Many people struggle with not only dependence and/or addiction but also with the illness that preceded it. According to American Addiction Centers there is about 4.7million people who are struggling with co-occurring addiction and illness (physical or mental) (AmericanAddicionCenters.org). Too many people are unaware of the potential of addiction until it happens to them. Throughout this paper there will be a discussion of addiction and illness, what causes it, the risks, the dangers, and what we can do about it.Dependence is often confused with addiction but is not at all the same thing. Drugabuse.com states that “… dependence specifically refers to a physical condition in which the body has adapted to the presence of a drug” (Drugabuse.com). Dependency is the absence of the cravings which is what drives addiction. Dependency occurs when a substance is used over a period of time and the body gets used to the substance. Dependence can even occur with substances that are not addictive such as the medicine in asthma inhalers that support breathing. With the inhaler being used for so long the body doesn’t take measures to support its own breathing because the inhaler did the job. The same scenario goes for other medications like the ones for pain where the body doesn’t have to produce pain relieving chemicals. When an individual becomes dependent on a substance the body feels abnormal without it and will experience withdrawal. If an individual returns to a substance to alleviate withdrawal symptoms that doesn’t mean addiction is the cause.Addiction differs from dependence because cravings are present. The National Institute on Drug Abuse (NIDA) describes addiction as “…chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences”. While dependency can stabilize the body to normal conditions addiction typically provides pleasurable and euphoric sensations that the abuser will crave and seek. With addiction the substance is prioritize over almost anything else. For the abuser the enjoyment of the substance overrules the harmful side effects that come with it. These side effects can be physical, mental, social, financial, legal, and career related. An addicted individual may or might not want to quit or cut down but will feel unable to do so. According to Addiction.com, over fifty million Americans are currently living with some form of disability. Such disabilities can include physical injury, mental health, medical conditions, and birth defects or injuries. Any disability comes with its struggles and obstacles that can hinder one’s capabilities. Both dependency and addition have various forms of treatment but typically dependency is easier to treat and less likely to result in relapse. With medical assistance a dependent individual can be slowly weaned off a substance to adjust their body natural chemistry. Addiction is trickier to treat because the desire for the substance and the lack of a physical need. For an addict the vulnerability to the substance is emotional. According to American Addiction Centers “More than 50 percent of people with traumatic brain injury, spinal cord injury, and mental illness abuse drugs or alcohol” (AmericanAddictionCenters.org). Physical injuries and disabilities can be long term or short term. Physical injuries and disabilities often result in overwhelming pain for the sufferer. Those with physical injuries may be prescribed prescription medication to manage their pain but even doctor prescribed medication comes with risks. One of those risks is dependence which can be dangerous but even more so when that dependence develops into an addiction. After an injury an individual might seek the use of non-prescribed drugs and alcohol deal with pain, to avoid withdrawal symptoms, or to satisfy a developed craving. Different types of physical injuries and disabilities result in different side effects and require different medical interventions. Physical injuries can range from a small cut or sprain to a major injury such as paralysis or severe trauma. Amputation of a limb, for example, can cause extreme pain during recovery and pain in the “phantom limb”. Psychologically, an amputated limb can invoke deep emotion feelings for the sufferer and may lead them to self-medicating. American Addiction Centers speaks on amputation in great detain stating that “The injury that led to the amputation can also be incredible traumatic, and the loss of a part of one’s body often creates a sense of grief. It’s just as easy to turn to intoxicants for relief from the emotional pain” (SunriseHouse.com). Amputation has lasting effects that for some are too much to bear. Another physical injury with potentially lasting and catastrophic effects is brain injury. Brain injuries can have psychological or cognitive effects that increases the risk of dependence and/or addiction. There are many scenarios of physical injury and illness that put different people more so at risk for dependence and/or addiction. As mentioned previously, brain injuries can alter ones thinking to where they do not think clearly and cannot recognize the frequency of their substance use (prescription or non-prescription). Brain injuries such as concussions can even cause forgetfulness. This can be dangerous when someone who has a concussion forgets they took a medication already and retakes it or takes it too close to the next dosage. This can cause an accidental “high” or result in something as dangerous as an overdose.Among athletes and the very physically active is the risk of multiple or repeated injuries. For many of these individuals this results in prolonged use of a pain management prescription. Long term substance use increases the potential for dependency and tolerance. Tolerance fits into both dependence and addiction because tolerance is the body adjusting to a substance use frequently to the point where it does not preform in the way it once did. Tolerance can trigger withdrawal symptoms which can lead an individual to seek other substances that can provide the desired effect that the previous substance once did. Another risk that comes with athletic lifestyles is pressure to perform. This is when someone’s performance, particularly in a sport, begins to weaken and they seek substances to provide them with the “boost” they think will allow them to preform better. Many people think that a prescription given by a medical professional such as a doctor is safe to take