A Treater’s Speculative Support of Rx Medication in the Field of Drug & Alcohol Treatment
- 17 hours ago
- 8 min read
For nearly 14 years, I've helped individuals navigate the complex landscape of addiction in order to achieve recovery. Nicknamed "The Casual Counselor", my approach is unconventional but undeniably effective.
Disclaimer: People, other treaters, or people using Medication-Assisted Treatment (MAT) are going to be rankled or even angered by this examination and my opinions about this topic. If they are not triggered to feel negatively about my opinion, they will likely be confused. I know this because I get confused while examining this topic. It’s okay to feel however you feel after reading this, anger, confusion, or an agreement to disagree. It is okay for you, dear reader, to feel however you feel about our current model of treatment for drug and alcohol abuse in this country.
I have witnessed MAT save countless lives. Hell, it probably saved my own when I fell into a deep pit of depressive symptoms in my second year of recovery. I was okay one day, and then suddenly, a precipitous drop into a state in which I wasn’t leaving my bed. I wasn’t showering or grooming myself. I wasn’t attending my nighttime courses at the community college I was enrolled in. Just a free-fall into a hellscape of feeling empty nothingness. I just wanted to sleep and not wake up. Out of nowhere.
It was then that I decided to see a proper psychiatrist who prescribed me an SSRI. Within a week or so, maybe even less, I noticed a change. My energy was returning. I had more “oomph.” More get-up-and-go. More resilience. Over the days, weeks, and months that followed, I was back in the rhythm of my healthy lifestyle. It was a lifesaver. Literally. As time passed, we gradually increased my dosage, finding that sweet spot, the therapeutic dose that would help serve as guardrails as I continued to heal, so that I wouldn’t drift off the road and go tumbling into a fireball out in the weeds.
Every several months, the dosage I was on would plateau, and then it would be increased. This happened four or five times in the handful of years I was taking the drug. Every time I reported to my physician that the medication felt like it was losing its efficacy, we’d give it a boost. I would then be back in tempo, continuing to work on learning how to live a healthy, ordinary life. The low-lows were now gone. But nothing is free in this life. I lost my high-highs, too. Much in the same way the dosage would plateau, I found myself in a state of mental “flat-line.” I would know when something was funny, or when something was sad, but I’d lost my tears. I’d lost my belly laugh.
When I eventually maxed out at the highest dosage, and its effectiveness began to plateau, I was faced with a crossroads. I was told that we could add another medication, one in the same family of antidepressants, to give my brain’s bounce-back a boost, or just stay put where I was with my dose and live with it. I chose a different option. I did some soul-searching and felt strongly about the belief that I could learn how to be “Josh,” naturally, and discover whatever I could do that didn’t involve swallowing a pill to feel okay being me.
To re-regulate. Recalibrate. Sit with myself and my feelings and be okay. To be okay with the tears. To earn back my belly laugh. And thus, I began to titrate. I began to wean off the medication. I did this over the better part of a year, slowly bumping down my dosage, and I found myself gratefully not falling into the valley of not being able to function. When I got down to the starter dose and then jumped off it altogether, my doctor told me that I’d “feel fine.”
This was not the case. Though the SSRI didn’t give me bliss, euphoria, or a high, it turns out that it’s a mighty powerful medication in itself. I went through a withdrawal period, brain zaps, vertigo, hot sweats, cold chills, sleeplessness, mood swings, GI distress, and headaches. It wasn’t so severe that I couldn’t get through the day, but it wasn’t pleasant. I experienced depressive and anxious rebound symptoms in the months that followed. It took a while to feel “Josh” again. I haven’t had to go on medication since. I still get depressive symptoms. I still get anxious. I have different tools I use now when that happens.
Here’s the thing, leaning into feelings hurts. It hurts "a lot". In the early days of recovery, it can actually harm someone if they go too fast, the shock of going “cold turkey” is too much overload on the CNS. As someone who works with people in the early stages of abstaining from whatever they have been self-medicating with for long periods, it is never something I recommend. They should be medically supervised through that process. Period. Meds are part and parcel for people going through detoxification and in the months beyond. Comfort meds. Meds that have less potential for abuse. Powerful substances in themselves, however.
The thing about meds is that they don’t necessarily have to be a life sentence for the user or the drinker, although that often tends to be the case for many in the end, despite their desire not to forever be drugged. I mentioned the term “guardrail” earlier. MAT is a wildly effective guardrail in early recovery. It presents an individual with a tool that protects them, a resource that keeps people on the road in the journey of becoming healthier without the worry of drifting off the street and flipping back into problematic use with more dangerous substances. They literally save lives. I see it with nearly all of my clients.
