When is a Duck Not a Duck?

When is a Duck Not a Duck?
Very rarely have I had a client question me about the accuracy of their diagnosis or prognosis. Managed care (misnomer) has perpetuated the role of clients/patients as passive recipients. Folks tend to expect that a professional who is educated, trained, and licensed to provide a service should know far better than they what is wrong with them, how it can be cured/managed, and what the outcomes are likely to be. These are completely reasonable assumptions. In the case of addictions and co-occurring disorders, these assumptions are often just plain wrong.

Amusingly, the folks who are most likely to question my findings are a small percentage of alcoholics and addicts when I insist that they can make a full recovery. To all who suffer addictions, the work of recovery is daunting though the rewards are extraordinary. To some it simply seems too good to be true. There is often a fear of how much irreparable damage has been done by abusing their bodies and minds with substances. They wonder how they will manage life without their drug of choice, and more specifically they are concerned that they will not be able to manage their mental illness without the use of medications that are both addictive and easily abused.

Often these folks have been told by medical professionals that they have a condition that requires a lifetime of medication management. This is true for a small percentage of recovering addicts and alcoholics. This is painfully untrue for a very large percentage who have been diagnosed as living with ADHD, Bi-Polar Disorder, Major Depressive Disorder, and the full range of Anxiety disorders, most notably folks who suffer Panic Attacks.

There’s an old adage that if it walks like a duck and quacks like a duck it’s probably a duck. Sometimes it’s not a duck. Sometimes it’s an addiction masquerading as a duck. Sometimes its emotional immaturity passing itself off as a mental illness. Sometimes it’s the very process of recovery itself that looks like cause for taking medication.

A person who frequently and/or excessively abuses alcohol and/or drugs is going to appear to have a mental illness because their behavior is often highly irrational and erratic. Mood swings, obsessive and compulsive thoughts and behaviors, short attention spans, being easily distracted, and doing crazy shit is not necessarily a sign of a mental illness. It is more accurately a description of what goes on in local bar rooms and dance clubs. A person who does not accurately (honestly) describe their use of alcohol and drugs to a health care professional is likely to get the wrong diagnosis, the wrong medications, and the wrong treatment.

Emotional, mental and physical instability are a predictable consequences of abusing substances. They are also naturally and predictably part of the process of being in recovery from addictions. If you’re in the first few years of recovery from addiction and you’re NOT experiencing some times of depression and anxiety then you’re doing it wrong. William Anthony defined recovery from mental illness as a , “deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. The same can be said for recovery from addictions. More succinctly, as my friends in AA say, “We found the only thing we needed to change was everything.” If you’re going to change everything – most especially how you cope, relate, and function, then you should expect a lot of highs and lows along the way. Don’t medicate them – work through them.

Once you’ve made the decision to stop abusing drugs and alcohol, you become free to see the world through new eyes. In the past, taking addictive medicines may have seemed necessary or desirable. Their presence may have added to your high or you may have chosen to temporarily stop using them because they interfered with your high. A word of caution here – NEVER stop using a medication without consulting your doctor.

Klonopin, Xanax, Ativan, and Valium are commonly prescribed to people who live with significant levels of anxiety. These drugs offer a sedating and euphoric affect and may even help a person in blocking out unpleasant thoughts, feelings, and memories. Vyvanse, Concerta, Adderall, and Ritalin are medications commonly used to treat Attention Deficit Disorder (with or without Hyperactivity). They are all stimulants that work on what’s called the paradoxical affect. It’s counterintuitive that people whose minds and bodies are given a stimulant and they slow down, but it is the case with people who are legitimately ADD. It’s important to know that nonaddictive medications that are not easily abused are available for a very high percentage of mental health conditions and effective treatments to change a person’s thoughts and behavior are also widely available.

Here’s where things start to get even more problematic. Anxiety disorders look a LOT like ADD and ADHD and are often misdiagnosed. The symptoms between the two types of diagnoses significantly overlap. If the prescriber does not ask the right questions (many of which are intensely personal) the wrong diagnosis will often be derived. Now we can muddy the waters even further: if a person has either chronic Depression or Anxiety, there is a very high likelihood that they will have both. Bi-Polar Disorder involves alternating patterns of Depression and Mania. Mania looks a lot like Anxiety. A person who has both Depression and Anxiety looks a lot like a person who has Depression and Mania and thus a wrong diagnosis of Bi-Polar Disorder is derived. According to the DSM (clinicians reference guide) the prevalence of Bi-Polar Disorder is somewhere around one person in every 200. Take a poll of people in recovery from addictions and you’ll see that the percentage diagnosed as living with Bi Polar Disorder skyrockets beyond anything that even loosely resembles a reasonable probability.

The emphasis on accurate diagnosis cannot be stressed enough. A person who truly does live with Bi Polar Disorder, Attention Deficit Disorders, and some forms of Depression were born with a genetic link and their symptoms are present by early adulthood. Anxiety disorders are generally not genetically linked and yet they run in families because they are most often the product of learned behavior (most notably how one learns to deal with negative emotions). In short, if you’re born with a condition it is likely a lifelong condition that needs to be managed – with or without medication is a frank discussion to have with your prescribing professional. If the diagnosis is not a product of your DNA then it is a product of your experience and may well be overcome completely and without medication.

It has been said for decades now that we have become a society that seeks a pill for whatever ails us. It is well past time for us to stop being passive recipients of health care services and to simply accept what a health care professional’s findings are. We seek second opinions when surgeries or other intrusive treatments are ordered. Let us do the same with mental health conditions – most especially when we have a history of substance abuse or addictions.

Jim LaPierre

About Jim LaPierre

Jim LaPierre LCSW CCS is the Executive Director of Higher Ground Services in Brewer, Maine. He is a Recovery Ally, mental health therapist and addictions counselor. He specializes in facilitating recovery (whether from addiction, trauma, depression, anxiety, or past abuse) overcome obstacles, and improve their quality of life. Jim offers a limited amount of online therapy to those with very flexible schedules.