By Robert W. Mooney, M.D.

For those in recovery, preventing relapse is top-of-mind. For many, however, relapse can be triggered in relatively innocent, unsuspecting ways through the reaction some pharmaceuticals have on their brains. For example, alcoholics know to stay away from alcohol, but do they understand the need to steer clear of Tylenol® PM or Benadryl® — medicines that are perfectly OK for non-addicts?

What makes the chances of an unintentional relapse more frightening is that it is not necessarily associated with large doses of drugs. Even exposure to minimal amounts can trigger an allergic sensitivity.

So how are those in recovery to know? Sometimes it can be an innocuous situation such as going to the dentist or having surgery. It can even be as innocent as taking an over-the-counter medication to relieve the symptoms of a common cold.

Drug and alcohol addiction is basically a kind of allergic response to chemicals that change brain activity and reward systems. The brain’s response to these chemicals can be immediate, such as instant cravings for similar drugs. Or, it can be more gradual — thinking and perceptions become altered in such a way that motivation for sobriety decreases and addicts return to old patterns of behavior closely linked to their original substance use. That is why it is important to understand the impact of some pharmaceuticals and hazardous chemicals on patients and their sobriety.

What’s a hazardous substance in recovery? Essentially, a hazardous chemical is any drug that is associated with relapse. Of course, alcohol is the No. 1 offender, but the others can be divided into three distinct categories:

•    Street narcotics: frequently abused, illegal and recreational in nature.

•    Prescription medications: available only with written instructions from a doctor or dentist to a pharmacist. These include Seroquel®, Adderall, Vicodin, Xanax® and Lexapro.

•    Over-the-counter drugs: sold without a prescription and found in almost every corner drug store, such as Tylenol® PM, Benadryl®, NyQuil, Robitussin® DM and Stackers.

Unfortunately, even though a doctor may prescribe these drugs or patients may not have had previous experience with them, it doesn’t change the affect on the brain.

The most innocent medical event can trigger a relapse. Scheduled medical procedures, in particular, present challenges for those in recovery. It is paramount that patients discuss their experiences as a recovering alcoholic or drug addict with their physicians or dentists, focusing on their special sensitivity to any mood-altering substances, which include medications given before, during or after surgery.

Doing so will help recovering patients avoid any unnecessary risk of relapse. This does not mean that doctors or dentists are responsible for their patients’ sobriety — they aren’t. But there are things they can do to make it easier for patients to get through the procedure with their sobriety intact.

Before Surgery: Instead of ordering sleeping pills on the evening before or a mild tranquilizer on the morning of a procedure, seek non-pharmacological ways to ensure that patients’ emotional states do not interfere with their surgery.

During Surgery: Being put to sleep with general anesthesia is like being passed out drunk. The brain just does not see the difference. If appropriate, consider local anesthesia or an epidural. If an alternative is not medically possible, just remember that it is not unusual for an alcoholic or addict to require higher doses for general anesthesia. Patients should be prepared for their personalities, including their judgments, to be altered for approximately three months.

After Surgery: This is when most addicts end up in trouble. At this point, their brains will probably be convincing their bodies that they need relief—spelled N-A-R-C-O-T-I-C-S. Besides the physical discomfort, patients may seem anxious, irritable, or unable to sleep, and it will be very tempting to treat these symptoms with a variety of medications that could be hazardous to their recovery. So before getting a prescription, remember: The Phenergan® for nausea, the Xanax® or Ativan for anxiety, the Trazodone, Ambien® or Benadryl® for sleep or even Ultram for pain can all trigger a compulsion for more.

The ideal but often impractical solution is to keep patients in a controlled environment until medications are no longer needed. Sending them home with a prescription can be dangerous. In the rare cases where narcotics are required for pain control, it may be best to use a medication that most are hesitant to administer. Giving a more potent narcotic for a shorter period of time is less risky than using a milder drug for a long time. Addicts often admit that Tylenol, Motrin or Toradol actually worked as well as narcotics in most cases following a procedure.

How can someone educate his or her healthcare provider? Start with a frank conversation and ask that a history of addiction be flagged on your medical record. Most providers will not always know what may be hazardous to recovery, so it is your responsibility to learn a drug’s effects before taking it. You may need to contact a doctor with special training in addiction, such as one connected with an alcohol or drug rehabilitation center.

Robert W. Mooney, M.D., is an Addiction Psychiatrist and Medical Director at Willingway Hospital, an alcoholism and drug addiction treatment center in Statesboro, Georgia.