In the last ten years, more attention has been paid to police officers and PTSD. PTSD was originally defined for soldiers returning from combat, but the definition has been expanded with increased research.
If you have been involved in a traumatic event at work, whether that event involved you being injured, you seeing a dead body or you hurting another human being, it could trigger symptoms of Post Traumatic Stress Disorder. The name says it…stress occurring after the event. Symptoms include nightmares, flashbacks to the event, running the event over and over in your mind, insomnia, and others.
At the time of the incident, your brain is on overload. Your brain has signaled the alarm for combat, for flight or fight response to your body. You are super charged with adrenaline. You may have auditory exclusion. You may fire shots and not hear them. You may not hear commands being shouted nearby. You may have distortion of time and space. You may think a chase goes on forever when it is only a few seconds. You may sense that the perpetrator is very close when later, you notice that there are hundreds of yards between you. All of these symptoms are normal. Your body is doing it’s job to keep you safe. If you were not hyper vigilant when you are in danger, you wouldn’t live long.
Make no mistake, all of this is important. Being faced with your own mortality is a big deal. Killing or thinking you killed another human being (even if it is you or them) is a big deal. You may have symptoms like insomnia, not wanting to go to seep, tearfulness, nightmares, going over and over the event in your head or talking about it nonstop. These are all normal symptoms. You may not want to or be able to perform sexually. You may be over cautious with your children. You may get irritated with regular tasks at work. All of these symptoms are normal and will go away in a week or two. If these symptoms continue for more than a month or if you are troubled by them, ask for help. If you are uncomfortable, ask your chaplain for assistance. In most cases no medicine is ever needed. Some counseling sessions take care of the issues most of the time. It is good to talk to another person about the event on the same day, if possible, before you sleep. That is not always possible. It usually is a simple but necessary procedure to take that traumatic memory and move it from the center of your brain to a back shelf somewhere. You will always be changed by such an event, but you do not have to be scarred by it.
I have been practicing social work since March 16, 1981. In 1981, it was cool to do a lot of stuff that we don’t do at all now. It was cool to tease your hair up as high as you could possibly get it without tangling it in a ceiling fan. It was cool to stop at a telephone booth to call someone from the road. It was cool to drive a baby blue Camaro with T tops. It was not, however, cool to counsel alcoholics and drug addicts. Like it or not, we (everyone who had a pulse in this country) thought that to be an alcoholic, you had to be lying in the street, missing a leg, dirty and home-less. And I was a professional! My peers asked me thousands of times “how can you work with “those people’?” They did not think my work was cool.
Pro alcohol ads were full color page scenes with beautiful people on sunny beaches or at disco clubs with seductive messages. Pro sobriety ads were tiny black and white ads in the very back of magazines. Betty Ford changed all of that by announcing that she was a drug addict and an alcoholic. A DRUG ADDICT AND ALCOHOLIC! Our vision of drug addicts were dirty people with needles sticking out of their arms. Well, with grace and elegance, Betty Ford set us in the substance abuse community, in the world, straight.
I heard Betty Ford speak at a women’s conference in north Atlanta in 1982. She candidly discussed the intervention that her family had held with her way before interventions were a weekly series on TV. She told an audience of several hundred professional women that her children were afraid to leave the grandchildren with her. After her husband left the presidency (Who was he anyway?), they moved to Palm Beach and lived a lifestyle of leisure. She was drinking way too much, way to early in the day and mixing alcohol with prescription medication. And she referred to herself as a DRUG ADDICT and ALCOHOLIC! I was tremendously impressed with the way she shared her darkest self shamelessly with those few hundred women that day.
Well, we in the counseling community had to do a bit of a double take and redefine our definitions of alcoholics and drug addicts. Because Mrs. Betty Ford was certainly not lying in a gutter with a leg missing. We had to open our minds to the fact that a CEO of a company could be an alcoholic, a sports star could be a drug addict, even the king of rock and roll could be an acceptable drug addict. I have a saying that if only Elvis had lasted about 5 more years. He could have been hospitalized at the Betty Ford Center for de-tox and extended treatment. Why, he would have developed his own rehab facility located in Memphis, named Graceland. Rock stars and blues singers, truck drivers and servicemen from all over the south would have followed his footsteps in recovery. But, alas, Elvis was a few years too early with his addiction problems. It wasn’t cool in 1978. Well, it really wasn’t cool in 1981, but Betty Ford did it.
