Pain and mental health disorders are two of the most common causes of self-medication, a dangerous behavior which frequently leads to episodes of substance use and, for some, addiction. For individuals with osteoarthritis, rheumatoid arthritis or another arthritis-related condition, the temptation to use drugs or alcohol in these ways can be great.
Properly managing the disease, its symptoms and the impact on a person’s life is key in preventing medication misuse and other forms of substance use.
Understanding Arthritis As It Relates To Substance Use
Arthritis is a chronic and progressive disease that causes inflammation of one or more of a person’s joints. According to the CDC there are over 100 diseases and conditions afflicting the joints which are referred to as arthritis. The most common form is osteoarthritis, however other potentially severe forms include gout, lupus and rheumatoid arthritis.
Severe arthritis can be crippling, making it difficult for a person to carry out daily tasks or take part in activities which previously brought them enjoyment. The declining quality of life many individuals experience from these diseases causes some to cope with drugs or alcohol.
The symptoms of arthritis primarily affect the joints, including, but not limited to, the hands, wrists, hips, knees and ankles.
Arthritis can cause:
- aching
- inflammation
- pain
- stiffness
- swelling
- redness
- a reduced range of motion
Individuals contending with lupus or rheumatoid arthritis can have extensive symptoms beyond joint pain, including complications of the organs. Various forms of substance use can cause organ damage, making drug and alcohol use potentially dangerous to these individuals.
Even more, both lupus and rheumatoid arthritis are autoimmune diseases. Prolonged, chronic substance use can weaken the immune system, making it even harder for the body to heal and fight infection, a hazard to anyone with an autoimmune disorder.
A large number of individuals with arthritis also have another chronic disease. The CDC reports that “About half of US adults with heart disease or diabetes and one-third of people who are obese also have arthritis.” This makes it even more imperative to prevent substance use and addiction, as drug and alcohol use can be very dangerous for individuals with these conditions.
Risk Factors For Drug Addiction In Arthritis Patients
Each person struggling with substance use contends with a unique set of risk factors. While not every person with risk factors for substance use will develop a substance use disorder, these factors do increase a person’s vulnerability to drug or alcohol use.
Chronic illness is itself a major risk factor for substance use. Additionally, the way the illness impacts a person’s life and health can create an additional set of risk factors. For arthritis, these risk factors include:
- pain
- prescription medication usage
- sleep disturbances
- mental illness
- social isolation
- stress
- disability
- loss of work
Ignoring or mismanaging these conditions can make a person more sensitive to the effects of drugs or alcohol. It can also make a person more susceptible to the risk of use.
Seeking the proper treatments and therapies for arthritis can help to protect a person from these risks.
Opioid Use And Arthritis
Though mild arthritis may treated by over-the-counter pain relievers, more severe cases are often treated with opioid painkillers. Though many doctors feel that individuals without a past history of substance use face little risk for addiction, using opioids to treat pain does open the door to the possibility of drug misuse and use.
The National Institute on Drug Abuse writes that of those individuals prescribed opioids for chronic pain, approximately 21 to 29 percent misuse their prescription, while 8 to 12 percent develop an opioid use disorder.
Individuals seeking to self-treat pain may be tempted to misuse opioid painkillers, either their own or someone else’s. Doing so places a person at risk of developing physical dependence, tolerance and the compulsive patterns of addiction.
While arthritis can develop in individuals of any age, the elderly population is particularly affected by these diseases. Elderly persons are at high risk of substance use, especially prescription drug use.
Using Alternative Therapies Can Reduce The Risk Of Use
Some individuals and providers jump too quickly to opioids as a treatment for arthritic pain. While opioid medications may be necessary at times, a variety of non-narcotic medications are available which effectively reduce symptoms of certain arthritis-related diseases.
In fact, Harvard Health Publishing published results on a study which found that oral non-steroidal anti-inflammatory drugs (NSAIDs) and various oral opioid pain medications produced nearly equivalent results for the relief of osteoarthritis pain. Both NSAIDS and opioids which ranged from the less potent (tramadol) to the potent (oxycodone) reduced pain by approximately 30 percent.
The non-opioid medication used will be dependent on the specific arthritis-related disease, in addition to the patient’s health and medical history. These could include:
- acetaminophen
- ibuprofen
- non-steroidal anti-inflammatory drugs (NSAIDs) (osteoarthritis)
- disease-modifying antirheumatic drugs (DMARDs) (for inflammatory or rheumatoid arthritis)
- targeted biological therapies (rheumatoid arthritis)
Further, there are several non-medication based approaches which may help to alleviate pain. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) urges patients to try the following to help reduce symptoms of pain:
In osteoarthritis:
- rest the affected area
- avoid activities which trigger pain
- exercise to strengthen the joints impacted by osteoarthritis
- lose weight
- heat and cold therapies
- nutritional supplements (glucosamine and chondroitin sulfate)
In rheumatoid arthritis:
- using a splint around the affected joint
- using tools to reduce strain on the joint (zipper pullers or long-handled shoe horns)
- resting the joint and taking breaks during periods of activity
- reducing stress
- eating a healthy diet
Stress, worry, pain and mental illness (which are prevalent in this population) can all make it difficult for an individual to sleep. Improving the quality and duration of sleep can help to control and reduce pain. Physical therapy and occasional steroid shots have also been shown to improve pain and inflammation.
