Recently I got an email asking about what "some people in AA say" about antidepressants and other medications.
While no one speaks for Alcoholics Anonymous -- we have no official spokesperson -- there are a number of places in AA literature which clearly state that AA suggests people only take direction regarding medication from doctors and other qualified, licensed professionals. The book "Alcoholics Anonymous" (AA's Big Book) advises that "the world is blessed with many fine doctors and we would do well to make good use of them" (a rough but accurate-to-the-spirit-of-the-quote paraphrase). There is also a great brochure -- which sounds so lame, I know, suggesting people read a brochure -- with an intelligent and balanced discussion of this issue, but again, reiterates that people should follow a doctor's recommendations when it comes to medicine, not anyone else -- be they a sponsor, a spouse, an impassioned and opinionated sober friend or a crusty middle-aged sober blogger. (Okay, they didn't actually say that last one, but I think it's implied.)
Just in case the five times I said it in my previous writings I may not have been completely clear, I will say it once more here:
A doctor -- a licensed medical doctor -- is the only person one should listen to about what medication is or is not appropriate for a recovering alcoholic to take. No sponsor or any other member of any 12 Step group is qualified to give direction on this -- in fact, persons who try to do so are both misrepresenting what Alcoholics Anonymous itself states and also should be viewed with grave misgivings. And are probably on an ego trip. And might also be, as my mother used to say, nutsy-kookoo.
In addition let me say that not only should a doctor be involved in putting you on a medication, but there should be check-ins to be sure dosages are within appropriate parameters and no one should suddenly stop taking medication without involving a doctor as well -- that is sometimes the most important thing of all.
I confess after I put up the answer to the email question about antidepressants I did not feel good about it. And by that I mean I think my answer was clear, but a little ... simplistic. On one level, yes, it is a very simple question: Who should you listen to about medication? A doctor and only a doctor.
But on another level sometimes it is not a simple issue at all.
Nothing I write here is intended to undermine or contradict what I said above or in my earlier post about taking medication only with a doctor's advice. But to let that stand on its own without further discussion doesn't feel clean to me, and so I am moved to add the following:
I think it is naive to paint all doctors with a broad brush. Some doctors are less familiar than others with addiction. Some doctors are just as happy to listen for 20 seconds and then whip out a prescription pad and write a few 'scrips and then send you on your way, billing your insurance company (if you're lucky enough to have insurance) and moving on to the next patient. As in any profession, the quality of the professional can vary widely.
And I think it is especially naive to forget that the pharmaceutical industry is not part of some grand philanthropic movement, bent solely on bettering the lives of people everywhere. There is a product to be sold and a sophisticated sales and marketing element in play to get that product moving -- and not only is the general public sometimes influenced by that element, but doctors and the medical profession as well. Some treatments -- and medications -- seem to come "into fashion."
My experience is that there is situational depression (or anxiety) and organic depression (or anxiety) -- the former comes from tough things which happen in life and the latter from genuine brain chemistry imbalances, or crossed wires, etc. My experience is that medicating situational depression or anxiety is potentially a bad idea for someone in recovery.
Today we are more adept at identifying the many, many different kinds of mental and emotional illnesses there are, and no one should suffer needlessly. In getting a diagnosis it is important to consider the genetics factor. Looking at family history can be a big clue as to what is appropriate diagnosis and treatment. But it is certainly possible that people in someone's family tree remained undiagnosed -- it's not always going to provide solid information -- we know more now. Plainly put, just because (for example) no one in your family has been diagnosed as manic-depressive doesn't mean it doesn't run in your family -- but at the same time, if no one in previous generations or your extended family has been diagnosed with something you think you might have, and there are no family "stories" about them which paint a picture of organic imbalance ... well, that should be a clue to examine things more carefully before embracing any labels.
If an addict is taking medication as directed for severe anxiety or depression that they have experienced, then it is a damn good thing there are such medicines available to help them. But if an addict is taking medication because they are afraid they are going to have feelings of anxiety or depression ... that is troubling, and I would urge anyone in such a situation to consult with a psychologist and get some good 12 Step input IN ADDITION TO talking with a doctor -- but NOT instead of.
Many people I sponsor are on appropriate medications for a variety of issues. My suggestion to those that ask my experience on the subject is that, if they have more than one doctor prescribing medicines they commit to making sure all the doctors know about each other. I suggest they write down all the different medications they are taking, what dosages and for what conditions -- just for the sake of clarity.
Most medications of this nature work best with a consistent application -- and for an addict to feel like they're taking medicine instead of drugs it is a good idea to have a rock solid routine as to when the medication is taken, i.e., always take it before you shower in the morning, or just before bed, or what-have-you.
Just as it's our responsibility to be smart about our recovery, and learn about the 12 Steps and the principles of the Program, it is each person's responsibility to learn about whatever medication they may be taking -- so they can be wise about noticing any changes in themselves -- for the better or worse -- over the course of their treatment.Addicts are shortcut people. If you tell me I have to do the work or I can take a pill, I want the pill. Real medicine is not a shortcut, it is something to help you function -- and the long term ramifications for addicts who are looking for a medicinal shortcut are not good when it comes to staying sober.
The most terrifying truth in the world to me is that I can convince myself of anything ... anything. I do not seem to be alone in that -- lots of alcoholics are able to do that. So I must add here that sometimes it feels like some people are medicated needlessly, or over-medicated, or frighteningly casual about these very powerful drugs. I wouldn't feel like I've been completely honest if I didn't say that, too.
Thus I believe the best follow up to the statement that only a doctor should be giving advice about antidepressants, or mood stabilizers, or anti-anxiety medication, etc. is that people in recovery should go very slowly and carefully in this area. Proceed with caution, and only when you are well armed with the facts.
Finally, I think sleeping pills of any sort do not fall under the heading of antidepressants, et al, and are a bad, bad, bad idea for alcoholics. But maybe that's a post for another time.
Only a doctor should give direction when it comes to medication -- this is merely my attempt at a few follow up suggestions and ideas for people to consider, nothing more.