Can Addiction be "Cured"

[longhornfan1]

So, I am a recovering addict. I like to think of my addiction as "acute" "in remission" or dare I say it "cured".

I never tried a drug until I became a nurse. I didn't take them simply because they were accessible. I took them initially after a surgery for pain and then I took them because my body craved them so intensely that I would stoop to any level to get them.

I made my decision making "drug focused". Every action I took could be related to finding the drug, getting the drug and using the drug. I worked in the ICU and used 10 mg Morphine vials multiple times for post-op patients.

When a patient comes out of surgery it is really fast paced. The process of signing out and then wasting each unused drug took precious time away from patients. Why waste 8 mg's of MS when you will probably be giving an additional 2 mg's Q 10 mins for the 1st hour post-op anyway. So, you would give 2 mg's and put the vial in your pocket and pull it out each time you needed it until the patient was comfortable. Then you would chart the doses and waste what was left with another nurse.

One morning when I got home from work, I had forgotten to check my pockets. There it was. 6 mg's of MS. So, I set it aside and planned on taking it back on my next shift. But I had to put it someplace safe so no one would see it. What would they think.

It happened over and over again, intentionally, maybe, maybe not. Never used it, just put it in the drawer. I think I was afraid to use it cause what if I had a reaction? Or took too much and my kids found me on the floor unconscious?

One day, I put it in my hip. I felt like I was energized. I got so much done at home that day. After about a month of IM Demerol and Morphine, I had a patient on dilauded.

Took the excess drug home........along with an insulin syringe. I must have tried for 30 minutes to find a vein. I can find them blind-folded on my patients, but it is more difficult when your doing it upside down. After another month, I was shooting MS and demerol 4 or 5 times a day. But I did not believe I was an addict.

It all started with the Lortab after my tonsillectomy. I felt efficient, loving, attentive, smarter and focused when I took opiates. I didn't have to use every day. I was PRN so I would go a week without working and without using. I went on vacation for 2 weeks and didn't have any problems.

When I came back I worked 1 shift, took some dilauded and used it when I got off. I was called in the next day, I thought to work a shift, and was confronted by the DON, HR and several Admin nurses. I denied diverting but said I had partied while on vacation and would probably test + on the UDS.

Ignorant as I was, I gave them the urine and went home totally freaked out. I knew it would be positive and could not begin to imagine what would happen next. Looking back, I should have just quit and dealt with "suspicions" of diversion instead of giving them a dirty drug screen. But I didn't know I had a choice.

I broke down and told my husband that I was suspected, tested and probably terminated for using. But I didn't tell him what I used or that I was diverting. Told him it was Lortab, but I didn't have a current RX for it. So, when I was terminated and reported to TPAPN, I had to finally tell him what really happened. He reamed me up and down. Not supportive, did not recognize a "problem", just called me a junkie and was more concerned that I had potentially screwed my career. Our marriage is fine, believe it or not, and we only bring it up when we are really angry.

I have been sober since June 2 2006, the day after I got caught. Been through treatment, meetings and so on. I am working in LTC and have access to Lortab, MS tablets and Roxinal. Do I have cravings or feel compelled to take them? Nope. Did I learn my lesson? Yep.

But if you ask the professionals if I am "cured" they say there is "no cure". Once an addict, always an addict. But why? If I never did drugs until they were prescribed and have quit without issue and have proven my ability to be around the same drugs that I was addicted to?

Simply because I am the child of an alcoholic, the sister of an addict and the daughter of an undiagnosed and untreated mother with depression and bi-polar. Since I was molested as a child and my father died when I was 16. Since I slept around during high school so I could avoid the abuse at home. Since I dated men twice my age looking for a father figure until, Thank GOD, I met my husband and became a responsible adult and a mother.

Do all of these characteristic combined with the exposure to and subsequent physical addiction to Lortab define me as an addict for the rest of my life. Does that mean AA and NA meetings forever? Does that mean I can't drink at parties and dinner with friends because I might relapse and start using?

Someone please explain this to me. All addicts deny the addiction at some point in recovery, but don't people recover from the physical addiction and are strong enough to make the right choices when confronted with similar situations? HELP!! Thanks

[sheilagh]

Wow,where to start! I have been clean for 3 years,and similar to you never even looked at a drug before I was a nurse.I had surgery and discovered opiates,and felt the same type of energy and ability to focus you did...fast track 2 years ahead and I'm shooting up Demerol or whatever was available. Am I still an addict? HELL YES!!!! I don't have cravings anymore,but my mind will always see drugs,food,sex,or any self abusive behavior as a coping mechanism,it's what addicts do! Go to meetings,get counseling,ask for help...PLEASE!!!!

We have a great forum on here,and just a suggestion but maybe drag the hubby with you to a meeting or counseling...Good luck,feel free to IM me

Sheilagh

[eriksoln, BSN, RN]

Hmmm, a bit off topic, but I see in your credentials Saifudin that you list Addiction and psych together. Like they are...........related, brother and sister.

