Dr. Alistair James Reid Finlayson is an Assistant Professor of Psychiatry at Vanderbilt University School of Medicine. He graduated in Medicine from the University of Western Ontario, London, achieved Fellowship in the Royal College of Physicians and Surgeons (Canada) and certification from the American Board of Psychiatry and Neurology. He is certified as a specialist in addictions by the American Board of Addiction Medicine. Dr. Finlayson is a Fellow of the American Society of Addiction Medicine and a Distinguished Life Fellow of The American Psychiatric Association. His career interests are general psychiatry, addiction psychiatry, and sexual behavior. He has published several book chapters and scientific papers. Dr. Finlayson directs the Vanderbilt Comprehensive Assessment Program, which has completed over 400 fitness-for-duty evaluations for physicians and other professionals.

Q: What are the warning signs for prescription abuse?

A: Anyone who has a history of abuse of alcohol or drugs and those who have relatives who have been addicted may be more likely to abuse prescription drugs. A marked sense of pleasurable well-being after taking the medicine, that exceeds the drugs usefulness – beyond relief for anxiety, pain, sleep, attention etc. – can be a warning sign that the prescription is potentially habit forming. Many alcoholics, for example, vividly describe how good and whole their very first experience with alcohol made them feel, in spite of the hangover. Another sign is the tendency to take more of the medicine than is prescribed because the feeling doesn’t last, or to use up all the pills before the next prescription refill is due. Offering prescription medicines to other people is a dangerous and illegal practice that leads to abuse.

Q: What does dependency on a drug mean?

A: Dependency is a physiologic term that simply means tolerance (increased dosage is needed to produce the same effect) and withdrawal (specific symptoms which occur when the drug is no longer present in the body). Tolerance and withdrawal symptoms develop over time and often without increases in dosage. Dependence is a confusing term, because “Dependence” replaced the term “Addiction” in the current DSM (IV-TR), but other symptoms must be present to diagnose Substance Use Disorders. Thankfully, it appears that the next revision of the manual will try to clarify this confusion.

Q: Are there any common misconceptions about prescription abuse and addiction? If so, what are they?

A: There are two confusing and dangerous mistakes that patients make using drugs. The first is to assume, usually without asking their doctor, that if the recommended dose produces a good effect, that more could be better.

The second, and much more subtle issue is that the withdrawal symptoms of many of the prescription drugs that are abused are often remarkably similar to their desired effect. Hypnotic drugs, or sleeping pills, for example, after use for several weeks can actually produce insomnia, as has been verified repeatedly in sleep laboratory studies. Abuse of hypnotic medicines is one of the leading causes of sleep problems. Another frequent and concerning example is the abuse of narcotic agents (opiates) for pain. Although these medicines provide excellent short-term relief, withdrawal can intensify pain, a phenomenon called rebound pain, which is difficult for the patient alone to distinguish from their painful condition. The sedating drugs that are used to treat anxiety and panic symptoms produce dependency within a few weeks and stopping them is associated with guess what? – anxiety, poor sleep and panic attacks!

Many of these misconceptions have been perpetrated and exploited by pharmaceutical manufacturers, who like the tobacco industry, have literally bought science and bribed physicians in order to dominate these lucrative markets. Studies estimate that nearly 90% of people who smoke become dependent upon nicotine, whereas roughly 15% of those who use alcohol have problems as a result. These population differences are probably genetic. We don’t know as much about prescription drug abuse, and it may be that sedative-hypnotic drugs have a problem frequency similar to alcohol but narcotics develop at rates closer to nicotine.

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