ADDICTIVE BEHAVIOUR

Although my addiction to sleeping pills was due to my knee pain, I realize that I also have an addictive behaviour. When I fell sick in the past, I would very often request the doctor to prescribe me with a heavier dose of medicines and for a longer period. My excuses were such as "I have an important meeting to attend" or "I have to go on a business travel" or something else. If I need to travel overseas for work, I will worry about sleep, so I will always carry sleeping pills with me. Even if I self-medicate for a common cold or flu, I will tend to take a few more tablets than required. In the case of shopping, I felt instant gratification for buying something nice and expensive but it may not necessarily be something that I need. These are typical patterns of an addictive behaviour. And my knee pain was just the trigger for me to fall into a full blown addiction to sleeping pills.

WHAT IS AN ADDICTIVE BEHAVIOUR?

Addictive behaviour is defined as one which is characterized by or susceptible to addiction. There is no single set of characteristics that fit all addicts but there are some shared similarities with different addicts. These are some common characteristics of addictive behaviours:-

· Low self esteem                                   · Compulsiveness

· Obsessiveness                                      · Need instant gratification

· Perfectionist                                         · Insecurity

· Depression or anxiety                          · Loneliness

· Aggressiveness                                    · Lack of self-control

· Lack of love and affection                   · Self-destructive

· Impatience                                           · Co-dependent

People with addictive behaviour do not necessarily mean that they will be destined to develop an addiction problem. Some of them still are able to make positive life choices. However, they must become more aware of the potential dangers of addiction.

WHAT IS ADDICTION?

Addiction is defined as a means "to devote or surrender oneself to something habitually or obsessively; behaviour that impairs the performance of a vital function, a harmful environment." Addiction causes you to lose your sense of balance and rationality. Beneath all addictions is a longing for immediate gratification - to feel good, powerful, worthy of admiration, problem free and an insistence on ignoring the long-range self-destructive implications of the behaviour. In simpler term, addiction is an out-of-control habit.

WHAT CAN WE BE ADDICTED TO?

A person can become addicted, dependent or compulsively obsessed with anything. It can be broken down as:-

Psychological addiction such as work, shopping, exercise, video/online games, gambling, sex, eating disorder etc.

Physical addiction such as drugs and alcohol. This occurs when the body has to adjust to the substance by incorporating the substance into its "normal" function. This state creates the conditions of tolerance and withdrawal. Tolerance is the process by which the body continually adapts to the substance and requires increasingly larger amounts to achieve the original effects.

Withdrawal refers to both physical and psychological symptoms that people experience when reducing or discontinuing a substance the body had become dependent on. Symptoms of withdrawal generally include but are not limited to anxiety, irritability, intense cravings for the substance, seizure, nausea, hallucinations, headaches, cold sweats and tremors.

Most physical addiction also has a psychological addiction. For example, an alcoholic who has not used alcohol for years may still crave a drink. This is referred to as a "Dry Drunk" syndrome. Normally, recovering addicts require a lot of help such as an established program, support groups, counseling, behavioural therapy etc. However, in such instance, the addict simply stopped drinking without any proper help, understanding of addiction, issues involved etc. Therefore, the addict remains emotionally disturbed, mentally unstable and vulnerable to relapse.

WHAT ARE THE SIGNS OF ADDICTION?

Some people ask "Can I be physically dependent on prescription medicines and not have an addiction?". The answer is "yes". If you depend on sleeping pills to sleep or pain killers to control pain but you can keep it within a low dosage, you do not have an addiction yet. But if you are told by your doctor to reduce the amount of the pills you are taking, your body will probably react by giving you very vivid dreams or you may toss or turn and be unable to sleep for a few nights. This is because your body has already become physically dependent to some degree on the pills and is reacting to the loss of the medication. So as long as you can control your choices, you are not addicted but you are at risk.

