Dr. James Laurent Gagne, MD

I assume that by "pain medication" you mean an opioid ("painkiller") like Norco, Vicodin, hydrocodone, oxycodone, Percocet, etc. STOP THIS MEDICATION AS SOON AS POSSIBLE. Addiction is a real risk if you've taken it for more than three days. If you've been taking it for a week or more, you may need to taper it over a few days. Don't worry if you have opioid withdrawal symptoms like body aches, fatigue, runny nose, sweating, etc. That's uncomfortable, but won't hurt you at all. You need to do whatever's necessary to stop it.

The answer to your question depends on which medication you're taking. There are several classes of anti-anxiety drugs: benzodiazepines, antidepressants, antipsychotic drugs like Seroquel, and anti-seizure medications like gabapentin. The latter two aren't FDA approved to treat anxiety and are be used off label. Finally, many people use over-the-counter drugs like diphenhydramine (e.g., Benadryl) for sleep and occasionally also for anxiety.

The only group that's really addicting are the benzodiazepines. Xanax is the worst and the most addicting. Moreover, for most people benzodiazepines stop working after a few weeks, but when you try to taper or stop them, your anxiety often gets a lot worse. As a result, most knowledgable physicians avoid prescribing benzodiazepines for anxiety because they can trap you like a roach motel. For many people, the best treatment for anxiety isn't taking a drug but learning self-management and coping skills like cognitive behavioral therapy and mindfulness. You should find a physician who is familiar with these medications and, if you're on a benzodiazepine, work out a way to taper and stop taking it or find an alternative.

Opioids can indeed help mood in many people, but you're playing with fire. The effect diminishes over time, and cutting back or stopping the opioids can be difficult and uncomfortable. Please find a competent physician who can help you find proper antidepressant medication.

Unfortunately, there are hundreds of kinds of prescription medications, so saying he has a lot of prescription medications isn't all that helpful. Specifically, which meds? You might write down a list of all the drugs you found and either look them up on Google or ask your family physician.

That said, most likely he'9s obtained addicting medications like opioids (hydrocodone, oxycodone, etc.) and benzodiazepines (Xanax/aprazolam, Ativan/lorazepam, or Klonopin/clonazepam). If these are among the mix, you should have him see an addiction medicine specialist. Note that most psychiatrists claim expertise in addiction medicine they don't have, and too many family physicians will pat you on the head and tell you not to worry. But mixing opioids and benzodiazepines can easily cause a fatal overdose.

An alternative is finding an addiction treatment facility for adults over age 18. The problem is many or most of these programs are of questionable quality, and many are rigid and quite ideological (we're a hammer so you must be a nail). So, choose wisely. Search online or your personal network to find out more.

There are thousands of kinds of "prescription medications," but I assume you mean prescription painkillers (opioids). Nationwide, this is a huge problem and extremely risky for anyone entangled in opioid addiction. You should find a physician who SPECIALIZES in addiction. If your health insurance covers it, research various rehab facilities. Quality and competence vary enormously, so buyer beware. There's a lot of ideology and misinformation among people who treat addicts, so research is essential.

A good general rule is that antidepressants are generally extremely safe and effective, even when taken for years. A common mistake is to decide you shouldn't be taking a DRUG and stopping it before you're ready. A relapse commonly follows. Also, current research shows that once you decide to quit, you should taper and stop the medication very slowly.

Regarding risks and side effects, the answer is, it depends. First, which antidepressant are you taking? Some promote weight gain by increasing craving for carbohydrates. But bupropion (Wellbutrin) can help people lose weight. SRI-type antidepressants commonly interfere with sexual function. You should research and understand side effects. You should also investigate non-drug ways to combat depression. Both mindfulness and cognitive behavioral therapy are scientifically proven to help and sometimes can resolve sad moods for life. A good psychotherapist can help a lot too. But be picky about choosing a therapist. Sometimes the therapist is the last one to know their treatment isn't helping.

