I belong to several addiction discussion groups on ‘LinkedIn.’ I really love (not really) when I see a discussion topic posted like the title of this blog.
Geez, talk about opening up Pandora’s Box! The discussion will usually start out fairly civil; at least for the first two or three comments anyway.
Then the ‘Ad Hominem Abusive’ (attacking the person rather than the argument) statements begin to roll. These people will try to veil their snide emotional remarks and comments with what they believe to be logical, rational statements.
They will quote statistics without reference, try to ‘impress’ the group discussion by citing their vast knowledge and experience. Others will go with the old narrow, “Well it worked for me” scenario.
Enough already people.
First of all, we know that A.A. does not take surveys or keep statistics on this type of information. Secondly, due to this fact, A.A. effectiveness cannot be viewed or measured on an “evidence based system.”
Therefore, effectiveness is of a subjective nature, not an empirically based one.
This is not to say that twelve step programs are not effective for many people – they are and can be. On the other hand, this does not mean they will work for everyone nor does it mean that they can be effective in and of themselves.
In a previous blog (http://willydrinkwater.blogspot.com/2012/04/substance-abuse-co-occurring-disorders.html) I mentioned the fact that I work primarily with those that have substance abuse coupled to co-occurring disorders; such as depression and bipolar disorder. Rarely will my clients benefit from traditional twelve step programs alone. Many will utilize them as their ‘base’ of recovery; however they may also be involved with individual & group therapies, twelve step programs such as DRA (dual recovery anonymous), nutrionists, psychopharmocologists, etc.
The question should be, “Is A.A. effective for the client; can it be effective for the client?”
Treatment plans should be ‘individualized.’ Not one size fits all, right? For instance, Cognitive Behavior Therapy does not conflict with A.A. As a matter of fact, in most instances it complements A.A. It can help a person to look at their value system and assist them in making needed changes.
Loyalty on the part of a therapist/counselor to a particular modality of treatment such as A.A. coupled to an indifference to the other modalities or mix of modalities can result in the client not being effectively served.
What is in the CLIENT’S BEST INTEREST.
Friday, April 27, 2012
Tuesday, April 24, 2012
Sober… & Still Crazy
December 10th, 1985 marks the start point of my sobriety. I have been working in the field of addiction/psych for twenty plus years now.
Before going further I feel the need to state that ‘I do not believe a person has to be recovery (or recovered) in order to work effectively with those that have addiction and/or co-occurring disorders; such as depression, bipolar disorder, trauma, grief, abandonment, etc.’
I have several close friends that work in the field that do not have ‘addiction issues.’ What they do have is excellent clinical experience coupled to a sound academic background. Empathy, compassion, and the ability to listen are the qualities and hallmarks required of a good counselor.
When I first began in the field working shelters and open detox units, I was always fascinated by the patients that never seemed to sleep, those that never seemed able to get out of bed, and those that appeared to be carrying on conversations with people that were not there.
In later years I realized my fascination in part was more than likely due to my ‘other’ issue which came to a head ten years into my sobriety.
The other issue is being a person with Bipolar Type II Disorder. At the time my wife and I were going through couples counseling (thirty-two years married as of this month – guess counseling works, huh?) During the course of our sessions the therapist would continually have to ask me to not interrupt my wife when she was talking and then the therapist would have difficulty trying to get me to ‘come up for air’ once I started on a roll. After a few sessions like this, the therapist suggested that I see a psychiatrist she worked closely with.
Long story short, I was diagnosed with Bipolar II Type Disorder. For me, this was marked by minimal sleep, always having multiple projects going on (with few of them ever being completed), rapid, pressured, tangential speech, and a mercurial temperament. After weeks of running on minimal sleep my mood would become dark and foreboding. AA often refers to this state as a ‘dry drunk.’ I refer to it agitated depression.
When I was on the comedy scene people with my traits were viewed by many as ‘normal.’ People spoke of performers as often times having an “Artist’s Temperament.”
One of my favorite quotes is by Arthur Schopenhauer, “Every person takes the limits of their own field of vision for the limits of the world.”
