Effects of Addiction on Mesothelioma Treatment
Substance use disorder is a mental health condition that may be pre-existing before a mesothelioma diagnosis or may occur as a treatment side effect. Treatment of co-occurring mesothelioma and addiction can be challenging for both patients and practitioners. If you are facing this dual diagnosis, you will need a compassionate multidisciplinary health care team that is willing to provide a balanced, individualized approach to minimize discomfort while providing effective treatment.
Medically Reviewed By:
Patricia Shelton, M.D.
Medically Reviewed By:Patricia Shelton, M.D.
According to the Centers for Disease Control and Prevention (CDC), 20.4 million people in the United States met the diagnostic criteria for substance use disorder in 2019. As many as 65.8 million admitted to binge drinking in the past month, and 35.8 million admitted to using illegal drugs or misusing pain relievers during the same period.
It is only logical that some people diagnosed with mesothelioma will also present with problematic substance use. This presents challenges in the management of pain and anxiety associated with mesothelioma treatment. Individuals with substance use disorders deserve to receive as much attention to their pain and discomfort as any other patient, despite the challenges their co-occurring conditions present.
What is substance use disorder?
The CDC defines substance use disorders as “treatable, chronic diseases characterized by a problematic pattern of use of a substance or substances leading to impairments in health, social function, and control over substance use.” People with substance use disorder continue to use the substances despite experiencing negative consequences.
According to Jahan and Burgess of the University of Missouri in Kansas City, substance use disorders stem from chemical changes in the brain involving dopamine and the brain’s reward center. These changes lead to an inability to regulate use of the substance.
Yale Medicine notes that the use of addictive substances can cause a release of dopamine in the brain 10 times greater than any naturally rewarding behavior could produce, resulting in a strong sense of euphoria. As the brain becomes overwhelmed with dopamine, it reduces the number of dopamine receptors. This means that a given level of dopamine will produce a smaller effect in the brain than it previously did. The effect is known as tolerance, and it leads the user to seek increasing quantities of the drug to repeat the initial high, or even to feel normal.
When the substance is unavailable, the individual may experience both physical and psychological symptoms of withdrawal. The specific symptoms vary from substance to substance, but may include the following:
- Nausea and vomiting
- Excess sweating
- Cognitive decline
People with substance use disorder often turn to drugs and alcohol to cope with psychological distress. A mesothelioma diagnosis provokes extreme distress that could threaten the mental health of even the most stable person.
Expecting a person suffering from substance abuse disorder to abstain from use or taper down during such monumental psychological challenges may be unrealistic. It will need to be addressed as a co-occurring diagnosis along with mesothelioma.
How Drugs and Alcohol Affect Mesothelioma Treatment
Like most cancer treatments, mesothelioma treatment is not for the faint of heart. It usually involves a combination of the following:
The side effects associated with treatment can be severe. Symptoms may include the following, according to the National Cancer Institute:
- Nausea and vomiting
- Hair loss
- Mouth sores
- Brain fog
- Sexual dysfunction
- Sleep disturbances
- Urinary problems
- Flu symptoms
People with substance use disorder may not be able to cope with these side effects without turning to substances. According to the Journal of the Advanced Practitioner in Oncology, the following observations have been made regarding cancer patients with substance use disorders and their practitioners:
- Patients may not adhere to treatment.
- Oncologists are not always equipped to treat substance use disorder.
- Oncologists may not identify substance use disorder early in treatment.
- Patients with substance use disorder face severe stigma.
Substance use disorders are chronic illnesses, but misconceptions prevail that addicted individuals are choosing to have the illness or that they are just weak. Rather, they have an altered brain chemistry that prevents them from choosing to stop using the substance, despite the harmful consequences.
Each substance impacts mesothelioma treatment in its own way.
Alcohol is the most commonly abused substance, according to the CDC. It is officially classified as a carcinogen by the U.S. Department of Health and Human Services. According to the MD Anderson Cancer Center, alcohol may cause cancer through the following mechanisms:
- Alcohol breaks down to acetaldehyde, which damages DNA. It can also prevent cells from repairing DNA damage, which allows cancer cells to grow.
- Alcohol impacts the levels of hormones such as estrogen, which encourages cells to grow and divide, possibly facilitating cancer.
