I’ve long been interested in the connection between mental health and addiction because the worlds of recovery are so similar and yet so different. One of my biggest frustrations in addiction recovery circles is the lack of awareness of mental health–especially the physiological nature that threatens lives. And many depressed folks don’t take seriously enough the addictive nature of sedatives in their pursuit of sanity. So I was happy to interview Howard C. Samuels, Psy.D., author of “Alive Again: Recovering from Alcoholism and Drug Addiction” and the founder and president of the prestigious The Hills Treatment Center in Los Angeles. An internationally renowned recovery expert, Dr. Samuels appears regularly on national TV news shows about the challenges of drug addiction.
Question: Why is Treating Addiction Not Always a Cure for Treating Mental Illness?
Well, you may have addiction and alcoholism on one hand, but I can tell you, at my facility, we discover many alcoholics also have a chemical imbalance which, if you want to get technical, falls under the category of mental illness. We call these dual-diagnosed patients. And when dealing with a dual-diagnosed patient, the first thing you have to treat is the addiction; because the only way you’re going to get to the mental illness and be able to figure out what it is, is to get the individual clean and sober. It is only in this space that we can do the work and diagnose what kind of mental illness (if any) the patient is afflicted with.
I, myself, didn’t even discover I even had a chemical imbalance until I’d been clean and sober for several years. I’d inherited it from my mother, and I take Lexapro (an anti-depressant) today to deal with it, and I talk about it all the time because I want to difuse all of the shame in our culture around this issue; no one should ever be made to feel bad about taking care of themselves. Ever. That being said, if we use my own recovery as a case study, we see that there was a lot more going on with me than just the drinking and the drugging, but none of it was apparent through the riot of my addiction. Once you removed that “noise” and the dust settled, we got a very clear picture of this other malady that I was afflicted with. And then I could move forward into the solution and lead a healthy, productive life.
Treating the addiction wasn’t a cure, but you need to understand that my addiction made the diagnosis difficult. For some people, their own drinking and drugging makes diagnosing any underlying problems nearly impossible, because they become so invested in damage control and harm reduction, they can’t see the forest for the trees.
Most people that come in (I’d say about 60%) to treatment centers are dual-diagnosed, I think. But they may not know that because they may have been using drugs or alcohol to self-medicate themselves. They may have depression; they may be bipolar; they may have anxiety disorders . . . but they’ve been self-medicating for years and they don’t have an awareness that they have any of these afflictions. You can’t treat the chemical imbalance and find the right medication until you remove the addictive component and do away with the smoke screen of alcoholic or drug-induced behavior. You just can’t.
Question: How can a person be more depressed after stopping drinking: Why does life feel worse when the alcoholic puts the drink down?
The alcoholic has been using alcohol to function; they’ve been treating life and the feelings that come from living life on life’s terms with alcohol. So, if you take away that alcohol, what you wind up with is a very depressed person; one who cannot function without alcohol. Add to this the fact that an alcohol detox can be grueling for most — not just emotionally but physically as well; an individual could spend almost three weeks putting themselves back together again — and you wind up with a person who doesn’t know that it’s normal for someone coming off of alcohol or drugs to be depressed. That’s part of the process. The next part of the process is teaching the individual how to take certain action in order to feel better about their life; or how to be able to change their negative thought patterns which have been creating the negative feelings they’ve been having for all of their life.
It’s these negative thought patterns that the addict/alcoholic has that drives their anxiety; that drives their depression; and which, ultimately, drives the compulsion to drink and drug. And that’s why it becomes vital — usually within the first month of recovery — to ascertain, “Is the depression the result of the drugs or the alcohol, or is there a chemical imbalance at play here that needs to be treated?”
Question: Should a person take sedatives if they have a history of addiction?
First of all, it needs to be said that the alcoholic/addict cannot take any “benzos” — they cannot take any kind of sleeping pill, because the benzos are habit-forming; they’re addictive. And here, I think, is where many doctors in our society today are remiss in treating alcoholics and drug addicts.
If you give an addict/ alcoholic Xanax, Klonopin, or anything like that, you’re setting them up for relapse and for continual addiction or alcoholism issues. The reason for that, is because the alcoholic is extremely sensitive to addictive drugs; and it triggers that craving for more — whether that expresses itself as a need to drink or a need to get loaded on even more drugs is incidental — it’s the craving that becomes the enemy; it’s the craving that becomes the awakened beast that, more often than not, is far more deadlier than the occasional sleepless night.
The addict/alcoholic can’t handle the benzo; they can’t handle the “sleep aid”.
What can happen in dire cases — and by dire, I mean cases where sleep is necessary but not possible, like patients who suffer from night terrors and the like — is we can introduce sleep aids like Trazadone and other anti-depressants which have a temporary side effect of drowsiness or sleep. The psychiatrists and the doctors we work with have a variety of medications that the client can take that are not addictive or habit-forming like benzos and, at least in my treatment center, patients are taught to be vigilant and aware of what they are putting in their bodies and why. Getting to a place in your life where your every decision isn’t governed by the next drink or the next fix is important, but there has to be an emphasis on knowing how to take care of yourself, because that’s where your self-esteem is going to come from; it’s going to come from taking your power back without exchanging one master for another. This isn’t “Meet the new boss, same as the old boss” — this is “Welcome to your brand new life, now go out and live it.”
© 2013 Howard C. Samuels, Psy.D, author of Alive Again: Recovering from Alcoholism and Drug Addiction
Published originally on Sanity Break at Everyday Health.
Having developed and administered several “dual diagnosis” programs in psychiatric hospitals I read this interview with keen interest. First job was to get patients “clean” so we could get a better read on their Axis I diagnosis. We used the 12 step program combined with “Marlatt’s “relapse prevention” model to address substance abuse issues. Psychotropic medication was an integral part of a therapeutic milieu used to assist patients with schizophrenia, bipolar illness, schizoaffective disorder, etc.
More and more research suggests that Neurontin significantly increases chances people will remain “clean”. Additionally it is used to treat certain target symptoms in this population.We don’t have a magic bullet but Neurontin shows such promise it warrants wider use and more research. Thanks Therese.
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