Dependance or Addiction???

The difference between dependence and addiction can be found in the outcome.

A chronic pain patient that takes their narcotic pain reliever(s) as prescribed will develop tolerance and physical dependence over time. Those are biological processes and are expected with many medications, not just narcotics. Physical dependence, in and of itself, does not have negative consequences. For a chronic pain patient, the overall result of their drug use is positive; they experience a reduction in pain, which leads to improved function.

Addiction, on the other hand, is a psychological process and is characterized by continuing use in spite of consistently negative consequences. People become addicted when the drug use is no longer appropriate or adaptive.  They continue to use the drug inappropriately, even though the direct result is a decrease in their ability to function and they experience increasingly negative consequences.

 

I knew I would get some good responses....

Let's say we have 2 CP people that take the same kind of pain meds, and they have for years. For some reason they happen to run out...and they both go through withdrawls, both physically and mentally. Just because they have the same symptoms are they both addicts? or are they just physically dependent? To me it could be either or both....am I wrong? and what does it matter? The outcome is the same...

????Me????

A significant aspect of this is genetic, and may be no fault of the person him/herself. If there is a family history of addiction, then dependence and tolerance may occur more rapidly without there having been any addiction history with that particular individual. I think we have to be careful about blaming too quickly. I've got professional background dealing with addicitons, which I'm not here to specify no to give professional advice (as that's not permitted on the forum anyway), but as a chronic pain patient I now can see a lot of things from the inside out, so to speak, and that has added a new dimension. The concept of pseudo-addiction also needs to be understood, and I also think the total context of how difficult it is for many of us to get adequate pain treatment from doctors is also critical. Undertreated pain I think is far more common than addiction in relation to chronic pain patients; it's just not as sensationalized.

PaLady

from my understand opiods attach to the brain which in return causes the pain relief. there is no way, whether the drugs are abused or not, after 6 years of being on opiods she would not have withdrawls. its in her chemistry now. from my understanding withdrawls can take up to a week... and again it can be simply from all those years of using these meds. vh1 has a show called celebrity rehab- it touches on this subject a lot, there is a lady who has been on opiods for 35 years & embarrased when told she may have severe withdraws. its not her fault how long it takes, its in her system. have you voiced your concern about this to her? i'm by far no dr, but there are safe ways to come off these drugs that can come with counseling- which she will more than likely need. i know its probably a tough topic, but if she admits to you she runs out of meds- maybe she is asking for help? i know i had some severe stomach issues that caused me to withdraw from not being able to keep the meds down. i finally went to the dr & once they got my meds in me it was within the hour i felt so much better. combined with the stomach issues it was almost too much. if there ever comes a day when i stop needing my meds i would 100% go someplace safe to come off of them. it was an awful experience. check out that show, i watch it online- maybe it will offer some insight. maybe ask your dr for some info to present to your friend in a comfortable enviroment & a family intervention. i am sure you are not the only one concerned at this point. you are a really good friend, it may get tough- but hang in there & good luck! maybe put a rehab post up & see if you get any bites?

For me, the statement "she often runs out because she takes way more then she should and then she has horrible withdrawls, both physically and mentally" wraps up in nice tidy package there's a problem that needs to be addressed. Regardless of the reason, she is abusing her medications by not taking them as prescribed.

I "cut loose" anyone that crosses that line and abuses their medications. I will go to the ends of the earth and offer absolute support to my friends and family who are struggling and living with undertreated pain, within the limits of the law. But if they engage in the very behaviors that have created this system and that leave so many of us fighting to receive basic, adequate pain management, I have no place in my life for them. People have told me that I'm too harsh on that topic, but I refuse to support the people who support (by their behaviors) a system that treats me like a criminal because I live with chronic pain.

In my case,I have required ever-increasing amounts of opiates just so that I can shuffle around with my elbow-length crutches after my last botched operation over nine years ago.I have letters from some of the best Dr's in the business (Provincially) that state any further surgury has too great a risk of me losing my ability to walk at all.If I was not on narcotics, I'd not be able to get out of bed even, as I can't sit without leaning forward and putting alot of weight on my elbows on the table for short periods of time.So, in other words,even if I could live through the withdrawl period,the excruciating pain would still be there afterwords.I doubt I'd live long being unable to get out of bed.I've never ran out my medications because I take my long lasting narcotics exactly as prescribed no mater how bad a day I have and only use my break-through meds on the very worst of days or "as needed" like my prescription says.This way I've been able to save a few extra pills for the really bad days and not run myself short.We all likely have some days that are better than others so if you can get by until your next dose of long lasting meds without a B/T med, do it.You will sure appreciate your efforts the next time you have a really rotten painfull day and need a little more painkiller.

I certainly believe in taking the least amount of medication possible to effectively manage pain, but I don't quite understand saving the so-called extra pill for a bad day perspective. I've never had a doctor prescribe pain medication "as needed" without the stipulation of a certain number of hours between doses and/or maximum doses per day, which leaves me wondering how one could take their medication exactly as prescribed, but appreciate/take an extra pill on a bad day.

Ray22,
Exercising 2-3 hours at a time for chronic pain patients? That could be dangerous. It also sounds like an addictive behavior. And I don't believe the forum rules allow for links to such websites.

PaLady

I do believe in the difference between dependence and addiction. To me, there is a HUGE difference. Recently I was reading something written by a drug counselor talking about his patient. This statement is to me a defining point in the debate of dependence over addiction.

Sorry if this derails any debate that you're having over how to follow dosing directions, but I thought it was an interesting statement on where use/dependence turns into addiction.

"He started taking the pills for pain — like most. He later became dependent. Then he crossed the line and started becoming addicted.

When you start having behaviors that you wouldn’t have when you are sober, there is a problem. When the chemical begins to be a primary relationship - like a spouse - and motivating factor in your life, then you know you have a huge problem. This is when addicts use with harmful circumstances."

My doctor knows I save a few pills out of my prescribed amount. He laughs and
says, "You just never know when your doctor will skip town."
He knows I wouldn't take a bunch and do myself in. I have his permission to
take extra if I have dental work done or have to go to my out-of-town doctor.
What if the factory burns down? (Could happen in CA) What if the manufacturer
goes bankrupt?
I take really good care of my prescriptions. I think most of the people who post
here take care also.
Pamela

Perhaps I'm a little thick, but I still don't understand how holding your unused medications equates to "You will sure appreciate your efforts the next time you have a really rotten painfull day and need a little more painkiller."

If your prescription reads take 1-2 pills every 4-6 hours as needed, then simple math says you may take a maximum of 8 pills per day. Where does the appreciation of your efforts come in on a really rotten painful day? A maximum of 8 pills is a maximum of 8 pills, regardless of how many days you only needed and took 6.

You know, I tried specifically not to do it and I did it anyway..  that 8 in my last post should have been a 12.  

I guess simple math isn't always so simple when you've programmed yourself to understand that when the doctor writes 1-2 pills every 4-6 hours, he actually means 1 pill every 4 hours (6 a day) OR 2 pills every 6 hours (8 a day).  I recognize that some doctors write that and allow 2 pills every 4 hours, but I've never had one that does, so I come pre-programmed to read that as 8 pills a day. 

It doesn't really change why taking fewer on a good day would directly benefit a person on a bad day?