Arthritis and Addiction

Arthritis is an umbrella term that refers to as number of conditions that result in joint pain. 

These conditions may be diseases or other related conditions. Arthritis is one of the leading causes of physical disability in the United States. According to the Centers for Disease Control, over 50 million adults and nearly 300,000 children have some type of arthritic condition.

Types of Arthritis

relationship between arthritis and substance use disorders

According to the Arthritis Foundation, one of the largest organizations that provides information and research regarding arthritis, there are more than 100 different types of arthritis. Some of the major types of arthritis include:

  • Degenerative arthritis: Osteoarthritis is a condition that occurs as a result of the deterioration of cartilage on the ends of the bones, and it is the most common form of arthritis. It is generally degenerative and gets worse over time. The risk factors for the development of osteoarthritis include having a family history of arthritis, the individual’s age (with older individuals being a greater risk), a history of joint injuries, and obesity.
  • Inflammatory arthritis: This condition occurs when the immune system begins to attack the joints and other tissues in the body, causing joint erosion and other effects such as internal organ damage. Common types of inflammatory arthritis include rheumatoid arthritis and psoriatic arthritis. Susceptible individuals are those who have a family history of rheumatoid arthritis and those who smoke.
  • Infectious arthritisInfections can trigger inflammation in the joints. A number of different infections can result in arthritis, including sexually transmitted diseases, hepatitis C, and bacteria or viruses as a result of food poisoning. In some cases, antibiotics may relieve the infection of the joint, whereas in other cases, arthritis as a result of the infection may become long-lasting.
  • Metabolic arthritis: High levels of uric acid as a result of the normal process of metabolism can occur in some people, and these high levels of uric acid result in buildups of crystals in the joints. These crystals result in extreme pain. A common metabolic condition that is associated with arthritis is gout.

Arthritis and Substance Abuse

There are two ways to view the relationship between arthritis and substance use disorders. The first viewpoint is how individuals with chronic substance use disorders increase the probability of contracting some form of arthritis. The second viewpoint is to try to explain how individuals who already have arthritis may develop substance use disorders.

Regarding the first viewpoint, how chronic substance abuse can increase the probability of developing arthritis, it is well known that individuals who have chronic substance use disorders are at risk for a number of detrimental effects to their health, including issues that could increase the probability of developing different forms of arthritis. These issues include:

  • Osteoporosis: Chronic abuse of drugs is often accompanied by malnutrition in individuals who abuse stimulants, narcotic medications, and even alcohol. This can result in decreased bone density (osteopenia), which is a precursor to the development of osteoporosis.
  • Osteomyelitis: Osteomyelitis is a term describing bone infections. Osteomyelitis is often a result of intravenous drug use, and these infections can result in developing a number of forms of infectious arthritis as well as in massive bone destruction.
  • Spinal effects: The integrity of the spine is seriously affected by individuals who develop poor posture. Individuals who take central nervous system depressants, such as opioid drugs, benzodiazepines, barbiturates, etc., often have poor posture. Stimulant abusers often have very tense posture that can affect the spine. Over time, chronic drug abuse can affect the spine and result in arthritic conditions.
  • Interacting effects: Any time an individual chronically abuses drugs, does not pay attention to their nutrition, is at risk for the development of infections, and continues to engage in risky behaviors that may result in injuries, the potential for the development of arthritis is significantly increased.

arthritis linked to substance use disorders in elderly patients

Thus, it is quite conceivable that individuals who chronically abuse certain types of drugs may develop arthritic conditions that result in significantly increased pain. This pain may motivate the individual to abuse more of their drug of choice or to begin abusing different drugs that have the effect of suppressing pain. The situation may result in a downward spiraling condition where the individual with a substance use disorder continues to use drugs to deal with pain, and the use of drugs along with poor personal maintenance habits results in an exacerbation of their arthritis.

The second viewpoint, regarding individuals with arthritis who develop substance use disorders, requires a bit of clarification. First, it is important to understand that individuals being treated for chronic pain as a result of an arthritic condition will be prescribed some very powerful pain-suppressing drugs, such as narcotic medications. The long-term use of any narcotic medication, whether its use is strictly for medicinal purposes or the drug is abused, may result in the development of physical dependence on the drug.

According to authoritative sources, such as the American Psychiatric Association, physical dependence consists of the both the syndromes of tolerance (or needing more of a drug to achieve effects that were once achieved at lower doses) and withdrawal (which is a syndrome of negative physical and psychological effects that occur when a person’s system has become habituated to the presence of the drug and the drug is suddenly discontinued).

Individuals who develop physical dependence while taking a medication within the boundaries of its prescribed uses, under the supervision of a physician, and for medicinal purposes are not diagnosed with substance use disorders. By definition, a substance use disorder results from the nonmedical use of drugs that leads to a number of dysfunctional situations, including issues with control and negative ramifications on the person’s life.

So individuals who have chronic arthritic conditions and use prescription medications under medical supervision for pain are not abusing the substances or developing a substance use disorder (addiction).

Reliable figures that depict prevalences of individuals who begin using medications for the treatment of arthritic pain and start abusing them are not readily available. Individuals who sometimes take more of their medication than prescribed in order to deal with pain are misusing the drug, but unless they are taking increased doses to achieve the psychoactive effects of the drug, they most likely are not abusing the drug, nor would they most likely qualify for a diagnosis of a substance use disorder. Substance use disorders are complicated psychological/psychiatric disorders that consist of a number of dysfunctional behaviors and negative ramifications. There are a number of case histories and anecdotal reports of individuals who began taking narcotic medications for the suppression of pain and developed full-blown substance use disorders; however, reliable figures as to what proportion of individuals who have chronic arthritis, use prescription medication for the treatment of arthritis, and eventually abuse the medication and develop substance use disorders are difficult to come by. The take-home message here is that it is certainly possible for an individual with some arthritic condition who is prescribed narcotic medications to begin abusing the drug and eventually develop a substance use disorder, but it is most likely not a common occurrence.

Some of the signs that this may be occurring include:

  • Doctor shopping: This occurs when an individual attempts to get multiple prescriptions from different physicians for potential drugs of abuse, such as narcotic medications. This type of behavior is not considered to be within the parameters of treatment.
  • Obtaining the medication illegally: Even if an individual has a prescription for medication, if they attempt to obtain more of the medication illegally, they may have a substance use disorder.
  • Using for the wrong reasons: Individuals who have a prescription for medication and begin taking the medication to deal with stress, for its euphoric effects, or to escape from the daily pressures of life are developing a substance use disorder. Narcotic pain medications are not prescribed for stress reduction or to “get high.”
  • Regularly using far more than prescribed or regularly using the drug more often than prescribed: A person who occasionally uses more medication than prescribed may be misusing the drug, and this individual should discuss these issues with their physician if they need a higher dose to deal with their pain. Individuals who habitually use far more medication than they are prescribed may be displaying signs of a substance use disorder.
  • Mixing drugs: When individuals are prescribed pain medications for arthritis, they are informed about the dangers of mixing these medications with alcohol or other types of drugs. Individuals who intentionally engage in this behavior are demonstrating signs of substance abuse.

There are number of other diagnostic signs that someone is displaying behaviors associated with a substance use disorder. Typically, the signs include issues with control, continuing to use a substance in spite of experiencing negative ramifications, failing to meet personal obligations as a result of drug use, using the drug in potentially dangerous situations, and frequent cravings for the drug. Because a substance use disorder can only be diagnosed by a trained and licensed mental health professional, anyone who believes that they or someone else they know might have a substance use disorder should consult with an addiction professional.