The traditional stereotype of a drug addict is someone addicted to an illegal hard drug such as heroin; however, millions of people worldwide are dependent upon drugs which are legally available – indeed, which they have been prescribed by doctors. The inconvenient truth is that many of the most popular medicines prescribed in the UK are potentially addictive; in 2017, one in every 11 NHS patients was prescribed an addictive medication.
Addiction to prescription drugs happens when a person becomes dependent upon them after taking them regularly (for a period which will vary from one drug to another); their body and mind adjust to the presence of the drug in the system – and usually build tolerance to it (when higher dosages are required to produce the same effect) – and the person begins to feel that they need to take the drug to feel “normal” and to get through their daily routine. Unfortunately, addiction can develop even when a patient takes medication entirely in line with their doctor’s instructions.
Different drugs will produce different effects (and therefore different visible symptoms of abuse) in a person, and some signs of addiction to one substance may resemble the normal effects of another. However, in general the following signs can suggest that a person’s prescription drug use is becoming (or has become) an addiction:
A surprisingly large number of popular medications are potentially addictive, either physically or psychologically (or both). Although all medications which are known to be habit-forming have strict conditions placed upon their supply – and doctors will be very clear about the dangers they pose when they prescribe them – in practice patients can often circumvent these restrictions and/or ignore their doctors’ advice, and the number of people addicted to prescription drugs is now reaching epidemic proportions in many parts of the developed world.
However, one silver lining is that there is now a very good level of understanding within the medical community about the dangers and effects of prescription drug addiction, and this has resulted in the development of robust treatment methodologies which mean that people struggling with addiction now have a range of options if and when they seek help. This is especially the case with the three classes of drug which most commonly lead to addiction: opioids; tranquilisers and benzodiazepines; and stimulants.
Opioids are substances – primarily used medically for pain relief – which target opioid receptors in the brain to produce morphine-like effects. They include opiates – such as morphine itself, as well as some illegal drugs such as heroin – and a number of synthetic drugs used both medically and recreationally. Some of the most commonly available painkillers in the UK are (or include) opioids: tramadol, fentanyl and codeine are all provided on prescription, while codeine is also available as an over-the-counter medication in combination with other ingredients including paracetamol (as co-codamol). Opioids can also be taken to suppress diarrhoea and to treat coughs; meanwhile, they are commonly abused recreationally for the euphoric effects they produce in the user. Opioids are highly addictive both physically and psychologically, and their misuse can be extremely dangerous, with overdose sometimes proving fatal. Withdrawal from an opioid dependency is typically extremely unpleasant with a variety of symptoms manifesting as soon as 24 hours after the last dose.
Tranquillisers are drugs designed to treat anxiety, stress, tension and other disturbances of the mind. Whilst the word “tranquilliser” is in common usage, it does not have any precise definition and is not considered to be “official” medical terminology; it is most commonly used to describe the benzodiazepine class of drugs which includes many well-known brands such as Xanax (the trade name for alprazolam) and Valium (one trade name for diazepam). Benzodiazepines have a broad range of muscle relaxant, anticonvulsant, sleep-inducing and sedative properties and are commonly prescribed for conditions including insomnia, agitation, anxiety and muscle spasms, as well as withdrawal from alcohol and some other substances. They are amongst the prescription drugs most commonly abused recreationally, thanks in part to their widespread availability on prescription. They are known to be highly addictive, and withdrawal from benzodiazepines can be extremely dangerous, potentially resulting in death from seizures and other complications. As a result, they are normally prescribed for short-term use only.
