Barbara is an alcoholic instable recovery.
She attends 12-Step Meetings, has a sponsor, routinely works the steps
and attends an outpatient counseling group.
Then tragedy strikes! She develops breast cancer and her doctor tells her
she needs surgery - right now!
I can't have surgery," she tells her doctor.
"I'm a recovering alcoholic and can't use mood altering drugs or
is politely told that she is the patient and he is the doctor and that she needs
these medications for successful surgery. Barbara
goes into shock. Not only does she
have cancer, but it's treatment will cost her sobriety.
Barbara has just entered a no-man's land where the normal rules of
recovery don't hold.
The normal rules of
recovery are simple - a drug is a drug is a drug!
Recovering people don't take drugs of any kind because drug use will
reactivate the addiction and cause relapse.
How does this apply
to Barbara? "I need surgery and that means preoperative medication,
anesthetic and post operative pain killers," she complains to her counselor.
"What am I supposed to do - bite a bullet during surgery?
It seems my only other choice it to refuse the surgery and die of
of recovering alcoholics face this dilemma each year.
There are no simple answers to their questions, but there are guidelines
that can lower the risk of relapse during these critical periods of recovery.
The use of
medically necessary drugs pose a potential threat to sobriety, but their use
does not necessarily condemn a recovering person to relapse.
The following guidelines can help recovering addicts to successfully
recuperate from surgery and other critical medical procedures without relapsing
into addictive drug use.
1. Be Sure Your
Doctors Take Your Addiction Seriously
people should insist that their doctors and anesthesiologists take their
addiction seriously! This means openly discussing their addiction and sharing
their concerns about relapse. Many
doctors are unaware that recovering addicts may have a high tolerance for
anesthetics and pain killers that can create complications during surgery. As a result recovering people should insist that their
doctors consult a Board Certified Addictionologist before selecting anesthetics,
or other mood altering medications. Addictionologists
are trained to select drugs that have the lowest addiction potential and the
lowest potential for cross tolerance with the addict's primary drug of choice.
If a physician is unwilling to consult with an Addictionologist,
recovering people should seriously consider changing doctors.
Their can be a high
price for failing to follow this guideline.
Emily, a recovering cocaine addict, needed cosmetic surgery to remove a
facial scar. She told her doctor
she was a recovering cocaine addict. Although
the doctor had no knowledge of cocaine addiction, he placated her with the
assurance that there was no problem. Although
Emily felt the doctor was not taking her addiction seriously, she was
intimidated and said nothing.
The doctor used a
local anesthetic that was cross tolerant with cocaine and panicked when Emily
started screaming during surgery. Serious
complications resulted that could have been avoided had Emily insisted that her
doctor take her and her addiction seriously.
2. Have Someone Else
Monitor Your Medication Use
addicts need to have someone else monitor their drug use.
This is necessary because any use of mood altering drugs can reactivate
addictive thinking, ignite craving, and distort judgment.
Recovering people should warn their doctors that addictive thinking and
drug seeking behavior may be reactivated and could result in the manipulation
for more medication than is needed.
Setting up a system
for controlling the use of prescribed medication on an outpatient basis is
essential. Arrange for someone other than the recovering person to
receive and fill the prescriptions and distribute the medication on a daily
basis as prescribed.
3. Recognize The Risk
Of Craving &
that any use of mood altering drugs may reactivate craving, impair your judgment
and impulse control, and cause difficulty in thinking clearly and managing
emotions. Jerry, a recovering
alcoholic, was in a serious car accident that mangled his legs.
The severe pain required narcotic pain killers and the muscular and
skeletal damage required the use of muscle relaxants.
Even though these medications were given in minimal therapeutic doses and
discontinued as soon as possible Jerry experienced withdrawal, agitation, and
confusion when the medication was stopped.
He wasn't prepared for this, and when the cravings hit he was
recuperating alone at home and had lost regular contact with his Twelve Step
Group and counselor.
4. Prepare Before
before surgery. Recovering people need to alert their sponsors and other
recovering people to what is happening and ask for frequent visits from
recovering people while in the hospital and recuperating.
They should plan to have closed meetings in their hospital rooms during
visiting hours. With proper preparation a recovering friend could be with them
when they wake up and support them through the fears that may have been aroused
by the use of medication and stress of the illness and surgery.
should plan to be actively involved in counseling and the Twelve Step program
during convalescence. Since many people may be unable leave home during the
convalescence, arrangements can be made to continue regular counseling sessions
by telephone. Most counselors are willing to this if asked.
If the person is too sick to attend AA meeting, they need to invite other
twelve step members to meet in their home.
5. Get Into
Counseling Before & Stay in After Surgery
Finally, get into
counseling before surgery and make a commitment to at least ten weeks of
counseling with a Certified Alcohol And Drug Abuse Counselor after surgery.
Openly discuss any problems with craving, withdrawal, or depression.
6. Use Addiction-free
Pain Management For
Post Surgical Pain
Grinstead has developed an excellent program for Addiction-free
Pain Management. Steve can be contacted for training
and consultation in establishing addiction free pain-management programs
simple can guidelines can make the difference for recovery and relapse.
It can also reduce the fear and apprehension of using medically necessary
drugs during periods of medical emergency.
Gorski, Terence T.
Alcoholism & Addiction Magazine: Relapse - Issues and Answers: Column
4: Prescription Drugs And Relapse,
May 22, 1990