Fixing The Problem Is Much Better Than Taking Addictive Drugs

He looked more like the romantic hero from the era of Lord Byron than a psychiatric patient – he wore his hair longer than today’s style and he obviously pumped iron.  Indeed, I found out that working out was an important part of his life.

He was 28, and he had just been released from a two day stay at hospital and his medication was standard fare — Zoloft (sertraline) antidepressant.

I had no clue why he had to be seen by me on an emergency basis. It turned out he had been admitted to the hospital because he was uncomfortable about his roommate’s anger.  He had been concerned he might get “attacked.” I had no way of telling whether the roommate had an actual history of this sort of behavior or if this was delusional.  But the roommate was not the patient before me. “Just give me klonopin,” Lord Byron said. “Everybody else does.”

Those who know me by now know how those words get under my skin.  I am most definitely NOT “Everybody else.”  Especially when it comes to psychiatric treatment.

And asking me for benzodiazapenes – highly addictive tranquilizers similar to Valium – really gets my fighting spirit roused.

However, the chart didn’t back up his story — he had no klonopin in the hospital.  In fact, he hadn’t had any for quite a few years, judging from his chart. This made it extremely easy to answer “No.”

The typical drug-seeking behavior of an addict suddenly surfaced — he was angry, he started trying to bargain.  “I can take it every other day.  Or even a couple times a week.” “No.”  I really wanted to say something like “read my lips” or “what part of ‘no’ don’t you understand,” but experience had taught me that movie cliches do not work with addicts, and I’ve also learned you don’t act like a smarty-pants to pumped up young men.  Especially when they really, really want drugs.

So I spoke the truth, instead – which is what a good, honest, responsible and ethical doctor is supposed to do. “Fixing the problem is a much better idea than giving you an addictive drug.” He looked shocked — as if nobody had spoken to him like this before. I called a social work therapist, and in less than 15 minutes we had a couple of safe places he could go if he felt threatened by his roommate.  He wanted “help” in finding a better place to live (claimed the mental health departments in other counties were better at that!) and the social worker gave him some alternatives.

He seemed to have objections to many (understandably, since most shelters are not real nice) but we came up with free legal aid to get him out of an apartment lease and I basically dismissed him to the social worker.

Together we overwhelmed him with possibilities until a miracle happened — He was satisfied.  He seemed more empowered than frustrated, and left my office convinced that he actually can continue on with his life. It was not physiological habituation to klonopin (sold under the brand name Clonazepam) that made him request the drug, for he had not had it for many years.  It was an underlying belief that feeling “relaxed” or somehow tranquilized was more important than solving the problem.

I think a lot of people believe that.  Is it some kind of intellectual laziness? Whatever it is, I see it too often.  People will compromise their independent ability to think and act for a few moments of real or imagined semi-bliss.  How much of this attitude is responsible for reliance on prescriptions — or for addiction to street drugs? I don’t have good answers.  I do have–some teaching abilities.  In conjunction with a therapist who is practical and has answers to some practical questions, the way can be pointed, even simplified. I know only one way to get things done by other people.  It is positivity. Praise to this person for being his own man and taking charge of his life.  I got a little bit of a smile from him; not a lot, but something.

I do not know how durable any change can be.  All I can do is elicit weak promises for the future, but I can flood someone with good feelings about the present.