I saw a new client the other day, the wife of a man succumbing to a vicious opiate addiction which recently landed him in inpatient rehab. She wondered how on earth this happened to them. They were an upper-middle-class couple, with healthy and intelligent kids, one preparing to take the SAT and looking forward to moving on to college and the other already enrolled in an Ivy League school. They both came from good parents, good families, and good upbringings. They reported no depression, anxiety, or any other history of mental health criteria whatsoever. So how could her husband be found passed out on the side of the highway, crashed into a guard rail with a substantial amount of oxycodone, roxycodone, and hydrocodone on his person (according to what the police officer told his wife)? Well, it turns out this man suffered from a lot of pain.
He got into a work accident three years ago, went out on disability, and was prescribed painkillers ever since. His doctor, like many physicians, did not counsel patients on the nature of narcotic painkillers and the risks of addiction, and also did not see the risks inherent in prescribing painkillers for a three-year period of escalating amounts. The rationale for this is in the nature of pain. Pain is subjective; it is a very case-specific phenomenon. What is painful for you may not be painful for me. We all have unique thresholds for pain, what we feel we can tolerate, and what we feel is unbearable.
This man’s physical pain became so great, so pervasive in his life, that he began stockpiling pain medications and began what is called in the addiction world as “doctor shopping”—getting prescriptions for the same symptoms from multiple providers. A vicious cycle may ensue wherein the tolerance of these medications grows and grows, to the extent that dosages that would be harmful or even lethal to someone initially starting out on painkillers may not even affect the pain anymore. This is a scenario that is cross-cultural, cross-economic status, and may be even more specifically an issue for those in fields requiring significant bodily exertion. That can range from construction workers to professional athletes to physicians themselves.
Thus, the way to address addiction most often for those who struggle with pain is to question what exactly pain is, and what does it tell us? It is an automatic human reaction to retract from pain. It is our body’s way of communicating to us that whatever behavior we are engaging in is threatening, and continuing to do it may prove harmful. It is why we experience pain on differing levels—potentially lethal behavior generally has a lot of pain associated with it. If you doubt this, touch a hot stove. Better yet, just trust me—it’s quite hot, may very well lead to a burn, and is very, very painful. Our bodies are programmed to avoid, eliminate, and escape pain whenever necessary.
Pain is not only a physical phenomenon, but a mental and emotional one as well. Just think of the feelings involved after a recent breakup, a negative remark from a loved one, or a demotion at work. Emotional pain is something we also avoid at all costs, and can be just as hazardous to our health. It is the reason addiction is so powerful and has such a draw—substances numb pain. They also numb other emotions, including happiness, shock, love, lust, and a host of others. But they do numb pain. And thus we are drawn to that experience in a visceral way.
Ultimately, pain is a part of life. For some, it may be said that we cannot experience the positive emotions we crave without the experience of pain. Pain is something that informs us we are alive, and ought to stay that way. Pain inclines us to alter our behavior. Pain, in a way, is an aspect of the initial process of healing. Once an injury occurs, the first stages of how the injury begins to repair itself may be quite painful. It is a lesson from our bodies not to repeat that behavior, a memory-inducing state that hints to us, “If you continue to let others jump on your arm to the point that the bone breaks, I will encourage you to feel pain so that the next time someone thinks of doing that, you remember this feeling.”
However, that state is not permanent, either physically or emotionally. Even chronic pain ebbs and flows, where some days are worse than others. And so we must learn to live with a certain amount of pain that is inherent in life. Perhaps, rather than attempting to avoid pain at all costs, we should try to learn from it, learn that some pain is a part of a process in healing and improving. Some pain indicates that we should not repeat past mistakes. Some pain may be inexplicable, but at least it reminds us of how our bodies and ourselves endure and stay alive.
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