by Robert M. “Mike” Leath, MD

People recovering from addiction to drugs or alcohol frequently don’t consider their problem to extend beyond their drug of choice. But this is not necessarily true. If a person has addiction issues with a particular substance, it is appropriate to consider this person will likely have problems with all classes of addictive substances.

Many relapses occur when recovering individuals feel that their addiction is under control and therefore controlled use is possible. Or, the person may recognize that their previous drug of choice is obviously not an option, but may feel that experimentation with other substances is harmless. Relapses under these circumstances may be unfortunate, but the person is rarely surprised of the outcome following this behavior.

Unfortunately, many people in good recovery have unexpectedly relapsed and later traced the relapse back to a seemingly innocuous prescription issued by their physician for something unrelated such as sleep, pain, anxiety or even attention deficit disorders. Taking an addictive drug of another class may lead to a new addiction, but more than likely will lead back to the original substance of choice.

Cross-addiction can occur by different mechanisms. A person in solid alcohol recovery, for instance, may go to the dentist and be prescribed some pain medicine along with an antibiotic. He may take this exactly as prescribed thinking nothing of it. He may then, without considering what is happening, begin to increase the dosage and/or frequency of the medication and may even seek a refill although the pain does not warrant a narcotic. This person, who was previously doing well as a recovering alcoholic may be on the path to developing a dependency on narcotics or, at very least, is on a slippery slope for an alcohol relapse.

A situation like this is not limited to the narcotics such as Vicodin (hydrocodone), Oxycontin (oxycodone) or even Ultram, but is frequently seen in anxiety disorders in which Xanax (alprazolam), Valium (diazepam) or Ativan (lorazepam) may be prescribed. One of the more frequent culprits is Ambien (zolpidem), a commonly prescribed sleep aid, which is chemically similar to drugs such as Valium and Xanax and shares a common pathway in the brain with alcohol. The amphetamine type stimulants which are used for attention deficit disorders are common relapse agents as well.

The reason for this cross addiction is as follows: There is an area deep in the brain which in lay terms is called the “pleasure center”. This is the part of the brain which is stimulated following pleasurable activities such as eating, having sex, etc. Again, the primary neurochemical responsible for this stimulation is dopamine. It is the main “feel good” chemical in our brain and release of this transmitter in our pleasure center is incredibly reinforcing for repeating the particular behavior which caused its release.

Though each class of addictive drugs has its own unique area, or nucleus, in which it exerts its actions, there is a common nerve pathway that acts to increase the release of dopamine in the pleasure center of the brain, following the use of any of these drugs. Interestingly, the pleasure center of the brain is a group of nuclei located in the same area in which the drive for survival resides. The nucleus accumbens and the Ventral tegmental areas are the primary sites responsible for dopamine release causing pleasure and relaxation. This release of dopamine in the reward center of the brain creates a desire, or reinforcement to repeat a particular activity. In the same fashion that certain pleasurable activities cause a surge of dopamine, drugs of abuse in certain individuals trigger a far greater release and/or response to the dopamine release. We think this is one reason some people may be more predisposed to addictive behavior than others.

Researchers have implanted electrodes into the pleasure centers of the brains of rats and then connected the electrodes to a switch which allowed the rats to self stimulate the area by tapping a paw on the switch. These rats would activate the switch repeatedly at the expense of food, water and everything else. They would even cross an electrified floor to reach the switch in order to stimulate their reward circuit. Given the fact that this circuit and the drive for survival are so closely related, and that drugs of dependence have the ability to stimulate the neural pathways so much more strongly than do the actions necessary for survival, it is easy to understand how addictions may override and usurp the brain’s normal functions.

In my practice, I have witnessed countless relapses stemming from a prescription written in good faith by a physician for a problem such as insomnia, headache, anxiety, etc. to a patient who was in addiction recovery. Another common scenario is the emergency room visit during a busy shift in which the doctor or nurse may have been made aware of a previous history of addiction, but failed to take this information into account when determining a course of therapy. In many of these cases the patient was so desperate for resolution of the problem for which he sought relief he failed to consider that the prescribed medication might prove problematic.

Many physicians are not taught about addiction or cross-addiction in medical school, so it is not uncommon for a practitioner to prescribe a potentially hazardous drug for someone in recovery. For this reason, it ultimately becomes the patients’ responsibility to ask questions about the prescription and check with his or her addiction professional before filling the prescription to avoid any potential problem.

There are usually alternatives to these drugs which may reduce the potential for cross-addictive problems. Many safe and non-addictive drugs are available for insomnia. Likewise, there are other effective treatment modalities for pain. For attention deficit issues, viable non-stimulant options exist. Again, if you have a history of chemical dependence or are concerned about the use of addictive medications to treat your symptoms, remember to mention this to your treating physician before they write the prescription. Don’t be afraid to ask questions. It’s your life and your recovery.