Archive for the ‘Families of Addicts and Alcoholics’ Category

Families Suffer, Too

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I get many comments from readers in despair over the addiction of a loved one, so I’m re-running this blog entry from last year:

“Just found out my son who is on suboxone treatment, is also taking Xanax from a dealer. He came home this a.m. and dropped into a dead sleep. I checked his phone and found a message requesting Zanny from a certain Austin. I do not want to be his cause of death. Do I get tough and kick him out, or continue to try and help him? I am worried that his doctor will not continue to give him the suboxone if he tests positive for Xanax. I am worried if I kick him out, he will go back to heroin use. I feel damned if I do or don’t. I am a believer in prayer and God, but right now I am in a quandary. Any suggestions?”

It’s not just the addict who suffers from this disease of addiction; families also feel pain. Addicts are fooling themselves when they say they have a right to do what they want with their bodies because they are only harming themselves. The addiction causes the addict and all who love him to hurt.

This mom wants to know what she should do, and I’m tempted to give advice.
On the one hand, anything she does to make it easier for her son to use drugs is making his addiction worse. She should call his doctor and tell the doctor what’s going on, and let the doctor take it from there. If her son decides he wants to keep using Xanax rather than get into recovery, that’s his decision, not hers, and if he’s over eighteen, then his recovery is his responsibility.

And then on the other hand, it’s more difficult to overdose on Suboxone and Xanax than on a full opioid like oxycodone and Xanax. But overdose is still possible. If he stays on Suboxone, at least that’s reducing his risk of death. In the end, his doctor is going to do drug testing and it will become obvious what’s going on.

Not being a parent, I can only try to imagine how difficult her situation is. Most people are overwhelmed and unprepared for such grim circumstances. When she says she’s “damned if I do or don’t,” she’s right. She cannot control the outcome. She cannot cure him.

I know a mom who allows her son to live in the basement, fully knowing he is injecting heroin. She sometimes gives him money to he won’t have to commit crimes to finance his addiction. She says if she turned him out and he died on the street, she would feel awful, like she had abandoned him. On the other hand, I know a mom who did the same thing, and her son overdosed and died while living in her basement. She now feels like she didn’t do enough to help him, and that she contributed to his death by enabling him. At an Al-anon meeting, I heard a mom crying because her son died from a violent assault from a drug-using associate, shortly after she kicked her son out of her house for using pain pills. She felt like he might still be alive had she provided a safe place to stay.

This disease often kills young people, no matter if their families enable or provide tough love. Families can set boundaries, do interventions, and give consequences for continued drug use. They can reduce harm to the addict who is still using, by giving clean needles and a safe place to life. And the result may be the same either way.

I do know this mom needs to get help for herself. She can go to Al-anon, a 12-step recovery program for friends and families of alcoholics and addicts. It’s free, available in nearly every city, and it works. There, she can meet other moms and spouses and adult children of alcoholics who can share what they did to restore sanity to their own lives, independent of what their addict or alcoholic is doing. Or, she can go to a therapist to help her decide what course of action – or inaction – is right for her.

I had an addicted family member. I decided to be direct with him. I told him how I loved him and how I was worried his disease would kill him. I told him that I would pay for a treatment center, if he would go. I would go with him to 12-step meetings if he wished. I would support him in any way he thought necessary. The first time we talked, he made a joke of it, said I was worried for nothing, and he didn’t have a problem. Even though it wasn’t the response I hoped for, I felt better, because I said something I desperately needed to say. I was able to speak my truth to him in a way that felt good. I didn’t blame or shame him. I just told him I loved him and I was worried, and if he wanted help, I’d move mountains to make it happen.

I didn’t cut him out of my life, but decided what my boundaries should be in order to maintain my sanity. I couldn’t be around him if he was obnoxiously drunk. When I visited him, I always drove my own car in case I needed to leave if I started feeling overwhelmed. And I would not, under any circumstances, buy alcohol for him. I told him I didn’t allow drinking in my house, and if he came for a visit, he couldn’t bring alcohol with him to drink. I believe he did his best to honor my requests, but he couldn’t control his drinking, and I did have to shorten a few of my visits.
I didn’t nag him, but after he was admitted to the hospital with liver failure, I again offered to help in any way I could. This time, he said AA might be a good thing if a person needed it, and if he ever got that bad he’d go to AA. His drinking continued, and he died of liver failure four months later.

