1. JR had a history of alcohol abuse—twelve to twenty-four beers per day, shots on weekends, blackouts, and a DUI fifteen years ago. He also smoked and snorted one to two grams of cocaine per day for a few years. After his DUI, the court ordered him to attend twelve-step meetings. Much to his surprise, he attended, grew to like the meetings, got a sponsor, and worked the Twelve Steps. His recovery was going well—so well that he got married, got promoted, and was so busy with family and work that he stopped going to meetings. Six months later, he lifted a heavy box in his garage and sprained his back. An MRI showed no significant cause for his pain, and his doctor started him on Lortab and Soma, with Ambien to help him sleep. Before he realized it, he was taking the entire thirty-day prescription in the first nine days, and for the rest of the month he would beg and borrow more drugs, eventually resorting to stealing drugs from his ailing mother or buying them on the street. He would drink when he ran out of pills, which became a more frequent occurrence. Clearly, he had reactivated his addiction and required treatment, which got him reengaged in the recovery process. He also needed to acquire tools to deal with chronic pain without medications. He admitted that he had been taking the pills for all sorts of reasons, including to relax, to get energy, and sometimes just to get high. 2. Deirdre wonders how this happened to her. She was a regular working stiff, living in a nice house with her husband and two kids. She never used drugs to any great extent; she didn’t like them. She had tried cocaine and pot when she was younger and got drunk on weekends in college but that’s about it. She had hardly had more than a glass of wine with dinner once a month for the past few years. She lost her taste for alcohol when she started taking pain pills. Her mom was a pill addict, and she never wanted to be like her. Then she developed pelvic pain and adhesions after surgery for endometriosis. She found that one or two Lortab in the morning took the pain away and got her going better than a double espresso. So she started using the pills to get going, keep going, and relieve the pain. When the doctor gave her Soma, she could calm down, numb out, and sleep—she was hooked. Chronic pain was a great excuse, and her doctors were perfect accomplices. She progressed from Lortab to Percocet, which she was getting from her pain doctor, internist, GI doctor, and gynecologist, and neither she nor they realized what was happening. She eventually found that chewing the pills gave her a more intense high. A few months ago she started buying from friends, and now she is spending $500 a month on pills. She’s up to twenty pills a day. She knows she is out of control, addicted, and needs help, but she’s mystified—how did this happen to her? After all, it just started with the pain! She’s not even sure if she’s in pain or not anymore. 3. May wants off medications, but feels she is not an addict. She never abused drugs, took anyone else’s prescription, or stole to support herself. Her medications are all prescribed by her doctor. She wants to try going off meds because they have significant side effects—she is not herself. She sleeps a lot and her pain is still pretty bad. The medications don’t work as well as they used to, and she’s taking stronger medications in higher doses. She heard that stopping meds may decrease her pain, although she finds that hard to believe. She developed fibromyalgia ten years ago and has no life. Her husband left and her grown kids don’t come around, and she doesn’t blame them. She sleeps most of the time, and when she’s awake she’s depressed, grumpy, and complaining. And the constipation is killing her! She thinks of an addict as someone who lives on the street. Addicts take medications to get high. They lie, cheat, and steal. She doesn’t do those things. Her dad was an alcoholic and she doesn’t ever want to act the way he did. He was abusive and downright hateful. She never drank because of that, and tried pot only a few times as a kid. She takes no other drugs except what is prescribed. She doesn’t buy that she’s an addict and doesn’t want to participate in addiction treatment, but she wants off the medications and doesn’t know how she’ll be able to live with in chronic pain. She is consumed with fear all the time. She’s angry at herself for not being stronger, at her husband for leaving, and at the doctors for allowing this to happen. 4. Henry doesn’t think he has addiction and doesn’t want off his drugs, but THEY want him to stop. He sustained a fracture of his lumbar spine and herniated three discs in 2001. He hasn’t worked since. He is angry at the person who left the floor wet and slippery, which caused him to slip and fall. He is furious with the workers’ comp company and especially with the case manager who wouldn’t let him have another surgery and who delayed his MRI. They generally made his life miserable. He is angry at his wife for any number of reasons and irritable with his kids. They can barely get by on the money he gets from disability, and as for his lawyer, the SOB won’t even call him back. He is miserable and depressed. He is in a dead-end life that on many days he wishes would end. On Tuesday he was confronted by all of them—wife, lawyer, case manager, doctor; even his poor kids were dragged into it. He couldn’t stand the tears, and in fact, he can’t stand emotion at all. So he agreed to detox and try to stay off medications and do something different with his pain. On a scale of one to ten, his optimism about success was a zero, but at least he’d get them all off his back. He can’t imagine living without his medications.How will he sleep? he wonders (even though he never sleeps now for more than an hour or two). Medications were the only thing that made his life tolerable—that and lying perfectly still until the meds kicked in and he was able to fall asleep. Not much of a life, but what else was there? He was adjusted to this life, such as it was, and now THEY want to mess it up. The examples of these individuals illustrate the four types of clients seeking help for chronic pain whom we generally find in the Chronic Pain Rehabilitation Program at LVRC: 1. You identify as having addiction. You know you are an addict and have experienced recovery. Due to chronic pain issues, you have relapsed in an attempt to relieve or control your pain. 2. You had no history of addiction, but you started on pain medications and now you are out of control. You are addicted and unable to stop or regain control of your life, and you are beginning to realize this and what you have to do—that is, stop the drugs. 3. You do not believe that you are an addict. You take only the medications prescribed by your doctor, but your life is not better with pain-relieving drugs; in fact, it’s worse. Even though you are taking medications, your pain is increasing rather than being controlled. Your dosage is escalating in the face of inadequate pain relief, and your function is more impaired since you’ve been on the drugs. You’re reluctant to do anything lest it make the pain worse. 4. You in no way think you have a problem with your medications or addiction, but someone else does. This may be a spouse, significant other, parent or child, employer, doctor, counselor, therapist, lawyer, judge, workers’ compensation company, or others in your life. This person or organization is making you do something about your drug use. (Does anyone or anything really make you do something?) You’re in pain and you don’t think it can get any better. You are convinced that coming off medication will make your pain and your life worse. You may even think you need more medication, not less. This blog post is an excerpt from Pain Recovery – How to Find Balance and Reduce Suffering from Chronic Pain by Mel Pohl, MD, FASAM, Frank Szabo, LADC, Daniel Shiode, PhD, Robert Hunter, PhD; Published by Central Recovery Press (CRP).