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Why not everyone ends up addicted to pain medication – set and setting

Posted Apr 13 2013 5:00am

How psychological factors can affect the addictive potential of drugs

English: Source: The National Institute on Dru...

 Source: The National Institute on Drug Abuse, part of the National Institutes of Health (NIH), which is part of the U.S. Department of Health and Human Services. 

Some people with chronic pain are able to take pain meds for a long period of time with apparently no addiction problem while other people can become addicted to a pain med after using a single prescription. A major factor in this outcome is a thing drug counselors know as set and setting.

The way you perceive the use of a medication or drug may have more of an effect on the results than the actual chemistry of the medication. Both “set” and “setting” influence these effects

Set refers to “mind set” not the taking of drugs on a Hollywood move set. The drug will produce larger effects in the direction you expect than the opposite direction. This is similar to the things we have talked about as placebo and nocebo effects.

Someone who is in a bad mood, who drinks when angry, is likely to become more angry and violent when drinking. Another person at the same party, thinking that this is a happy occasion will likely become more outgoing and uninhibited. Both people are taking the same drug, in this case alcohol, but the results conform to the expectations or mind-set of the user.

The place matters – setting

A single glass of wine will affect some differently if consumed at a religious ceremony than if consumed in a bar late at night. Drinking some wine as part of a ceremony may be relaxing or spiritual, that same glass of wine consumed at a party may result in the person consuming the wine becoming more sexual rather than more spiritual.

What does all this have to do with abuse of prescription pain medications?

People who take prescribed medication, say morphine or an opioid, in the hospital when it is prescribed for pain are at low risk to develop an addiction. That same person who has taken large amounts of morphine in the hospital with no apparent ill effects is at high risk to develop an addiction if they purchase a single prescription from a dealer in the alley. The difference is in the setting in which the drugs are consumed and the purpose for which they are used.

Unfortunately many of us can’t tell the difference between physical pain and emotional pain. Taking drugs for emotional pain, especially pain medications, is a high risk behavior. Those illicit meds can quickly become an addiction.

Recently we have seen a huge increase in teens and young adults who are abusing prescription meds, often stolen from older family members. While grandma may take a morphine pill every day for pain and not develop the signs and symptoms of a psychological addiction the grandson who steals those meds and uses them to get high can quickly become addicted both psychologically and physically. (See the post on Grandma as a drug pusher .)

What you are thinking about and where you are when you take drugs or medications can and does affect the results you get and the potential for addiction.

The recognition of set and setting points us to a better understanding that the psychological factors in drug addiction are far more powerful than the physical effects in a great many cases.

If you come to believe that you “need” your drug of choice to function well, that you can’t do things without your drug to get you through, even if that drug has a low abuse potential you are at risk to develop a psychological addiction to that drug.

Consider your own drug use and how set and setting may be affecting the results of that drug use. 

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page . For information about my other writing work beyond this blog there is also a Facebook authors page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com


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