The combined treatment of co-morbid pain and addiction is not only possible but as retrospective analysis from an established treatment center clearly shows, is available and highly effective. Bay Recovery Centers is an integrated treatment setting with individual treatment plans which establishes time frames for stabilization of both pain and addictive disorders.

The study is discussed in client/patients who received 24-hour residential treatment for multiple diagnoses of chemical dependence, pain/medical disorders often impounded by psychiatric/psychological conditions.

Eighteen of twenty clients completed the program and returned home. Two left AMA because of unresolved issues and inability to complete the full course of treatment.

Four of the clients had been referred by self or relatives/friends to the center when seeking addiction treatment, and had complaints of pain as secondary, collateral problems. Seven clients were referred from other pain programs: nine patients were referred from other addiction centers.

Seven clients initiated the prescription drug use after an injury or with psychiatric illness without pre-existing drug or alcohol problems, but seven of these patients had had psychological pre-existing trauma or diagnosis. Six had an average of three prior chemical dependency treatments. Two had six chemical dependency treatments, and one had 12. Six had an average of two chemical dependency treatment centers treatment courses. All were active pain management clients. Six used Subutex (Buphrenophine).

The length of stay was 4 – 6 months for eight clients and 1 -2 months for the others. Eight clients had alcoholic fathers, two had alcoholic grandfathers and a total of eight had underlying issues of physical, sexual and/or psychological childhood trauma.

Treatment was initially aimed at stabilizing the pain and associated medical conditions then integrating elements of pain management and chemical dependence treatment. Addressing dependence/addiction to pain pills by utilizing treatment techniques focused upon the physiological changes that occur with addictive medications prevented the stigmatization usually associated with “addiction”. Patients suffered both from aberrant addictive behaviors as well as, more often, physiological dependence on a mixture of prescription narcotic, benzodiazepine and tranquillizers. Many of these patients were not primary drug addicts, but had become dependent or addicted to drugs as a result of their physical or mental conditions and/or associated chronic pain.

Historically and currently it appears that most conventional 28-day drug or pain treatment programs or tracks cannot adequately address the complex and compounding problems of physical dependence, addictive behavior and long term chronic pain with the usual associated medical and/or psychiatrist illnesses. At Bay Recovery we have found the aforementioned combined treatment, at times including the use of buphrenorphine and occasionally complemented by immunotherapy, to be very effective. Increasing utilization of and research into these modalities lends a further support of such effectiveness for these complex conditions.

Contrary to conventional wisdom, we find that successful treatment outcome occur more frequently with both chronic pain and addiction to “pain killers” than with the uncomplicated “primary” (street drug) addiction population. Once the pain enters a state of remission and/or tolerability, the patient with chronic pain no longer fears a return of intractable suffering, and is therefore more motivated and responsive to the treatment paradigm. Without the characteristic and severe degrees of denial, workplace and materialization typically of the individuals with non pain associated primary drugs addiction. The problems for patients with chronic pain associated addictive disorders is significant with the treatment.

Conclusion

Combined, integrated treatment for chronic pain and associated drug addiction is highly effective, but requires extensive multidisciplinary treatment. The initial treatment phase of 2 – 6 weeks is basically directed at pain management and medical stabilization with most clients unable to address or fully engage the addiction treatment component until 5 – 6 weeks when a shift from pain control and management to include a focus on drug dependence as well can be affected. At this point the full integration of pain and addiction treatment ensues.