SUBSTANCE ABUSE DISORDER

BY ADRIANA ARIZMENDI PSY101

References

Harvard Heath Publications. “Painkillers fuel growth in drug addiction.” http://www.health.harvard.edu/newsletter_article/painkillers-fuel-growth- in-drug-addiction Harvard Health Publications. “How addiction hijacks the brain.” http://www.health.harvard.edu/newsletter_article/how-addiction-hijacks-the-brain Drug Abuse Gov. “Drugs, Brains, and Behavior: The Science of

Addiction.” https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery Addictions and Recovery Organization. Help for the Family.

http://www.addictionsandrecovery.org/families-and-addiction.htm

 ”It bears repeating. Make me good, God. But not yet. ” –Jackie Payton

The Leading Psychological Disorder

Substance Abuse definition: the overindulgence, improper use and/or dependence of an addictive substance, especially alcohol or drugs. Drugs are any substances, other than those necessary for maintaining normal health. Opiates (painkillers) are one of the most common addiction in America. In its raw form and different blends, opiates were available in America before the 1800s for various prescriptions. Valued for its calming, and relatively mild psychological effects, the drug was supplied deliberately by physicians. Opiates were a drug that calmed was specially attractive since physicians could at least treat his/her patients’ anxiety.

“Objects Are Higher than They Appear”

The Beginning of the End

In the pilot episode of Nurse Jackie, we see Jackie upset since she only has one pill left for her “bad back.” We see her rushing from patient to patient and performing her professional skills even better than Dr. Cooper, one of hospital’s doctor. Jackie appears screaming about pain in her back. Dr. Cooper hears her and offers her something for her back, then takes him up for some Oxycodone. They get a moment of silence before a code is called. Later in the episode, by the end of the episode, the audience see Jackie popping pills in three different occasions. By then, the show unequivocally portrays and nurse who is addicted to pain killers.

Opiates in America

According to DrugAbuse.Gov in 2012, it was estimated that 2.1 million people in the United States were suffering from substance use disorders related to prescription opioid pain relievers. This is a major concern in the U.S., the consequences of this abuse have been devastating and continue on the rise. The number of unintentional overdose deaths from prescription pain relievers has climbed within the country, more than quadrupling since 1999. “It is now an epidemic. Prescription opioids are one of the three main broad categories of medications that present abuse liability, the other two being stimulants and central nervous system (CNS) depressants.”

Many factors have contributed to the severity of the current prescription drug abuse problem. A dramatic increase in the number of prescriptions written and dispensed, greater social acceptability for using medications for different purposes, and aggressive marketing by pharmaceutical corporations.

 These factors together have helped create the broad “environmental availability” of prescription medications and opioid analgesics in particular. In most cases, opiates abuse begins when patients are prescribed with any of its form to relieve pain.

Such is the case of Eddie Falco’s character in Nurse Jackie. The audience is likely to make the assumption that Jackie became addicted to painkillers after having hurt her back. Researchers studied that prescription opioids are similar to, and act on the same brain systems affected by drugs such as heroin and morphine, which they show an intrinsic abuse and addiction liability, particularly if they are used for non-medical purposes.  They are most dangerous and addictive when taken via methods that increase their euphoric effects, known as “the high,” such as crushing pills and then snorting or injecting the powder, or combining the pills with alcohol or other drugs.

  It is also noteworthy to mention that many people taking them for their intended purpose risk dangerous adverse reactions by not taking them exactly as prescribed. For example, taking more pills at once, or taking them more frequently or combining them with medications for which they are not being properly controlled. Throughout the duration of Nurse Jackie’s show, we see Jackie do this in several occasions, as time goes by, her addiction gets worst, she begins mixing painkillers with alcohol and other drugs. It is possible for a small number of people to become addicted even when they take them as prescribed, but the extent to which this happens currently is not known.

The Very Functional Addict… For Now

It is not uncommon to think that many people who suffer fro substance abuse disorders are not as productive as many others who are not drug abusers. On most media outlets, drug addicts are often depicted as criminal characters making deals on dark street corners. These depictions are far from the reality of many people affected by this disorder. Drug Abuse Disorders affect people from all walks of life. Another risk factor that influences drug abuse is age. Teenagers and young adults are more likely than older adults to abuse or become dependent on opioid painkillers. A Harvard Health publication, released an analysis of national studies from 2002 to 2004 found that slightly more than 1% of people ages 12 to 25 were abusing or were dependent to painkillers — twice the percentage in people ages 26 to 49, and six times the percentage in those 50 and older.

Jackie Payton, Falco’s character portrays the face of one of the many people whose lives appear not to have any issues other than the usual struggles. She is the mother of two you girls, and has husband who seems to be a supportive man. Jackie could be considered as a “The High-Functioning Addict,” a term used to describe an person who may seem to have a very productive, seemingly manageable, and in some cases an almost pleasant life on the outside. In the show, Zoe, one of the nurses, refers to Jackie as “a saint.” Zoe admires Jackie’s skills as a nurse, a woman, and also a friend.

