When I was in medical school in the late 1990s, there was a movement to promote the idea of the "fifth vital sign." It was thought that pain was under-treated, leading to unnecessary suffering. Around the same time, prescriptions for opioid analgesics increased dramatically. It was not long before rates of addiction to these prescribed pain medications also began to increase. Prescriptions have become harder to obtain, and some formulations have been developed that are harder to alter for a greater high. This has pushed the street value of prescription opioids higher, and many people have sought out heroin to avoid the intolerable withdrawal symptoms that occur in people who are physiologically dependent.
It's frightening to see someone you love become trapped in this cycle, and you can feel alone and helpless in the face of such an overwhelming situation. The following are some basic ideas that may help you in this struggle.
• Educate yourself about the disease of addiction.
The stigma of addiction is very hard to overcome, and some people see it as a moral failing — as if your loved one lacked character and resolve. The path to addiction is actually much more complex and no one is immune. Patients with opioid use disorders include people from all races, ethnicities, socioeconomic status, religions or lack thereof. You are far from alone.
Yet, you cannot watch helplessly from the sidelines. Learn as much as you can about why it is now considered a chronic illness that has biological, psychological and sociological underpinnings, not unlike other chronic diseases like diabetes or hypertension. Get information about addiction from reputable sources such as the Substance Abuse and Mental Health Services Administration (SAMHSA), medical societies like the American Medical Association, the American Psychiatric Association, and the American Society of Addiction Medicine. Understanding more about addiction will also help you navigate the next two steps.
• Find support from qualified professionals or groups
Addiction takes a terrible toll on families. There is a not-so-fine line between loving and enabling that you may not recognize. Families are unprepared to face what can be typical behavior among people with opiate use disorders, including exposure to alarming health risks, police and court encounters, loss of a job, and estrangement from those who love them.
Qualified therapists and organizations such as Al-Anon, Nar-Anon and Learn to Cope can provide the support and guidance you will need to weather this crisis. Medication-assisted treatment has been shown in many studies to be the most effective treatment for many with opioid use disorders. Most communities have local clinics providing medications like methadone, bupenorphine and naltrexone. Medications need to be combined with psychosocial treatment to be most effective. In addition, our local hospitals and mental health organizations have day treatment programs, as well as residential rehabilitation for those in need of more intensive treatment.
• Never stop encouraging your loved one to get help
I've seen many patients get better and resume a high quality of life, but it's a long-term process. Just as the causes are multifactorial, most successful treatments are varied, including biological, psychological and social approaches. You may have lost the closeness of your relationship before addiction, but don't stop talking. It is vital to learn about enabling, because as hard as it can be to set firm limits, these kinds of behaviors will not save their lives. While you won't enable their addiction, make sure they know you will always be available to support their decision to seek professional help and will stand by them every step of the way. It is understandable to be angry and distrustful, but try to avoid language that may make them more ashamed than they already are. Understand that the road ahead is long and frequently interrupted by relapse. The process will be frustrating for all of you, but the outcome can be recovery and a more hopeful future.
Adam Rosen, MD, is an ASAM-certified substance use disorder specialist and Medical Director of Berkshire Medical Center's Jones 2 inpatient unit. Donna Marie Geary, RN, and Bob Cote, LADC, also contributed to this column.