In other words, if the people you are hanging with have similar traits then everyone is that way, right? In much the same way when I have a patient that says, “All my friends drink the way I do, so how can I be an alcoholic.” Birds of a feather…
For those of us that are “Dualies” (people with substance abuse & co-occurring disorders), there are support groups such as DBSA (Depression Bipolar Support Alliance) and DRA (Dual Recovery Anonymous - 12 Step based). In these groups people can identify with someone that not only used what they did, but also have their same co-occurring issue. (I will do a future blog on these two groups).
This is not to say that traditional 12 Step groups cannot form the foundation of a dual-diagnosed person’s recovery. Of course they can. One learns how to socialize again or for the first time without a drug or drink, and the common purpose is not to drug or drink.
Rarely however will the traditional meeting be enough for those of us with a co-occurring disorder(s) to maintain sobriety and balance. Just ask the people in the dual-diagnosis day treatment program I work in. They will tell you that they cannot discuss their other mental health issues without being ostracized by some members. So they have a meeting after the meeting to discuss those ‘other’ issues with people they know to be of the same bent.
I intentionally have not gone into detail regarding medications or practices I employ to maintain stability for a simple reason. What works for me may not for someone else. Therefore I do not want to set-up an expectation. A person with substance abuse and a co-occurring disorder should have his or her plan of action based on their specific issues and nuances; an individualized treatment plan in other words.
Before going further I feel the need to state that ‘I do not believe a person has to be recovery (or recovered) in order to work effectively with those that have addiction and/or co-occurring disorders; such as depression, bipolar disorder, trauma, grief, abandonment, etc.’
I have several close friends that work in the field that do not have ‘addiction issues.’ What they do have is excellent clinical experience coupled to a sound academic background. Empathy, compassion, and the ability to listen are the qualities and hallmarks required of a good counselor.
When I first began in the field working shelters and open detox units, I was always fascinated by the patients that never seemed to sleep, those that never seemed able to get out of bed, and those that appeared to be carrying on conversations with people that were not there.
In later years I realized my fascination in part was more than likely due to my ‘other’ issue which came to a head ten years into my sobriety.
The other issue is being a person with Bipolar Type II Disorder. At the time my wife and I were going through couples counseling (thirty-two years married as of this month – guess counseling works, huh?) During the course of our sessions the therapist would continually have to ask me to not interrupt my wife when she was talking and then the therapist would have difficulty trying to get me to ‘come up for air’ once I started on a roll. After a few sessions like this, the therapist suggested that I see a psychiatrist she worked closely with.
Long story short, I was diagnosed with Bipolar II Type Disorder. For me, this was marked by minimal sleep, always having multiple projects going on (with few of them ever being completed), rapid, pressured, tangential speech, and a mercurial temperament. After weeks of running on minimal sleep my mood would become dark and foreboding. AA often refers to this state as a ‘dry drunk.’ I refer to it agitated depression.
When I was on the comedy scene people with my traits were viewed by many as ‘normal.’ People spoke of performers as often times having an “Artist’s Temperament.”
One of my favorite quotes is by Arthur Schopenhauer, “Every person takes the limits of their own field of vision for the limits of the world.”
In other words, if the people you are hanging with have similar traits then everyone is that way, right? In much the same way when I have a patient that says, “All my friends drink the way I do, so how can I be an alcoholic.” Birds of a feather…
For those of us that are “Dualies” (people with substance abuse & co-occurring disorders), there are support groups such as DBSA (Depression Bipolar Support Alliance) and DRA (Dual Recovery Anonymous - 12 Step based). In these groups people can identify with someone that not only used what they did, but also have their same co-occurring issue. (I will do a future blog on these two groups).
This is not to say that traditional 12 Step groups cannot form the foundation of a dual-diagnosed person’s recovery. Of course they can. One learns how to socialize again or for the first time without a drug or drink, and the common purpose is not to drug or drink.
Rarely however will the traditional meeting be enough for those of us with a co-occurring disorder(s) to maintain sobriety and balance. Just ask the people in the dual-diagnosis day treatment program I work in. They will tell you that they cannot discuss their other mental health issues without being ostracized by some members. So they have a meeting after the meeting to discuss those ‘other’ issues with people they know to be of the same bent.
I intentionally have not gone into detail regarding medications or practices I employ to maintain stability for a simple reason. What works for me may not for someone else. Therefore I do not want to set-up an expectation. A person with substance abuse and a co-occurring disorder should have his or her plan of action based on their specific issues and nuances; an individualized treatment plan in other words.