I would feel wretched if I had never spoken what was on my heart. It sounds like such a simple and obvious conversation to have, but in alcoholic families, conversations about alcohol consumption are often taboo. Logical and necessary conversations often feel bizarre in addicted families. In my family, we were silently aware that our family didn’t talk about such matters.

It took an unexpected amount of courage for me to be able to talk to my loved one about his drinking.

Besides Al-anon, individual counseling can help a great deal. A therapist, knowledgeable and experienced with dealing with families of addicts is worth her weight in gold. With either option, this mom will learn the threes C’s of Alana: you can’t control his using; you can’t cure him; and you didn’t cause his addiction. For some reason so many parents seem to think their son or daughter’s addiction is their fault, which of course is untrue.

With help, this mom will be able to think more clearly. She’ll be able to decide where to draw the boundaries. I don’t think there’s any right or wrong with boundaries. Each family member gets to decide where their limitations will be with the addicted love one.

For more about Al-anon, you can go to: http://al-anon.alateen.org
Families Anonymous, a similar group, has this website: http://familiesanonymous.org/

Nar-Anon is a 12-step group for the families of addicts: http://www.nar-anon.org

Helpful Websites for Patients on Medication-Assisted Treatment of Opioid Addiction

I’ve compiled some of my favorite web sites which deal with the medication-assisted treatment of opioid addiction. There are so many pitiful, ignorant sites on the web, it’s great to go to one of these for some sanity. 

http://www.methadonesupport.org/

This is just what the address suggests: a support site for people being treated with methadone for either addiction or pain. This site has message boards and discussion forums as well as good information for patients and their families. There’s information on pregnancy and methadone, with links to recent studies. There are several advocacy links. One describes current legislative challenges to treatment with methadone.

The forums have some interesting topics. For example, there was a thread with methadone clinic patients writing in to say what they would do if they saw a drug deal at their clinic. Would they notify clinic administrators or ignore it? The answers were interesting.

You can get information about Methadone Anonymous, and locations of current meetings. You can also enter a methadone anonymous chat room each evening between 8 to 9 EST, but you do need to register on the site to participate in meetings and to post on other sections.

This site it a little busy and some of it hasn’t been updated recently, but overall it’s a great site for support and information.

http://buprenorphine.samhsa.gov/

This is the website I give people when they’re trying to find a doctor who prescribes Suboxone. This is the most up-to-date list of Suboxone doctors, but it’s not 100% correct. Sadly, there are some doctors who don’t update their information at this site when they are no longer able to take patients. But besides the names, addresses and phone numbers of Suboxone doctors,, there’s some reliable information on this site about buprenorphine. This may be a site you pull up for a friend or family member who has misgivings about medication-assisted treatments of opioid addiction.

 http://www.methadone.us/

This is the best all-purpose site for information about methadone, information about opioid treatment centers, locations of treatment centers, and answers to FAQs about methadone. It also provides a link to a great blog: mine. I’m proud they carry my blog entries on their site. OK so maybe I’m a little biased, but check it out. It’s an extremely well-maintained site, and kept up to date with interesting and new information.

http://suboxonetalkzone.com/

This is a blog written by Dr. Junig, a physician who is obviously well versed in opioid addiction and its treatment with Suboxone. And it’s much more. He gives a link to his Ebook “User’s Guide to Suboxone.” I haven’t read it, but he says it contains information about situations that commonly arise during treatment with Suboxone, like acute pain management, surgery while on Suboxone, pregnancy on buprenorphine, and other problems. His blog has been around for many years, and I believe Dr. Junig is one of the first doctors to publically advocate for medication-assisted treatment for opioid addiction, and I admire this.

http://store.samhsa.gov/home

If you’re interested in the disease of addiction and recovery from it, you’ve got to go to this website. It’s the government’s publication site, where many pamphlets, booklets, and bulletins are free. Even postage is paid, so go browse at the site. It’s arranged so you can search by topic, by audience (patient, family, health professional, etc.), or by drug. There are even DVDs which are available for a small charge.

http://www.casacolumbia.org

This is the website for the National Center on Addiction and Substance Abuse at Columbia University. There’s great information here, though it’s not specific to medication-assisted treatments with buprenorphine and methadone. This site is packed with information about drug addiction, its treatment, and its costs to society. You can download CASA’s famous white papers about the following topics: “Adolescent Substance Use: America’s #1 Public Health Problem” or “National Survey of American Attitudes on Substance Abuse XV” or “Behind Bars II: Substance Abuse and America’s Prison Population.” These are excellent sources of information, much of it downloadable for free. My personal favorite is “You’ve Got Drugs,” about the ease of obtaining controlled substances over the internet.

