Light at the end of the tunnel

As an employee at a drug rehabilitation center, I have seen countless individuals who arrive at treatment with multiple psychological diagnoses and various prescriptions to treat them. More often than not, they’ve received these prescriptions from previous treatment providers and rehabs. Due to the stigma surrounding mental health, a person that’s dependent on drugs may not disclose all the facts to treating physicians or psychiatrists. Without full disclosure about the cause of their symptoms, practitioners cannot correctly diagnose. This lack of detail can lead to the prescribing of more medications for a condition that may not be accurate.

These factors can lead to a lot of confusion about what’s real and what’s not. Many of the clients I’ve spoken with who chose abstinence-based or holistic treatment approaches discovered that their previously diagnosed disorders vanished once they completely detoxified and stabilized. This isn’t hard to imagine since we’re talking about people who often haven’t experienced a state that isn’t chemically influenced for many years. It’s not exactly a surprise that concurrent use of heroin and crack can mimic a bipolar disorder.

When examining the symptoms of drug addiction and drug withdrawal against the symptoms of many mental illnesses, you’ll find many things that overlap. Regular opioid use can create depression-like signs, and drug withdrawal can create anxiety. Similarly, stimulant use can foster psychosis and schizophrenia-like symptoms, and withdrawal from these drugs can also lead to severe depression. So why are substance abuse treatment providers so quick to place people on psychotropic medications?

If we know that the drug addiction and withdrawal cause many mental symptoms, shouldn’t we handle that before starting them on more drugs? The thing that must be determined is whether the psychological issue is a pre-existing, organic condition that preceded and potentially precipitated the drug use. If not, then it’s likely a secondary symptom brought on by drug use. With this in mind, dousing the person with more chemicals that alter brain function would only serve to complicate matters further and would be potential mistreatment.

Without an extensive, well-documented psychological history from before the person’s substance abuse began, we have to err on the side of caution. This means before further diagnosis and medication of a psychological nature, we have to get the person off of drugs to determine what their baseline is. This would include a full detox and post-acute withdrawal management. An emphasis on nutrition and if medications are used, keeping this to acute symptom-management interventions. Doing the above would allow the person to achieve a healthy state that’s not mired by chemicals and their side-effects. They may discover their own surprising truth.

Many may argue that this idea is cruel and flies in the face of standard practice. Perhaps what we should be examining is why it’s standard practice to endlessly prescribe drugs to a population that’s already embroiled in their effects. Further, the cruelty of bolstering a belief that there’s something wrong with them, and that chemicals are a solution likely outweighs the temporary discomfort of making sure we get it right this time.