Tuesday, April 17, 2012
The Stigma of Addiction/The Stigma of Mental health
I can remember growing up in the sixties in an affluent town in Connecticut (our family was middle class – felt the need to put that in). There were no alcoholics; only problem drinkers or those who could not hold their liquor; a sign of the times I guess, the country club attitude, or perhaps a combination of both.
No alcoholics – therefore, no stigma.
God forbid, if you had a loved one that died of cirrhosis from alcoholism in those days. You begged the doctor to put anything down on the death certificate but that; maybe a heart attack, some incurable disease, etc.
As if the neighbors and friends did not know. It was just not discussed. Well openly anyway.
Zoom ahead to now. Addiction is more openly discussed in families and social settings than ever before. Yet at times one can see that stigma is still prevalent and often ignored or downplayed. How else can one explain that up until a few years ago if a person was civilly committed in Massachusetts (Section 35) for mandated addiction treatment they would be sent to a correctional facility? That’s right a correctional facility, not a treatment facility.
I am glad to see that this ‘stigma’ piece has changed.
There are still those in our society that mumble, ‘you know those people want to be that way.’ I always find it interesting when these people change that attitude when it is a member of their family that suddenly appears to be having an addiction issue. I guess it is just not the same thing.
Those people want to be that way? You know, I have yet to see it on a resume, ‘Professional Addict/Alcoholic.’ Yea I’m sure when they were growing up they were thinking, ‘you know, someday I want to become a professional addict/alcoholic; homeless, jobless, walking the streets, drinking a half-gallon of vodka a day.’ Yup, that’s what I want to do.
People who make those types of statements show their ignorance; they are part of the problem – not the solution.
There are other areas of mental health often times shrouded in stigma and secrecy. Why else would a family not talk about ‘Uncle Tony’ who has not worked in two years due to his depression, or, no one talks about the times when ‘Grandma' has made Sunday morning breakfast for everyone practically naked because she was in a full-blown manic episode.
In the case of depression, one might hear encouraging words from family such as: ‘what do you have to be depressed about’ or, ‘just pick yourself up by the bootstraps.’
Gee, those motivating statements should do the trick. I do not understand how ‘putdowns’ of that type can be considered motivating. Can someone explain to me how that works?
Yet these are statements that patients/clients tell me they can go through on a daily basis. There are support groups for the friends and families of those with addiction and/or other mental health issues.
Often times the patients/clients I work with tell me their families are not willing to attend such groups to learn about their illnesses due to the beliefs I stated previously.
The suggestion I make to them in that case is, look directly at them and say something to the effect, ‘you say you love me, and care about me, but you won’t attend a group to learn about my illness…’ Some people have told me this is unethical to suggest – so be it. I advocate for my patients/clients however I can.
We need to continue to have dialogue and education on addiction and mental health issues; we need to do away with ‘blanket’ statements that allow us to turn our heads away from these issues; we all need to be part of the ongoing solutions.
There is no place for ignorance and stigma if we truly care about our fellow human beings.
No alcoholics – therefore, no stigma.
God forbid, if you had a loved one that died of cirrhosis from alcoholism in those days. You begged the doctor to put anything down on the death certificate but that; maybe a heart attack, some incurable disease, etc.
As if the neighbors and friends did not know. It was just not discussed. Well openly anyway.
Zoom ahead to now. Addiction is more openly discussed in families and social settings than ever before. Yet at times one can see that stigma is still prevalent and often ignored or downplayed. How else can one explain that up until a few years ago if a person was civilly committed in Massachusetts (Section 35) for mandated addiction treatment they would be sent to a correctional facility? That’s right a correctional facility, not a treatment facility.
I am glad to see that this ‘stigma’ piece has changed.
There are still those in our society that mumble, ‘you know those people want to be that way.’ I always find it interesting when these people change that attitude when it is a member of their family that suddenly appears to be having an addiction issue. I guess it is just not the same thing.
Those people want to be that way? You know, I have yet to see it on a resume, ‘Professional Addict/Alcoholic.’ Yea I’m sure when they were growing up they were thinking, ‘you know, someday I want to become a professional addict/alcoholic; homeless, jobless, walking the streets, drinking a half-gallon of vodka a day.’ Yup, that’s what I want to do.
