Safe Medicine for Sober People by Jeffrey Weisberg, M.D., is a guide for the millions of people in recovery from addiction---and their medical providers---on which medicines are safe to take, from a sober viewpoint, and which are risky. Very specific medications are singled out according to their potential for triggering relapse.
Safe Medicine for Sober People by Jeffrey Weisberg, M.D., is a guide for the millions of people in recovery from addiction---and their medical providers---on which medicines are safe to take, from a sober viewpoint, and which are risky. Very specific medications are singled out according to their potential for triggering relapse.
Safe Medicine For Sober People: How to Avoid Relapsing on Pain, Sleep, Cold, or Any Other Medication
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Safe Medicine For Sober People: How to Avoid Relapsing on Pain, Sleep, Cold, or Any Other Medication
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Overview
Safe Medicine for Sober People by Jeffrey Weisberg, M.D., is a guide for the millions of people in recovery from addiction---and their medical providers---on which medicines are safe to take, from a sober viewpoint, and which are risky. Very specific medications are singled out according to their potential for triggering relapse.
Product Details
| ISBN-13: | 9781429982238 |
|---|---|
| Publisher: | St. Martin's Publishing Group |
| Publication date: | 04/01/2007 |
| Sold by: | Macmillan |
| Format: | eBook |
| Pages: | 240 |
| File size: | 434 KB |
About the Author
Jeffrey Weisberg, M.D. was recently an executive vice president for Continuum Health Partners, Inc. He is cofounder of DOCS, a chain of urgent care medical centers.
Gene Hawes was coauthor with Dr. Weisberg on Rx for Recovery: The Medical and Health Guide for Alcoholics, Addicts, and Their Families. His recent books include Addiction-Free: How to Help an Alcoholic or Addict Get Started on Recovery (with Anderson Hawes).
Gene Hawes is the author of many books including Rx for Recovery: The Medical and Health Guide for Alcoholics, Addicts and Their Families (with Jeffrey Weisberg, M.D.); he lives in a small town just north of New York City.
Read an Excerpt
CHAPTER 1
Safeguarding Recovery:
THE MEDICAL FUNDAMENTALS
Let's start with an irrefutable observation: alcoholism and drug addiction destroy lives and wreak havoc on families. Anyone involved with an addict and anyone hearing the myriad of personal accounts told in treatment programs around the world can attest to this.
Is addiction a disease? We think so, but whether or not the term disease is accepted, there is no denying that alcoholism and drug addiction damage a person's organ systems and physiologic processes while causing emotional and mental deterioration.
Almost magically, though, abstinence and recovery reverse the physical and emotional deterioration. The addict is returned to normal life and physical health returns in months, as long as permanent damage has not occurred. Emotional and mental health have a more variable but generally positive course.
All is lost, however, if the addict returns to drinking or using drugs. In fact, with renewed drinking or drug use, there is an ugly and rapid return of physical and emotional deterioration, along with immediate physical craving and addiction.
So recovery must be protected fiercely. Recovery programs — most prominently, Alcoholics Anonymous — deal with the complexities of the recovery process. In this book, we treat one area of treachery for the recovering addict: the dangerous area of interaction with the medical world.
Prescription and nonprescription drugs are part of almost everyone's life. However, for people in recovery, some of these medications are dangerous, as they can increase the likelihood of relapse. Thus in this book we examine prescription and nonprescription medications with regard to their mood-altering potential and their risk to the recovering addict. We intend this to serve as a resource for recovering addicts, their family members, and clinicians.
Active alcoholism or drug addiction has a predictable course. Once recognized, the prognosis is clear: deterioration is chronic, progressive, and in the end, usually fatal. Indeed, other diseases are often less predictable.
For example, I recall a patient, Phil W., who came to me with a swollen knee. Blood tests indicated he had rheumatoid arthritis. When Phil asked what he could expect as time went on, I told him that symmetrical joints usually develop pain and swelling of varying degrees. There are medicines and physical measures to help, I said, but often deformity results. I did say that every situation is different, however, and we'd just have to wait and see. Luckily, the swelling in Phil's knee went down within two weeks, and he has had no symptoms of rheumatoid arthritis since. That was eight years ago.
