Moms on Drugs: The Prescription Pill Epidemic
It started out innocently enough. Julie Hartman, an administrative assistant and mother of three kids, ages 10, 7, and 2 at the time, hurt her back while lifting a TV. "I was in chronic pain and couldn't sleep for a month," says Hartman, of St. Paul. When an MRI detected mild arthritis, her internist prescribed the painkiller Vicodin and told her to take the pills as needed.
At first, Hartman did need them. But her back improved with visits to a chiropractor -- yet month after month she kept taking the pills. "I was in love with how confident and in control they made me feel," she explains. Whenever her prescription ran out, she'd simply go back to her doctor, lying to him about her pain and using her kids as an excuse to get a refill. "I told him I'm a mother and need to be able to function," she says.
As Hartman's dependence on the drugs grew over the next year, she started doing things she never thought she'd do: finding other doctors and lying to them to get additional prescriptions, and stealing Vicodin right out of the medicine cabinet of friends and relatives. "I was always afraid I would run out," she says, "so I manipulated people to get what I needed." For three years, she took more and more pills but couldn't admit to herself that she was addicted. "I kept telling myself, 'You're okay; you're not that bad,'" she says. "I didn't want to believe it. But my addiction began to take over my life."
Her denial came to an abrupt halt on August 31, 2009, when she walked downstairs on a Monday morning to a roomful of people who, along with a counselor trained in addiction interventions, confronted her about her drug use. Her husband was there, along with her sister, her pastor, and friends from her church. "My husband cried for 15 minutes straight, and I'd never seen him cry before," Hartman says. He told her he'd caught her in too many lies, she'd missed too many of their children's events, he no longer trusted her, and she was tearing their family apart. He threatened to take their kids away from her if she didn't get help. He admitted that he was afraid that he'd find her dead. Her pastor spoke up and said that he didn't want to give the sermon at her funeral.
But the smallest voice was the one she heard most clearly. Through tears, her then 11-year-old daughter begged her mother to get better. "Please, Mommy, go get help," she said. "I don't care if you miss my first day of middle school. Just go."'
The New Drug Epidemic
Julie Hartman is one of a rapidly growing group of drug abusers in America. More than 18 million women ages 26 and older reported using prescription medications for unintended uses in 2008, the most recent year for which statistics are available. This is almost a million more than in 2007. The drugs include sedatives like Xanax, stimulants like Ritalin, and opioid painkillers like Vicodin and OxyContin -- opioids being the biggest problem, according to Stephen Ross, M.D., clinical director of the Langone Medical Center's Center of Excellence on Addiction, at New York University.
The number of people who were admitted to treatment centers for narcotic-painkiller addiction increased a staggering 400 percent from 1998 to 2008, found a 2010 government study conducted by the Substance Abuse and Mental Health Services Administration, an agency in the U.S. Department of Health and Human Services. The number of fatal overdoses involving these drugs more than tripled during a similar time period. No group is immune: The increase includes women and men of every race, education level, and geographic region, employed or unemployed.
The trend is striking because while abuse of prescription drugs is exploding, addiction to alcohol and other drugs is actually dropping. In the last decade, admissions to treatment centers decreased by 16 percent for cocaine addiction and 5 percent for alcoholism.
Why the spike in Rx-drug abuse now? Availability, for one thing. There are more opiate painkillers in circulation in this country than anywhere else in the world, says Dr. Ross, in large part because doctors started prescribing them more frequently once OxyContin began being marketed for pain in the late 1990s. "And anytime you have a greater supply of an addictive drug, you will see more addictions."
There's also a big demand for drugs. "Patients go to the doctor in pain and expect to walk out with a prescription," says Marvin D. Seppala, M.D., chief medical officer at Hazelden, the addiction-rehab facility where Julie Hartman was treated. It's less time-consuming for the doctor to write it and send the person on her way. "She's happy, she gets immediate relief, and no one looks at the long-term effects," he says. "It is that easy, unfortunately."
This giant supply and heavy demand also makes it simple for moms to share their meds. Nearly 29 percent of women reported borrowing or sharing prescription drugs, according to a survey conducted by the Centers for Disease Control and Prevention and Oak Ridge Institute for Science and Education, in Oak Ridge, Tennessee.
One of them is Claire (not her real name), a 34-year-old mother from a Las Vegas suburb. After getting into a car accident six years ago, she started out taking Vicodin for pain -- and eventually added another painkiller, a muscle relaxant, and an anti-anxiety drug. All she had to do to score drugs was show up at the sporting events of her kids. "Other moms were taking them," says Claire, a former PTA president. If she said, "I need a Vicodin," another mother would readily offer one -- as if it were an aspirin. "It was as nonchalant as that."
