By David Joel Miller.
How safe is it for someone in recovery from drugs or alcohol to take psych meds?
Many recovering people are worried about the effects of taking psychiatric meds on their recovery. The recovery community has long been divided on this issue. Here is some background on the topic and my thoughts as a professional counselor.
Any decision to take, start or stop any medication should be talked over with your doctor. There can be side effects, withdrawal effects and the effects of the medication can change over time as your body adjusts to the effects. Never make sudden changes to meds without talking to your doctor.
Unfortunately, not all doctors are equally informed when it comes to the area of addiction and psychiatric medication. You need to be an informed consumer. Ask questions and talk these issues out with your doctor. Here are some things to consider in making your decision about taking psychiatric meds.
One long-standing belief in some recovery circles is that if you are taking medication then you are not clean, you are still using a drug to alter the way you feel. I think this is a bogus argument.
If you have a medical condition and there is a med that will help you, by all means, take that med. Diabetics need insulin and using that should in no way interfere with or compromise your sobriety.
Are you taking your meds AS PRESCRIBED!
This question is important. It is not should you take them but are you using them correctly.
Two med compliance issues arise for people in recovery. One they tend to play doctor and one day they take the med then the next day when they feel better they skip the meds. Most meds, and psychiatric meds are especially in this group; need to be taken every day. You need a certain level in your bloodstream to be effective. Taking them some days and not others can result in developing tolerance more rapidly, or can prevent building tolerance and can result in them not working correctly when you start taking them again.
Do not do the on and off thing with prescribed meds. Take them as prescribed.
Second problem – If one is good 30 should work better right?
If you find yourself boosting the dose, taking more than was prescribed, this is the dangerous path to addiction and problems. First, most psych meds do not work that way. More is not better. The correct dose is what you need and only you and your doctor working together can figure that one out. If taking more of most psych meds makes you feel better, then this may be more a placebo effect than the meds. Talk to your doctor and your counselors about those issues.
As a counselor what can I tell you about psych meds and their risk for recovering people? Here are my thoughts based on experience for whatever they are worth. If this gets you thinking for or against, please talk this over with your doctor.
There are four main categories (based on use not chemical formula) of psych meds, Antidepressants, Mood stabilizers (anti-mania), antipsychotics and Anti-anxiety meds.
Let’s look at these one at a time and let me tell you what clients who have taken them tell me about the effects they have had on their recovery. I will sneak in a few things from the effects of drugs and alcohol on the body and the brain class I teach. For more on this topic check either “Drug Use and Abuse, Maisto, Galizio and Connors” or “Uppers Downers and All Arounders, Inaba and Cohen.” Any recent edition has good information.
These are NOT happy pills. They need to build up slowly over time and it can take 30 or 45 days to have an effect. You must take them every day as prescribed.
No self-respecting addict will take a pill today to feel better a month from now. No one in recovery has told me they had any problem with an antidepressant. If you don’t need them they just don’t do much and pass out of your system.
Occasionally someone will have sudden, week or ten days, response to an antidepressant this makes me think that the person may have bipolar disorder or that this is a medication-induced hypomanic episode. If that happens, talk it over with your doctor. This is rare in my experience though I suspect psychiatrists see this more than a recovery counselor hears about it.
Either way, I don’t worry about clients in substance abuse recovery taking an anti-depressant.
2. Mood stabilizers (anti-mania.)
Mood stabilizers are used to treat Bipolar and other mood instability problems. I am told they do not make you feel any particular way. They seem to just take the edge off.
Some of these have side effects that people find unpleasant. If you need them you need them if not you will not want to take them. Either way, there is not a lot of abuse potential for recovering people.
There are two main kinds of antipsychotics the older ones or typical and the newer atypical. Some of the older ones are very sedating and they tended to be overused in prisons and institutions to keep people “zombie out.” If you like being stoned and nodding out all the time then you may want to discuss with your doctor taking the newer atypical antipsychotics.
The newer atypical ones, no one has said they like how it feels enough to abuse it. Mostly they do not like the risk of weight gain that comes with these. If you take an antipsychotic invest some time in diet and exercise and try to keep the weight off.
All in all, antipsychotics do not seem to be a big issue for those who are in recovery.
Not taking an anti-psychotic if you need one, is a major risk for relapse if you are in recovery. Getting rid of or managing hallucinations or delusions are best done with prescribed medication and counseling, not street drugs.
4. Anti-anxiety meds.
This one seems to cause the most problems for people in recovery.
If you need them, you really need them, and prescribed meds are a whole lot better than alcohol or street drugs for managing anxiety.
The worry with this group of meds is that many, (probably most) are tranquilizers. People can and do abuse these. So if you are one of those “the more pills the better” people, you will need to have that hard talk with your doctor about the risks and benefits of these meds. Let that doctor know you are in substance abuse recovery and that you are concerned about the effects of meds on your recovery.
Also with anti-anxiety meds take them EXACTLY as prescribed. Do not take extras unless the doctor has said it is OK and if they are to be used when needed try to get through as many things as possible without “needing” to take them.
Anxiety disorders are a time when social supports may be absolutely essential to your recovery. Whenever possible reach for the phone and talk with your support system before you reach for a pill.
There you have it, my opinion on psych meds. Most help and have a low risk of abuse. If you need them, you need them and do not be afraid to take them as prescribed. If you find yourself abusing them, talk with everyone on your treatment team, the doctor and the therapist about these issues.
One last aside, those who do the best in recovery use every resource they can. Meds help but they will not do the whole job. You need a head change, a change in your way of thinking, and you need a good support system if you want to go the rest of the way in recovery.
Best wishes on your happy life.
David Joel Miller, LMFT, LPCC
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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books
- Why not everyone ends up addicted to pain medication – set and setting (counselorssoapbox.com)
- Why we need to talk about mental illness, drugs, and alcohol in combination (counselorssoapbox.com)