Social Support Programs As A Preventative Resource
Individuals with arthritis should consider joining a support group. These groups can improve a patient’s attitude, teach valuable coping skills and teach important methods of self-care. Maintaining an optimistic attitude and decreasing stress are critical ways that person can reduce their risk for substance use.
Substance use peer support or mutual help groups are also vital resources for fighting drug use, especially for individuals with a chronic illness. They can also help a person in recovery maintain an abstinent state. Individuals who have recently relapsed or fear that they might, can greatly benefit from taking part in these meetings, too.
These groups aren’t the only form of support which is critical for individuals with a chronic disease. Staying active and involved in one’s community and family (to the extent that symptoms permit) can fight the isolation many individuals struggle with. Family members and close friends should strive to have a role in their loved one’s life and disease management.
Mental Illness And Arthritis
There is a strong correlation between arthritis and arthritis-related diseases and mental illness. Individuals with these diseases face from a two to ten times higher rate of mental illness when compared to those without these conditions.
Arthritis, like many chronic illnesses, can greatly disrupt a person’s mental and emotional well-being. For many individuals, this toll is so severe that they develop a mental health disorder or experiencing a worsening of an individual one. Depression and anxiety are the two forms of mental illness most frequently experienced with arthritis.
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Inversely, mental health disorders can make a person’s arthritis worse. Research has found that depression and anxiety can reduce a person’s pain threshold. As pain is felt more intensely, symptoms of a person’s mental illness may worsen, causing a vicious cycle.
To put this in perspective, one scientific review asserted “that persons with arthritis had a lifetime prevalence rate of psychiatric disorders of 63.6 percent and a 6-month prevalence rate of 42.8 percent.” The prevalence of these disorders was higher than numerous life-threatening diseases, such as cardiovascular disease, COPD, diabetes and hypertension.
Treating Mental Illness To Remove Triggers For Substance Use
Untreated or under-treated mental illness is a risk factor for substance use. With two of the most common arthritis-related mental illnesses (depression and anxiety) also being the forms most frequently linked to substance use, arthritis sufferers need to be proactive about protecting themselves from this risk.
Aside from using drugs to moderate pain, many individuals self-medicate to cope with the overwhelming symptoms of a mental illness. Treating a mental illness reduces both the temptation to use drugs this way and the potential for future triggers.
Behavioral therapies and counseling are critical components of treating a mental illness. These sessions can also help to alleviate stress and improve the quality of a person’s sleep, both factors which can help to reduce the risk of substance use.
Preventing Substance Use In Adolescent Arthritis Patients
Adolescent and teens are a high-risk age group for substance use. Research has shown that adolescents with chronic medical conditions tend to use drugs and alcohol at high rates. Young people with chronic arthritis frequently fall prey to this trend.
It’s estimated that roughly one out of every 1,000 children will develop chronic arthritis. This equates to roughly 300,000 diagnosed cases of chronic child-onset arthritis across America. At these ages, this condition is referred to as juvenile chronic arthritis, juvenile idiopathic arthritis or juvenile rheumatoid arthritis.
One study found that alcohol use was high in this population. It also found that young people with arthritis first began using alcohol at younger ages than their healthy peers. Using alcohol at these ages, and with this condition, can cause a person to disregard their healthcare and forget their medications.
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Preventing substance use at these ages is a critical step towards protecting them from later instances of drug or alcohol use, just as with any young person. The aforementioned study found that juvenile arthritis patients had a greater risk for developing a substance use disorder down the road compared to healthy adolescents, making prevention even more important.
Parental supervision and involvement, academic achievement, healthy peer relationships and community involvement are all protective factors against adolescent substance use.
Teaching youth and teens coping and stress-reduction skills can better equip them to navigate this time in a healthy, sober way. Adolescents with arthritis need support and guidance regarding disease management. Peer-support groups can further improve life-skills while offering a safe and encouraging space for teens to explore feelings relating to their disease.
Pursuing Treatment To Heal The Body And Mind
If an individual with arthritis or any other chronic disease is currently addicted to drugs or alcohol, drug rehabilitation treatment should be sought as soon as possible. Due to the complexity of needs and treatments required in this situation, inpatient drug rehabilitation programs are often the most optimal choice.
When selecting a program it’s critical to choose one which offers trained, intensive medical services, allowing for a person’s illness to be adequately treated throughout the duration of treatment.
Persons with a co-occurring disorder, such as depression and anxiety, will have an increased chance of success with a dual diagnosis program which treats both the mental health and substance use disorders.
Contact Vertava Health to learn more about preventing substance use in arthritis patients.
