The Face of the Person with an Addiction
DECEMBER 19, 2017
Sr Rosemary Donley, PhD, APRN, FAAN
Sr Rosemary Donley, PhD, APRN, FAANIt is a common belief that people who misuse or abuse drugs live in run-down neighborhoods, come from minority groups, are unemployed, and have dropped out of school. The fact is that addiction is a chronic brain disease that affects people across all racial, gender, age, and social class lines.1 Although some people in vulnerable communities do misuse and abuse drugs, addiction touches all individuals and is a major public health problem and a tragic cause of morbidity and mortality. Approximately 100 individuals die every day from drug overdoses, a rate that has tripled over the past 20 years.2 In 2011, over 125 million emergency department visits were drug related.3 In 2016, the surgeon general of the United States reported that 27 million Americans used illicit drugs or misused prescribed medication.4
The highest illicit drug users are young adults aged 18 to 25 years. The National Institute of Drug Abuse (NIDA) reported that 15.8 million adults, 18 years and older, have used illicit drugs.5 These statistics are frightening because 90% of persons with addictions began drinking, smoking, or using illicit drugs before the age of 18.5 Illicit drug use usually lessens as individuals move into middle adulthood; however, there is a growing group of drug users: middle-aged women.6 The Centers for Disease Control and Prevention (CDC) reported that every 3 minutes a woman goes to an emergency room seeking a prescribed drug for relief of pain.7 Since 1999, the percentage of women who have died from drug overdoses has increased 400% compared with a 26.5 % increase in men.8-10
How did this happen? In the mid-1990s, when pain was named the fifth vital sign, opioids became the drug of choice to treat pain from injuries, minor surgeries, dental procedures, and arthritis. Opioid pain medication was aggressively marketed by the pharmaceutical industry to the public, as well as to providers. Prescriptions for MS Contin and OxyContin were distributed in clinics and doctors’ offices; the drugs were effective and enabled providers to treat more patients.11 Sadly, prescription drug misuse has become the second most common form of drug use in America.12 Opiate abuse is the fastest growing drug-related issue in 11 states: Alabama, Arizona, Arkansas, Delaware, Maine, Michigan, Missouri, Nebraska, Oklahoma, Tennessee, and West Virginia.13
Why are middle-aged women at increased risk of addiction? Women seek medical attention more than men do. Hence, they are at greater risk of being prescribed opiates for less serious health problems or temporary discomfort. Women also take medication longer and react to opiates differently than men do.9
Because of the myths about addiction and the associated stigma, teachers, families, friends, and health care providers often look the other way, ignoring early signs of addiction: mood swings, change in appetite and sleep patterns, restless behavior or lethargy, and the continued need for more medication to relieve pain.14 Unfortunately, myths about addiction lead people to ignore this major public health epidemic. Addiction is a taboo topic in many families and communities. Family and friends may become aware of drug misuse or abuse when their loved one is involved in a drug overdose, a serious accident, or an arrest. Addiction is not a personal moral failure; it is a disease of the brain. Like most chronic illnesses, addiction affects the whole person—body, mind, and spirit.
The good news is that addiction can be prevented. Parents, teachers, counselors, and coaches should talk about the risks and dangers of drug abuse with children and young teens. Parents should talk honestly with their children about prescription and illegal drugs. Teachers, counselors, and coaches should be particularly observant if the academic performance of their students declines or if there are changes in their behavior.
Physicians and other health professionals should be attentive to adults who come frequently to the office or emergency department. These patients need to be carefully assessed and asked about their medication-taking behavior. Most people do not consider pain medication to be a recreational drug. When confronted, the person that you love, teach, or treat may lie, deny drug use, or lash out and accuse you of being a misinformed, uncaring person who does not grasp the magnitude of their pain.
Addiction is treatable. However, like other chronic diseases, the person with an addiction experiences ebbs and flows over the course of treatment. Treatment is not easy; addiction alters brain chemistry and affects judgment and decision making. Persons with addiction are obsessed with their desire for drugs. Like individuals with any chronic disease, those with addictions experience relapses. However, relapses can be very serious because they are usually associated with a return to drug use. Because during periods of abstinence a person with an addiction loses his/her tolerance for the drug, taking the “usual dose” can be fatal.
The person with an addiction needs to be identified, supported, and referred for treatment. The war against addiction is everyone’s war.
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2. National Institute on Drug Abuse. Overdose death rates. drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. NIDA website. Revised September 2017. Accessed October 30 2017.
3. US Department of Health and Human Services. Drug abuse warning network, 2011: National estimates of drug-related emergency department visits. Substance Abuse and Mental Health Services Administration website. samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf. Published May 2013. Accessed October 30 2017.
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7. US Department of Health and Human Services. Drug Abuse Warning Network, 2011: national estimates of drug-related emergency department visits. samhsa.gov/data/emergency-department-data-dawn.Substance Abuse and Mental Health Services Administration website. samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf. Published May 2013. Accessed October 30 2017.
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9. National Institute on Drug Abuse. Sex and gender differences in substance use. NIDA website. drugabuse.gov/publications/drugfacts/substance-use-in-women. Revised April 2017. Accessed October 30 2017.
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12. Mattson M, Lipari RN, Hays C, Van Horn SL. A day in the life of older adults: substance use facts. SAMHSA website. Published May 11, 2017. https://www.samhsa.gov/data/sites/default/files/report_2792/ShortReport-2792.html. Accessed October 30 2017.
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14. Symptoms and signs of drug abuse. DrugAbuse.com website. drugabuse.com/library/symptoms-and-signs-of-drug-abuse/. Accessed October 30 2017.