One day while Dr. Sheila Sorkin was recovering from her suicide attempt, her physician sat down next to her hospital bed and said to her, “You have a problem.”
“Oh?” replied the quick-witted Sorkin. “You’ve met my ex-husband?”
Actually, her problem was not her ex-husband — although he, being an alcoholic and the son of an alcoholic, didn’t exactly help.
Her problem was that she is a drug addict who began her career of addiction in an innocuous way — with medications that a physician prescribed to help her with pain following surgery when she was a young medical student.
Today, this Madison-area native is both recovering and helping others to recover. She is what she calls an “addictionologist” at Milwaukee Psychiatric Hospital.
Her own addiction history is “my secret weapon” in treating others, she said in a recent interview at her office. “It helps the patients a great deal to know that I have a happy life and do good…. It’s fun work and I like it.”
But this problem — addiction to prescription medications, particularly those for pain and anxiety — not only persists in the general public. It is one that could have particular resonance in the Jewish community, according to at least one local expert.
Psychologist Dr. George R. Jacobson, associate professor at the Medical College of Wisconsin, is the author of two books on addiction and has been treating patients in the Milwaukee area since 1972.
In a recent interview, he said that in that time he has seen “two or three” Jewish alcoholics, no adult Jews addicted to “street drugs” like heroin — and “a lot of [Jewish] men and women addicted to prescription meds.”
He estimates that between ten and 15 percent of all the patients he has treated for addiction to prescription medications were Jews. Given that Jews are about two percent of the total U.S. population, they are “vastly over-represented in the population that I see,” said Jacobson.
Happens by accident
It should be emphasized that these are one expert’s impressions. Another addiction expert, psychologist Dr. Edward Rubin of Aurora Behavioral Health Services, who is also a consultant to Jewish Family Services, cautions that carefully collected statistics about the extent of this problem in the Jewish community are difficult to obtain. No local treatment facility “compiles data of the religion of people who come for services,” he said.
Moreover, both Rubin and Sorkin doubt that the Jewish population’s statistical proclivity to become addicted differs significantly from that of the non-Jewish population. Sorkin said that about five to six percent of all people have a “propensity for addiction” that can be triggered by lengthy (one month or more) exposure to some prescription drugs.
Still, all three indicated that a stigma about addiction to alcohol and street drugs helps keep Jews away from those, while no such stigma exists regarding prescription medications.
After all, “prescription drugs are respectable,” said Jacobson. Physicians prescribe them legally for valid medical reasons — which can become a rationalization for wanting and needing more.
Nevertheless, a stigma does seem to attach to becoming addicted to prescription drugs, even though it happens most of the time by accident and is due to inherent, biochemical susceptibility, not the patient’s intent. “People perceive getting hooked as an immorality, a sin, a sign of personal weakness,” even when it manifestly is not, said Sorkin.
Perhaps for that reason, neither Rubin nor Jacobson were able to find any of their Jewish patients who were willing to discuss this with The Chronicle even with identities disguised. (Sorkin would not ask any of hers, saying she did not want to put any kind of pressure on them.)
Observable signs and symptoms in oneself or others can help indicate that addiction may be developing. According to Jacobson, if someone starts needing to take the medication in increasingly large amounts, or more frequently than prescribed, that indicates growing tolerance for the drug, and “tolerance is probably one of the most fundamental indicators of addictions.”
The problem, he said, is that it is also one of the few objective signs that a problem may be developing. So many of the others are subjective, such as cravings for the medication, or attempts to fool oneself by telling oneself that the pain or anxiety are coming back sooner than they really do.
And it becomes easy to play “intellectual games,” as Sorkin put it. “You say ‘I really do have pain, I really feel anxious [and] if these idiots knew how bad I feel, they would give me what I need,’” she said.
Some people in this situation then find ways to manipulate the health care system to get more of the drugs. “Patients don’t always tell the truth about pain, or they go to multiple physicians with the same complaint,” said Rubin.
And physicians may go along, said all three of these experts, out of real desire to help, ignorance of the manipulative games addicts play or the general bias of Western medical training toward treating symptoms and to prescribe quick-acting drugs rather than longer-term alternatives.
But there are alternatives. Addiction itself is treatable through combinations of medical treatment and psychotherapy. Moreover, the problems for which potentially addictive drugs are prescribed — most frequently pain and anxiety — can be treated and managed in other ways.
Rubin recommends that people ask their physicians “Could this drug be addicting?” when medications for these kinds of conditions are prescribed. Both he and Jacobson would like to see physicians become better trained in alternative therapies.
“There are psychological components to many physical ailments and we should be treating that part of the problem as well,” said Rubin. “We should treat the whole person, not just the one symptom.”
According to pyschologist Dr. George Jacobson, psychologist Dr. Edward Rubin and “addictionist” Dr. Sheila Sorkin, patients most frequently become addicted to members of two broad categories of prescription drugs:
• Opiates — Medications prescribed to help manage severe pain. The most well-known is morphine, but many drugs in this category have similar chemical structures and work in similar ways. One commonly abused group has oxycodone as its active ingredient: trade names include Oxycontin, Percodan and Tylox.
• Tranquilizers — Medications often prescribed to treat anxiety. Trade names include Xanax, Valium, Librium, Klonopin. Jacobson pointed out that while withdrawal from opiates can be “unpleasant and painful, but generally not dangerous,” withdrawal from tranquilizers can be dangerous, causing patients to have seizures.
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