I'm on a pulmonary unit and the phych unit dumped a very..........challenging ETOH withdraw pt. on us somehow. There was a little discussion about whether or not withdraw/DT's was a psych or a medical issue.

I was under the bief that it is a psych issue. Some said no way.

[2BSure]

You can't pull yourself out of quicksand by tugging on your own hair. Hence the need for a higher power. For many, that is God. For others it is friendship or children or accomplishing a long-range goal that is incompatible with alcohol or drugs. Don't waste time getting angry over groups whose members want to focus on God. The important thing is to find what works for you and do it. And keep doing it. And keep doing it.

If you are addressing me please do not assume I am angry. I am fully able to make an observation and express an opinion without being excessively emotional about it.

[sheilagh]

The D/T's portion is the physiological effect of ETOH withdrawal,and have to be managed or they may seize or die.The psychological addiction is dealt with when the body begins to recover

[southernbeegirl, BSN, RN]

2B..i dont think that was directed at you but even if it had been, it was said with love and respect. no need to get defensive.

as i have posted many, many times...i am 5 years clean and sober. am i cured? well let me tell you a short story about last week and then you tell me...

i went to take care of my grandmother last week while my aunt had surgery. my grandmother is bedbound and total care. i had to give my grandmother her meds, including Kadian. all i could think about while i was there was that morphine in her drawer. i couldnt stop thinking about it! i wanted it so bad i could taste it! it took every thing inside me to NOT take it. i was unable to go grab a meeting because i couldnt leave the house so instead i was on the phone to everyone i know telling them about the morphine yelling at me from the drawer. i was able to make it thru the whole week and not relapse on the morphine but it was only by the grace of my God, who is MY higher power.

this craving hit me completely out of the blue. it hit me like a ton of bricks. it was so unexpected. the minute i opened her med box that first night to give her that morphine my disease said WOOOOHOOOOOOO ITS ON NOW! and for a week i fought my disease. my disease was constantly saying to me "you are all the way down here, 5 hours from home, noone would know! just take one.

so for those that think they are cured...i am NOT going to argue with you. all i am going to do is hope and pray you have a strong recovery plan for when you suddenly realize you are NOT cured. because it will happen to you..it's not a matter of "if" but "when".

[2BSure]

2B..i dont think that was directed at you but even if it had been, it was said with love and respect. no need to get defensive.

Now that is seriously funny. I ask someone to refrain from assuming I was angry and someone else assumes I am defensive. And yes, I really mean it is funny. Obviously I am easily amused.

[southernbeegirl, BSN, RN]

Now that is seriously funny. I ask someone to refrain from assuming I was angry and someone else assumes I am defensive. And yes, I really mean it is funny. Obviously I am easily amused.

well, a sense of humor is good to have then

[rn/writer, RN]

If you are addressing me please do not assume I am angry. I am fully able to make an observation and express an opinion without being excessively emotional about it.

My comments weren't made in response to any of your posts.

[Saifudin]

"Hmmm, a bit off topic, but I see in your credentials Saifudin that you list Addiction and psych together. Like they are...........related, brother and sister.

I'm on a pulmonary unit and the phych unit dumped a very..........challenging ETOH withdraw pt. on us somehow. There was a little discussion about whether or not withdraw/DT's was a psych or a medical issue.

I was under the bief that it is a psych issue. Some said no way."

I'm DON in an addiction and mental health hospital in Saudi Arabia and formerly in primary care and ER NP practice in NYC.

The hospital I'm in began as an addiction facility back in the mid-80s. There are 3 in Saudi called Al Amal Hospital. (Amal means hope in Arabic). My facility opened an adjoining building in 2000 for psychiatry and the main governmental psychiatric unit was transferred with all services from the cities central hospital (Ministry of Health). We are now called Al Amal Complex for Mental Health-Dammam.

Addiction is considered to fall under mental health. Addiction is listed in the DSM IV. Approx 30% of psych patients have addictive disorders and certain drugs such as meth can cause psychotic disorders and bring on schizophrenia (that was likely coming), so, yes, often a close relationship. But, it is a biopsychosocial-spiritual disorder. At least I believe in that model for addiction as well as primary care.

Where I work, the doctors are all psychiatrists and don't like addiction. They try to use the medical model and basically treat the addicts like pscyh patients because that is there orientation and they have no interest to approach addiction treatment based on good evidence based knowledge and practice. Many are poor practitioners any way.

Regarding withdrawal, it is a medical issue. Detoxification is considered medical stabilization however if a client has concurrent pscyh issues then its both medical and psychiatric (i.e. dual diagnosis). Amphetamine use is really climbing and at any given time we might have 15 or more patients in our detox unit with psychotic manifestations. (34 admission beds).

Delirium Tremens (DTS) of course is a severe form of ETOH withdrawal and the management is medical essentially. It can be life threatening but with good management mortality is greatly reduced. As u know from critical care, deliriuim can occur for many reasons and is a major assault on the brain. The treatment is supportive while looking for the cause.