The problem with the term "blackout" relating to alcohol is can mean different things. One is drinking until you lose consciousness. Another is "I don't remember anything after 7:00." Or you mostly sort of remember, but can't find your keys. Any of these more than very rarely is a sign of a serious drinking problem. Since you're all going out drinking together, it's likely that more than one of you has a problem. A quick definition of problem drinking is pretty simple: recurring problems due to drinking. What kind of problems? Your family is upset about your use. You have trouble getting to work on time on Mondays. You have someone call your boss to say you're sick when you're really just hungover. A single driving under the influence arrest is strong evidence of alcoholism. Health effects like cirrhosis or alcoholic dementia are typically the last to arise.

Not if only one ear hurts, but possibly yes, if you hurt on both sides. Sometimes (depending upon the drug), you can get jaw joint pain because you're clenching and grinding your teeth. You can tell this is the case if opening your mouth fully (wide enough to insert three fingers one above the other) causes pain. If you can't hear it when you rub your fingers together just outside your ear, or if it's painful when you tug on your earlobe, you should see a physician.

You're right, there's an excellent chance he's abusing something, not entirely clear what. If he nods out for a while with pinpoint pupils and later is irritable, could be heroin. If he comes home with enlarged pupils, agitation, and maybe some hallucinations, could be meth. See if he'll show you his arms to look for needle tracks. But as his mom, you should turf this issue to a skilled, neutral third party. If available, consider hiring an interventionist. This is an experienced addiction specialist who can pull together family members and others to help get to the bottom of what's happening. Or, you could have him seen by an addiction treatment program, but be careful that you pick a good one. Some are just in it for the insurance.

I'm sorry to be a bearer of bad news. None of the medications she's taking will cause any sort of false positive drug test. Drug dealers are adding fentanyl to virtually any drug they sell, because it's dirt cheap and addicts really like the high. There's no way to tell if a drug you buy on the street contains fentanyl short of doing a chemical test. So, your daughter used something, not clear what, that unbeknownst to her was laced with fentanyl. And unfortunately, that's also a great way to die of a drug overdose.

Some folks do extremely well with community-based Alcoholics Anonymous. Most won't get sober simply seeing a psychotherapist. Rehab has the best outcome, so long as you realize many rehab facilities are in it.

There is a TON of information on the internet about your question. I'd suggest entering "What's the science behind Suboxone" into a Google search. Click on the articles from the NIH to get the most reliable results. Bottom line: there's abundant evidence Suboxone works very well indeed for addicts who are willing to actually take it.

That's a great question and is more involved than I can answer in a few sentences. But briefly, opiates relieve all kinds of pain - TEMPORARILY - including emotional distress. Troubled teens, who often come from abusive backgrounds, often find opiates relieve their depression and anxiety better than anything else they've ever tried. For 1-2 hours, their emotional pain is completely GONE for the first time in their lives. Wonderful and amazing! They keep using to try to continue experiencing this relief, but it goes away within a few days or weeks. Then they have to keep using just to feel even a little bit normal. The more they use, the more anxious and depressed they become. Many become desperate and keep increasing the dose, but it doesn't work. Despair becomes overwhelming, to the point they don't care if they live or die.

Suboxone works right away, usually within an hour. Please remember that if your son STOPS taking Suboxone, the risk of relapse is extremely high. He needs to stay on it for YEARS. Luckily, it very rarely has any significant side effects or risks unless mixed with a lot of other drugs.

Some people have been able to reduce their cigarette consumption with e-cigarettes (I'm not sure brand matters) and a few have been able to stop completely. The science isn't clear on the safety of e-cigarettes, and the liquid inside often contains small amounts of cancer-causing chemicals. But it's much less toxic than a regular cigarette, and you're not inhaling all the microscopic ash that destroys lungs. You might get better results with nicotine replacement using a nicotine patch plus something that will give you a quick nicotine hit when you're craving a smoke. I like nicotine lozenges like Commit for this extra burst of nicotine. These are all over-the-counter and don't require a doctor's prescription. Prescription-only medications probably work better and include Revia (bupropion) and Chantix. If possible, you'll probably have better results if you work with your doctor to stop smoking. And don't forget that managing your stress is a skill you can learn. You're not stuck with using a chemical to calm down.

