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Prescription drug abuse is on the rise in the United States. According to the 1999 National Household Survey on Drug Abuse, in 1998, an estimated 1.6 million Americans used prescription pain relievers non medically for the first time. This represents a significant increase since the 1980′s, when there were generally fewer than 500,000 first-time users per year.
From 1990 to 1998, the number of new users of pain relievers increased by 181 percent, the number of individuals who initiated tranquilizer use increased by 132 percent, the number of new sedative users increased by 90 percent, and the number of people initiating stimulant use increased by 165 percent. In total, in 1999, an estimated 4 million people,12 and older, used prescription drugs nonmedically.
Although prescription drug abuse affects many Americans, some trends can be seen among older adults, adolescents, and women. In addition, healthcare professionals -including physicians, nurses, pharmacists, dentists, anesthesiologists, and veterinarians -may be at increased risk of prescription drug abuse because of their ease of access, as well as their ability to self-prescribe drugs. In spite of this increased risk, recent surveys and research in the early 1990′s indicate that healthcare providers probably suffer from substance abuse, including alcohol and drugs, at a rate similar to rates in society as a whole, in the range of 8 to 12 percent.
Data suggest that up to 17 percent of adults aged 60 or older may be affected by prescription drug abuse. Elderly persons use prescription medications approximately three times as frequently as the general population and have been found to have the poorest rates of compliance with directions for taking a medication. In addition, data from the Veterans Affairs Hospital System suggest that elderly patients may be prescribed inappropriately high doses of medications such as benzodiazepines and may be prescribed these medications for longer periods than are younger adults. In general, older people should be prescribed lower doses of medications, because their body’s reduced ability to metabolize many medications decreases with age.
An association between age-related morbidity and abuse of prescription medications likely exists. For example, elderly persons who take benzodiazepines are at increased risk for falls that cause hip and thigh fractures, as well as for vehicle accidents. Cognitive impairment also is associated with benzodiazepine use, although memory impairment may be reversible when the drug is discontinued. Finally, use of benzodiazepines for longer than 4 months is not recommended for elderly patients because of the possibility of physical dependence.
Data from the National Household Survey on Drug Abuse indicate that the most dramatic increase in new users of prescription drugs for nonmedical purposes occurs in 12 to 17 year-olds and 18 to 25 year- olds. In addition, 12 to 14 year-olds reported psychotherapeutics (for example, painkillers or stimulants) as one of two primary drugs used.
The 1999 Monitoring the Future Survey showed that for barbiturates, tranquilizers, and narcotics other than heroin, the general, long-term declines in use among young adults in the 1980′s leveled off in the early 1990′s, with modest increases again in the mid-to late 1990′s. For example, the use of methylphenidate (Ritalin) among adolescents and young adults increased from an annual prevalence of 0.1 percent in 1992 to an annual prevalence of 2.8 percent in 1997 before reaching a plateau. According to a recent survey by the University of Wisconsin, one in five students had used Ritalin nonmedically.
It also appears that college students’ nonmedical use of pain relievers such as OxyContin with aspirin (Percodan) and hydrocodone (Vicodin) is on the rise. The 1999 Drug Abuse Warning Network, which collects data on drug-related episodes in hospital emergency departments, reported that mentions of hydrocodone as a cause for visiting an emergency room increased by 37 percent among all age groups from 1997 to 1999. Mentions of the benzodiazepine clonazepam (Klonopin) increased by 102 percent since 1992.
Studies suggest that women are more likely than men to use prescription drugs, particularly narcotics, and anti-anxiety drugs -in some cases 48 percent more likely. This may be in part because women are two to three times more likely to be diagnosed with depression and thus are more often treated with psychotherapeutic drugs. Overall, men and women have roughly similar rates of nonmedical use of prescription drugs. An exception is found among 12 to 17 year-olds. In this age group, young women are more likely than young men to use psychotherapeutic drugs nonmedically. In addition, research has shown that women and men who use prescription opioids are equally likely to become addicted. However, among women and men who use sedatives, anti-anxiety drugs, and hypnotics, women are almost two times more likely to become addicted.
Although most patients use medications as directed, abuse of and addiction to prescription drugs are public health problems for many Americans. However, addiction rarely occurs among those who use pain relievers, CNS depressants, or stimulants as prescribed; the risk for addiction exists when these medications are used in ways other than prescribed. Healthcare providers such as primary care physicians, nurse practitioners and pharmacists, as well as patients, can all play a role in preventing and detecting prescription drug abuse.
Assessing Prescription Drug Abuse: Four Simple Questions for You & Your Physician
Adapted from Ewing, J.A. “Detecting Alcoholism: The CAGE Questionnaire.”
Years of research have shown us that addiction to any drug, illicit or prescribed, is a brain disease that can, like other chronic diseases, be effectively treated. But no single type of treatment is appropriate for all individuals addicted to prescription drugs. Treatment must take into account the type of drug used and the needs of the individual. To be successful, treatment may need to incorporate several components, such as counseling in conjunction with a prescribed medication, and multiple courses of treatment may be needed for the patient to make a full recovery.
The two main categories of drug addiction treatment are behavioral and pharmacological. Behavioral treatments teach people how to function without drugs, how to handle cravings, how to avoid drugs and situations that could lead to drug use, how to prevent relapse, and how to handle relapse should it occur. When delivered effectively, behavioral treatments -such as individual counseling, group or family counseling, contingency management, and cognitive-behavioral therapies -also can help patients improve their personal relationships and ability to function at work and in the community.
Some addictions, such as opioid addiction, can also be treated with medications. These pharmacological treatments counter the effects of the drug on the brain and behavior. Medications also can be used to relieve the symptoms of withdrawal, to treat an overdose, or to help overcome drug cravings. Although a behavioral or pharmacological approach alone may be effective for treating drug addiction, research shows that a combination of both is the most effective.
Rimrock Foundation has pioneered the Advanced Integrated Model of Addiction Treatment (AIMAT). This model focuses education and therapy on the always-present psychological core of the addiction experience: psychological dependency, mental obsession, emotional compulsion, and the complex pattern of safeguarding behaviors that hide the reality of the illness from both patient and family.
We directly address the physical and psychological elements of dependency disorders, as well as the defeating beliefs that accompany addiction. We give our patients and family members an unparalleled understanding about themselves, their disease, their thinking patterns, and alternative behaviors necessary for abstinence from mood-altering chemicals or experiences.
For further information on Rimrock Foundation’s treatment of prescription drug abuse, call Jamie Hixson, Admissions Supervisor at 1-800-227-3953 or 1-406-248-3175, or visit our website at rimrock.org. For more educational information on prescription drug abuse, contact the Rimrock Foundation Library at 1-800-227-3953 or 1-406-248-3175.