mental health

In the early years of my recovery, a lot of my friends tested positive for HIV and the AIDS virus. I went along with all the lifestyle changes to support them. Overnight we became non-smoking, macrobiotic, vegan, aerobic-class enthusiasts reading A Course in Miracles and quoting Marianne Williamson. Considering we’d all been art-damaged, punk rock-nurtured criminals and sex-working gay & straight IV drug users, throwing ourselves enthusiastically into every possible holistic and spiritual way to heal ourselves expressed our collective desire to live. And we never missed an opportunity to laugh at ourselves. Some of our adventures in spirituality-seeking bordered on the ridiculous but we needed more miracles – the first miracle being that the desire to use drugs had left us.

Years passed, we accumulated clean time, and life-saving HIV cocktails became available. The miracle had happened. Without the threat of impending death motivating lifestyle change, some people started picking up and putting down cigarettes again, ordering steak, going from sex-abstinent to sex-abundant, opting out of cardio for yoga. Over time, we exited the self-help route and found therapy.

In recovery we continue striving to enrich our lives, our relationships with others and most importantly, our relationship with ourselves. I encourage people to seek professional help whenever needed. However, Rome wasn’t built in a day. For many addicts, learning how to live with our feelings must come before we are ready to dig deeper. We do this by staying clean, building a foundation, and gaining courage by living life on life’s terms. For others, staying clean would not be possible without healing the wounds of trauma with a professional early on. Wherever you fit in this spectrum, the combination of listening to your heart and the suggestions of those with more experience will be your guide.

Therapy is a commitment to show up and be honest so it is important that you find a therapist who is a good fit. This can be done with a little research and interviewing. You can often get names of therapists from various centers connected to organizations dealing with GLBT, Women’s Services, victims of violence or sexual abuse, sex workers, runaways etc. You can Google “therapist, your location and whatever specific issues that may concern you” and see what comes up. You can ask your doctor, ask friends about their therapists. Once you begin seeking, names will come. You can find sliding scale often connected with larger university mental health facilities, some therapists take insurance and others are cash only. Prepare questions for the first meeting – it’s okay to ask them about themselves and their practice. You will intuitively know who you feel safe with. Remember, you are building a new relationship so don’t expect an instant fix. It takes time for many of us to build trust before we are able to be thoroughly honest. This is not surgery. Healing happens over time. Therapy is really a case of “more will be revealed”. The willingness to begin is all you need to start the ball rolling toward change.

People often ask “Was it worth it?” and want to know what I got out of the experience. Often during therapy I’d be asking myself the same question. I tackled many different issues according to what was happening in my life, how I was handling situations, and feelings. For example, nothing ever seemed to get me angry yet I would cross a line (usually because I felt I wasn’t being heard) and literally see red and start swinging. I knew this was strange and wanted to know how to have a different experience. That was one reason I sought help. In retrospect, what I have gained from therapy is that I now experience my feelings as they come up. I don’t intellectualize them and I don’t check out. This has enabled me to live fully in my body and be present in the moment in my life.This had not been the case for most of my life. I numbed out feelings that either were painful or scary first with drugs and then clean with escapist behaviors. These days I wouldn’t even know where the switch was to flip it to the “off” position if I wanted to. I believe this change is definitely the key to the contentment I feel most days.

I’m going to talk for a moment about medication. Personally, I’m not against meds in recovery. I do not believe we have to suffer to prove our willingness to be clean. I also know addicts have a history of preferring a pill to hard work, that we are self-deceptive and very skilled at deceiving others. So this is my own personal philosophy on the matter. I was offered anti-depressants a number of times by my therapist. It  is her job to offer solutions – and medication is a solution. I decided to exercise, meditate and get fresh air to see if it helped first. I also pinpointed things in my life I could change (people, places, jobs) that were bringing me pain. I did the work and felt better. The depression lifted without medication. If you do not try alternative methods first, my guess is you want a pill to fix it. Now there are people who will not find relief from depression or anxiety no matter what holistic avenues they take or what lifestyle changes they make. And there are people with other mental health issues. It is important to be completely honest with your psychiatrist and to choose one who has a lot of experience working with addicts. I know a psychiatrist in NYC who believes no one needs more than 3 medications to deal with disorders common to addicts. I’ve had clients come to me who have a regiment of 8 pills a day. Since I’m not a doctor all I can do is insist they get a second opinion. Also, if you came into recovery on anxiety meds, Adderall, antidepressants and sleep medication, my question is always “Did your doctor know you were abusing drugs? The symptoms that he treated, could they have been partial withdrawal symptoms from your drug of choice?” I don’t care if you’re 30 and you have been on these meds since you were 16. It is possible you were misdiagnosed because you were using at the time. Be willing to get honest with a psychiatrist who specializes in working with addicts in recovery and trust him to evaluate you.

At the end of the day, we have to learn to be honest with ourselves and honest with mental health professionals. We have to be willing to make lifestyle changes and to heal old wounds in order to find peace and comfort in our skin if we are to stay clean and sober for the long haul.







Patty is a nationally recognized certified recovery coach and writer. She lives in New York City.


Hi Patty,
As always the insight you share with all of us is a welcome assurance that we are not alone in our journey.
I remember a time in my first attempts in recovery when any mention of drugs at a AA meeting was a taboo. And anyone who identified themselves as having a problem with anything besides alcohol where shunned and even asked to leave the meeting.

