This post was originally published on September 22, 2014.
AfterParty is pleased to have a number of esteemed professionals in our back pocket who are employed in various fields of psychological and spiritual wellness. Today we’re talking to Constance Scharff, Ph.D., Senior Addiction Research Fellow, Director of Addiction Research at Cliffside Malibu and coauthor of the bestselling Ending Addiction for Good, about addicts and medication.
Q: What is your approach to co-occurring disorders or “dual diagnosis“?
A: When you bring up co-occurring disorders in a treatment context, people panic and think of schizophrenia, but that’s only about 1% of the population. Statistics say 50% of addicts have a co-occurring disorder, yet few treatment centers are licensed to treat them. At Cliffside we’re seeing almost 75% of addicts coming in with a diagnosable disorder, mostly depression, anxiety, PTSD or ADHD. It’s no surprise that addicts might be depressed, right, but you have to treat the co-occurring disorder and the addiction at the same time. Otherwise, you have very little chance of success. We don’t know which one is the chicken and which the egg, but what we do know is addiction and co-occurring disorders feed each other. Because they feed each other, you must deal with them simultaneously, which means our addiction treatment centers need much more education on co-occurring disorders. Every treatment center needs to become qualified to treat co-occurring disorders, or we cannot expect them to resolve the issues people come in with. For example, we can’t have groups run by techs whose only qualification is having gone through the program themselves and who are pretty early in sobriety. You need a qualified therapist who can manage a discussion that includes issues of co-occurring disorders. That’s why we don’t talk about other disorders in [12-step] meetings, because people in meetings aren’t qualified to handle those subjects. So then why would we say that techs are magically qualified?
As for treatment, I’m against putting people on meds for co-occurring disorders as a first line of treatment. Studies show that antidepressants have very low efficacy for mild to moderately depressed people. For severely depressed people, they may be needed for a short time, but in my opinion, they’re overprescribed by doctors. ADHD is another issue. Very few adults need Ritalin or Adderall to deal with ADHD. Here’s the problematic part about meds. The drugs physicians give for schizophrenia or bipolar disorder or other sorts of psychiatric disorders aren’t generally addictive. You don’t hear of someone overdosing on Librium. But medications for anxiety and ADHD and PTSD are often highly prone to abuse. And yet, when we fail to look at both problems together, addiction and the co-occurring disorder, we give these abuse-prone drugs to people with substance abuse issues. So of course they don’t use them the way they’re prescribed! I have a friend who’s afraid of flying and gets on a plane maybe three times a year, and she likes to take a Xanax before she flies. That’s an appropriate use of a medication like Xanax. But let’s take someone who has anxiety in their house, and is prescribed that medication whenever they feel anxious. And let’s say they’re using a little coke too, which they may or may not tell the doctor about. Well, then they’re going to feel anxiety, and that Xanax is going to take the edge off…and you’ve got someone well on their way to an accidental overdose from mixing illicit and prescription medications.
So, no, I’m not an advocate for using pharmaceuticals as a first-line practice in treating the most common co-occuring disorders addicts present with. We’re addicts because we’ve learned to take a drink or pill whenever life does not suit us. And our brains become so dysfunctional that we don’t have the capacity to make a different a choice. But clinicians do have choices. In fact, there are dozens of therapeutic interventions that are non-pharmaceutical. The problem is they’re not funded for research. Because if you find the pill that will prevent alcoholism, you’re going to be rich. Drug research makes money for drug companies. Like the painkiller, Zohydro—nobody wanted that drug approved. Doctors and pain specialists didn’t want that approved. We really don’t need another painkiller, certainly not one without an abuse resistant formula. The US uses 80% of the world’s painkillers. We have an expectation that we will not feel bad ever. Addicts are really just doing what everybody else is doing, only more. They’re in so much pain that they use more of those numbing substances than everybody else does. And that’s the way we have to shift the discussion.
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