I confess that I used to be very judgmental when it comes to people on government assistance who use drugs, homeless people who beg for money and use it to buy alcohol… but I know I was a hypocrite when I shook my head and made snarky comments. Being a middle-class mom has afforded me the freedom to self-medicate in a socially acceptable manner. It’s why I no longer judge people who are recovering from destructive addictions. The main difference between them and me was the fact that I had access to appropriate health care, the ability to afford that care, and the support from friends and family who finally got me to seek help in the first place. Take away any of those things, and I easily could have found myself at the bottom of a bottle each night to cope with the things I cannot control.
Prescription Drugs: Acceptable but Expensive
My psychiatrist currently prescribes three different medications for me. These drugs are maintenance medications for my depression, anxiety, and CFS-induced insomnia. Two of these drugs are super cheap generic drugs that have been around for years. A month’s supply of these pills costs less than $10, even without insurance. One of them – Ativan (lorazepam) – is also my PRN (“take as needed”) anxiety pill. It’s good that this is so cheap and accessible, because it can clear up a panic attack in short order, and lots of folks with crippling anxiety can certainly use that sort of help. My third drug is not so cheap. Even the generic form of Effexor XR (venlafaxine) is over $100 for a month’s supply of pills. I credit this drug with my long-term sanity. It’s no match for situation-induced anxiety, but it makes the low-level always-on-edge anxiety tolerable, and the same for my dysthymic always-in-the-dumps depression.
And then there’s the cost of seeing the psychiatrist himself. Each visit clocks in around $130. Some people may be able to get away with monthly visits for medication management only, but my doctor also provides exceptionally helpful talk therapy, so my appointments are bi-weekly. Between appointments and medications, my mental illnesses alone cost at bare minimum $250 each and every month. Over the years, the various insurance plans my husband’s employer has offered have been anywhere from awful to awesome. The last few years have been on a ridiculous high deductible plan. The first year nearly broke us with a $3,000 deductible…which we reached. It went up to $5,000 the next year, but his company footed the bill via FSA for the first $2,000. This past year, the deductible went all the way up to $7,000, but the company ponied up for the entire amount of the deductible via FSA reimbursements. I have no idea what the next plan will look like, but I hope it won’t cost us more out of pocket. My health care gets more and more expensive each year as my body breaks down.
At some point, I may need to start physical therapy to deal with my chronic fatigue syndrome symptoms. That will add the cost of another regularly scheduled appointment. Physical pain has been becoming more and more of an issue, and I may need to talk to my doctor about a prescription for that in the future, as well. (I will be avoiding that for as long as possible, because I really hate how pain meds affect my mind.)
If we didn’t have an insurance plan to help with the substantial costs of my care, it would be a hardship. But all of these things, my prescriptions and my doctor visits, are helping me live my life as a contributing member of society. With my health care in hand, I am able to run my business and contribute to the economy. Having gone through a fair number of those situational depressive episodes that my medication doesn’t touch, I know it becomes virtually impossible to be productive when I’m in a depressed state. If my depression went untreated because we couldn’t afford to treat it, I would be unable to work, and we cannot afford to live on only my husband’s income. This would be a major problem.
And Then There’s Alcohol
“Instead, I’m here with you, no offense, a moron pushing the last legal drug.” – Melvin Udall (Jack Nicholson) to the bartender in As Good As It Gets
Alcohol is, indeed, the last legal drug. (Unless you live in one of those states that recently legalized marijuana, of course.) And society finds it perfectly acceptable to enjoy a glass (or three) of wine with dinner or relax with a six-pack of beer after a long day at work. And when I’m having a rough go of it because of my anxiety, my depression, or my physical pain, my husband plays amateur bartender. Sometimes I can enjoy a glass of cranberry chablis and be fine with that. Other times, I need something with a bit more kick to it. My drink of choice is the amaretto sour. My husband has perfected these for me. I never drink more than two of them, but one is often sufficient to dull whatever was ailing me. Most often, I drink because of physical pain. Drinking because of mental pain is rarely the best course of action.
