By: Peter Gannon, ARNP, MSN, BC – VP Medical Services – Board Certified Psychiatric Nurse Practitioner
What is a drug addict, who are they, and where do they come from? These questions have been the subject of research and debate for generations. We in the treatment community usually use the word addiction in relation to “a man or woman whose life is controlled by drugs and the finding of ways to get and use more.” We find a correlation between addiction and pathological behavior including lying, cheating, and stealing. In Narcotics Anonymous, the end results of addiction are believed to always be the same…jails, institutions, and death. Does everyone that is “addicted” to drugs fall into this terminal category.
In my 34 years as a nurse, I have seen and treated hundreds of individuals with substance abuse disorders. The degree of use, drug of abuse, and demographics of these individual patients vary from patient to patient. There seems to be very little rhyme or reason behind the cause or course of the individual’s illness. In an effort to provide care for these individuals, certain standards of treatment have been established. In most cases, the 12-Step model of treatment has been adopted. The fundamental issue with this model is the acceptance by the individual that they are an “addict”. Many patients have difficulty with this term because of the negative connotations associated with it. Denial also plays a major role in their unwillingness to accept the fact of who and what they are.
More and more, however, we are beginning to see a new type of addict for whom this term may be inappropriate. These individuals include those who are taking addictive medications as prescribed by their physicians, usually for pain or anxiety, but who have become chemically dependent upon these medications. These patients take the proper dose of the medication at the proper time and for the right reason. Narcotic medication being what it is, however, higher doses are eventually required to obtain a therapeutic result. Because of this, doses are usually increased to meet the demands of the presenting symptoms. As the dosage increases, so does the degree of dependency on the medication.
Chemical dependency shares several characteristics with true addiction. The development of tolerance (needing more of the drug to get the same effect) and withdrawal (a syndrome of distressing symptoms which occur when the drug is quickly tapered or abruptly discontinued) are the primary similarities between those with addiction and those who are chemically dependent. In most cases however, this is where the similarity ends. The psychosocial, economic, physical, and spiritual consequences usually manifested in true addiction are often absent in cases of chemical dependency.
Knowing this, however, treatment programs continue to categorize everyone as an “addict” and require the individual’s acceptance of this concept if they are to progress in their recovery. Is this thinking realistic or has it become obsolete? Why with our advanced understanding of substance abuse do we tend to cling onto old thoughts and ways of doing things? Are we actually helping and treating the individual in the way most appropriate for him or her?
I recently treated an older gentleman who had been taking large amounts of opiates for many years due to a true chronic pain condition of the cervical spine. Although his dosage of pain medication increased over the years, his compliance with regimen was always consistent and adherent. When he entered the detoxification program, he did so willingly and was very open minded . He also attended outpatient group therapy to help him explore his “addiction”. Although he found some of the group process beneficial, as it helped him to deal with other issues he had experienced in his life, he was totally unable to identify himself as an addict. Was this resistance or denial on his part? After much conferencing, staff came to the consensus that this individual’s condition was different and perhaps not as unique as we had first thought. As a result, it was decided that group therapy requiring an admission on the individual’s part, that they are an addict, was inappropriate for this man. A treatment of individual therapy focusing on other, more pertinent, psychosocial issues was provided to assist him in dealing with the stress, anxiety, and anger which aggregated his chronic pain. It was also determined that his degree of chronic was such that he was referred to a physician for very low dose Suboxone maintenance (2-4mg). This was a vast improvement over the 100 plus milligrams of Morphine Sulfate he was taking on a daily basis.
In order to treat the disease, we must treat the individual. No two people are the same nor are their conditions. The DSM-5 has now recognized this and the diagnosis of “addiction” has been replaced with that of Substance Use Disorder (SUD). This indicates that substance use occurs on a spectrum ranging from very mild to very severe. We in the Recovery field must recognize that our approach to the treatment of Substance Use Disorder must truly become individualized and accept the fact that chemical dependency is a separate entity which much be addressed with special sensitivity and measures for success.
About the author:
Peter Gannon, ARNP, MSN, BC – VP Medical Services, New Beginnings Recovery Center/ Board Certified Psychiatric Nurse Practitioner. Peter oversee all medical services at NBRC. You can reach him at 888-840-5189. The NBRC website is www.newbeginningsrecoveryctr.com
