“I found painkillers after a routine cosmetic surgical procedure and I became addicted. The morphine becomes the warm bath from which to escape painful reality. I was lucky. I was able to see that the pain had started long ago and far away and that finding the narcotic was merely a matter of time. The pain needed numbing. My recovery from drug addiction is the single greatest accomplishment of my life… but it takes work – hard, painful work.”
This is how actress Jamie Lee Curtis described her long-term battle with prescription-medicine addiction in a blog for The Huffington Post, with less fortunate celebrity casualties including Whitney Houston, Heath Ledger and Michael Jackson, whose autopsies revealed a lethal, legal cocktail. But if recent figures are anything to go by, prescription medicine abuse is not exclusive to pampered celebrities; the US is the leading consumer of prescription painkillers, using 71 per cent of the world’s oxycodone and 99 per cent of the world’s hydrocodone and Vicodin. There are now more fatal overdoses from prescribed medicine than from cocaine and heroin combined.
An easy descent
Prescription drugs prone to abuse generally fall into the following major categories: Depressants (such as Xanax and Valium), which slow brain function via the central
nervous system and include calming sedatives and tranquillisers to reduce anxiety; opioids, also known as painkillers (such as Oxycontin and Vicodin); stimulants, intended to increase energy and alertness (such as Ritalin and Dexedrine), and antidepressants prescribed to manage depression (such as Prozac and Zoloft).
Most people who use prescription drugs do so legally and correctly, their quality of life significantly improved by professionally monitored pain management or psychotropics. However, with persistent use, a patient can develop tolerance for the medication, needing more and more for the same effect. Suddenly stopping the dose can cause withdrawal symptoms including mood swings, shivering, profuse sweating and headaches. These symptoms are sometimes so debilitating that returning to the drug seems like the most sensible, and the only viable, option. This is the tipping point of addiction.
“It is often mistakenly assumed that drug abusers lack moral principles or willpower,” explains Johanna Griffin, an addiction counsellor at LifeWorks Counselling and Development in Dubai. “People think addicts could stop using drugs simply by choosing to change their behaviour. In reality, drug addiction is a complex disease, and quitting takes more than good intentions. In fact, because drugs change the brain in ways that foster compulsive drug abuse, quitting is difficult, even for those who are ready to do so.”
So how does one define prescription-medicine abuse – the point at which, for instance, effective pain management slips into full-blown physical and psychological dependence? Dr Aamnah Husein, a Dubai-based, US-trained clinical psychologist summarises it as, “When someone starts using the drugs not for their intended purpose, and not in compliance with their doctor’s advice.” According to LifeWorks’ Johanna, addicts will often register with more than one doctor in order to keep their supply flowing. She says, “An extreme case is when the client has been going to numerous doctors.
Their dependency is such that they will be dishonest and hide their medication so that people are not aware of how much they are taking.” When the legal avenues of sourcing their drug of choice become blocked, people might take the next step of finding a dealer, or ordering the drugs online. Official statistics are therefore just the tip of the iceberg. Here in the Middle East, figures have yet to be collated so the topic of prescription drug addiction is largely uncovered. While prescription medicine addiction typically follows surgery or treatment from trauma or psychosis, there are other common denominators.
Predisposition to addiction is believed to be genetic, meaning certain families could be more at risk of developing addictions, but it is not all down to genetics of course. Dr Husein says, “The chances of becoming an addict are higher if you have family members that are substance dependent. However there are environmental factors that also play a part, such as traumatic events in a person’s life, physical and mental abuse, peer pressure and other mental disorders.”
American clinical forensic psychologist Dr Raymond Hamden, who treats addiction at Dubai’s Human Relations Institute, agrees with this. He says, “People who are most vulnerable to addition are individuals who have difficulty with temperament, who have ADHD, or who come from dysfunctional families or broken homes.” In these cases, prescription-medicine addiction often replaces other addictions such as alcoholism, illegal drugs, sex or gambling – the addiction is a way of self-healing the hurt of a painful life experience.
It is for this reason that experts say it is crucial to recognise the bigger picture when treating patients. However, Dr Hamden says this theory works both ways – he says it is also crucial that patients recognise the risks associated with taking painkillers and prescription medication. He says, “Medical professionals take an oath to provide sound diagnosis and treatment to all people and governments have an obligation to protect society from quackery and charlatans.
Yet a few psychopaths do get by the system. Iatrogenic medicine, meaning unnecessarily administered treatment or surgery, is a problem, and cases have been brought before the ethics committees of professional societies and government licensing bodies.”
Alleged collusion between doctors and multinational pharmaceutical companies favouring profits over ethics is another contentious issue. “Prescription drug abuse could be increasing because doctors are prescribing these drugs more widely than before, and because policies regarding regulation have become lax,” says Dr Husein. “It is entirely possible that these things could be affected by collusion between the pharmaceutical companies, political parties and doctors. However, it is also possible that a person’s drug dependence goes somewhat unnoticed for a while.
Very often doctors will prescribe medication based on the patient’s report of symptoms – pain, insomnia, anxiety, panic attacks, fatigue – and they don’t always have collateral information from family or friends to verify this. So determining how much medication they need can be tricky.” It seems that, in many cases, it takes a dire consequence resulting from prescription-drug abuse, or a concerned loved one, for the addict to seek treatment. Fortunately the prognosis is bright.
