Patti Geier, LCSW

The Dark Side of Prescription Drugs: Part 2

Dependence or Addiction

There is a difference between dependence and addiction. Dependence occurs when tolerance builds up and the body needs the drug in order to function. Withdrawal symptoms will begin if the drug is stopped abruptly. On the other hand, when a person turns to the regular use of a drug to satisfy emotional, and psychological needs, they are addicted to that substance. Physicaldependence exists as well, but the drug has become a way to cope with (or avoid) all kinds of uncomfortable feelings.

Many prescription drug addicts do begin by needing the drug they are prescribed for medical reasons. Somewhere along the line, however, the drug begins to take over their lives and becomes more important than anything else. Nothing will stop them from getting their drug of choice.

It may be difficult to understand how someone could let this happen. How could someone who is reasonably intelligent and sophisticated in regards to drug addiction become an addict? Addiction has nothing to do with intelligence. And addiction to prescription drugs is no different than any other substance abuse problem. Many people in the medical profession abuse prescription drugs. Health care providers may have a slightly higher rate of addiction due to both the stressful nature of the work and their relatively easy access to supplies of narcotics. Clearly, the potential risks and dangers involved with taking narcotics are not unknown among health care providers. This, however, doesn't stop someone from becoming an addict. Some 12-step members have described addiction as a disease of the emotions.

Addictive Behaviors

Along with addiction, there are addictive behaviors that are quite common among addicts. Lying, keeping secrets, hiding pills and obsessively counting them, making unnecessary emergency room visits and constantly "doctor shopping." As the addiction escalates, engaging in such illegal activities as stealing prescription pads, committing forgery, and buying drugs off the street is also quite common behavior.

These behaviors usually stem from the desperation an addict feels regarding getting, securing, and taking their drug of choice. Under other circumstances, the individual would probably not engage in the behaviors listed above, unless they were previously partof his/her personality structure. In other words, addictive behaviors are limited to the addiction itself and are generally dissonant with the person's beliefs and values in any other area of their life.


Paul* is a 29 year old advertising executive who was first prescribed medication for a relatively minor neck injury caused by a car accident. While hospitalized he was first treated with morphine and then was switched to Percocet. He left the hospital with a prescription for a week's supply of pills.

The pills took awayPaul's pain. They made him feel calm and a little distant from his emotional pain, as well. Paul welcomed the relief from the emotional pain he was going through following the break-up of a serious relationship. It seemed to him the pills made him feel less lonely and needy. In addition, he found that the pills allowed him to feel more confident at work; he got more done, felt less stressed, and believed he functioned better.

Paul was upset when he finished his prescription. He called his doctor, telling her that he was still in pain. She prescribed more Percocet. She also let him know that if the pain continued any longer, she would prescribe Motrin. Paul felt elated that he could get more pills for now but also. decided he would stop taking them after this latest prescription was finished.

Two months later, Paul had to have oral surgery. All he could think about was how he'd now be able to get more Percocet. He found himself looking forward to, rather than dreading the surgery. After this newest prescription ran out, he began to devise aches and pains that would lead to more pills and was able to con several emergency room doctors into giving him further prescriptions.

Paul began to notice that the pills did not have quite the same effect. The initial euphoria he once felt was gone. He took more. He kept trying to "chase" that first high, but could not achieve it again.

A friend turned him on to Oxycontin. He loved the feeling the pills gave him and began to buy them from his friend. He no longer missed his ex so much. The pills made his emotional pain tolerable and filled the empty feeling he had inside.

Soon, he began to screw up at work. He was missing deadlines and no longer competed for the most prestigious and high-paying ads. Paul began to sink into a depression. His self-esteem plummeted because of his growing need for the drug and the extremes to which he would go to get it. He didn't want to think about how his life was beginning to fall apart. He could not tolerate the negative feelings he was having. He began chewing the pills so he'd feel their effect sooner.

Paul sank further into a depression and believed that the only thing that made him feel better was to take more pills. His friend expressed concern that Paul was becoming too dependent on Oxycontin. He pointed out that the pills seemed to make Paul more depressed. He told Paul that he felt very uncomfortable supplying him with any more pills. Sensing that Paul needed help, he suggested going to an NA or AA meeting. Paul was angry that his connection to Oxycontin was going to be cut off. He thought his friend was overreacting. He was just using pills, not something dangerous like heroin or cocaine.

Paul realized, however,that he didn't feel he could function without his pills. It was the only thing in his life he felt he could depend on. He began to chew them by the handful. One morning he woke up in a stranger's apartment not knowing how he'd gotten there. He couldn't remember anything. He called his friend who said he must have had a blackout and that he needed to get off the pills before he self-destructed any further. Paul finally agreed and went into an inpatient detox and rehab program.

He began to get in touch with the empty void the pills filled up. He felt a great deal of shame about becoming addicted to them. He also felt a great deal of remorse about the behaviors he engaged in to feed his addiction.

Shame and Guilt

Both shame and guilt are feelings that are very common to the experience of addiction. No one wants to be a drug addict. There is tremendous shame in having your life ruled by a vial of pills. There may also be a tremendous amount of shame and guilt about the type of behaviors you can become capable of engaging in to get drugs. The way one behaves on pills--falling down, slurring one's words, blackouts--are all shameful experiences.

A person whose become addicted to prescription drugs may feel guilty about the way they have treated others, particularly those closest to them. There's a great deal of guilt associated with lying and betraying the people they love.

Neither shame or guilt is conducive to getting the help that is needed. In fact, these feelings can be quite destructive. Shame can prevent you from getting treatment. Guilt can lead to all kinds of self-destructive behaviors that will interfere with sobriety. Bottomline: shame and guilt lower self-esteem and foster self-hatred.