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Relationship, Mental Health, Substance Abuse, and Medication



There are mental health, relationship issues, and emotional problems that are beyond or at least at the edge of behavioral control. People are not trying to be depressed or crazy – they act that way because of the complex brain, hormone, environment, and background issues. There are times when medications are not required where therapy alone or coaching or exercise and diet are all that is required to return a person to normal – whatever that is. I firmly believe that if you think someone is normal you just don’t know them well enough. Some situations require medication. I want to make sure that if someone needs medication that they get it, and further that they get only the correct medication for their condition and then only the minimum they need to “have a life”.

In my psychotherapy practice, I saw people almost every day who had a history of self-medicating. I asked people what their drug of choice was and made some diagnostic ground by then asking them what it did for them – not ruined their life (which often it does) but how did it make them feel. Some examples: If a person’s drug of choice is methamphetamine and it makes them able to relax (from the beginning not after they have burned themselves out) then it is highly indicative of AD/HD. If they tell me it makes them manic I want to rule out Bipolar Disorder – the reason being that no one likes to be depressed and the methamphetamine will bring them out of a depression – it isn’t a good choice, it is just a useful diagnostic.

I have also had several AD/HD clients whose wife or mother would tell me that their son or husband is smoking Marijuana. I asked them what the person is like while under the influence and they will say, “well he is more talkative and more interactive and he is nicer to me”. I will usually follow that statement with “so what is the problem”. I am not for Marijuana – it turns out that it does help several conditions, but SPECT scans of users' brains show signs of toxic exposure – brain damage – from extended use. There are also legal issues. Drugs and alcohol will usually get you in trouble eventually. But I find that people are trying to medicate themselves most of the time. They are just using the wrong medication. Some people get a few seconds of relief from such illicit substances but at the cost of a thoroughly chaotic and often dangerous life. People who are treated for AD/HD with the proper medication are far less likely to be substance abusers than the average person. Those who have AD/HD and are not treated are FAR MORE likely to abuse substances than the normal person.

According to research at the Amen Clinics by Dr. Daniel G. Amen and his colleagues ADD is not just one thing, it is seven different things. If you give a person with AD/HD Ritalin – if it is the proper medication for that type of AD/HD – it is like a miracle. If it is the wrong medication for that type of AD/HD they may become psychotic – hallucinating and delusional, requiring psychiatric hospitalization. People with AD/HD often benefit greatly from medication, the right medication, others learn to cope, still others are considered grouchy or antisocial largely because it is so hard for them to hold it together all day at work or school. Those individuals often need a second dose later in the day.

Some violent people have a cluster of brain issues that cause violent behavior and medication not only gives them their life back but also gives them back to families and society as valuable, contributing, members of society.

This article is short to give you a perspective that not many understand. We know people with problems need help, but we often don’t realize how much of the behavior is either, at the edge of, or beyond their control.

Doctors need help treating these people. The average doctor visit is about seven minutes long. If I come in with depression the doctor will likely give me an antidepressant. If I don’t tell her I have a history of risk-taking behaviors (road rage, promiscuous sex, driving fast, impulsive behavior,…) she doesn’t even know to rule out bipolar disorder. I take the antidepressant and it pushes me into a manic state (think of the cartoon characters the Animaniacs, or someone who is driven to keep moving, not sleep and engage in those risk-taking behaviors). I was not depressed, I am bipolar. I probably won’t go back to the doctor because at least now I am happy – so happy I am driving everyone else crazy. If someone cares enough about me they might drag me back to the doctor at which point the doctor would change the medication to a mood stabilizer to treat bipolar disorder, or even send me to a psychiatrist. That’s all good but it takes a patient psychologist to get the right information out of a patient – it takes a very knowledgeable and aware patient to tell the doctor all that is relevant to their condition.

Psychiatrists are highly trained doctors but they still rely on trial and error based on extensive training and experience – and they still often get it wrong. And that is a psychiatrist, the general practitioner has little chance if it is something complicated like bipolar. Oh and bipolar is often misdiagnosed when the person’s mania is dysphoric: irritable, or angry but with the energy of our old friends the Animaniacs! Those people are either considered to be antisocial personality disordered or treated for depression which makes them worse.

What I did is help the doctor with the diagnosis, suggest medication or approaches based on the work of the Amen Clinic (a team of Psychiatrists, Psychologists, and therapists with a proven track record) and I would follow the patient watching for changes in behavior, ask about common side effects and watch for uncommon ones, I could spend time with them. A therapist’s time is a fraction that of a doctor and an even smaller fraction of a psychiatrist's fees. The doctors are good but they just do not have the time to spend with people that is required. Psychiatrists could spend the time but because of the cost people will see their psychiatrist between once a month and once a year in most cases.

I used the assessment instruments that were developed by the Amen Clinic based on close to 60,000 SPECT scans. I often went to the doctor with my clients. Doctors are usually not very sympathetic to drug addicts and even if they are it is likely that they will at least suspect they are just there to get some prescription drugs to get them high. There are a lot of addicts that are suffering from and dying from treatable brain dysfunction. Our prisons are full of people that are suffering from and dying from treatable brain dysfunction. People are suffering from treatable brain dysfunction that is destroying their relationships, their education, their professions, and their lives. I want to rule those things out upfront. I want to help people get their lives back from drugs, alcohol, mental issues, emotional issues, and relationship issues. We need to use all the tools at our disposal to treat people in the most effective and least damaging ways possible.

As a coach, I can use the tools I used as a psychotherapist but focused on the future. I can work with clients that are struggling with mental disorders and or their families. In addition, I have been through my own break and come out on the other side. I understand.

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