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

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.


Photo courtesy of Pixabay.com

Psychological factors can affect the addictive potential of drugs.

Some people with chronic pain are able to take pain meds for a long period of time with no apparent addiction problem.

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 “mindset” not the taking of drugs on a Hollywood movie set. The drug will produce larger effects in the direction you expect than in 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 mindset of the user.

The place matters – setting.

A single glass of wine will affect someone 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 the 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.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

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4 thoughts on “Why not everyone ends up addicted to pain medication – set and setting

  1. Pingback: Does Alcohol make you happy or angry? | counselorssoapbox

  2. Pingback: Social or anti-social drinker? Dangers of emotional drug use. | counselorssoapbox

  3. Pingback: What is Alcohol and Drug tolerance? | counselorssoapbox

  4. Pingback: Should an addict take psych meds? | counselorssoapbox

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