- Alcohol decreases the body’s ability to absorb folate and vitamins A, C, D, and E, which are important protectants against cancer.
Consuming alcohol while receiving cancer treatment can cause a worsening of treatment side effects, including nausea, vomiting, dehydration, and mouth sores.
According to Alcohol Research, a functioning immune system is critical for optimal response to chemotherapy. Both chronic alcoholism and binge drinking can impair the immune system.
Nicotine and Tobacco
According to Frontiers in Oncology, tobacco products contain numerous carcinogens, including nicotine. Nicotine has been implicated in several steps of cancer development, and may aggravate a cancer patient’s condition and also increase the chance of recurrence. During cancer treatment, nicotine may do the following:
- Encourage tumor growth
- Inhibit the antitumor immune response
- Adversely affect cancer-fighting dendritic cells
- Reduce the effectiveness of treatment, including radiation therapy and chemotherapy
- Reduce overall survival, even in those who use smokeless tobacco products, and even for cancers not related to tobacco
If you have been diagnosed with pleural mesothelioma, you may experience shortness of breath, chest pain, and severe coughing. Smoking can worsen these symptoms.
There are no large-scale studies clarifying the impact of marijuana on cancer patients. Some experts believe that there’s a potential for it to be harmful. According to the National Cancer Institute, marijuana is addictive, carcinogenic, and contains many of the same harmful chemicals as tobacco smoke. Smoking marijuana could increase shortness of breath in pleural mesothelioma patients.
Marijuana use is also associated with several negative side effects, including rapid heartbeat, drowsiness, paranoia, dizziness, and hallucinations.
However, the National Cancer Institute has also identified some chemicals in marijuana that may be helpful. Two cannabinoid drugs derived from marijuana have been approved by the FDA to relieve nausea and vomiting associated with chemotherapy when other drugs fail. These drugs are dronabinol and nabilone.
These drugs have also been found to be effective for pain management, although they are not specifically approved for this purpose. Several other marijuana derivatives may be beneficial for improving sleep, pain, anxiety, depression, fatigue, and overall well-being.
Prescription drug misuse may be the most challenging form of substance use disorder for mesothelioma practitioners because, in many cases, the drugs being abused are the very drugs that are usually used to help patients with pain and anxiety.
Opioids are the mainstay of pain management in cancer care. According to the National Cancer Institute, the opioid epidemic has made it more difficult for cancer patients to access narcotic pain medications at the dosages they need, even at the end of life. Some patients even refuse opioids for fear of addiction or overdose.
Patients with opioid use disorder develop a reduced pain threshold concurrent with a high tolerance to the drugs, resulting in higher doses needed to accomplish effective pain management. This can lead to the perception of drug-seeking behavior when a standard dose is applied, and the patient asks for more. This adds to the stigma and may result in patients not receiving sufficient pain management.
Mesothelioma treatment has two primary focuses: controlling the cancer and reducing patient suffering. An individualized approach that addresses mesothelioma and opioid use disorder is crucial.
Some addicted patients cannot experience pain relief from opioids, while others become more preoccupied with managing pain than with improving overall health. This may result in the following:
- Reduced adherence to treatment
- Drug-seeking behavior and obsession with getting more opioids
- Masking of symptoms that may point to disease progression
Under these circumstances, using opioids for pain management may increase the patient’s overall suffering. However, abruptly discontinuing opioids can lead to dangerous withdrawal symptoms. It may be necessary to use alternative methods for pain management, while using opioids as necessary to manage the addiction.
Benzodiazepines are used during mesothelioma treatment to control anxiety, pain, insomnia, and nausea. However, they are highly addictive. Memorial Sloan Kettering Cancer Center warns that the use of benzodiazepines with opioids can result in respiratory arrest and death.
This is a risk for patients who begin mesothelioma treatment with a co-occurring benzodiazepine addiction. Mesothelioma treatment centers typically provide a non-threatening, compassionate environment where patients are more likely to disclose drug use than in other settings. However, it remains possible that a patient may fail to disclose misuse of benzodiazepines, and providers may prescribe opioids to treat symptoms like pain. This could cause an unintentional combination of these two types of drugs, which can be very dangerous.
