A 12-step group that is lesser known than those frequently used as referrals for those in early recovery, Pills Anonymous is a concept that goes far back into the history of Alcoholics Anonymous and Narcotics Anonymous. While pills are generally considered to be narcotics–and many of those who suffer from the ravages of this addiction are comfortable with the recovery in NA or AA–there is a subtle distinction in the type of addiction found with prescription medications.

The early beginnings of Alcoholics Anonymous were fraught with addiction to medications. The co-founder of AA, Dr. Bob Smith, was addicted equally to alcohol and prescription medications. This is where some of AA’s early foundation was laid. There was little discrepancy for the early members between those who abused pills along with their alcohol and those who did not. Some of the early literature and stories in AA are about the two. One of the most recognized members of AA, Dr. Paul O. was very active in attempting to begin a program for those who were addicted to pills. He himself wrote, in his story, which is a foundation story in AA’s “Big Book,” about his addiction to prescription medication. The first title of his story, “Doctor, Alcoholic, Addict,” later changed when the fourth edition of the book was published in 2001.

Pills Anonymous records its beginning at about the year 1972. A long-running group in New York has the claim as being the first. This is at about the same time that Dr. Paul O. worked to form groups as well, probably in his home in Southern California. The formation of Pills Anonymous as a nonprofit corporation, housed near Phoenix, AZ, was accomplished in 2008. Since that time, literature has been approved and distributed, stating the purpose of Pills Anonymous, sample formats for meetings, and other literature to separate PA from AA, its closest “parent.”

Pills Anonymous began using the literature and format of AA, as well as the text, Alcoholics Anonymous, otherwise known as the “Big Book.” Today, there is a text being written for Pills Anonymous to deal with the specifics of their brand of recovery.

One of the phenomena of the 21st century is the sheer volume of prescription medications being abused at this time. For those who are striving to recover from this addiction, the subtle differences between the recovery programs (via 12 Steps), they can access are enough to discourage them from attempting. While AA has strong recovery and definite fellowship potential, the members discourage talk about drugs. NA is specifically geared toward drug addiction, but many of those who are seeking recovery from pills do not relate to the recovery from street drugs and the differences in lifestyles they encounter in
NA.

Pills Anonymous has the potential to fill the need for those who abuse prescription medications and offer them a way out of addiction, into recovery. At this time, there are 65 meetings listed for the US, with one Skype meeting in Bulgaria. Most of these meetings are in Arizona and Southern California. The website has instructions on how to begin a meeting for groups that may feel the need to do so. They also have a list of the meetings currently underway, as well as other useful information that will assist those who are either looking for an existing meeting or just wish to read their literature.

Kelly McClanahan has an MSW in clinical social work, with a specialization in substance abuse treatment. Having worked in this field for over 20 years, she is currently working on her certification as an addictions’ counselor.

While a basic understanding of the function of narcotics and their effect on the (normal) brain of a chronic user is simplistic when determining who is likely to abuse opiate medications and why they are in a particularly high risk group for opiate addiction, the truth is, of course, much deeper than that.

Historically, opiate addicts–those who abuse and become dependent on heroin and other other forms of opium including synthetic opiates, such as methadone–have been characterized primarily by their low functionality on the social spectrum. Stimulant addicts; those abusing cocaine, methamphetamine, amphetamine and other stimulant drugs are the “go-getters” of the addiction spectrum, as a general rule. Therefore, it is important to determine who is likely to become addicted to and dependent on opiates. This information can educate those in the medical field about who are more likely to use and abuse opiate medications.

By and large, there is a certain amount of truth in the theory that “B-type” personalities are those drawn to the opiate family of drugs. There is a certain tendency for opiate addicts to come from certain types of personality and character development patterns. The largest tendency for opiate addicts is those who suffer from disorders stemming from development of social anxieties or having difficulty with relationships, both personal and social. This group also has a low tendency toward regulation of affect, along with little or no development of psychosis. Another group predominantly tending to abuse opiates is those with a low threshold of reality-based cognitions, with impaired views of reality vs. fantasy regarding relationships. The third group is probably the most highly-functional of the three, socially and intellectually. They are somewhat disillusioned about reality ideation, but not psychologically impaired. They are somewhat, mildly depressed as a rule, but not clinically depressed or impaired. Many in this group function with a low energy for many years, with and without opiates.

In today’s trend toward abusing prescription pain killers (synthetic opioids) the latter is probably the most frequently found group. While a certain amount of social functioning is present, due to the high cost of maintaining their addiction and the necessity for obtaining and maintaining numerous prescriptions, they are highest in likelihood of pulling this off. In astonishing numbers, we see them in hospitals, public sector jobs, and other places where drugs are part of the world they inhabit.

