Are You Really Sober If You're On Meds?

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You cannot pray away your depression. Often, you cannot pray away your anxiety and you cannot pray away highs and lows of a bipolar disorder.

A few years ago, in a 12-step meeting, a long-term-sobriety member suggested that I try stopping an anti-depressant (Prozac) and just rely on the program to help me with my depression, which she called my “character defect.” (I’ve heard shyness—anxiety—described as a “character defect” as well; it was considered to be simply “self-centeredness.”) Was I even sober, this person challenged, since I wasn’t “abstinent” from a mind-altering substance (Prozac)? I asked my sponsor at the time what she thought. She said, “I reserve judgment on that one.” I still cannot decide if that was an aggressive or a kind thing to say (we broke up shortly afterwards).

Wanting to be the perfectly sober member of AA, I quit on the spot. Right after I did I was dead tired, yet my anxiety was so high it was like a razor in my throat.

Abstinence and 12-step meetings is how I try to deal with addiction but addiction, a mental illness, can co-exist with other mental illnesses. And illnesses need to be treated. The program of Alcoholics Anonymous (AA) believes that the only treatment of addiction is abstinence, and although medication might be considered an “outside issue,” the program seems to struggle with this “outside issue” as much as Bill Wilson, a co-founder of AA, used to struggle with his concurrent mental illnesses.

Wilson led a life-long battle with depression. He didn’t drink because of it (or did he?); depression was there long before and long after he got sober. Wilson was, at one point, a proponent of using LSD. He believed it could help the less spiritual alcoholics achieve Higher Power, although he remained conflicted about his support and use of the drug. At one point, he “removed himself from the AA governing body to be free to do his experiments,” which according to The Guardian article, LSD could help alcoholics stop drinking. (When I was 17, I heard Jesus speaking to me from the inside of an oven while on acid so I can totally see how that artificial push toward finding Higher Power would make sense.) Wilson enjoyed the effects of LSD and even said that it helped him regain his appreciation of beauty destroyed by depression but the only medication he treated himself with when it came to depression directly was niacin (vitamin B3).

My experience with quitting an anti-depressant under the suggestion of that 12-step member was awful. Wanting to be the perfectly sober member of AA, I quit on the spot. Right after I did, I wasn’t sure if I was seeing the things I was seeing. I was dead tired, yet my anxiety was so high it was like a razor in my throat. I prayed and prayed but none of that—the anxiety, the strange vision—would go away, and eventually, I was no longer sober. I know now that the physical reactions were related to a sudden withdrawal and my non-sober spell was short but all of that was enough to cure me of not trusting fanatics in 12-step programs but also, finally, of the kind of Higher Power situation where I can pray away my “defects of character” (depression).

In the official literature of A.A., The A.A. Member-Medications & Other Drugs Pamphlet (revised in 2011), it says that “because of the difficulties that many alcoholics have with drugs, some members have taken the position that no one in AA should take any medication. While this position has undoubtedly prevented relapses for some, it has meant disaster for others. AA members and many of their physicians have described situations in which depressed patients have been told by AA to throw away the pills, only to have depression return with all its difficulties, sometimes resulting in suicide (…) Unfortunately, by following a layperson’s advice, the sufferers find that their conditions can return with all their previous intensity. On top of that, they feel guilty because they are convinced that ‘A.A. is against pills.’”

Mary, four-plus years sober member of AA says, “A member of my home group got her one-year medallion while openly on methadone, and she wasn't the first. I don't sponsor people who are actively using mind-altering drugs with no plan to quit because I have no experience with that and wouldn't have any insight into how to manage that experience. A friend of mine recently helped himself to some Tylenol 3s (not using them for the prescribed pain, which had ended, but rather to manage anxiety) and he eventually picked up a desire chip because he is also a drug addict and needed to take serious action to put the breaks on such behavior. However, another friend, who never had a problem with drugs, was recently prescribed Percocet for pain, which she took and enjoyed but stopped once the pain stopped and no one ever considered her not sober.”

An official bulletin by Narcotics Anonymous (NA),—whose members sometimes use opioid medication to get off heroin—says this, “When an individual under the influence of a drug [in this case methadone] attempts to speak on recovery in Narcotics Anonymous, it is our experience that a mixed, or confused message may be given to a newcomer (or any member, for that matter) For this reason, many groups believe it is inappropriate for these members to share at meetings of Narcotics Anonymous.” But, also, “Tradition Three says that the only requirement for NA membership is a desire to stop using. There are no exceptions to this. Desire itself establishes membership; nothing else matters, not even abstinence. It is up to the individual, no one else, to determine membership. Therefore, someone who is using and who has a desire to stop using, can be a member of NA.”

I suppose “member” and “sobriety” are not mutually inclusive terms at all but this lack of vote of confidence in a methadone-aided NA member is heartbreaking.

