Problems in late stage alcoholism treatment: Part 2
Antidepressants and alcoholism treatment
Like many other alcohol patients both of us had taken antidepressants while going through treatment. Many people are given antidepressants to try to help in dealing with an alcohol problem, but people who are severely progressed alcoholics with a lot of damage from their drinking commonly have very dangerous complications from them. They caused a very powerful reaction after Janet went off them around the time she went to Evanston (they might have been withdrawn at the program in Evanston causing the severe complications that she had from them). She was very confused about what caused the problems when she quit them. Of course the underlying problem was from the alcohol instead of the pills and the counselors at the state hospital emphasized to her that the alcohol was her primary problem, although they didn’t do much to help her with this situation.
In the end my friend’s extreme reaction to the medications (which was caused by the type of alcohol damage she had) prevented her from being able to recover. But problems like this were ignored in treatment, and each of the private and public programs she had failed to warn her about the medications. Also, they didn’t diagnose her alcoholism correctly as a primary diagnosis type medical condition so that she could have the appropriate information she needed to start her recovery. Either of these things would have strongly affected her ability to recover, and both of the problems were preventable and the programs should have been aware of them.
State hospital treatment for alcoholism
Since the mid-80’s (the time when many programs were cut) alcohol patients who were the worst afflicted often wound up being sent to the substance abuse treatment program at the state mental hospital in Evanston when regular treatment didn’t work for them. While we were at Evanston they had one of the most strongly punitive programs in the state. In the past their program had once been one of the main programs in the state to help patients with advanced damage from alcoholism or an addiction, but the treatment they had was shortened and consolidated with criminal offender treatment to save money during the Reagan era social program cuts. When my friend was there it was intended as punishment and as a last chance type program for people who had failed in regular treatment (the state has made excuses about the elimination of programs in the past, saying that the “old” programs “didn’t work” – but the truth is that the programs were cut to save money).
Is punitive treatment for late stage alcoholism OK?
For many years the program at Evanston was simply what was known as criminal offender treatment. It was a strongly punitive program, and while my friend was at Evanston they used Synanon-type tactics that rivaled the worst methods used anywhere in the country. I think Janet was referred there through the courts due to her failure to recover in regular treatment, but she was truly sick and that was really why she was there. This occurred just before the heavily punitive treatment was finally ended at the state hospital’s program – she died in 2002, and they finally stopped these tactics in 2003.
When I was in Evanston the antidepressants that I was taking were deliberately withdrawn abruptly without giving me the time to taper them off causing severe problems for me, and it is important to note the fact that they used these abusive tactics at Evanston – withdrawing medications in this way was just one of the tactics used in the substance abuse program at Evanston. It was done in order to intentionally create a crisis for people with this type of alcoholism, and I believe this same tactic was probably done with Janet just like it was done with me – she had an extreme reaction right at the time that she went off the pills when she arrived at Evanston late in 2001, and I think it’s very likely she was dropped off them just like I was without being allowed time to taper them off because of the sort of difficulties she encountered that were very similar to my own.
This method of causing a severe withdrawal was used as a punitive way to get the attention of patients with the kind of treatment that was done at Evanston, and in her case I believe it turned into an unpredictable mess while she was trying to recover from the sort of condition she had from the alcohol. And actually it wasn’t unpredictable – it was very predictable, because it is well known that complications can occur with these medications when severe alcohol damage is present.
I believe the pills were stopped cold turkey to convey a harsh message for her with the sort of methods that were used at Evanston. And that was just part of what went on at the state hospital’s program until 2003 when their severe tactics were finally stopped.
Confrontational treatment for alcoholism
The state hospital was said to have the toughest program in the state. It was called confrontational treatment. But their program utilized humiliation tactics with people that included the use of mind games, outright lies against patients and verbal abuse to break people down. They singled people out and turned the group against individuals using “hot seat” techniques and degrading patients who were in very vulnerable condition. The idea was to constantly increase the pressure on people, and the program went to the extent of using unethical practices such as dropping patients off medications abruptly to send a harsh message to them. None of this was appropriate for severely advanced alcoholics, and although the program was supposedly meant to break through denial in certain cases that kind of label is not a correct assessment if a person is facing the very beginning of a truly long term recovery process (rather than needing to find acceptance and break through “denial” many of these patients desperately want to recover and just need a very long time for their condition to begin to improve).
From my time there I believe the treatment that was done at Evanston amounted to torture. Several of the counselors at Evanston bragged that people in their program often had what they called “psychotic breaks” due to the methods that were used. There’s no doubt their tactics had the wrong effect for people who were simply very sick like my friend.
Lack of cooperation or severe illness?
I believe that due to the transformation of treatment in the past this different level of alcoholism has become a misunderstood subject for counselors whose focus now is working with young people and others whose problems are not so severe. Minus any sort of recognition of these problems in treatment I believe that most of Janet’s counselors were not even aware of the type of damage she had from her level of alcoholism, and I am sure many counselors in Wyoming remain in the dark not knowing what is really happening with this type of patient. The standards here call for counselors to just make a call and discontinue treatment if they feel a client is unwilling to cooperate – the few who are extremely sick fall through the cracks and get thrown out of treatment in this way. They intended to throw Janet out if she didn’t do what was required in Evanston – it was supposedly her last chance to make it in treatment, or at least that was what they wanted her to believe. And in effect she was thrown out. She failed the program because of her deteriorating condition and was forced to leave because of the extreme methods that they used.
