Common Prescriptions That Can Push You Over the Edge
Except for the most hard-headed hardliners, most addiction experts agree: taking certain drugs doesn't mean you're not sober. Here we separate the good from the bad.
According to conventional A.A. wisdom, committing to a life of sobriety means not taking mood-altering substances. Still, as in all things, there must be balance. Caffeine and nicotine, for instance, are mood-altering and addictive, yet few would claim that a cup of joe breaks sobriety. And, no matter what you may have read, addicts do not have to suffer unendurable pain to stay sober. (Even Bill W. experimented with L.S.D. years after he founded A.A.) As Debora Mosby, a professor of psychopharmacology at Metropolitan State University in Saint Paul, Minnesota, points out, "You can't get high off Novocain."
Most A.A. stalwarts and addiction specialists agree: taking doctor-prescribed drugs that are necessary to maintain your physical and psychological health is alright. What addicts need to avoid is taking pills to get high. Alas, according to Mosby, doctors are often the last people you should trust for help in making that determination. According to Dr. Jesse Mason, a behavioral pharmacologist researching the issue, because of the hidden triggers in all sorts of seemingly benign medications, addicts should actively seek out professionals—ideally psycho-pharmacologists—who have experience working with addicts. “Many muscle relaxants have GABA, which is very similar to Ecstasy,” he points out by way of example. “So any addict who used Ecstasy would want to avoid it.”
When taking any medication, even natural remedies or over the counter products, you’re on your own. Just because a doctor, or even some groovy gal at the herb counter, tells you something is safe, it’s up to you to protect your sobriety.
One way to avoid the issue all together is to seek out alternative medicine—a concept Mosby supports. "With nutrition, sleep, exercise and something like meditation, self-help or group support,” she says, “many people can manage many medical issues without drugs." But even alternative medicines should be approached with caution. Early in sobriety, I had severe arthritis and wisely did not fill the Vicodin script the doc gave me. Instead I consulted with the health food store herbalist, told her about my arthritis and alcoholism, and she filled these little brown dropper bottles from impressive green glass dispensers: tinctures of stinging nettle for arthritis, Valerian root for sleep, St. John's Wort for mood, and milk thistle for liver health. Not long after my very first dose, I felt the first tingle of an alcohol buzz and rushed back to the store. The herbalist said, “Oh yeah, the tinctures are in grain alcohol, but it is such a small amount.”
The point is this: when taking any medication, even natural remedies or over the counter products, you’re on your own. Just because a doctor, or even some groovy gal at the herb counter, tells you something is safe, it’s up to you to protect your sobriety. So read labels, ask questions, and seek low-dependency-risk alternatives.
If, after checking with an addiction professional or working with a medical doctor familiar with your history, you determine that a medication that’s potentially dangerous to your sobriety is medically necessary, develop a plan for how you’re going to take it and when you are going to stop. Similarly, if you are currently on a medication that worries you, don’t come off it until you work with a medical doctor or addiction specialist, since many prescription drugs have terrible withdrawal symptoms that can trigger relapse if you try to go off without tapering. Use an AA sponsor, a counselor, or sober family or friends for support and as a reality check in when taking or tapering off any potentially addictive or mood altering substance—including coffee and cigarettes. Also, never take anything given to you by a friend or family member—ever.
A number of treatment facilities, working with psycho-pharmacologists, have put out guides for recovering addicts or alcoholics. What follows is a sort of “best-of” the guidelines they provide:
Keep in mind that many over the counter medications, like Nyquil, contain alcohol, as do many mouthwashes (in medications, it’s often listed under “inert” ingredients). Cold and allergy medications are a grey area; if possible, avoid or choose a “non-drowsy” formula and try not to take anything with pseudoephedrine, ephedrine, diphenhydramine, dextromethorphan (often labeled DM) or alcohol in it. Over the counter sleep medications can also be considered dangerous, and addicts—particularly ones who took sedatives like Ambien—may be better off avoiding anything with a PM in the name. Weight loss and appetite suppressants that contain ephedrine can be similarly dicey due to the amphetamine.
When it comes to prescription medicine, always make sure that your doctor knows that you are an alcoholic or addict in recovery. If your doctor doesn’t have experience working with addicts, you may want to run what their advice by an addiction professional that specializes in psychopharmacology and knows your specific history.
The terrain gets most dangerous of all when you’re talking about prescription pain medications Tylenol 3 or Hydrocodone and anxiety and depression medications that contain Benzodiazepines like Xanax and Valium. That being said, sober people have managed both—particularly pain meds—usually by making a plan with a sober friend, family member or sponsor to dole out the drugs and then discard them when they’re no longer needed. And there are pain management centers, like the Courage Center in Minneapolis or the chronic pain clinics at Mayo, who will work with chronic pain patients for non-narcotic pain management strategies.
Most nausea and vomiting/diarrhea medications are safe, while anti-nausea meds like Phenergan, Dramamine, Scopolamine transdermal and Compazine should be used with caution since some contain compounds that are closely related to the nightshade family of plants, which includes jimson weed. Other anti-diarrheal medication, like Lomotil, contain a type of opioid and the liquid form of the drug contains alcohol—as do Immodium A-D or Paregoric.
All saline-based nasal sprays are safe—including Aerobid, Nasonex, Flonase and Azmacort—but be cautious with Vicks Inhaler. Medications that contain Naphazoline—used in Clear Eyes—Pseudoephedrine (Sudafed), and Phenylephrine (Dimetapp PE)—have speed-like compounds, and so should be used cautiously, for short periods, and with supervision if possible.
Muscle relaxants can become habit forming and use should be limited to short periods. Of those available, Baclofen is considered the safest choice.
Buspar, an anti anxiety medication, is generally considered safe while others, like Seroquel and Vistaril/Atarax, are safe if used with caution. The anticonvulsant and antipsychotic medications Clozaril, Zyprexa, Luminal, Dilantin, and Risperdal should be avoided if at all possible.
Much has already been written about SSRI’s in sobriety and AA’s official stance on the matter is that this decision should be left to medical professionals. Most who have been on anti-depressants can attest to the fact that Prozac, Paxil, Effexor and the like don’t leave them feeling high, and some manage to tolerate slow-release Adderall for ADHD without being triggered. While it’s ideal to get these prescriptions from a psychiatrist, internists are increasingly the ones doing the prescribing; the crucial factor, in the end, is that some medical professional is overseeing the process.
Finally, keep in mind the fact that people in recovery can develop dependence on substances not typically considered addictive so it’s important to be careful when taking any drug—even those that are typically considered benign. "Pay attention to cues,” says Mason. “When an addict is taking medication and in an environment that is similar to an environment where they used to use, it can heighten craving and mood altering effects." For that reason and others, go slow, seek out therapies with less dependency risk, do your research, read all labels, ask lots of questions, enlist the help of your support system, and pay attention to your internal cues.
Oh, and when you are having oral surgery, get the Novocain.
Jeff Forester is a writer based in Minnesota. His book, Forest for the Trees: How Humans Shaped the North Woods, an ecological history of his state's famed Boundary Waters, came out in paperback in 2009. He has written about sober high schools and painkillers, among many other topics, for The Fix.