he or she is in too much pain to go, I usually
Secondary Gain: A Hidden Obstacle to Recovery
Secondary gain is a psychiatric term that means any hidden reason that is motivating a person to hold onto an undesirable condition or problematic behavior. Here it can refer to any perceived benefit _______________ receives from having pain, or it can refer to any perceived benefit you receive from _______________’s pain. If not identified, secondary gain can cause you to unconsciously hold onto unhealthy behaviors. This does not mean _______________ is pretending to hurt for these benefits, or that you want him or her to remain in pain, just that the benefits are making the pain rewarding in some ways and thus more complicated to treat.
Some examples of secondary gain that might result from having chronic pain are listed below. Check those that apply to _______________.
_____ Receiving more attention.
_____ Not having to work.
_____ Being excused from responsibilities.
_____ Being on disability—essentially, being paid to be in pain.
_____ Getting out of activities.
_____ Having an excuse to take pills.
Some examples of secondary gain that might result from caring for someone with chronic pain are listed below. Check those that apply to you.
_____ Giving you a sense of purpose and meaning in life.
_____ Being the hero/caregiver/helper/rescuer (having someone who rewards your need to be needed).
_____ Being able to “people please.”
_____ Being in more control or having more power in the household.
_____ Getting you out of the house, since you have to work to support family.
_____ Being the major breadwinner.
_____ Receiving disability benefits that help support the family.
_____ Expecting a large financial windfall from a lawsuit due to injuries.
_____ Reinforcing your sense of being a martyr/victim, fulfilling a need from early childhood.
When you become aware of them, you may view secondary gain as deserved compensation for the challenges you are experiencing. These thought processes may be conscious but are usually totally unconscious. Either way, if these beliefs remain unexamined, they will interfere with your ability to improve your situation. Taking inventory of secondary gain you and _______________ may be experiencing, and examining your attitudes about this, is an important step in moving toward balance.
{exercise} 2.5
Identifying Secondary Gain ____________________________________
List all the real and perceived benefits you have ever received from _______________ having chronic pain. Be sure to include the things you get, as well as things you were or are able to avoid. One example of each is provided for thought.
PHYSICAL {example: I do not have to be involved in activities I never really liked because _______________ can’t do them now.}
MENTAL {example: Since _______________ is out of it most of the time, I can speak my mind more freely.}
PEMOTIONAL {example: I can avoid emotional intimacy.}
FAMILIAL (Include emotional as well as specific household or practical responsibilities.) {example: I am in charge of what happens around here.}
SOCIAL/WORK LIFE {example: Just like I always wanted, I have to go to work. What a relief!}
SEXUAL {example: He’s in too much pain for physical intimacy, so I don’t have to do that anymore.}
It’s important to look closely at secondary gain, as the perceived benefits might not be as attractive as you believe. Most of the time secondary gain is not gain at all, but loss. Chronic pain sufferers and their families often inadvertently buy into the concept of secondary gain without looking at primary loss.
{exercise} 2.6
Examining Secondary Gain ____________________________________
Go over the list of examples of secondary gain you identified and take a minute to look at what is actually going on. Write about your observations.
Most people find they are just stuck and afraid to move forward. Once you walk through this fear, you will find you gain much more by a return to normalcy in your life.
Looking back, Chris couldn’t say exactly when things had changed for Amy and him, but it was probably soon after she started on Lortab and Soma for the diffuse pain all over her body that left her anxious and depressed. When she started taking the pills, everything got better for both of them for a while because Amy’s pain was reduced, but eventually the doses and strength of the pills increased. The pain doctor she found had rapidly advanced her medication intake. She became emotionally distant; she seemed to disappear into a drug haze, but when unmedicated, she was miserable with the pain. Chris called her doctor to discuss his concerns but was unable to speak with anyone because of HIPAA* restrictions. Amy was clearly addicted to her medications, which became a complicating factor in her relationship with Chris. Chris now had to deal with his responses to chronic pain as well as her addiction.
In this chapter, we’ve discussed the many ways in which families react to the entry of chronic pain into the system and how it can upset the balance of the family system. Important in this discussion are the issues of what defines a family system and the effects that chronic pain has had on your family, as well as codependence, enabling, and secondary gain. We hope you have seen how these issues relate to you and your family. With this background, we turn now to a discussion of addiction and the effects of drugs on the family.
*The Health Insurance Portability and Accountability Act (HIPAA) provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information.
3 Chronic Pain and Addiction: Double Trouble
During a rare moment of clarity, Amy admitted to herself that her life was a mess. She had deteriorated over the last few years, experiencing increasing pain and a general feeling of being a loser—and the more drugs she took, the worse she got. On some level she knew her screwed-up