As an addiction counselor for the last 32 years, I am extremely grateful to Mrs. Betty Ford. How brave she was to step forward at a very difficult time in her life. She has helped so many hundreds, maybe thousands of people look at themselves in a different light, a less harsh light of addiction. I use her as an example whenever I am able in my groups and talks. She truly was a woman who changed the world. Thank you Mrs. Betty Ford!
Since 2008, this social worker has seen a huge increase in court ordered treatment for pill addiction or pill related arrests. With the advent of Oxycontin and the increased education about the dangers of methamphetamine, users are turning to prescription medications These offenders use or abuse only prescription drugs prescribed to them by their physicians. They feel that they are totally validated in their ability to use whatever prescription drugs their doctor(or doctors) have ordered, in any combination necessary. They are rigid in their beliefs that they are not responsible for their DUI/Drug arrests. “They are only following doctor’s orders!”, sort of. And their pain is REAL! Pill addiction is sweeping through our community and our nation in alarming numbers. There have always been pill addicts. Remember the distant aunt you had on your mother’s side who always had Valium for her “spells”? Well, multiply that by 10,000.
The two most abused classifications of drugs in this county are narcotics and benzodiazepines. In laymen’s terms: pain pills and Xanax. These two classifications are fast acting mood changing drugs. For the purpose of this post, I will focus on narcotics. Oxycontin is a relatively new drug on the market used for severe pain management. It has a time release coating which delivers 12 hours of pain medicine to the body over a period of time. This social worker has seen Oxycontin make the difference in someone writhing(yes writhing) in the floor in terrible pain and being functional. So, there is a need for this drug. But, if the coating from the pill is destroyed in some way… like crunching it off, or sucking it off or even cutting it in half… the dose is 12 hours of medication in one blast. There is a high…an incredible high. But there are drawbacks!
Drawback number one: If one is using pain pills to get high instead of to manage pain, the tolerance builds very quickly. I have known addicts who become physically addicted in a three month period of daily use. It is not un-heard of for a pill junkie, as I refer to them, to start getting high by eating 15 milligrams of a 30 milligram Roxycontin. In a three month period, the user can progress to needing 90-100 milligrams of the same medication to get them high.
Drawback number two: There is a physical addiction and withdrawal with pills. The withdrawal includes but is not limited to shakes, sweats, muscle cramps, lower back pain, diarrhea, feeling like you have the flu. The intense withdrawal (depending of course on the dose and longevity of the addiction), is four days. They feel like they are about to die, but they are not. Less intense withdrawal symptoms include sleep disorder and shaking for a period of 30 days. Often, the detoxification regimen is “cold turkey” while serving a sentence in the county jail! Again, narcotic withdrawal is not usually life threatening, however benzodiazepine withdrawal can be life threatening.
Drawback number three: The cost. Roughly speaking, the cost of Oxycontin addiction is $1 per milligram. And 100 milligrams use per day is blasé. An average addict can easily consume 240 to 320 milligrams per day. Oxycontin is dosed in 80 milligram pills. One can use Hydrocodone, Lorcet, Darvocet or other lower dosed drugs, but the popular narcotics on the street are the Roxycontin (30 milligrams) and Oxycontins (20, 40, 80, milligrams, etc). Can you see how quickly a person could get into financial trouble with a narcotic addiction? They end up doing one of three things: They deal, they steal or they substitute heroin because it is actually cheaper. But there are a few well documented drawbacks to heroin.
Drawback number four: Any crumble of a pain pill that the user does not have a prescription for or a crumble of a pain pill that is not in a proper container is a felony drug arrest. Uh oh.
Drawback number five: One can very easily be charged with a DUI for using just the prescribed amount of pain pills, alone (note the label on all of this stuff that says “Do not drive or operate heavy equipment”), mixed with a cold beer, taken on an empty stomach or taken without much sleep. It is easy to become involved in a DUI accident or an accident with injuries, or worse, on medications.
Drawback number six: Overdose potential. While it is difficult to overdose on medications that your doctor and your pharmacist know that you are taking, it is easy to overdose when you take an extra pill because you are hurting, you are in withdrawal or just for fun, with a cold beer. I am always amazed at the number of meth addicts who survive catastrophic medical problems, but when pain pills and Xanax tell your heart to stop beating, it will follow orders… period. And we have had multiple accidental pill overdoses in this community in the last 10 years…unnecessary deaths.