People who make those types of statements show their ignorance; they are part of the problem – not the solution.
There are other areas of mental health often times shrouded in stigma and secrecy. Why else would a family not talk about ‘Uncle Tony’ who has not worked in two years due to his depression, or, no one talks about the times when ‘Grandma' has made Sunday morning breakfast for everyone practically naked because she was in a full-blown manic episode.
In the case of depression, one might hear encouraging words from family such as: ‘what do you have to be depressed about’ or, ‘just pick yourself up by the bootstraps.’
Gee, those motivating statements should do the trick. I do not understand how ‘putdowns’ of that type can be considered motivating. Can someone explain to me how that works?
Yet these are statements that patients/clients tell me they can go through on a daily basis. There are support groups for the friends and families of those with addiction and/or other mental health issues.
Often times the patients/clients I work with tell me their families are not willing to attend such groups to learn about their illnesses due to the beliefs I stated previously.
The suggestion I make to them in that case is, look directly at them and say something to the effect, ‘you say you love me, and care about me, but you won’t attend a group to learn about my illness…’ Some people have told me this is unethical to suggest – so be it. I advocate for my patients/clients however I can.
We need to continue to have dialogue and education on addiction and mental health issues; we need to do away with ‘blanket’ statements that allow us to turn our heads away from these issues; we all need to be part of the ongoing solutions.
There is no place for ignorance and stigma if we truly care about our fellow human beings.
Wednesday, April 11, 2012
Waste of Time???
The patient came to our partial hospitalization program with a history of bouncing from shelter to shelter; short term program to short term program. He was admitted to our free male dorm to attend the program and I initially felt concerned that he might attempt “squatters rights” when the time came to discharge.
When case managing such a patient, one needs’ to be careful not to assume this will be the case again; even though it would understandably, be easy to do so.
Having this ‘history’ in mind I was a bit taken back when the first day he asked if I had lists of half-way houses and transitional programs for the Boston area. ‘I don’t want to wait until last second,’ he told me. Sure I said, and provided him with the lists feeling slightly perplexed.
For the next two weeks he could be found on the patient phone before groups started in the morning, in between groups, and after the group day making calls to various programs. He would then come to me to make the follow-up calls to see what information I needed to fax them (usually the bio/psych/social, TB test results, etc.).
Usually most mornings I head into work early so as to be able to ease into the day, have a second cup of coffee, do some writing (such as this blog for instance).
Well, on many of these mornings I would arrive and this patient would be waiting for me to call programs that he had spoken with the day before, after I had left for the day. I would have to explain to him that most programs would not have someone to ‘chat’ with at six-thirty; maybe we should wait until around nine o’clock or so.
Several times I would have to catch myself from getting annoyed with him; geez, he was doing the footwork on his aftercare, right?
He had never attended a half-way house. We had applied to five and were waiting to hear back from them. Late one afternoon I received a call from one of them stating he was accepted and that they would have a bed for him the following week. I needed to call the insurance company and seriously advocate that he be allowed to continue our program till the following week – which I gladly did and secured the time for him.
When I informed the patient he seemed happy, yet a bit frightened by this prospect of change. I explained to him that I would be more concerned if he did not feel nervous and apprehensive; after all he had been up to that point in a safe, secure, environment.
At the time I truly believed I had allayed his fears.
The patient was four days from what would have been his discharge date to enter the half-way house – and he took off! Someone on staff at the morning interdisciplinary rounds when hearing of this said, ‘that was a waste of time, huh?’
Actually, I do not see it that way; disappointing, yea, of course; but a waste of time?
Absolutely Not.
How so? This patient took his treatment to a new level when he came into our program and started calling programs to advocate for himself. He had never done that before. Although he did not ‘close the deal,’ maybe next time he will.
I’ve heard over the years it is about, “Progress not Perfection.”
When case managing such a patient, one needs’ to be careful not to assume this will be the case again; even though it would understandably, be easy to do so.
Having this ‘history’ in mind I was a bit taken back when the first day he asked if I had lists of half-way houses and transitional programs for the Boston area. ‘I don’t want to wait until last second,’ he told me. Sure I said, and provided him with the lists feeling slightly perplexed.
