Dealing with Substance Abuse

WebMD Live Events Transcript

Abuse of alcohol and drugs can cut a wide swath of damage across a life, affecting not only the user, but also friends and loved ones. Has your life has been altered by substance abuse? Our guest, David Rosenker, executive vice president of treatment services at the Caron Foundation, joined us on April 22, 2004 to discuss the physical and emotional toll, as well as the hope found in treatment.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
How do you know when use has turned to abuse?

ROSENKER:
That's a very good question. There is no very clear line from abuse to addiction for most people. There's no yellow line we can all see that determines that somebody's gone from use to dependency. You don't wake up one day and say yesterday I abused chemicals and today I'm dependent.

The most common signals that somebody's in trouble with their use would include a general loss of control performing behaviors you would not normally do when you're not under the influence, blackouts, concerns from other persons, family members, and job issues. Those are the most common ones.

MODERATOR:
Perhaps we should define "substance" when we are talking about abuse. What do you include -- illegal drugs, alcohol, prescription medicines, cigarettes?

ROSENKER:
When we talk about substance abuse we typically are talking about mood-altering chemicals. There's a distinction between drugs such as antidepressants, which moderate your mood, they're not in the same category as drugs of abuse, such as alcohol, marijuana, pain pills, anti-anxiety drugs.

When it comes to tobacco, it's certainly addictive, but it does not fall into the category of a mood-altering chemical, except when someone's trying to quit.

MODERATOR:
What is the first step you would take if you feel that a family member is abusing a substance?

ROSENKER:
There are a couple of steps. The first is to contact somebody who is familiar with addiction or substance abuse. It could be a counseling agency, it may be school personnel, it may be a psychologist, or could even be a family physician. But to make sure they have a significant amount of information about addiction. After contacting them the first step is to get an evaluation done to determine the scope of the abuse or addiction.

"The most important people to help when the family is affected by addiction are the family members. Oftentimes the alcoholic or addicted person will not get help until the family does."

MODERATOR:
What's the difference between abuse and addiction?

ROSENKER:
The most significant differentiation between abuse and addiction, abuse tends to be occasional, harmful consequences followed by reduced use. Addiction tends to be harmful consequences as a result of use and you see no decrease in the pattern of use and an increase in consequences in addition to many other behavioral signs, depending on the age population.

MEMBER QUESTION:
My husband used alcohol and pot. I'm worried that my son may fall into the same pattern, even though his dad is no longer part of our lives. Is this a valid concern?

ROSENKER:
There has been ample research and studies done to prove there is a genetic link with alcoholism and substance abuse. The fact the father is not in the picture any more does not diminish his impact on members of the family, specifically children. Anybody who lives in an alcoholic household for any period of time while there was an active or inactive abuser has the potential to abuse in the future.

Although there are no guarantees, again there's some things to be aware of. His using style, his school behavior, his general personality, his social relationships, and overall risky type of behaviors that he may exhibit will be things that you need to be concerned about.

MEMBER QUESTION:
My husband has used marijuana for years. He has always been a responsible member of the family and community. He says he is not addicted, but he still smokes. Is his a case of abuse not addiction?

ROSENKER:
Although I would never venture to evaluate somebody's addiction over this type of circumstance, I would venture to have you ask yourself two questions:

  • Does it bother our relationship?
  • Does it interfere with our relationship?

And if so, then it's a problem, not necessarily an addiction, but certainly a problem that needs to be dealt with.

MEMBER QUESTION:
I am concerned about my son (15 years old). How do I best approach him with my suspicions about his drinking?

ROSENKER:
The best way to approach adolescents with concerns about their drinking is with honesty and face-to-face communication. I would encourage you to involve anyone else in the family who has similar concerns and/or his school. Sit down with your son face-to-face. Share your concerns in a non lecturing, non judgmental framework. And encourage him to get an evaluation to determine the extent of his abuse.

