Mind and Body/Opinion

Finding the off-ramp from a dysfunctional highway

What happens when you reach for your anxiety medication at the same time you are reaching for your wine glass?

Photo courtesy of Katy Linwood

Katy Linwood, author of a regular column in ConvergenceRI, "The Bright Side" of sobriety.

By Katherine Linwood
Posted 9/18/23
In talking about her journey to sobriety, Katy Linwood asks insightful questions about the relationship between alcohol misuse and medication treatments for mental health.
If research links 80 percent of all overdose deaths to alcohol misuse as a contributing factor, how do the recovery and prevention strategies need to change to improve health outcomes? In looking at the problems related to what happened with PVD Fest, how many may be related to what happens when climate denial [presumptions about controlling the weather] are mixed with an alcohol-driven economy [presumptions about controlling/promoting the consumption of food and drink]? Would Brown University be willing to sponsor a conversation between psychiatrist Peter Kramer, author of Listening to Prozac, and Frederike Petzschner, developer of the new app, SOMA, about how to manage our perceptions of pain?
At the RIBGH health summit held on Thursday, Sept. 14, one of the more fascinating challenges issued to the business community on what steps they could take to improve the delivery of primary care was this: Businesses needed to demand that every one of their employees have a primary care provider as a condition of their health insurance package. The idea was championed by both Dr. Jeffrey Borkan and by Carmilla Tan, who heads Benefits for CVS Health, who described her own difficulties about trying to arrange an annual physical with her primary care provider.
Another fascinating moment occurred when Dr. Edward McGookin, president of Lifespan/Coastal Medical, described the problem of having some 6,000 patients who had become “orphans” because a number of his doctors had retired – and how the corporate response was to engage with an insurer to resolve the issue by prospective payments and a team approach, while attempting to hire new doctors.
However, the optimistic corporate solution turned out to be far, far different for the patient in the real world. In the audience was someone who had become one of the 6,000 “orphans,” without a primary care provider. That “orphan” had been instructed to go to a Coastal “urgent care” facility if and when they were in need of primary medical care.

PROVIDENCE – The road between mental health and substance abuse is often a dysfunctional highway, paved with a search for temporary relief and built on quicksand.

Without proper education, the tools and treatment that we are given for mental health can intensify the abuse. That’s a substantial piece of the story of how I found myself blacking out on Harvard’s campus, spiraling into binge drinking, and eventually crashing into sobriety at 28.

The best way I can describe un-medicated anxiety is the chasm between reality and the fight-or-flight system. My brain is unreliable in this arena, telling me that something is deeply wrong, when I have no concrete reason for the pervasive dread. Without medication, it’s a fruitless search for what might be causing the alarm. It feels like wearing a damp itchy wool sweater three sizes too tight against bare skin. It feels the way that watching TV static can make you feel: jumpy, unclear and unsettling. It’s exhausting.

It was in fifth grade that an impending sense of doom settled heavily on my shoulders. I couldn’t express it as such at the time, but what I remember most is being terrified of boredom. I was afraid of not having something to do, of somehow finding myself inert. It was a sinking feeling, and I remember knowing that most other children my age didn’t carry this fear. I was different and it wasn’t in a good way.

I found an antidote to this: making lists of optional activities, books I could read, projects I could take on. Today, when I look back at these lists that I have since rediscovered, it hurts my heart. The lists are filled with childish handwriting, desperately trying to get the thoughts down on paper, to tame the disorder that was in my head. I was coping with the only tools I could find to try to create order out of chaos.

Punishment or reward?
Depending on how they manifest, our society rewards or punishes mental health issues.

    •    You have anxiety that displays perfectionism, overworking, and obsessing about your next accomplishment. You're seen as driven, valuable, focused.
    •      You have depression that renders you unmanageably numb, OCD [obsessive-compulsive disorder] that makes daily tasks painful, or another diagnosis that is disruptive. You’re lazy, not trying hard enough, you don’t have discipline.

It was when I was in high school that Prozac became available generically, and it entered the market with a bang. Family members of mine went on the drug, and I followed, shortly behind them. Name the popular anxiety pharmaceutical and I’ve tried it over the years: Prozac, Zoloft, Lexapro, Effexor.

It takes a few weeks for this type of medication to regulate, so it can be months before the dosage is correct. The time it takes is a thief. Suspended in the in-between, tantalizingly close to peace in my own body but still without a guarantee of how to feel OK.

[I have recognized this before and it needs to be repeated: I come from a place of privilege. I had access to comprehensive health care, I had a family that supported me as I sought a solution, my family could afford treatment, I had stable housing and all the necessities, I am a middle-class white woman. My experience would have been so different without these factors, and this privilege is part of what fuels me to change to conversation around mental health and sobriety.]

As I introduced medication to my anxiety-managing toolbox, I entered my late teen years. My newfound independence gleamed brilliantly; drinking beckoned to me as a rite of passage. I discovered that drinking was incredibly effective at silencing anxious thoughts and recurring thoughts. I liked this. I liked this so much that I kept going until I blacked out. Not every day, not every single time, but an awful lot. As time went on, I was bewildered at friends who kept pace with my drinking and yet didn’t black out.

The thing that I didn’t understand at the time was the way that these pharmaceuticals amplify the effect of alcohol. Sure, there were warnings on the label, but let’s be honest: What teenager and 20-something really reads or heeds all of those?

Looking back, I wish that one of my health care providers had explicitly warned me about the effect that these pills would have if I drank. I was drinking too much and I was taking selective serotonin reuptake inhibitors [SSRIs]. Don’t take my word for it – if you search ‘SSRI alcohol interaction,’ the top hit is the Mayo Clinic site, which states: “The combination of antidepressants and alcohol will affect your judgment, coordination, motor skills and reaction time more than alcohol alone.”

I want to be extremely clear that I am sharing my story here. I am not saying that all who have mental health issues shouldn’t drink, or that all who take medication will end up abusing alcohol. Similarly, not all who do end up abusing alcohol are also on medication or have an anxiety diagnosis. Like most things in life, it’s not black and white.

I’m also not blaming my alcohol abuse on the anxiety medication. It’s the fact that I reached for my prescription at the same time I was reaching for my wine glass, searching for relief from the mechanics of my very own brain. If my medication would take months to settle in my system, then why not have a drink to help me with the here and now?

I was chasing a long-term solution with a short-term fix. One helped, one hurt, and together they wreaked havoc. I was chasing the same goal with each. Unknowingly, I intensified the damage done.

A cozy relationship?

It’s a cozy relationship, one that the $283 billion alcohol market surely doesn’t want made clear. But I can’t un-see what I’ve seen: alcohol is an easily available substance that temporarily pauses anxiety. I’d imagine that it is a temporary “fix” for other issues, as well. It’s particularly alluring to those of us who are moving through life with mental health challenges.

The National Institutes of Health estimates that more than one in five U.S. adults live with a mental illness  [some 57.8 million adults in 2021)] – and surely it isn’t a step too far to ask: How many are abusing alcohol to cope? How many are seeking treatment yet making their road to recovery so much harder by drinking?

Katherine Linwood writes a monthly column, The Bright Side of Sobriety, for ConvergenceRI. Connect with her on IG@katherine.linwood

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