However, had Phil come to me with a deteriorating marriage and depression related to drinking too much, I could have predicted his future much more accurately. "If you continue to drink," I would have said, "your marriage will become unsalvageable. You'll become isolated and lonely, filled with self-disgust and fear. You will begin to drink every night until you pass out, and there will be nothing in your life besides work and drinking. You won't have any fun in life; you'll be besieged by problems that seem insurmountable, and soon you'll have trouble at work. Your liver tests will show alcoholic hepatitis; you'll develop gastritis or ulcers, and then more serious consequences. Finally, if you keep drinking, in time there will be a critical or fatal event, either a medical catastrophe or a fatal accident."
This clinical predictability is uncannily accurate. We invariably see a complex pattern of emotional and physical circumstances that leads to a compulsion to drink a toxic chemical. This then sets up a cascade of events that, without fail, results in the deterioration of one's physical, social, and emotional health.
The hereditary character of alcoholism is clear. A classic forty-five-year study of alcoholism found that more than three times as many men with relatives who abuse alcohol developed alcohol dependence, compared to men with no relatives who abuse alcohol. (This was reported in The Natural History of Alcoholism by George E. Vaillant in 1983.) Another study analyzed alcoholism among two groups of Danish men who had been adopted in early infancy by nonrelatives. One group consisted of men with at least one alcoholic biological parent. The second group consisted of men with biological parents who were not alcoholics. Four times as many men with an alcoholic parent became alcoholics. In addition, there was no consistent relationship between alcoholism in adoptive parents and alcoholism in the adopted sons, thus suggesting that environmental factors were inconsequential compared to hereditary factors. (Donald W. Goodwin, F. Schulsinger, L. Hermansen, S. B. Guze, and G. Winokur, "Alcohol Problems in Adoptees Raised Apart From Biological Parents," Archives of General Psychiatry, 1973, 28:238–243.) In all, more than one hundred scientific studies confirming the genetic character of alcoholism have been made.
Most diseases are usually first recognized in their most severe or pronounced form. Later, more subtle and less severe forms of the disease are recognized, and soon the disease has a much broader definition. Eventually, scientific research establishes diagnostic parameters for a given disease (laboratory tests, X-ray findings, and the like), and then, when possible, a cause, or etiology, is uncovered. A treatment or cure may be found at the same time.
The process whereby we first discover and then learn successively more and more about a disease is happening with alcoholism. At first, only the most hopeless, extreme cases were recognized as alcoholics. In the 1930s, when Alcoholics Anonymous (AA) was established, these extreme cases served as the model of the disease.
Since then, less extreme cases with varying patterns of drinking have broadened the concept of the disease of alcoholism. The American Medical Association first officially defined alcoholism as a disease in 1956. A recent revision of the official diagnostic manual of the American Psychiatric Association specified three main criteria for the diagnosis of alcohol or drug dependency:
1. the suffering of withdrawal symptoms after intake is stopped,
2. the need for ingesting constantly increased quantities in order to realize the desired effect,
3. an obsession with alcohol or drugs so severe that it leads to taking risks to obtain them and seriously interferes with work and social life.
Other organizations that define alcoholism as a disease include the American College of Physicians, the American Hospital Association, the American Public Health Association, the American Psychological Association, the National Association of Social Workers, and the World Health Organization.
There are several ways to view alcoholism, but as a clinical entity, it can be described as a maladaptive and self-destructive behavior pattern involving the compulsive consumption of alcohol leading to personal, emotional, and physical deterioration. This behavior is associated with excessive fear, depression, and anxiety, and a resulting difficulty in coping with the normal stresses of life.