MEMBER QUESTION:
We have always talked to our kids very openly about drugs and alcohol. But both of them use pot and do some drinking. Where did we go wrong?

ROSENKER:
You didn't go wrong, is the most important point. Adolescent drug and alcohol use is not necessarily a reflection of your parenting ability.

Hence, it doesn't mean you're a good parent or bad parent. It's important to continue to give the same consistent messages about your family values to your kids and enforcing consequences when their behavior does not match your values, but not taking it internally that it's your fault.

MEMBER QUESTION:
What are your thoughts on methadone treatment?

ROSENKER:
I believe methadone treatment for some heroin abusers is very effective. Similar to other forms of drug and alcohol treatment, I don't believe there is one way to treat everybody.

MEMBER QUESTION:
This is my last hope to save my family. My wife and I have been married for a little more than seven years and we have a 4-year-old son. For about three years now, her sex drive has been on a steady decrease. Today it is close to zero. We've done the marriage counseling thing and were separated for awhile but I always keep coming back and doing whatever it takes to "save" our marriage. I have come to the point of not knowing if I want to still love her or if it is all just for our son. Our situation, however, is different. She has been a regular user of meth since I've known her except for the period of her pregnancy (and she really did stay clean during that time) but started up again to "lose some weight." She refuses to admit her addiction but she will always make the speed a priority over helping to find a solution to my unhappiness. So, once again, I am searching for answers by myself. How can I get her to admit there is a problem so that we can begin trying to fix it?

ROSENKER:
I think most importantly, it's not your fault and not your son's fault. It sounds as though your wife is very harmfully involved, if not addicted, to meth. It also sounds like the majority of the problems you're describing are directly related to her substance abuse. You may not be able to fix this.

What you can do are a couple things: For one, you can get help for yourself and your son either by contacting a family therapist, getting involved in Al-Anon or other support groups, or contacting a nearby drug and alcohol treatment facility for drug and alcohol support groups in your area.

The second thing you can do is to contact a local facility for names for a possible interventionist. This is somebody who will be able to help you design an intervention strategy to intervene on your wife, knowing the ultimate goal is you and your son first getting help, then your wife, because she may choose to never be drug-free.

MEMBER QUESTION:
Is Al-Anon good for parents of kids who abuse or only for kids who have parents that use?

ROSENKER:
There are many different types of Al-Anon groups out there. They all have their own personality and makeup of attendees. Some are specifically for parents of adolescents; some are made up of older spouses of adult male alcoholics; and some are a combination of all. Contact your local AA Inter group for a listing of meetings in your area, and try various ones until you find a group that fits for you.

MEMBER QUESTION:
Does it help to hide the bottles if he won't stop drinking? I just keep throwing them away.

ROSENKER:
In short, no, it doesn't help. Similar to a previous response, the most important people to help when the family is affected by addiction are the family members. Oftentimes the alcoholic or addicted person will not get help until the family does. Hiding substances, making excuses for their behavior, calling in sick for them, only serves to enable their addiction process to continue. It's important to learn skills that you can receive through attendance at Al-Anon to help you stop some of these enabling behaviors. Again, you can't fix it or stop it, nor are you responsible.

"I understand your reluctance to tell your family, but you've got to let somebody in, because you can't do it alone."

MEMBER QUESTION:
How does a person get off from hydrocodone after being on it for more than 12 years?

ROSENKER:
The medication that you're speaking of has a difficult withdrawal process. If taken by mouth the withdrawal process is less intense and you should be detoxed medically in a drug and alcohol detoxification facility only. If snorted, the detoxification is much more intense, and again, needs to be done only at a drug and alcohol detoxification facility. Withdrawal from this medication is not something you can do "cold turkey" you need help from a detox facility.

