Those of us who were born in a certain era can vividly remember the relief we felt when we walked into our childhood classroom and spotted the old cathode ray tube TV on the rolling cart. Unless the teacher had devised some cruel mechanism for testing our attention, it meant we were blessedly off the hook for at least one academic period. But film may not get the credit it deserves as an educational and therapeutic tool. Much of our childhood glee may have stemmed from the fact that we were receiving a mental break from our tired daily routine. Just as it’s important to mix things up in the classroom, it’s also important to utilize varying techniques in a group therapy setting. Film can facilitate an inspiring forum for clients to talk about their issues and concerns.
In an addiction treatment environment, one useful film is Prescription Thugs – an exposé style documentary which addresses the prevalence of prescription drug abuse and the pharmaceutical companies behind the epidemic. While Prescription Thugs has received rightful criticism for employing superficial investigative techniques and making sweeping over generalizations, it raises two talking points that are of immeasurable value to newly recovering clients:
- If Americans make up five percent of the global population and account for seventy-five percent of the world’s prescription drug consumption, how does one survive in this drug saturated culture? How can one feel comfortable breaking free from the “norm”?
- In the past, the doctor may have been akin to a drug drug dealer. How does one establish a healthy relationship with healthcare providers? How does one advocate for oneself?
In terms of relapse prevention, self-advocacy and assertiveness are essential to the health and longevity of recovery. Before one can work on self-actualization and spiritual evolvement, one must first learn how to get basic needs met. In the case of an independent adult, the meeting of basic needs requires the ability to effectively self-advocate. Assertiveness can be especially challenging for women. In a NIDA article entitled “Service Providers and Treatment Access Issues”, Shirley D. Coletti, D.H.L., writes: “Because men and women are socialized differently, women frequently have fewer assertiveness skills and need more supportive networks to remain alcohol- or other drug-free (Marsh and Miller 1985). In U.S. society, women’s social status usually derives from men, and the drugs they use are often obtained from men (Boyd 1993). Often, female addicts report having been sexually abused (Wildwind and Samson 1981, pp. 109-163)…To be successful in drawing women into treatment, it is necessary to be cognizant of gender differences. Problems specific to many female substance abusers include low self-esteem”. While Coletti cites sources from the 1980s and 1990s, many of these issues are still relevant today.
It’s important to distinguish between assertiveness and aggression. The University of Iowa defines assertion as “standing up for oneself in such a way that one does not violate the basic rights of another person. It’s a direct, honest, and appropriate expression of one’s feelings and opinions”. Aggression, on the other hand, “is standing up for oneself in such a manner that the rights of the other person are violated in the process. It’s an attempt to humiliate or put down the other person”. Assertive people generally feel “confident” and “self-respecting”, while aggressive people generally feel “righteous, superior, depreciatory…and possibly guilty”.
But wait…why do we have to worry about being assertive when we see our doctor or other healthcare provider? Isn’t it the job of the healthcare provider to look out for our best interests? The answer to this question is not cut and dry. Yes, healthcare providers should be operating by a “do no harm” philosophy. However, the current healthcare system isn’t always conducive to this notion of unconditional benevolence. At the end of the day, advocating for health and wellness is ultimately our own responsibility.
So, if you are in recovery from drug and alcohol addiction, how do you assertively navigate and advocate in the current healthcare system?
Not surprisingly, communication is key. It’s okay to tell a doctor or other healthcare provider if a certain class of drugs makes you feel uncomfortable. Ask about your other options. Your body is your temple and you have the final say about what is allowed in your system. It’s also a good idea to ask questions about side effects. Taking medication without seeking clarification can be dangerous.
Honesty and clarity are also crucial. It’s okay to disclose your drug and alcohol history. Be specific. Tell the doctor exactly which substances were problematic for you. Specificity reduces assumption and decreases the stigma associated with generalizations or lack of information. It’s important that you feel safe talking to your doctor about your history of substance misuse. If you don’t feel safe, it’s a sign that the relationship may be headed in the wrong direction. You have the right to terminate a healthcare relationship at any time.
Although it is important to find a provider with whom you are compatible, it is equally important to remember that any relationship is a two way street…and honesty is critical for your safety. For example, if a provider prescribes a medication that should not be mixed with alcohol, and you do not disclose that you are a daily drinker, the provider is not responsible if you experience negative side effects as a result of your alcohol consumption. Part of healthy communication is the ability to be honest with others, but it starts with the ability to be honest with yourself. If you recognize that a provider is unethical or incompatible, the burden lies with you to acknowledge the flaws in the relationship and make a change. This is not a minimization of accessibility issues – such as a lack of providers in rural areas or a shortage of affordable options – but an observation that self advocacy is imperative for both sustainable recovery and survival.
