need advice on pain killer addcition & depression

[Daisy DJ]

My 26 yr old nephew is suffering from depression w/anxiety and this seems to have resulted following a couple years abuse of pain killers to make life easier.  He obviously became addicted and no longer has coping skills and thus has clinical symptoms of depression.  Do you treat the depression or the drug addiction or both and HOW?????  Does he need to see a drug counselor, does he need to go into an addiction program or see a psychiatrits/psychologist.  Help!  I know nothing about this.  But I do know that smart people ask smart questions.

[foodie99]

just went to site u referenced...NAABT.ORG   grt source:

I just read for hour and found: Is continued addictive behavior a voluntary behavior?

The initial decision to take drugs is mostly voluntary. However, when drug misuse takes over, a person's ability to exert self control can become seriously impaired. Brain imaging studies from drug-addicted individuals show physical changes in areas of the brain that are critical to judgment, decision making, learning and memory, and behavior control. Scientists believe that these changes alter the way the brain works, and may help explain the compulsive and destructive behaviors of addiction.(1) The patient's struggle for recovery is in great part a struggle to overcome the effects of these brain adaptations.(3)

Behavior modification can help recondition the brain and reverse some of the brain changes, medication can sometimes help too, but often it is a combination of both. Not all of the brain adaptations resulting from addiction can be reversed, so patients need to develop strategies to compensate. Cognitive tools may be enough for some patients while others will require a combination of cognitive tools and medication to keep the addictive behavior in remission.(4)

1. NIDA, National Institute on Drug Abuse - Addiction: "Drugs, Brains, and Behavior - The Science of Addiction" 2008
3. Kosten TR, George TP. The neurobiology of opioid dependence: implications for treatment. Science & Practice Perspectives. 2002;1:13-20.
4. NAABT - http://www.naabt.org/education/behavior-modification-and-the-brain.cfm

[CATUF]

I don't buy in to the notion that rehab works only if you want it.  More importantly, the statistics on treatment centers don't support it.  There is a much higher direct correlation between
a) time-in-treatment and success than between b) desire to quit outcome of rehab is much.  Studies show that 4 months provides the max benefit.  Some do fine with less, some require more.

As I was being dropped off at the rehap where I spent the next 122 days, the family member driving me said "Well, I hope you really want it this time."  I quickly, and honestly replied, "you just don't get it do you?  I don't want it AT ALL!  I wish I had some more RIGHT NOW!!!"

On that day, and for a long time prior, I was in no condition to know what I wanted.  If I had come home after 30 days I am certain I would have quickly relapsed.  I'm almost as sure I would have relapsed after 60 days.  I was almost ready to make it and 90 days, but it could have gone either way.  Going home after 122 days was no picnic, there were some rough days, but I've never come close to relapsing.

Time magazine recently did an article on addiction (see http://www.time.com/time/magazine/article/0,9171,1640436,00.html).  One significant point in the article is how the brain apparently re-sets after about 90 days clean: "It turns out that this is just about how long it takes for the brain to reset itself and shake off the immediate influence of a drug. Researchers at Yale University have documented what they call the sleeper effect--a gradual re-engaging of proper decision making and analytical functions in the brain's prefrontal cortex--after an addict has abstained for at least 90 days."

I found this to be VERY true in my Recovery.  

In my opinion addicts need to be kept in a safe place long enough for them to return to sanity.  Only then are they in any kind of shape to decide what they want.

I will always be grateful that my wife refused to listen to those who said "it won't work if he doesn't want it."  Somehow she knew that I was in no shape to decide anything and that if she waited for me "to want it," I'd just be dead first.

CATUF
Day-839

[Anhedonio]

I'd start at the psychiatrist or just his primary care physician. For many with depression, opiates are the only things that seem to help.

As far as dealing with the addiction/dependence, he has to get through a lot more than the initial withdrawal or he may likely relapse. Suboxone (Buprenorphine), as was mentioned can be a great help for some. A good source for info on that is naabt.org. Lots of great info on both the addiction side and depression side of the issue.

I suffer from refractory depression and have for most of my 55 years. I discovered when treated with painkillers for chronic back pain that they were also the best antidepressant. So I rapidly became dependent on them.

Suboxone is also a powerful opiate, but lacks the euphoric qualities, and you don't develop a tolerance to it like other opiates. Some of us just don't produce enough endorphins (sp) naturally.

One thing on his side is having such a supportive aunt. Your desire to help is inspiring.

Keep in mind that there is no quick fix, but with the proper support and help, he can and will get through this.

Jas.

[No name22]

Space great advice!

Daisy does you're nephew want to get clean? I know no one wants to be depressed...If so I would thik inpatient rehab would be a great idea that way he can get EVERYTHING out in the open and being in rehab he wont have any acess to pills and I know the 1st week is the worste physically...You may want to check into it, also most insurance covers it if he doesn't have it there may be places in you're area that give free care.

[Spacemonkey]

First, there is hope.  You sound like a good role model for him to use as a blue-print for "Living Well" so keep up the good work.

Second, painkiller addiction and depression seem to go hand-in-hand (at least from my personal experience) so you can't really treat one without dealing with the other.  The 2 depression drugs that worked (and are still working well) for me have been the combination of Cymbalta and Lamictal.  I only have 8 weeks without crunching Tylenol-4 + Vicodin @ 10-15/day but I can say for sure that it would have been tougher without these two pharmaceutical helpers.

You've also got another option with the painkillers that just hit the market/treatment centers.  It's called "Suboxone".  Do a Google Search on "Opiate Addiction and Suboxone" and read up on it.  It's a drug that "tricks" your brain into thinking it's getting an opiate (like oxy, vicodin, t4, codine, etc...) but it's really not. This makes the 1st week or 2 of quitting physically bearable instead of absolutely painful and horrible (it's still no picnic, but I made the mistake and went cold turkey ---> which I DO NOT ADVISE!!!! The 1st week was really, really bad; I wouldn't wish it upon an enemy)

It sounds like your nephew probably has mental as well as physical addictions. The physical addiction can be dealt with in a few weeks (well, ok, it's been 8 weeks for me and I still feel sick/jittery) but the mental/psychological desires for "altered reality" are a life long struggle.  At the VERY LEAST he should see an addiction counselor. Visiting a Narcotics Anonymous meeting or two is also a good idea b/c there is a chance that he might see that there are alot of other people there that are just like him and are going through the same things. A good support group has always been a big help for me (I've been with out a drink for almost 5 years thanks to AA; my father has 26 years with AA, so I feel like I'm barely getting started !!!! )

But beware: He will ONLY get well when HE wants to get well! And no amount of therapy or drug regimen is going to change the problems inside his head. Shipping him off to a rehab center can very easily have the exact opposite effect that you intend and alot of people come out after a "forced stay" (or intervention) bitter, angry, and resentful. And they go RIGHT back out and do everything again and you're $10K-$25K poorer for it....

I can only say good luck, keep reading boards like this one, and listen to what worked for other people.  What worked for me may not work for others and conversely, what others have done may not have worked for me. Everyone is different in how they deal with addiction on a physical and mental scale.

The very first step that HE has to take is saying "I've got a problem". Good luck and God be with you.