Drawback number seven: Pill addicts tend to practice medicine without a license or training. They double up on one pill. They cut back on another. They feel like they have a medical degree from the “I Got This University”. They are sure that since they have handled this particular dose of a drug before, they can handle it again. They are sure that mixing this with that is ok. They are practicing medicine on themselves and behind the wheel of a 4000 pound vehicle.
So, what is the problem with these addicts in a treatment program? Well, they may actually have pain. They may actually need some of the medications that are prohibited in treatment. They may not be able to be clean. In which case, the coordinator cannot accept them into the program. Sometimes the drug test needed for their particular drug of choice may not be included in the routine drug tests that the program offers. Some medications, such as Ambien or Soma, are particularly difficult to test for. Hair tests, if you use them, may not pick up the drugs you need to test for. ! Coordinating treatment with a doctor for a pill addict can be difficult especially since they usually have multiple doctors prescribing them drugs. 99 percent of the time, these doctors are completely unaware that their patient is getting medications elsewhere. These people use the emergency room like we use the grocery store. They pop in and out two or three times a week, for cramps, for a headache, vomiting….anything they can think of to get medications prescribed by a physician that THEY NEED! Physicians are often difficult to contact. They also can become irate and defensive because they feel like you, the lowly counselor, are trying to tell them how to practice medicine.
So how do we address the impact of pill addiction in treatment? You have to educate yourselves and your staff about medication addiction. Go to all of the training and read all the research that you can on prescription medication addiction. You must be open to making changes and adjustments to your program as new treatment information becomes available. You must be prepared to spend more resources on these particular addicts. Pill addicts can(and do) cause DUI fatality accidents, drug arrests, child endangerment, etc. But a pill addict is a bit of a different animal than a street drug addict or an alcoholic.
Brain chemistry for beginners. This is where it’s at, my friends. The whole essence of addiction is narrowing down to a little part of the brain, sort of in the middle of the brain. I find this stuff fascinating, but then, I am a little off. I am going to try to explain in laymen’s terms, my terms about the brain chemistry of addiction.
When I came into the business about a hundred years ago, actually in 1981, we had one shaky theory of addiction. It was based on research done by a coroner, a coroner, what does that tell you? The research indicated a difference in the brains of alcoholics verses the brains of non alcoholics. One type. One difference. All the research and it wasn’t much, was done with alcohol. And we are still arguing about a genetic link, 32 years later. HELLO! The culprit of addiction appears to be in the pleasure centers of the brain. Each type of drug, amphetamines, cocaine, marijuana, opiates and alcohol have different areas that they target, but relatively speaking, they are near each other in the center of the brain. Now if we magnify that pleasure center spot, like a billion times, we have 2 cells next to each other. The tail of one is near the head of the other, separated by a synapse, a space (remember high school biology?) Basically, when we are going through daily life, not high, messages or neurotransmissions are sent from one cell to another really fast, faster than a speeding bullet..kind of thing. They are chemical messages, neurotransmitters. They jump each synapse like jumping a small creek when playing in the woods. Does anyone even do that anymore? When a person uses drugs or alcohol(and alcohol is a drug, my friends, it is not a fruit or a vegetable), the neurotransmitters flow differently through the brain from cell to cell. There are several kinds, but dopamine is one for pleasure. It sends a wonderful, powerful, incredible message through the cells. Actually, when you use drugs, dopamine floods the brain with a bazillion powerful messages of happiness, smoothness, excitement; you get the picture. A bazzillion, like a bazzillion friends on face book. (I feel like I need a dry erase board and a Jimmy Hendrix CD to explain this well, but stay with me.) The dopamine can also only land in special spots in the next cell, but that does not seem to be much of a problem, not like parking places at the mall at Christmas time. The flood of dopamine changes the cells, which makes the person want more and more of the drug to get the same high. And they do, use more and more of the drug to get high. The brain keeps changing because of the flood day after day into the pleasure center. So, not only does a person NOT “get high” naturally like when you hear the Eagles sing” Desperado” live, but they are desperate to get high because of their changed brains.
So, what do I want you to get out of this stuff? If you are an addict, you have changed your brain. You cannot use again, in Georgia, in Idaho, in Missouri. You cannot use drugs with your ex-girlfriend, a new one or President Obama. You are not stupid or weak; you have changed your brain, perhaps forever. Some parts of the cells grow back; others do not. Stop using. If the thought of being clean and sober makes you tremble, you may be in the club of addiction. Ask for help. Look online. Ask your preacher, your teacher or the best alcohol and drug counselor in the world, me. You are a good person, with a brain disease. Period. End of story.