According to the National Center for Health Research, sleeping pills increase the risk of developing cancer and dying. Some sleep aids are benzodiazepines, while others, such as Ambien, are in a separate class of medications known as Z-drugs. Z-drugs are less likely to result in addiction than benzodiazepines, but they still are not harmless.
According to Quality of Life Research, sleeping pills are associated with a poorer quality of life, and some people may become dependent on them, resulting in rebound insomnia when the drug is stopped. The Sleep Foundation has noted the following dangers and side effects associated with sleeping pills:
- Burning sensation in the extremities
- Gastrointestinal problems
- Impaired balance
- Mental impairment the next day
- Memory problems
- Difficulty concentrating
- Parasomnias (unusual behaviors that occur while asleep, or during a partial arousal from sleep)
- Allergic reactions
Benzodiazepines and sleeping pills should only be used for a period of a few days to weeks, in order to avoid addiction and maintain quality of life to the fullest extent possible during mesothelioma treatment. A multidisciplinary care team can help you develop a customized plan for sleep and for overcoming sleeping pill dependence.
Illegal Street Drugs
The use of many illegal drugs may increase the risk of developing cancer, according to the Dana-Farber Cancer Institute, a fact that makes their use counterproductive during mesothelioma treatment.
Like opioid users, illegal street drug users often have a lower pain threshold, and may also have a high tolerance to opioid medications. If they are in recovery, they have a high risk of relapse when faced with uncontrollable pain, according to the Oncology Times. These patients may be accused of drug-seeking behaviors when they are merely looking for relief from their pain.
Risk Factors for Addiction
Addiction can afflict people from all walks of life, but some people have higher risks of developing an addiction throughout life or during mesothelioma treatment. People with the following characteristics have an elevated risk of developing a substance use disorder:
- Pre-existing psychiatric disorders, especially ADHD, bipolar affective disorder, and post-traumatic stress disorder (PTSD)
- History of substance use disorders
- Disabilities, one of the strongest risk factors, with a 24.6 percent lifetime prevalence compared to 9.9 percent in the general population
- Genetic predisposition
- Adverse childhood experiences (such as abuse or neglect)
People with these risk factors may not be well-equipped to cope mentally with the trauma of a mesothelioma diagnosis and the rigors of treatment. The shortness of breath experienced with mesothelioma may bring on a disability or worsen an existing disability, raising the overall risk of developing an addiction during treatment.
Two groups with a unique risk profile that are commonly diagnosed with mesothelioma are veterans and elderly people.
PTSD is common among war veterans. According to the National Center for PTSD, more than two of 10 veterans with PTSD also have a substance use disorder, and veterans with PTSD are almost twice as likely to smoke as those without it.
Approximately one in 10 veterans returning home from the wars in Iraq and Afghanistan have problematic drug or alcohol use. Heavy drinking and smoking were the most prevalent substance use problems in veterans.
According to Substance Abuse and Rehabilitation, approximately 11 percent of veterans using VA health care meet the criteria for a substance use disorder. This is slightly higher than the general population. A survey by the Substance Abuse and Mental Health Services Administration found that 12.8 percent of veterans admitted to using marijuana.
Even without a prior history of substance use disorders, veterans that have engaged in combat may have numerous risk factors for developing an addiction during mesothelioma treatment.
Due to the latency of mesothelioma, approximately two-thirds of people diagnosed with mesothelioma are age 65 or older. According to the National Institute on Drug Abuse, older adults are more susceptible to the effects of drugs because their bodies cannot absorb and break down drugs as easily as those of younger people.
Older adults often manage multiple medications for other conditions, and so they are more likely to misuse medications unintentionally. They are also more likely to abuse alcohol, with approximately 65 percent reporting high-risk drinking. More than 10 percent of older adults binge drink.
The rate of marijuana use and heroin use among the elderly is lower than in the younger population, but this number is rising.
It is common for health care providers to mistake symptoms of drug abuse in the elderly for symptoms of aging. For this reason, it is important to be honest with your mesothelioma doctor about any substances you consume. These substances may interact with chemotherapy drugs or other drugs you receive as part of your mesothelioma treatment regimen.
The Potential for Addiction During Mesothelioma Treatment
Even without a history of substance use disorders, mesothelioma patients may develop addictions to opiates and/or benzodiazepines during the course of treatment. Opiates are typically prescribed for pain management, and benzodiazepines are often prescribed for anxiety.