For the next two weeks he could be found on the patient phone before groups started in the morning, in between groups, and after the group day making calls to various programs. He would then come to me to make the follow-up calls to see what information I needed to fax them (usually the bio/psych/social, TB test results, etc.).
Usually most mornings I head into work early so as to be able to ease into the day, have a second cup of coffee, do some writing (such as this blog for instance).
Well, on many of these mornings I would arrive and this patient would be waiting for me to call programs that he had spoken with the day before, after I had left for the day. I would have to explain to him that most programs would not have someone to ‘chat’ with at six-thirty; maybe we should wait until around nine o’clock or so.
Several times I would have to catch myself from getting annoyed with him; geez, he was doing the footwork on his aftercare, right?
He had never attended a half-way house. We had applied to five and were waiting to hear back from them. Late one afternoon I received a call from one of them stating he was accepted and that they would have a bed for him the following week. I needed to call the insurance company and seriously advocate that he be allowed to continue our program till the following week – which I gladly did and secured the time for him.
When I informed the patient he seemed happy, yet a bit frightened by this prospect of change. I explained to him that I would be more concerned if he did not feel nervous and apprehensive; after all he had been up to that point in a safe, secure, environment.
At the time I truly believed I had allayed his fears.
The patient was four days from what would have been his discharge date to enter the half-way house – and he took off! Someone on staff at the morning interdisciplinary rounds when hearing of this said, ‘that was a waste of time, huh?’
Actually, I do not see it that way; disappointing, yea, of course; but a waste of time?
Absolutely Not.
How so? This patient took his treatment to a new level when he came into our program and started calling programs to advocate for himself. He had never done that before. Although he did not ‘close the deal,’ maybe next time he will.
I’ve heard over the years it is about, “Progress not Perfection.”
Monday, April 9, 2012
Substance Abuse / Co-Occurring Disorders & 12 Step Programs
When I am educating my patients on community resources one of the first statements I make to them is that if you are attending, or, plan to attend traditional 12 Step meetings, please, please, for your own sake do not discuss or talk about any medications that you are prescribed and currently on for a co-occurring disorder.
It just takes one person to hear what is being said and feel the 'need' to tell the person they are 'chewing' their booze, and that they are not sober.
Before going into more detail and examples, I feel I should state for the record that I am NOT ANTI-12 STEP. As a matter of fact, many people that are 'dual-diagnosed' utilize traditional 12 Step meetings as their base of recovery. Traditional 12 Step meetings can help one to learn again (or for the first time) how to socialize without a drug or drink in their system. Also, people attending these meetings share a common goal, namely, maintaining and fostering sobriety.
Conflicts can arise for the dual-diagnosed person in these meetings with regards to some of the traditionally held sayings and beliefs.
Example: I had a client that was told at a meeting to, “Just go to another meeting.” Well, the fact of the matter was my client had been awake for four days and had attended six meetings. What he really needed was a medication adjustment for his bipolar disorder.
Example: “No one ever died from lack of sleep.” I have never sought research to confirm or deny this statement. I can tell you from working in the psych/addiction field for twenty plus years now, people can become extremely paranoid, psychotic, and suicidal if they have been awake for a number of days (particularly people in a manic episode for instance).
Example: “They broke out because they stopped going to meetings.” This is definitely a blanket statement. What if the person was ‘so depressed’ they could not get out of bed?
I recently had a patient I was working with inform me that his AA sponsor was telling him to ‘get off’ the anti-depressant he is on. He asked me what he should do. I asked him if he felt the anti-depressant was working for him, he said yes. I told him I think you have your answer then.
So what are some of the other support groups? The first one I tell them about is DBSA - Depression Bipolar Support Alliance (www.dbsalliance.org/ ). These are meetings for people that have major depression with or without anxiety, and those with bipolar disorder.
The largest group within these meetings is “Double Trouble.” These are people with substance abuse coupled to the aforementioned above. People who often times were trying to self-medicate. Many of these members also belong to traditional 12 Step groups as well.
In much the same way that 12 Step programs have sponsors, people in “Double Trouble” can find a sponsor that not only has their same addiction, but the other mental health issue as well; “you pace your kitchen at 3am agitated and drinking – I thought I was the only one!”
The reason support groups work for many people is the identification factor. I realize now that I am not the only person that has ever felt or feels the way I do. I am not alone.
