (for instance stealing money and forging prescriptions) that are used to obtain a drug.
Tolerance to a drug and physical dependence are not defining characteristics of addiction, although they typically accompany addiction to certain drugs. Tolerance is a pharmacologic phenomenon where the dose of a medication needs to be continually increased in order to maintain its desired effects.[2] For instance, individuals with severe chronic pain taking opiate medications (like morphine) will need to continually increase the dose in order to maintain the drug's analgesic (pain-relieving) effects. Physical dependence is also a pharmacologic property and means that if a certain drug is abruptly discontinued, an individual will experience certain characteristic withdrawal signs and symptoms.[2] Many drugs used for therapeutic purposes produce withdrawal symptoms when abruptly stopped, for instance oral steroids, certain antidepressants, benzodiazepines, and opiates.
However, common usage of the term addiction has spread to include psychological dependence. In this context, the term is used in drug addiction and substance abuse problems, but also refers to behaviors that are not generally recognized by the medical community as problems of addiction, such as compulsive overeating.
The term addiction is also sometimes applied to compulsions that are not substance-related, such as problem gambling and computer addiction. In these kinds of common usages, the term addiction is used to describe a recurring compulsion by an individual to engage in some specific activity, despite harmful consequences, as deemed by the user himself to his or her individual health, mental state or social life.
Patient 1:
My battle with addiction is not new. I have been fighting this demon for five years. My addiction is not illegal, and you can buy it practically anywhere. My addiction is food, or rather certain substances in food that we eat. To me, my addiction is like any other addiction; it comes to steal, kill, and destroy. To me, sugar is like crack cocaine. Once I start eating it I cannot stop...it’s like there is no end to the insanity of stuffing doughnuts and ice cream down. I was sober from my addiction for three months, but then I went to this party and I picked up a piece of cake and ate it. Well, within a week I was full blown into my addiction again and literally drunk on binge food. It was like an alcoholic picking up that drink again.
Patient 2:
Food addiction is a tough one. Unlike all the others (alcohol, pills, coke, heroin) you cannot completely give up food. We all have to eat to live. So in this case, you have to learn how to manage your addiction to live a normal, carefree, happy life. I, too, am in recovery from an eating disorder. Fortunately, through a lot of help and much support, I have learned how to eat normally.
Living with this kind of addiction can be done. Do you have any support there at home? How about any live support from people who are dealing with this addiction?
Patient 1:
I am a married 25-year-old woman with an addiction to pain medication. I have been addicted for about a year and even though my family knows I have to take the pain medication for a valid reason, they have no idea I take it for the high. I have endometriosis that is extremely painful.
About a month ago I was switched from Vicodin to Percocet because I had some other health issues arise. Since then I have discussed with my doctor that I don't want to have to live with pain forever, so he referred me on to a local pain clinic. I am half relieved and half scared out of my mind because I know that more than likely means living pill-free, and it scares me to death. On the other hand, it's a relief because I know I can't keep going on like this.
I am currently waiting for my doctor to call and let me know my prescription is ready for pick up. My body aches. I took my last two pills last night at about 5pm and I am already panicking that he may not have it ready or something may come up. I am sure it will come thru, but I am sure you all know what I feel like right now.
I am up to 10 Percocet a day, and I know this road needs to come to an end. I am so sick of counting pills and going to a pharmacy with my head down. I want my life back. Then, the other side of me is DYING for that phone call letting me know that script is ready for pick up.
Patient 2:
Withdrawals are no picnic, but they don't last forever and you can do it. I am addicted to Vicodin/Lortabs as well. You are not alone. I went for a week or so without the pills and got another prescription yesterday. It’s a cycle that I am just frustrated with.
Not all doctors agree on the exact nature of addiction or dependency [3] however the biopsychosocial model is generally accepted in scientific fields as the most comprehensive theorem for addiction. Historically, addiction has been defined with regard solely to psychoactive substances (for example alcohol, tobacco and other drugs) which cross the blood-brain barrier once ingested, temporarily altering the chemical milieu of the brain. However, "studies on phenomenology, family history, and response to treatment suggest that intermittent explosive disorder, kleptomania, problem gambling, pyromania, and trichotillomania may be related to mood disorders, alcohol and psychoactive substance abuse, and anxiety disorders (especially obsessive–compulsive disorder)."[4] However, such disorders are classified by the American Psychological Association as impulse control disorders and therefore not as addictions.