MEMBER QUESTION:
I think I may be addicted to painkillers. I know for a fact that I cannot afford to go to some clinic to get help. What are my options? I know that in a matter of weeks I will not be able to get any more painkillers. What kind of withdrawals can I expect emotionally and physically? Take into account that I will be alone in this because I cannot bear to tell anyone. My dad and grandfather are both addicts to nicotine, alcohol, and painkillers. Do I stand a chance? I really can't even think of a good reason why I started taking pills. I know it happened after I had my baby. The doctor prescribed me the painkillers. Then two weeks later I had back surgery and that doctor prescribed the same medication and I haven't stopped yet. It's been 1.5 years now. I want to stop and like I said in a few weeks I won't have any choice. In a way I'm looking forward to it because I know the access to the drug won't be available but at the same time I'm scared of what my reaction to not having the drug is going to be. Can you offer some suggestions?

ROSENKER:
To begin with, as much as you would like to do this on your own, it is not recommended. If you cannot afford it and do not want to enter a detox facility, then get hooked up with a Narcotics Anonymous or AA meeting in your area. They can help you through the emotional and physical withdrawal you're going to experience. Withdrawal from pain medication is often times long-term and painful and very anxiety producing. Although you realize you don't have access to any other pain medication, your chances of using other drugs, including alcohol, to help with the detox, will only hinder the process.

I understand your reluctance to tell your family, but you've got to let somebody in, because you can't do it alone. The withdrawal process will be difficult physically and emotionally and even though you may think nobody knows what's going on, I will guarantee you that others will know something's happening just by your behavior alone very soon, if not already.

MEMBER QUESTION:
My brother and his wife use pot and have two teenagers that are now starting to experiment. Their daughter Jenn, age 13, came to me recently and I had an opportunity to talk with her about the harmful effects of drugs etc. but when it's so openly done in the household and the parents have the idea if the kids are doing it at home they aren't getting it from anywhere else. I grew up in the same environment and I've since realized the horrible effects addictions have caused. Any ideas in talking to them both and helping them not follow in the same footsteps?

ROSENKER:
What you're observing is one of the most common parental epidemics that we're seeing today. A number of years ago parents would ask the same question you're asking, but only with alcohol. Parents today are coming from a generation where there was more drug and alcohol use than anytime in the history of the U.S.

So in turn, the attitudes they have about substances such as alcohol and marijuana are very different. They're much more lenient, reluctant to set limits, and see marijuana use no differently than drinking a beer after a football game. Attempting to convince them of anything different will more than likely be fruitless. I would encourage you as a family member to be available, continue to give upfront, accurate information, and to realize at some point in time, when these kids want to talk or end up in trouble, that they will come to you.

MEMBER QUESTION:
What if recreational cocaine use has turned addictive?

ROSENKER:
First of all, it's highly improbable that somebody can use cocaine on a recreational basis at any time of his or her life. The term recreational means the use is approved and accepted socially. I am not aware of anywhere in the U.S. that social, obvious cocaine use is accepted. Just by the nature of the chemical, it doesn't lend itself to be recreational. Crossing the line to abuse and addiction is very quick.

MODERATOR:
What trends are you seeing in adolescent drug use today?

ROSENKER:
The most common trend that we're seeing today is alcohol is still the No. 1 drug of choice. It's the most widely accepted and easily obtained, and as discussed earlier, seen by parents as an "OK" drug. The other most significant trends that we're seeing are abuse of pain medication, ecstasy, amphetamines, marijuana, and acid. Not necessarily in that order. In addition, many kids today are abusing and reselling some of their ADHD medications that are prescribed for that particular condition.

MODERATOR:
Is there any correlation between teens who have ADHD and increased drug use?

ROSENKER:
At this point there is no research that is clearly making the link between early onset addiction and kids that are on ADHD medication, which are called psycho-stimulants. Correlations appear to be society in general as a pill-taking, fix-me society. Not only as parents do we want our anxieties, pain, and moods changed at a moment's notice, we want our kids' behavior, moods, and feelings changed in a moment's notice, all of which has made our society an incredibly drug-using society. Many of the kids that we see in treatment, 65% of them come in diagnosed with some other type of co-morbid concern and on some type of medication for such.

