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Suggest Treatment For Addiction To Codeine Cough Syrup
Question: I am asking for my friend. He is codeine cough syrup addict. He takes every day around 1-2 bottles,4-5 on weekends. What exactly he uses and how much I don't know clearly. He is working in government job. My query is how can he seek treatment or psychological counselling, convincing etc to get rid of his habits without taking a long break or quitting his job. He is willing to try help but he says he won't compromise govt. job or risk creating medical records on his name for his job security.
He says that there is some psychological compulsion that he keeps going back to his habits. He says that short stress,problems of life which he always can't find the right people with whom venting out would help or every time he has a problem, he can't share everytime with such a helpful other person.....makes him take codeine as it destresses,calms his heartbeat and stops his thinking. He says he feels he won't be able to ever give up his habits. He has been to rehab 2 years ago once for around 3-4 months but he presently is back to his habits and says he is only on codeine syrups but I am not sure what all he uses. He is a chain smoker too. This addiction is going since past 9 years.
KINDLY GUIDE on what kind of treatment options are available(outpatient/inpatient/phsychological counselling etc.).....because he always says he can't seek treatment by taking leave from job. He fears going to doctor/seeking treatment also openly as it might cost him his government job. I am concerned about my friend. Kindly advise how to execute 'getting him help/treatment'. He says he only uses codeine now and cigarettes. Before rehab he did use marijuana,heroine,opiates etc. He says having cash with him makes it easier for him to buy codeine syrups from stores using prescriptions. How can we cut him from accessing money as he earns himself already. He says that he doesn't get the right kind of person to share his thoughts and who would understand him properly.He is very sensitive and a perfectionist. He says he has failed so many times on quitting his habits that he feels he will never be able to get rid if these habits ever. Please help. I don't know how to start getting him help as he always gives his job excuse but he has expressed he wants to get rid of these habits.
He also takes cigarettes once every 2-3 hours as he says cigarettes make him work faster, give him energy, make him feel more alert.
He says that there is some psychological compulsion that he keeps going back to his habits. He says that short stress,problems of life which he always can't find the right people with whom venting out would help or every time he has a problem, he can't share everytime with such a helpful other person.....makes him take codeine as it destresses,calms his heartbeat and stops his thinking. He says he feels he won't be able to ever give up his habits. He has been to rehab 2 years ago once for around 3-4 months but he presently is back to his habits and says he is only on codeine syrups but I am not sure what all he uses. He is a chain smoker too. This addiction is going since past 9 years.
KINDLY GUIDE on what kind of treatment options are available(outpatient/inpatient/phsychological counselling etc.).....because he always says he can't seek treatment by taking leave from job. He fears going to doctor/seeking treatment also openly as it might cost him his government job. I am concerned about my friend. Kindly advise how to execute 'getting him help/treatment'. He says he only uses codeine now and cigarettes. Before rehab he did use marijuana,heroine,opiates etc. He says having cash with him makes it easier for him to buy codeine syrups from stores using prescriptions. How can we cut him from accessing money as he earns himself already. He says that he doesn't get the right kind of person to share his thoughts and who would understand him properly.He is very sensitive and a perfectionist. He says he has failed so many times on quitting his habits that he feels he will never be able to get rid if these habits ever. Please help. I don't know how to start getting him help as he always gives his job excuse but he has expressed he wants to get rid of these habits.
He also takes cigarettes once every 2-3 hours as he says cigarettes make him work faster, give him energy, make him feel more alert.
Brief Answer:
No risk to his job. No need for long term admission.
Detailed Answer:
Hi XXXX,
Welcome to Healthcare Magic!
You have explained your friend's problem very well. Addiction to codeine containing cough syrups (CCCS) is very common in young people. Since codeine is similar to opiates and heroin, many people who are trying to quit heroin/opiates start using these cough syrups.
Quitting CCCS is comparatively easier than quitting heroin as the withdrawal symptoms are milder. Your friend need not fear any risk to his job from taking treatment for the addiction. It can be done on an out-patient basis and your friend would just need to take time out to see his doctor every two to three days. If he wishes to get in-patient treatment, he would need to be away from his job for not more than a week. I guess he will not have much difficulty in getting a week's leave.