CASA funds research of treatments for addiction, and also makes recommendations to policymakers in the country. They also provide information and help exchange of ideas between the government agencies, criminal justice system, service providers and education systems.

http://international.drugabuse.gov

This invaluable website is National Institute on Drug Abuse (NIDA) summary of all the research studies about methadone, upon which our present treatment recommendations are based. If you need to know any facts about methadone treatment, you can probably get them here, along with references to support the information. If you are in medication-assisted treatment with methadone, you need to go to this site. You can download the whole of the Methadone Research Web Guide, and can take it to anyone who is pressuring you to “get off that stuff” to show them the science behind treatment with methadone.

http://www.indro-online.de/

If you travel out of the U.S., go to this website to see what other countries allow regarding buprenorphine or methadone. For example, the website tells travelers to Russia: “Methadone or buprenorphine must not be brought into Russia.” Using medication-assisted treatment with these two opioids isn’t legal in that country, and clearly it’s risky to travel with your prescription medication. The site does go on to say that if you must, travel with a letter from your doctor, translated into Russian.

I’ve referred to this site several times, looking to see what’s required for a patient who traveling out of the U.S. It’s an interesting site to peruse, to see how different countries are. There are tips about necessary phrasing for the doctor’s letter that’s usually required.

Readers, do you have suggestions for other great sites about medication-assisted treatment of opioid addiction?

Things You Can Do to Reduce the Impact of Addiction in Your Community

Sometimes it’s frustrating to hear repeatedly on the news that opioid addiction is such a problem. It’s easy to feel helpless about the situation, and doubtful about how you can help. In this blog entry, I’m going to describe some very specific things you can do to reduce the impact of addiction on our society.

