Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Religion and Injury

Addiction and physical dependence are not the same thing.

Briefly, addiction is a chronic, relapsing disease characterized by compulsive drug-seeking and use and by neurochemical and molecular changes in the brain. It is a physiological and psychological compulsion for a habit-forming substance. In extreme cases, an addiction may become an overwhelming obsession. It involves uncontrollable craving, seeking, and use of a substance.

For chronic pain patients, the physical dependence created by long-term use of drugs such as Oxycontin and numerous others is anticipated. Dependence is a state of adaptation manifested by a drug class-specific withdrawal syndrome produced by abruptly decreasing blood levels of the drug, and/or administration of an antagonist. Tolerance also develops, which means that over time, a higher dosage of the medication is needed to achieve the same level of pain relief.

Physical dependence and the “high” of addiction are not synonymous, but because both share symptoms of withdrawal, addiction is frequently and incorrectly equated with physical dependence.

This is why it is important not only to attempt to verify whether the patient is, in fact, in pain, the degree of that pain, the past history of substance abuse of the patient, the criminal history of the patient, and even the existence of family/friends who make demands upon the patient for access to their prescribed medication.

Increasingly, prescribing physicians require a drug contract and drug screening for patients who are maintained on high levels of opiates.

Comments for this post are closed.

Self-fulfilling Referrals

When I was in training, one of the interns was seeing a psychoanalyst for intensive psychotherapy. One day he entered the …
Read Blog Post

Fit for Duty, but…still in Pain

Pain The final months of treatment in workers’ compensation sees the surgeon complete his/her role in the patient care. …
Read Blog Post

Oxycontin, Pain Clinics and the Rural South

Let me summarize an article by Dr. Stephen G. Gelfand, rheumatologist. It is lengthy but very well worth taking time to read …
Read Blog Post