MODERATOR:
Do school drug deterrent programs work? Do we have evidence that things such as the DARE program, aimed at middle school students, reduces drug use in teens?

ROSENKER:
The DARE program came up with information approximately two years ago showing they were not receiving results they wanted to, along with many other prevention programs. Since that time the DARE program has been retooled and taken back out into the community. My understanding is that there's not enough time that has gone by to document its effectiveness.

Although there are some prevention programs out there that are research based, such as Life Skills , by Dr. Botvin, which have shown to be very effective, this problem cannot be solved by a prevention program alone. It's a society/parent/community-wide problem that will take a unified approach and is not up to the schools to fix.

MEMBER QUESTION:
I'm concerned about what happens when my son goes off to college. He's been using pot and beer. We've clamped down on him, but when he goes off to college, what will happen? He doesn't control himself.

ROSENKER:
Kids that go off to college that are already experimenting with substances more than likely will continue to do such in college.

It will be important, as parents, to set limits around your support for college based on grades and college attendance versus behavior. This is where an adolescent turns into an adult, and it will be important for you to enforce adult consequences. If he continues to use and his grades drop and his school performance decreases, then that should be reflected in your financial support, not your love.

It will be also important to state very clearly the ground rules prior to going off to college as far as your expectations regarding grades and performance. His behavior and drug and alcohol use is not something you'll be able to control.

"Not only as parents do we want our anxieties, pain, and moods changed at a moment's notice, we want our kids' behavior, moods, and feelings changed in a moment's notice, all of which has made our society an incredibly drug-using society."

MEMBER QUESTION:
My sister drinks. She thinks no one notices but I do. She's gotten worse since her children grew up and she divorced. What can I do to make her see she has a problem?

ROSENKER:
The most effective way to help somebody see that they have a problem with their substance abuse is for one, for family members to stop enabling, such as making excuses, paying bills, covering up consequences. Also understanding that as a family member, you can't make somebody see they have a problem on your own, without multiple family members or concerned persons sharing the same information at the same time.

In addition, it's helpful to present your information in a loving, caring, nonjudgmental manner, which can be at times very difficult when you're emotionally invested. This is where asking for outside help, such as an interventionist, is helpful.

It's also important for everyone that has a family member addicted or abusing to keep in mind that some people will decide never to get help. Most often people get help as a result of internal and external consequences directly related to their substance abuse, such as legal problems, school problems, family members discontinuing financial support, employer problems, and internal emotional psychiatric problems. There is a myth that people that have a problem with substance abuse have to be willing to get help. In fact, what's true is they have to be motivated to be willing to get help. And that's done by not enabling and raising the level of consequences they're experiencing.

MEMBER QUESTION:
How does a recovering addict -- clean for 12 years -- avoid becoming addicted to pain relief medication needed for ongoing physical disabilities after other avenues of pain relief are ineffective?

ROSENKER:
That's a very common and complicated question. It's also very personal. First of all, pain is very subjective. What's painful to you may not be painful for me. We all have our levels of tolerance so that makes it difficult to go to a support meeting or to friends at times and to say, "I need to do this for my level of pain, despite my recovery." Most often their reaction is you should never ever use any pain medication if you're in recovery. That is also a myth. There are times when that may be the only alternative. The important actions or steps to keep in mind are:

  • Maintaining your connection with your sponsor; increase attendance at AA.
  • Connection with a physician who is very familiar with your addiction background.
  • Including your family and close friends in this decision and asking for their help in monitoring your behavior, understanding that others will see it as problematic before you do.

Above all, be honest with your level of pain, which is very difficult to do if the line gets crossed from using for pain only or to feel good, so to speak.

The more people you involve in this process and are aware of what you're doing, the less "secretive" it becomes. I would continue to ask questions. Continue to ask yourself daily, "do I need this today," and continue to monitor how long you end up using the pain medication. This issue has become the most common reason for relapse today.