Another group is DRA – Dual Recovery Anonymous (http://draonline.org/ ). This is a 12 Step based group. In these meetings people can not only talk about their addiction issues, they can also discuss their other mental health issues as well. In traditional 12 Step if you want to discuss the other mental health issues you do so after the regular meeting (sometimes referred to as the meeting after the meeting).
DRA is relatively young compared to the other support groups; and meetings can be far and few between. Several months ago I had a couple of former patients drop by the program where I work and they were complaining about this very fact.
I told them I had a suggestion. There are two of you, and it only takes two to have a meeting, right? So why don’t you contact DRA to get the materials to start a new meeting group of your own. They liked that idea (Hopefully they have done so).
Until the next blog,
WRD
It just takes one person to hear what is being said and feel the 'need' to tell the person they are 'chewing' their booze, and that they are not sober.
Before going into more detail and examples, I feel I should state for the record that I am NOT ANTI-12 STEP. As a matter of fact, many people that are 'dual-diagnosed' utilize traditional 12 Step meetings as their base of recovery. Traditional 12 Step meetings can help one to learn again (or for the first time) how to socialize without a drug or drink in their system. Also, people attending these meetings share a common goal, namely, maintaining and fostering sobriety.
Conflicts can arise for the dual-diagnosed person in these meetings with regards to some of the traditionally held sayings and beliefs.
Example: I had a client that was told at a meeting to, “Just go to another meeting.” Well, the fact of the matter was my client had been awake for four days and had attended six meetings. What he really needed was a medication adjustment for his bipolar disorder.
Example: “No one ever died from lack of sleep.” I have never sought research to confirm or deny this statement. I can tell you from working in the psych/addiction field for twenty plus years now, people can become extremely paranoid, psychotic, and suicidal if they have been awake for a number of days (particularly people in a manic episode for instance).
Example: “They broke out because they stopped going to meetings.” This is definitely a blanket statement. What if the person was ‘so depressed’ they could not get out of bed?
I recently had a patient I was working with inform me that his AA sponsor was telling him to ‘get off’ the anti-depressant he is on. He asked me what he should do. I asked him if he felt the anti-depressant was working for him, he said yes. I told him I think you have your answer then.
So what are some of the other support groups? The first one I tell them about is DBSA - Depression Bipolar Support Alliance (www.dbsalliance.org/ ). These are meetings for people that have major depression with or without anxiety, and those with bipolar disorder.
The largest group within these meetings is “Double Trouble.” These are people with substance abuse coupled to the aforementioned above. People who often times were trying to self-medicate. Many of these members also belong to traditional 12 Step groups as well.
In much the same way that 12 Step programs have sponsors, people in “Double Trouble” can find a sponsor that not only has their same addiction, but the other mental health issue as well; “you pace your kitchen at 3am agitated and drinking – I thought I was the only one!”
The reason support groups work for many people is the identification factor. I realize now that I am not the only person that has ever felt or feels the way I do. I am not alone.
Another group is DRA – Dual Recovery Anonymous (http://draonline.org/ ). This is a 12 Step based group. In these meetings people can not only talk about their addiction issues, they can also discuss their other mental health issues as well. In traditional 12 Step if you want to discuss the other mental health issues you do so after the regular meeting (sometimes referred to as the meeting after the meeting).
DRA is relatively young compared to the other support groups; and meetings can be far and few between. Several months ago I had a couple of former patients drop by the program where I work and they were complaining about this very fact.
I told them I had a suggestion. There are two of you, and it only takes two to have a meeting, right? So why don’t you contact DRA to get the materials to start a new meeting group of your own. They liked that idea (Hopefully they have done so).
Until the next blog,
WRD
Wednesday, April 4, 2012
Addiction & Depression
I continue to be baffled when I hear of people being started on anti-depressants while they are still in a detox or shortly after being released from one without having had a previous history of depression. If you need to be detoxed from your drug of choice (yes, alcohol is also a drug) then your central nervous system has taken a major ‘hit.’
Post detox, there is going to be some degree of depression; from feeling a little out of ‘sorts,’ to, ‘man, I slept 12 hours and I still feel exhausted,’ or, ‘man, I was up and down every hour last night!’
This is part of the price for travel.
