Meds and Pills for All Our Ills
I was meeting with a colleague recently for Supervision, which is when I review cases with a certified counselor as part of the requirements to practice counseling for substance abuse. We talked for a while, and as it usually happens, we started addressing Co-Occurring disorders, like anxiety, depression and other mental health issues that go along with addiction counseling.
As addiction counselors, a lot of us are continually amazed at how many of our clients are on medication in situations in which no other assessment was made outside of the presenting symptoms. For example, going to your primary doctor, complaining about anxiety, and then getting a prescription for something like Valium or Xanax.
Before I go on: I’m not a person who generally blames doctors screwing us all up. Medical science is assaulted from all sides, it seems. Got a hot-button topic guaranteed to ruin your family reunion or even dinner? Chances are it involves the practice of medicine in one form or another. I have nothing but respect for the doctors, nurses, techs and even administrators who do their best to keep us functioning.
The thing is, they’re not all-knowing magicians or wizards who can diagnose our symptoms in ten seconds and get it right. That’s pretty much what they’re expected to do, by the way, and then pick the precise billing code for the insurance company so they can get paid. The demands of managed care are such that a thorough examination is almost impossible. I’ve seen it first-hand in addiction counseling, and it’s probably worse in other clinics and hospitals by a factor of 10.
Still, it’s scary to encounter someone who’s on a handful of meds along with a daily consumption of a fifth of vodka. For the record, there are 17 shots in a fifth, at 1.5 ounces each. I can’t say I come across this extreme case daily, but at least 1 out of 10 assessments I’ve done over the years is close to that level of “oh my god!”
In a separate but related incident, a person close to me has been laid up for months with excruciating back pain. She’s had surgery, spinal cord stimulation, and meds. A lot of meds, including morphine and a handful of other opioids. She has at least three doctors: her primary care physician, her pain management specialist, and another specialist specifically for her back. One weekend she told me how she was feeling, which was not very good. She was considering increasing her use of OxyContin, in addition to morphine, with another consultation coming up for more medication. Then we moved on to another topic, or so I thought…
She then started talking to me about her mattress. She was beginning to search for another bed, and she wasn't sure what she wanted to get. While talking to her, it occurred to me that something seemed slightly "off." I mean, most of her pain was centered around her back. And now, she was trying to figure out what kind of mattress to get. A simple question came to my mind:
"Have you ever talked to your doctor about your mattress?”
“Why would I do that?”
I’m sure most of you reading this know where this is going. I think it's important to remember, though, that in situations as complicated as back pain, medication, and multiple doctors, it's straightforward to let the most simple stuff slide right by. There's an old saying that everything looks like your nail if you only have a hammer. I think professionally, we suffer from the same thing, whether we are addiction counselors or doctors. We tend to get a kind of tunnel vision, and the only thing we know how to address our stuff we are trained and experienced in.
I'm not excusing the doctors, not by any means. They and the doctors who prescribed medication for the first client I was writing about deserve a firm slap on the wrist. Physical causes, environment, and behavior should always be explored—the biopsychosocial model of addiction treatment comes from the medical profession and the whole idea of holistic care! Not asking the most fundamental questions, like what your alcohol consumption’s like or what essential environmental factors may contribute to your pain, seems reasonable to ask.
It turns out; her mattress is nearly 30 years old! Even if she turns the bed, there's a divot on the other side. So it seems reasonable to speculate that a new, firm, ergonomic mattress may relieve her of the pain and discomfort she's been feeling for over a decade. Had even one doctor asked about that over the past decade, her life could at least be a little different.
Instead, we have meds and pills for all of our ills. Whatever we feel, from emotional discomfort to physical symptoms, we take some medicine or medication to relieve us of those symptoms. I don’t have an answer to this problem right now, and I’m certainly not a doctor. No one should take medical advice from a blog like this. But I think it’s reasonable to ask ourselves questions when we experience pain or discomfort. Things like: have I had enough water today? Is my diet healthy? Am I drinking more than I should? How old are my shoes, and do they hurt my feet?
And darn it: could my mattress be causing my back pain?
Thanks for reading, and I have a challenge for you. First, take a look at your daily routine and environment. Then, can you make any simple improvement to diminish your pain or symptoms?
-Scott