The Illusion of Legitimacy
But perhaps the biggest contributor to Rx-drug addiction is ignorance: People assume that the medicines aren't harmful. They see drugs such as heroin as "bad" and drugs like Vicodin as "okay" because they were given a stamp of approval by the FDA, prescribed by a doctor, and purchased at a pharmacy.
"That's a frightening and misguided assumption," says Wilson Compton, M.D., director of epidemiology, services, and prevention research at the National Institute on Drug Abuse. The active ingredients in heroin and opioid painkillers like Vicodin and OxyContin are essentially the same. They work very quickly on the brain, releasing the pleasure-boosting chemical dopamine. If you keep taking them, your tolerance could increase, you'll need more to achieve the same effect -- and if you stop them suddenly you may experience harsh withdrawal symptoms, including sweating, nausea, and violent shaking, for up to a week. You are hooked, sometimes in only a few months.
Anyone can become addicted because the drugs are so powerful, says Johanna O'Flaherty, Ph.D., vice president of treatment services at the Betty Ford Center, in Rancho Mirage, California. But four risk factors appear to increase your vulnerability: a history of mental-health problems, such as depression or bipolar disorder; prior drug or alcohol abuse; a family history of alcoholism or drug abuse; or past trauma, such as child abuse or rape.
The stress of motherhood can make some women especially vulnerable. "They are exhausted, they are worried, and they can't sleep," says Dr. Ross. "Any time you are in a heightened state of stress, you're more at risk." After Michaelanne (who wanted her last name withheld) gave birth to her daughter in 2006, she wasn't just stressed -- she was seriously depressed. "I didn't even want to hold her," says the mom from Austin. "I became very anxious about dropping her." She was having trouble breastfeeding and blamed herself for not being able to provide nourishment for her daughter.
Her doctor diagnosed her with postpartum depression and prescribed an antidepressant and the anti-anxiety drug Xanax -- and almost immediately Michaelanne felt better. "Everything smoothed out and I was able to take care of my daughter." Life was going as well as it could, she believed: "I was so happy about the baby, and my fund-raising consulting business was booming." Her husband, a nuclear physicist, had just landed a great new job, and they lived in a beautiful home.
The only problem: She couldn't get through the day without three or four -- then five or six, and eventually as many as ten -- Xanax. (She'd been instructed to take one pill per day.) Her 90-day prescription didn't last anywhere near 90 days, so she started buying pills from online pharmacies, which don't require a prescription. She found herself paying $500 for a FedEx delivery of drugs that would've cost $25 from her local doctor. She kept this up, trying out more and more pharmacies, until one day she received a letter in the mail from the Drug Enforcement Administration (DEA), threatening to investigate her if she didn't stop.
"That was the biggest wake-up call I could've gotten," Michaelanne says. She went cold turkey and didn't hear back from the DEA. But she finally revealed to her husband that she was addicted. "I told him I was detoxing off Xanax and that's why I was sweaty and shaking and vomiting," she says. "He was shocked at the amount of drugs I'd been taking and shocked that I hadn't told him." He insisted that she never go near the drugs again, but he also stayed by her side during an excruciating week of withdrawal at home -- not a strategy recommended by experts, who advise doing it only under medical supervision. But Michaelanne got through it and has been in recovery for three years.
In Danger and Denial
An addiction can turn out far worse, of course. At the height of her drug use, Claire was ingesting a cocktail of 20 Percocet (a painkiller), two or three OxyContin, 15 to 20 Soma (a muscle relaxant), and ten Xanax four times a day. This was all while driving her kids, then ages 9, 6, and 1, around. "When I could tell I was high, I didn't drive them," she explains, "but most of the time I felt normal." Unable to get enough medication between visits to her doctor, she'd "find whoever I could think of who knew somebody who knew somebody who had extra," Claire says. She'd even give rides to an older woman who lived on her street in exchange for pain meds.
One day her body rebelled and Claire overdosed at home. Her husband found her and called an ambulance. When she woke up in the hospital -- with no memory of what she'd taken or how long she'd been unconscious -- doctors told her she'd swallowed enough drugs to kill three people. "I was taking ten to 20 times the recommended dosage of all the meds I was on," she says.
Some women pay the ultimate sacrifice for their addiction. Tina Kasper, a 41-year-old mother who lived in the Houston suburbs, went out to dinner with her husband in 2010; the next morning he found her dead in their bed. The cause of death: nine different prescription drugs for long-term medical problems, including an anti-anxiety drug, an antidepressant, and a muscle relaxant, prescribed by two doctors. Her husband knew she took pills but didn't think she was addicted.