Heroin and other opiates are considered “street drugs.” The groups using these substances are more traditionally recognized as the addicts who steal money and goods to pay for their drugs, rather than those who must maintain employment and insurance and who are more functional socially. This group is lower functioning and less likely to be involved in the workplace, unless it is on jobs where they have low productivity and poor attendance records.

Initially, opiates will have beneficial and highly pleasurable effects on the user. Dependence develops quickly because the drugs produce euphoric sensations that lead to more frequent use.. Dependence also develops due to the tolerance to specified amounts of the drug that develop rapidly with use. Because these are the drugs most frequently used for pain management, those with chronic pain symptoms and long-term and chronic pain are highly susceptible to addiction and more likely to go through symptoms of opiate withdrawal. Understanding the nature of those who are likely to become dependent on the drugs is important for monitoring patients on pain medication regimens for early signs of abuse. Figuring out what caused the addiction initially and figuring out other solutions is the first step toward opiate recovery.

Kelly McClanahan has an MSW in clinical social work, with a specialization in substance abuse treatment. Having worked in this field for over 20 years, she is currently working on her certification as an addictions’ counselor.

In early recovery from drug/alcohol addictions, as with other addictions as well, there are things that “trigger” the recovering addict into thinking that may result in relapse behavior. From one addict to the next, these things will have similarities as well as differences, depending upon the person and the addiction.

Examples of situations or items that may trigger a relapse to alcohol use/abuse would be a time of day when the recovering addict would normally have their first cocktail or a time of day when they would begin their drinking behavior if a consistent pattern had been established. Another might be seeing a commercial on television portraying a particular favorite brand of wine, beer or alcohol. Scenes of drinking behaviors in movies or portrayed on television could also trigger that response, as well as certain objects that were significant in the drinking history of someone, such as a favorite martini glass or shot glass. Other triggers for recovering addicts can be the smell of a favorite beverage or driving by a bar or liquor store that was a favorite during their drinking days. Even driving in the same neighborhood or on the same street may bring up memories that are uncomfortable and difficult to contain.

For recovering addicts who used/abused drugs, it may be just as simple to be triggered by events or by seeing certain objects that are reminders of the old ways and behaviors. In those instances, it can be a lighter that was used for smoking marijuana, or a match strike that smells of sulphur for an addict who used matches to “cook” their drugs before injecting them with a syringe. The sounds of certain types of music can act as a trigger, as can many types of sensory stimuli they are not aware of until they encounter them in a new environment and feel the tug of the old days pulling them back into the addictive behavior.

Relapse prevention is an important factor in treatment for addictions. Without an open awareness of what some of their triggers may be, addicts are left unprepared for meeting and working through those triggers without relapsing into behaviors or even ways of thinking that are going to prevent them from successful abstinence. It is the same parts of the brain that will figure largely into their recovery that are heavily inundated with these types of sensory stimulus. Key to recovery being successful is that they uncover and have contingency plans available for these moments when they are hit hard with old sights, smells, sounds and situations that were inviting for them during that time of life and in those circumstances. It is important for the addicts in recovery to have back up plans available so they can be on guard to the triggers and then to walking away without succumbing to the temptations that will arise when those triggers are met.

Relationships with other recovering persons can be priceless in these situations; because they will inform the newly-recovering addict about how they met and overcame similar circumstances and validate the feelings that come up. A misconception that most newly-recovering addicts have is that the knowledge they have gained about their addiction is adequate to keep them from relapse. This is not the case. When those triggers are met and encountered unawares, they have powerful pull on every addict, whether they have knowledge about their addiction or not. So when they learn that they are not alone in fighting off the temptations faced with those triggers, they have a stronger weapon with which to resist.

Kelly McClanahan has an MSW in clinical social work, with a specialization in substance abuse treatment. Having worked in this field for over 20 years, she is currently working on her certification as an addictions’ counselor.

The principle applied to recovery of freedom is written about in the ninth step of 12-step program materials. However, freedom is experienced for most recovering addicts the minute they are able to honestly admit to themselves that they are not able to give up the addiction without some type of help.

Our culture dictates that our heroes are those who single-handedly overcome obstacles to success and become fearless in the face of adversity. This is laudable and sometimes possible in other arenas, but when it comes to addictions it is not the best road for recovery. The act of letting go of the tough-guy façade is usually the beginning of a process that allows an addict to embrace recovery.