One long-term (five years) clean former heroin user, says, “(It’s) ironic in a way that they (NA) wanted us to come out in a meeting anytime but it frowned on outpatients (speaking) a lot.” (By outpatients he means those who were on methadone.) NA’s stance on methadone maintenance is at best confused but the language – using – just makes it sound passive-aggressive, nothing more: “(…) it is also a common practice for NA groups to encourage these members (or any other addict who is still using), to participate only by listening and by talking with members after the meeting or during the break. This is not meant to alienate or embarrass; this is meant only to preserve an atmosphere of recovery in our meetings.”

Recently, a woman I know was told by some members of a 12-step group (AA) that being on Suboxone—a drug that is actually a combo of opiate (buprenorphine), and an opioid antagonist (naloxone), and can be habit forming—while trying to get off heroin meant that she was not sober. Neither of those members was a medical professional, and while the woman has remained on the drug, she is angry and has questioned her sobriety. I don’t know how many clean days she’s got now—or how many heroin-free days, I suppose.

Also, if addiction is considered a mental illness should an addict not be allowed to take medication to deal with his or her illness yet still be considered sober? According to Dr. Vera Tarman, the sobriety of the woman on Suboxone is "a judgement call. Most medical professionals, including myself, would say that she is NOT getting high on Suboxone. I see it as no different than being on an antidepressant - both are mood altering slow release drugs. How are they different? Just perception."

A friend and a member of AA says that sometimes she takes Ativan to deal with anxiety. She says she doesn’t abuse it and considers herself sober. She’s vague about the length of her sobriety and she doesn’t share about it (Ativan) in meetings. Ativan, which is a benzodiazepine has been known to be abused as a substance to get you high—its effects might be similar to those of alcohol: some euphoria, drunk-like dizziness. I can attest to that: I’ve taken it in the past and I enjoyed its effect immensely. Ironically, the first time I took it, was when I had to speak at an AA meeting to a large room of people (I didn’t say during my speech that I was currently on it – duh). I’ve, also, taken it on flights (very pleasant for this freakout flyer) and I’ve been offered it in an emergency room recently when I cut my hand. I had a very long nap after I got home. I admit, too, that I’ve taken it when not needed because I liked its effects. Or I just didn’t like having a razor of anxiety in my throat? I don’t know.

Sarah, who identifies as a sober AA member says she takes two milligrams of Ativan every night for her panic disorder. “Before ever becoming alcoholic, I started drinking alcoholically to get rid of the panic.” She says that every person in AA she has talked to is against it but if she didn’t take it, she believes her quality of life would suffer. “I would be likely dead from drinking to avoid that horror of panic, and it isn’t just panic. It’s like, my world turns upside down, a sort of insanity; terrifying.” She says “I understand my disease (of alcoholism), and I understand my panic disorder and I know what I need is to treat both.”

Stan, a long-term member of AA and a former alcohol and drug counselor for 20 years, says, “My stance on using other medication depends on why the person is taking the drug/substance. If you are taking it to get the high and avoid dealing with reality, then you've basically swapped addictions. If you are using the other substance for a documented medical/psychiatric problem, and taking it as prescribed then I don't see the problem. It is like taking an aspirin when you have a headache, or a drink of water when you are thirsty.”

Another long-term member of AA, Rob, says, “I had grown up in the fellowship. My first sponsor had also been my Alateen sponsor in the late seventies. I first came to AA in 1984. My sponsor was a very educated man (a practicing lawyer) and we would talk about working my way out of depression by actions [prescribed by a 12-step program] and—to a point—that helped. I did find relief, but still lived with those horrible impending thoughts of doom. I think that was a contributing cause of my relapse. My family physician diagnosed me with Seasonal Depression Disorder because of several years of behaviors from November to March. He was first to prescribe meds. Wow what a difference almost overnight!” Rob quit the meds eventually and shortly afterwards realized he was dipping back into depression until a few years later when he found himself locked up in a psych ward. After a few more bouts of trying not to take the meds, he met an Addiction Specialist who educated him about depression and why he needed medication. Rob says the medication saved his life. “My depression—as I took the (fourth step) inventory—started way before my drinking. It was not as a result of my drinking and drug use.”

I take medication to deal with my bipolar II and depression. It helps. It has changed my life for the better, in some ways. I’m also a member of a 12-step program (yes, I’m breaking tradition 11 here). And when thinking about my own social anxiety or fear of flying, I remain conflicted. I know that taking a benzo would definitely be me trying to avoid reality. At the same time, recently, I almost chewed through my cheek to deal with reality on pure abstinence terms.

The reality was that I was on a media tour related to my memoir and I spoke on radio and TV without any aid of anti-anxiety medication… and it was hell. Partly, that was because I worried that I would be asked if there was anything I was using and I would have to lie, were I taking something like an anti-anxiety medication. So, I lived in that particular hell for quite some time with the reality of tearing the insides of my cheek to shreds, quietly, as I answered uncomfortable questions about being an irresponsible drunk parent. When I’m particularly dramatic I describe that period as performing an autopsy on myself in front of an audience.

Since I’m no medical expert, I cannot tell if the depression that hit afterwards had anything to do with how my body reacted to being tense for so long. Everyone said I seemed very calm and collected during the interviews.

Jowita Bydlowska is a regular contributor to The Fix. Her memoir Drunk Mom was published by Penguin.