Whether he goes for out-patient or in-patient treatment, the basic principles are same. The initial phase is of detoxification in which the withdrawal symptoms are managed with the help of medicines. This lasts for 7 to 10 days. After this, maintenance phase starts. The goal of this phase of treatment is to ensure that the patient remains abstinent. This phase involves both medicines and psychological treatment. Medicines are given to reduce craving for drugs. This helps the patient fight the urges that make him seek drugs. The psychological treatment is called "relapse prevention counseling". In this, the doctor discusses with the patient the situations which make him vulnerable to drugs. For example, stress, frustration, anger, pressure from friends to take drugs etc are the common situations in which patients lose control and go back to drugs. Once a patient learns to identify these cues, he becomes more cautious. Family members are also taught about these situations so that they can keep an eye on the patient and provide support. The patient is taught to deal with these situations in healthier ways without resorting to drugs. It will XXXXXXX you to know that around 90% patients return to using drugs within a year of quitting. Relapse prevention counseling also deals with what should be done when the patient makes a mistake and starts using drugs again. He is asked not to lose hope and try again. His family is also advised not to be critical of his weakness but to help him try to control his urges.
Even with the best of treatment, relapse rates are high. The fight against addiction is in a way a lifelong battle. Please tell your friend that all is not over for him. He can quit again. It is possible that even after that, he might resort to drugs again in a moment of weakness. So what if he makes one mistake? He should not let that dishearten him but make sure that it does not become a habit again.
There is absolutely no risk to his job. He can give whatever name he likes. Nobody will ask for any proof. He need not mention that he is in a government job. All the information that he gives to his doctor is confidential.
You mention that he was in a rehab center. Most rehab centers in our country are nothing better than jails. They do not have doctors attached to them. Many of my patients who have been admitted in rehab centers say that they were beaten up there. Some even say that they were asked to take tobacco when they complained of withdrawal symptoms. Ultimately they came out of rehab with another addiction.
Your friend is using both CCCS and cigarettes. I would suggest that he should not try quitting both simultaneously. He should first quit CCCS and after a few months try quitting smoking. This is likely to be more successful than trying to quit both at a time.
I hope this helps your friend. He needs to be strong and believe in himself. Quitting will not be easy but also will not be impossible. He has done it earlier and can do it again. Please let me know if you need any clarification.
Best wishes.
Dr Preeti Parakh
MD Psychiatry
No risk to his job. No need for long term admission.
Detailed Answer:
Hi XXXX,
Welcome to Healthcare Magic!
You have explained your friend's problem very well. Addiction to codeine containing cough syrups (CCCS) is very common in young people. Since codeine is similar to opiates and heroin, many people who are trying to quit heroin/opiates start using these cough syrups.
Quitting CCCS is comparatively easier than quitting heroin as the withdrawal symptoms are milder. Your friend need not fear any risk to his job from taking treatment for the addiction. It can be done on an out-patient basis and your friend would just need to take time out to see his doctor every two to three days. If he wishes to get in-patient treatment, he would need to be away from his job for not more than a week. I guess he will not have much difficulty in getting a week's leave.
Whether he goes for out-patient or in-patient treatment, the basic principles are same. The initial phase is of detoxification in which the withdrawal symptoms are managed with the help of medicines. This lasts for 7 to 10 days. After this, maintenance phase starts. The goal of this phase of treatment is to ensure that the patient remains abstinent. This phase involves both medicines and psychological treatment. Medicines are given to reduce craving for drugs. This helps the patient fight the urges that make him seek drugs. The psychological treatment is called "relapse prevention counseling". In this, the doctor discusses with the patient the situations which make him vulnerable to drugs. For example, stress, frustration, anger, pressure from friends to take drugs etc are the common situations in which patients lose control and go back to drugs. Once a patient learns to identify these cues, he becomes more cautious. Family members are also taught about these situations so that they can keep an eye on the patient and provide support. The patient is taught to deal with these situations in healthier ways without resorting to drugs. It will XXXXXXX you to know that around 90% patients return to using drugs within a year of quitting. Relapse prevention counseling also deals with what should be done when the patient makes a mistake and starts using drugs again. He is asked not to lose hope and try again. His family is also advised not to be critical of his weakness but to help him try to control his urges.
