Treating Depression as a Co-occurring issue in Addiction

posted in: Mental Health | 0
Allow me to editorialize about the reported new policy of a local recovery program of not allowing even commonly prescribed SSRIs for depression to be used by their clients in recovery…..This is, in my opinion, unfortunate and unnecessary and will lead to more people being unable to access needed recovery help. Is this a move to improve “success rates” to one’s reported goal of 80% in order to secure more corporate and community financial support or is it a religious dog…ma that denies the power of God to use medical science as one of many means of grace and healing? What is the motivation? And what are the potential consequences to our community for those without the financial resources to pay for costly substance abuse treatment if they are unable to access it free of charge? Will this drive people to resort to methadone clinics or other “harm reduction” therapies instead of getting the long term residential support they need to be entirely substance free?
From 1998 to 2004 I was involved in initiation and support for a women’s depression impact group after experiencing a bout of undiagnosed depressio…n in my early 40’s. Our children had graduated from college and moved away and I went through a series of transitions that challenged my resilience. Our group met to share our ways of coping with our common experience, encourage one another, learn ways to brighten the darkness in which we felt engulfed, and learn more about depression from various pastoral, medical, counseling, and other professionals who came to answer questions and share the most recent information available. There were women who shared that they had been told by well-meaning family members, friends, or pastors, “if your faith was strong enough you could be healed from this.” I’m saddened by such lack of responsible counsel to people in emotional distress and with what is many times a clinical, biochemical imbalance in the brain. When I hear that some Christian programs ban medications that are inexpensive, with negligible risk for abuse, and tremendously helpful to a number of people struggling with a dual diagnosis of depression and substance abuse, I am moved to advocate for the rights of people who already may have few choices for long term care to address their need for substance abuse recovery services. This amounts, in my opinion, to religious abuse by those who feel it necessary to separate good sound medical practices from their faith. They may well be burdening individuals with guilt and shame not only for substance abuse behaviors but also for their brain’s neurochemistry and for a supposedly inadequate faith in God. Such individuals needing recovery now have the additional burden of being unable to manage the emotional turmoil associated with post-acute withdrawal syndrome, normal anxiety associated with change, and what may be a more chronic and permanent depression that is not merely situational and will not simply resolve with stopping substance abuse. This week’s request by another program for Titus 2 to take a woman using a commonly prescribed SSRI (selective serotonin inhibitor) because their program no longer allows depression medications simply pointed out the need for better education about addiction issues and dual diagnoses in our community and a dialogue about this and other issues associated with recovery programs and local mental health service providers, particularly for those individuals needing long term recovery care who lack financial resources for such services.

I, as a Christian counselor and educator, became interested in the healing ministry of the church in part because of my experience of depression 17 years ago. Today I advocate strongly for the inclusion of the spiritual component in recovery from the various issues that often lead to and exacerbate substance abuse and other addictive behaviors. But I am also a trained scientist, having worked as a medical technologist in my first career, then later in sales of pharmaceuticals for certain neurobiological, psychiatric illnesses. There is no sound reason to demand such a separation of faith and science in the healing art of recovery for dual diagnosed individuals with depression and addiction. This is a discussion that our community needs to have as many with few resources will now have even fewer options available to them.

A couple of years ago a friend of mine found herself in the grip of profound depression. There was no warning, no situational cliff that plunged her into it. It simply descended. I visited her in her home and found curtains drawn and her huddled in the corner of the sofa, clutching her faith and praying daily for relief. Her husband stood by, feeling somewhat at a loss. He did not know how else he could help. But neither one ever felt that their faith, or the One in whom… that faith was vested, was failing them. I took her hand and talked to her and prayed with her. We talked about our shared experience of the black cloud. She was seeing a psychiatrist, referred by her family physician. She had already tried several medications over the last few months, but nothing seemed to be working. We talked about how long each “trial” of a new anti-depressive medication can take and I encouraged her to keep on trying until she had exhausted every single one. Each person responds differently to the different SSRIs. She continued to see the doctor and try different meds at varying doses. Some time later she told me that when the right SSRI for her was finally found, after a few days it was as if a switch was flipped. She said she could almost pinpoint the moment when it happened and the dark shadow began to lift. In a matter of days she was restored to her smiling, energetic self. She has continued on it, feeling renewed, and grateful for God’s mercy in bringing a kind and patient physician and in giving her the patience, too, to persevere in the process. Sadly, too many give up too quickly or feel that they are burdening others, including their doctors. And then, if and when they do find the right medication and the cloud lifts, they assume they are no longer “depressed” and quit the medication at some point…….only to find that it is still hovering close by, waiting.