Many people, both psychology professionals and laypersons, now feel that there should be accommodation made to include psychological dependency on such things as gambling, food, sex, pornography, computers, work, exercise, spiritual obsession (as opposed to religious devotion), cutting and shopping so these behaviors count as 'addictions' as well and cause guilt, shame, fear, hopelessness, failure, rejection, anxiety, or humiliation symptoms associated with, among other medical conditions, depression and epilepsy.[5][6][7][8] Although, the above mentioned are things or tasks which, when used or performed, do not fit into the traditional view of addiction and may be better defined as an obsessive–compulsive disorder, withdrawal symptoms may occur with abatement of such behaviors. It is said by those who adhere to a traditionalist view that these withdrawal-like symptoms are not strictly reflective of an addiction, but rather of a behavioral disorder. However, understanding of neural science, the brain, the nervous system, human behavior, and affective disorders has revealed "the impact of molecular biology in the mechanisms underlying developmental processes and in the pathogenesis of disease".[9] The use of thyroid hormones as an effective adjunct treatment for affective disorders has been studied over the past three decades and has been confirmed repeatedly.[10] Modern research into addiction is generally focused on Dopaminergic pathways. There is great and sometimes heated debate around the definition of addiction with parties falling into two main camps the Disease model of addiction and the behaviorists.
Patient 1:
Can someone please explain dependence versus addiction? Does everyone who takes narcotic pain medications become addicted and need to go to a detoxification center? I have been in so much pain for the past year that I had been going out of my mind (I have Degenerative Disc Disease, two past surgeries, and nerve damage). My pain management doctor told me I need to be taking more pills to manage my pain. I am at the point where I understand that in order to have any quality of life, I need to take more of my prescribed pain medicine. My pain is not going away and I have two young children to take care of. I know my body will become dependent on them at some point, but does that automatically mean I will have to detox and will become an addict?
Patient 2:
I'm no medication expert, but the plain and simple of it is: Opiates/Opioids, by nature, taken on a long-term, consistent basis, will cause physical dependence. If you are taking the amount of medication that your doctor has prescribed (or less) and you are not taking them to achieve a high or euphoric state, then there should be no problem.
Addiction is a state where a person is taking these medications to get high or obtain the energy/euphoria that some narcotics produce, instead of for legitimate pain. Sadly, there are many, even in the medical community, who do not understand the difference. Thus, chronic pain sufferers get a bad reputation. We are too commonly labeled as addicts, when in fact, we are nothing of the sort.
Usually, if a person no longer needs the medications (pain is gone), then weaning off or tapering down of the med is usually necessary. Most people are able to do this at home, with the supervision and instruction of their doctor. In my case, because I am chronic and there is currently no medical way to end my pain, I will be on some form of medication for the rest of my days.
In the United States, physical dependence, abuse of, and withdrawal from drugs and other substances is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR). It does not use the word 'addiction' at all. It has instead a section about Substance dependence:
"Substance dependence…When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse, is considered Substance Use Disorders..."[11]
Terminology has become quite complicated in the field. Pharmacologists continue to speak of addiction from a physiologic standpoint (some call this a physical dependence); psychiatrists refer to the disease state as psychological dependence; most other physicians refer to the disease as addiction. The field of psychiatry is now considering, as they move from DSM-IV to DSM-V, transitioning from "substance dependence" to "addiction" as terminology for the disease state.
The medical community now makes a careful theoretical distinction between physical dependence (characterized by symptoms of withdrawal) and psychological dependence (or simply addiction). Addiction is now narrowly defined as "uncontrolled, compulsive use"; if there is no harm being suffered by, or damage done to, the patient or another party, then clinically it may be considered compulsive, but to the definition of some it is not categorized as 'addiction'. In practice, the two kinds of addiction are not always easy to distinguish. Addictions often have both physical and psychological components.