Addiction counsellor Johanna says, “Through scientific advances we know more about how drugs work in the brain than ever before, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and lead productive lives.” The most effective treatment, she says, is a combined effort from the doctor, patient and psychiatrist or therapist.
At the Human Relations Institute, Dr Hamden and his staff treat addictive behaviour from a psychological angle through cognitive, emotional, social and familial processes. He says, “The course can involve the individual and the family without compromising confidentiality. The treatment is long term on an out-patient basis, and usually requires in-patient psychiatric coverage.”
Similarly, Dr Husein’s method of diagnosis begins with identifying the root cause of a person’s addictive behaviour. She says, “I would then help them understand the physiology of their addiction, how it affects their neural pathways, their chemical make-up. Help them understand that it is not a temporary or circumstantial problem.
Very often the first thing to do is crisis management because by the time these addicts seek help, they are deep in financial, physical, social, or legal problems. Depending on the extent of their psychological trauma or pain, I would then help the person process their issues and manage their emotions through healthy coping strategies.
The rapport between a client and a mental health professional is really important – it is usually a pretty painful process, and honesty on the part of the client is instrumental in achieving relief.” As with any addiction, giving up the habit is just the first hurdle. Staying off it is a long-term marathon of hurdles. Johanna is keen to point out that relapse is normal “and does not signal treatment failure – rather, it indicates that treatment should be reinstated or adjusted to help the individual regain control and recover.”
However, this shouldn’t dissuade people from trying to stop an addiction… Despite the adage ‘once an addict, always an addict’, the experts remain optimistic, which is key to recovery. Dr Husein says, “Sometimes people will forgo one addiction for another. Sometimes the psychological damage is so deep or the circumstances so hopeless they cannot escape their addiction at all. But certainly I would say it is possible to live a healthy, happy life with appropriate symptom monitoring, treatment, support and – most importantly – hope.”
For more information on LifeWorks, visit www.counsellingdubai.com. For more information on the Human Relations Institute, visit www.hridubai.com.
CASE STUDY
Confessions of an addict: PR consultant Mariam* tells Aquarius about her Xanax habit
“I’m a long-term migraine sufferer, with triggers ranging from stress to my menstrual cycle. I used to get them every five weeks or so and, oddly, during weddings, or on the first day of a holiday. They’d be crippling 24-hour episodes that only my prescription nasal spray could get rid of. But while the throbbing pain would subside, the side effects were chronic nausea and fatigue. So when my sister said she’d read in an article that excitement as well as anxiety can cause migraine, it didn’t seem so strange a pattern.
I went to my GP and, conceding the link between migraine and high emotions, he gave me five Xanax tablets – but warned me to only take them ahead of big events, as discussed, as they were habit forming. “After a combination of long working days and a busy social life – not to mention my husband’s interminable snoring – I started taking them regularly just to get a good night’s sleep. Well, that was my excuse anyway. No longer was it damage limitation for migraine, I was pill popping at the slightest hint of a bad night’s slumber.
If I didn’t nod off as soon as my head hit the pillow – which was seldom as I’d always been a light sleeper – I would reach for my secret stash. And such was my bedside pharmacy of vitamins and mineral supplements, my husband had no idea I was now hooked on Xanax. “I registered with another GP, meaning I could maintain a steady supply, and then started bypassing the medical system altogether by ordering stronger doses online for those ‘stressful work moments’.
For the first time since I could remember, I was sleeping soundly, without worrying about my work or domestic life. This went on for months until one day I had to make an emergency trip to my home country. I didn’t even have an overnight bag, never mind my meds. Alone in my aunt’s spare room, my heart and head pounded. How would I ever get through this without my Xanax? I worked myself into such a panic that I barely slept for three nights and had hallucinations.
My family assumed my erratic behaviour was due to the stressful circumstances of my visit, but really it was withdrawal. I broke down to my sister, who arrived on the day I was leaving. “With just hours before my departure, she booked me an appointment with my doctor, an addiction therapist and, to my shame, told my husband everything. He was stunned, though in retrospect said he had noticed changes in my behaviour, such as forgetfulness, confusion and mood swings.
He had assumed I was just working too hard. He was instructed not only to accompany me to my appointments, but to throw away my supplies. “All I wanted was one last Xanax. Just one. But my ranting and raving quickly subsided into shame, and then into surrender. I was exhausted and, ironically, slept like a baby that night. It was the first time I had slept well naturally in months.
“On the advice of my doctor, my cognitive behavioural therapist, my husband and my sister, I was physically and emotionally weaned off Xanax. Therapy has really helped me understand the nature of my addiction and given me the tools to develop healthier life skills. Weekly yoga and cardio classes have reduced my stress levels considerably and, thanks to the advice of a nutritionist, I now know which foods boost my energy and which help me relax. I’ve also learned to say no more at work!
“My journey has not been easy and I worry sometimes that my Xanax addiction might be replaced with something else. But I’m yet to relapse, so I consider myself one of the lucky ones, that I’ve been given a second chance. On those restless nights when I’m staring at the ceiling, I admit I yearn for my former crutch… but then I remember that staying clean is a blessing, not a curse.”
*name changed to protect identity
