Imagine the Triple Threat of Chronic Pain, Addiction, and Depression
Suppose you develop a severe pain condition that never really gets better. You go to the doctor, and she gives you medications to make you feel better. When you take them, they work, but they work less and less well as time goes on. And each bout of pain depresses you.
Or perhaps, you started with depression, and the chronic pain followed. Or the addiction was first, and then the other two. They go together and play off each other in ways that can make it very difficult to escape the pattern.
This is the situation of many of the people you help.
Medicinenet.com lists ten symptoms of addiction to pain medication. This is an important list, and excellent information for anyone who works in mental health, poverty alleviation, or similar fields. Be sure to read through it.
WebMD discusses the links between chronic pain and depression. Nearly 32 million Americans have chronic pain, and up to half of them also have depression, and from SAMSHA, between 8 and 20% of Americans have issues with illicit drugs, binge drinking, or heavy drinking.
Inevitably, all three problems will occur in one person. It is an often repeated truism in poverty and homelessness work that a person does not get ‘here’ because ‘something went wrong’, people get ‘here’ because many things went wrong.
The symptoms for the three separate issues blend and expand on one another. The person who is isolating himself because of depression becomes doubly solitary because of addiction. The person whose chronic pain is making her irritable gets more so because of depression. The person whose addiction has him stealing money to get drugs will do so even more if he’s seeking pain medications.
Here are seven things to keep in mind when working with this population:
- Assume the pain is real. No matter how troubling the behavior, if you start by assuming the person is truly in pain, you will make better choices in working with the person, and will build the helping relationship more quickly.
- If at all possible, get releases from all professionals working with this person, including doctors and mental health professionals. Coordinated care is very important with people in this situation.
- Start at any door. If she is willing to pursue treatment for depression but not addiction, start there. If she is willing to attempt rehab, but not admit she is depressed, focus on addiction. If she is willing to admit to chronic pain, but won’t admit to any other issues, help her discover how her depression or addiction is preventing her from doing or having things she wants.
- If you are just there to hand out food from the food pantry, or some other relatively short interaction, don’t overdo it. Know who to refer the person to if he is not already seeing someone, and be willing to engage the person in conversation while he is packing up groceries and filling out paperwork. Even if your role is minor, any support that will help him begin to tackle any of these problems is helpful.
- If you are the primary support person for this person, don’t be afraid to ask for help. This is a difficult set of problems for any person to have, and it is easy to get overwhelmed when helping. Call any of the people on the individual’s treatment team and get the advice, the time, or the physical support you need.
- Roll with the punches: There are bound to be setbacks when individuals have this set of problems. When an individual relapses, or has a mental health crisis, stay focused on helping her meet her goals. If the person wants to spend time talking about what went wrong, give them that time, but keep your focus on “what now?”
- Consider non-medical alternatives such at teaching yoga and mindfulness and coping skills for stress and depression and to reduce chronic pain. There is a lot of good scientific evidence that these non medical interventions are effective, and they have the bonus of being inexpensive or free.
- Alcohol, Binge Drinking and Associated Mental Health Problems in Young Urban Chileans (plosone.org)
- Binge drinking ‘costs uk £4.9bn’ (dailymail.co.uk)
- American Voices: Study: Kids Allowed To Sip Alcohol Drink More As Teens (joronomo.com)
- This brain protein can curb binge drinking (health.einnews.com)
- Opioid Misuse In Chronic Pain Patients Is Around 25%, New Study Shows (forbes.com)
- Depression and chronic pain go hand in hand (youthofanation.com)
- How to Relieve Acute and Chronic Pain (nutritionw.com)