Pill seeking behaviour in treatment from a medical perspective

For many of our clients, an un-chemicalised reality, is pure agony. Many of them have been variably intoxicated for most of their adult life or for extended periods at a time. The absence of a chemical filter in their life is an unfamiliar sensation, a foreign environment, similar to a fish out of water.

The process of admission to a treatment facility, irrespective of the motivation or urgency behind that admission, does not instantly ameliorate the situation. For addicts in treatment, their first epic achievement is simply achieving a sober state. We tend to forget that many have attempted sobriety and failed repeatedly, as the obsession for intoxication overwhelms the desire for sobriety. This often leaves them with the mistaken belief that they cannot survive or function without drugs.

In the early stages of the treatment process, post-admission, as clients try to resolve their conflicting motivations and recurring doubts about the journey ahead, pill seeking behaviour often manifests, driven by a number of contributing factors:
  • As a manifestation of the unfamiliarity of sobriety, as a physically experienced phenomenon
  • As an projection of an internal ambivalence about the treatment process and the prospects
  • As a genuine need for medication for a variety of symptoms and ailments.

Good addiction nursing should manage the first element. Skilled addictions counselling addresses the second factor.  The third option is a medical responsibility. It can be difficult to discern the true nature of these symptoms and ailments, although all explanations are treatment-relevant in their own way. Firstly they may be psychosomatic in origin, in that it is easier for the client to talk about the pain of a physical injury rather than the pain and burden of an emotional dis-ease. The somatic is often the entrance to the psyche. Secondly, the ailment might be deliberate malingering in which case the symptoms are fabricated but this also reflects an unspoken discontent often about a treatment issue. And thirdly, the ailment might be a genuine medical problem that requires some form of medication.

Even genuine problems are notoriously difficult to evaluate, especially in a treatment setting as pain, discomfort and suffering are very individually mediated experiences. Some people with a common cold ignore it; others put themselves to bed; while a third groups just want acknowledgement and sympathy for their discomfort. This makes the evaluation and adjudication of pill seeking behaviour a complicated and sensitive task requiring a consideration of subjective, objective and environmental variables. Irrespective of the underlying motivation behind pill seeking behaviour, above all the patient wants to be heard and, whatever they are trying to say, it deserves an appropriate response.

The danger is to lump pill seeking behaviour as treatment resistance and frown upon it. Rather, pill seeking behaviour should be seen as an obtuse engagement with the treatment process where the patient subconsciously chooses the pharmaco-medical arena to resolve their ambivalence. Pill seeking behaviours should be embraced by therapists as an unrestrained entrance into a therapeutic conversation with our clients regarding their relationship with mood altering chemicals.

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