In Recovery: Dealing with Surgery or Hospitalization and Addictive Medications

Don't rely on your doctor to understand or protect your recovery.

The average doctor understands very little about addiction. In a recent report, the National Center on Addiction and Substance Abuse (CASA) at Columbia University found that most doctors fail to recognize, diagnose, and recommend treatment for substance abuse with their patients. Given that the amount of addiction training received in med school continues to be insufficient, there’s little reason to expect that this will change. For those in recovery, we must ensure that our physicians do not unwittingly place us in harm’s way.

Educate Your Doctor about Your Needs

During my recent inpatient stay, I expressed my concerns to my surgeon. I told him I have an addictive personality and live at the extremes of all or nothing. His face was a mixture of benevolence and confusion. He said, “As long as you take what I prescribe as it’s intended, everything will be fine.” I wanted to scream, “You do NOT know that.”

Dilaudid, Morphine, Percocet, OxyContin, and Fentanyl were all prescribed to me and available in extra doses - all I had to do was ask. I had a healthy fear that I would enjoy their effects too much and overestimate the pain I was in. I’ve watched what the disease of addiction can do to people who are clean and sober but come to experience legitimate pain.

In some cases, what’s prescribed is a person’s drug of choice. It’s mindless a horrible display of ignorance, but it’s our job to educate our providers about our specific needs.

It’s darkly amusing that my medical staff was so concerned with my nicotine patch. They urged me to quit smoking while pushing Fentanyl intravenously. I assured them each time that I had no intention of quitting. They wondered how, could I choose this, knowing the impact it would have on my healing? “Because I’m addicted and because I love it.”

To my medical staff, smoking is dangerous but opiates are safe. There’s no “right way” to ingest nicotine. As an addictions counselor I can tell you that the latter tends to kill a lot faster than the former.

When You Must Take Pain Meds

Accountability remains key; you have to inform your doctor of your recovery needs..

1. Remember, your doctor doesn't know you personally, and if s/he doesn’t understand addiction s/he won’t detect when your disease is dictating the decisions and when you are.
   
2. Regardless of how long we’ve been clean and sober, we sometimes con ourselves and others as naturally as we draw breath.

Rely on Your Support System

Everything that works to keep you clean/sober is useful for navigating these dangerous waters.

1. Utilizing your support system at the earliest possible juncture will make this far more manageable.
   
2. Share with them what your needs and fears are and seek their assistance in monitoring you.
   
3. The value in this is that no one can detect an addict’s self deception better than another addict.

Plan for Triggers

For most of us, the most dangerous time is at discharge. If we are given scripts there’s a good chance we’ll be triggered. We must be prepared even when what we’re prescribed is not addictive. For a lot of us, just having a pill bottle in our pocket is enough to send us into orbit.

Regardless of what we’re taking, extra support is in order. If you go to meetings, double up on them for a time. If you have a sponsor, mentor, concerned family members or friends, tell them what you’re up against. Leave nothing to chance. The risks are too great.

How to Talk To Your Doctor

• Tell them very directly, “I am an addict/alcoholic. I am at risk for _____( relapse, abusing meds, developing a new addiction, other fears). Do not give me more than what a person should require with my condition. Whenever possible, prescribe me medication that is not potentially addictive.

Ask questions. Interrupt if necessary. Remember that passive approaches simply do not work for us. Talking to doctors and other medical staff can be intimidating, but be mindful of what’s at stake. If you find that you simply cannot effectively advocate for yourself, call upon friends, family or others who support your sobriety to do so on your behalf. All this requires is a signed release (legal document allowing providers to speak to those we identify).

Also read:

Don't want to take opioids? Consider these 42 non addictive pain management alternatives.

Opioid guidelines for people in recovery.

Pain catastrophizing - does your attitude worsen your pain experience?