Some have the support, insurance, maturity, luxury of time and of not being required at a job, or of being responsible for caring for dependent children to slog through the medication mystery tour and get the supportive counseling to find a permanent resolution. Others don’t. They simply give up and escape through self medication, shamed and humiliated by those who view their depression as a “choice” and tell them to “get over it” and “God heals, not pills.” Sometimes God uses pills or other medical treatments to heal……just ask all of those who are alive because of penicillin or the polio vaccine or levothyroxine (Synthroid) or hypertension meds…..Get in the 21st century….God is.

Other questions come to mind in reflecting on the decision to eliminate depression medications altogether from recovery programs- If clients are banned from using medications for depression, are staff members also asked if they are on such meds and forbidden to use them? If “God will heal” the clients’ depression, has he also healed the staff members’ depression? If “depression is a choice” for the clients, has it also been a choice for members of the staff? And what about clients’ other medical issues….diabetes, hypertension, infections, hypothyroidism, arthritis, etc….is this now to be a Christian Science approach to recovery? Are clients with these issues expected to get off all meds, too? Surely, if God would choose to heal one malady, he would heal the others, too, right? If he would choose to heal clients, he would heal staff, too, right? Starting to sound a little absurd,? It did to others, including counselors and psychiatrists and pastors, when they heard it, too.

Irony of ironies that is duly noted:
Last March 7th-April 7th I was put on paid leave while the administration of PCRM “investigated” students’ charges that I failed to provide their medications to them which, by the way was not on my list of duties but was the responsibility of others. PCRMs newly “discovered” medication policy, of which I had never been apprised, was used to suggest that I was denying people their right to be treated for various medical conditions. I was a…cquitted of the charges (that were mostly trumped up by disgruntled individuals who disliked being disciplined or held accountable) and was returned to duty without even a reprimand in my file. And even though the Board affirmed that I had been productive and responsible in my leadership at BV, they left the decision of whether or not to retain me in employment to the executive director, who it appeared had determined after the first few weeks of his arrival to remove me any way that he could.

When I had a concern about a student’s medications, I would send a letter or call the healthcare provider to discuss the concerns observed, review the drug’s prescribing information, attempt to educate the student about the medication and help her see that the lifestyle changes and other tools we were giving her deserved a chance. On several occasions I have actually gone with clients in order to provide an observation of the client’s behavior or to be sure that they actually tell the doctor about their addictive history. (Deception and drug seeking behavior doesn’t necessarily end just because one enters a recovery program.) By doing these things one can observe attitudes about medication. 

One’s attitude toward medication can affect success in addiction treatment as well as other conditions. If one is adamant that she wants and needs a pharmacological solution to her problems (whether it has potential for abuse or not) and denies the need to make lifestyle changes, the likelihood of success may be small. If one has a healthy and realistic view of medications as adjunctive support to counseling, lifestyle changes, spiritual growth, supportive community, etc., then medication can more safely be included in treatment and may not represent an impediment or threat to one’s recovery. So, rather than hard and fast rules, it may be advisable to evaluate each individual to discover one’s attitude toward medication and monitor the use and adherence. If, however, one is in a residential program with other recovering addicts use of meds with potential for abuse can represent a risk for theft, abuse, or anxiety as a trigger to others and require tighter medication management or banning use of such drugs

This was generally only necessary in reference to ADDICTIVE MEDICATIONS WITH POTENTIAL FOR ABUSE THAT WE DID NOT WISH TO ACCEPT LIABILITY FOR ON THE PREMISES. In at least 1 case. a hired staff member, who had been in recovery for several years, had been fired for theft of students’ medication that the employee was able to get. And that was only one of several such instances of which I was aware. This has been an ongoing problem with inability to manage the security of certain medications and the reason that some medications simply were not allowed in some programs. Such concerns, however, are not part of the dynamics of treatment with SSRIs.
If individuals working with clients in addiction lack the knowledge and training to address such issues this is the kind of decisions that are likely to be made………eliminate ALL mental health meds and use religion as the reason. Not good mental health practice, not good recovery practice especially as demonstrated in studies with women, not good leadership, not even good religion. And this is just the opinion of a woman with a heart for hurting women who’s been there.

 

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