In my 28-year career, I have noticed one of the biggest causes of relapse for people in recovery is the abuse of prescription medications. This is even the case for recovering people with decades of abstinence. It is critical that addicts and alcoholics are extremely careful when and if they are prescribed addictive and mood-altering medications because they can easily trigger a regression back to old addictive patterns.
My philosophy is that we need to do more to teach the recovering person what to do “when they have to take medications, not if they have to take medications,” because sooner or later most of us are going to have some medical procedure for which medications will be prescribed. And remember, pain is just as much a threat to one’s recovery as pain medication, so we must help people get through these difficult situations and maintain their recovery. This article offers some concrete information and suggestions that can help to avoid a relapse.
Many addicts and alcoholics have relapsed following a “legitimate reason” for taking prescription medications. Some medications are harmless and do not necessarily pose a threat to one’s recovery, anti-depressants for example, are less likely to trigger cravings. However, once the recovering person takes an addictive, mood-altering medication such as pain medications, sleeping pills, anxiety medications, and/or muscle relaxants, there is great risk that the addictive disease will be awakened once more. And once awake the disease will often demand more of the drug and a return to old addict behavior, such as lying and manipulating to stay high.
The recovering person is often unaware or prepared for the risk. He or she may not know to ask for non-narcotic pain medications. The addict may defer to the prescribing physician’s expertise, assuming that the doctor knows what to do, but many doctors have very little training in how to deal with addiction. They may inadvertently prescribe medication that can start the disease process in motion. It is extremely important to know what medications you are taking, what the abuse potential is, and whether the drug is addictive and mood altering. Just because a doctor prescribed it doesn’t mean it’s okay. It is the responsibility of the recovering people to protect their recovery. Ask questions, look the drug up online, get feedback and be accountable before taking medication.
Even some over-the-counter medications contain substances that can be dangerous to the recovering person. Many cough syrups and mouthwashes contain very high alcohol content, and some antihistamines contain stimulants, so read the labels very carefully before you start taking one of these seemingly harmless medications.
The most commonly abused prescription medications:
- Opioids—usually prescribed to treat pain
- Central nervous system (CNS) depressants—used to treat anxiety and sleep disorders
- Stimulants—most often prescribed to treat attention deficit hyperactivity disorder (ADHD)
Physicians are very quick to prescribe pain; sleep and anxiety medications and recovering people need to be extra cautious. Even in addiction treatment we are seeing enormous lobbying from pharmaceutical companies advocating for medication-assisted recovery (using one substance to treat addiction to another) as the first line of defense.
Some managed care policies actually block attempts to place teenage opiate addicts in into residential treatment, mandating that these young people be seen instead by buprenorphine-prescribing physicians in private practice. Hospitals have very strong policies regarding pain and are eager to prescribe pain medications to assure that patients have little or no discomfort. This makes their jobs easier but puts the patient at enormous risk for dependence.
So here are some suggestions that may help a recovering person avoid a relapse:
BEFORE you take medications:
- Find a doctor that is educated about addiction, preferably one that is ASAM, (American Society of Addiction Medicine) certified.
- Be very clear when you tell your doctor that you are a recovering addict or alcoholic and you do NOT want any medications that can threaten your recovery.
- Ask about the medication. Is it a narcotic? Is it addictive? Is there abuse potential?
- Do your own research on the medication, research it and find out for yourself what it is and what it does.
- Ask for non-narcotic or other safe alternatives if you need medication.
- Ask for a small amount of the medication with no refills.
- Contact your sponsor and other members of your support group and inform them that you will be taking medications. Tell them what you have, how many you have and what the recommended dose is.
- Ask if you can dose in the office rather than take meds home.
- If you have to take drugs home ask for a 3-5 day prescription.
When you HAVE to take medications:
- Take only as prescribed.
- Stay in daily contact with several members of your support system and keep them current on your dosage and reactions.
- Consider giving the medication to a member of your support system who will be responsible to administer the medication you every day.
- Talk about it at meetings and other support functions.
- When the prescription says “Take as needed for pain or other symptoms”, monitor your symptoms and contact your support when you are not sure if you really need it.
- Stay in close contact with you doctor and comply with doctor’s orders.
- Be careful to not re-injure yourself so that you have to take more medications or for a longer period of time.
- Keep a journal and monitor your thoughts, feelings, cravings and actions.
- Report any concerning changes to members of your support system.
Once the need for the medication is over:
- Throw away any unused medications. Don’t save them in case you need them later.
- Inform your support system that you no longer need to take the medications.
- Share at meetings what issues came up for you while on the medications and how you managed you handled them.
In summary, the key to avoiding relapse is to advocate for your own recovery, be honest and open about your thoughts, feelings, urges and behaviors -- and most of all stay accountable. The biggest danger is going underground and not letting the key people in your support system know what’s going on. I have seen many addicts relapse, and some even die, because they were unwilling or unable to reach out and ask for help when they were struggling.