as long as they are available. There are also people who continue to take a medication until the bottle is complete or they run out of refills even if they feel better. Over-prescribing can be just as dangerous as taking non-prescribed medication. Taking a medication longer than needed only puts the individual at higher risk of tolerance, dependency, and/or addiction later. Just as taking a medication too long is a risk so is taking a prescription incorrectly. Incorrectly administering a medication can lessen its effects, heighten its effects, or cause an unwanted reaction. For example, drinking alcohol with a pain killer can heighten its effect which puts the individual further at risk of dependency and/or addiction. Some other risks to tolerance, dependency, and addition include lack of education, isolation, and enablement by friends or family. Lack of education doesn’t necessarily mean uneducated although that can play a part. Many people are not properly informed of what they are taking and how it could affect them. Awareness of the substance being consumed can greatly reduce the risk of negative effects. Those who have a physical injury that has reduced their mobility such as a broken bone or paralysis may experience isolation. Like brain injuries, isolation can trigger emotions that an individual might use substances to escape. Lastly, enablement is a risk factor that supports addiction. Addiction.com discusses family members who, most likely without intention, fuel an addiction. An enabler is blinded by the sufferer’s current situation and does not recognize dangerous behavior or even accidently supports the addiction even if they don’t like. For example, a father becomes paralyzed after an accident at work and now lives with his daughter. Everyday he asks her to bring home alcohol on her way from work. As time goes on the amount he asks for increases and although his daughter doesn’t think it’s a good idea that he drinks she can’t tell him no. In this case his daughter is enabling the addiction because otherwise her father cannot obtain the alcohol himself. She could be in this position because she feels bad for him and thinks he’s been through enough already or she could be afraid to tell him no because he is her father. Enablers like this example may think they are doing no harm but by supporting someone’s unhealthy relationship with a substance they are only furthering their progression into addiction. While physical illness and substances are dangerous separately they are even more so together. There are well known dangers such as imprisonment, overdose, loss of employment, and relationship difficulties but when physical injury and addiction are combined other outcomes are also possible. Addiction.com discusses these outcomes thoroughly and they include preventing adequate medical care, dangerous substance interactions, and worsening conditions. Addiction is an all-consuming illness that can quickly takeover someone’s life. When someone with a physical illness or disability becomes addiction to a substance they are at risk for neglecting medical treatment for existing or new conditions. There are many reasons why this occurs but mostly out of fear of their addiction being discovered. When someone isn’t being properly monitored by a medical professional but continue to take prescription and/or non-prescription substances they put themselves at risk for drug interactions. This is when two substances combine and provide undesirable and often dangerous results. Lastly, both inadequate medical care and drug interactions can result in worsening condition(s). An addiction craving and finally using can feel like a relief to the user but at the same time their condition can be worsening due to many factors that may or may not be directly related to their substance use.Mental health and injury can be just as debilitating as physical illness if not more so. Many mental health conditions go undiagnosed and untreated. This can be because of lack of insurance/inability to pay, denial, stigma among family and friends, and embarrassment. Also, mental health is very complex and no two people with the same diagnosis will react the same way to the same treatment. Typically, broken legs and many physical injuries are treated similarly which lessen the need for trial and error which comes with mental health. Mental health conditions are at times complicated to identify and diagnosis, but some are more common than others. Some mental health conditions are depression, anxiety, schizophrenia, post-traumatic stress disorder (PTSD), eating disorders, bipolar disorder, obsessive compulsive disorder (OCD), and ADD or ADHD. There are many others that are not mentioned here and the potential for these conditions to co-exist within one person as co-occurring conditions. The symptoms of mental illness can be intense and unavoidable for those living with the condition(s). For those with these conditions, diagnosed or not, there is a need to suppress their symptoms to be able to get through the day. This is where the use of substances come into play to help the individual feel normal and thus “…the person is more vulnerable to using substances in a desperate attempt to alleviate troubling symptoms, such as insomnia or low energy, and numb painful emotions” (Addiction.com).When it comes to mental health and addiction there are very similar risk factors to physical injury. However, there are a few risk factors that are not the same. One of the largest risk factors for co-occurring addiction and mental health condition is stigma. There are all kinds of misconceptions about mental health that cause people to avoid treatment. Mental health can be seen as a weakness or only for those who are “crazy” but this is not true. Another risk factor is self-medicating which is often the go to for those wishing to avoid mental health treatment for whatever reason. Taking a substance of medication that is not prescribed to the individual by a medical professional is dangerous in many ways but especially when some mental health conditions can be temporarily or permanently affected by a substance. Substances becomes the next best thing for many people who find themselves injured or facing a diagnosis. For the reasons mentioned previously people engage in substance use that in fact does more harm than good. CNN article “Unintended Consequences: Why Painkiller Addicts Turn To Heroin” sought