The word “stimulant” is used to describe any of a large number of drugs – legal or illicit – which increase central nervous system activity and create feelings of energy in the user. Various prescription medicines classed as stimulants are available in the UK to treat conditions such as impulse control disorders – including attention deficit hyperactivity disorder (ADHD) – obesity, sleep disorders, asthma, mood disorders – including depression and bipolar disorder – and nasal congestion. Some of the most prominent brand names for stimulants include Ritalin, Adderall and Concerta. Recreational abuse of stimulants is very common in the UK, including amongst young people (some of whom are prescribed stimulants at an early age to treat behavioural and attention deficit disorders). Precise effects (and side effects) vary from one substance to another, but generally speaking stimulant addiction can develop comparatively quickly and can have profound consequences including long-term neurological damage, while withdrawal symptoms can include depression and suicidal ideation.
There are various feasible approaches to treatment for an addiction to prescription drugs, though in general that with the highest likelihood of permanent success is usually considered to be residential rehabilitation – including medically assisted detoxification – followed by ongoing therapy and possible participation in support groups to minimise the chances of relapse.
Residential rehabilitation – “rehab” – sees the addict receiving treatment at a dedicated, confidential facility in a peaceful and pleasant setting to provide the environment most conducive to recovery. A stay in rehab – the duration of which can vary but is usually between 30 and 90 days – will begin with a period of detoxification (during which the patient’s system is cleansed of substances of abuse) monitored and assisted by health professionals (as withdrawal can be dangerous – indeed, fatal in the case of some substances including benzodiazepines – it is vital to have medical assistance during the detoxification stage). Once the addict is free of drugs and the worst of the withdrawal has passed, they can then move onto therapy to address the underlying causes of their addiction.
Rehab can be attended on an inpatient or outpatient basis. Inpatient stays are preferred, as while they are at the facility patients will not have access to any substances of abuse and will therefore be unable to relapse, and will be able to concentrate fully on their recovery without the distractions of the outside world. Outpatient treatment may be preferable for those who simply cannot take the time away from responsibilities such as work and family life which the inpatient option entails; however, because they will not be kept fully away from the temptations of their customary environment such patients are significantly more likely to relapse.
Unfortunately there is no pharmaceutical “cure” for prescription drug addiction: there is nothing doctors can prescribe which will mean an addict no longer feels the inclination to indulge in substance abuse. However, certain medications can prove useful when going through detoxification, to alleviate some of the worse withdrawal symptoms. For example, some antidepressants may be prescribed to help reduce the impact of depression and anhedonia (an inability to experience pleasure); some benzodiazepines will work well to reduce anxiety, muscle spasms and restlessness (and may also be prescribed in cases of addiction to other benzodiazepines, to make for a smoother transition away from the original substance of abuse); while antipsychotics may help some of the more serious mental disturbances which can arise in the most serious cases. It’s absolutely vital that an addict looking to break their substance abuse disorder doesn’t self-medicate: withdrawal can be an extremely dangerous process and this will only be compounded by taking drugs (some of which can interact with each other very harmfully) without the correct medical instruction, so anyone looking to overcome an addiction should always get advice from a medical professional and, if possible, ensure they are at hand throughout the withdrawal phase.
Therapy is a vital aspect of treatment: detoxification will rid an addict’s body of their substance of abuse, but will not address the underlying psychological and emotional issues which led to the addiction in the first place. Various therapy models have been developed to counter addiction, or have been discovered to be particularly efficacious in such cases; the most prominent of these include cognitive behavioural therapy (CBT) and motivational therapy (MT). As every person responds differently to different types of therapy, it may be that an addict will need to try various methods before hitting on those that work especially will in their case. Good rehabs will offer a broad range of therapies – both one-to-one and group – provided by experienced therapists familiar with the stresses and challenges thrown up by addiction.
Support groups are also extremely useful during treatment and ongoing recovery. Addicts can benefit from the advice and companionship of others who have gone through the tumult of addiction and understand the complexities of the condition – as well as providing urgent support if a recovering addict feels that they are in danger of relapsing. Organisations such as Narcotics Anonymous (NA) are active across the UK with free meetings on a regular basis, and have helped thousands of people stay clean having gone through the initial treatment phase.