Over 20 million people in the United States suffer from a substance use disorder, and 7.9-million of those suffer from a co-occurring mental disorder. Cooccurring disorders, also known as dual diagnosis, happens when someone with a mental disorder such as bipolar, schizophrenia, PTSD, anxiety, or depression becomes addicted to a substance such as drugs or alcohol. Dual diagnosis is extremely common, simply because mental disorders put most people at a significantly higher risk of becoming dependent on or addicted to a substance.
Dual diagnosis can become problematic, especially as you move into recovery and then into long-term care through self-help groups and support, because many are not structured around enabling individuals to start taking or continue taking their psych meds. With some organizations such as 12-step focusing on abstinence-only, individuals with dual diagnosis can feel left-out, non-compliant, and otherwise unwelcome. At the same time, psych meds are often highly addicting and may be problematic on their own. Anyone in recovery from another substance use disorder may be tempted to lean on them, switching from one problematic substance relationship to another.
If you or a loved one has to use psych meds in recovery, it’s important to understand why, how to control usage, and how to prevent it from becoming a problem.
Talk to Your Doctor
It’s important to see a doctor and to have an honest discussion regarding your health, past history, recovery, and concerns about substance abuse. Most psych meds are at least slightly dependence forming, and you will be at a higher risk of addiction. It’s important to discuss your options, a possible risk management schedule, and whether or not you need the medication.
Chances are that if you have anxiety, major depression, bipolar disorder, or schizophrenia, you do need psychiatric medication to manage your symptoms. There’s nothing wrong with this and they can work to dramatically improve your life and prevent you from needing other substances to cope with your mental disorder.
Your doctor may recommend:
- Behavioral therapy to help you learn to cope with some aspects of your disorder without medication
- A dose reduction in combination with therapy
- A risk management program to track your usage and prevent abuse
- A change in medication to a lower-risk medication
It’s important to keep in mind that you may actually need your psychiatric medication to cope. Many people physically need something to maintain chemical balances inside the brain to prevent psychiatric episodes, suicidal thought or ideation, and extreme anxiety and panic attacks. If you need it, there’s no shame in taking pills to maintain your health. However, it will complicate your recovery in several ways.
Taking Psych Meds in Detox and Recovery
Many forms of recovery take an abstinence-only approach to medication and drugs, expecting users to be completely clean while in the program and in the self-help group. This can be extremely problematic for dual-diagnosis patients who may need benzodiazepines, SSRI’s, MAOI’s, and other types of anti-depressants and anti-psychotics to manage symptoms and function well. If you go into a recovery program that doesn’t support dual diagnosis or co-occurring disorders, you will run into issues because the program won’t allow you to take medication while part of it.
While outpatient care is often as effective for most addicts, anyone with dual diagnosis should strongly consider inpatient residential treatment. With increased complexity of symptoms, more problems likely to arise during detox and when in therapy, and additional complications regarding substance abuse, including an inability to stop usage altogether, you need the additional care, support, and medical monitoring offered by inpatient care. It is important that you seek out a program offering dual-diagnosis specific programs and then work with the team upfront to determine a custom treatment schedule that meets your needs. In many cases, additional problems resulting from substance use and your disorder will likely arise as you go through detox, so you need consistent monitoring and access to a therapist and medical team.
Psych Meds in Self-Help Groups
Most people move from detox and therapy into a long-term support group such as Alcoholics Anonymous or Narcotics Anonymous and often begin to run into problems with psych meds. For example, most 12-step groups call for true abstinence from any medication, and while they will make exceptions and allow someone who needs a prescription from medical reasons, it can leave you feeling left out, like you aren’t truly part of the group, or as though you can’t contribute because you aren’t fully abstinent.
In addition, 12-step groups don’t actually bar prescription medication:
“But this does not mean that we disregard human health measures. God has abundantly supplied this world with fine doctors, psychologists, and practitioners of various kinds. Do not hesitated to take your health problems to such persons. Most of them give freely of themselves, that their fellows may enjoy sound minds and bodies. Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case afterward.” _ Page 133, The Big Book
At the same time, many people in 12-step groups will feel more comfortable and confident in group therapy if they seek out programs designed specifically for dual-diagnosis patients. For example, Double Trouble in Recovery is a 12-step group completely geared towards dual diagnosis patients, and their often-strong need of continuing medication.
If you can’t seek out a recovery group geared towards dual-diagnosis, it’s important that everyone in your group understands what you are using and why. Being open about it and why and getting understanding and nonjudgement is important if you are going to benefit from being in the group, because you will need their support and understanding, as well as the added accountability of group expectations.
Preventing Reliance on Psych Meds in Recovery
While psych meds are often crucial for people in recovery, many of them are dependence inducing and anyone in recovery will be especially vulnerable to relapse and substance abuse. Managing your drug usage, being extremely careful with how much and when you are taking medication, and getting help from your doctor to monitor your usage to ensure it doesn’t go over your prescribed usage is important. However, your risk of dependency will change a great deal depending on what you are using and why.
If you have a prescription for psychiatric medication, it can complicate your recovery. You do likely need it, but you may have options to go into therapy to attempt to reduce the need for some medication or to reduce your dose. That may not be a possibility. In either case, it’s important not to rely fully on your psych meds as you move into recovery, because complete reliance on any drug may interfere with your ability to fully recover. However, taking psychiatric medication of any kind doesn’t mean you can’t move past your substance abuse and addiction. For more information about other treatment options please contact Lighthouse Treatment Center today. We are to help and happy to provide a no-cost, no-obligation consultation with one of our experienced treatment advisors.