Behavioral/cognitive Vs. Medication

[EmmJay]

Hi all. I am undergoing behavioral cognitive treatment for PTSD and alcoholism, and honestly I do not feel it is working for me. I am under a lot of stress daily, and though my flashbacks have been less and less, they feel more intense when I have them.

My therapist is very, very against medication, but I would like to talk to him about maybe trying a low dosage of something to ease the symptoms, or something to help me not feel like I need to drink, which I do because of the stress and anxiety.

Mostly my issues are with dissociation and the flashbacks, hypervigilance, anxiety attacks, and obsessive thoughts. Any ideas on how to bring it up to him in a positive way? Thanks for any advice!

 

[Deleted member 1860]

Hi,
I think therapists who are very against medication are dangerous. I have a feeling they've never been in the position of needing and taking a medication that actually helps. I think they all have outside opinions based on observation, or the "it didn't work for me so it won't work for anybody" attitude.

I recently terminated with a therapist because she thought medications were poison. If I believed her, my quality of life would still be in the toilet and she'd still be pushing vitamins on me as a cure.

I am now on a very low dose of one medication and honestly, I mentally feel great----the best I've been in a very long time. Yes, there are side effects, but overall they are worth dealing with.

I hope you can tell your therapist that you would like to try medication because you think you need extra help. If he is adamant that they're bad, please move on. It is NOT his decision nor does he have the right to make you feel bad for reaching out for extra help.

Do therapists take the hypocratic oath? I think they should! First of all, do no harm....I think telling patients that medications are bad IS doing harm. There are many people who are able to function with the help of pharmaceuticals. Not all of us take them and numb out (which is a common mis perception). I am now actually able to feel more.

Good luck!

 

[The Albatross]

The therapist I worked with while in therapy was anti-medication... but that was why I chose him. I had co-occurring issues like you do Emm Jay, alcohol and was being treated for ADD/ADHD but it became apparent that it was really PTSD. I commend you for undertaking both issues as I know it is not easy. Not by a long shot. I wonder though if you are making serotonin?

A lot of alcoholics stop. I probably did. I agreed with my medical practitioner to be on low dose Effexor for a period of one year as I was dealing with sobriety from alcohol, on the condition that I would attempt to stop to see what happened. There are tests for it now I think but none were available when I got sober. In my case, it was determined that I produce now "low" rather than "no" serotonin. I have improved in both areas, substance abuse and PTSD. Even the ADD/ADHD improved enough that I tested normal range several years ago.

I did withdrawal at one year of Effexor. It was not easy to do the med withdrawal for me, if I had not researched it, I would have been unprepared for the effects and I would have run screaming back to my medical practitioner asking to be put back on. But I am now not on meds, am sober, and am leading a relatively PTSD manged life.

Cognitive therapy helped me a great deal. In my case, I felt that reinforcing the habitual behavior of taking something from the outside (be it an prescription med or a drink) to change the way I felt was a risk for me because I felt I have an addictive personality. So, I took the bare knuckle, more difficult route. But I learned a lot of good skills and management techniques on the way so in hindsight, it was very, very worth it.

Like I said, I think they now can test serotonin. I might broach the subject with that depending on how long and how hard you drank. You say you are alcoholic, so it is entirely likely that you may require an attempt to reboot your body. Sometimes it works, sometimes it doesn't. I was lucky, in my case, my body rebooted and I started making serotonin again.

 

[Promicarus]

I agree with Solara--anyone who tells you that all medications are dangerous is usually dangerous, themselves, in my experience.

...by virtue of the fact that making such a blanket statement is a pretty big sign of irresponsibility.

It makes me wonder if the therapist is against ALL psych-meds, or just against, for example benzodiazepines, and other potentially addictive meds.

I might tend to agree with the opinion that benzos are counterproductive during the therapeutic process, even if one discounts the possibility of addiction. But even then, it depends on many things, and the individual-for example, some have symptoms of anxiety, and panic attacks, so severe that it's impossible to function without at least a small dose of a benzo PRN (as required), during a panic attack.

But most people agree that the only experts regarding medications are those who've been to medical school (or Pharmacology school, perhaps). And unless this therapist has been...,and knows your unique medical history, for them to say that "all medications are bad" would be enough for me, personally, to view him as a crackpot, and seek help elsewhere.

 

[The Albatross]

... though my flashbacks have been less and less, they feel more intense when I have them.

As you avoid the numb out behavior (booze) the intensity of all emotions and formerly medicated/chemically insulated stuff can increase, for a time. But it can and does normalize.

 

[The Albatross]

Do therapists take the hypocratic oath? I think they should! First of all, do no harm....I think telling patients that medications are bad IS doing harm. There are many people who are able to function with the help of pharmaceuticals. Not all of us take them and numb out (which is a common mis perception). I am now actually able to feel more.

With all due respect, people (like me) that are in the co-occurring substance abuse category, have the lowest prognosis for recovery. By Emm Jay's own account, with her current treatment - her number of disturbances are less. It is the intensity that is more. It is a question that should be determined by Emm Jay with her therapist and MD. As she identified herself as alcoholic, there could be a physiological reason that requires meds. Like I shared, however... for people with co-occurring behaviors that include substance abuse. Harm could mean, risking Rx drug abuse in place of alcohol. Be careful what you wish for Emm Jay, would be my advice.

Look up some prognosis statistics... we are in the lowest percentile for recovery. But recover we can.