However, Jackie is living a secret dual-life. One of productivity, marked with high-achievement, while the other is a life of escape through the abuse of painkillers. She is able to succeed in their life well enough to where the effects of their addiction has not impacted the life they project to others. This is the case for many people who hold professional degrees, who have families, and help provide for them. One of the biggest steps towards recovery, is that the individual with this disorder recognizes that him/ her have an addiction problem. Although, this does not mean that once the person recognizes addiction, will change their lives. Spme of the approaches to recovery are professional intervention and in many cases recovery clinics are necessary to help a patient, with their permission of course.

“Sorry Sister, You Are Fired.”

Individuals with Drug Abuse Disorders who are high-functioning, are most likely to decline their performance in all the areas of their lives. What begins as a treatment for certain conditions that require opiates to manage pain, turns into liking, and then to addiction. No individual starts out with the intentions to develop an addiction, but many people of them will get caught in its trap. Another Harvard Health publication states that according to the latest government statistics, nearly 23 million Americans — almost one in 10 — are addicted to alcohol and/or other drugs. More than two-thirds of people with addiction abuse alcohol. The top three drugs causing addiction are marijuana, opioid (narcotic) pain relievers, and cocaine. The publication also states that “genetic vulnerability contributes to the risk of developing an addiction. Twin and adoption studies show that about 40% to 60% of susceptibility to addiction is hereditary. But behavior plays a key role, especially when it comes to reinforcing a habit.”

In the last studies, the scientific consensus has changed and today we recognize addiction. A chronic disease that is known to change both brain function and structure. Just as cardiovascular diseases cause damage to the heart and diabetes harms the pancreas, addiction hijacks the brain.

To recovery from addiction, willpower is necessary, certainly, but it is only is not enough. To "just say no" — as the famous slogan in the1980s suggested, drug addicts will need to use multiple strategies — as mentioned before, professional help as psychotherapy, medication, and self-care for them to try to break the grip of an addiction.

As the show’s seasons develop, Jackie encounters problems in all areas of her life. She begins by cheating on her husband, having sex with another men in exchange for drugs. She divorces her husband, her relationship with her daughters, friends and colleagues deteriorates dramatically, she tries to get sober by checking into rehab, she relapses, and loses her job. Lie after lie continuously.

The picture of an addict portrayed in Nurse Jackie reveals many of the realities drug addicts face in their lives.As she tries in various times, her relapses seem nothing more but intentional. But in reality, the chronic nature of this disorder means that relapsing to drug abuse at some point is not only possible, but very likely.

The relapse rates, meaning how often addiction symptoms recur for people with substance use disorders are similar to relapse rates for other well-understood chronic medical illnesses such as hypertension, diabetes, and other chronic diseases, which also have the same behavioral and physiological components. Relapse does not mean treatment has failed.

The treatment of chronic diseases involves changing deeply imbedded behaviors. For a person who wants to recover from addiction, lapsing back to drug use shows that treatment needs to be reinstated and in some cases adjusted with the hopes that another treatment might prove effective.

Family and the Path to Recovery

The Addictions and Recovery Organization works to educate the family members of those suffering with addiction. Drub abuse and dependence destroys families as much as it destroys those with addiction. Many families who live with an addict endure heartbreaking and exhausting times, torn between how to help the addict and how to avoid being affected by the addict’s disease. In the Addictions and Recovery Organization web page, individual are offered helpful suggestions that they’ve have found over the years of working with addicts and their families, and here are some of their advices:

• Things You Can Do For the Addict• Educate yourself on addiction and recovery.• Try not to accuse or judge. Avoid name calling. This is a

difficult time for both of you.• Provide a sober environment that reduces triggers for using.• Allow the addict time to go to meetings.• Understand that your lives will change. Do not wish for your

old life back. Your old life to some extent is what got you here. You both need to create a new life where it is easier to not use alcohol or drugs.

• Make sure that you both have time for fun. People use alcohol and drugs to relax, escape, and as a reward. The addict needs to find alternative ways to relax, escape, and as a reward otherwise they will turn back to their addiction.

• Recognize and acknowledge the potential the addict has within them.

• Behave exactly as you would if your loved one had a serious illness. What would you do if they were diagnosed with heart disease 

• Do not enable. Do not provide excuses or cover up for the addict.

• Do not shield the addict from the consequences of their addiction. People are more likely to change if they have suffered enough negative consequences.

• Set boundaries that you all agree on. The goal of boundaries is to improve the health of the family as a whole. Do not use boundaries to punish or shame.

• If you want to provide financial support, buy the goods and services the addict needs instead of giving them money that they might use to buy alcohol or drugs.

• Recognize and acknowledge the potential the addict has within them.

• Behave exactly as you would if your loved one had a serious illness. What would you do if they were diagnosed with heart disease