  • If you are an addict, get help immediately. Many people have so much shame about becoming addicted that they’re mortified to seek help, fearing the stigma attached to addiction and to an admitted addict, so it takes tremendous courage to admit you have this problem. If you are getting medications from your doctor, tell her the truth. Tell her you are misusing the medicine and need help. She should be able to guide you to an appropriate addiction treatment center, to get an evaluation. At a good treatment center, you should be informed of all of your treatment options. This should include information on both medication-free treatment and medication-assisted treatment.
  • If you are doctor shopping for prescriptions, stop it now. As more and more doctors use their states’ prescription monitoring database, sooner or later you will be discovered by one of your doctors. In my state of North Carolina, doctor shopping is a felony, because it’s considered using false pretenses to get a controlled substance. Instead, get treatment. If you’re selling these medications, stop it before you go to jail or kill someone.
  • Get rid of all old medication in your cabinets, especially if they are controlled substances like opioid pain pills, sedatives, sleeping pills, or stimulants. According to a recent survey, most young people got their first opioid drug from friends or family. Many times, they took what they found in their parents’ medicine cabinets, or in their friends’ parents’ medicine cabinets. Some communities have regular “drug take back” days, where people bring unused medication for disposal. If you don’t have these in your community, you can wet the pills and mix them with coffee grounds or cat litter, and then throw them in the garbage. The coffee grounds and cat litter will deter addicts looking for medication. Don’t flush pills in the toilet, because there are fears the medication can enter our water supply.
  • Don’t share your medication, with anyone, even family. In this country, sharing medication is so common people don’t realize it’s a crime. Some people feel that if it’s their medicine, and they bought it, they have the right to do with it what they want. This isn’t true. Giving controlled substances to another person is a crime, and dangerous as well. Selling a controlled substance is even worse. Speak up to friends and family, letting them know you don’t think it’s OK for Aunt Bea to give Jimmy one of her Xanax pill because his nerves are bad today. Jimmy needs to see his own doctor.
  • Give your children clear and consistent anti-drug messages. Don’t glamorize your own past drug use, including alcohol, by telling war stories. It should go without saying, though I’m going to say it: don’t use drugs with your kids, including alcohol and marijuana. Also, don’t err in the opposite direction, and exaggerate the harms of drug use, because you’ll lose credibility with your kids. Some may remember how the film “Reefer Madness” was mocked. Talk to your kids in an age-appropriate way about drugs and alcohol, even if they don’t appear to be listening.
  • If you have a family member addicted to prescription medication, call their doctor to describe what you see. The doctor probably can’t discuss your relative’s treatment, unless given permission, but your doctor can accept information. Write a letter, and be specific with what you’ve witnessed. If your loved one runs out of medication early and then buys off the street, let the doctor know.
  • If you feel your addicted loved one is seeing an unscrupulous doctor, report what you know to your state’s medical board. These professional organizations are the best equipped to review a doctor’s pattern of care, to decide if the doctor is prescribing inappropriately. Charts are often reviewed by other doctors who decide if the standard of care is being met.
  • Underage drinking is serious. For each year you can postpone your child’s first experimental drug use, including alcohol, you reduce his risk of addiction by around five percent. (1) Don’t involve your kids in your own alcohol consumption; for example, don’t send you kids to the refrigerator to get you a beer. Don’t allow adolescents to drink in your house, fooling yourself with the idea of, “At least I know where they are.” Not only is it illegal, but it’s harmful.
  • Don’t use drugs or alcohol to treat minor emotional discomfort, unless you have discussed it with your doctor. For example, don’t use pain pills to help you sleep. Don’t use the Xanax your doctor prescribed for your fear of flying to treat the sadness you feel from breaking up with a boyfriend. Try to get out of the mindset that there’s a pill for every bad feeling, and try to help your friends and family see this, too.
  • See a doctor for the treatment of serious mental illness. Some mental disorders are so severe that they require medication. There are many non-addicting medications that treat depression, anxiety, and other mental disorders. Getting the appropriate treatment has been shown to decrease your risk of developing an addiction to alcohol and other drugs.
  • Monitor your adolescent’s friends. Youngsters with friends who use drugs are more likely to begin using drugs. Of course, most youngsters who experiment with drugs and alcohol won’t develop addiction, but the younger experimentation begins, the more likely it is that addiction will develop. Older siblings can be a good or harmful influence.

1.  Richard K. Ries, David A. Fiellin, Shannon C. Miller, and Richard Saitz, Principles of Addiction Medicine, 4th ed. (Philadelphia, Lippincott, Williams, and Wilkins, 2009) ch.99, pp1383-1389.

Am I Addicted to Prescription Pain Pills?

I am a guest blogger on addictionblog.org, and recently had a well-received article published on that site about how to know if you are addicted. I thought I’d repeat a version of that column here.

 There’s so much confusion about the differences between the disease of addiction to opioid pain pills and mere physical dependency on pain pills. Even some doctors don’t understand the differences, regretfully. Any person who regularly takes opioid pain pills for a period of weeks to months, for whatever reason, will develop a physical dependency to these drugs. That’s a biologic event. But addiction is much more than just the physical process. With addiction, there’s also a psychological component. People with addiction think about the drug often, spend time using and recovering from the drug, and continue to use the drug even though bad things happen. In physical dependency alone, this doesn’t happen.

 Here are a few specific questions that I ask patients, that help me decide if they have the disease of addiction:

  • Do I take more medication than prescribed? Do I take early doses, or extra doses?
  • Do I take medication in ways it’s not intended? For example, do I snort it, or chew it for faster onset? Do I inject it?
  • Do I get medication from friends, family, or acquaintances because I run out of my prescription pills early?
  • Do I become intoxicated, or high, from my medication? Without telling my doctor?
  • Do I drink alcohol with medication, even though the pharmacist advised against this?
  • Do I look forward to my next dose of medication?
  • Do I get impaired from my medication, to the point I’m unable to function normally?
  • Do I take pain medication to treat bad moods, anxiety, or to get to sleep?
  • Do I use street drugs like cocaine, marijuana, or others?
  • Have I driven when under the influence of pills, when I know I shouldn’t be driving?
  • Do I get prescriptions from more than one doctor, without telling them about each other?
  • Do I spend a great deal of time worrying about running out of medication?
  • Do I spend a great deal of time thinking about my medication, and how it makes me feel? 

