SECTION XXI: MEDICAL ISSUES Therapists Overview
COPING WITH ADDICTION AND OTHER MEDICAL PROBLEMS
GOALS OF THE EXERCISE
1. 2. 3. 4. Understand the relationship between medical issues and addiction. Reduce the impact of medical problems on recovery and relapse potential. Reduce the risk of relapse by using therapeutic strategies to cope with both addictive problems and other illnesses or injuries. Participate in the medical management of physical health problems.
ADDITIONAL PROBLEMS FOR WHICH THIS EXERCISE MAY BE USEFUL
Chronic Pain Opioid Dependence Substance Abuse/Dependence
SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH CLIENT
The Coping with Addiction and Other Medical Problems activity is designed for clients with, as the title indicates, serious medical problems apart from their addictive issues. It addresses issues of self-medication as a factor in addiction, the possible causal role of addictive behaviors in having suffered injuries or illnesses, and coping strategies to achieve the best practicable quality of life for these clients. Follow-up could include referral to additional support groups that are focused on the specific medical problems that clients are experiencing. Another suggestion is bibliotherapy involving books such as Kitchen Table Wisdom by Rachel Naomi Remen, M.D., which addresses the interaction between spirituality and coping with physical trauma from the perspective of a therapist, physician, and client.
EXERCISE XXI.A
COPING WITH ADDICTION AND OTHER MEDICAL PROBLEMS
Some people suffer from both substance abuse problems and other medical problems that may be very serious, even life-threatening. If you are working to recover from both an addiction and another serious or painful medical problem, this assignment will help you use the same tools for both tasks where possible and guide you in coping with some special challenges in this situation. 1. What is the connection between addictions and other medical problems? Sometimes there is no connection. Its just coincidence or bad luck that the same person is both having a problem with alcohol, another drug, or an addictive behavior, and is also badly hurt or sick. However, its also true that people who engage in addictive behaviors are much more likely than others to get hurt or sick, and people with debilitating injuries and illnesses are at higher-than-average risk to have problems with addictions. In some cases, peoples injuries or illnesses are directly caused by their drinking, drug use, or other high-risk behavior (e.g., a heroin addict becoming infected with hepatitis C through a shared needle or a person contracting HIV from unsafe sex). This is not pointed out to blame anyone, but merely to acknowledge the role of cause and effect. Please describe any ways your addictive behavior caused or contributed to your becoming injured or ill.
2.
Sometimes the connection between addiction and medical issues works in the other direction. The medical problems come first, and then people medicate themselves for their pain or other symptomsthen they end up with addictions as well as the injuries or diseases they started with. When people use drugs (street drugs or prescription medications) to try to control or cope with their medical symptoms, they may become dependent on those drugs. Please describe how your medical problems may have led you to addictive behaviors in the search for relief.
EXERCISE XXI.A
3.
If you know other people who have succeeded in recovering from both addictions and serious medical problems at the same time, what did they do? How could you use some of their methods?
4.
Many people find that some of the same methods they use to overcome chemical dependence can also help them to deal with injuries or diseases that sharply limit their physical capabilities. These can be things like participating in support groups, learning new coping skills, and finding replacement methods and activities for things they cant do any more. What drug and alcohol recovery tools might help you deal with your own medical problems, and how would they help?
5.
On the other hand, there are some treatment approaches used for medical problems that may not seem to fit into recovery from substance abuse, such as the use of narcotics and other powerful drugs for pain management. If you are under a doctors instructions to take medications for your sickness or injury, have you talked about your substance abuse issues with the doctor who prescribed the medications? If you have, what did the doctor tell you about this? If not, what keeps you from sharing this information, and what results might keeping this secret have for your recovery from both issues?
6.
What might happen to you and your recovery if you stopped taking those medications, or didnt take them as prescribed?
7.
Have you also talked about this with people working with you on your addictive issues? If so, what did these people tell you?
EXERCISE XXI.A
If you are participating in a 12-Step recovery program, are you aware of the policies such programs have developed about the use of prescribed medications? Actually, the official position of Alcoholics Anonymous is that if your doctor knows your history with addiction, is experienced working with people with addictions, and has prescribed medication with that knowledge, and you are taking it exactly as prescribed, you are doing what you need to do to stay sober. Other programs have similar policies. If anyone in your group challenges this, they dont know their program. If you have questions, check the official literature. 8. Do you know others in a 12-Step program who take powerful prescribed medications? How do they avoid the trap of substance abuse?
9.
Please use this space to describe the tools, methods, and resources you will use to cope with the combined challenges of an addiction and a serious injury or illness. If you haven't thought this far ahead yet, what questions and concerns do you have about this issue?
Be sure to bring this handout back to your next therapy session, and be prepared to talk about your thoughts and feelings about the exercise.
