Prescription Drug Addiction – When Medication Becomes A Drug
by Dr Rodger Meyer
Addiction to prescription medication can be a confusing problem. Many drugs, prescribed as medication, have a well-identified but poorly understood property, whereby they are able to induce a physiological dependence. This means that the body, after a variable period of time, will react to the absence of the drug with discomfort, which may be physical or mental.
The profile of the discomfort is different for each substance that possesses this quality of dependence. This withdrawal often prompts the person to continue using the substance, even though the original condition for which the medication was legitimately prescribed, may have passed. The patient is unwittingly locked into a drug dependence cycle. This pattern of medication use can look very much like an addiction, a situation that arises when someone has an impaired ability to control their substance use, despite adverse consequences.
The situation is further complicated by the fact that many of these medications have an additional quality, namely a property called tolerance. This is also a poorly understood phenomenon whereby, with the passage of time, the effect of a medication diminishes. The cumulative effect is that the patient often has to increase the dose to achieve the desired effect. This escalated use can also look very much like the loss of control that characterises addiction.
The medications that are most commonly the culprits for dependence are the tranquilisers and sleeping pills, known as the benzodiazepine group of medications, and painkillers or analgesics, usually a member of the opiate group. The problem often arises from codeine in a variety of disguised forms, including as a component of many cough mixtures and more recently, the notorious oxycontin epidemic in the USA. To a lesser extent, stimulants like methylphenidate (Ritalin) and dexamphetamine can also cause dependency problems, although these substances are usually deliberately abused and are not strongly dependence producing.
The challenge in addiction treatment is to distinguish between patients who are innocent victims of pharmaceutical dependence and those who are addicts, whose drug of choice happens to be prescription medications. Both groups can look the same but the treatment approach is different because the cause of the problem is different.
So how do you tell the difference? The giveaway can be detected in the patient’s relationship with the problem.
Addiction is syntonic – addicts are in love with their addiction (although they often claim to hate it) whereas dependents are clearly uncomfortable with the problem. Addicts tend to deny the problem by minimising, comparing, rationalising, and more, whereas dependents are more prone to disclosure about the gravity of the problem, looking for alternatives, and open to discussion. Addicts feel hopeless, which feeds their addictive cycle whereas dependents feel helpless about being caught in a cycle of dependence. At the same time, addicts often exude an air of confidence that they will sort out the problem when “the time is right”, while dependents are justifiably worried about a poor prognosis. Finally, addicts usually resist interference whereas dependents are amenable to help
Dependence on pharmaceutical medications requires a medically-managed detox with psycho-educational input, a skilled nursing team, a review of the underlying diagnosis with consideration of alternative medication, and therapies. Addiction to pharmaceutical drugs, in contrast, is best managed with a treatment programme as one would manage any substance use disorder.