One “yes” answer to any of these questions is worrisome, though not necessarily diagnostic of addiction. I think of addiction as a continuum, and it’s easier to diagnose with multiple “yes” answers. For example, people taking prescriptions may have a few worrisome symptoms, like taking an extra pill occasionally. Perhaps they did this because of a temporary increase in pain. Without any other symptoms, I probably wouldn’t diagnose addiction. At the other end of the spectrum, if a patient is crushing pills to inject or snort, I feel confident making the diagnosis of addiction.

 Sometimes addiction only becomes apparent over time. This is why doctors need to see patients frequently who are prescribed potentially addicting medication, like pain pill, stimulant, and benzodiazepines.

 If you had one or more “yes” answers to the above questions, please see a doctor who knows something about addiction, because untreated addiction usually gets worse. In fact, it can even be fatal.

Description of Methadone Patients

The following is an excerpt from Chapter 2 of my book, titled, “Pain Pill Addiction: Prescription for Hope.” In this chapter I’m describing the patients I saw at methadone clinics where I worked in the years 2001 through 2009.

 I was surprised how casually people shared controlled substances with one another. As a physician, it seems like a big deal to me if somebody takes a schedule II or schedule III controlled substance that wasn’t prescribed for them, but the addicts I interviewed swapped these pills with little apprehension or trepidation. Taking pain pills to get through the day’s work seemed to have become part of the culture in some areas. Sharing these pills with friends and family members who had pain was acceptable to people in these communities.

In the past, most of the public service announcements and other efforts to prevent and reduce drug use focused on street drugs. Many people seemed to think this meant marijuana, cocaine, methamphetamine, and heroin. The patients I saw didn’t consider prescription pills bought on the street as street drugs. They saw this as a completely different thing, and occasionally spoke derisively about addicts using “hard drugs.” Most addicts didn’t understand the power of the drugs they were taking.

 Some opioid addicts came for help as couples. One of them, through the closeness of romance, transmitted the addiction like an infectious disease to their partner. Most were boyfriend/girlfriend, but some were married. The non-addicted partner’s motives to begin using drugs seemed to be mixed. Some started using out of curiosity, but others started using drugs to please their partner. I was disturbed to see that some of the women accepted the inevitability of addiction for themselves as the cost of being in a relationship with an addicted boyfriend. Often, addicted couples socialized with other addicted couples, as if opioid addiction bound them like a common fondness for bowling or dancing. Addiction became a bizarre thread, woven through the fabric of social networks.

 We saw extended family networks in treatment for pain pill addiction at the methadone clinics. One addicted member of a family came for help, and after their life improved, the rest of the addicted family came for treatment too. It was common to have a husband and wife both in treatment, and perhaps two generations of family members, including aunts, uncles, and cousins. Many addicts who entered treatment saw people they knew from the addicted culture of their area, and sometimes old disputes would be reignite, requiring action from clinic staff. Sometimes ex-spouses and ex-lovers would have to be assigned different hours to dose at the clinic, to prevent conflict.

 When the non-profit methadone clinic where I worked began accepting Medicaid as payment for treatment, we immediately saw much sicker people. Over all, Medicaid patients have more mental and physical health issues. Co-existing mental health issues make addiction more difficult to treat, and these patients were at higher risk for adverse effects of methadone. However, data does show that these sicker patients can benefit the most from treatment.

 When I started to work for a for-profit clinic, I saw a slightly different patient population. I saw more middle class patients, with pink and white-collar jobs. Occasionally, we treated business professionals. The daily cost of methadone was actually a little cheaper at the for-profit clinic, at three hundred dollars per month, as compared to the non-profit clinic, at three hundred and thirty dollars per month. However, the for-profit clinic charged a seventy dollar one-time admission fee, to cover the costs of blood tests for hepatitis, liver and kidney function, blood electrolytes, and a screening test for syphilis. The non-profit clinic had no admission fee, but only did blood testing for syphilis. I believe the seventy dollars entry fee was enough to prevent admission of poorer patients, who had a difficult enough time paying eleven dollars for their first and all subsequent days.

