by Robert W. Mooney, MD,

Knowledge concerning relapse prevention has been a mainstay of recovery principles for years and has, during the past decade, become increasingly important during the treatment process. Unfortunately, of the patients who relapse, many begin the process in an apparently innocent manner.

For those millions of people attempting to recover from alcohol or drug addiction, it is essential that they have the necessary information in regard to the affects of pharmaceuticals on their brains.

Generally speaking, an estimated 10 percent of the general population has an addiction to alcohol or drugs, and this addiction takes the form of a kind of allergic response to chemicals which changes brain activity and reward systems. The brain's response to these chemicals can be immediate, such as cravings for similar drugs. Or, it can be more gradual where thinking and perceptions become altered in such a way that motivation for sobriety decreases and patients return to old patterns of behavior closely linked to their original substance use.

Because this type of response does not occur in the other 90 percent of people, it is fair to say that the drug is not to blame.  However, there is something different about the make-up of the addict. It is still unknown why this reaction occurs—but it does—and could mean life or death for those in recovery. That is why it is important to understand the impact of hazardous chemicals on patients and their sobriety.

The Most Innocent Medical Event Can Trigger a Relapse

For those in recovery, their past addictions are obvious. But, do they recognize the day-to-day chemical hazards that may confront them? For example, alcoholics know to stay away from alcohol, but do they understand the need to steer clear of Valium or Xanax? How do they know what does constitute a hazardous substance in recovery?

Essentially, a hazardous chemical is any drug that is associated with relapse. Of course, alcohol is the No. 1 offender, but the others can be divided into three distinct categories:

• Street narcotics: frequently abused, illegal and recreational in nature.
• Prescription medications: available only with written instructions from a doctor or dentist to a pharmacist.
• Over-the-counter drugs: sold without a prescription and are found in almost every corner drug store.

What makes the chances of an unintentional relapse more frightening is that it is not necessarily associated with large doses of drugs. Even exposure to minimal amounts can trigger an allergic sensitivity.

According to a recent article written by Mark S. Gold, M.D, in the Journal of Addictive Diseases, "In addicts, doses of drugs that are too low to produce any conscious recognition that they received drugs are still quite capable of inducing changes in the brain and influencing behavior."1

So how are those in recovery to know? Sometimes it can be an innocuous situation such as going to the dentist, having surgery or being involved in another medically supervised event. It can even be as innocent as taking an over-the-counter medication to relieve the symptoms of a common cold.

Unfortunately, even though a doctor may prescribe these drugs or patients may not have had previous experience with them, it doesn't change the affect on the brain.

Open Discussions Prior to Surgery Keep Sobriety Intact

Scheduled medical procedures, in particular, present ongoing challenges for those in recovery. It is paramount that patients discuss their experiences as a recovering alcoholic or drug addict with their physicians or dentists, focusing on their special sensitivity to any mood-altering substances which include medications that could be given before, during or after surgery.

Doing so will help recovering patients avoid any unnecessary risk of relapse as a result of any upcoming medical procedures. This does not mean that doctors or dentists are responsible for their patients' sobriety—they aren't. But, there are things they can do to make it easier for patients to get through the procedure with their sobriety still intact.

Before Surgery

Doctors will often order sleeping pills on the evening before or a mild tranquilizer on the morning of a procedure. Although beneficial to most patients, there are non-pharmacological ways to ensure that patients' emotional states do not interfere with their surgery. They should never feel pressured to take something beforehand.

During Surgery

Being put to sleep with general anesthesia is like being passed out drunk. The brain just does not see the difference. Doctors should consider using any alternative such as local anesthesia or an epidural. If an alternative is not medically possible, just remember that it is not unusual for an alcoholic or addict to require higher doses for general anesthesia. Patients should be prepared for their personalities, including their judgments, to be altered for approximately three months. So, a patient's left-field decision to move to Alaska to teach sled dog racing may not represent truly rational thinking.

After Surgery

This is when most addicts end up in trouble. At this point, their brains will probably be convincing their bodies that they need relief—spelled N-A-R-C-O-T-I-C-S. Besides the physical discomfort, patients may seem anxious, irritable, unable to sleep and it will be very tempting to treat these symptoms with a variety of medications which could be hazardous to their recovery. So before getting a prescription, remember: The Phenergan for nausea, the Xanax or Ativan for anxiety, the Trazodone, Ambien or Benadryl for sleep or even the Ultram or Darvocet for pain can all trigger that compulsion for more.

The ideal but often impractical solution is to keep patients in a controlled environment until medications are no longer needed. Sending them home with a prescription can be dangerous. In the rare cases where narcotics are required for pain control, it may be best to use a medication that most are hesitant to administer. Giving a more potent narcotic for a shorter period of time is less risky than using a milder drug for a long time. Most doctors are more likely to stop Demerol or Morphine after a few days than to continue to write prescriptions for longer periods. Addicts often admit that Tylenol, Motrin or Toradol actually worked as well as narcotics in most cases following a procedure.

Help Empower Patients in Recovery to Recognize Chemical Hazards

It often takes a village to keep a recovering alcoholic or addict on track. It is always best to involve someone else when it comes to medical procedures and the administering of medications. Doctors and dentists should be encouraged to ask about a sponsor, family members or perhaps an addiction medicine specialist to monitor a patient's state of mind. The health provider should have full permission to ask or suggest whatever is needed to ensure their patient's return to full health—physically, mentally and spiritually.

It's not only about fulfilling their duties as a medical professional, it's also about helping their patients do what is necessary to recognize and avoid the negative impact hazardous chemicals can have on their recovery process. Remember: "It doesn't take a lot of sense to stay sober; it just takes all you've got."

Dr. Mooney will be a keynote speaker at the Spectrum Conference, scheduled for October 1-3, 2010 in Houston, Texas.