Withdrawal from antidepressants during alcoholism treatment
I know the worst problems began for Janet following her withdrawal from the pills (a true psychological crisis condition developed). And with no medically based treatment allowed no follow up was ever done for her after Evanston’s program concerning the sort of situation that ensued due to the pills. When she went off them she complained of acute problems with depression and extreme problems with her nerves, and she said she was unable to tolerate any other medications to help in dealing with the crisis situation that was happening. The crisis began when she first arrived at Evanston, and with all of the problems she was having she decided to leave their program due to the tactics they used – but with nowhere else to go she returned as a result of the extreme condition she was in due to the crisis. Then she left a second time when she couldn’t handle their tactics again.
Basically she had to leave after being forced out because of their tactics, and afterwards she was left alone with this kind of condition that she couldn’t control – the depression and problems with her nerves were very severe combined with the type of alcohol damage she had, and the problems became unbearable for her. Not long after leaving their treatment program for the last time she had a nervous breakdown. With the extreme problems due to 4th-stage alcoholism plus the severe psychological crisis and then the breakdown she committed suicide shortly after Evanston’s program.
She was put in the position where there was really no option left for her. She was facing a truly long term process to recover from the alcoholism alone, and she couldn’t go back to the programs because “treatment” amounted to throwing people out along with the use of punitive methods even in cases where true illness-level alcoholism was present. Even if they would have allowed her to return she couldn’t have gone back because of the way that treatment worked at the time.
The pills were never monitored in any of the programs that she went to, and her condition with the alcohol was left undiagnosed until she wound up with the worst sort of mental consequences due to the type of alcohol damage she had. Then she was forced from treatment at Evanston and left to deal with this type of 4th-stage alcoholism alone. This was a purely non-medical response from the state for people who are the most severely afflicted with this type of alcoholism, and in my opinion everything that went wrong with Janet’s recovery was the result of the poor treatment she received.
With the reaction my friend had from the pills the problems were so severe she couldn’t tolerate taking any other medications when the crisis happened – she couldn’t take anything else because the pills WERE THE CAUSE OF THE PROBLEM TO BEGIN WITH. With the severe reaction from the advanced alcohol condition and the pills it wasn’t possible for her to take any more of them to try to deal with the crisis condition – the problems from the pills and the 4th-stage alcohol damage were too severe for her to take anything else at that point, and it was a true dilemma for her not being able to do anything to ease the extreme mental anguish she was experiencing. I had the same difficulties with the pills and I went through the same withdrawal reaction from them, and after a period of time I was close to a nervous breakdown and I decided to use alcohol to stop the nervous condition. It was an agonizing decision because I was terrified of falling back into a relapse condition again, and I had no idea how it would affect me to drink again (I didn’t know what might happen because of the condition I was in at that point). I started drinking again and wound up in very bad condition as usual. But it stopped the nerves, and it is possible that it saved my life. Just like Janet I knew that taking any more medications would have been disastrous for me when the complications from the reaction they caused was so acute, and it was a truly terrible problem. It took a very long time for the damage from the pills to clear up for me.
But in Janet’s case she couldn’t control the problems that were happening from the withdrawal. And when the nervous breakdown happened it was an incredibly complex setback along with the sort of end-stage alcohol condition that she was already suffering from. She was already facing the prospect of a true long term path to recovery that very few alcoholics ever encounter, and then she suffered this sort of very serious nervous breakdown condition along with everything else that was happening (she was under an extraordinary amount of pressure at home and with her job, etc.).
Is the system complacent?
People today are usually sent to two or three inadequate, revolving door-type programs, and then the counselors give up and throw them out of treatment. Patients are still not diagnosed correctly, and in certain cases they can acquire a new set of problems when they are given medications that can make their recovery from alcoholism many times more difficult. The problems with the medications are almost certainly still being ignored today just like they have always been. These patients take years rather than a few weeks or a few months to start to recover, but there is just complacency in the treatment system when it comes to dealing with people who have the most severe damage.
I believe Janet was trying in desperation to get help time after time in private and public programs in the state, but patients like this were always denied a diagnosis. And though the dangers of the antidepressants were well known for advanced patients those dangers were simply ignored for her, and the treatment people continued prescribing the pills without monitoring what was going on. Then the “tactics” that they used at Evanston which were meant to send a harsh message and break through denial backfired in the worst possible way in this particular case – in my opinion incompetence in the system killed this person, and it can’t possibly have been the only time this sort of situation occurred. It happened in both of our cases, and I have no doubt the same thing is still happening today with alcoholics who are having medication problems that are just being overlooked, and no diagnosis is allowed for them.
to be continued…
Photo credit: Paul Garland