The patients at the for-profit clinic seemed a little more stable. Maybe they hadn’t progressed as far into their disease of addiction, or maybe they had better social support for their recovery. This clinic didn’t accept Medicaid, which discouraged sicker patients with this type of health coverage. Both clinics were reaching opioid addicts; they just served slightly different populations of addicts. The non-profit clinic accepted sicker patients, which is noble, but it made for a more chaotic clinic setting. This was compounded by a management style that was, in a few of their eight clinics, more relaxed.

 For the seven years I worked for a non-profit opioid treatment center, I watched it expand from one main city clinic, and one satellite in a nearby small town, to eight separate clinic sites. The treatment center did this because they began to have large numbers of patients who drove long distances for treatment. This indicated a need for a clinic to be located in the areas where these patients lived. Most of this expansion occurred over the years 2002 through 2006.

 Three of these clinics were located in somewhat suburban areas, within a forty-five minute drive from the main clinic, located in a large Southern city. The other four clinics were in small towns drawing patients from mostly rural areas. One clinic was located in a small mountain town that was home to a modest-sized college. Nearly all of the heroin addicts I saw in the rural clinics were students at that college. But by 2008, we began to see more rural heroin addicts, who had switched from prescription pain pills to heroin, due to the rising costs of pills.

Within a few years, clinics near the foothills of the Blue Ridge Mountains of Western North Carolina were swamped with opioid addicts requesting admission to the methadone clinics. These clinics soon had many more patients than the urban clinic.

I saw racial dissimilarities at the clinic sites. In the city, we admitted a fair number of African Americans and other minorities to our program. Most of them weren’t using pain pills, but heroin. I don’t know why this was the case. Perhaps minorities didn’t have doctors as eager to prescribe opioids for their chronic pain conditions, or perhaps they didn’t go to doctors for their pain as frequently as whites. If they were addicted to pain pills, maybe distrust kept them from entering the methadone clinic. In the rural clinics, I could count the number of African-American patients on one hand. They were definitely underrepresented. The minorities we did treat responded to treatment just as well.

A recent study of physicians’ prescribing habits suggested a disturbing possibility for the racial differences I saw in opioid addiction. (1) This article showed statistically significant differences in the rate of opioid prescriptions for whites, compared to non-whites, in the emergency department setting. Despite an overall rise in rates of the prescription of opioid pain medication in the emergency department setting between 1993 and 2005, whites still received opioid prescriptions more frequently than did Black, Asian, or Hispanic races, for pain from the same medical conditions. In thirty-one percent of emergency room visits for painful conditions, whites received opioids, compared to only twenty-three percent of visits by Blacks, twenty-eight percent for Asians, and twenty-four percent for Hispanic patients. These patients were seen for the same painful medical condition. The prescribing differences were even more pronounced as the intensity of the pain increased, and were most pronounced for the conditions of back pain, headache, and abdominal pain. Blacks had the lowest rates of receiving opioid prescriptions of all races.

This study could have been influenced by other factors. For example, perhaps non-whites request opioid medications at a lower rate than whites. Even so, given the known disparities in health care for whites, versus non-whites in other areas of medicine, it would appear patient ethnicity influences physicians’ prescribing habits for opioids. The disparities and relative physician reluctance to prescribe opioids for minorities may reduce their risk of developing opioid addiction, though at the unacceptably high cost of under treatment of pain.

Interestingly, we had pockets of Asian patients in several clinics. We admitted one member of the Asian community into treatment, and after they improved, began to see other addicted members of their extended family arrive at the clinic for treatment. Usually the Asian patients either smoked opium or dissolved it in hot water to make a tea and drank it. When I tried to inquire how much they were using each day, in order to try to quantify their tolerance, the patient would put his or her thumb about a centimeter from the end of the little finger and essentially say, “this much.” Having no idea of the purity of their opium, this gave me no meaningful idea of their tolerance, so we started with cautiously low doses.