Alcoholism is also characterized by varying degrees of toxic damage brought on by excessive consumption. Alcohol is, of course, toxic to the nonalcoholic as well as to the alcoholic. As a drug, it is absorbed directly through the stomach wall or the walls of the small intestine and passes quickly into the bloodstream. It then moves into every part of the body that contains water. Five percent of it is eliminated through the breath, urine, or sweat, but the remaining 95 percent must be broken down by the liver. The liver processes alcohol at the rate of about one-third ounce of ethanol (pure 200-proof alcohol) per hour. Any more than this continues to circulate in the blood and the cells.
Within a few minutes, alcohol reaches the brain, where it initially stimulates and agitates but eventually acts as a depressant. First, the functions of inhibition and judgment are depressed, which accounts for the release of normal restraint. Sexual inhibitions, for example, may initially be relaxed, but alcohol actually impairs sexual function, performance, and eventually desire. Mood changes are severe with intoxication, and some people suffer Jekyll-and-Hyde personality changes.
Alcohol then affects motor ability, reaction time, eyesight, and other functions, and if there is continued intake, vital functions can be affected and death can occur. Usually the body rejects the alcohol by vomiting first; later it may become comatose before a fatal dose can be consumed.
Because alcohol reaches every cell and organ of the body, its physical effects are wide-ranging. When chronic alcohol intake persists, the result is metabolic damage everywhere: in the liver, the central nervous system, the gastrointestinal system, and the heart. Other effects include impaired vision, impaired sexual function, circulation problems, malnutrition, water retention, pancreatitis, skin disorders (such as acne and dilation of blood vessels), muscle atrophy, and decreased resistance to infection.
The liver is the most common site of alcohol toxicity. First, fatty liver, an infiltration of the liver with abnormal fatty cells, occurs, producing general liver enlargement. Next comes alcoholic hepatitis, in which the cells are injured and some die. Further alcohol exposure eventually causes cirrhosis, the irreversible destruction of liver cells and fibrous scarring of the entire liver. Obstruction of the flow of blood through the liver and deterioration of liver function result. Many bodily functions are disturbed by each of these liver diseases, and death results in 10 to 30 percent of cases.
Alcohol reduces the amount of oxygen reaching the brain and destroys brain cells directly. With chronic abuse, an individual may experience seizures, as well as neurologic disorders characterized by dementia, such as Korsakoff's syndrome. Its symptoms include amnesia, disorientation, hallucinations, emotional disturbances, and loss of muscle control.
The digestive system suffers various injuries when alcohol abuse is chronic. Inflammation of the esophagus and stomach (that is, esophagitis and gastritis) occurs, and there is an increased incidence of ulcers. Indirectly, the blood vessels in the esophagus dilate due to obstruction of blood flow in the portal system of the liver. This can lead to a fatal hemorrhage.
With alcoholism, there is also an increased frequency of cancer, both in the liver and upper gastrointestinal organs (such as the esophagus). In addition, the heart is affected directly by a disease of the heart muscle called cardiomyopathy, and indirectly by high blood pressure and arrhythmias.
Alcoholism is relentlessly progressive. That is, as long as drinking continues, all symptoms steadily worsen. The rate of the destructive progression varies, often with long periods of slow decline and then sudden periods of much more rapid deterioration. Every case is somewhat different from the next.
Some alcoholics begin drinking abnormally from their first drink, behaving from the beginning in ways destructive to their health. For others, there is a period of acceptable social drinking. Perhaps there are a few "drunks" and related hangovers, but on looking back, it would be difficult to distinguish the early alcoholic from the social drinker. Indeed, most alcoholics have had an early period when there was still some fun in their drinking.
Sooner or later, however, the alcoholic begins to inappropriately use alcohol or drugs for their mood-altering qualities. In the early stages, perhaps the drinking is limited to recreational, or "reward," periods. That is, the individual is still working well and handling life adequately, but weekends are characterized by needing some form of escaping or decreasing tension. Drinking or drugging becomes the chief activity of nonworking recreational time. Activities are chosen subconsciously because they involve drinking or drugging. Gradually the alcoholic will socialize mainly or only with others who drink; he'll plan dinners and events that involve drinking, such as visits to restaurants suited to several cocktails and wine with dinner, family outings to pizza parlors where having a pitcher of beer is appropriate, or trips to sports events where beer is plentiful.
