Public Comment

In 1988 and 89, I made a meagre living working for a pizza shop. After my first month, the owner confronted me that I appeared "on drugs", and his manner was harsh and accusatory. At that point I had to "come out" and explain that I am schizophrenic and must take psych meds. If I remember right, he may have demanded a doctor's note to prove this. He did not believe a mentally ill person was a bad person, but he felt strongly about not employing someone addicted to street drugs.  

There are some similarities between both conditions, which I intend to discuss in this piece. A big difference: taking drugs to get high involves taking a physical action, while psychosis in the case of mental illness is something your brain does to you whether you like it or not. 

But I can't "judge" someone unless I've walked a mile in their shoes, and I don't believe people should be so quick to condemn. Drug addiction could happen to someone just because they've made the mistake of trying something the first time. When someone is addicted to something, the addiction becomes a beast that has a life of its own, and willpower and/or self-control are rarely enough. 

"Dual Diagnosis" refers to a person with a psychiatric problem compounded by addiction to a substance. This is not uncommon. I am not dual diagnosis, even though I have smoked pot. When I was fourteen and fifteen, I smoked pot a few times, but by the fourth time of smoking pot, it stopped having appeal for me, and I had no desire for it. By eighteen, which was the time I became mentally ill, I hadn't had an illicit substance in years. My psychiatric problem wasn't produced by a substance. 

When I was in my twenties, a few years after I first became ill, and while I was medicated, I tried pot again and it made my symptoms of psychosis much worse for several days, until the effects wore off. My outpatient psychiatrist had advised against pot; I've stayed away from it for more than 30 years, and I don't miss it. In my twenties I also tried alcohol. Beer not only made me sick; it made me depressed and mentally shut down. I was so sick from it and the headaches were so bad I gave that up as well. I have no quarrel with the "Just say no," espoused by Nancy Reagan of the 1980's. 

However, there seem to be some characteristics of a substance abuse problem that are parallel to traits of a psychiatric problem. When people get psychotic, often we have an emotional zing from the delusions. The reward mechanisms in the human brain are apparently triggered by psychotic thoughts; and I can see this because I'm able to witness this within my own internal processes. And in recent years, what I've described is one of the directions that many brain researchers have gone. 

Psychosis is very insidious, and it manipulates the pain and pleasure mechanisms in the brain to reinforce symptoms. This makes psychotic processes resemble a drug. 

Alcohol and a number of other substances affect different people in different ways. But clearly, a number of substances do not mix with psychiatric medication. Usually, the warning labeling on medication packaging will give you the applicable advice you need. If in doubt, read the labeling. 

I've seen examples of a great many people meeting their death through mixing prescription drugs with alcohol. And even prescription drugs by themselves, in excessive dosages or in a bad combination, can kill. 

A friend-of-a-friend met his death by accidental overdose. The problem of potential overdosing is compounded when a drug is sold under more than one name. For example, Zyban is the same substances as Wellbutrin. They're both "Bupropion." The drug is the same with either label, but the name "Zyban" is applied when it is used to help quit smoking, while the name, "Wellbutrin" is applied when the substance used for antidepressant purposes. If dealing with more than one doctor, there could be a slipup in which the same substance is prescribed by two or more doctors. Sometimes it is the pharmacist who will catch this error, but that may be one of the last lines of defense. 

Prescription drugs can often be addictive and subject to the same problems as street drugs. Doctors need to watch out for this, and often they do. Doctors can get in trouble just as the rest of us do and can be sued and/or prosecuted when they practice badly enough and when this results in death. 

But when we take street drugs or addictive prescription drugs, or alcohol or tobacco, the problem is fully in our laps. After all, it is our bodies and our lives that can potentially be ruined. Therefore, we need to watch out for ourselves, and we must be informed. 

Sometimes a doctor will discontinue giving us a prescription drug after it is found to be deadly or after it is found to be excessively addictive. We don't fully know how people respond to a number of drugs until the public has been exposed to them for about ten years--and that's only my opinion. But insofar as what substances I'm willing to take, I'm picky. And I can be that way and get away with it because of my track record. 

If you question the wisdom of your doctor in prescribing something, get a second or even a third opinion. 

ADDENDUM: PSYCHOSIS IN EARLY STAGES CAN BE ADDICTIVE 

I've found myself clinging to a delusional thought because it appeals to me. It might offer a false explanation for something perplexing. It might offer a system of denial so that my mind doesn't have to face a difficult reality. Delusions manage to trigger the pleasure mechanisms in the brain. That's how it seems to me, at least. And, again, that's where a lot of research is headed. It may take effort to halt a delusion or a set of delusions. It can be unhappy in the short term to have to face a hard reality that was masked by a delusional thought. 

But when the brain wanders too far away from reality, things get worse. We no longer have the pleasurable escapism; we have everything becoming topsy-turvy and we find ourselves to be in something resembling an internally generated war zone. This is because we've followed the delusions too far, and they became assumptions that have led the entire system to go haywire. At that point, we will probably need external help. And we may still resist it because we may still not want to face a false belief being false. 

We may not be able to get out of a delusional "system" without external intervention. We may not be able to "come back" without being hospitalized. 

But coming back home to the truth can be a hugely comforting thing, a relief, and a reset--a good reset. Once we are getting well once again, it is time to consider taking steps to ensure this doesn't keep happening.