My brother has had a significant drinking problem. Now he's on prescription narcotics for back pain. Isn't this a no-no?

Managing disabling back pain is a major challenge for health care specialists. The use of opioids for pain control is very controversial. There's no doubt these drugs are effective. But they do come with their own set of problems. Drug dependence and addiction are the biggest concerns.

Is it possible your brother's physician doesn't know about the history of alcohol use? Many physicians rely on patients' self-report to recognize a problem. But this isn't always accurate and can't be relied upon.

Studies show the best predictors of a prescription drug abuse problem include a previous history of alcohol and/or other drug abuse, previous drug convictions, and a history of driving under the influence (DUI). Unless the patient tells the doctor about these behaviors, he or she will not have the information needed to prescribe or withhold narcotics.

In such cases, the physician must monitor the patient closely. This type of monitoring will help the doctor see signs of problems early on. Treatment can be modified at that point.