Partnership for Drug-Free Kids // By Dr. John Dyben, DHSC, MCAP, CMHP
Jennifer was 30 when she found herself in residential treatment for alcohol and drug addiction that had devastated her life for nearly five years. Though she struggled at first, she began to experience freedom in sobriety and became increasingly excited about the proposition of recovery. She became so committed, in fact, that she decided she would never take pills of any kind ever again.
Unfortunately, Jennifer struggled with more than just substance use disorder (SUD). Around the age of 20, she learned she had a significant mood disorder that responded very well to psychiatric medication but that was debilitating without it. This story is common, as many people who struggle with addiction and/or substance use disorders also struggle with symptoms and conditions that may require medication. For those in recovery and their families, this inevitably brings up several questions.
Is my child really in recovery if he/she takes psychiatric medication?
Mental health conditions are just that: health conditions. They involve the brain, a major organ. Sometimes people have conditions where organs are not working as they should and we treat these issues in different ways, the two most common being change of lifestyle and medications. When the organ needing help is the brain, it is unreasonable to expect we should do otherwise.
Is a specialist needed to help with medication management?
Without question, yes. Anyone with a history of substance use disorder who needs medication management for any condition, especially one that involves the brain, should be certain that their prescriber has a thorough understanding of their history with addiction as well as drugs, alcohol or other substances and how it might complicate other conditions. Psychiatrists board certified in addiction psychiatry and other physicians board certified in addiction medicine are available and most helpful. Substance Use Disorder is a specialized area of practice and those who have specific training and expertise will be able to guide you best.
What do health care practitioners need to know about my child’s history?
Most of your health care practitioners will not be addiction psychiatrists. Your child may see dentists, podiatrists, OBGYNs, etc. that may potentially prescribe for him or her. All health care professionals should know they have a history of substance use disorder and that there are certain medications that they need to avoid. It can also be helpful to allow communication between your child’s primary care practitioner and addiction psychiatrist so that they can collaborate on how best to guide your child medically.
What kinds of medicines should my child watch out for in particular?
This is an excellent question that would be best answered by your child’s addiction psychiatrist. In general, for persons in recovery from addictions and/or substance use disorder, there are a few broad categories of drugs that should be avoided:
Opioids: These are drugs given for pain and they can be highly addictive. They should be avoided except in acute severe injury or post operation. If your child is going to require opioids post-surgery, develop a plan with your child’s physician and all support systems to get off of them as quickly as possible and identify who will support your child through the process.
For those with chronic pain, we now understand that even without a history of substance use disorder, opioids are generally not the best course of action to manage long-term chronic pain. Over-the-counter NSAIDs such as acetaminophen and ibuprofen can be as, if not more, effective. Additionally, new non-opioid medicines and non-medicine tools such as massage, acupuncture, psychotherapy and mindfulness have proven to dramatically improve quality of life for those with a history of chronic pain.
Benzodiazepines: These drugs are generally prescribed for anxiety and they can also be highly addictive. Their effect is quite similar to that of alcohol for most people. Persons in recovery should consult with their addiction psychiatrist as well as other mental health professionals in order to determine alternative methods of dealing with anxiety. In fact, research has demonstrated that in the long term, therapy is more effective than benzodiazepines for dealing effectively with anxiety.
There are drugs that are not fully benzodiazepines but that have similar effects and addictive potential. They are generally prescribed for sleep. Persons in recovery should clearly ask both their prescriber and their pharmacist about abuse potential of any medicine they take. Also, like with anxiety, sleeping problems are best resolved without medicine in the long run.
Psychostimulants: The research on the continued use of psychostimulants by those with confirmed diagnoses of ADHD is mixed. However, for the vast majority of persons in recovery, psychostimulants should be avoided as they have a high abuse potential. For those with ADHD and in recovery, there are alternative medications such as Selective Serotonin Reuptake Inhibitors (SNRIs) that are effect and are not addictive.
How can I best support my child who has to take medications?
You can help by having an open dialogue with your child about medications and monitoring symptoms that may signal a relapse either from substance user disorder or mental health problems. Often your son or daughter might start to feel better and discontinue medication without discussing it with his or her doctor. Sometimes he or she will be reluctant to take medications because of side effects. In either case, it’s important to encourage your child to have a discussion with the prescribing doctor.
Doctors will be able to assess the situation to determine if the dosage is right or needs to be increased, another medication needs to be added, or the medication needs to be discontinued and, if so, how to taper off of it in the safest way. Sometimes, side effects like drowsiness can be addressed by taking the medication at a different time of the day or splitting the dose, taking part of it in the morning and the rest in the evening.
Regardless of the situation, the best course of action is to discuss concerns with the prescriber rather than try to figure this out without professional guidance. (In order to share any additional concerns you may have regarding your child’s medication, it will help to have your child sign a release of information. If he or she refuses, you can still share your concerns with the prescriber; however the prescriber won’t be able to discuss your child’s specific circumstances in return.)
Medication management, especially in the early days of recovery, can be extremely confusing, and it can be tempting to use an “all or nothing” approach. One size does not fit all by any means, and what is good for one person may not be for another. This is why no one need go it alone. With your son or daughter in recovery, he or she will find great solace in establishing relationships with medical professionals who understand addiction, and clearly communicating their history of substance use disorder to all practitioners.