[jackstem]

The Chinese have developed an extensive look at the genetics of addiction. This information is freely available on the internet. All data, database schema, and MySQL commands are freely available for download at their download page:

http://karg.cbi.pku.edu.cn/download.php

Here is a summary of what they have discovered:

Assembling the jigsaw puzzle of drug addiction

Using an integrative meta-analysis approach, researchers from the Center for Bioinformatics at Peking University in Beijing have assembled the most comprehensive gene atlas underlying drug addiction and identified five molecular pathways common to four different addictive drugs. This novel paper appears in PLoS Computational Biology on January 4, 2008.

Drug addiction is a serious worldwide problem with strong genetic and environmental influences. So far different technologies have revealed a variety of genes and biological processes underlying addiction. However, individual technology can be biased and render only an incomplete picture. Studying individual or a small number of genes is like looking at pieces of a jigsaw puzzle - only when you gather most of the pieces from different places and arrange them together in an orderly fashion do interesting patterns emerge.

The team, led by Liping Wei, surveyed scientific literature published in the past 30 years and collected 2,343 items of evidence linking genes and chromosome regions to addiction based on single-gene strategies, microarray, proteomics, or genetic studies. They made this gene atlas freely available in the first online molecular database for addiction, named KARG (http://karg.cbi.pku.edu.cn), with extensive annotations and friendly web interface.

Assembling the pieces of evidence together, the authors identified 18 molecular pathways that are statistically enriched in the addiction-related genes. They then identified five pathways that are common to addiction to four different substances. These common pathways may underlie shared rewarding and response mechanisms and may be targets for effective treatments for a wide range of addictive disorders.

These genetic alleles help determine the CNS response to a variety of addictive substances. One of the responses someone with a genetic prdisposition to addiction is an "over-response" to the effect of a drug. The brain releases dopamine in the ventral tegmental are (VTA) when an activity is determined by the brain to be "good" for the survival of the organism and/or perpetuation of the species. By rewarding the brain with dopamine, it assures the organism will repeat the activity. In someone with a genetic predisposition, the brain dumps significantly larger amounts of dopamine in response to that drug (ETOH, cocaine, opioids, etc.), increasing the repetition of this action. As the person continues using their drug of choice, the brain is altered physically and chemically. When these changes occur, the person moves from using because it's fun and feels good, to using because the brain demands it. It is now a compulsion. The brain now believes this drug is necessary for survival. When the brain is cut off from it's substance, it will drive the addict to do whatever is necessary to obtain and continue to use the drug.

A big problem for the recovering addict is it takes 1.5 - 2 years of abstinence for the brain to recover as much as possible. Research is showing this recovery is incomplete, meaning the brain is always susceptible to cues, even decades after the last use of the substance. As a result, a person who isn't aware of this susceptibility is at increased risk of relapse, especially when they stop working their program of recovery. It also takes much less time for the brain to degenerate once the use of mood altering chemicals begins. Any addict who has relapsed will tell you it seemed like it took very little time to return to the level their disease achieved when they achieved abstinence.

I find it interesting there is such resistance to the disease model of addiction despite the wealth of research to back it up.

Jack

[Magsulfate, BSN, RN]

Perfectly said.

[VivaLasViejas, ASN, RN]

The Chinese have developed an extensive look at the genetics of addiction. This information is freely available on the internet. All data, database schema, and MySQL commands are freely available for download at their download page:

http://karg.cbi.pku.edu.cn/download.php

Here is a summary of what they have discovered:

These genetic alleles help determine the CNS response to a variety of addictive substances. One of the responses someone with a genetic prdisposition to addiction is an "over-response" to the effect of a drug. The brain releases dopamine in the ventral tegmental are (VTA) when an activity is determined by the brain to be "good" for the survival of the organism and/or perpetuation of the species. By rewarding the brain with dopamine, it assures the organism will repeat the activity. In someone with a genetic predisposition, the brain dumps significantly larger amounts of dopamine in response to that drug (ETOH, cocaine, opioids, etc.), increasing the repetition of this action. As the person continues using their drug of choice, the brain is altered physically and chemically. When these changes occur, the person moves from using because it's fun and feels good, to using because the brain demands it. It is now a compulsion. The brain now believes this drug is necessary for survival. When the brain is cut off from it's substance, it will drive the addict to do whatever is necessary to obtain and continue to use the drug.

A big problem for the recovering addict is it takes 1.5 - 2 years of abstinence for the brain to recover as much as possible. Research is showing this recovery is incomplete, meaning the brain is always susceptible to cues, even decades after the last use of the substance. As a result, a person who isn't aware of this susceptibility is at increased risk of relapse, especially when they stop working their program of recovery. It also takes much less time for the brain to degenerate once the use of mood altering chemicals begins. Any addict who has relapsed will tell you it seemed like it took very little time to return to the level their disease achieved when they achieved abstinence.

I find it interesting there is such resistance to the disease model of addiction despite the wealth of research to back it up.

Jack

AWESOME post, Jack. Thank you for sharing this knowledge..........something I didn't know even after 17 1/2 years in recovery. You rock!!