There are people who can use cocaine occasionally, but commonly it's quite addictive. You might try to learn more. I'd recommend AGAINST blasting him with questions like, "ARE YOU AN ***ADDICT***?" Instead, approach quietly and gently, remembering that those with substance use problems are often much more truthful about past use than the present. Examples: "Was there ever a time when you thought cocaine might become a problem for you?" Or get down and dirty with, "What's the MOST cocaine you've ever used?" (Phrased like he really enjoyed using it) or, "Have you ever tried to cut down on your cocaine use?" or "Did anyone ever get on your nerves by bugging you about this?" If you're mature enough to handle it, you might ask if he thinks YOU should try it. You're listening not just to his words, but his manner. For a real addict, cocaine is their best friend. But don't you dare start using it with him, because then your relationship becomes all about using together. That's a very dark path.

Red flags suggesting addiction: ever a period of daily use or more than twice a week. Injecting it intravenously. Needing other drugs (alcohol, Xanax) to come down. Getting paranoid and seeing things that aren't there.

I'd be quite concerned about your son. Heroin is unbelievably addicting, and cravings to resume it last months after an addict stops using. So, it's vital to get professional help. Too many treatment programs are out to make a quick buck, so careful vetting of rehab programs is essential. An interventionist can help separate wheat from chaff, and looking for someone with an excellent reputation is key.

Unfortunately this is an incredibly common problem. I worry that the longer you take oxycodone, the more you'll hurt. (Look up "opiate-induced hyperalgesia.") The next step depends upon whether you can find an addiction specialist nearby. If you lived in Los Angeles near me, I would perform a Suboxone detox over a few days. That's a little bit uncomfortable, not bad for most, and then you're done. You could try to talk you primary care physician into switching you to tramadol, which may help as well. You'd taper tramadol over 7-10 days, then stop. That's easier to stop than oxycodone. Other helpful detox medications include Clonidine and gabapentin, but they are potentially dangerous unless supervised by a physician.

As a rule the pain from an auto accident lasts a few days to 2-4 weeks and then goes away. Pain that lasts more than that is almost always due to muscle spasm, which you should treat with a muscle relaxer like Flexeril (cyclobenzaprine) but mostly physical therapy. Ice packs or heat can be helpful; often ice is more effective. Be sure to use a thickness of towel so you don't get frostbite.

DO NOT STAY IN BED, but move around within a range of reasonable comfort. Prolonged rest makes this worse. Once you're beginning to feel better, you should be walking every day. If you have nerve damage causing weakness or numbness somewhere, you should see a neurologist right away. (Not a surgeon.) If you're having trouble controlling bladder or bowel function, GO TO THE EMERGENCY ROOM AT A GOOD HOSPITAL IMMEDIATELY. This rarely occurs, and usually your pain is just due to muscle strain.

There are several good drug choices for pain relief. Most simply, you can take a NSAID like Advil (ibuprofen), Aleve (naproxen), or aspirin in combination with Tylenol with generally good results. Ibuprofen: 400 to 600 mg four times a day as needed; don't exceed 2400 mg/day in all. Aleve: 440 mg every 8 hours as needed (works longer and is often a better pain reliever). Don't mix Aleve with ibuprofen on the same day. You can add regular-strength Tylenol 650 mg four times a day.

Second choice: buprenorphine. This is the same drug that's in Suboxone but is available in much lower strength as Balbuca strips, which you put in your cheek every 12 hours as needed. It's an atypical opiate that shouldn't trigger relapse. Unless you immediately feel euphoria and opiate craving (unlikely), it's extremely safe. Bad news: most physicians have never heard of Belbuca, and it can cost $600 for a month's supply.

Most people won=E2=80=99t like the third choice: go to a methadone clinic. I would do this only if you think your pain will last a long time.

I'm not sure there's really such a thing as "caffeine addiction," but certainly we become TOLERANT to caffeine and suffer withdrawal if we stop suddenly. As you note, headaches are one symptom of caffeine withdrawal, and persistent sleepiness is the other. These last a few days to a week after stopping caffeine cold turkey. They're unpleasant, but neither will hurt you. If you want to stop drinking coffee, just taper how much you drink over 2-3 weeks, then stop. It seems obvious that coffee and caffeine should be bad for you. Scientific studies suggest the opposite: they're good for your heart and may reduce cancer risk. That said, too much caffeine can cause heart rhythm irregularities, irritability, and insomnia in susceptible people.