Relapse and Prescription Medications: Advocating for Recovery
In my twenty-eight-year career, I have noticed that one of the biggest causes of relapse for people in recovery is the abuse of prescription medications. This is even the case for recovering people with decades of abstinence. It is critical that addicts and alcoholics are extremely careful when and if they are prescribed addictive and mood-altering medications because they can easily trigger a regression back to old addictive patterns. My philosophy is that we need to do more to teach the recovering person what to do when they have to take medications, not if they have to take medications, because sooner or later most of us are going to have some medical procedure for which medications will be prescribed. Remember, pain is just as much a threat to one’s recovery as pain medication, so we must help people get through these difficult situations and maintain their recovery. This article offers some concrete information and suggestions that counselors can use with clients to help avoid a relapse.
Many addicts and alcoholics have relapsed following a “legitimate reason” for taking prescription medications. Some medications are harmless and do not necessarily pose a threat to one’s recovery—antidepressants, for example, are less likely to trigger cravings. However, once the recovering person takes an addictive, mood-altering medication such as pain medications, sleeping pills, anxiety medications, and/or muscle relaxants, there is great risk that the addictive disease will be awakened once more. Once awake, the disease will often demand more of the drug and a return to old addict behavior, such as lying and manipulating to stay high.
The recovering person is often unaware or prepared for the risk. He or she may not know to ask for non-narcotic pain medications. The addict may defer to the prescribing physician’s expertise, assuming that the doctor knows what to do. Unfortunately, many doctors have very little training in how to deal with addiction and may inadvertently prescribe medication that can start the disease process in motion. It is extremely important to know what medications your clients are taking, what the abuse potential is, and whether the drug is addictive and mood-altering. Just because a doctor prescribed it, doesn’t mean that it is okay. It is the responsibility of the recovering person to protect his or her recovery. Counselors should encourage their clients to ask questions, look the drug up online, get feedback, and be accountable before taking any prescribed medication.
Even some over-the-counter medications contain substances that can be dangerous to the recovering person. Many cough syrups and mouthwashes contain very high alcohol content, and some antihistamines contain stimulants, so advise clients to read the labels very carefully before they begin taking one of these seemingly harmless medications.
The most commonly abused prescription medications are as follows:
- Opioids—usually prescribed to treat pain
- Central nervous system (CNS) depressants—used to treat anxiety and sleep disorders
- Stimulants—most often prescribed to treat attention deficit hyperactivity disorder (ADHD)
Physicians are very quick to prescribe pain, sleep, and anxiety medications. Recovering people need to be extra cautious. Even in addiction treatment we are seeing enormous lobbying from pharmaceutical companies advocating for medication-assisted recovery as the first line of defense. Some managed care policies actually block attempts to place teenage opiate addicts in into residential treatment, mandating that these young people be seen instead by buprenorphine-prescribing physicians in private practice. Hospitals have very strong policies regarding pain and are eager to prescribe pain medications to ensure that patients have little or no discomfort. This makes their jobs easier, but puts the patient at enormous risk for dependence.
So here are some suggestions we as counselors can provide to our clients, so they may avoid a relapse:
Before clients take medications:
- Encourage them to find a doctor who is educated about addiction, preferably one that is ASAM certified.
- Ask them to be very clear when they tell their doctor that they are a recovering addict or alcoholic and that they do NOT want any medications that can threaten their recovery.
- Have them ask the doctor about the medication. Is it a narcotic? Is it addictive? Is there abuse potential?
- Invite them to do their own research on the medication. They can research it and find out for themselves what it is and what it does.
- Assure them that it’s okay to ask for non-narcotic or other safe alternatives if they need medication.
- Make sure they ask for a small amount of the medication with no refills.
- Encourage them to contact their sponsor and other members of their support group and inform them that they will be taking medications. Clients can tell their peers what they have, how many they have, and what the recommended dose is.
- Have them ask if they can dose in the office rather than take meds home.
- If clients have to take drugs home, they can ask for a three- to five-day prescription.
When clients have to take medications:
- Make sure they are taking medications only as prescribed.
- Encourage them to stay in daily contact with several members of their support system and keep them current on the dosage and their reactions.
- Ask them to consider giving the medication to a member of their support system who will be responsible to administer the medication to them every day.
- Recommend that they talk about it at meetings and other support functions.
- When the prescription says “Take as needed for pain or other symptoms”, they need to monitor their symptoms and contact their support system when they are not sure if they really need it.
- Encourage them to stay in close contact with their doctor and comply with the doctor’s orders.
- Remind them to be careful to not reinjure themselves so that they don’t have to take more medications for a longer period of time.
- Suggest that they keep a journal and monitor their thoughts, feelings, cravings, and actions.
- Propose that they report any concerning changes to members of their support system.
Once the need for the medication is over:
- Ask them to throw away any unused medications. They shouldn’t save them in case they “need them later.”
- Have them inform their support system that they no longer need to take the medications.
- Encourage them to share at meetings about what issues came up for them while on the medications and how they managed them.
In summary, the key to avoiding relapse is to have your clients advocate for their own recovery; be honest and open about their thoughts, feelings, urges and behaviors; and most of all stay accountable. The biggest danger is for them to go underground and not let the key people in their support system know what’s going on. I have seen many addicts relapse, and some even die, because they were unwilling or unable to reach out and ask for help when they were struggling.