While it may be tempting to seek the counsel of a trusted friend, it is risky to take medical advice from laypeople or to compare medications with friends. Everyone has different needs and reactions. Some medicines are meant to achieve stabilization and be discontinued, while other medicines are necessary over the long term to correct chemical imbalances. Some people will be able to take a controlled substance as prescribed and others will not. This will vary by individual. The subject of medication can sometimes cause controversy in certain recovery communities. It’s important to remember that 12 Step programs DO NOT claim to have any expertise over psychiatric issues or medication – any program member who says otherwise is not sticking to the core tenets of the fellowship.
Narcotics tend to be the most contentious of all medications. As the film Prescription Thugs illustrates, pain medications have precipitated the downfall of millions of Americans. Comparing medication amongst friends may lead to confusion and discord, but that doesn’t mean one can’t learn from the experience of those who have years in recovery. Instead of seeking direct advice, the key is to ask: “What works for you?” When you make an inquiry from this perspective, you allow yourself the opportunity to gain insight from others but also preserve the integrity of your own voice.
For the purpose of this blog, one community member with nearly two decades of recovery shared what works for him:
“If you are fortunate enough to achieve recovery – and even more fortunate to achieve longterm recovery – your disease should be treated with the utmost respect. I would never judge anyone for taking medication and I would never tell anybody that they’re not clean. This is not coming from a self-righteous place – it’s just what works for me.
I have taken a stance of not taking any narcotics – or other mind altering substances – unless in dire need. I don’t think it’s worth the risk. I have been to doctors who told me I needed medication that I didn’t actually need. They told me: “You need to take these, you’re going to be in a lot of pain”. I said: “I’ll deal with the pain, thank you”. I took ibuprofen. It was painful but it was doable. I’m not willing to compromise my livelihood. Without recovery, I have nothing. I’ve had four circumstances where they wanted to give me pain meds: I had my wisdom teeth out, I had a broken bone, I had a hernia operation, and I cracked my coccyx. I took ibuprofen and I was able to get through those situations.
I believe in doctors. They have a lot of knowledge. But just because a professional gives you an opinion doesn’t mean you shouldn’t have your own opinion about what’s best for you and your recovery. I will never, ever leave a hospital or a doctor’s office with a prescription for narcotics, but if I’m in so much pain that I need to readmit myself or return to the doctor, I will consider taking the narcotic. That has never happened. I think in most circumstances where people are prescribed narcotics, that would be the case. They would be uncomfortable and in pain but they wouldn’t go back. That’s my opinion and that’s what works for me – I’m not trying to impress that on anyone else – but I do think it’s an issue that needs to be carefully considered.
If you have a surgery and you’re taking an opiate, you’re going to get high. So the question is: “Can you avoid it?” Everybody has to answer that for themselves. I’ve had multiple circumstances where I could avoid it. I could deal with a little bit of pain. I’ve seen people who have adhered to the advice of the doctor, taken narcotics, and relapsed. It’s a really risky endeavor. The disease of addiction doesn’t know the difference between a medication and a drug. It triggers the obsession to use. You awaken the beast and hopefully get through it. Most people would be advised, if you do have to take the stuff, to find someone else to administer it to you. It’s really easy to justify taking an extra one. It’s really easy to mismanage your medication”.
Science and anecdotal experience alike show that healthcare is a complex issue, especially for recovering people. There are no cookie cutter guidelines. But medicines, in and of themselves, are not necessarily unfavorable – nor are the doctors who write the prescriptions. Medications can play an important role in a holistic recovery program and are sometimes necessary in day to day life. However, your voice and your recovery must be guarded at all costs. Do you feel safe and comfortable with the medication regimen being suggested? Do you have a relationship with your provider in which you can safely express an opinion? Are you asking questions and making honest disclosures? Can you achieve similar outcomes with behavioral interventions? Are the medications in question capable of causing a high? Can you avoid them? If you can’t avoid them, do you have a support person who can help you safely administer them? When these factors are carefully considered, the likelihood of achieving a desirable outcome is dramatically higher. While assertiveness skills are not an all encompassing solution to the problems plaguing our healthcare system, they provide a starting point for you to actively protect your recovery.
Autumn Khavari is the Process Recovery Center’s web content writer. She received an education in Substance Abuse Counseling from Beal College in Bangor, Maine.