Some people use recreational drugs over the weekend. They can still keep control over how much and how often they use them. Many people can regularly drink limited amounts of alcohol too. The problem is that many people gradually lose control over how much they use and are overcome by the increasingly strong desire to consume more and more. Sometimes, a certain crisis such as an emotional trauma due to relationship, work, health, financial problem etc. can trigger a full blown addiction. In my case, it was the knee pain.  Here's a link to a real life example as a point of reference.   

http://www.thatslife.com.au/Article/Real-Life/Real-Life-Stories/I-was-an-alcoholic

Most people who are addicted to certain substances are very aware of their addictions and even the harms caused by the addiction but keep doing it anyway. This is because they feel they cannot cope without the addiction and they are avoiding having to deal with the real issues. It is only when a crisis happens and the substance is taken away completely, then the person goes into withdrawal and cannot cope. The most obvious sign of addiction is when the addict's life has become unmanageable.

IS RECOVERY POSSIBLE?

Yes, but recovery is a continuous process because addiction is a disease and there is no cure for it. Recovery can be controlled with treatment, therapy and commitment from the addict. Just like diabetes is a disease which cannot be cured but it can be controlled with medication. If you stop doing what is necessary, the disease will relapse.

Here are some steps for recovery:-

1. Admit that you have a problem and that you need help.

2. Seek therapy from a treatment center or rehab facility.

3. Commit to the program and actions established for recovery.

4. Join a support group.

The most important thing is that after you have sought treatment, which road will you choose - relapse or recovery? I will never forget this one exercise we did at the treatment center which I attended. We were each given 6 pieces of small paper and asked to write on each of them what we felt was important to us. So I wrote - family, money, career, health, house and car. We were asked to quash each of the paper into a ball and hold them in our hands. After that, the facilitator asked who had written "recovery" in one of the paper and there was only one person in the group who put up her hand. Then the facilitator said the rest of us can throw all the quashed paper away. The point was that if we did not choose recovery, we will lose everything that we felt is important to us. At that point of time, I became emotional because it was as if I had thrown away my family and all those things I wrote which were important to me. This was so clear to me that recovery is the road that I have to choose.

DOES ADDICTION AFFECT TKR?

Yes and particularly for me, it’s the sleeping pills and for some people, it’s the pain killer. And don't forget the sedatives during the surgery and morphine for controlling pain after surgery.

I was able to sleep quite well for the first 24 hours due to the effects of the sedatives and epidural during surgery. After that I had so much discomfort from the pain, sleeping position, noises and my lower back problem. I cringed at the thought of asking for sleeping pills but since it was for a medical reason, I felt that it was acceptable. So I took sleeping pills twice at the hospital. Did I feel guilty? Yes! But the most important thing is that I did not abuse the situation and was totally disciplined after that. Even though I had many sleepless nights at home due to all the discomfort and non-activity, I was able to remain disciplined. When I started to be more mobile, my sleep got better and better.

What about pain killers? I did not have a problem with this. But I have come across patients who are addicted to pain killers and had to struggle with it. You see, after TKR, we need to take pain killers for about 1- 2 months in order to control the pain and swelling in early recovery. So for a patient with a history of addiction to pain killers, this is a tough situation. I would think that these patients have no choice but to take the pain killers but I feel that it would be advisable for them to discuss the issue with their OS. If these patients do not abuse the pain killers and make conscious efforts to get back to their aftercare program and do what is necessary, the situation may be under control.  Here's a link to a life story about addiction to pain killers which is interesting.

http://www.thatslife.com.au/Article/Real-Life/Real-Life-Stories/My-addiction-to-pain-killers

CONCLUSION

Education about addiction is very important. This was something that I did not understand when I got into trouble until I sought treatment. I kept thinking that it’s okay to take my sleeping pills. I will just take 1-2 pills every night for the rest of my life. And when I relapsed afterwards, I was still naive to think that I could take 1-2 sleeping pills for the rest of my life and things would be okay. That was how insane addiction has made me. So fighting back to regain my sanity was the best thing I ever did.