Chronic Pain and Addiction

mashazak clarifies some particulars of her Loved One’s situation. The chronic pain that underlies her addiction adds complexity to her situation. With her Loved One facing an impending eviction, how can this family member reach out a supportive hand that helps get her into the treatment she needs?
 

Thank you for your response. Your professional words of wisdom, experience and understanding are most appreciated! To answer your questions:

My daughter does not work. She has not been able to work since age 22 when she got on SS disability (she is 27 now).

Her case is a little different from most of the cases described on alliesonrecovery as addiction is the most recent layer to the chronic pain and generalized anxiety disorder problems. In the last year she started to take molly which she claims gives her relief from her chronic pain and facial tics. She is addicted to clonazepam and adderall which were originally prescribed to her by doctors but now she uses her SS money to get it from a "private supplier". In the last year she also began daily drinking. Read this member’s full comment here.

So often our Loved Ones struggle with more than just addiction. Your daughter has chronic pain, facial tics, and anxiety. Chronic pain combined with addiction is a very difficult combination. It is not unusual to seek out drugs for pain relief, only to find it doesn’t work well, has the opposite effect, and leads to becoming addicted. Buying prescription drugs on the street is not the answer. With the daily addition of the alcohol your daughter is in even more serious trouble.

Model treatment for pain and addiction involves addressing the symptoms and cause of the pain, withdrawing the person from the addictive drugs, and a plan going forward that involves psychiatry, psychology, physical therapy, alternative modalities and addiction treatment.

A transitional home is not the place to start for your daughter. She needs a comprehensive assessment and individualized plan to address the pain and the willingness to follow it. Only then will she be a candidate for transitional housing. Here is an article from the National Institutes of Health that describes treatment for chronic pain. https://www.ncbi.nlm.nih.gov/books/NBK92054/

Since your daughter is on Social Security Disability Insurance (SSDI), does this mean she is covered by Medicaid? Would Medicaid pay for an inpatient pain center? I did not do a thorough search, but here is an example of one:

https://www.hopkinsmedicine.org/psychiatry/specialty_areas/pain/patient_information/inpatient.html

The facial tics are bothering your daughter most. And using molly might have altered her experience of the pain and tics, and perhaps it did provide some temporary relief – especially when she first used it – but most certainly is not an appropriate long-term solution for these problems. Could you get your daughter on the phone with a professional at Johns Hopkins to talk about treating the tics as part of the comprehensive inpatient care?

The plan you would offer your daughter involves support for the pain center. Once she is close to completing this then you lay out other options for housing that can include transitional living, etc. She will be in a different frame of mind for this discussion as it would come after solid treatment for her pain and tics and a pain management system that doesn’t involve self-medicating with drugs purchased on the street.

I hope that this response helps put detail to the “intervention” you are trying to do with your daughter prior to her eviction in early March. She may still refuse everything. The earlier response I posted lays out how to address options with her. She may need to be homeless if she refuses help and your home is not an option. A stint of homelessness is not what we want, but it will be her choice, if she doesn’t accept any other option. Put Pine Street Inn in Boston on the list if she refuses everything else, you can help her get to that door. https://www.pinestreetinn.org/

Considering the complexity of having to manage chronic pain on top of multiple addictions, it is no wonder things have spun out of control. In the past, people without SUD have repeatedly reported frustrations trying to have their chronic pain even acknowledged, let alone addressed through the health care system. This has started to shift in recent years as attempts to better understand chronic pain have been more widely publicized. Pain medication itself doesn’t cure the root of the problem, and this “band-aid” approach has sadly led many down the path of addiction to prescription pills.

Successful treatment can look different depending on the individual’s particulars, and even when medication is found to be helpful in some stage of that recovery, it can’t provide an absolute cure for the disease itself. This requires a multifaceted approach, and a willing to look at – and commit to – healing on multiple levels. It’s worth repeating that treatment for pain and addiction is best accomplished with multiple levels of support: psychiatry, psychology, physical therapy, alternative modalities and addiction treatment.

Alternative modalities might include acupuncture, hydrotherapy, massage, or any number of others, but don’t get stuck on finding a “magic bullet” approach. Whatever the modality, the connection between your daughter and the practitioner, and her willingness to engage with them, will go a lot farther in her recovery than worrying about which modality is “right” or not. Trauma Specialist John Fitzgerald wrote about such considerations earlier in the winter in a post on treatment for trauma.

There are many perspectives to consider and a lot to think about here. With your daughter’s housing situation coming to a head soon, try to keep fostering that open, compassionate communication each time you have a new opportunity with her. The work you do in compiling the needed info to support her in this transition will be invaluable… We wish you strength and clarity as you take a fresh look at the resources out there for her. You’re on the right track.