If you’re seeing a psychologist or counselor for a mental illness, the chances are fairly good that you also drink or take drugs that are not prescribed for you (or abuse drugs that are prescribed for you).
The chances are also fairly good that your therapist has no idea that you are using alcohol or drugs. Many therapists in private practice do not take complete drug and alcohol histories when doing the initial or subsequent evaluations. If you ain’t volunteering the information, they won’t know.
In a mental health program, such as an outpatient clinic, therapists are more likely to ask about your present and past drug and alcohol use, but they don’t usually follow up with drug and alcohol tests, so if you don’t feel like sharing the information, they, too, won’t know the truth.
I’m taking advantage of the APA Blog Party to share this important message: If you are in therapy, and you drink or do drugs (whether or not you are also prescribed medication) please let your therapist know. Here’s why:
1) If you use alcohol and drugs they can interact with medication. They can potentiate (make stronger) or reduce the potency of your medication. This means your medication isn’t able to work as well as it should. Alcohol and drugs can alone, or in combination with your medication, can also cause unpleasant emotional and physical reactions. There is even the danger of serious mental and physical reactions, even hospitalization or permanent health problems.
2) If you are obtaining drugs illicitly, you may put yourself at risk of harm by dealing with unsavory people and environments. Your therapist needs to know that you are acting responsibly and keeping yourself safe.
3) If you drive or operate dangerous machinery (or even if you merely take public transportation) the risk of injuring yourself or others is much higher. Your therapist and you should have a plan to keep you safe.
4) If you have mental illness and you’re drinking or doing drugs, you can make your mental illness much worse.
5) If you don’t have a mental illness (but are seeing a therapist for other issues), drinking or doing drugs can actually trigger mental illnesses. (For all you naysayers out there, my clinic treats people every day who have drug or alcohol induced mental illnesses).
6) Your therapist will not be able to tell which came first: Did your mental illness or other emotional problems come first, and you “medicate” yourself with substances? Or, Did your drinking or drug use came first and did that trigger a latent mental illness? Your therapist needs to know this information in order to craft an effective treatment plan.
7) If you are using alcohol and drugs, you should know: A lot of symptoms of alcohol and drug use (and withdrawal) can mimic symptoms of mental illness. *In order for your therapist to differentially diagnose you (that means getting the real picture of your mental health and what is causing your problems), you need to be off alcohol or drugs for six to nine months. This does not mean you should stop taking your prescribed medication, but the situation needs to be discussed openly with your therapist.
8) If you are drinking or drugging, you probably won’t be getting the appropriate treatment/therapy either, and will just be wasting your time and money. Yes. Some therapy is better than none at all in many cases. But, if you want really effective therapy, your therapist needs to know the whole story.
9) Believe it or not, I have seen patients stop drinking or drugging and their mental illness subsides. Yes. This is true. However, it doesn’t necessarily mean they can stop going to therapy or taking medications right away. That’s because when you start using alcohol or drugs, you retard your emotional growth. When you stop using them, you still need time to catch up to your chronological age and heal your emotions.
10) If you are doing drugs or alcohol please: Tell your psychologist or counselor. And get the appropriate treatment for substance use. It doesn’t matter how educated you are, how sophisticated, how intelligent. You cannot out think the problem of substance abuse. If you’re using substances to alter your mood it makes no difference whether you are quaffing a $45 dollar bottle of award-winning Cabernet Sauvignon or popping a $5.00 opiate.
*For example, coming down off alcohol or drugs can cause episodic depression or anxiety.