Sickle Cell and Overcoming Addiction

This is the second part of the series, read the first part HERE. So now that we know what isn’t addiction…the next question is: what is?

Once again I will rely on the combined definition of the American Pain and Addiction organizations.

Addiction is a primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations.

Addiction is characterized by at least one of the following behaviors: impaired control over drug use, compulsive use, continued use despite harm, and cravings.

I struggled for a long time with believing that by taking opiates, I was subjecting myself to become an addict. I actually spoke to a pain specialist about my concerns and she told me one thing that has stuck with me through this day.

Do you feel pain when you use your pain medication? If you are having pain, then you are not addicted. You cross the line when you start to take pain medicine AND YOU HAVE NO PAIN AT ALL.

So, if you feel that you might be teetering on the brink of addiction what do you do?

For a week, keep a pain diary. This will help you chronicle your pain. Document how much pain you are having, what type of pain it is, what time it started, where it is, what time it stopped, and what you did to control the pain. At the end of the week, look at your pain diary. Are you using your pain meds appropriately? Do you try alternative therapies like rest, hydration, distraction, massage etc. before you reach for the narcotic? Are you using Motrin or Tylenol for lower levels of pain?

The pain diary is to help you notice your bad patterns and hopefully break them. Continue with the diary for another week, and this time, try to manage your pain better. Compare the two weeks, and see if there is any change to your pain methodology.

If you notice that you are still taking opiates all the time, with no rhyme or reason, even when you are not in pain…then honey, you might be addicted.

How Do You Overcome Narcotic Addiction?

Keep a pain diary. In your pain diary, write how you are feeling when you take your pain pills. Are you depressed, anxious, angry, bored, tired or lonely? Are you using pain meds to manage stress, or to fall asleep? Find out what your triggers are for using the pain meds…and then, find an adjunct therapy for it instead. For example, if you use pain meds when you can’t sleep—try to create a sleep routine which may include a lavender bath, some warm milk, a book, soft lighting at night, and some relaxation before bed. Try some melatonin. Find some other way to go to sleep besides a pill of Percocet. The same thing goes for other reasons…like if you use pain meds when you are sad, angry, anxious etc. You have to explore other coping strategies for your emotions, moods, and life stressors. Most people that overuse narcotics have issues with depression and anxiety.

Lean on your support system. Your family, significant others and friends can be a great source of help and support during this time as you are trying to kick the habit. It might be nervewracking to admit your addiction to your friends and family, but it needs to be done to ensure that you have some help. Pick 1 or 2 people that you are closest to. Share with them your struggles and ask that they help you overcome. Use them as your sounding board and verbalize your stressors, emotions or triggers that make you want to reach for the opiate. Let yourself be accountable to them ie. have goals and let them help you celebrate and keep those goals. For example, you can say that you want to go 3 days without using a narcotic unnecessarily. Increase this to 7 days, then 10 days until it becomes a habit. When you hit each milestone, celebrate with your support system.

Involve your doctor or pain specialist into your treatment. Once you have a support system in place, now it’s time to tell your doctor.  The conversation can be something like this, “Dr. Zane, I think I may be over-using my pain medication. Can you help me come up with a plan to control this and prevent or stop addiction?” Hopefully, your doctor will be cool and will be supportive.

Tell your doctor that you want a pain contract. Most physicians’ that prescribe opiates have a pain contract around. This contract is a promise between you and your doctor. It usually states that you will not get drugs from another physician, you will not use illicit drugs, and you will follow your pain treatment plan. It’s important that you agree and even help come up with some of the rules in your pain contract because it’s something that you have to be comfortable with. Your doctor is your partner in this contract, but you are the one primarily responsible and accountable for your actions in upholding the terms of the contract. The contract is a promise to yourself that you want to stop overusing pain medications unnecessarily. I can tell you from previous experience, doctors really frown on patients who break their pain contract. Some patients with broken contracts often find themselves treated worse than if they never had a contract at all. If you feel that you cannot uphold the terms, don’t agree to it, and don’t sign it until you are able to do so. Do not enter into this lightly.

Start your Treatment Plan. Some doctors might want to immediately start you on Methadone, however, not everyone that is addicted needs to go on Methadone. Methadone is a long-acting opiate agonist, which means that it doesn’t give you the high that most other narcotics give you. Methadone is to help curb cravings. You can be on Methadone even when you are taking other narcotics. I will write a drug summary on Methadone and link it back to this post HERE. In most addiction treatment plans, doctors avoid the use of IV pain medications and stick only to oral pills. This can be nerve-wracking for sickle cell because if you do get into a crisis, you will have to wait the extra 30-45 minutes that it takes the oral pain meds to kick in. The important part is that you don’t want your pain to get to that level.

Most treatment plans include long-acting pain meds like Oxycontin and MS Contin, with short-acting meds used just for breakthrough pain. Make sure your doctor has you on the right dose to start out with, remember, you are also tolerant. So he might have to prescribe a higher dosage than he would for an average patient.  [stextbox id=”alert”]Just because you are dealing with addiction does not mean you should be in pain. [/stextbox]Your doctor will limit the number of pills he prescribes, and you have to see him at regular intervals to get a refill on your prescription. You might also have random urine drug tests administered to make sure you are sticking to the pain plan and not using illicit drugs.

Talk to a counselor. You need a neutral party to talk to during this process. Engage the services of a psychologist, life coach or counselor. Since most people that are addicted often deal with depression and anxiety, these two issues must be addressed in your couseling sessions. Be open to the process, and don’t be ashamed that you are seeing a therapist. You can learn so much about yourself and your relationships. You might be carrying around baggage from your childhood, previous relationships or even current relationships that you have not addressed. These issues might be blocking you from being in a calm space. Addressing these concerns will help you grow as a human being and transcend your current paradigm.

Find your spiritual center. Whether it’s church, meditation, yoga. music or just  quiet time, find a way to connect to your spiritual center. You need to find that still, small voice within that you can go to in times of crisis.

Set realistic goals for yourself. You are not just going to get better all of a sudden. It took a while to become addicted, and it is going to take a while to get out of it. Celebrate your victories, both small and little. Don’t get discouraged if you do have a set back, just pick yourself up warrior, and try again. Don’t substitute one addiction with another ie. alcohol, cigarettes etc. The goal of  this process is to get you off all substances that are unnecessary, and give you coping mechanisms to deal with the issues that come to your life.

Above all things, don’t give up. You can overcome this struggle, and live to share this testimony with others.

References

Navigating clinical care at the intersection of pain and addiction. Krupnick SLW; MEDSURG Nursing, 2009 Nov-Dec; 18 (6): 381-4

Managing chronic pain in patients with cancer who have a history of substance abuse. (includes abstract); Pillet S; Eschiti V; Clinical Journal of Oncology Nursing, 2008 Aug; 12 (4): 663-7