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Overcoming Prescription Drug Addiction

A Guide to Coping and Understanding

Addicus Books

Understanding Addiction

Somewhere, at this very moment, a man's wife agonizes as she receives a call from the police — her husband has been arrested for forging prescriptions for tranquilizers. In another community, a mother weeps as her adult daughter, intoxicated on painkillers, disrupts yet another family gathering. In a small Midwest town, a family is grieving the death of their teenage son who died at a party from an overdose of prescription anxiety medication and alcohol. The case scenarios go on and on. Legions of Americans are abusing and becoming addicted to prescription drugs.

In fact, chances are you know someone who is abusing prescription drugs. Maybe it's your spousee, a relative, a friend, or a casual acquaintance. Maybe it's you.

Defining Addiction

Addiction is a pattern of compulsive drug use characterized by a continued craving for drugs and the need to use these drugs for psychological effects or mood alterations. Many abusers find that they need to use drugs to feel "normal." The user exhibits drug-seeking behavior and is often preoccupied with using and obtaining the drugs of choice. These substances may be obtained through legal or illegal channels.

The American Society of Addiction Medicine considers addiction "a disease process characterized by the continued use of a specific psychoactive substance despite physical, psychological, or social harm." Addiction is a chronic disease that is progressive — it worsens over time. It can be diagnosed and treated, but without treatment, it is ultimately fatal.

How Addiction Affects the Brain

It was once thought that addiction was a result of being weak-willed — addicts could stop using drugs if they wanted to. But research has shown that this is not the case. In fact, after prolonged use of an addictive substance, the "circuits" in the brain virtually become "rewired."

When a medication enters the brain, it is absorbed through receptor sites. Addictive drugs are believed to act on the brain by reinforcing the action of the body's natural chemical, known as dopamine, that is involved in producing the sensation of pleasure. When the body is getting such chemicals from an outside source, the brain stops making some of its own and becomes dependent on the outside source. As the brain adapts to the drug's presence, the individual using the drug builds tolerance and must continually increase the dosage in order to achieve the initial pleasure sensations. However, most addicts in recovery report that they rarely achieved that initial sense of euphoria or feeling of well-being again.

Further, if the drug is stopped abruptly, it usually triggers a withdrawal syndrome. Symptoms of withdrawal may vary depending on the length of the addiction and the drug being used, but common symptoms from painkillers may include anxiety, irritability, chills alternating with hot flashes, salivation, nausea, abdominal cramps, or even death. Some individuals describe withdrawal as the worst possible flu you can imagine. As one goes into withdrawal, the body "begs" for more of the addictive drug in order to escape the misery. Understandably, giving up the drug is difficult.

This inability to stop using the drug is a characteristic of addiction. Although an addicted individual may intellectually understand the destructive consequences of addiction, he or she may not be able to stop the compulsive use of a drug; the changes in brain structure can affect emotions and motivation, both of which affect behavior.

Another common characteristic of addiction, denial, makes it even more difficult for the addicted individual to give up a drug. Denial refers to the addict's belief that he or she really does not have a drug problem. This self-protective mechanism is governed by the subconscious areas of the brain where the main addiction pathways exist. Denial keeps the addict from acknowledging both the drug problem and the underlying emotional issues that may be influencing the use of drugs. Usually, the longer the drug abuse has gone on, the stronger the denial.

Drug Abuse

Drug abuse refers to "the use, usually by self-administration, of any drug in a manner that deviates from the approved medical use or social patterns within a given culture. The term conveys the notion of social disapproval, and it is not necessarily descriptive of any particular pattern of drug use or its potential adverse consequences," according to The Pharmacological Basis of Therapeutics by Jerome Jaffe. Drug abuse may include using a medication "recreationally," using it for reasons other than those intended, or using the drug more frequently than indicated by the prescriber. Abuse may or may not involve addiction.

It is estimated that as much as 28 percent of all prescribed controlled substances are abused. That estimate translates to tens of millions of drug doses being diverted annually for the purpose of abuse. Diversion refers to the redirecting of drugs from legitimate use into illicit channels. The drugs may be obtained through any number of sources — by bogus prescriptions, from a friend, or purchased on the streets.

How Many Americans Are Abusing Prescription Drugs?

It's difficult to say with precision just how many Americans are abusing prescription drugs, although estimates are available. According to 2007 statistics, nearly 17 million Americans aged twelve or older reported having used prescription drugs — painkillers, sedatives, tranquilizers, or stimulants — for nonmedical purposes during the year. In fact, the number of people abusing prescription drugs is greater than the combined number of people using cocaine, hallucinogens, inhalants, and heroin. Overall, 56 percent more Americans abuse prescription drugs than these illegal drugs.

