Specialists trained with a psychosocial framework provide the bulk of substance abuse treatment in the U.S. These clinicians do a great job of addressing many of the major threats to sobriety such as stress, relationships and reminders of past drug use. But without a diverse interdisciplinary team that not only includes therapists and counselors but also doctors, nurses and other medical specialists, underlying medical concerns may go overlooked and undertreated, often to the detriment of the patient’s recovery. Here are a few of the medical reasons for relapse.
Pain, such as the type that follows a surgery, accident or injury, presents unique challenges for people in addiction recovery. If treatment isn’t managed properly, the use of addictive opiate painkillers could trigger relapse. I have many clients who suffer from chronic pain conditions and end up receiving pain medicines from their doctors to relieve their suffering; however, the patients end up abusing the pain medications and sometimes moving on to harder drugs such as heroin. On the other side of the spectrum, failing to adequately address pain could lead to self-medicating behavior, including drug use. It’s a complex balancing act.
Fortunately, a number of organizations such as the World Health Organization have created guidelines for physicians to minimize the risk of pain treatment leading to addiction or relapse. Some of the precautions include offering non-addictive medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and alternative approaches like meditation, physical therapy or acupuncture for mild pain; prescribing the minimum effective dose of opioids; reassessing pain control needs periodically; and having one physician provide all pain medication prescriptions. It’s also critical for the patient to share their complete history with their medical provider, follow their physician’s instructions carefully, and continue working a program of recovery. When pain is properly managed, the relapse risk is much lower.
#2 Thyroid Disorders
The thyroid — that large endocrine gland that regulates hormones, sets the pace for using up fat and carbs, and helps control body temperature and other key functions — has been tied to drug relapse. When the thyroid produces too little hormone, a condition called hypothyroidism, some studies suggest the relapse risk is particularly high.
In many cases, the link between thyroid disorders and addiction/relapse is a matter of trying to manage symptoms. People who struggle with hyperthyroidism (too much hormone) have symptoms of excessive metabolism including weight loss and increased anxiety. The symptoms can also mimic other psychiatric conditions such as bipolar disorder, which includes hyperactivity, impulsivity and resulting uncharacteristic behaviors. With this condition, people may be drawn to substances that calm the body such as benzodiazepines, opioids or alcohol. Those with hypothyroidism (too little hormone) have symptoms that include low energy, weight gain and depression and are at risk of abusing drugs that help them feel more stimulated or energized, such as cocaine, methamphetamine or prescription stimulants.
#3 Sleep Disorders
Sleep disorders can play a role in every stage of addiction and recovery. Some experts estimate that sleep disorders are five to 10 times more prevalent in people with drug or alcohol addiction than the general population.
People with sleep disorders often self-medicate with alcohol and tranquilizers or abuse stimulants to stay awake during the day. In addition, substance abuse can cause sleep disturbances such as insomnia and sleep apnea, even months or years after the person has successfully stopped using alcohol or other drugs. These disturbances, which can cause irritability, foggy thinking and poor focus, are a significant predictor of drug relapse. Many of the medications prescribed as sleep aids can be addictive, such as benzodiazepines, which is why doctors need to screen for drug abuse and addiction, suggest non-drug techniques and lifestyle changes to improve sleep, and only prescribe potentially addictive medications short term.
So how can you prevent a medical issue from leading you back to drugs or alcohol?
Medical and physical health involves a review of your own dimensions of wellness. There are genetic risk factors as well as social and psychological risk factors and they all work together to help us or increase the manifestation of illness in our bodies. It is important to treat any underlying psychiatric disorders with a dual diagnosis treatment plan in order to sustain sobriety. Psychiatric concerns are medical concerns and it is equally important to treat the underlying physical health concerns. This can involve addressing underlying pain issues, blood pressure problems, diabetes, heart disease, hormonal problems and a host of other medical concerns that may play a role in recovery.
Essential tools in preventing relapse include comprehensive assessments and treatments designed to maximize health and wellness. At Journey, we incorporate healthy eating, exercise and sleep habits into treatment because they are essential for recovery. There is an old saying in the recovery community: “If we want to be able to stay sober we need to change one thing … everything!”
When I hear from clients after they’ve been sober for a year or two, they tell me that when they treat their underlying medical conditions and incorporate healthy choices into their day, they have fewer cravings for drugs and longer periods of sobriety than those who do not make these “whole-life” changes.
Michael Desjardins, APRN, PMHNP-BC, is a psychiatric mental health nurse practitioner and addiction specialist with over 20 years of experience working in addiction treatment. He lives in Draper, Utah, with his wife and daughters and works for Journey Healing Centers, a residential drug rehab treatment center in Utah.