Recovery and Prescribed Medications

I had my consult today with the surgeon who will be repairing my hernia. I broke the first rule for those in substance use recovery in dealing with medical professionals (prescribers): I did not inform the doctor that I am in recovery from substance use disorder. I did let the nurse who later scheduled the surgery know that I didn't want any narcotic (opiate) prescriptions, but only after she mentioned that a prescription would be sent to my pharmacy to be picked up after surgery. It's not that I wasn't cognizant that this could be an issue; my thinking was that "I can take care of this myself; I don't need to let anyone know" (which breaks the 2nd rule of recovery - we don't do it alone). 

There is a protocol to be followed by those in recovery who have to deal with legitimately taking addictive medication:

• Inform your PCP that you are in recovery and do not want to be prescribed mood-altering or addictive medication unless absolutely necessary;
• Inform any other medical prescriber who may be caring for you;
• If your prescriber insists that you have to take medication which is potentially harmful to you, discuss your options with:
• Your prescriber
• Your sponsor, mentor, or recovery coach
• Your significant other or loved ones
  
• Others in recovery who have gone through similar experiences  
• If, after this, you decide that the medication is necessary for your overall well-being and healing, find someone who cares about your well-being to dispense your medication for you. Accountability is key.

By writing here, I am beginning the process of reversing my errors. I will follow the steps listed above. 

However, let me share my thoughts, feelings, and experience with this:

For my healthy recovery, I need to not only avoid addictive and mood-altering substances - I also need to avoid the behaviors associated with substance use, such as being sneaky and dishonest. Not wanting to tell anyone that I have been (or will be) prescribed dangerous-for-me drugs is sneaky, and some part of me gets some form of gratification from that. Not disclosing the whole truth to my medical care providers is dishonest, and I don't get gratification from that, but dishonesty can still be a go-to for me when I get afraid. It's important for me to be honest with myself about the whole picture.

I have never been physically addicted to opoids; I have, however, misused them, even while supposedly in recovery from alcoholism. It has been my experience that if I misuse any potentially mood-altering medication, I will eventually go back to my drug of choice (alcohol). This has been the experience of many others, as well.

One might ask, "Ken, why can't you just take the medication as prescribed, instead of misusing it?" And the answer is, to be honest, that I am not that far advanced to do so. The idea of getting a little taste of something that I used to get high from is not pleasing to me - it's like taking one drink, for which I have no desire. I've never had a desire for one, and only one, drink, oxycodone, brownie, or several other things. When I see a prescription that says, "Take 1 every 4 hours as needed" I see, "Take 4 every hour, and you need it." I would rather live with physical pain which I know to be temporary (and able to be alleviated with other methods) than the inner anguish of craving. When I was recently going through my intensely painful gastrointestinal issues, I was buying all sorts of over-the-counter stomach remedies, and rarely did I follow the usage instructions. (I also found that by over-medicating myself, without a physician's advice, that I was potentially creating more problems for myself than I was solving. I guess I still have stuff to work on!) So I really do not want to hand my prescription over to someone else and have them dole out the correct dosage for me - it would create more discomfort for me than it might alleviate. 

But this is why we discuss it with others, preferably those who have experience - there are some instances where treating the pain of whatever is going on is necessary for the healing process. In my particular case, I don't think I'll need to take anything more than NSAIDS (Ibuprofen, naproxen, meloxicam, etc) and acetominophen (Tylenol). I learned this from a dentist, who has encountered many patients who need to stay away from opiods - that alternating ibuprofen and Tylenol is effective. My surgery is going to be minimally invasive, I have a high physical pain tolerance, and I have the tool of meditation. I believe I can live with the physical pain and discomfort, but I will discuss it with others.

But why not trust solely upon what the doctor is saying? If you're in recovery from substance use disorder, you know the answer. If not, the answer is that most physicians are given about a day's education on substance use disorder and are unaware of the dangers to certain populations of certain medications. In general, pharmacists know more about pharmacology than physicians do, and are good resources to talk to about alternatives and possible drug interactions. 

Next question: "Why don't you simply resolve to avoid that which gives you trouble (wtf is wrong with you)?" Because by choice, genetics, or fate, I have a disorder which has hijacked the parts of my brain dealing with survival and choice. This is irreversible; I will never be able to drink like a gentleman (nor do I have any desire to do so). Additionally, I have created strong neural pathways (habits) in my brain which can't be eradicated overnight. The human brain creates these neural pathways for our survival - neural pathways are so that we don't have to consciously decide whether or not we're in danger each time we encounter a tiger in the woods. Neural pathways are why I still occasionally reach for my keys to unlock the door to my house even though we have a push-button lock, and I've lived here for 6 months. Neural pathways are great, except when we want or need to change something in our lives.

So yes, I am dead certain that alcohol and other mood-altering drugs are not good for my survival; but my subconscious, which isn't nearly as smart as I am, is not really aware of this. In fact, it still thinks they're probably ok. Yes, it's an aberration; yes, it's like lying down with the tiger even after it's eaten one of my hands and feet. So the freeway to hell still exists in my brain even though I haven't used substances for a while. It takes time, experience, and conscious decision making to let that freeway disappear. I have to experience triggers to use, and consciously tell myself a different story each time. This is why there is so much relapse in addiction, and why it is such a dangerous disorder - knowledge of our condition is not enough. We need to actually expect triggers and consciously re-do our thinking when we encounter them. Today was a trigger. I'm implementing manual override.

That which isn't understandable to people who have not experienced it can be understandable to those who have experienced it and approach it without shame, guilt, or embarrassment. It's called learning to live in the solution, rather than the problem. What can I consciously do today to ensure my survival, because I recognize that my subconscious (automatic thinking) probably won't do it for me. With practice, the process becomes an accepted way of living rather than an onerous burden.

I appreciate you reading this and being part of my recovery!

Namasté,

Ken