What we need to watch for is whether this is a case of substance induced mood disorder, or, true major depressive disorder. Substance induced mood disorder will usually clear over a period of time. How long it takes depends on variables such as: what type of drugs, how much, for how long, medical issues that may also be going on, etc.
What was the person’s history like when they were drug and alcohol free for an extended period of time? Did they have bouts of depression over a lengthy period of sobriety? If so, were there life events that could have brought on depression such as: end of a relationship, death of a loved one, losing a job, etc.
As I say to my patients, “Do I drink/drug because I am depressed, or, depressed because I drink/drug?”
The answer is “Yes.”
Both issues need to be addressed concurrently. Prescribing a psycho-active drug and not requiring a person to be in some type of treatment or therapy to help determine the causation to me is just another example of our societies often held belief, “give me a pill, fix me now!”
I remember reading years ago a recommendation that was put forth by a collaborative effort between MGH and McLean’s Hospital that if a person was not a good historian as to their past mood status, or, did not have a history of extended periods of sobriety from which to report, then being followed by a qualified therapist on a weekly basis for a period of between two weeks to two months, they should be able to ascertain if medication intervention is warranted.
So what would I recommend before the start of anti-depressants? Well for starters, how about a complete physical exam with blood work to establish a beginning baseline; not the knee tap, cough, cough, quick look-see that more often than not takes place when one is entering a detox.
Next, a nutrition consult. In one of the programs that I currently work in I inform the patients that I can arrange such a consult. Very few ever take me up on my offer. I recommend to them that they stay away for the alcohol/addict diet; nicotine, caffeine, flour, sugar and sometimes Crisco (deep fried food).
Then on the agenda is exercise. I suggest they start out by walking maybe two or three days a week for twenty minutes to half an hour. One just has to ‘Google’ exercise and mental/physical health to see the benefits that can be derived. Exercise is a natural mood elevator. Caution should observed in not doing too much, too soon however.
By the way, if a person wants a safe, family orientated place to work out but money is an issue, YMCA’s will never turn anyone away for an inability to pay. They will have a person fill out financial aid forms and adjust the membership fees accordingly. Many halfway houses here in the Boston area have agreements with local YMCA’s for their house members. Makes sense, no? (I must admit I am a little biased here. I have been a member of the “Y” since the age of six, lol)
To me the most insidious form of depression is dysthymia. The U.S. National Library of Medicine defines it as: “a chronic type of depression in which a person's moods are regularly low. However, symptoms are not as severe as with major depression.”
In my private practice if I have a client that has several months clean and he or she begins to talk about being bored and/or tired I see red flags flying all over the place.
You feel bored?
Yea, there’s nothing to do. At least when I used I didn’t feel anything.
Did you ever have a time in your life that you had ‘stuff’ to do?
Well yea, but I was a kid.
What type of stuff?
You know, go hiking, fishing, maybe hit the movies.
Why don’t you try to do some of those things now?
I would but I’m always so wicked tired.
Are you bored and tired, or possibly in a dysthymic state of depression. Research states that more women than men suffer from depression. From my clinical observations of the past twenty years I don’t believe this to be true.
What I do believe is that more women than men ‘report’ depression. This might explain why more men than women are successful in their first suicide attempts. Although ‘successful’ is not really a great term to use. (http://www.sciencedaily.com/releases/1998/11/981112075159.htm)
Men are more apt to report addiction issues before other mental health issues; women the inverse is true.
On a final note, I always suggest to my patients that they do not allow their primary care physicians to prescribe them psycho-active medications. They simply do not have the expertise to do so. If you knew how much time (or how little time as the case is) they had in medical school on addiction and mental health, I doubt you would really want them prescribing for you. Unless of course, you are looking for a doctor “feel good.”
As an example, you go to your primary care physician stating you feel depressed. He or she may think, well, xyz medication is fairly innocuous; I’ll just put them on a low dose, that’s all. Did they ask you how long you have felt depressed, or, have you recently been going through life changes such as: death of a loved one, loss of a job, or, the big question, ‘have you been feeling suicidal?’ Did they highly suggest that you see a therapist in addition to the medication? Probably not.
Post detox, there is going to be some degree of depression; from feeling a little out of ‘sorts,’ to, ‘man, I slept 12 hours and I still feel exhausted,’ or, ‘man, I was up and down every hour last night!’
