Despite the science, culture still rules when implementing drug policy at any level. Culture is often seasoned with morality — personal morality. The question of where medication fits into the current swath of those in recovery looms, like a giant dangling participle, untethered and unresolved.
For decades, the ruling class of recovery in American life has been Alcoholics Anonymous and its spinoff programs. To be certain, millions have found aid and comfort in the welcoming bosom of AA. But times have changed, and advances in knowledge and understanding now challenge the conventional wisdom that AA is the solution to any kind of substance misuse.
Specifically, the hard lines seem to have softened with regard to medication. There was a time when the foreboding culture of recovery was like waiting to see a stern and cranky principal for the latest scolding. The language of inclusion has increased, at least in urban centers, but the institutional med shaming is still with us and is still very much a problem. Where does medication fit in among the Styrofoam cup coffee-drinking set? Does it fit in at all?
In my case, medication for depression was always a clinical recommendation. My youthful bravado and lack of understanding as well as unwillingness to learn forbade it. “I’m not sad” was my curt reply to any clinician who dared suggest medication. I was irritable, with an exaggerated startle response, a disturbed mood, inadequate sleep patterns and a general malcontent attitude. (I still have these traits, though I am also much better.)
I couldn’t make the connection between these symptoms and my original plan: pour alcohol on the stew until I could sleep. It never occurred to me that that was medication — haphazard and dangerous as well as self-prescribed, but it was medication.
I found my way to AA and was utterly convinced I needed the spiritual shift that was discussed at meetings. It helped, but the symptoms of depression would roll in like fog on a late San Francisco afternoon.
Five years in, my best friend in AA was killed instantly in a skiing accident. When the dust settled from the experience, I was left in the mire of chronic depression amplified by situational depression. Awash in the unpredictability of a grief tide table that came in and rendered me incapacitated, I relied on what I knew: AA camaraderie.
“You need more meetings.” “Do another 4th step.” I got the rote and pat answers for pretty much anything from resenting the slow barista to dealing with a divorce. Ultimately, a social worker insisted I see a psychiatrist for medication. I shared the council in a meeting. Post-meeting, I was like the only guy with food pellets at a petting zoo full of starving goats. At me they came, with stern warnings, scoldings, and medical advice about the perils of medication. Ultimately I could no longer stand the feelings, and saw a psychiatrist, who prescribed me an SSRI.
It helped. A lot. I think what it did was raise the bottom enough for me to be able to move through the feelings of losing one’s best friend. It was a miracle I didn’t start drinking again. The irony is that AA, the very thing that helped me not drink, was now what was getting me to flirt with drinking again.
Fifteen years later, I am still on medication. It helps me, but it doesn’t correct me. Daily I fight the mood issues and can be triggered easily into a cutting discourse of insults. Sleep is now, and always will be, an issue. I like isolation, Dylan CDs, and the idea of leaving it all for a clean, well-lighted place and a bottle of scotch, but that never tips into actions. I do the best that I can to manage mental illness and function. Most of the time, it works out.
Would I be able to do this without medications? Doubtful. Mental illnesses need to be thought of in the same way as other chronic but treatable and manageable health problems. People can manage diabetes, but most likely they will need medication. Hypertensive folks can do a lot — diet, exercise, low-stress lifestyle — but most likely, they will need medication. What’s different about mental health is the desire to correct it with spirituality.
Intellectually curious and living lives dedicated to their understanding of God, the Jesuit faction of Catholicism doesn’t think science and spirituality negate each other. A Jesuit I know explains it this way: “Maybe Jesus gave us people whose strength is science to develop the medications.” Maybe so, Father.
The science is clear: Medication helps. People who are medicated properly and compliant with their plan stay off drugs of abuse for longer. They live healthier lives. Responses and results of course vary, but the culture of shame and non-medical people offering medical advice doesn’t help.
There are reasons to be on meds and reasons not to be, but the opposition of one’s sponsor, the plumber, shouldn’t be the reason not to take medication. America likes to posture that racism is gone, presumably because the widespread practice of lynchings is gone and the language of racism has softened. But it’s still there. It seems to be the same with recovery cultures. The option to take medication is presented, but under the surface there’s a simmering, unstated judgement and lots of pressure to steer clear of doctors. And sometimes it’s not subtle.
In a recent Facebook debate — okay, fight — a self-ordained AA guru had the temerity and arrogance to say: “There are very few doctors who know as much as I do about this subject and the impact of medications on addicts.” Forget the stupidity of the fact that practicing medicine without a license is a felony. The individual happily posted this statement on Facebook but then wouldn’t allow me to credit his words in this blog. That doesn’t much matter — “that guy” is everywhere and he is dangerous. Asking for experience, another person who wished for anonymity said this: “My sponsor told me if I finished the steps, I would no longer need medication.” The individual went on to describe fear of being “found out” that she takes medications. “I can’t count the number of times I have heard people say they don’t need medication, just the steps in meetings,” she said.
The opiate issue in America has upped the volume on this issue. While it’s undeniable that medications help people with potentially life-saving interventions, the pressure to be drug-free reigns, often with disastrous consequences. Just last week a young actor, Jackson Odell, died in a sober living home. I emailed the sober living home and asked their medication policy. The response from the sober living operator, Monte Hurly, was: “Depends on the medication.” When I asked him to elaborate, asking specifically about medications used to treat opiate dependence and avoid overdose, I was ghosted.
We can extrapolate a few things from this. The sober living home “doesn’t allow” suboxone and Jackson Odell was getting medical advice from a sober living operator. Of course I could have this story wrong, but this is an all-too-common scenario with a now-predictable result.
America is in a fever pitch crisis of death with our voracity for drug use. We’re not getting out of it with well-meaning, homespun AA lore. We can’t arrest our way out of it. Opiate dependence specifically, and mental health in general, can be treated as a health issue, and as such, medications must be considered as part of the plan to tame and cage the beast. Shame, morality, the ego of a sponsor, tradition, and resistance to change are all incredibly bad reasons to not use the potential benefit of science. Americans love Jesus, almost as much as they love beer, guns, and Cheetos. Maybe the Jesuits are right (they generally are) and Jesus is waiting for us to do our part.