Chasing the Pills
“There’s a pill for that” should be our national motto. Because in most cases, there is. Sometimes several pills actually. But what happens when medication management takes over behavioral modification? What happens when we think our magic pills will cure all of our mental ails? The answer is prepare to be sorely disappointed.
Medication Assisted Treatment
Medication Assisted Treatment (MAT) is a termed used in substance use disorder (SUD) and means exactly that: using medication to “assist” treatment. Notice the highlight of the word “assist”. Not cure. Help. There is no cure for the human condition. We are designed to be addicted. We are designed to seek pleasure. What MAT does is help reduce cravings and modify brain chemistry through what’s called agonists or antagonists – medications that add something or block something from happening in our brains.
In mental health (MH), there is really not a term like MAT. Rather just a jumble of protocols best described as “medication management” since pretty much all MH issues have a medication associated with them. What these medications primarily do is work on the trifecta of brain chemicals that regulate our moods and interactions: serotonin, dopamine, and norepinephrine. (This is a simplification of course – there are many other mechanisms that cause and treat MH.)
The onset of the opioid epidemic is often attributed to the over-prescription of opioid-based painkillers. There was a push towards the use of a “pain scale” by doctors that over time crept into a scoring system pushed partly by the pharmaceutical industry. I’m not getting in the why or the litigation or telling that story – but what I am getting into is the desire to be “painless”. It’s not an untoward desire and we shouldn’t moralize it. But it is frankly unrealistic to think that we can ever go through life without pain. There is debilitating pain and there is manageable pain. Both of those concepts still contain the word pain, not painless.
The goal of medication is to properly manage medical symptoms. It is true that some medications eliminate some symptoms. But when it comes to MH and SUD, thinking we can eliminate the symptoms of our natural predilections and our desires is completely unrealistic. Instead, these medications should be thought as helping manage our symptoms. As in they are part of an overall treatment plan. Not the magic pill solution.
The goal of therapy, self-help group participation, and mindfulness efforts is to alter or change our behaviors. I often describe all self-help groups as helping teach us new coping methods (as mine previously was shutting my brain off with alcohol so I needed to learn new ones). Certainly, medication has a large part to play in that – but that is also very specific to the individual and their chemical makeup and needs.
Changing our behavior to something healthy and enduring is the end goal of every MH and SUD treatment program. This takes discipline and a significant amount of time. For many of us it took years for us to get this way – it will most likely take years for us to fully change. It’s our day-to-day efforts that help us get there. It is not an easy button solution. It is work.
There is no Easy Button
We are lazy. Don’t take that as an insult – it’s just true. We seek to make hard things easy. It is in our nature. But be aware of that desire. Seeking the easy button and chasing a pill is lazy and, in the end, we won’t appreciate the effort we didn’t take. The things in life that I appreciate were very hard to achieve: sobriety, 25 years of marriage, financial stability, etc. Speaking of marriage, there really is no magic pill for that is there? The point is that all of these things took time and effort to see the results. I often call medication what gets our feet under us but we still have to do the walking.
There is a difference between uncomfortable and intolerable. Learn how to be uncomfortable. Social anxiety – do you really think you’re alone in that? Most people in most groups have social anxiety (why do you think there’s alcohol everywhere?). Here’s something right down the line of Unonymous – tell them that. You may be surprised of the responses. Cravings – who doesn’t have them? Who doesn’t really really want what they can’t have? It’s human nature. You’re not special. Again – ask someone. You may be surprised of the responses.
It is uncomfortable to be left in our own skin and vulnerable to every stimulus that we receive. But guess what? If you are reading this, you have survived every bad day you have had so far. Which means you can keep learning to do so.
There is no Hard Line
Just as there is no easy button, there is also no hard line. There is no shame in needing medication to process life, your addiction, or to cope with an underlying condition. Recovery programs (self-help or otherwise) would be wise to accept the symbiosis between medication and therapy. Everyone needs therapy, some of us need both. Just like I’ve talked about in other Rants: you have a headache you take a pill; you are depressed you take a pill. It’s no different.
People who think everyone should approach recovery with a zero-medication mantra make about as much sense as saying you don’t need a jacket because they don’t feel cold. It’s not their recovery method you should be concerned about – it’s yours. You do you.
Seek the Balance
As usual, I tend to relate these ideas to something we know well: diabetes. Insulin is medication management. Behavioral modification is our new diet. We need both to achieve balance. Just like I need both to achieve the balance in my own life.
I have mood disorder. I take three types of mind-altering medications: lamotrigine, bupropion, and lithium. Finding the combination has been an absolute game changer. But I didn’t start with that. I started with my psychologist shortly after I got out of rehab for alcohol. Then after about a year we decided that even though I was learning new disciplines, the internal mood issues remained. I needed something more, so I saw a psychiatrist and started lamotrigine. Several months later we added the bupropion and about a year later we topped it off with lithium, working over the next couple years to find the best dose combinations. All this time I was seeing my psychologist every two weeks for cognitive behavioral therapy.
I am not balanced. I don’t think I will ever be truly balanced – but I can be stable through a combination of both cognitive therapy and medication management. There is no perfect solution and there is no magic pill to chase after to fix it all. At this point, I don’t think I would take it anyway.