PRESCRIPTION DRUGS & SOBRIETY
People often ask, “are you sober if you use prescription drugs?” This is a complicated question. It depends on why you are you using them, and how you are using them. Plus, what is your plan of action is going forwards? Many people are on a raft of legally prescribed drugs when they enter treatment for their substance abuse, and often they are still on them when they leave rehab. In some cases this is necessary, and in some it isn’t.
Obviously Alpha is a sober house where we adhere to strict abstinence criteria. But does this mean people are not allowed to take prescription drugs when they enter sober living? Well again, it depends what those drugs are – how they are prescribed – and what the plan is going forwards.
Long term recovery is not just about sobriety. It’s about having a life worth living when you are drug free. If prescribed drugs interfere with this process of growth more than they help it, then a managed withdrawal from those prescribed drugs may be desirable. On the other side of the coin, there are people who will be unnecessarily miserable in their recovery because they legitimately need medicating due to ongoing psychotic symptoms or very serious depression.
In other words, the distinction is around ‘abuse’ of prescription drugs. So let’s look at what drugs are commonly prescribed to people before they come to treatment (and after) and what their potential for abuse is.
WHAT ARE PRESCRIPTION DRUGS?
Essentially, a prescription drug is any drug prescribed by a doctor. In the mental health field prescription drugs are usually given to treat the following conditions;
- Anxiety and depression
- Substance dependence
- ADHD or ADD
- Sleep disorders
- Psychotic disorders
An increasing amount of people today (especially young people) have been prescribed drugs by their family doctor or psychiatrist long before they enter rehab for substance use issues. This may have begun as an attempt to manage their addiction or other co-existing mental and emotional health disorders like those above.
Oftentimes, our clients have stayed on these meds (like benzodiazepines for example) for much longer that they should have, and wind up becoming dependent on them as well as on their drug of choice. Sometimes the prescription itself becomes the drug of choice. Sometimes however, the medications have clearly made a big difference in assisting the situation, and keeping the person grounded enough to get into treatment, so it’s a mixed bag.
For example, a doctor may have prescribed Methadone or Buprenorphine to assist the addicted person in staying away from street heroin. Opioids like these are often used as maintenance medications (which means the person may stay on them long term). They are considered safer than illicit street heroin, because their manufacture and dispensation is monitored and regulated.
Many treatment professionals would say the opposite however. They would say that the only thing these substitute drugs maintain is the addiction. The reality is that there are relevant points to both arguments. It depends where you are in the treatment journey, what your prognosis is, and what you want to achieve.
Opioids are often prescribed for pain. In Asia, Tramadol is a good example of an opioid which people in recovery believe is safe to use for pain, but which in fact may lead to dependence and relapse onto illicit opioids. In the USA, Oxycontin and Vicodin have been overprescribed in epic proportions. What started out as a campaign to reduce pain in the general public has turned into an opioid epidemic.
In addiction treatment programmes like Alpha Sober Living, there is little room for maintaining opioids after the primary stage of addiction treatment. Opioids are usually tapered and then if pain is a recurring issue, non-addictive drugs are used in conjunction with mindfulness practice, corrective exercise, and other behavioural health protocols.
Other people may have been prescribed Resperidone or other anti-psychotic drugs, due to symptoms of stimulant induced psychosis. People who binge on stimulants like cocaine and meth over a long period can often have quite severe hallucinations and tend to lose their grip on reality, even when they are not on the drug. Psychosis occurs when the excessive amounts of brain dopamine (which is particularly targeted by these drugs) gets fired off for long periods with no respite.
Anti-psychotic drugs like Risperidol can help to reduce these symptoms. But do clients need to be kept on them long term after they have discontinued chaotic stimulant abuse. Many would say no … and yet, the practice is common! Like many abstinence oriented treatment programmes, at Alpha we work in conjunction with outpatient psychiatrists to slowly discontinue antipsychotic medications once psychotic symptoms have abated. Sometimes this takes a considerable time period.