There is a great amount of relief in admitting that a problem has us stumped, no matter who we are or what the problem may be. Allowing for our human failings can sometimes relieve pressure to perform that is endemic in our cultural indoctrination. This pressure does not serve any purpose other than to isolate us from the resources that will, in fact, allow us to begin to band together to become stronger than that which is undoable alone. This is the true meaning of freedom.

Then there is the obvious freedom from the addiction itself. This concept appeals greatly to most addicts. As they continue to process through the 12 Steps, they begin to experience freedom from the dishonesty and cover up that was required to maintain their addiction. Then there is the freedom from the shame, anger, and pain of active addiction. These are not to be minimalized by anyone, as their toll is often the incentive to begin a recovery process from the onset.

Other freedoms are those that are less obvious to those not savvy in the life of an addict. Some of these are the freedom to travel without having to worry about having enough of the addictive substance available in new and strange places, the freedom to spend time with loved ones and family that has suffered because it was too difficult to maintain an “even keel” emotionally or physically during active addiction, and the freedom to go where one wants and do what one wants without the ball and chain of the addictive habit going along for the ride. These freedoms are great! Other freedoms that come in recovery are the freedoms to stop looking over one’s shoulder waiting to be caught or found out for participating in their addictive behaviors, freedom to live life without the day-to-day pain of ups and downs of physical and emotional cravings and serving those cravings, and the freedom to walk with one’s head held high and look others in the eye because one feels that they have finally found a good way to live in the world.

Not to mention the financial freedom that comes when all one’s available money is not being spent on the substance or addictive behavior. Freedom from the guilt and shame that come with knowing that they are taking necessary resources away from their families and loved ones and spending them on addiction. This is a great weight which gets lifted off the shoulders of every recovering addict, whether they borrowed, earned, stole or otherwise gained that money from whatever sources. They can now have the freedom to focus all of that energy and attention in the directions they would deem most appropriate for it to be channeled. This is great freedom, indeed.

Kelly McClanahan has an MSW in clinical social work, with a specialization in substance abuse treatment. Having worked in this field for over 20 years, she is currently working on her certification as an addictions’ counselor.

Fear is more than emotion for most people entering recovery. There is the dread that they will begin to experience the same life occurrences that brought them to the gates of recovery. Repeating those situations brings a sense of impending doom that is very familiar and one of the reasons for escaping into the addiction.

Learning to walk through fear into a new way of life is the path of recovery. Every situation which was reason or cause for escape becomes a challenge. For someone new in recovery, it is a daunting one. Few have experienced the other side of a fearful situation without relapsing back into that behavior. Recognizing fear when it comes into play is important. Many newly recovering people do not know how to identify their fear, will deny they are afraid or cannot bring themselves to admit when afraid of…a job interview, a test of any kind, the dentist, the doctor, going to court, facing their families, working through a troublesome marriage problem, a wedding, a funeral…the list is endless.

An understanding sponsor and friends are necessary to help bolster the courage of this person. They will gain a great deal of strength as they master each intimidating situation and come through it without falling back into old patterns of either avoidance and/or escape via addictive behaviors.

For some reason, fear is the most powerful emotion that recovering people will deal with. There is terror in life that not everyone experiences, but is the common thread running through most addicts’ lives. When kept to oneself, it becomes gigantic and impossible for any one person to overcome. If they do not learn to talk about their feelings, this is the one that can wipe them out. Historically, chances are good that their only source of courage and fortitude came from an addictive substance or behavior. Without that, they will become immobilized and frozen in fear, unable to participate in life at any level.

Dwelling in fear can become the onset of phobic behaviors for many recovering people. Their silence is a deadly foe that needs fresh air to be vanquished. Working in recovery requires a great deal of honesty in discussing fear and what it feels like. Admitting to silly fears that most people laugh at helps newly recovering individuals relate to some of their silly fears and to gain mastery over them by walking through their fear, rather than to succumb to frozen nonparticipation in the life going on around them.

Without their substance or behavior of choice, many will not even know how to recognize the impact that fear has had on their lives. Some will not admit to having felt fear, and many will continue this bluff for some time after they begin their recovery. Like whistling in the dark like fear is not present, they will bluster and bluff their way through situations or avoid them altogether, thus never benefitting from learning to share their fear, air their fear and then walk right through the vanishing cloud left behind. This is the gateway into real recovery.

Kelly McClanahan has an MSW in clinical social work, with a specialization in substance abuse treatment. Having worked in this field for over 20 years, she is currently working on her certification as an addictions’ counselor.