Teen Abuse on the Rise

Prescription drug abuse among teenagers has tripled since 1992. Today, nearly 19 percent of all teens report having taken a painkiller for nonmedical purposes. Prescription drug abuse among college students is estimated at 20 percent.

The National Center on Addiction and Substance Abuse at Columbia University reports that more than half the nation's twelve-to-seventeen-year-olds are at risk of substance abuse because of high stress, frequent boredom, too much spending money, or a combination thereof. Unfortunately, many teens believe that prescription drugs, such as painkillers, are safer than illegal street drugs, and many are not aware of the addiction risks associated with narcotics. Many teens report getting drugs from their family medicine chest or from friends.

Emergency Room Visits on the Rise

The number of prescription drug abusers seeking treatment in emergency rooms is also on the rise. In 2005, drug and alcohol abuse sent nearly 1.5 million people to hospital emergency rooms. To make the magnitude of this statistic more real, imagine every man, woman, and child in the city of Philadelphia going to a hospital emergency room as the result of substance abuse.

Overdoses on the Rise

Fatal poisonings from drug overdoses are rising dramatically in the United States. Officials say most of these deaths are from prescription drugs rather than illegal drugs such as heroin. According to the Centers for Disease Control (CDC), more than 33,000 Americans died of drug overdoses in 2005, the most recent year for which statistics are available. This number makes drug overdose the second leading cause of accidental death. (Traffic accidents are the leading cause of accidental deaths.)

In 1990, the CDC reported 10,000 drug overdose deaths; in 1999, the number was 20,000. The 2005 death toll represents a 60 percent increase in drug- related deaths between 2000 and 2005. The government estimates that such abuse costs about a half trillion dollars a year, or about $1,650 per American.

Addiction Rate in the United States

It's generally believed that between 10 and 16 percent of Americans are chemically dependent at some point in life. These percentages refer to all addictive substances, including alcohol, prescription medications, and illegal substances, but do not include tobacco. Many individuals in recovery report that they often used both alcohol and prescription drugs, depending on their availability. A 1998 report by the University of Chicago states that multidrug consumption is the normal pattern among a broad range of substance abusers.

Symptoms of Addiction

Prescription drug abuse is often difficult for friends and family to recognize. Contrary to popular belief, one need not abuse drugs daily to have a problem with addiction; the pattern of abuse may be occasional or habitual. The abuse is usually an intensely private affair between the abuser and a bottle of pills. And the pill taker is not subject to the social stigma associated with the shadowy world of street-drug dealing. Still, the following are symptoms of addiction:

• Showing relief from anxiety

• Changes in mood — from a sense of well-being to belligerence

• False feelings of self-confidence

• Increased sensitivity to sights and sounds, including hallucinations

• Slurred speech and poor motor control

• Decline in hygiene and appearance

• Altered activity levels — such as sleeping for twelve to fourteen hours or frenzied activity lasting for hours

• Lack of interest in activities previously enjoyed

• Unpleasant or painful symptoms when the substance is withdrawn

• Preoccupation with running out of pills

Who's at Risk for Addiction?

Who is at risk for addiction? Medical science has also determined that those with a family history of addictions have about a threefold greater risk of developing addictions. But, in addition to family history, there are other risk factors.

The risk for addiction is greatest among women, seniors, and, as mentioned earlier, teenagers. Women are two to three times more likely than men to be prescribed drugs such as sedatives; they are also about two times more likely to become addicted. This stems in large part from the fact that women are more likely to seek medical attention for emotional problems. Seniors take more drugs than the rest of the population and have a reduced capability of breaking them down and eliminating them; this increases their odds of becoming addicted. And the surge in teenage abuse of prescription drugs has led to dependency among many. Other groups at increased risk for addiction are medical professionals, alcoholics, and smokers.

Other factors that put one at risk for addiction include:

• Medical condition that requires pain medication

• Extreme stress from family tragedy or death

• Divorce

• Excessive alcohol consumption

• Fatigue or overwork

• Poverty

• Depression

• Dependency

• Poor self-image

• Obesity

Is everyone who takes addictive drugs at risk for addiction? The answer is no. "Twenty years ago, it was widely believed that virtually anyone who took psychoactive drugs was a likely candidate for dependency, but that thinking has changed," states Bonnie Wilford, Executive Director of the Alliance for Prescription Drug Abuse Prevention. "Our change of thought has come about as a result of our increased knowledge about addiction. For example, perhaps seven out of ten people could take tranquilizers and not progress to addiction. But those who do become addicted likely have a preexisting addictive disorder, such as predisposition to alcoholism. The difficulty is, we don't always know which patients this will be."