These drugs are meant to be taken for a brief period, but due to the lack of equally effective alternatives, practitioners may prescribe these drugs for a longer period, often for the duration of mesothelioma treatment.
Stress and Mesothelioma
A mesothelioma diagnosis can prompt the development of severe anxiety or even PTSD due to the shock of the diagnosis and the associated low life expectancy, combined with the following:
- Physical symptoms
- Treatment anxiety
- Treatment side effects
- Death anxiety
- Physical limitations
- Travel for treatment
- Changes in lifestyle
- Reduced well-being
- Stress due to upcoming scans and tests
- Bad news from tests
The overwhelming emotions associated with a mesothelioma diagnosis could lead to a fatalistic point of view that facilitates illicit drug use or misuse of prescriptions, with such thoughts as, “I’m going to die anyway …”
However, becoming addicted to substances even at the end of life is detrimental. It can increase your pain, reduce your quality of life, and decrease the quality of your time with your loved ones. When you are addicted to a substance, you will crave it, and it will be difficult for you to focus on anything positive, such as the people who care about you.
Symptom Management During Mesothelioma Treatment
Shortness of breath is a common symptom of pleural and pericardial mesothelioma. This can be a frightening experience. Benzodiazepines may be prescribed to relieve the associated anxiety. Opiates are sometimes prescribed in hospice situations to patients with breathlessness. These medications act to slow breathing and reduce the sensation of breathlessness, according to the Journal of Pain and Symptom Management.
Sleep Disturbances and Mesothelioma
Sleep disturbances due to breathing problems, chemotherapy, stress, anxiety, and depression associated with a mesothelioma diagnosis may occur, along with a reduction in sleep quality, according to Current Treatment Options in Neurology.
Sleep is important for recovery and mental health. Lack of sleep can increase the risk of turning to substances to cope. Sleep medications may be prescribed, but if these are used for longer than a few weeks, addiction may develop.
Mesothelioma and Mental Health
Being diagnosed with mesothelioma often creates severe mental health challenges. Depression, anxiety, and suicidal ideation may develop, resulting in the need for medications that are sometimes addictive, including benzodiazepines. It may be tempting to self-medicate by consuming alcohol or street drugs or by misusing opioids, but these actions will only increase your suffering.
If you are having difficulty coping, you should discuss this with your mesothelioma doctor. The best mesothelioma treatment centers have multidisciplinary teams with strong emphasis on palliative care, which includes the management of overwhelming emotions. Your treatment team wants to hear about any challenges that you are experiencing, so they can provide you with the best possible care.
Drug Withdrawal During and After Mesothelioma Treatment
Mesothelioma is an aggressive cancer that requires immediate treatment upon diagnosis. If you are battling a substance use disorder, there is no time to seek treatment for the substance use disorder separately, before starting cancer treatment. It will be necessary to treat both conditions concurrently. This may be a delicate balancing act.
The biggest challenge lies in the fact that you may need to take a higher than average dose of pain medication, ideally without worsening the addiction. You will often need to continue taking the substance if it is legal, and tell your treatment team about it so that they can adjust your treatment accordingly. If it is an illegal substance, a prescribed substance may be available to minimize or prevent symptoms of withdrawal.
It is crucial that you choose a mesothelioma practice that will view your substance abuse disorder as a disease that requires treatment, without stigmatizing you or depriving you of necessary pain management. Experiencing withdrawal symptoms along with cancer symptoms and chemotherapy side effects could be unbearable. Withdrawal symptoms will vary based on the type of substance you use.
Opioid Withdrawal Symptoms
The World Health Organization has found that the following withdrawal symptoms occur as a result of abrupt cessation of opioids, whether they are prescription opioids or illegal opioids such as heroin:
- Nausea and vomiting
- Hot and cold flushes
- Excess sweating
- Watery discharge from the eyes and nose
Your doctor should be able to prescribe medications to wean you off of opioids, if necessary. Medications are also available to help manage withdrawal symptoms.
Benzodiazepine Withdrawal Symptoms
According to Lucid Lane, a digital health company focused on reducing addiction to medications, cancer patients often observe that benzodiazepine withdrawals create more distress than the cancer symptoms that these drugs are meant to alleviate.