MEMBER QUESTION:
I'm interested in knowing why nicotine addiction is not addressed more fully in treatment facilities. I understand withdrawal from it likened to withdrawal from heroin. Why isn't nicotine addiction addressed more fully in treatment centers?

ROSENKER:
You're exactly right. Addiction to tobacco is an issue that for many treatment centers, we have long avoided. Most of the current research shows that the belief that you can't stop everything at the same time is false. In fact, it's highly recommended that it is easier to stop all substances, including tobacco, during the treatment process. There is also additional research that shows continued tobacco use, for some, hinders recovery. There are a lot of links between addiction and tobacco addiction and depression. Many treatment centers today are attempting to integrate methods and processes for people to also give up tobacco while they're in drug and alcohol treatment. It is a long-term battle and most often need to fight the myth that you can't do it at the same time. But I agree that it is definitely possible.

MODERATOR:
We are almost out of time, David. Do you have any final words for us?

ROSENKER:
You can feel free to contact Caron Foundation's web site; the address is caron.org. Though there are many different avenues you can get information and help. In addition, there is a parent network on our web site where parents can ask questions of other parents that have had kids in treatment. Also on our web site are links to other treatment facilities and other drug and alcohol sites where they can get additional information, including interventionists. Most importantly, be informed, read up about this destructive illness, and ask for help, whether you are a family member, spouse, child, or addict yourself. You are not alone, nor is it your fault.

MODERATOR:
David Rosenker, thank you for sharing your expertise with us. Members, for more information please visit the Caron Foundation online at www.caron.org.

MEMBER QUESTION:
How does a recovering addict -- clean for 12 years -- avoid becoming addicted to pain relief medication needed for ongoing physical disabilities after other avenues of pain relief are ineffective?

ROSENKER:
That's a very common and complicated question. It's also very personal. First of all, pain is very subjective. What's painful to you may not be painful for me. We all have our levels of tolerance so that makes it difficult to go to a support meeting or to friends at times and to say, "I need to do this for my level of pain, despite my recovery." Most often their reaction is you should never ever use any pain medication if you're in recovery. That is also a myth. There are times when that may be the only alternative. The important actions or steps to keep in mind are:

  • Maintaining your connection with your sponsor; increase attendance at AA.
  • Connection with a physician who is very familiar with your addiction background.
  • Including your family and close friends in this decision and asking for their help in monitoring your behavior, understanding that others will see it as problematic before you do.

Above all, be honest with your level of pain, which is very difficult to do if the line gets crossed from using for pain only or to feel good, so to speak.

The more people you involve in this process and are aware of what you're doing, the less "secretive" it becomes. I would continue to ask questions. Continue to ask yourself daily, "do I need this today," and continue to monitor how long you end up using the pain medication. This issue has become the most common reason for relapse today.

MEMBER QUESTION:
I'm interested in knowing why nicotine addiction is not addressed more fully in treatment facilities. I understand withdrawal from it likened to withdrawal from heroin. Why isn't nicotine addiction addressed more fully in treatment centers?

ROSENKER:
You're exactly right. Addiction to tobacco is an issue that for many treatment centers, we have long avoided. Most of the current research shows that the belief that you can't stop everything at the same time is false. In fact, it's highly recommended that it is easier to stop all substances, including tobacco, during the treatment process. There is also additional research that shows continued tobacco use, for some, hinders recovery. There are a lot of links between addiction and tobacco addiction and depression. Many treatment centers today are attempting to integrate methods and processes for people to also give up tobacco while they're in drug and alcohol treatment. It is a long-term battle and most often need to fight the myth that you can't do it at the same time. But I agree that it is definitely possible.

MODERATOR:
We are almost out of time, David. Do you have any final words for us?

