COULD YOU BE AN ADDICT? (LA TIMES)

http://www.latimes.com/news/local/la-me-banks11-2009jul11,0,6020182,full.column

Could you be an addict?



Mark Boster / Los Angeles Times We know Michael Jackson was dependent on sedatives and painkillers, but our reliance also needs examining.

It's not just the Michael Jacksons and Anna Nicole Smiths who pop pills. Society's reliance on painkillers and sleeping aids has us walking a fine line.

Sandy Banks July 11, 2009

Subpoenas have gone out, the DEA has been brought in, and every doctor who has ever come within a prescription pad of Michael Jackson can probably expect a phone call soon.

But even absent the results of the inquiries and toxicological reports, it seems obvious that prescription drugs played a role in the pop star's sudden death.

In fact, what we already know about Jackson's reliance on sedatives and painkillers is enough to prompt the kind of public discussion we have sidestepped too many times before -- when Anna Nicole Smith died from "combined drug intoxication" two years ago after mixing sleeping pills and sedatives; or when Heath Ledger was found dead last year with six different legal medications for pain, anxiety and insomnia in his blood.

Instead of simply dismissing them as celebrity drug addicts or pitiable tragedies, it's time we take a look at our own lives -- and the contents of our medicine cabinets.

It's no secret that the use of pharmaceutical drugs is on the rise. Prescriptions for painkillers climbed from 40 million to 180 million in the last 15 years. More than 56 million prescriptions were written for sleeping medications in 2008, up 54% since 2004. And 7 million Americans admit to "non-medical" use of drugs prescribed for pain or mental disorders.

Even the nation's new drug czar Gil Kerlikowske has called Jackson's death "a wake-up call." More Americans die from overdoses of legal drugs each year than from gunshot wounds, he told CNN on Thursday.

It's a complicated problem. There is no bright line separating use from misuse. And a constellation of circumstances is nudging us toward chemical solutions to the struggles of everyday living.

An ever-expanding list of mental illnesses means almost anyone can be diagnosed with a treatable malady. Pharmaceutical ads -- with butterflies flitting through bedroom windows and happy, prosperous families -- promise pills that can make you happier or more social; help you stop hurting and get to sleep. And doctors have been pressed by patients, plied by drug reps and squeezed by insurance companies until a 10-minute visit gets you a refillable prescription.

Yet pharmaceutical advances have allowed schizophrenics to hold down jobs, insomniacs to get a good night's sleep, and people with depression to go about their lives.

Substance abuse recovery programs have long relied on a simple nostrum: You're an addict if "your life has become unmanageable due to drugs or alcohol."

But what if your life is only manageable because you're taking drugs? How do you recognize addiction then?

I took my questions to Vickie Mays, a nurse and professor of psychology at UCLA.

"We think about addiction as 'Your life is out of control,' " Mays said. "But it's the medication that gives you a sense of control when you've got so many balls in the air . . . with so many demands from the job, the kids."

Sounds a lot like the lives that us non-rock stars live.

"It's the demands on us that are out of control," Mays said. "You yearn for just a little bit of peacefulness, a way to try to shut things off. . . . It's the normal, average, very busy, high-achieving person" who is most vulnerable to reliance on prescription drugs.

We're not trying to get high, just trying to get some sleep, blunt the pain from that old sports injury, keep from screaming at the kids.

But pill-popping can move almost imperceptibly, she said, from habit to ritual to need.

"When there's no other way in your mind to relieve the pain, and you start taking it more frequently and in higher doses. . . . When it's become too automatic. You can't sleep and you don't wait; you just reach over for the bottle on your bedside table.

"It's a slippery slope," she said. But that's when you ought to ask, "Am I becoming an addict?"


Her answer gave me pause this week, when I tossed and turned through a sleepless night.

I rolled over and reached for the bottle of pills my doctor prescribed last year, when chest pains that sent me to UCLA's emergency room turned out to be anxiety, not a heart attack.

Is this, I wondered, how Michael Jackson's problems with drugs began?

A pain pill when your hair catches fire and you end up mainlining Demerol? A tranquilizer when you're stressed out by the paparazzi and soon you're throwing back 10 Xanax pills at a time?

OK . . . so those were middle-of-the-night thoughts. But I can't blame Jackson for wanting a break from the cacophony in his head; relief for a 50-year-old body, called on to perform for hours every day onstage.

His manner of death was a tragedy with implications for all of us.

Have I started down the slippery slope if I have refilled that year-old prescription twice? If I can tell you exactly how many of those pills I have left?

Or was I wise not to take the sedative that night, even though I stumbled through work the next day? Instead I watched the sun come up, with "Man in the Mirror" playing in my head.

sandy.banks@latimes.com