I admit I’m a dinosaur in that alcohol was the only drug I consumed.
With that I want to add that I am also one who adheres to the belief that a drug is a drug and no matter what our drug of choice may have been it took US ALL to the same places.

To move to the area you are addressing. I also remember an incident vividly that happened over 30 years ago at a noon time meeting in Boston which was nicknamed the loony noony.
The incident that occurred was when a elderly woman who had been struggling with her addiction and also severe mental health issues and was under a doctors supervision and was taking prescribed medications but after listening to many uninformed participants of this group was convinced that she could honestly claim that she was truly clean and sober if she continued to follow her prescribed medications. I witnessed her deterioration which happened quickly and was obvious that she was in need of help.
I at the time did not have the creditability to champion her need to listen to her doctors and to people within in the program who could convince her that her sobriety and clean time would not be jeopardized if she were to take the antidepressants and other psych medications she needed.
I was fortunate to know a physician who was in the program and agreed to speak at this meeting and to also educate this woman and others myself included that that alcohol and drugs are a symptom of underlying problems and sometimes medications were necessary in order for one to cope in a healthy frame of mind to fight our disease.
I bring this up, because I too suffer from clinical depression and I too have paid the price of not adhering to my doctors advice and follow a strict policy to taking my prescribed medications and to my daily awareness to treat not just my addiction but also the mental health issues, that are also a part of my overall daily responsibility to live each day to the best of my ability and that includes paying attention to my NEEDS and to take care of my physical mental and spiritual obligations to achieve a healthy well balanced life.
I am very grateful to see this forum available to each and everyone of us and it is also gratifying to know that we live in a time when this help is here for all of us to share and use the tools that are here for us to use to fulfill our goals.
Recovery is an evolving process and I hope everyone has the opportunity to share in this process in which we have the choice to be a part of the solution instead of the alternative in which we were trapped in the problem.
Thanks again Patty for giving us this opportunity to share with each other.
Sincerely yours, Dennis

This is a very hard answer to annoye to try to provide. In small, the drugs alone are rarely the answer. I am not some prohibishionist trying to argue against the value of drugs certainly they have value. But, when treatment for anxiety is nothing more than meds, it is very dodgy to really solve the problem. Best case scenario, the patient might find a logic that works for them as to when they had them. Perhaps all through these times that they are on the meds they feel better. But what about when they aren’t taking them? And how often are they taking them? Do they want to take them more often? Do they want to up the dose? Without resorting to scare tactics, these mind medicines are commanding and to give everyone wtih anxiety a bottle of pills and one sheet of paper probably isn’t vacant to really help them much. It would very well hurt them.With therapy, you have a professional who can analyze your circumstances and try to get to the underside of it. Why are you nervous? How nervous are you? How often do you experience anxiety? Are there things you could try to deal with these issues without meds? The therapist will have some techniques that you may find very helpful. In not, the therapist can work with a doctor to prescribe something for your anxiety. But that still won’t be the answer to all of your problems. Perhaps unsurprisingly, the best forms of treatment often combine both medication and therapy.

Medications for depression and anetixy are commonly prescribed. When meeting with your surgeon, you need to make sure that all medications including over the counter supplements are listed for them to see. As long as there is no contraindication related to anesthesia or the stress of surgery being on these medications, it is not usually a problem. Your medical doctor can help you and your surgeon make this a safe experience for you. Good Luck!

Thank you Patty.
This is perhaps the most insightful discussion of these issues I have seen posted anywhere. It is also clear to me why ACA is a only 12 step fellowship that suggests you GET a therapist. I agree with you 100% on medication. Many are helped with thoughtful Rx and many are lost with over prescribed meds…
Thank you again for your clarity and service.

OK, I’m gonna try here, I just finished wonkirg in a Physical Rehab Hospital for 7 years and I was a med nurse. Some of our pts got meds before pt and others did not, the above answers have it all covered. Sometimes the doc would say, let her try it first without and then if it is too painful, give her a little something.We are only licensed to practice medicine but we’re not perfect yet, and folks want definite answers. Get all the info and then trust your own judgment.My dentist just loves to get me on the other side of the situation. But I just tell him I am chicken and I ain’t gonna hurt. Actually he is very good about pain management.And about the disagreement, there is a world of coordination between all those disciplines and there are as many ways to skin a cat as there are cats. Allow for the subtle differences.Maybe some of this helps, I have 2 kids who want pat answers and don’t get them either. This internet can be the best and the worst about info, just get all the info you can from people you trust.Sorry to go on so long. Personally I think they are way smarter than most folks know, it’s just such a totally, awesomely hard career choice.

I would. Therapy tends to make the pain worse because you’re ianmkg the painful parts work. That’s a pretty bad answer from the PT, but he did give you the go-ahead. You can always try the first time without meds to tell him when it hurts, but PTs tend to know where it hurts and even if they are hurting you, their goal is to get the painful part moving properly again. I believe I took my pain meds before I went, yet I knew what would hurt since that’s why I was going. And, therapy is painful enough that simple pain meds aren’t going to mask the pain just dim it. Mine wasn’t as bad as say a knee replacement and yet I limped out of there. Stretching those with knee replacement is so painful for them that I winced just watching it and they are on pain meds when they go. I would definitely take it before you go.

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