But I also work with many people who have that same strong feeling that I stumbled upon all those years ago. They want to get to a place where they feel ready to experience what it’s like to naturally be themselves. Honoring that nothing is free in this life, the price that they or we pay for coming off psychotropic or replacement therapies is going to be a story of hurt. Not forever and ever, but for quite a while. Coming off those meds is going to suck. That’s a guarantee. But then, there’s always this chance. After a person gets through the suck, life can start getting awesome. If they can be patient and cope with the discomfort.
That means leaning into some of the most painful feelings a person can experience. Not just of the physiological variety, but of the emotional kind as well. Terror, shame, guilt, anger, anguish, grief, panic. The worst of the worst feelings of hurt. Here’s the thing, though, as much as it hurts to do it, leaning into feelings isn’t going to put us in peril, just so long as we do it in a safe and contained fashion. Feelings, by their nature, are not dangerous. Drugs, whether prescribed or not, and alcohol often are, and some of the associated side effects will injure us if we continue using them indefinitely. They can even shorten our lifespan.
Worming our way through feeling our feelings for basically the first time since we were very young is like going through a painful rebirth of self. It’s not painful all the time, but the intensity of being confronted by the thoughts and sensations based on choices we’ve made when abusing substances is not easily reconciled. It gets easier with time, relatively speaking. Like anything, with more practice, we get better at doing it. And it helps to have a helper to share these feelings with, someone who can safely guide us through the thick of it. Out of the woods.
Diving into the deep end of this kind of work is not encouraged early on, and there will always be stories of individuals who absolutely have to be on some Rx medication or a combination of them for the duration of their lives. People with more exotic disorders, like bipolar 1 or schizophrenia, for instance, will benefit from getting on an effective mood stabilizer and staying on it indefinitely in order to live a good-enough life.
But for many users who were self-medicating depressive symptoms or anxious symptoms, and the emotions resulting from them, they often don’t need a life sentence of self-medicating with FDA-approved drugs. They aren’t going to offer bliss, euphoria, or sweet oblivion necessarily, but they will provide the user with the same thing that brought them to the point of asking for help in the first place, relief. Containment.
Looking through the lens of a drug or drink being a tool of relief and containment tells us that the FDA options may very well save our lives, but they very rarely give us the ability to feel the wholeness of ourselves. They don’t give us our lives back. When we lean into the stuff that hurts, we start to learn about the stimuli that trigger us into states of dysregulation, an overload of stress, overwhelm, and angst, and then the belief that there are other tools out there in the world, natural ones, tools that don’t come in a pill, a powder, a potion, or a pipe, that may be effective enough to help us cope with whatever we’re going through.
The belief and affirmation that we must provide ourselves is faith in the truth that we are capable of handling whatever life throws at us in healthier ways. The commitment we must make is to follow the formula that if we make different choices, given the circumstances of whatever we’re facing, we will get different outcomes. They may not be positive outcomes. We discard that which does not serve us, and then we make a new, different choice to learn its outcome. And so on and on and on. Trial and error can be frustrating as hell, but there’s no one blueprint for achieving “recovery.”
There is one blueprint for containing “recovery,” and often, medication is a key feature in its design. Those medications provide us with relief. Again, if a person is okay with just quick relief, all the power to them. If it keeps them alive and well and provides them with the guardrails to stay on the road to building a manageable life, to each their own. But I will posit to you that relief does not necessarily equate to re-regulating our nervous system when it’s on overdrive and learning about ourselves on a deeper and more substantive level.
Can we learn how to re-regulate using tools like breathwork? Exercise? Yoga? Meditation? Spending time in nature? Writing? Reading? A cold shower? A hot bath? I would posit to you that we absolutely can, but none of those methods are guaranteed. The only way to find out is to try, commit, practice, and learn until these methods integrate and help recondition us. What was it that the feeling was doing for me rather than to me? What is it that is lurking underneath the symptoms? The feelings of anger or angst? Here is where we start learning about who we are, and what in this life helps us to feel connected to self, to others, to the world. Things of value. Things of meaning.
So much of the work I do is all about the “F-word.” Feelings. Much of it is also about encouragement in the direction of lifestyle change. But the place where the real healing happens? That’s where the feelings come into play. That’s where true therapy happens, and real change and growth take place. May we always remember that if we’re in pursuit of true and whole healing, it always happens from the inside out, and not the other way around. The wholeness is the story of both, in alignment and as much balance as we can gather on the long and winding lifetime road to recovery.
Read more from Joshua Bennett-Johnson
Joshua Bennett-Johnson, Licensed Counselor & Owner of JBJ Counseling
After working for 7 years in an amazing clinic, I launched into private practice in 2018. I love my job. I can say that without reservation. Watching people rebuild their lives is something that is worth more than any dollar amount.