 

[franciemarnie]

Just a thought - there are other type of therapies that can moved out trapped trauma energy (Somatic Therapy, craniosacral, etc.). Medication can be helpful when debilitating but it's also important not to numb out. Some meds do, some don't.

I drank too and quit. Painkillers also. Healing can be painful just like with physical wounds but its not good if difficulty releasing or dealing with trauma keeps you from functioning. You might want to think of what you else you can do for symptoms, in addition to meds - if you so choose to get on them. Some meds only camouflage, so there is no change. It can be a difficult dance. Whatever you do, be honest with yourself because you deserve the best!

I was on an antidepressant for twenty five years. It alone allowed me to work and sleep and function. When I got off them, I was flooded with the symptoms I had before I took them. But I was ready to heal at a deeper level then. If I had no quality of life again, I would reconsider meds. But I love my life now without them.

 

[Britt.f7]

When I was worried about how I would be cutting down on my meds(for financial reasons), my therapist told me not to put all the faith in the meds. That I had overcome a lot and to give myself credit.

Meds can be good if you are responsible and the person who issues them is also responsible. It can not, nor should it, take the place of alcohol or other substances. It would be best, if you try a med, to try one that does not have the possibility of addiction.

Therapy wasn't enough for me. My meds help. I hope you find what works for you.

 

[DMerish]

Mostly my issues are with dissociation and the flashbacks, hypervigilance, anxiety attacks, and obsessive thoughts. Any ideas on how to bring it up to him in a positive way? Thanks for any advice!

Hi EmmJay,

I'm sorry your going through such a rough time. I know it's not fun, and dealing with a therapist isn't fun sometimes also. :(

You shouldn't need to be too concered about having to say something to your therapist in "a positive way" - He/She is there for your healing. If you feel you need to tip-toe around him/her, then he/she isn't the kind of therapist you want/need. Just be honest by saying something like, "Therapy doesn't seem to be working by its self very well, so I want to try medication too."

I don't know what part of the globe you are in, but therapists in the USA cannot prescribe meds. In the USA only a medical doctor (MD) can prescribe. Pyschiatrists, having graduating medical school before they specialize in pyschiatry, do take the Hippocratic oath. I think sometimes phychiatrists are a little too eager to prescribe (a whole other topic.) I think if you go to a regular doctor, tell him/her what your going through, and want meds to help you deal with the stress and the therapy to get better, most would be happy to oblige - providing you keep in touch.

To get deal with PTSD (and other disorders) one has to be very pro-active. It's a stress disorder, so do everything you can to get your every day stress level down. Educating yourself on the different methods used to treat PTSD is helpful, and CBT is a method that seems to help many people. It helped me, but not until I began taking meds and really got serious.

I think there a two big things that most people with PTSD deal with: a loss of trusting themselves and feeling they need to be in control. Therefore, I say, if you think meds may be helpful for you then go for it (maybe start off with a low dose SSRI?) and find out. And keep coming back here for suppot!

Drew

 

[Deleted member 1860]

@The Albatross

You quoted something said as a generalization, yet applied it to a specific case. I never said meds would be great for her. My point is that making blanket statements regarding the evils of medication is harmful because it is essentially fear mongering.

 

[BloomInWinter]

I am a recovering alcoholic with over 23 years of sobriety, and I had PTSD way back then but none of us knew anything about it.

Those of us with a duel diagnosis face some additional challenges due to our addictions. One of those is the very real risk of becoming addicted to additional substances. Being in a state of floating anxiety feels terrible. But if we drink, too, adding prescription meds to our "easily accessible immediate relief" toolkit can easily be lethal.

Being in a terrible state of mind + alcohol = hangovers and regrets (hopefully that's all.)

Being in a terrible state of mind + alcohol + Xanax (or other prescribed meds) = drunk + possible severe organ damage, seizures, respiratory failure, and/or death.

The increase in your symptoms and distress are painful but typical of the first few months of sobriety, even without the PTSD. They will get better, so long as you don't self-medicate or overdose on prescribed meds. But it sucks.

Definitely ask your therapist for help managing your symptoms. He is doing his job of trying to minimize risk to you where possible, and do harm-reduction strategies when it's not. He is showing wisdom by being cautious. But if your coping skills are being overwhelmed, you need to share that with him so you can be given other options. Don't suffer in silence.

There are other meds and options out there, and it is your right to ask for them. I am no fan of meds but I take them because they do help me manage my symptoms better. Keep trying because you'll find something that helps enough that you will be able to employ cognitive-behavioral therapy.

 

[GingerAli]

I am not an alcoholic (though I would be if alcohol ever did anything for me), instead, I am addicted to cutting, with basically the same problems you have described. I am currently on medication because I hit rock-bottom so badly I had no choice, but it's my hope to go off of them. Meds certainly have their uses, sometimes wonderful ones, but we often need help with changing how we think and learn to cope as well. Some therapists get so stuck on the fact that meds often (not always) only "cover up" the problem instead of fix it, that they are completely against it. But often times, this is what they are taught, so it's best not to hold it against them.

As for the flashbacks, sometimes they get stronger after you start treatment as things start to clear. I think it can be pretty normal. But like others have said, there are other therapy options if you do not believe CBT is working for you. For me, it helped some, but not completely. (I was actually doing very well until some family events and the therapist I started seeing was horrible and really messed me up) I have since found a new therapist and they taught me mindfulness meditation which has actually been very helpful. That might be an option for you to look into. It really helps to teach you to stay grounded.