Even with the best of treatment, relapse rates are high. The fight against addiction is in a way a lifelong battle. Please tell your friend that all is not over for him. He can quit again. It is possible that even after that, he might resort to drugs again in a moment of weakness. So what if he makes one mistake? He should not let that dishearten him but make sure that it does not become a habit again.
There is absolutely no risk to his job. He can give whatever name he likes. Nobody will ask for any proof. He need not mention that he is in a government job. All the information that he gives to his doctor is confidential.
You mention that he was in a rehab center. Most rehab centers in our country are nothing better than jails. They do not have doctors attached to them. Many of my patients who have been admitted in rehab centers say that they were beaten up there. Some even say that they were asked to take tobacco when they complained of withdrawal symptoms. Ultimately they came out of rehab with another addiction.
Your friend is using both CCCS and cigarettes. I would suggest that he should not try quitting both simultaneously. He should first quit CCCS and after a few months try quitting smoking. This is likely to be more successful than trying to quit both at a time.
I hope this helps your friend. He needs to be strong and believe in himself. Quitting will not be easy but also will not be impossible. He has done it earlier and can do it again. Please let me know if you need any clarification.
Best wishes.
Dr Preeti Parakh
MD Psychiatry
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you for answering the basic problem of how to go for treatment while he is working.
I forgot to mention few important things.
He either suffers from bipolar disorder or borderline personality as detected by doctors in his rehab. The exact detail i can't provide right now as his file is with him presently in the city where he works. He manages his job well, sometimes misses office when he overdoses the previous night on codeine and gets seizure. Otherwise he doesn't take break inbetween his office hours.
Before his rehab stay ....when he was addicted already since past 2006-2010 he had 2/3 seizures. After rehab treatment and since 2013 he has been getting seizures more frequently till even now( One/two seizures every 3 months) which he says could be due to his overdosing on codeine intake for the night. He says codeine helps him to stop thinking and fall asleep as he gets stressed when things are not happening in the right way in moral terms etc (citing problems of corruption in office etc etc). I just wanted to know how severe his condition could be due to this past 9 years of addiction and what could be the impact on his lifespan or other major risks that he could get expose dto in future?
Another question is can he get married in near future as he undergoes this treatment alongside. The usual opinion is drug abusers should be avoided as partners or unless they are completely clean. He has been living alone since his job and loneliness might be more dangerous for him when it comes to his habits.
I forgot to mention few important things.
He either suffers from bipolar disorder or borderline personality as detected by doctors in his rehab. The exact detail i can't provide right now as his file is with him presently in the city where he works. He manages his job well, sometimes misses office when he overdoses the previous night on codeine and gets seizure. Otherwise he doesn't take break inbetween his office hours.
Before his rehab stay ....when he was addicted already since past 2006-2010 he had 2/3 seizures. After rehab treatment and since 2013 he has been getting seizures more frequently till even now( One/two seizures every 3 months) which he says could be due to his overdosing on codeine intake for the night. He says codeine helps him to stop thinking and fall asleep as he gets stressed when things are not happening in the right way in moral terms etc (citing problems of corruption in office etc etc). I just wanted to know how severe his condition could be due to this past 9 years of addiction and what could be the impact on his lifespan or other major risks that he could get expose dto in future?
Another question is can he get married in near future as he undergoes this treatment alongside. The usual opinion is drug abusers should be avoided as partners or unless they are completely clean. He has been living alone since his job and loneliness might be more dangerous for him when it comes to his habits.
Brief Answer:
Good prognosis but only if he remains abstinent
Detailed Answer:
Hi XXXX,
Regarding the diagnosis of bipolar disorder or borderline personality disorder, whatever it is, should be treated. This will help him in remaining off drugs as well because mental illness makes one vulnerable to drug abuse. Both can be treated with medicines.
Seizures are common in opioid intoxication. The probable reason why frequency of seizures increased after rehab is that he perhaps changed the opioids he was abusing. Heroin and opium are less commonly associated with seizures than CCCS and dextropropoxyphene capsules (Spasmo-proxyvon). These will subside once he quits.
