Posted by Elizabeth on October 15, 2001, at 19:39:22
In reply to Misuse of Drugs » Elizabeth, posted by Rosa on October 15, 2001, at 8:13:59
> Does this group have any such guidelines concerning what they consider to be misuse of drugs or a slip?
This group? You mean Psycho-Social-Babble? I think that, with the exception of nonsupportive (i.e., mean or rude) remarks (and certain other types of content, such as encouraging people to do something that's illegal), there are no rules governing post content. I think it's generally agreed that each individual needs his own treatment and that it's ultimately between the individual and his treater(s).
> A slip is when after having abstained from alcohol or drugs for a period of time, while in a 12-step program, one goes back out and uses alcohol or drugs.
I would leave out the 12-step part and say that if a person uses his DOC (and not just any drug)while trying to abstain as part of a program of recovery, that would be a slip. There are addiction treatments that have been proven effective and that don't require or use a 12-step approach.
> How do you describe self-medication?
Many people don't receive any treatment (or don't receive adequate treatment) for mood and anxiety disorders (and other psych disorders, but these are the primary ones). When they come across and try "hard" drugs (i.e., addictive drugs such as alcohol, opioid agonists (heroin, etc.), cocaine, amphetamine (and similar drugs), and some of the older types of "minor tranquilizers" such as methaqualone or barbiturates), they discover that the drugs seem to fix whatever problem they're having (depression, chronic pain, panic attacks, social phobia, posttraumatic stress, anger-control problems associated with various conditions (such as bipolar disorder and ADHD), etc.), so they start using it regularly. Because their drug use is not supervised by a doctor, it's hard for them to keep a limit on the amount they use, and they often (perhaps almost always) end up becoming addicted. (Even if they're not addicted, though, it's still self-medication.)
Some people do this because they aren't aware (or don't want to believe) that what they have is a psychiatric disorder which can be treated. Others, however, have tried to get treatment, but it has not worked, often because doctors are reluctant to prescribe the most effective treatments (such as benzodiazepines for anxiety disorders or stimulants for ADHD) or only prescribe them in sub-effective doses. In some cases the effective treatment is not recognized as "legitimate" by the medical establishment (e.g., opioids for certain cases of treatment-resistant depression)
I am not an addict; but I do love a former addict, and I can appreciate what he goes through. I've been clinically depressed (on and off) since I was 14 years old, and there's no doubt in my mind that if I'd had a mind to, I would have sought out heroin myself as an adolescent and probably would have become addicted. After trying many, many treatments, none of which had been completely effective, I finally happened upon hydrocodone (when I had my wisdom teeth removed). When I mentioned this to a psychopharmacologist who I was seeing for a consultation (after phenelzine pooped out on me), he thought of buprenorphine, an opioid that is relatively non-addictive (it's in the lowest controlled-substance category in the US, Schedule V) and is safe in overdose. The drug, which is used in many other countries as substitution therapy for opioid addiction and is approved here for pain, had recently been the subject of a paper that this consultant had published in the Journal of Clinical Psychopharmacology about a small clinical trial in depressed patients for whom other treatments had failed to work. A couple of years after I first met with the consultant, I had tried practically everything that my doctor and I could think of, and we decided it was time to try buprenorphine. My doctor spoke to the consultant, who had more experience using opioids in depression than just about any other psychiatrist, and decided that he was comfortable prescribing it to me. It works, although it has all the typical side effects of full-agonist opioids (nausea, constipation, dry mouth, pruritis). I am pretty sure I'm not unique in being preferentially responsive to opioids; I can only assume that others like me usually take the other path and become heroin addicts. My aforementioned boyfriend is one of these people. I do not see him as weak or immoral. He is what I could have been if I hadn't been lucky enough to live within walking distance of Harvard Medical School. And yes, it angers me when people say that addicts are decadent, evil, subhuman. They are not.
> Here are some guidelines concerning the misuse of drugs for alcoholics.
I think that these rules are a good template to start from for a person who's trying to design a treatment program for addiction, although there is no single program that will work for everybody. (Addicts are unique human beings too.)
> 1. Remember that as a recovering alcoholic your automatic response will be to turn to chemical relief for uncomfortable feelings and to take more than the usual, prescribed amount. Look for nonchemical solutions for the aches and discomforts of everyday living.
I'm not convinced that it's that simple. Many addicts lack resilience, the natural ability to cope and adapt. Learning coping skills can help, but in the end it may not be enough. For others, their drug use relieves daily stress or pain due to a situation that nobody could tolerate by themselves, or to a trauma from which they have never fully recovered. In these cases, help is needed to get out of the intolerable situation or to heal the injury caused by trauma; and again, medical treatment may still be needed.
> 2. Remember that the best safeguard against drug-related relapse is an active participation in a program of recovery.
Always a good idea. But I've noticed that there are very few such programs in which the addicts are treated as the suffering human beings they are. Much of "treatment" seems to consist of convincing the addict that he is a bad person.
> 3. No member plays doctor.
Generally it's a good idea for people in support groups not to "play doctor;" but this can mean different things to different people. I think it's fine for people to share information with other group members. I don't think it's okay to pressure another person to become involved in a particular type of treatment. (Of course, I don't think it's okay for doctors to pressure or coerce patients into a particular type of treatment, either.)
Doctors can become addicts -- anesthesiologists, for obvious reasons, seem especially vulnerable. I think it's certainly fine for a doctor in a support group to share medical knowledge with other group members.
> 4. Be completely honest with yourself and your physician regarding use of medication.
I believe it is the treater's responsibility to prove to the patient that he will not be punished for honesty. This is the only way that a trusting therapeutic alliance can be formed.
> 5. If in doubt, consult a physician with demonstrated experience in the treatment of alcoholism.
Always a good idea, although who you should consult probably depends what exactly your "doubts" are about.
> 6. Be frank about your alcoholism with any physician or dentist you consult. Such confidence will be respected and is most helpful to the doctor.
Unfortunately, too often patients are punished for honesty.
> 7. Inform the physician at once if you experience side effects from prescribed drugs.
Another good idea, although it's probably not wise to make a big fuss about minor side effects! :-)
> 8. Consider consulting another doctor if a personal physician refuses or fails to recognize the peculiar susceptibility of alcoholics to sedatives, tranquilizers, and stimulants.
...or if the physician rules out the use of these drugs as treatments, based on a history of alcoholism. I think I went into this issue earlier.
I'm not convinced that alcoholics are especially liable to abuse tranquilizers, although they are probably liable to use more than the prescribed amount if the prescribed amount is inadequate! And I don't see any reason why they would be prone to stimulant abuse.
> I believe that the guidelines for drug addicts is more strict.
Alcoholics are drug addicts. Alcohol happens to be a legal drug; for some reason, the federal government acknowledged that a Constitutional amendment was required in order to prohibit alcohol, but they argue (in support of the Controlled Substances Act and successive drug legislation) that the commerce clause permits criminalization of other drugs, including some substances which occur naturally in the human body! Very inconsistent and intellectually (not to say legally) dishonest, IMO.
So, you still didn't answer my question: what do you mean when you ask, "What is your policy concerning the misuse of drugs?" (I don't have a lot of "policies," seeing as I'm not a government or a corporation. :-) )