In time, all recreational activity probably has some relationship to drinking, and the alcoholic comes to depend more and more on the mood-altering qualities of the drug. A drink is needed to relax, to celebrate, to mourn, to welcome the weekend. Soon the special occasion is any occasion.
At this stage, the alcoholic begins to feel anxious and uncomfortable with many of life's normal activities. He may need a few quick drinks to get ready for a party or social engagement. He may even avoid social activities in favor of staying home and drinking in front of the TV or going to his favorite bar.
Some alcoholics may consciously control the number of drinks they allow themselves (for instance, "no more than two before dinner"). As time goes on, however, alcoholics find their drinking time to be increasingly important. They may make it through the workday without drinking, but they begin to get tense toward afternoon and sometimes even become obsessed with the idea of getting home, where they are able to drink. The compulsion to get the first drink of the day increases. The first drink may move into the workday and to an earlier hour on the weekends.
Although the tolerance for alcohol may become high, the alcoholic begins to have more periods of drunkenness and soon has blackouts (periods of memory loss). For example, during a blackout, Terry C. drove from San Francisco, California, to Reno, Nevada, and got married, not remembering any of it afterward. Some alcoholics are not aware of blackouts, however, because they don't have anyone around to describe the forgotten events.
By this time, there are usually significant problems as a result of alcoholism. The alcoholic may feel depressed and may think he drinks because of depression. During this phase, many alcoholics try psychotherapy, but because they deny their drinking problem, they usually get little help. They know something is wrong, but their drinking seems secondary, a response to anxiety and depression. They can't see drinking as the primary problem.
Marital problems, social problems, and health problems may now be part of the picture. The alcoholic at this stage is having no fun. He is desperately trying to avoid the pain he doesn't understand. Only drinking does the trick, briefly. But the pain returns daily. Anxiety, tearfulness, difficulty making it through each day, and a sense of doom and failure characterize his life.
The drink or drug now sets up a craving for more, and matters are totally out of control. Awful things sometimes happen at this point: a spouse may leave, a serious accident may occur, a job may be lost. Something can easily happen to bring on "the bottom." The alcoholic's bottom is that point of such hopelessness and desperation that he will do anything to change and will even consider that the drinking itself may be the problem. There is now a crack, however small, in the alcoholic's denial.
This progression is a general description. Many alcoholics go through long periods of trying to control their drinking or even attempting to stop. Without recovery programs, however, this rarely helps. The emotional part of the disease persists during self-imposed attempts at control or abstinence, and eventually the progression picks up steam again. Active alcoholics attempt to control their progression in varying ways. Many switch from liquor to beer or to wine or even to other drugs, convincing themselves that this may solve their problem. Sometimes they give up drinking to prove they are not alcoholics, but take Valium or other drugs instead, and the disease presses on. Others try a "geographic cure," moving to a new state or a new job to start over. These are desperate attempts to treat the confusing, painful turmoil in their lives. They still can't see alcohol or drugs as the primary problem. Denial is an extremely strong mechanism in addiction.
Denial tells the alcoholic that alcohol is not his problem. Although he is caught in a tumultous array of troubles all linked to his drinking, denial allows the alcoholic to blame everything but drinking for them. Drinking is rationalized to be the result of his problems, not the cause. The alcoholic thinks he gets drunk because of stress, depression, situations at work, unfairness, and the like.
Toward the end, everyone suffers. The alcoholic blames everyonearound him and spreads his self-centered misery to each family member, even though he may not wish to.
(Continues…)
Excerpted from "Safe Medicine for Sober People"
by .
Copyright © 2005 Jeffrey Weisberg, M.D., and Gene Hawes.
Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Acknowledgments,
Preface,
1. Safeguarding Recovery: The Medical Fundamentals,
2. Safe Medical Caregivers: Choosing and Working with Doctors,
3. Safe — and Highly Unsafe — Medicines in Recovery: A Comprehensive Directory,
4. Safe Treatment for Special Medical Conditions,
Appendix: Sources of Information and Help,
Index,