One middle aged patient from the Hmong tribe presented to the clinic and when I asked when and why he started opioid use, in broken English and with difficulty, he told me he had lost eight children during the Vietnam War, and was injured himself. After the pain from his injury had resolved, he still felt pain from the loss of his family and he decided to continue the use of opium to treat the pain of his heart, as he worded it. I thought about how similar his history was to the patients of the U.S. and how they often started using opioids and other drugs to dull the pain of significant loss and sorrow. I thought about how people of differing ethnicities are similar, when dealing with addiction, pain, and grief.

1. Pletcher M MD, MPH, Kertesz, MD, MS, et. al., “Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments,” Journal of the American Medical Association, 2008 vol. 299 (1) pp 70-78.

Pain Pill Addiction: Prescription for Hope

Finally, here’s the cover of my book about pain pill addiction and its treatment. It’s available at http://prescriptionforhope.com or you can order it from Amazon, and soon from Barnes and Noble.

My book contains much of what I’ve been blogging about. I wrote the book because there are so few sources of reliable information about the treatment of opioid addiction (pain pills). It seems  that abstinence-based programs don’t like to talk about medication-assisted programs, and some methadone clinics don’t let their patients know about other options. Methadone and buprenorphine can be life-saving when used appropriately, but they have some drawbacks, as well.

There’s not one single right answer for all opioid addicts. Some treatments work for some patients, but no treatment works for all patients. In my book, I present the data supporting treatment methods, so opioid addicts and their families can chose the best course.

If you like this blog, you’ll like my book. I also have a chapter in the book about the unjust stigma patients face when they are treated with medication-assisted methods. It takes a strong person to stay on a treatment that helps them, despite criticism from friends, family, law enforcement, and even unenlightened medical professionals.

Bibliotherapy for Families Affected By Addiction

It’s never just the addict (or alcoholic) who suffers.

Anyone who cares about or depends upon the addict suffers. Living with active addiction is too much for most people. Thank God there are more resources now than ever before for the families afflicted by addiction. Treatment centers have family groups and family days, and many therapists are skilled at helping family members. There are 12-step groups devoted to helping family and friends of alcoholics (Alanon) and addiction (Naranon) in nearly every area of the country. Alanon does make a distinction between alcohol and other drugs, while Naranon is for families of people addicted to any drug including alcohol. However, in practice, many people attending Alanon do so because their loved ones use drugs in addition to alcohol.

Well-written books for families of addicts can help initiate the process of understanding and healing. These books can give a starting point to desperate family members, literally worried sick about the addict in their lives.

Popularized by the TV show “Intervention,” some families hold these interventions for the addicted family member. An intervention usually contains certain elements: the addicted person’s friends and family gather together in the presence of the addict, they tell the addict how much they love him or her, they tell the addict how much their addiction hurts them, and what they want the addict to do about his/her problem. Usually this means going to an addiction treatment center. Families usually also tell the addict there will be definite consequences for non-compliance with their requests.

Other people deal with addiction in less directive ways. For example, in Alanon, the focus is kept not on the addict, but on the distressed family member or friend who is affected by the addiction. Alanon helps people deal with the dilemmas that appear with addiction, whether the addict is in or out of the home. Some people go to Alanon years after the addict is dead, because of the long-lasting emotional effects addiction can have. More about Alanon’s approach to dealing with the distress of addiction can be found at their website: http://www.al-anon.alateen.org   Alateen is not for alcoholic teens, but for teenagers who have been affected by the alcoholism of a parent or other close relative, or friend.

I’ve compiled a list of books I’ve found to be useful for family members. These books range widely in their approaches, and at times may contradict each other.

When Enough is Enough, by Candy and Sean Finnegan

            This great book clearly explains the mechanics of holding an intervention, as well as the risks and possible pitfalls. It’s 208 pages long and the paperback version is quite affordable. The authors cover much ground. They discuss all of the factors that must be considered, like financial concerns, physical and mental health issues, and legal issues. Candy is sometimes the interventionist on A&E’s “Intervention,” and has worked for treatment centers with stellar reputations. This is a top choice if you are considering holding an intervention.

