Ask an Expert: I'm Addicted to Prescription Painkillers

By Lance Dodes 02/19/15
Today's question is on what to do after you get addicted to the pills the doctor prescribed to you.

"I became addicted to oxycodone four years ago because of back problems and then finally kicked it by going through a local detox clinic. The follow-up therapists they recommended weren't very good, at least not for me. Most of them weren't sensitive enough to the fact that I didn't start out deliberately as an addict and so wasn't covering up trauma or medicating emotional issues. My trauma and emotional issues and life setbacks came because of the addiction - I didn't know how bad Oxy was and my doctor was a fool to over-prescribe. My question now is I need help and want to know what kind of therapy or coaching should I be seeking?  I live close enough to a big city to be willing to travel there. Are there specific therapy techniques or people with certain kinds of training I should look for? I also may now be asking all the right questions here so what should I be asking if I have not said it here?  Thanks. -- Daniel


Lance Dodes:  This question raises the distinction between physical addiction and psychological addiction. As we all know, certain drugs are physically addictive, so anyone who uses enough of them over enough time will become physically addicted. Physical addiction has, therefore, nothing to do with who you are. It is also easy to treat by detoxification, so if a person has only a physical addiction, once finishing detox, there is no need for any further treatment.

Psychological addictions produce the more serious problems we associate with addiction: repeated, compelled addictive behavior that cannot be stopped, even after detox when there is no physical component.  It is what makes addiction the major problem it is for individuals and society.  Appreciating that the most important aspect of addiction is a psychological symptom also allows us to finally understand why addictions are able to shift back and forth, from drug to non-drug addictions such as gambling, eating, or shopping. The addiction is the compulsive drive to repeat a behavior, and it doesn't necessarily have anything to do with drugs.

With this in mind, let me return to your question. You said you had a physical addiction to the physically addictive drug, oxycodone. If you became addicted simply because of overuse (due to overprescribing and concern about return of your back pain), then you had only a simple physical addiction. That would mean that detox is all the treatment you would need. But, you said that you still need help, so the situation must be more complex. If your use of oxycontin actually had an emotional purpose and drive (beyond your concerns about back pain or a fear of withdrawal symptoms), that would indicate it may have been  a true psychological addiction. In that case, it would be advisable to learn about the way the addiction mechanism works in you. You could learn the particular emotional themes that precipitate your addictive urges, how to anticipate them, and how to deal with them in a new way. You could learn this, in part, on your own (my book, Breaking Addiction describes this in detail), or with a good therapist who understands the psychological mechanism behind addiction.

That is also the key to answering your question about whom you should see.  It's a good idea to ask potential therapists how they understand the nature of addiction, before embarking on any addiction treatment. Therapists who think of addiction as somehow entirely different from other psychological  symptoms, or believe it should be treated apart from understanding the rest of you, should be avoided. The best therapists will work with you to understand both your addiction and yourself.



Lance Dodes, MD, has been Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the alcoholism treatment unit at Spaulding Rehabilitation Hospital and Director of the Boston Center for Problem Gambling. His books, The Heart of Addiction, Breaking Addiction: A 7-Step Handbook for Ending Any Addiction and The Sober Truth, have been described as revolutionary advances in understanding how addictions work.   Full Bio.

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