medicationDrug addiction is all too common for individuals in society today. Drugs are relatively easy to obtain, both through prescription and nonprescription sources such as online or through undocumented sellers. Drug use is considered socially acceptable in some groups regardless of the risks. Being aware of the risks of drug addiction is critical to your health.

When drugs affect brain function and behavior, an individual cannot control their use. Addictions can come in many forms, such as prescribed medications, illegal drugs, alcohol, and nicotine. Individuals can also become addicted to food, exercise, sex, and just about anything else. Addictions become detrimental when the body craves the ‘drug.’ Today’s blog contains information about drug addiction, and alcohol addiction will follow next week.

There are some prescription medications that are addictive. These might be prescribed to control the effects of paralysis from central nervous system (CNS) injury, including brain injury and spinal cord injury, disease or trauma. For example, some medications prescribed for tone (spasms) are addictive, but that medication may be the only treatment that controls your tone, or the pain associated with it. Other addictive medications may include prescriptions to control neuropathic pain, the pain that is caused specifically by injury to nerves. These drugs may be used under the supervision of a healthcare professional as the treatment benefits outweigh complications. Other addictive prescribed medications include some pain medication (opioids), stimulants, sedatives and tranquilizers.

Some drugs will speed up the body, others sedate. Taking these medications, especially with a central nervous system injury, can affect especially in the cardiac and respiratory systems.

Just as with any addictive drug, the body becomes accustomed to the dosage of addictive prescribed medications rendering them less effective as time passes. Larger doses may be needed to be taken over time to get relief from the underlying issue. Stopping these medications must be done using a schedule to slowly reduce the body’s need for them over time. Quitting ‘cold turkey’ leads to unpleasant symptoms of withdrawal, including nausea, vomiting, shaking, sweating, muscle pains, seizures, and even death. Sudden withdrawal makes the control of the issue more difficult to treat.

Some individuals will want to stop taking addictive prescription medication for healthcare issues or just not to be addicted even for medical benefit. This stopping medication must be planned out with your healthcare professional to reduce withdrawal symptoms. A tapering schedule should be meticulously followed with supervision by your healthcare professional. In the case of neuropathic pain, some individuals will find neuropathic pain has changed or even resolved after time on prescribed medication requiring no further treatment. For others, non-addictive medication or therapies are then prescribed for continued treatment. Tone may change but typically remains. Alternative non-addictive medications or other treatments may be used to try to control tone. This might include increased movement and external or internal electrical stimulation to control the tone.

Individuals that use drugs before brain injury or spinal cord injury are likely to continue drug use after injury. This can be a complication for recovery and rehabilitation of drug use is continued. Slower progress in rehabilitation with poorer outcomes are found in individuals who continue to use drugs. Hiding drug use or not disclosing other drugs can lead to complications of prescribed medication not working as well or exaggerating the effects of prescribed medications. Both can lead to issues of either not having the desired result of the prescribed medication or having too much reaction to the prescribed medication. It is imperative that you disclose any drugs that you take, even if just occasionally or more, as prescribed medications' lack of effects or additive effects can lead to physical harm or death.

Chronic illness or injury can be a source of depression due to extreme lifestyle changes. Mental illness, including depression, may not be an acceptable diagnosis to some individuals who therefore do not seek treatment. They may then opt knowingly or unknowingly to self-medicate with drugs. Depression is a medical condition that has been scientifically demonstrated as an imbalance of chemicals in the brain, not a weakness. It is a cycle where some individuals seek self-medication for depression, but self-medication typically causes brain chemical imbalances which lead to depression. It can be difficult to recognize and break this cycle. When first medicating with drugs, there might be a boost in the mood, but quickly the boost dissipates, and more significant depression occurs.

Marijuana, including THC and cannabinoids, are drugs that can be taken in many forms. Typically, in some formulations, a form of euphoria is the result. However, with brain injury, the drug may be metabolized in different ways creating acute psychosis, hallucinations, delusions and loss of a sense of identity. Invulnerable individuals, such as those with injury to the central nervous system, these feelings can be long-lasting. Medical marijuana has been legalized in some states. However, comprehensive research on the product is yet to be conducted. Some find successful outcomes to their issues with use, and others do not.

Opioid use is an epidemic in our society. Typically, these medications are prescribed for pain control after an injury or even for dental procedures. Opioids are extremely addictive and often not effective for pain control. They do not have an effect on neuropathic pain. Some individuals have a difficult time stopping the opioid medication because of the addictive effects. Be sure to let your healthcare professional know if you take opioids. Opioids can slow your breathing which can be already affected by brain or spinal cord injury due to reduced respiratory muscle function. They can cause constipation which adds to complications of neurogenic bowel function. With brain injury, opioids can greatly increase confusion and drowsiness.

Heroin is also a commonly used drug. This can be taken in a variety of ways but most often by injection. Scars form at the injection site called tracks. Heroin users are usually identified by physical changes and by the tracks. Heroin affects individuals with brain injury by decreasing thinking, feeling drowsy, and increasing depression. Heart rate and breathing will slow down with both brain injury and spinal cord injury. This can be especially harmful with spinal cord injury due to autonomic dysfunction affecting already slowed heart rate and breathing.

Cocaine is another extremely addictive drug. It can be smoked, snorted, or injected. It speeds up your body and then crashes your body systems. After brain injury or spinal cord injury, your body may be speeded up with cocaine, but body regulation through the autonomic nervous system may not be able to keep up with the intensity leading to a crisis within the body. The crash can lead to further slowing of already slowed life functions.

Fentanyl drug use is at an epidemic proportion in the U.S. It can be obtained by prescription for pain or purchased from uncontrolled sources. It does not affect neuropathic pain. It causes respiratory distress, especially in those who have impaired respiratory systems from central nervous system injury in the brain or spinal cord. It is extremely toxic and even fatal when mixed with other drugs such as heroin and cocaine.