to explain why so many people progress on to heroin after taking pain medication. The article state that “It is precisely because there are so many similarities that pain pill addicts frequently turn to heroin when pills are no longer available to them” (CNN). Although these similarities exist the differences could mean further injury or death in some cases.When dependency is the issue the most used approach is gradual reduction of medication use. The primary concern would be the withdrawal symptoms that can be very uncomfortable and even dangerous to the sufferer. Withdrawal comes when a used substance is stopped suddenly, or the usage is decreased abruptly. Withdrawal symptoms are best handled by a medical professional because withdrawal symptoms vary from person to person and can be fatal if not managed properly. The American Addiction Center lists some of the possible symptoms of withdrawal as: tension, panic attacks, tremors, difficulty concentrating, short-term memory loss, anxiety, irritability, disturbed sleep, headache, heart palpitations, sweating, nausea, muscle pain/stiffness, hypertension, and irregular heart rate (AmericanAddictionCenters.org). With the help of a medical professional or in the safety of a detox center many people who face dependency can safely recover. The American Addiction Center discussed types of treatment adjustments that would greatly benefit those struggling with addiction and a physical illness. These treatment adjustments include “Integrated substance abuse treatment and vocational rehabilitation”, “Accessibility”, “Physical therapy and exercise”, and “Specialized understanding of specific disabilities and substance abuse outcomes” (AmericanAddictionCenters.org). “Integrated substance abuse treatment and vocational training” is when a professional incorporates job training into an addiction treatment plan. This treatment adjustment would be beneficial to individuals who have a physical injury that has affected their ability to do their job. “Accessibility” is simply having the ability to attend treatment. Accessibility is especially needed by those in a wheelchair or bed bound. Creating options for these individuals will allow them to attend treatment without the added worries. “Physical therapy and exercise” is good for almost any situation but especially when a physical injury could have weakened the body. Also, exercise is a great emotional release that can be incorporated into the treatment plan. Lastly, “Specialized understanding of specific disabilities and substance abuse outcomes” means having a trained professional who is aware of the needs of both populations. For example, someone with both an injury/disability and addiction would not be able to discontinue all substance use due to possible needed prescriptions. For those living with mental illness there are also treatment accommodations that can make treatment possible and potentially long lasting. These accommodations include “Simplification of presentations and resource materials”, “Comprehension checks and repetition”, “Specialized staff”, and “Variety” (AmericanAddictionCenters.org). The first two accommodations/adjustments involve have a plan and materials that can cater to the cognitively impaired. Also, being able to rephrase and present information as needed. Having a “specialized staff” means having trained staff who are not only well informed on addiction but also well informed on mental health conditions. Lastly, “variety” means having an array of available resources, plans, ad information that can cater to almost anyone.Addiction is hard enough to deal with and treat but for those with physical and mental illness obstacles make it even harder if not impossible to seek treatment. Other than the obvious obstacles and adjustments there is the obstacle of communication. Yes, language diversity is important but what would be the approach for someone who is blind or death? “Only 27 percent of opioid treatment facilities featured interpretation services for people with impaired hearing, according to a national survey. This makes the vast majority of rehabilitation centers for this addiction inaccessible for the deaf unless they are able to pay for their own interpreters “(SunriseHouse.com). Not having the ability to communicate with medical professionals would be a main reason someone does not come for treatment. Addiction as a result of illness of injury is incredibly widespread. Just like anyone can face injury at some point in their life addiction also does not discriminate and anyone could find themselves victim to an illness related addiction. Addiction does not discriminate from gender, age, sexual orientation, race, ethnicity, nationality, income, marital status, weight, height, hair or eye color. In two separate Youtube.com videos “Former Athlete Shares Survival Story Of Opioid Addiction From Sports Injuries” and “‘Addiction Can Happen To Anyone’: Mom Shares Struggle With Prescription Pills” you can see how addiction took over the lives of two vey different people. In the first video, you’ll meet high school athlete Corey Palazzi who developed an addiction to pain medication and finally heroin after an injury. Corey eventually had a stroke from his substance use and today is cognitively impaired and partially blind. The second video you’ll meet a mom, Jen Simon. Jen was addicted to pain medication for five years after experiencing some pain following the birth of her child. Jen also struggled with mental health but continued to self-medicate. She did eventually seek help and is currently in recovery with her condition being monitored by a medical professional who prescribes medication appropriately. Injuries and conditions are often unexpected and it’s even more unexpected to then struggle with an addiction stemming from that injury/condition. Addiction because of injury is a very real thing and being knowledgeable of it is not just for medical professionals. Being knowledgeable about injury and addiction before the unexpected happens is the first step in eliminating the risk of developing an addiction. Also, medical professionals need to have an even better understanding of these co-occurring conditions so that they can better service their clients and help them reduce the possibility of relapse. With resources and information, prescription medication can remain safe to take as long as we take the precautions to prevent addiction.