Getting Them Sober, Volumes 1, 2, 3, and 4, by Toby Rice Drews

            Don’t let the title mislead you. These books aren’t all about forcing someone to get sober. These slender volumes, written in the 1980’s, have short chapters, written clearly and simply, and are packed with wisdom. I like that these books don’t give absolutes but rather suggestions. I don’t think there’s only one correct solution for every problem. Some people criticize the book, and say the best answer if you are married to an addict is to leave. And that might be the best answer for some people, but not all. It’s rarely so simple. Sometimes there are children involved. Sometimes the addict is your adult child, so there’s no “just leave” solution. The last volume, #4, is subtitled “Separations and Healings”

How Alanon Works For Friends and Families, by Alanon Family Groups

            This book gives a great description of what Alanon is all about. It tells about the common behaviors seen in the alcoholic and the family, and gives hope that even if the alcoholic never quits drinking, you can still have a happy life. It contains stories from other people who’ve lived with addiction, and much can be learned from their experiences. Alanon has several other great books: Paths of Recovery: Alanon’s Steps, Traditions, and Concepts; Alanon’s Twelve Steps and Twelve Traditions; From Survival to Recovery: Growing Up in an Alcoholic Home; The Dilemma of an Alcoholic Marriage. They also publish three small books containing daily meditations, or readings, on some topic connected to Alanon: One Day at a Time, Courage to Change (a bit old-fashioned, assumes the wife is the alanon member) and Hope for Healing (to me it seems this last one has more material for people who had alcoholic parents than the other two)

Codependent No More: How to Stop Controlling Others and Start Caring for Yourself, by Melody Beattie

            This is a classic. Written in the 1980’s, it still contains useful information that isn’t necessarily specific to addiction and the family, but most families with addiction of any sort do have codependent behaviors. The examples are helpful, and her writing is clear. I’m not sure anyone has come up with a great definition of codependency, but if you read this book to the end, you’ll know it when you see it. Also consider reading her daily meditation book, The Language of Letting Go.

Terry: My Daughter’s Life-and-Death Struggle with Alcoholism, by George McGovern

            This is a sad book, written by the father of an alcoholic, who died of exposure outside while drunk. The author is a famous politician, and his writing reveals how addiction is an equal opportunity destroyer. I got the feeling after reading this book that Mr. McGovern regretted not having done things differently. Though Terry went to treatment centers, she wasn’t successful at remaining sober. It sounds like the family detached with love, but now the author regrets detaching to the degree that he did.

 I think each family decides differently how much they can do for the addicted one. Should you provide free room and board to keep the addict off the street? Is that harm reduction… or enabling? Is it, “loving them to death?” Often, addicts say it was only when they had to face the unpleasant consequences of addiction, like sleeping outside in the cold, or going to jail, that they turned towards recovery. But then you read a story like this one, where Terry froze to death in a snow bank.

Beautiful Boy: A Father’s Journey Through his Son’s Addiction, by David Sheff

            This book was on one of my other lists. The book is poignant. In places it is heart-breaking. Over and over, I would think, “Ah, the kid’s finally in good recovery.” And the next sentence contained the next relapse. This author caught exactly the rollercoaster ride of emotions felt by someone who loves a person in active addicition.

From Binge to Blackout, by Toren and Chris Volkmann

            This is an unusual book because it contains the viewpoints of both the alcoholic and the mother of the alcoholic. This book hasn’t gotten the attention it deserves. Both authors are eloquent when describing their thoughts and feelings about what is happening with the son’s alcohol addiction. I believe this book would be interesting to any parent, particularly those with adolescents. From a doctor’s point of view, I was pleased to see Chris Volkmann quoted accurate information when she writes of the science of addiction to alcohol. I was impressed with her ability to convey these scientific concepts lucidly. You should get this book. Really.

Last Call, by Jack Hedblom

            This book is about alcohol addiction, but I don’t recall that it talked about other drugs. It contained a great description of why addiction is classified as a disease. The author, a psychotherapist with a PhD, goes into some detail about recovery from alcohol addiction from mostly a 12-step perspective. It’s a great book, covering all the necessary topics in a straightforward way but without “talking down” to the reader. I like that the book has end notes and references, and also an index. It’s recent – published in 2007, but kind of pricey – new book is $40 on Amazon but used copies are available &  much cheaper.

 This is barely scratching the surface. I have many more recent books that are still in my ever-towering “to read” pile.

 Please tell me about your favorites.

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