Examples of drugs that stimulate your body are cocaine, Ritalin, and amphetamines, where drugs like Adderall and Dexedrine increase blood pressure and heart rate. This challenges a circulatory system affected by CNS injury or autonomic dysfunction. These drugs also elevate blood sugar which contributes to the secondary complication of diabetes. Breathing can be increased, which challenges the respiratory system if your nerves are affected. Also, body temperature can be elevated without regulatory systems to bring it back to normal. Seizures are common, especially for those who have had a head injury or stroke.

A complete list of symptoms of a drug is provided at this site.

Anyone can fall into the pattern of drug abuse and addiction, especially when attempting to treat issues and concerns that are perceived to be overlooked by the medical system. Teens can be especially vulnerable to drug additions as it is a peer pressure activity. They might innocently get involved with opioids after an injury. Some find addictive medications sold at school or online. These medications are often manufactured poorly without control and therefore do not contain the stated medication. Be sure to get your medications from authorized sources.

Signs of drug abuse might not be self-recognized. Others might see the signs before you do. It is important to listen to your family or caregivers if they express concern about drug abuse. Signs of drug abuse include poor eating habits; decreased concern about personal care, ambition, interest, and relationships; not keeping commitments; making excuses; sadness, anger, irritability; problems at work or with money.

Many individuals with drug abuse issues who have a brain injury or spinal cord injury ignore, slow, or stop personal care that must be done, such as the movement for pressure releases, catheterization to maintain urinary continence, bowel care for controlled evacuation and constipation, poor diet and hydration, and skincare and general hygiene. Many will offer excuses why they should not have to do these activities that are now needed for a healthy life; however, these activities maintain life.

Drug addiction typically follows four stages. Some go through step by step, and others zip straight through to full addition. The addiction process generally begins with experimentation. The next step is regular use of drugs. The third step is risky to use or abuse. The last stage is drug addiction and dependency. Individuals like to describe themselves as experimenting when others see addiction and dependency. Recognition of drug addiction is difficult for individuals.

Treatments start with screening for drug abuse. This can include a blood test for drugs in your system. There are also questionnaires that will indicate a drug abuse concern. Take action to help yourself. Some actions may include the following:

  • Be open about your drug use. Disclose every drug you take to your healthcare professional. This is not to punish or judge you but to acknowledge your drug use in your plan of care, so that prescribed medications can be delivered safely within your body.
  • Discuss medications with your healthcare professional. This will help you understand how they may help or harm your individual condition. Some believe opioids and marijuana have neuroprotective features, although this is under study. These drugs need to be better understood in dosing and administration. Taking them without understanding the best treatment is not beneficial and can be harmful.
  • If you have an addiction to a drug, follow a medically supervised withdrawal plan. Join a support group as addictions stay with you for years.
  • Detox (detoxification) is a process where the body becomes used to being without the drug. An individual may experience anxiety, depression, nausea, vomiting, seizures, muscle aches, and sweating during the detox period. An individual with a central nervous system injury such as brain injury, stroke or spinal cord injury may have difficulty caring for themselves during detox. Seizure thresholds can be lowered, and neuropathic pain can increase if you cannot sweat when your body is overheating. Autonomic dysreflexia episodes can be heightened, especially with elevated blood pressure. Tone (spasticity) can increase. Medical supervision can reduce these serious side effects of detox.

Medications are available to help you curb drug addictions. Narcan creates immediate withdrawal. Benzodiazepines may be provided for anxiety. Antidepressants can treat depression that occurs from the chemical loss of the addictive drug. Clonidine can reduce muscle cramps, aches, tone, tremors, and seizures.

Remove yourself from individuals who use drugs or provide them to you. Temptation is reduced if the drug is not available to you.

As a nurse, it is important to attend seminars to learn to care for individuals with drug use issues. Addiction was explained at one of these seminars as comparing drug cravings to a hot plate. The hot plate is hot when it is plugged in (as a person using drugs), but if you unplug the hot plate, it cools down (drug withdrawal). For some individuals, their ‘hot plate’ or cravings will cool quickly, reducing their rate of using more drugs. For others, their ‘hot plate’ or cravings remains for a long time. A few people are able to stop their drug addiction rather quickly: most fight it for a lifetime. You cannot tell who or when a person will re-ignite their craving for drugs. Long-term support is needed.

If you commit to a clean life, you need to know that it is difficult to stop any addiction. However, with dedication and support, you can succeed. Get the treatment you need. Help is available for you. You can do this. Nurse Linda

Pediatric Consideration:

Children know a lot more about drugs than adults think. They may be exposed to drug use through prescription, seeing adults take medication, and through their peers. We think of drug use coming from peer pressure, but it is so common that your child may not even be pressured. They may see taking drugs as a normal or ‘adult’ activity.

Be aware of changes in your child. If you are suspicious of drug activity, have your child tested along with their routine blood work or as necessary.

Drug addiction involves the entire family. Consult an experienced therapist to help guide you through the process with your child. As a parent, you will need resources to deal with this concern. They can assist with approaching your child and monitoring behavior. Each child is unique. Assistance can aid in maintaining a relationship.

More information about adult, teen and child drug abuse can be found on this site sponsored by the National Institute on Drug Abuse. Nurse Linda

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

In our community, Nurse Linda is a blogger where she focuses on contributing functional advice, providing the "how-to" on integrating various healthcare improvements into daily life, and answering your specific questions. Read her blogs here.

And if you want more Nurse Linda, sign up for her monthly webinars here. Don’t worry, we archive her answers so you can refer back and sift through her advice. Consider it Nurse Linda on-demand!

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