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Many painkiller addictions begin when the patient starts taking the drug not just for pain, but as self-medication for depression, anxiety, or fatigue.
Addiction is a disease of denial, and it may take an encounter with the law, or intervention by a concerned partner, family member, or medical professional, before the patient's harmful dependence on prescription drugs is recognized. Before the patient is ready for recovery, the addiction may threaten relationships and jobs as the patient focuses on getting more of the drug, to exclusion of other priorities. Some become unable to care for children or themselves.
In addition, because many people addicted to painkillers are responsible, middle-class adults, they frequently experience strong feelings of shame about their addiction. Effective therapy for a painkiller addiction should include treatment for any underlying depression or other emotional condition.