Vallarta Tribune, Mar 19-25, 2006, issue # 467, pg 24

Over the years I have heard people in recovery say, “they are just replacing one drug with another” or “trading one dependency for another” or “they must learn to be sober without taking any other drugs.” This is not always true. Sometimes medications are necessary.


We are very aware that there are still people (especially in recovery circles) who believe that once someone becomes clean and sober they should not take any other medications especially for the treatment of psychiatric symptoms. They believe that if someone chooses to take medications for depression, anxiety, or to treat and manage alcohol/drug cravings that they are not clean and will end-up depending on/become addicted to these medications. Nothing could be further from the truth. In fact, anti-depressants, anti-anxiety, and medications for cravings are not addictive and are very necessary to treat the chemical imbalances in the brain.

Of course there are some medications that should generally not be prescribed to people with addiction, particularly benzodiazapines (ie: Valium, other tranquilizers) and narcotic pain killers because they are so addictive. Prescribing pain killers (analgesics) to a person with addiction/chemical dependency is very delicate. The doctor should be made aware of the addiction and should cautiously prescribe a limited dose for a short period of time (ie: recovery from surgery).  Treating people with chronic pain is even more complicated and challenging.

Mental Health Disorders/ Mental Illness/ Dual Diagnosis

Approximately 50% of people diagnosed with mental illness (depression, anxiety, bi-polar, schizophrenia, psychosis) are also afflicted with addiction. This is referred to as “dual diagnosis.” If these disorders go untreated the person suffers miserably with sometimes overwhelming and incapacitating symptoms (depending on which disorder) such as auditory or visual hallucinations, chronic insomnia (results in exhaustion), extreme paranoia; may believe someone is following them or wants to hurt them, in psychosis they may be out of touch with reality or may believe they are someone else. Depression can render someone incapacitated or suicidal, leading to death.

Bi-Polar Disorder is when someone fluctuates or cycles between depression and mania. In mania they have extreme energy, may only sleep 3-4 hours a night, may behave in extreme ways such as excessive spending, extreme sexual promiscuity, working crazed long hours without taking time to eat. Many people are very productive and enjoy their manic periods and are therefore resistant to take medications to bring them out of it. However, they are usually reckless and spiraling out of control, doing a lot of damage along the way, ending up with extreme consequences; major debt, sexually transmitted diseases, lost relationships, lost jobs. Eventually, they end up very depressed, sometimes unable to get out of bed for days or weeks, they may stop eating, lose weight, disconnect from everyone, become incapacitated; unable to work/function, unable to take care of their kids, and they lose interest and motivation. If it goes untreated they could end-up feeling suicidal and actually attempt or succeed at taking their own life. Do you feel tired and overwhelmed just reading this, imagine living with it?! Believe me, it is difficult enough to live with when they are taking medications, let alone when they are not. Now add this to also having an addiction and battling with sobriety and recovery!!

Which came first the addiction or the mental illness?

It is of course very important to distinguish between drug induced depression or psychosis for example. There are many symptoms caused either by intoxication or withdrawal which mimic mental health disorders. Once the person is sober, it can take several months or longer to determine which came first, the depression/ hallucinations/ anxiety or the drug addiction. However, in the meantime the symptoms usually need to be treated in order for the person to get better (or at least improve) and stay clean/sober long enough to make an accurate diagnosis.

Addiction / Chemical Cravings

Chemical imbalance that can result from alcohol and drug use, but the problem is very real and more common than you might imagine. Unfortunately, it often goes undiagnosed and many addicts struggle to fight their addiction without realizing there is a chemical brain imbalance making things worse, sabotaging their efforts. There is nothing more frustrating than to see someone trying to make it, to keep their head above water, to keep from drowning, and despite their best efforts find themselves relapsing over and over again. Thank goodness science has made some strides forward in this area and come out with medications to help treat the actual imbalance versus the symptoms.

They need and deserve a 12-step support program

The need for them to be able to safely attend AA/NA without being judged or ridiculed is imperative.  Empathic understanding and acceptance while they are struggling with much more complicated issues and attempting to get better and turn their life around, is essential to their recovery.

 It’s not just a matter of will power or self-control.

Written by: Giselle Belanger, RN, LCSW,