The "Unwitting" Addict

Many individuals who become dependent on prescription drugs are "unwitting" addicts. These are individuals who have no prior history of drug abuse or addiction. They started using a prescribed drug for a legitimate problem, physical or emotional. For example, it may have been a painkiller for a back injury or a sedative for anxiety. Then, at some point, these individuals started increasing the dosages on their own because the drug made them feel better — giving them relief from physical or emotional distress. The nature of the drug required that they continue escalating the dosages to get the desired effect. Gradually, the abuse became full-blown addiction.

Which Drugs Are Being Abused?

According to the Drug Abuse Warning Network, prescription drugs are among the most abused substances in the United States; these drugs are abused more than heroin and cocaine combined. Only marijuana use is more common than prescription drug abuse.

At the top of the list of prescription drugs being abused are benzodiazepines and painkillers. The Drug Abuse Warning Network keeps a ranking of such drugs, based on information gathered during hospital emergency room visits across the nation. The patient must indicate that a drug was being used for purposes of recreation or dependence in order for the episode to be considered drug abuse.

Commonly Abused Prescription Drugs

Opioids

Opioids, more commonly known as painkillers, belong to a class of drugs also known as opiates and are typically prescribed to relieve acute or chronic pain, such as that from cancer or surgery. These drugs are also referred to as narcotic analgesics or pain relievers. For acute pain, opioids are normally used only for short periods — fewer than thirty days. Opioids may be taken orally or by injection.

Although they are medically indicated for the control of pain, opioids are drugs with high abuse potential. In addition to blocking pain messages being sent to the brain, opioids produce feelings of euphoria or pleasure. It is this sensation that makes the drug highly sought after by those wishing to free themselves from painful emotions. Chronic use of opioids results in both tolerance and dependence.

Common opioid products include:

• Darvocet-N

• Demerol

• Lorcet

• Methadone

• OxyContin

• Percodan

• Roxiprin

• Tylenol with Codeine

• Darvon

• Dilaudid

• Lortab

• Morphine

• Percocet

• Roxicet

• Tussionex

• Vicodin

According to the National Institute on Drug Abuse, the number of opioid prescriptions in the United States escalated from nearly 40 million in 1991 to 180 million in 2007. That's an increase of 350 percent at a time when the population increased by 19 percent.

Opioid Withdrawal

Stopping the use of opioids suddenly will bring on symptoms of withdrawal. Initial withdrawal symptoms usually begin within hours of the last dose and may include: cravings, running nose, excessive sweating, insomnia, and violent yawning. Those who have been addicted to opioids for a long time may progress to severe withdrawal symptoms, including: chills, fever, muscle spasms, and abdominal pain. Opioid withdrawal is rarely fatal.

Cessation of opioids is best accomplished under medical supervision, where withdrawal can be managed. A medically assisted withdrawal is safer and also increases the chance that an individual will "come off" a drug.

Stimulants

Stimulants are drugs that stimulate the central nervous system, increasing mental alertness, decreasing fatigue, and producing a sense of well-being. These drugs are often prescribed for attention deficit (hyperactivity or ADHD) disorder and narcolepsy, a condition characterized by excessive daytime sleepiness, even after adequate nighttime sleep. Common stimulation drugs include:

• Adderall

• Cylert

• Ritalin

• Concerta

• Dexedrine

Interestingly, while the drugs listed above stimulate the central nervous system in adults, they have a calming effect on children. Consequently, these stimulants are often prescribed for children diagnosed with ADHD. The drugs produce a calming effect in these children by stimulating nerves that slow down other overactive nerves.

In adults, other stimulants such as Adipex-P, Bontril, Didrex, Ionamin, Meridia, Prelu-2, Pro-Fast, and Tenuate may be used to suppress appetite.

Stimulants such as Dexedrine and Ritalin increase the amount of the natural brain chemicals norepinephrine and dopamine. The increased levels of these chemicals create both an increased heart rate and increased blood pressure and a sense of pleasure, resulting in an overall sense of heightened energy and sense of well-being. Once accustomed to an outside source of these chemicals, the body craves more of them.

Anyone taking high doses of stimulants runs the risk of irregular heartbeat and high blood pressure, which can result in heart failure. High doses may also result in feelings of hostility and paranoia.

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Excerpted from Overcoming Prescription Drug Addiction by Rod Colvin. Copyright © 2008 Rod Colvin. Excerpted by permission of Addicus Books.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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