Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Drugs and Pain

Some patients have positive drug and alcohol histories prior to injury that, for reasons unclear, do not appear in their records. At least one in four people enrolled in substance abuse treatment programs have experienced chronic severe pain as a foundation for their addiction.

24% of inpatients enrolled in short-term substance abuse treatment programs said they experienced persistent pain that interfered with their daily activities. Up to half of these patients–especially inpatients–said they self-medicated with illicit drugs and alcohol.

The two disorders, addiction and chronic pain, complicate each other. Surveys have indicated that more than 70 million adults in the US have chronic pain.

Most report that the chronic severe pain interfered with their sleep, and many patients said it disrupted their work, mood, and general activity.

Patients with chronic pain were more likely to report using illicit drugs to get relief from chronic, severe pain. Thirty-five percent of subjects said they used alcohol, 29% said they used cocaine and 26% percent said they used opioids and marijuana, respectively. Furthermore, 30% of patients in the methadone treatment programs used opioids–the most frequently used illicit drugs in this group.

Study results suggest that chronic pain contributes to illicit drug use behavior among persons who were recently using alcohol and/or cocaine.

There may not be adequate screening or goal setting for these chronic pain patients who anticipate that treatment for their pain will resolve all of their complaints, and they quickly become reliant upon short acting opioid medications. Addiction then becomes the consequence of care.

JAMA 2003;289:2370-2378.

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