ROSENKER:
You can feel free to contact Caron Foundation's web site; the address is caron.org. Though there are many different avenues you can get information and help. In addition, there is a parent network on our web site where parents can ask questions of other parents that have had kids in treatment. Also on our web site are links to other treatment facilities and other drug and alcohol sites where they can get additional information, including interventionists. Most importantly, be informed, read up about this destructive illness, and ask for help, whether you are a family member, spouse, child, or addict yourself. You are not alone, nor is it your fault.

MODERATOR:
David Rosenker, thank you for sharing your expertise with us. Members, for more information please visit the Caron Foundation online at www.caron.org.

MEMBER QUESTION:
How does a recovering addict -- clean for 12 years -- avoid becoming addicted to pain relief medication needed for ongoing physical disabilities after other avenues of pain relief are ineffective?

ROSENKER:
That's a very common and complicated question. It's also very personal. First of all, pain is very subjective. What's painful to you may not be painful for me. We all have our levels of tolerance so that makes it difficult to go to a support meeting or to friends at times and to say, "I need to do this for my level of pain, despite my recovery." Most often their reaction is you should never ever use any pain medication if you're in recovery. That is also a myth. There are times when that may be the only alternative. The important actions or steps to keep in mind are:

  • Maintaining your connection with your sponsor; increase attendance at AA.
  • Connection with a physician who is very familiar with your addiction background.
  • Including your family and close friends in this decision and asking for their help in monitoring your behavior, understanding that others will see it as problematic before you do.

Above all, be honest with your level of pain, which is very difficult to do if the line gets crossed from using for pain only or to feel good, so to speak.

The more people you involve in this process and are aware of what you're doing, the less "secretive" it becomes. I would continue to ask questions. Continue to ask yourself daily, "do I need this today," and continue to monitor how long you end up using the pain medication. This issue has become the most common reason for relapse today.

MEMBER QUESTION:
I'm interested in knowing why nicotine addiction is not addressed more fully in treatment facilities. I understand withdrawal from it likened to withdrawal from heroin. Why isn't nicotine addiction addressed more fully in treatment centers?

ROSENKER:
You're exactly right. Addiction to tobacco is an issue that for many treatment centers, we have long avoided. Most of the current research shows that the belief that you can't stop everything at the same time is false. In fact, it's highly recommended that it is easier to stop all substances, including tobacco, during the treatment process. There is also additional research that shows continued tobacco use, for some, hinders recovery. There are a lot of links between addiction and tobacco addiction and depression. Many treatment centers today are attempting to integrate methods and processes for people to also give up tobacco while they're in drug and alcohol treatment. It is a long-term battle and most often need to fight the myth that you can't do it at the same time. But I agree that it is definitely possible.

MODERATOR:
We are almost out of time, David. Do you have any final words for us?

ROSENKER:
You can feel free to contact Caron Foundation's web site; the address is caron.org. Though there are many different avenues you can get information and help. In addition, there is a parent network on our web site where parents can ask questions of other parents that have had kids in treatment. Also on our web site are links to other treatment facilities and other drug and alcohol sites where they can get additional information, including interventionists. Most importantly, be informed, read up about this destructive illness, and ask for help, whether you are a family member, spouse, child, or addict yourself. You are not alone, nor is it your fault.

MODERATOR:
David Rosenker, thank you for sharing your expertise with us. Members, for more information please visit the Caron Foundation online at www.caron.org.

MEMBER QUESTION:
How does a recovering addict -- clean for 12 years -- avoid becoming addicted to pain relief medication needed for ongoing physical disabilities after other avenues of pain relief are ineffective?

ROSENKER:
That's a very common and complicated question. It's also very personal. First of all, pain is very subjective. What's painful to you may not be painful for me. We all have our levels of tolerance so that makes it difficult to go to a support meeting or to friends at times and to say, "I need to do this for my level of pain, despite my recovery." Most often their reaction is you should never ever use any pain medication if you're in recovery. That is also a myth. There are times when that may be the only alternative. The important actions or steps to keep in mind are:

  • Maintaining your connection with your sponsor; increase attendance at AA.
  • Connection with a physician who is very familiar with your addiction background.
  • Including your family and close friends in this decision and asking for their help in monitoring your behavior, understanding that others will see it as problematic before you do.