There is also a lesser known situation called pseudo-addiction.[12] A patient will exhibit drug-seeking behavior reminiscent of psychological addiction, but they tend to have genuine pain or other symptoms that have been under-treated. Unlike true psychological addiction, these behaviors tend to stop when the pain is adequately treated. The obsolete term physical addiction is deprecated, because of its connotations. In modern pain management with opioids physical dependence is nearly universal. While opiates are essential in the treatment of acute pain, the benefit of this class of medication in chronic pain is not well proven. Clearly, there are those who would not function well without opiate treatment; on the other hand, many states are noting significant increases in non-intentional deaths related to opiate use. High-quality, long-term studies are needed to better delineate the risks and benefits of chronic opiate use.
Patient 1:
I saw my addiction doctor yesterday. I am now on 3mg suboxone. He thinks I am on 4 mg. He says that next month, he will put me on 2mg a day, and then it will be reduced to 0mg. He says this is not going to be a problem! I don't think this is going to be as easy as he says! Since I'm on 3mg a day now anyway, does anyone know the best plan for weaning off? After the prescription for 2mg a day, he isn't planning to give me anymore. Should I start weaning down .5mg at a time? If I go down a 1/2 mg, how long should I be on that lesser amount before weaning off another 1/2?
Patient 2:
My advice would definitely be to start slowly cutting back today, and eventually when he cuts you off, you will still have a lot left to keep cutting down and tapering. I was offered the opportunity to get on suboxone because of my heroin addiction, but I know how hard it would be to get off it eventually like you are dealing with. What I did was just took one pill and split in to four pieces, and tapered over four days. It worked like a charm. I am now eight days clean of heroin, and it’s been four days since I’ve taken suboxone, and I feel pretty good.
Patient 3:
You are so right! 2mg is way too high of a dose to jump off of. I know - I've done it. You need to start lowering your dose now (today). If you drop to 2mg today, you shouldn't feel anything. What I did was I would drop 1mg a week and then I went to .5mg a week and then to .5mg every other day for a week and then crumbs every three days for a week and then off. It worked so much better for me this way then trying it at 2 mg. I still had some withdrawal symptoms, but not too bad. Mostly I had a hard time sleeping and some of the hot and cold sweats, but nothing I could not handle.
Physical dependence on a substance is defined by the appearance of characteristic withdrawal symptoms when the substance is suddenly discontinued. Opiates, benzodiazepines, barbiturates and alcohol induce physical dependence. On the other hand, some categories of substances share this property and are still not considered addictive: cortisone, beta blockers and most antidepressants are examples. So, while physical dependency can be a major factor in the psychology of addiction and most often becomes a primary motivator in the continuation of an addiction, the initial primary attribution of an addictive substance is usually its ability to induce pleasure, although with continued use the goal is not so much to induce pleasure as it is to relieve the anxiety caused by the absence of a given addictive substance, causing it to become used compulsively.
Some substances induce physical dependence or physiological tolerance - but not addiction - for example many laxatives, which are not psychoactive; nasal decongestants, which can cause rebound congestion if used for more than a few days in a row; and some antidepressants, most notably venlafaxine, paroxetine and sertraline, as they have quite short half-lives, so stopping them abruptly causes a more rapid change in the neurotransmitter balance in the brain than many other antidepressants. Many non-addictive prescription drugs should not be suddenly stopped, so a doctor should be consulted before abruptly discontinuing them.
The speed with which a given individual becomes addicted to various substances varies with the substance, the frequency of use, the means of ingestion, the intensity of pleasure or euphoria, and the individual's genetic and psychological susceptibility. Some people may exhibit alcoholic tendencies from the moment of first intoxication, while most people can drink socially without ever becoming addicted. Opioid dependent individuals have different responses to even low doses of opioids than the majority of people, although this may be due to a variety of other factors, as opioid use heavily stimulates pleasure-inducing neurotransmitters in the brain. Nonetheless, because of these variations, in addition to the adoption and twin studies that have been well replicated, much of the medical community is satisfied that addiction is in part genetically moderated. That is, one's genetic makeup may regulate how susceptible one is to a substance and how easily one may become psychologically attached to a pleasurable routine.
