Addictive behavior can be recognized as a progressive loss of control over drug use, and can be reflected in behaviors such as "doctor shopping," or seeking multiple prescriptions for opioids from different doctors, difficulty functioning in important life areas such as at work or in important relationships, and escalating use of opioids despite the devastating impacts, both physical and psychological. If you or someone you are close to is suffering from these signs and symptoms, seeking a prompt evaluation by an addiction treatment professional is a good place to start.
Waiting for a loved one to hit bottom, we risk missing a chance to save a life. As knowledgeable consumers of medicine in the Digital Era, we have the power to make safer and more informed choices about pain treatment, and we can recognize the signs of a plan of pain management that is headed towards addiction and destructive consequences in a loved one.
The staggering statistics are all over the media. Drug overdoses are claiming more lives than auto accidents, with opioids as the main driver of the climbing death toll. The Centers for Disease Control and Prevention estimate that 78 people die every day from an opioid overdose, an unprecedented toll in the history of the health impact of drug abuse. With proper treatment, however, many recover from opioid addiction. With as much public awareness that has developed about the potential for opioid addiction and overdose, the rates of treatment initiation and recovery ought to increase dramatically, if this information is put to use by consumers of medical care.
Research studies have found medication-assisted treatments for opioid addiction, such as suboxone and methadone, to be highly effective in helping people recover from addiction and preventing overdose deaths. There are many reasons these medication-assisted treatments are underutilized, including limited availability of the medicines, cost and trained prescribers. Perhaps equally problematic is the skepticism that patients and health care providers have about the use of these medicines in treating addiction. Concerns about replacing one addiction with another are also common.
The desperation to avoid withdrawal contributes to excessive use, overdose and even criminal activities in the pursuit of more of the drug. Medicines such as Suboxone and Methadone are used to treat opioid addiction by stopping the cycle of highs and withdrawals while providing a stable dose of a replacement drug that acts on the same area of the brain. This restores the stability of the addict's brain chemistry, relieves cravings and helps the person become functional again, and to be productive and have meaningful relationships.
As scientific data concerning chronic pain treatment has accumulated, the benefits of opioids when prescribed for pain that extends beyond three months have been called into question. What's more, the repeated use of opioids has been found to worsen pain in a sizable group of patients, a condition known as "hyperalgesia." This can create a vicious cycle in which the pain sufferer takes larger doses of opioids to try and eliminate a pain condition that was itself worsened by opioids in the first place. As the pain progressively intensifies in response to escalating doses of opioids, the risk of addiction and overdose worsens.
Because opioids also affect the respiratory centers in the brain, which regulate breathing, at too high a dose, or when combined with other sedatives, respiratory depression and death can occur. This is now the too-often heard story of a fatal overdose.
New guidelines for opioid prescribers who are treating chronic pain, released in March by the Centers for Disease Control, recommend consideration of alternative treatments to opioids rather than starting with opioids as a "go-to" pain management strategy. As these guidelines are being implemented, we are not powerless against the devastating disease of opioid addiction. If a doctor prescribes opioids for your pain management, make sure you ask questions about the risks – and alternative treatments.
If you have a history of addiction, even if unrelated to controlled substances, or if you suffer from a mental health condition like depression, you are more vulnerable to becoming addicted to opioids. Adolescents also have an increased risk. But even those who are not at especially high risk can develop an opioid addiction; no one is immune.
Recovery from addiction can be achieved through a combination of behavioral therapies and effective medicines. Studies support the use of a variety of approaches including psychotherapy, exercise,
Addiction is not a simple problem with a simple solution. Many have tragically lost the fight, yet I have worked with and heard powerful stories from those who not only survived, but also have created rewarding and meaningful lives in the aftermath of their battle with this disease.
A licensed therapist who has been trained and certified in addiction can be a tremendous source of help.
Thom Kessler, LMFT, RAS
Below I have broken down my approach to couples work in the following sections. I do believe that “one size does not fit all,” so within this framework I also incorporate other modalities of therapy. However, couples therapy is very specific and separate form individual therapy. Couples come to me for guidance and suggestions so I am very active in session. I meet with couples for at least 60 minutes – many times for 90 minutes. Research has shown that after the first 40 minutes the efficacy of therapy goes up significantly. I will meet with the couple and then schedule separate sessions with each partner for further assessment. After most sessions I assign “homework” for each partner to work on – sometimes together and sometimes apart.
Research Based Methods:
I use several principals when working with couples. The first principal I use is to utilize proven research-based methods to treat couples. What this means is utilizing clearly thought-out, scientifically grounded approach to the challenges that the couple are trying to address in their relationship. For example one proven research finding and one that you might have felt intuitively: Healthy relationships require that we honor and support one another’s differentiated experiences. Healthy relationships emerge from integration. Integration in a relationship entails the honoring of differences and the compassionate communication that links two individuals together as a whole. Integration is the source of the idea that “the whole is greater than the sum of its parts.”
When I first meet with a couple I am assessing the health of the relationship and evaluating the full nature of what is exactly going on and then deciding on a course of treatment, while taking into consideration the expectations of each individual in the relationship. This process is a collaboration of goals to repair and or improve the health of the relationship.
It is necessary to understand each partner’s inner world. This means sensing each individual’s subjective inner experience, making sense of their world – their feelings, thoughts, hopes and dreams.
Process Past Regrettable Incidents:
When a “regrettable incident” has occurred and stored in our memory, it can be both at an implicit and explicit level and can alter how we feel about another person in ways that may persist for long periods of time following the experience. It is crucial to repair the rupture. We do this by processing not only the rupture but also the cause of the rupture and its unintended consequences.
Gentle Conflict Management Skills:
Often the challenges to the couple’s relationship are the four ways in which they relate to each other: criticism; contempt; defensiveness; and stonewalling. The first two, criticism and contempt are used as active weapons against each other; the second two are used as isolating and protective shields.
Strengthen Friendship and Intimacy:
There are so many ways in which we can connect in a close relationship as a couple. It is important that we honor our differences while promoting compassionate communication as we cultivate an integrated relationship. We learn to foster and nurture intimacy. If you think about friendship and intimacy, you may notice how close relationships require that you honor differences and promote respectful, caring communication. Each person in the relationship is unique, and each person can be connected to the other without losing his or her own identity.
Couples therapy is an opportunity to learn the tools that will help each of you to find shared meaning, and bring more kindness and compassion into your relationship and into your lives.
Thom Kessler, LMFT, RAS
Marriage & Family Therapist and Registered Addiction Specialist