Above all, be honest with your level of pain, which is very difficult to do if the line gets crossed from using for pain only or to feel good, so to speak.

The more people you involve in this process and are aware of what you're doing, the less "secretive" it becomes. I would continue to ask questions. Continue to ask yourself daily, "do I need this today," and continue to monitor how long you end up using the pain medication. This issue has become the most common reason for relapse today.

MEMBER QUESTION:
I'm interested in knowing why nicotine addiction is not addressed more fully in treatment facilities. I understand withdrawal from it likened to withdrawal from heroin. Why isn't nicotine addiction addressed more fully in treatment centers?

ROSENKER:
You're exactly right. Addiction to tobacco is an issue that for many treatment centers, we have long avoided. Most of the current research shows that the belief that you can't stop everything at the same time is false. In fact, it's highly recommended that it is easier to stop all substances, including tobacco, during the treatment process. There is also additional research that shows continued tobacco use, for some, hinders recovery. There are a lot of links between addiction and tobacco addiction and depression. Many treatment centers today are attempting to integrate methods and processes for people to also give up tobacco while they're in drug and alcohol treatment. It is a long-term battle and most often need to fight the myth that you can't do it at the same time. But I agree that it is definitely possible.

MODERATOR:
We are almost out of time, David. Do you have any final words for us?

ROSENKER:
You can feel free to contact Caron Foundation's web site; the address is caron.org. Though there are many different avenues you can get information and help. In addition, there is a parent network on our web site where parents can ask questions of other parents that have had kids in treatment. Also on our web site are links to other treatment facilities and other drug and alcohol sites where they can get additional information, including interventionists. Most importantly, be informed, read up about this destructive illness, and ask for help, whether you are a family member, spouse, child, or addict yourself. You are not alone, nor is it your fault.

MODERATOR:
David Rosenker, thank you for sharing your expertise with us. Members, for more information please visit the Caron Foundation online at www.caron.org.

MEMBER QUESTION:
How does a recovering addict -- clean for 12 years -- avoid becoming addicted to pain relief medication needed for ongoing physical disabilities after other avenues of pain relief are ineffective?

ROSENKER:
That's a very common and complicated question. It's also very personal. First of all, pain is very subjective. What's painful to you may not be painful for me. We all have our levels of tolerance so that makes it difficult to go to a support meeting or to friends at times and to say, "I need to do this for my level of pain, despite my recovery." Most often their reaction is you should never ever use any pain medication if you're in recovery. That is also a myth. There are times when that may be the only alternative. The important actions or steps to keep in mind are:

  • Maintaining your connection with your sponsor; increase attendance at AA.
  • Connection with a physician who is very familiar with your addiction background.
  • Including your family and close friends in this decision and asking for their help in monitoring your behavior, understanding that others will see it as problematic before you do.

Above all, be honest with your level of pain, which is very difficult to do if the line gets crossed from using for pain only or to feel good, so to speak.

The more people you involve in this process and are aware of what you're doing, the less "secretive" it becomes. I would continue to ask questions. Continue to ask yourself daily, "do I need this today," and continue to monitor how long you end up using the pain medication. This issue has become the most common reason for relapse today.

MEMBER QUESTION:
I'm interested in knowing why nicotine addiction is not addressed more fully in treatment facilities. I understand withdrawal from it likened to withdrawal from heroin. Why isn't nicotine addiction addressed more fully in treatment centers?