If you were addicted to benzodiazepines before starting treatment, it is crucial that any tapering be done slowly and carefully under medical supervision, especially while undergoing cancer treatment.
Symptoms of benzodiazepine withdrawal include the following:
- Agitation and irritability
- Poor concentration and memory
- Muscle tension and aches
If you take benzodiazepines regularly while undergoing mesothelioma treatment, you will need to be tapered off them slowly after treatment is completed. This process could take a year or even longer in some cases.
Withdrawals from Stimulant Drugs
Stimulant drugs such as cocaine and methamphetamine have a shorter duration of withdrawal, which may be easier for a practitioner to manage when initiating cancer treatment. Withdrawal symptoms include the following:
- Agitation and irritability
- Increased sleeping
- Increased appetite
- Muscle aches
Substance Use Disorder Treatment Options for People with Mesothelioma
Substance use disorder is not a matter of choice, willpower, or weakness. It is a serious medical condition that requires medical intervention. Getting treatment for substance use disorder can enhance the effects of mesothelioma treatment and improve your quality of life during and after treatment.
The most effective treatment for substance use disorder utilizes a combined approach of psychological therapy and medication. In severe cases, residential treatment is needed, but this may not be an option when you are undergoing mesothelioma treatment, especially if you must travel long distances to your treatment center.
According to the Journal of Pain and Symptom Management, reasonable management of substance use disorders in advanced cancer patients is both “necessary and feasible” and can be accomplished by the following:
- Help patients admit that they cannot stop through willpower.
- Encourage the patient to rely on weekly or daily support groups, family support, and some form of higher power.
- Set a goal to reduce the use of mind-altering substances, rather than to abstain completely.
- Incorporate the management of the substance use disorder into the mesothelioma treatment plan.
- Establish a supportive setting where the patient can count on receiving safe and effective pain management.
- Appropriately manage any additional psychiatric disorders, which occur in approximately 85 percent of alcoholic and chemically dependent patients.
Non-Addictive Alternatives for Managing Mesothelioma Symptoms and Side Effects
Opioid medications and benzodiazepines are safe and effective for the management of symptoms during mesothelioma treatment, and present minimal risk of addiction when prescribed appropriately on a short-term basis. However, many patients prefer to try non-addictive options first. These medications can also cause side effects that some patients find unpleasant and may prefer to avoid.
Non-addictive pain management options include the following, according to the American Cancer Society:
- Certain antidepressants
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen
According to Washburn House, a behavioral health company, the following anxiety medications are non-addictive:
- Certain antidepressants
- Vistaril (an antihistamine)
- Buspar (which acts on serotonin receptors)
- Beta-blockers (which block the effects of adrenaline)
Alternative and Complementary Medicine
Some patients experience positive results by using alternative treatment modalities to manage pain, anxiety, depression, nausea, vomiting, and other mesothelioma symptoms and treatment side effects. These include the following:
- Herbs and supplements
- Diet and nutrition
- Cognitive behavioral therapy
If you are interested in adding herbs, supplements, or dietary measures to your regimen, it is important to obtain your doctor’s approval first. Some herbs, supplements, and even foods may interact with drugs or you receive for cancer treatment or palliative care.
At any given time, numerous mesothelioma clinical trials are seeking volunteers to test various aspects of mesothelioma treatment, including palliative care. Most mesothelioma treatment centers participate in clinical trials. You can find current clinical trials online by visiting ClinicalTrials.gov.
Support Resources for Mesothelioma Patients with Addictions
Outside of your circle of loved ones, your most important support resource will be your mesothelioma treatment team. When you choose a reputable treatment center that specializes in mesothelioma, you will generally have a palliative care team that focuses on improving your comfort while you are undergoing cancer treatment.
When selecting your care team, ask whether the team has experience treating mesothelioma patients with co-occurring substance use disorders. Learn about the center’s care philosophy with regard to substance abuse. Select the provider that seems to be the most supportive and educated about substance abuse management and is willing to incorporate substance use treatment with your care plan.
If you are a military veteran, the Department of Veterans Affairs (VA) offers multiple substance use programs that you may be able to access while you complete mesothelioma treatment, including the following:
- Medical detoxification
- Drug substitution therapies
- Nicotine replacement and cessation
- Outpatient counseling and treatment
- Group therapy
- Residential care
- Relapse prevention
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