Eating disorders are complicated pathological mental illnesses and thus are not the same as addictions described in this article. Eating disorders, which some argue are not addictions at all, are driven by a multitude of factors, most of which are highly different than the factors behind addictions described in this article. It has been reported, however, that patients with eating disorders can successfully be treated with the same non-pharmacological protocols used in patients with chemical addiction disorders.[13] Gambling is another potentially addictive behavior with some biological overlap. Conversely gambling urges have emerged with the administration of Mirapex (pramipexole), a dopamine agonist.[14]
Patient 1:
I got clean (off Ultram) back in August 2004 and did excellent. I was diagnosed with Bipolar Disorder and put on Seroquel, Lamictal, Topamax, Clonidine and Wellbutrin for that. Then in January of this year, a combination of two things happened. 1) I had some PAINFUL dental work done where I was offered a prescription for Vicodin and took it. And 2) I came down with the stomach flu, was given Phenergan tablets and told I had a more severe stomach problem and was given Norco and Donnatal Syrup for that. So I have been on 4-5 tabs of Norco a day in addition to my bipolar disorder medications and taking this Donnatal elixir regularly. I feel like a fraud. I feel like I should be stronger and not NEED them. Is this weird?
Patient 2:
There is nothing to be ashamed about if the medications are being taken for the purpose intended.
Psychological dependency is a dependency of the mind, and leads to psychological withdrawal symptoms (such as cravings, irritability, insomnia, depression, anorexia, etc). Addiction can in theory be derived from any rewarding behavior, and is believed to be strongly associated with the dopaminergic system of the brain's reward system (as in the case of cocaine and amphetamines). Some claim that it is a habitual means to avoid undesired activity, but typically it is only so to a clinical level in individuals who have emotional, social, or psychological dysfunctions (psychological addiction is defined as such), replacing normal positive stimuli not otherwise attained.
A person who is physically dependent, but not psychologically dependent can have their dose slowly dropped until they are no longer physically dependent. However, if that person is psychologically dependent, they are still at serious risk for relapse into abuse and subsequent physical dependence.
Psychological dependence does not have to be limited only to substances; even activities and behavioral patterns can be considered addictions, if they become uncontrollable, e.g. problem gambling, Internet addiction, computer addiction, sexual addiction / pornography addiction, overeating, self-injury, compulsive buying, or work addiction.
Patient 1:
I used methamphetamine every day for six years. I’ve been clean now for two years and 16 days. I never went to rehab, just moved away from my home town with my boyfriend and started fresh. However, in the last few months, I’ve been getting flashbacks to all the times I’ve gotten high. Does anyone out there have any similar experiences or know if this goes away with time?
Patient 2:
Remember that these are instances from your past and are not necessarily a precursor to relapsing. Memories are there for you to be able to place things into perspective. Those who totally forget their negative past are doomed to repeat it. The sorrow, deception and other attributes associated with using are key components to keep in mind for those “rainy days”.
Addiction and drug control legislation
Most countries have legislation which brings various drugs and drug-like substances under the control of licensing systems. Typically this legislation covers any or all of the opiates, amphetamines, cannabinoids, cocaine, barbiturates, hallucinogens (tryptamines, LSD, phencyclidine (PCP), psilocybin) and a variety of more modern synthetic drugs, and unlicensed production, supply or possession may be a criminal offense.
Usually, however, drug classification under such legislation is not related simply to addictiveness. The substances covered often have very different addictive properties. Some are highly prone to cause physical dependency, whilst others rarely cause any form of compulsive need whatsoever.
Also, although the legislation may be justifiable on moral grounds to some, it can make addiction or dependency a much more serious issue for the individual. Reliable supplies of a drug become difficult to secure as illegally produced substances may have contaminants. Withdrawal from the substances or associated contaminants can cause additional health issues and the individual becomes vulnerable to both criminal abuse and legal punishment. Criminal elements that can be involved in the profitable trade of such substances can also cause physical harm to users.
Early editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) described addiction as a physical dependency to a substance that resulted in withdrawal symptoms in its absence. Recent editions, including DSM-IV, have moved toward a diagnostic instrument that classifies such conditions as dependency, rather than addiction. The American Society of Addiction Medicine recommends treatment for people with chemical dependency based on patient placement criteria (currently listed in PPC-2), which attempt to match levels of care according to clinical assessments in six areas, including:
Acute intoxication and/or withdrawal potential
Biomedical conditions or complications
Emotional/behavioral conditions or complications
Treatment acceptance/resistance
Relapse potential
Some medical systems, including those of at least 15 states of the United States, refer to an Addiction Severity Index[15] to assess the severity of problems related to substance use. The index assesses problems in six areas: medical, employment/support, alcohol and other drug use, legal, family/social, and psychiatric.