10 misconceptions you might hear from patients

In treating individuals with opioid addiction, I have discovered that patients often express misconceptions about their condition. Understandably, in the early stages of recovery, the patient is primarily concerned with withdrawal symptoms, cravings and triggers. But to ensure a greater likelihood of long-term recovery, we should provide individuals in treatment with a clear understanding of their condition, guided by the American Society of Addiction Medicine's (ASAM's) definition of addiction as a chronic disease.

Here are 10 of the most frequent misconceptions that I hear, followed by a brief explanation that might be provided to the individual with an addiction.

1. Shouldn’t I just get my drug of choice out of my system as quickly as possible, and eliminate the symptoms of withdrawal and cravings, so then I will be cured?

Patients often confuse detoxification with rehabilitation. They inquire about quick, painless and effective ways to eliminate opioids from the body. They ask about options that will quickly permit them to complete pharmacologic treatment, such as lowering their tolerance level and then going inpatient for a quick three-day detox of the opioids; entering a hospital for an accelerated detox in which they are placed under anesthesia and cleansed of opioids without feeling adverse effects; or going to Costa Rica for a week-long ibogaine treatment. They lose sight of the fact that over an extended period of opioid use, they have altered the functioning of their brain, which will require an extended period of healing. If this same patient tore his Achilles tendon, he would not expect to have surgical repair and then immediately run onto a football field and participate in a full-contact game. He would realistically expect months of grueling rehabilitation.

In summary, since addiction is a chronic disease, just like diabetes, gout, or depression, it can’t be cut out like an inflamed appendix can. It can’t be cured, but it can be managed.

2. I don’t need to abstain from my drug of choice once I have gotten it together.

Yes, you do have to abstain from using your drug of choice if you wish to sustain your recovery. Your mantra may well be, “I had an addiction. I have an addiction. I will have an addiction.” The three most frequent agents of addiction leading to relapse are triggers, stress and usage.

3. The doctor got me addicted so that (s)he could continue to treat me and take my money.

You may have confused professionals. That description sounds more like your supplier than your doctor. The pusher is a business/sales person who seeks to secure new customers and maintain existing ones. (S)he may be kind and even considerate, but works primarily on the principle of caveat emptor (buyer beware). Your doctor is a person who is trained to treat and help remedy existing conditions. It is ill-advised for him/her to create maladies and fake attempts at treating them. Some doctors may be unkind and inconsiderate, but they work under the ethical obligation of “do no harm” and the legal restraint of “perform no malpractice.”

4. Isn’t participating in medication-assisted treatment (MAT), such as buprenorphine, a form of cheating? Am I not trading one opioid for another?

There are those in the addiction community who will insist that a “cure” involves abstinence from all opioids, including prescribed medications such as buprenorphine. The goal of maintenance treatment with buprenorphine is to allow the patient to live a life free of withdrawal and cravings, and to feel normal. Another benefit of such treatment is that it is legal, and controlled. Also, the risk of overdose is very small at the doses necessary to be effective. It eliminates the continuous need to seek and secure drugs. It also gives the afflicted the opportunity to lower dosage and maintain or ultimately stop taking the drug.

5. If I should relapse after being on buprenorphine, wouldn’t that mean that the treatment was a failure?

Relapse is all too frequent among addicted individuals. Remission is the time spent with the addiction under control. Remember, buprenorphine does not “cure” addiction. If while on buprenorphine the patient is able to live normally and be productive, then the treatment is successful. If long-term, even lifelong, remission occurs either during or following buprenorphine treatment, then success is that much more pronounced.

6. I started taking opioids to relieve pain, and once I became addicted, I continued to use them to avoid experiencing pain.

This doesn’t seem like a very unreasonable course of action. Who wants to experience pain? Opioids can block and soothe both physical and emotional pain; however, the continual usage of opiods outside of medication-assisted treatment will prolong your active addiction.

There are other ways of dealing with chronic pain besides opioids. Has your doctor tried to work with you to find other means of pain management? These might include NSAIDs (ibuprofen, naproxen, etc.), physical therapy, massage, trigger point injections, acupuncture, meditation, and others. As for emotional/psychiatric problems, these should be addressed head-on under a counselor's or psychiatrist’s care.

7. I only continue taking opioids to avoid being “dope sick.”

There are alternative methods of avoiding acute withdrawal symptoms. Did you explore detoxification or medication-assisted treatment, inpatient rehabilitation, or outpatient rehabilitation?

8. I only continued taking opioids because I liked the extra energy that it gave me.

Patients have boasted of staying up all night and cleaning the house, or working an extra shift without getting fatigued. Surely these benefits, resulting from the artificial high derived from opioids, do not compensate for the adverse effects of obsessive yearning for drugs, preoccupation with drug acquisition, placing one’s safety and freedom in jeopardy, costly expenditures, alienation from friends and family, impairment of health, and loss of hope and happiness.

There is a realistic component to the question of energy. Prolonged and excessive consumption of opioids often leads to atypical surges of energy upon which you can become dependent. The reduction and/or removal of opioids from the body can leave you fatigued. This reality may necessitate a restructuring of activities, an increase in exercise and sleep, regulation of stress, and improvement in dietary habits in order to increase your level of energy naturally.

9. I can get it together alone. I don’t think I need a 12-Step program or a sponsor or an addiction specialist, especially if he is not an addict himself.

Not everyone “needs” a 12-Step program, but there is good reason to believe that seeing life beyond oneself, seeing that there is meaning and purpose to life, is necessary for a lasting recovery. When a person successfully comes off medication, the possibility of relapse is always there. Having a someone whom you trust, who is like a friend, telling you what you need to hear and not just what you want to hear, can be the support you need when using again seems like a good thing to do.

As for the feeling that no one but an addict can understand where you’re coming from, that doesn’t mean that a professional can’t have sympathy, even empathy, for your situation and provide useful assistance. After all, male obstetricians treat women, priests counsel married couples, non-psychotic social workers help people with schizophrenia.

10. I can associate with active addicts, frequent bars, live with users, and frequent places where drugs are sold.

You might have something there. After all, you probably know recovering addicts who counsel active addicts, tend bar, are married to addicts, or police drug-infested neighborhoods. Triggers are specific to each recovering addict. However, to confront on a regular basis your own personal triggers is playing with fire and inviting a return to active addiction.

If a patient does not understand the nature of the condition, (s)he is unlikely to make a commitment to remedy it. Patient understanding is a vital prerequisite to recovery.

Roland Vendeland, MEd, MA, LPC, is a writer and psychotherapist who works as a counselor at an outpatient buprenorphine maintenance clinic operated by Hutton Healthcare Services in Pittsburgh.