Many people have questions when it comes to the intersection of psychiatric medication and substance use rehab. Questions may cross your mind such as, “Why are psych meds so common in rehab?”, Will they automatically put me on medication in rehab?”, “I don’t want to be on medication – can I make it through without it?”, or even, “Can I stay on my psych meds in rehab?”. Just as in every other aspect of recovery, the use of psychiatric medication (such as mood stabilizers, stimulants, antidepressants, antipsychotics, or antianxiety medications) is highly individualized and ultimately depends on what you and your clinicians agree is best for you.
Why are psych meds so common in rehab?
There are a few aspects of the rehabilitation process that can benefit from the addition of psychological medications. The first is the straightforward aid of initial withdrawal symptoms. Because many substance use disorders affect brain chemistry, medications like antidepressants regulate neurotransmitters and help nerves communicate more efficiently as they are adjusting to functioning without an influx of drugs or alcohol (1, 2). Psychiatric medications are such helpful support that at least one form is used in about 80% of detoxification programs in America (3, 4). Antidepressants, antipsychotics, and antianxiety medications can be effective in treating addiction (namely, alcohol, opioid, methamphetamine, and benzodiazepine addictions) by curbing cravings and decreasing the severity of withdrawal symptoms (2, 3). While some of these symptoms are most severe in the first few weeks, such as sweating, severe anxiety, shock, or even a break with reality, others may last longer (1).
Once past the initial detox/withdrawal stage of rehab, many people still find benefit from psychiatric medication. Insomnia, impaired overall brain function, depressive mood, and anxiety and fear may all occur for months after the initial detox stage (1, 4). The continual support that psych meds provide can help to boost mental health and act as a buffer against the strong emotions that many people find they experience in rehab (1, 4, 5). When guilt, shame, sadness, anger, fear, or grief are felt full force without substances available to cope anymore, many people feel overwhelmed (2). When overwhelmed, they may find they plateau or even regress in their progress, unable to move forward or cope. Mood stabilizers, antidepressants, and other medications can give the boost that some people need in order to be more capable of working through their emotions and mental health struggles during rehab.
For many people, psych meds are only recommended for a short time, with the end goal being to eventually not need medication to improve mental health and support life-long sobriety. Some people may take them for a shorter time than expected, and some others may discover in their partnership with their clinician that psych meds might be necessary longer-term. In either instance, the goal is for psychiatric medication to help to prevent relapse and improve long-term sobriety efforts, both inside and outside of rehab (3).
What is the relationship between mental health disorders and addiction?
Another reason that psych meds are so common in rehab is that many people with addictions also experience co-occurring mental health conditions. When looking at a lifetime history of alcohol or substance abuse, there is a strong connection to those suffering from mental health disorders (1, 2, 3, 4, 5, 6, 7, 8). Those suffering from the following disorders experience an increased risk of lifetime substance abuse (6, 8):
- 61% of people with Bipolar I or II disorder
- 27% for those with major depressive disorder
- 17% with anxiety disorders
- 44% with PTSD (particularly veterans and those with childhood trauma)
- 47% of people with schizophrenia, and
- 84% with anti-social personality disorder
The exact relationship between mental health disorders and addiction is still being determined. Some instances show that the addiction caused the disorder – for example, extended alcoholism can cause a mild form of bipolar disorder (6). For others, the addiction cycle of craving, intoxication, and craving again can create fear or anxiousness that morphs into an anxiety disorder (7). Others may have used drugs or alcohol as the coping mechanism for their psychiatric disorder, and addiction was a side effect of trying to deal with their mental health (6, 7). And yet for others, mental disorders and addiction emerged at about the same time, revealing a much less clear delineation between the two (7).
Regardless of the cause-effect relationship, the damage that a comorbid addiction and mental health disorder cause is quite clear. Substance use disorders negatively impact mental illness, leading to overall lowered quality of life due to longer and more frequent episodes, decreased adherence to treatment, and in some cases, greater suicidal behavior (6). Unfortunately, the effects are just as severe when surveying the impact that mental health disorders have on addiction: many mental illnesses contribute to more severe addictions and increased chance of relapse (3, 5) Given this correlation, as well as the benefits during the stages of detoxification, the role of psychiatric medications in rehab centers becomes much clearer.
And in fact, this points to another reason that psych meds are so common in rehab. Because addiction and mental health struggles are so often linked, many people seek treatment for psychiatric needs before addressing their substance use disorders (5). Some people are concerned that they will have to go off of their psych meds when they enter rehab, which can deter them from getting the help that they need. While certain psych meds can interfere with some detox medications, you can rest assured that your clinicians will partner with you to consider all factors (5). Our goal is to create a treatment plan that supports your mental health and sobriety.
Will they automatically put me on medication in rehab? Can I make it through rehab without psychiatric medication?
Some people have had negative experiences with psychiatric medications, and others are keenly aware of the stigma that is sometimes associated with taking psych meds during the rehab process. Regardless of the reason, some people do not desire to take medication during their rehab process. This is where an intentional relationship between you and rehabilitation center staff (including the medical director, psychiatrist, and therapist) will make all the difference. While psychiatric medications can be incredibly helpful at all stages of addiction recovery, they might not be necessary or right for everyone. Others may enter rehab thinking they will never need medication, but upon discovering undiagnosed mental health issues that drove their addiction, may be interested in pursuing medication. In either case, a trusted partnership with qualified staff can help each person make the best decision about psychiatric medication based on their mental health, physical health, existing conditions, and other needed medications (4, 5).
Can medication alone fix addiction?
As mentioned above, psychiatric medications generally work to regulate neurotransmitters, helping reduce the symptoms of mental health disorders and support a more level and overall elevated mood (2, 3). While they also have some amazing effects that can help curb the symptoms of withdrawal and may be a core part of people’s overall success in rehab, there is a limit to how much medication can help. We are holistic beings, and it is vital that any treatment plan also be holistic and multidisciplinary. In order to fully treat addiction, medication must be paired with counseling and group therapy in order to address the root of the mental aspects of addiction (1, 4). At Bayshore, we offer other types of therapy that also focus on the body and heart. These alternative therapies can also make a big impact, including yoga, meditation, adventure therapy, art, dry sauna, and deep tissue massage therapies. We even have a dietitian and an in-house chef to help support your total health and recovery.
All the services that we offer at Bayshore Retreat work together to form an intentional, well-structured program that is customized for each person. If you have questions about psychiatric medication, rehab, detoxification, outpatient care, therapies offered, or even about our philosophy at Bayshore, please reach out to us. We would be privileged to partner with you to help you achieve sustained sobriety and long-term health.