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Prescription Drugs And Relapse

By Terence T. Gorski

GORSKI-CENAPS Web Publications 
(www.tgorski.com; www.relapse.org)

May 30, 2001

Terry Gorski and other members of the GORSKI-CENAPS Team are available to train & consult on areas related to recovery & relapse prevention

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!

 "But I can't have surgery," she tells her doctor.  "I'm a recovering alcoholic and can't use mood altering drugs or I'll relapse!"

 She 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 cancer!"

Literally millions 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.

Guidelines For Lowering The Risk

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

First, recovering 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

Second, recovering 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 & 
     Impaired Judgment

Third, recognize 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 Surgery

Fourth, prepare 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.

Recovering people 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

Stephen 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

Following these 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.

CENREF 003:  AAMAG04:

Reference

Gorski, Terence T.  Alcoholism & Addiction Magazine: Relapse - Issues and Answers: Column 4:  Prescription Drugs And Relapse, May 22, 1990

About the Author

Terence T. Gorski is internationally recognized for his contributions to Relapse Prevention Therapy. The scope of his work, however, extends far beyond this. A skilled cognitive behavioral therapist with extensive training in experiential therapies, Gorski has broad-based experience and expertise in the chemical dependency, behavioral health, and criminal justice fields.

To make his ideas and methods more available, Gorski opened The CENAPS Corporation, a private training and consultation firm of founded in 1982.  CENAPS is committed to providing the most advanced training and consultation in the chemical dependency and behavioral health fields.

Gorski has also developed skills training workshops and a series of low-cost book, workbooks, pamphlets, audio and videotapes. He also works with a team of trainers and consultants who can assist individuals and programs to utilize his ideas and methods.
Terry Gorski is available for personal and program consultation, lecturing, and clinical skills training workshops. He also routinely schedules workshops, executive briefings, and personal growth experiences for clinicians, program managers, and policymakers.

Mr. Gorski holds a B.A. degree in psychology and sociology from Northeastern Illinois University and an M.A. degree from Webster's College in St. Louis, Missouri.  He is a Senior Certified Addiction Counselor In Illinois.  He is a prolific author who has published numerous books, pamphlets and articles.  Mr. Gorski routinely makes himself available for interviews, public presentations, and consultant.  He has presented lectures and conducted workshops in the U.S., Canada, and Europe.  

For books, audio, and video tapes written and recommended by Terry Gorski contact: Herald House - Independence Press, P.O. Box 390 Independence, MO 64055.  Telephone: 816-521-3015 0r 1-800-767-8181.  His publication website is www.relapse.org.

Terry Gorski and other members of the GORSKI-CENAPS Team are available to train & consult on areas related to recovery & relapse prevention
Gorski - CENAPS, 17900 Dixie Hwy, Homewood, IL 60430, 708-799-5000 www.tgorski.com, www.cenaps.com

 

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