But sometimes, alcohol is actually the more “responsible” choice. If I’m ridiculously anxious and can’t calm down, Ativan works great… but I cannot drive for at least six hours. I also have trouble working when I’m drugged up by my tiny dose (0.5 mg) of Ativan because my mental functions are all muted – not just the unpleasant anxiety part. A glass of alcohol can take the edge off when I need it, and I’m sober in an hour. It’s generally only a temporary fix, in this way, but it buys me time until I can take my prescription fix when I need it.
And so I understand why people end up self-medicating with alcohol. If I’d never made that first call to make my first appointment with my psychiatrist – and working up the nerve took months – I can easily see myself swilling alcohol every day to ease the pain. It’s easy to see how our veterans, abandoned by the country that put them on the front lines, would turn to booze to drown out their demons of PTSD. Or how undiagnosed schizophrenics end up drinking when they have no explanation for their hallucinations and delusions that literally drive them crazy…
And Then There’s Illegal Drugs
My own personal moral code, combined with my terror concerning how drugs don’t always act properly with my body, prevented me from ever experimenting with any sort of illegal drugs. Secondhand pot smoke is the closest I’ve come, and that has reduced me to tears more than once. But I know of someone with fibromyalgia who has smoked marijuana to ease her chronic pain, and I can’t fault her for that. (Only the public way in which she discussed this illegal activity in front of children.) I think medical marijuana should be legal in all 50 states. I also think it should be legalized and regulated for recreational use just like alcohol, tobacco, and cigarettes. With New York’s public smoking ban and existing laws concerning driving under the influence of drugs, we’ve got public safety covered. People with glaucoma, chronic pain, and a variety of mental illnesses could certainly benefit from private consumption of marijuana, and I think it’s ridiculous that we don’t allow people to have that as a legal option.
Harder drugs like heroin and crack cocaine… I have a hard time wrapping my brain around anyone who would subject themselves to that. My brief stint as a grand juror gave me more of an education about the effects of these drugs than my graduate course in psychopharmacology ever did when one of my fellow jurors asked the ADA a question following one of our drug-related indictments. The ADA talked to us about the hell these drug users go through, and why the DA goes after dealers so hard. I can’t even imagine how desperate a person has to be before trying that first hit of crack cocaine. If someone had reached out to them, if they’d had a doctor or a therapist who could have helped them find a better way to treat their pain… But not everyone knows they have options. Not everyone thinks they deserve options.
[Update from 2024: I can no longer drink alcohol at all because it dehydrates me and interacts with multiple prescriptions I have to take. I do use medical marijuana in tincture form now.]
Personal Responsibility
And while I can sympathize with the suffering that leads people to self-medicate with drugs and alcohol, I want to point out that there is still a great measure of personal responsibility involved. People are not at fault for their suffering, but they are responsible for their actions when they “treat” themselves with their substance(s) of choice. You may have had a terrible childhood, but that does not grant you the right to drink yourself into a stupor and beat your wife and kids. You may suffer from debilitating physical pain each day, but that does not give you a free pass when you get behind the wheel after smoking pot, and maim or kill other people on the road because of your impairment. You may have served five straight hellish tours in Afghanistan, but that does not give you the right to steal from others in order to afford your new heroin habit.
If you are in a position where you realize that what you’re doing is self-medicating, or you’re considering it, please make the responsible decision to seek professional treatment before you make your problems worse. If you can’t stop at a glass or two of wine with dinner, or if you find yourself getting high so often that it’s never really out of your system, so you’re always operating “impaired,” please talk to your doctor or other health care professional. If you can’t afford one, and you’ve been told you don’t qualify for government-subsidized health insurance, there are still options.
- Call the 24/7 Substance Abuse Treatment Referral Line at 1-800-662-HELP (4357) for help with substance abuse.
- Call Child Help USA crisis line at 1-800-442-4453 for child and adult survivors of abuse, including verbal, physical, and sexual.
- Where available, dial 211 for help with food, housing, employment, health care, counseling, and more.
- Call the 24/7 Suicide Prevention Lifeline at 1-800-273-TALK (8255) if you or a loved one is feeling suicidal.