Pain Recovery. Robert Hunter

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Wanting the drug (craving).

      

Counting pills.

      

Worrying when the supply of pills is low.

      

Focusing on the time until the next dose (preoccupation).

      

Increasing the dose without a doctor’s order (tolerance).

      

Taking a pill or two in the morning to “get going” (using for purposes other than those intended by the prescriber).

      

Adding another substance to supplement the effects (commonly alcohol or other sedatives).

      

Using stimulants because of fatigue caused by the opioids.

      This stage usually occurs in individuals who haven’t had chronic pain for very long but are beginning to develop problems with opioids.

       STAGE II

      In stage II, the addict begins to experience the negative consequences of drug use. This stage is characterized by problems in one of the following major functional areas: family or home life, job or school function, social function, legal status, or health. In stage II you experience problems in one of these areas, although several areas may be affected as time goes on. Examples of stage II problems include:

      

Fighting at home, neglecting familial responsibilities, or separation.

      

Being disciplined at work or decreased work performance.

      

Calling in sick frequently or missing work without calling.

      

Failing a major test at school or dropping classes.

      

Using illegal methods to obtain drugs (consulting other doctors but not disclosing this to each doctor, acquiring pills from illegal sources, using multiple doctors or pharmacies, driving under the influence), but not yet having been caught or arrested.

      

Experiencing a worsening of health problems, many of which are side effects of opioids, such as escalating pain, nausea, constipation, diarrhea, headaches, sleep disturbance, fatigue, or depression.

      This stage usually occurs in individuals who have been dealing with chronic pain for some time, and though they may appear okay on the outside, they are beginning to experience deterioration of function.

       STAGE III

      In this stage, there is intense preoccupation with the desire to experience mood-changing effects of the drug(s). Daily drug use, depression, and thoughts of suicide are common. Family troubles increase. Legal problems may ensue. Stage III is characterized by any one of the following major consequences in any one major functional area. If family function is the problem area, these consequences include:

      

Being asked to move out for good, leading to the end of the relationship.

      

Getting a divorce.

      

Becoming estranged from close family members.

      If the problem areas are outside the home, they could include any of the following:

      

Getting fired.

      

Failing out of school.

      

Going to jail.

      Stage III physical changes include:

      

Being hospitalized.

      

Being physically dependent on drugs; suffering withdrawal when trying to cut down or stop.

      Again, for it to be considered stage III, the addict must have only one of these problems, not multiple problems in all areas of his or her life, even though that may be the case. This stage usually occurs in individuals who have been dealing with chronic pain for years and the amount and variety of their medications has steadily increased, with progressive decrease in function, dependence on the drug(s), and general worsening of quality of life.

       STAGE IV

      Stage IV is considered late-stage addiction, where the effects of the disease have spread to all areas of the person’s life. Stage IV addiction, like stage IV cancer, is the period that precedes death from the disease. The length of time people can survive in this stage varies, but if the disease is treated, even at this point, the destructive process stops, life expectancy increases, and quality of life improves. Common causes of death from addiction include overdose, liver failure, accidents, suicide, and infections that would be preventable or treatable in nonaddicts. Those who have reached this stage need increasing quantities of drugs just to feel normal. Physical signs, such as damage to the heart, liver, and brain; malnutrition; lower resistance to pneumonia or tuberculosis; and overdoses are common.

      Stage IV addiction is characterized by multiple problems in more than one major life area. Generally it means the person has no meaningful family life or relationships left, has no job or school life, is cognitively impaired by drug use, and has severe long-term, often permanent health consequences, including brain dysfunction. In stage IV, pain and addiction are deeply entrenched in a person’s life and the person is alienated from loved ones and medical professionals alike. People with stage IV addiction fit the stereotype of those with addiction and are commonly homeless, in jail, or in an institution.

      Individuals with chronic pain often have histories of overdosing on drugs, either accidentally or on purpose. The acetaminophen in their opioid medications has caused liver damage. Their lives consist of unending pain, periods of sleeping and sleeplessness, staying in bed most of the time, and trips to the emergency room, either to try to get drugs

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