Pain Recovery. Robert Hunter

any of the following:

      

Getting fired.

      

Failing out of school.

      

Going to jail.

      Stage III physical changes include:

      

Being hospitalized.

      

Being physically dependent on drugs; suffering withdrawal when trying to cut down or stop.

      Again, for it to be considered stage III, the addict must have only one of these problems, not multiple problems in all areas of his or her life, even though that may be the case. This stage usually occurs in individuals who have been dealing with chronic pain for years and the amount and variety of their medications has steadily increased, with progressive decrease in function, dependence on the drug(s), and general worsening of quality of life.

       STAGE IV

      Stage IV is considered late-stage addiction, where the effects of the disease have spread to all areas of the person’s life. Stage IV addiction, like stage IV cancer, is the period that precedes death from the disease. The length of time people can survive in this stage varies, but if the disease is treated, even at this point, the destructive process stops, life expectancy increases, and quality of life improves. Common causes of death from addiction include overdose, liver failure, accidents, suicide, and infections that would be preventable or treatable in nonaddicts. Those who have reached this stage need increasing quantities of drugs just to feel normal. Physical signs, such as damage to the heart, liver, and brain; malnutrition; lower resistance to pneumonia or tuberculosis; and overdoses are common.

      Stage IV addiction is characterized by multiple problems in more than one major life area. Generally it means the person has no meaningful family life or relationships left, has no job or school life, is cognitively impaired by drug use, and has severe long-term, often permanent health consequences, including brain dysfunction. In stage IV, pain and addiction are deeply entrenched in a person’s life and the person is alienated from loved ones and medical professionals alike. People with stage IV addiction fit the stereotype of those with addiction and are commonly homeless, in jail, or in an institution.

      Individuals with chronic pain often have histories of overdosing on drugs, either accidentally or on purpose. The acetaminophen in their opioid medications has caused liver damage. Their lives consist of unending pain, periods of sleeping and sleeplessness, staying in bed most of the time, and trips to the emergency room, either to try to get drugs or for treatment of complications of the advanced disease.

       Hopefully by now, you are beginning to understand addiction more clearly. In the next chapter, we will invite you to look at your use of substances and try to make sense of how these substances have affected your pain and your behavior. So open your mind and your heart and get ready to find some answers.

3 Am I an Addict?

       Now that we have explained addiction, we would like to help you answer this question. We’ll explore, in some depth, the reluctance, perhaps even overwhelming fear, that many with chronic pain have about addiction and the term “addict.” If you don’t consider the possibility that you have addiction, you may miss the opportunity to get better. In this chapter, we will not tell you whether or not you are an addict, but we will provide you with facts so that you can make an accurate and informed assessment.

       The Stigma of Addiction

      Why are the words “addiction” and “addict” so problematic for so many people? Much of this difficulty can be attributed to the stigma that is assigned to them. Merriam-Webster’s Collegiate Dictionary defines stigma as “a mark of shame or discredit.”* It is often attached to social judgment and cultural norms. The stigma attached to “addiction” and “addict” makes them “dirty” words. Despite volumes of research on drug dependence and scientific evidence to the contrary, addiction is viewed by many as a moral failing or weakness. Addicts and their families are subjected to social, legal, and financial discrimination, making it difficult for them to obtain the help they need. When addicts do access help, insurance is inadequate to cover the cost of effective treatment. Family members are often the most judgmental because they have experienced the consequences of the addict’s behavior, not realizing the addict is sick, not “bad.”

      Addiction is one of the few diseases that carries such a negative emotional charge and is a source of shame or embarrassment. Who would want to have a diagnosis or label that carries such a stigma? For those with chronic pain who take opioids, attempting to discuss this topic is often met with resistance and denial.

      { exercise 3.1 }

       Your View of Addiction____________________

      When you hear the word “addiction” or “addict, ” what is your emotional response?

      ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

      Do you believe either of these terms (addict, addiction) applies to you? Why or why not?

      ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

      Addiction is a term that often conjures up negative stereotypes. You may relate to some and not to others. Write your stereotypes about addiction. Where do these ideas come from?

      ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

      I AM AN ADDICT

      For some of you, there will be no question as to whether or not you are an addict—you already know you are. If you have experienced recovery you already understand it is extremely dangerous to put opioid painkillers in your system because eventually you will likely lose control and relapse, either with opioids or with other mood-altering drugs. For you, the main issue will be coming to terms with the fact that you can’t