One of the problems that I see frequently is patients with cross addiction, specifically those who are also being given “legitimate” prescription medications such as stimulants, benzodiazepines and opiates for bona fide symptoms. There is no doubt that all of the classes of medications mentioned above are useful for various conditions. In other words, stimulants such as amphetamines help people who actually have ADHD, benzodiazepines help with muscle relaxation and anxiety, and opiates relieve pain.
If you have the disease of addiction, however, these medications stimulate the part of the brain that regulates addiction and addictive behavior. The dopamine dysregulation in the limbic system of the brain seen in addiction is not able to tell the difference between addictive drugs. Therefore, if someone who has addiction is given another addictive drug for whatever reason, the individual with addiction is being set up for relapse into their drug of choice.
This concept of “a prescribed medication leading to relapse” is very controversial with many individuals and physicians, largely based on belief systems rather than hard data. For instance, this morning I was talking with a patient who relapsed on alcohol. On getting more data, the patient was given opiate pain medication for a back condition. Although taking it as prescribed, I believe, although I will never be able to prove, that the opiate prescription had a lot to do with the alcohol relapse. We have to figure out a way to help him with his pain and his alcoholism. If possible, accomplish this without the use of opiates.
Another problem that I frequently encounter is anxious patients who have been given benzodiazepines by well-meaning physicians to people who have alcoholism. This rarely ends well. The person gets some relief from anxiety but relapses into alcohol use. Since benzodiazepines hit the same type of brain receptors as alcohol, the person is triggered into alcohol use. In my mind, this is an unnecessary risk for alcoholic patients with anxiety.
Non-addictive substitutes need to be found for these patients.
Since I am not in charge of anyone else’s prescribing but my own, I can only make observations. But there are a whole lot of medications being prescribed that are not good for people with addiction. If you are someone with addiction or know someone with addiction, I suggest that great care be given to accepting prescriptions without a thorough understanding of what the possible ramifications are for someone with the problem of addiction.
Once again, I want to put in the disclaimer that I am not saying that someone with addiction should not be given adequate pain medications. I am saying that all medications have to be taken with the realization that intensive monitoring may be needed if someone has to be exposed to addictive medications.
Joseph Troncale, MD is Retreat’s Medical Director. He is both a fellow and a member of the American Society of Addiction Medicine (ASAM) and was named Outstanding Clinician by Addiction Magazine in 2010. He has publications in journals such as The Journal of Addictive Diseases and other peer-reviewed journals.