ROSENKER:
You're exactly right. Addiction to tobacco is an issue that for many treatment centers, we have long avoided. Most of the current research shows that the belief that you can't stop everything at the same time is false. In fact, it's highly recommended that it is easier to stop all substances, including tobacco, during the treatment process. There is also additional research that shows continued tobacco use, for some, hinders recovery. There are a lot of links between addiction and tobacco addiction and depression. Many treatment centers today are attempting to integrate methods and processes for people to also give up tobacco while they're in drug and alcohol treatment. It is a long-term battle and most often need to fight the myth that you can't do it at the same time. But I agree that it is definitely possible.

MODERATOR:
We are almost out of time, David. Do you have any final words for us?

ROSENKER:
You can feel free to contact Caron Foundation's web site; the address is caron.org. Though there are many different avenues you can get information and help. In addition, there is a parent network on our web site where parents can ask questions of other parents that have had kids in treatment. Also on our web site are links to other treatment facilities and other drug and alcohol sites where they can get additional information, including interventionists. Most importantly, be informed, read up about this destructive illness, and ask for help, whether you are a family member, spouse, child, or addict yourself. You are not alone, nor is it your fault.

MODERATOR:
David Rosenker, thank you for sharing your expertise with us. Members, for more information please visit the Caron Foundation online at www.caron.org.

MEMBER QUESTION:
How does a recovering addict -- clean for 12 years -- avoid becoming addicted to pain relief medication needed for ongoing physical disabilities after other avenues of pain relief are ineffective?

ROSENKER:
That's a very common and complicated question. It's also very personal. First of all, pain is very subjective. What's painful to you may not be painful for me. We all have our levels of tolerance so that makes it difficult to go to a support meeting or to friends at times and to say, "I need to do this for my level of pain, despite my recovery." Most often their reaction is you should never ever use any pain medication if you're in recovery. That is also a myth. There are times when that may be the only alternative. The important actions or steps to keep in mind are:

  • Maintaining your connection with your sponsor; increase attendance at AA.
  • Connection with a physician who is very familiar with your addiction background.
  • Including your family and close friends in this decision and asking for their help in monitoring your behavior, understanding that others will see it as problematic before you do.

Above all, be honest with your level of pain, which is very difficult to do if the line gets crossed from using for pain only or to feel good, so to speak.

The more people you involve in this process and are aware of what you're doing, the less "secretive" it becomes. I would continue to ask questions. Continue to ask yourself daily, "do I need this today," and continue to monitor how long you end up using the pain medication. This issue has become the most common reason for relapse today.

MEMBER QUESTION:
I'm interested in knowing why nicotine addiction is not addressed more fully in treatment facilities. I understand withdrawal from it likened to withdrawal from heroin. Why isn't nicotine addiction addressed more fully in treatment centers?

ROSENKER:
You're exactly right. Addiction to tobacco is an issue that for many treatment centers, we have long avoided. Most of the current research shows that the belief that you can't stop everything at the same time is false. In fact, it's highly recommended that it is easier to stop all substances, including tobacco, during the treatment process. There is also additional research that shows continued tobacco use, for some, hinders recovery. There are a lot of links between addiction and tobacco addiction and depression. Many treatment centers today are attempting to integrate methods and processes for people to also give up tobacco while they're in drug and alcohol treatment. It is a long-term battle and most often need to fight the myth that you can't do it at the same time. But I agree that it is definitely possible.

MODERATOR:
We are almost out of time, David. Do you have any final words for us?

ROSENKER:
You can feel free to contact Caron Foundation's web site; the address is caron.org. Though there are many different avenues you can get information and help. In addition, there is a parent network on our web site where parents can ask questions of other parents that have had kids in treatment. Also on our web site are links to other treatment facilities and other drug and alcohol sites where they can get additional information, including interventionists. Most importantly, be informed, read up about this destructive illness, and ask for help, whether you are a family member, spouse, child, or addict yourself. You are not alone, nor is it your fault.

MODERATOR:
David Rosenker, thank you for sharing your expertise with us. Members, for more information please visit the Caron Foundation online at www.caron.org.



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