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Prescribed Medications versus Illegal Drugs

"I'm not going to take this medication. I don't want to use drugs to feel better." Have you heard anyone say this? Have you said it yourself? Let's look at some of the differences between medications prescribed by a doctor versus street drugs, alcohol or illegally obtained prescription medications.

Why might someone be reluctant to take medications, particularly psychotropic medications that affect the mind, even when prescribed by a doctor, psychiatrist or psychiatric nurse practitioner?

  • I don't want to feel drugged.
  • I don't want to put some strange substance in my body.
  • I want to feel my feelings.
  • I have a problem with drug addiction or alcoholism. I don't want to get addicted to another drug.
  • My doctor keeps increasing my dose. That sounds like addiction to me.
  • I want to drink or use illegal drugs and I can't do that if I take the medicines my doctor prescribes.
  • I don't like the side-effects.
  • The risks aren't worth the benefits.

Let's look at some of the differences between drugs prescribed by a medical professional and those obtained on the street.

Safety. Medications obtained from a reputable pharmacy are in general manufactured under strict quality control. If there is a problem with the safety of a prescription medication, it makes the news. Who knows under what conditions street drugs are manufactured? The street drug supply chain is uncontrolled—anyone along the way can and often will cut the drug with any substance they want, including poisonous ones. Problems with street drugs generally don't make the news because such problems aren't news, they're regular occurrences.

Your Dealer or Your Doctor? With only a few, unfortunate exceptions, your doctor has your best interests at heart. You doctor, by inclination, training and ethical code, makes decisions and recommendations to help you. Your dealer is out to make a buck. If your doctor gives you the wrong medication, or irresponsibly helps you get addicted to prescription medicines, then they face the possibility of losing their license and their livelihood. Your dealer's best interest is in seeing you use as much of the drug he is selling you as possible.

Addiction. Street drugs stimulate the pleasure centers of the brain. Many are highly addictive. Some prescription medicines are addictive, especially the older ones. However, most newer medicines, including most antidepressants, bipolar medication, anti-psychotics and the like are not addictive. They do not produce a "high" that leaves you craving for more. They correct a chemical imbalance in the brain, allowing you to function normally. If you are prescribed a drug that has the potential for addiction, your doctor should inform you of the fact and carefully monitor your dose and the duration of your treatment. It is important to find a doctor who is forthright and communicative about the drugs he or she is prescribing to you.

Tolerance. With some medications, particularly psychotropic ones, your doctor will start you on a low dose, then gradually increase the dose. This gives your body time to adapt to the medicine. It also is more likely to result in you taking the smallest effective dose. Why start out on the largest dose possible if it is not needed? Also, after taking the medicine for a while, your doctor may need to increase the dose to maintain the effectiveness. This is not addiction, this is tolerance. Addiction includes tolerance, but also includes other attributes such as taking the drug to get high; thinking about the drug and ways to get the drug constantly; and continuing to take the drug despite severe negative consequences. Merely needing to take more of the drug as time goes by is by itself not sufficient for a diagnosis of addiction.

Recovery from Addiction. Addiction, whether to alcohol, drugs, gambling, sex, shopping or anything else, is generally an attempt to cope with difficult or overwhelming emotions. Medication, used properly, can give you the stability you need to address your emotions and deal with the core issues that are driving your addiction.

Side Effects. All drugs have side effects. If you experience a side effect that makes you want to stop taking a drug your doctor has prescribed, talk to your doctor. Every person has a unique metabolism and reacts differently to different medications. If one medication has intolerable side effects, chances are there is another which you can tolerate. It may take several tries to find the right one. It may be helpful to see a doctor who is trained in psychotropic medications, such as a psychiatrist or psychiatric nurse practitioner. Someone skilled in your condition should have an excellent knowledge of side effects and know what to try next.

Feeling Your Feelings. Many older drugs had a tendency to blunt feelings. This was recognized as a problem and pharmaceutical companies searched for alternatives without this characteristic. Most modern drugs do not blunt your feelings. If you are experiencing flat affect, see your doctor. Chances are there is another medication that will leave you feeling more normal. You should be able to take your prescribed medication and still feel the normal range of appropriate human emotion. But it should be in reaction to events, not because there is a metabolic problem that makes you feel a certain way. Also be aware that you may have gotten used to feeling depressed or some other way. When this stops, it may feel odd at first. It may feel odd to not feel anxious or sad all the time. Give yourself permission to feel normal again. With the right medication, you should be able to address problems in your life that affect you, grieve your losses, process your feelings and live a normal life.

Your Drugs or Your Doctor's? Maybe you would rather drink than take your prescription medicine. Or use illegal drugs. How well is that working out for you? Do alcohol or illegal drugs help you make wise decision? Do they help you build better relationships with people that are worth knowing? Do they help advance your career or your schooling? Or do you use alcohol or drug as a crutch, to avoid facing difficult emotions. Are alcohol or street drugs the easy way out? Or the easy way down? If you avoid taking prescribed medicine because it interferes with your use of alcohol or drugs, perhaps you are not ready to make serious changes in your life. If you are ready to take control, then it is time to give up your abuse of alcohol or drugs.

Do the Expected Benefits Outweigh the Potential Risks? This is the key question when considering taking any medication and can only be answered by a frank and open discussion between you and the prescribing doctor. Some conditions, such as bipolar disorder, major depression, anxiety, obsessive-compulsive disorder or schizophrenia, can cause great damage in your life if untreated. On the other hand, as pointed out earlier, all medications have side effects and some prescribed medications tend to be addictive. So if your condition is relatively mild, maybe no prescribed medication is necessary. However, if your condition is severe and there are relatively safe medications available, then medication may be indicated. Risk versus benefit is something you should talk over with your doctor.

Medications or Therapy? If your condition is severe enough to warrant medication, the answer is probably both. Sometimes medication is needed short term to stabilize mood so that therapy can be effective. For some conditions, medication will be needed longer term and therapy can help you learn to adapt and lead a happy, rewarding life.

Alcohol, street drugs and illegally obtained prescription drugs cause great harm to millions of people every day. Consequences include overdoses, death, crime, poor health and lost opportunities. You are wise if you fear addiction and the harm it causes. However, your doctor is trained in the use of medications, is ethically obligated to do what is best for you and has available a wide range of choices to achieve the desired results with a minimum of side effects. Prescribed wisely and appropriately, psychotropic medications can correct metabolic imbalances and help you lead a normal life, not avoiding your problems, but facing them with confidence and inner strength.

Sandra Nettles, LCSW, MSSW
Jamie Nettles, MS

The original of this article can be found online at—
http://deerval.com/Articles/PrescribedOrIllegalDrugs.htm.

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