Friday, September 18, 2009

Psychiatric Medication in Recovery

Psychiatric Medications are an acceptable part of a good Recovery Program. That said, there are clear guidelines which while not written in stone should be well known to those in recovery or those prescribing to those in recovery should the need for medications arise.
Abstinence from all substances is clearly the aim in the first year of recovery. A study out of Hazelton showed that there was greater relapse in those who used antidepressants than those who did not. There were factors of what was controlled for in this study but it did give an indication of the potential hazard 'treating a drug' problem with a drug might be.
Any drug that has a "price" on the street has potential for abuse and should be seriously considered before use in early recovery. This specifically refers to all the benzodiazepine class and the the amphetamines and pain killers.
The benzodiazepine class includes valium, diazepam, alprazolam, ativan, clonazepam, and temazepams as examples. The amphetamine class includes the dexedrine and ritalins. The pain killers are the narcotic class of drugs codeine, tylenol#1,2and 3, oxycontins, demerols etc.
This doesn't however refer to antidepressants or antipsychotics which necessarily have a positive place in recovery. Medications such as the SSRI's, paxil, prozac, zoloft, celexa, cipralex and the more broad spectrum antidepressants, effexor, duloxetine, remeron, wellbutrin are often beneficial in recovery. Antipsychotics or tranquillizers such as seroquel, zyprexia, rispiridone, zeldox, loxapine, flupethixol are very beneficial and commonly used instead of the benzodiazepine class for anxiety.
At an addiction medicine conference this summer the presenter asked how many of the hundreds of addictionists present had prescribed benzodiazepines or amphetamines or pain killers and 90% admitted to this practice. The majority of those doctors there were in 12 step recovery programs themselves.
The presenter said that the key factor was the 'recovery' program and the duration of recovery before the introduction of medication.
Each case required individualization within the context of strong guidelines putting recovery in the forefront.


Anonymous said...

Not only should we be leery of Doctors who seem to know little about the recovery process, we should be careful regarding our attitudes in the rooms. I recently read a peer reviewed journal article that looked at why people drop out of 12-step programs, one that was mentioned was folks that were made to feel uneasy about taking their psych meds. These are often people who need our support the most. There is a line in "acceptance is the answer" where Paul O. says something to the effect of "I can't ask God to solve my problems but in the mean time I'll rely on this pill" but I personally don't want any of my sponsees going postal at the local high school because they stopped taking their depacot.

haykind said...

I agree. I've been round long enough though to really appreciate Rob Lowe's comment recently when asked why he thought people didn't go to AA, something to the effect 'any excuse will do". I really liked Dr O's comments on the alcoholics and addicts capacity for criticism, "I could find a problem with a white wall and if you didn't see it that was even more of a problem." More and more I realize that in addiction the decision is being made by the drug telling the addict what they need in isolation, while in medicine and psychiatry, the doctor and patient get together in relationship and community to tell the drug what to do.