This kind of denial -- among both addicts and their loved ones -- is common. So is guilt. "The shame is worse for mothers than for other people," says Dr. O'Flaherty, because they're supposed to be in control and selfless. Claire felt this way: "I thought, 'How can I be the mom I always pictured myself to be, yet at the same time be a drug addict?'"
There's no denying the effect a mother's addiction has on her kids. "They are neglected, if not physically then emotionally, because their mother is not capable of being present and fully aware," says Dr. O'Flaherty. "Even if they can't verbalize what they're feeling, the children know on a subconscious level that something is not quite right."
As Claire's addiction worsened, she went from being what she calls "a Betty Crocker homemaker" to someone who got high all day. "I was out of it most of the time. I would nod off like a heroin junkie," she says. Claire's husband knew she was taking the drugs, but he didn't know she was going through them so quickly and getting them from other people. Her older son was sure there was something wrong with her too, but he didn't have the words for what it was. "I'd considered myself a really good mom, but I look back and I am horrified," Claire admits. "I did what I had to do to take care of the kids, and not a whole lot more."
And at the same time, a mother's devotion to her children can provide the strength she needs to recover. "I had a moment of clarity in that hospital bed after my overdose," Claire says. "I realized that if I didn't stop using drugs, no judge was going to let my kids stay with me." She agreed to enter rehab. "I wanted them to forgive me, and I wanted to be the mom I used to be again." She hasn't taken drugs for two years.
In recognition of the toll that addiction takes on families, most treatment centers have programs for spouses and children. The Betty Ford Center, in Rancho Mirage, California, for example, sponsors group discussions for kids ages 7 to 12 regardless of whether their parents are patients at the Center. "The children learn that they didn't cause this to happen to their parent; they are not responsible," says Dr. O'Flaherty. "This is about the whole family healing."
Lives Turned Around
Claire is one of the lucky ones. She and her husband divorced but remain friends -- he lives down the street and they share custody of their kids. She's gone from being an addict to being hypervigilant about drugs. When she was in another car accident she refused prescription pain medication, getting by with ibuprofen instead.
Julie Hartman is lucky too. She missed her kids' soccer and football seasons while she was getting clean. But after four months in rehab, followed by four months of outpatient treatment (paid for by insurance and donations from members of her church), she's been drug-free for more than a year. "I have an overwhelming sense of gratitude that I got through it," she says. "I'm at peace now."
Which doesn't mean her daily life is easy. "My obsession with the drugs has tapered off, but resisting them is still a challenge," she says. That's why she attends Narcotics Anonymous meetings, takes an antidepressant, and sees a therapist. She knows that her struggle will continue.
But she has four powerful motivating factors by her side every day: her three children and her husband, all of whom suffered terribly during her addiction and recovery. "The kids cried every time they left me when I was in treatment," Hartman says. "To see them hurting broke my heart and made me want to get better -- and stay better once I came home." While taking Vicodin, Hartman was moody and her kids were afraid of her. But now that's changed. "I'm so proud of you, Mom," her son recently wrote to her in a note, "and I don't have to worry about you anymore."
How to Get Help
Prescription-drug addiction can strike any parent -- mothers and fathers, says Dr. Stephen Ross, an addiction specialist at New York University. Signs that someone is abusing drugs include moodiness, withdrawal from the family and social interactions, excessive sleeping, forgetfulness, and neglecting responsibilities.
If you or someone you care about has a problem, take action. Should a loved one refuse to acknowledge the addiction, experts recommend an intervention with a trained leader who will help encourage her to enter treatment, which could include in-patient rehab and medically supervised drug withdrawal. These organizations can offer help:
NARCOTICS ANONYMOUS Click on "Information About NA," then "Is NA for Me?" to find a quiz that will help you determine whether you're an addict.
SUBSTANCE ABUSE & MENTAL HEALTH SERVICES ADMINISTRATION Access an interactive map to help you find a drug- and alcohol-abuse treatment program near you.
INTERVENTION CENTER Click on "Family Intervention" on the home page to find out exactly how you would do this for your loved one.
AMERICAN SOCIETY OF ADDICTION MEDICINE If you've been through recovery and then experience an injury or a medical problem that requires pain relief, it's important to look here to find a doctor who is trained in addiction and can oversee your medication.
You can also contact an addiction-treatment center anywhere in the country, even if you or your loved one are not planning to be admitted there. Most will provide resources on understanding addiction, offer guidance on getting help, and refer you to an intervention specialist.
Originally published in the November 2011 issue of Parents magazine.
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