This is part of the price for travel.
What we need to watch for is whether this is a case of substance induced mood disorder, or, true major depressive disorder. Substance induced mood disorder will usually clear over a period of time. How long it takes depends on variables such as: what type of drugs, how much, for how long, medical issues that may also be going on, etc.
What was the person’s history like when they were drug and alcohol free for an extended period of time? Did they have bouts of depression over a lengthy period of sobriety? If so, were there life events that could have brought on depression such as: end of a relationship, death of a loved one, losing a job, etc.
As I say to my patients, “Do I drink/drug because I am depressed, or, depressed because I drink/drug?”
The answer is “Yes.”
Both issues need to be addressed concurrently. Prescribing a psycho-active drug and not requiring a person to be in some type of treatment or therapy to help determine the causation to me is just another example of our societies often held belief, “give me a pill, fix me now!”
I remember reading years ago a recommendation that was put forth by a collaborative effort between MGH and McLean’s Hospital that if a person was not a good historian as to their past mood status, or, did not have a history of extended periods of sobriety from which to report, then being followed by a qualified therapist on a weekly basis for a period of between two weeks to two months, they should be able to ascertain if medication intervention is warranted.
So what would I recommend before the start of anti-depressants? Well for starters, how about a complete physical exam with blood work to establish a beginning baseline; not the knee tap, cough, cough, quick look-see that more often than not takes place when one is entering a detox.
Next, a nutrition consult. In one of the programs that I currently work in I inform the patients that I can arrange such a consult. Very few ever take me up on my offer. I recommend to them that they stay away for the alcohol/addict diet; nicotine, caffeine, flour, sugar and sometimes Crisco (deep fried food).
Then on the agenda is exercise. I suggest they start out by walking maybe two or three days a week for twenty minutes to half an hour. One just has to ‘Google’ exercise and mental/physical health to see the benefits that can be derived. Exercise is a natural mood elevator. Caution should observed in not doing too much, too soon however.
By the way, if a person wants a safe, family orientated place to work out but money is an issue, YMCA’s will never turn anyone away for an inability to pay. They will have a person fill out financial aid forms and adjust the membership fees accordingly. Many halfway houses here in the Boston area have agreements with local YMCA’s for their house members. Makes sense, no? (I must admit I am a little biased here. I have been a member of the “Y” since the age of six, lol)
To me the most insidious form of depression is dysthymia. The U.S. National Library of Medicine defines it as: “a chronic type of depression in which a person's moods are regularly low. However, symptoms are not as severe as with major depression.”
In my private practice if I have a client that has several months clean and he or she begins to talk about being bored and/or tired I see red flags flying all over the place.
You feel bored?
Yea, there’s nothing to do. At least when I used I didn’t feel anything.
Did you ever have a time in your life that you had ‘stuff’ to do?
Well yea, but I was a kid.
What type of stuff?
You know, go hiking, fishing, maybe hit the movies.
Why don’t you try to do some of those things now?
I would but I’m always so wicked tired.
Are you bored and tired, or possibly in a dysthymic state of depression. Research states that more women than men suffer from depression. From my clinical observations of the past twenty years I don’t believe this to be true.
What I do believe is that more women than men ‘report’ depression. This might explain why more men than women are successful in their first suicide attempts. Although ‘successful’ is not really a great term to use. (http://www.sciencedaily.com/releases/1998/11/981112075159.htm)
Men are more apt to report addiction issues before other mental health issues; women the inverse is true.
On a final note, I always suggest to my patients that they do not allow their primary care physicians to prescribe them psycho-active medications. They simply do not have the expertise to do so. If you knew how much time (or how little time as the case is) they had in medical school on addiction and mental health, I doubt you would really want them prescribing for you. Unless of course, you are looking for a doctor “feel good.”
As an example, you go to your primary care physician stating you feel depressed. He or she may think, well, xyz medication is fairly innocuous; I’ll just put them on a low dose, that’s all. Did they ask you how long you have felt depressed, or, have you recently been going through life changes such as: death of a loved one, loss of a job, or, the big question, ‘have you been feeling suicidal?’ Did they highly suggest that you see a therapist in addition to the medication? Probably not.
Subscribe to:
Posts (Atom)