The reasons for overdosing that he has mentioned are very similar to the cues that I explained in my previous answer. He finds it difficult to cope with stress at workplace and so, tries to find solace in drugs. The basic problem does not lie in the workplace but in his maladaptive coping. This will create problems for him all his life unless he takes steps to identify his weaknesses and overcome them. For example, he has to accept that he is not the only honest person working in a government job whether corruption is rampant. Does everybody else need drugs to cope with this? If not, then why should he? Can drugs change his workplace for the better? He also needs to take a candid look at whether he takes drugs to get over stress in his job or whether he is using the issues at the office as an excuse for justifying his habit. These are uncomfortable questions and would require a lot of soul-searching. Since most people are not strong enough for this, they continue with their poor coping and so, are unable to remain abstinent for long.
As far as physical health is concerned, he is still young and his body can get back to normal with time if he quits drugs. But he should know that seizures are harmful and he may even get seriously injured during a seizure. Drug abuse is also associated with other high risk behavior like rash driving, getting into brawls, sexual promiscuity etc. This is a major cause of morbidity and mortality in drug users.
There is no reason why he should not get married. You are right in saying that being lonely is not good for him. However, if a prospective partner were to ask me my opinion on her decision to marry a person who is on drugs, I would like to tell her three things:
1) I hope you are aware that there is a very high chance that your husband will continue to use drugs even after marriage. In spite of all the promises he makes before marriage. In spite of all the support and love you can give him.
2) After marriage, every little argument with you can be used as an excuse to take drugs, putting the entire blame on you, making you feel guilty to the extent that you become scared of saying anything that he may not agree with.
3) People usually do not change. Most women dream of reforming a man who is going on the wrong path and then living happily ever after. But this usually does not happen in reality.
Best wishes.
Dr Preeti Parakh
MD Psychiatry
Good prognosis but only if he remains abstinent
Detailed Answer:
Hi XXXX,
Regarding the diagnosis of bipolar disorder or borderline personality disorder, whatever it is, should be treated. This will help him in remaining off drugs as well because mental illness makes one vulnerable to drug abuse. Both can be treated with medicines.
Seizures are common in opioid intoxication. The probable reason why frequency of seizures increased after rehab is that he perhaps changed the opioids he was abusing. Heroin and opium are less commonly associated with seizures than CCCS and dextropropoxyphene capsules (Spasmo-proxyvon). These will subside once he quits.
The reasons for overdosing that he has mentioned are very similar to the cues that I explained in my previous answer. He finds it difficult to cope with stress at workplace and so, tries to find solace in drugs. The basic problem does not lie in the workplace but in his maladaptive coping. This will create problems for him all his life unless he takes steps to identify his weaknesses and overcome them. For example, he has to accept that he is not the only honest person working in a government job whether corruption is rampant. Does everybody else need drugs to cope with this? If not, then why should he? Can drugs change his workplace for the better? He also needs to take a candid look at whether he takes drugs to get over stress in his job or whether he is using the issues at the office as an excuse for justifying his habit. These are uncomfortable questions and would require a lot of soul-searching. Since most people are not strong enough for this, they continue with their poor coping and so, are unable to remain abstinent for long.
As far as physical health is concerned, he is still young and his body can get back to normal with time if he quits drugs. But he should know that seizures are harmful and he may even get seriously injured during a seizure. Drug abuse is also associated with other high risk behavior like rash driving, getting into brawls, sexual promiscuity etc. This is a major cause of morbidity and mortality in drug users.
There is no reason why he should not get married. You are right in saying that being lonely is not good for him. However, if a prospective partner were to ask me my opinion on her decision to marry a person who is on drugs, I would like to tell her three things:
1) I hope you are aware that there is a very high chance that your husband will continue to use drugs even after marriage. In spite of all the promises he makes before marriage. In spite of all the support and love you can give him.
2) After marriage, every little argument with you can be used as an excuse to take drugs, putting the entire blame on you, making you feel guilty to the extent that you become scared of saying anything that he may not agree with.
3) People usually do not change. Most women dream of reforming a man who is going on the wrong path and then living happily ever after. But this usually does not happen in reality.
Best wishes.
Dr Preeti Parakh
MD Psychiatry
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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