Young men are often prescribed stimulants such as Ritalin or Dexedrine for ADHD (Attention Deficit and Hyperactivity Disorder). This often begins in high school. ADHD and its adult counterpart ADD (Attention Deficit Disorder) are exactly what they sound like – conditions which are characterized by the inability to sit still (in the case of children) and the inability to concentrate on certain tasks which are not immersive (e.g. things which are boring to the individual).
There is a lot of argument about whether this practice of diagnosing ADHD is just over-pathologizing typical male developmental behaviour, e.g. rough and tumble play. Nowadays, school systems have largely opted for learning systems that require children to sit still and concentrate for hours at a time. Rough and tumble sports have also been significantly curtailed recent years (in schools) and so one wonders if, in fact, have we actually invented ADHD! Is it just what we used to call … ‘being a boy?’
At Alpha Sober House we believe in finding behavioural solutions to attention deficit problems. There is little reason (in our view) to use addictive stimulants to medicate problems of focus. There are many lifestyle changes, from meditation to finding new interests, which can significantly reduce the symptoms of so-called ADD.
People suffering from depression are frequently prescribed antidepressants which come in several different forms. SSRI’s (Selective Serotonin Reuptake Inhibitors) are perhaps the best known. But there are also SNRI’s (Serotonin and Norepinephrine Reuptake Inhibitors) and SARI’s (Serotonin Antagonist and Reuptake Inhibitors). Common antidepressants that we tend to see in people who come to rehab and sober living for treatment are;
- Trazodone (Desyrel)
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
- Escitalopram (Lexapro)
These meds are often really helpful to people who have enduring and quite serious depression. And it’s often the case that this depressive trait is clearly observable in the family lineage, being very clearly present in one or both parents. Well known public figures like Jordan Peterson (a clinical psychologist) have expounded the potential benefits of antidepressants such as Fluoxetine. But these medications do also have some issues when taken long term.
Antidepressants, opioids and antipsychotics all contain the risk of dependence. And whilst it’s important to note that physical dependence is not the same thing as addiction, it’s also important to note that withdrawal from these drugs will not necessarily be uncomplicated, and that continued use may cause what are known as ‘rebound symptoms’ (where the drug eventually causes, or exacerbates the same symptoms it was prescribed to treat).
At Alpha Sober House we take a more nuanced approach to antidepressants. Sometimes, there continued use may be justified. And like all prescription drugs, their withdrawal should certainly be monitored by the prescribing physician.
People with a more anxious presentation (rather than depression) are often given benzodiazepines. Benzo’s as they are more commonly known, have a sedative (calming) effect, as well as an anxiolytic (literally, anti-anxiety) effect. Common benzodiazepines that we tend to see in people who come to rehab and sober living for treatment are;
- Diazepam (Valium)
- Clonazepam (Klonopin)
- Lorazepam (Atiavn)
- Alprazolam (Xanax)
In a sober house, all clients will have been detoxed from benzos during the primary stage of addiction treatment (e.g. in a residential rehab facility) before they arrive. This is because benzos have significant potential for abuse, and the detox is often extremely complex, problematic, and potentially unsafe. Immediate cessation, or even rapid withdrawal from benzos can cause seizures and death. They should always be tapered in a facility or outpatient service that has the necessary level of support to assist in medical supervision.
So, in summary, the legally prescribed drugs that people are put on before they enter treatment are usually in the following families of drugs;
- Opioids for opioid dependence, or pain
- Anti-psychotics for bi-polar and schizoid disorders, or stimulant induced psychosis
- Anti-depressants for depression and anxiety
- Benzodiazepines for anxiety and sleep disorders
- Stimulants for ADHD and ADD
In the following blog posts we will look at each one of these in turn and see what role they should, or shouldn’t play in our sobriety.
Note: The information in this blog should not be misconstrued as medical advice. Always consult your doctor before tapering or withdrawing from any medications.