With prescription drug abuse now a major public health crisis, I’m grateful for the steps lawmakers have taken to create a better monitoring system. Electronic databases, for instance, will help to prevent “doctor shopping,” which has become a serious problem on Long Island, where I live, and across the country. Unfortunately, there’s still a lot of work to be done, especially when it comes to protecting people who are particularly vulnerable to overmedication.
From veterans who return home addicted to painkillers to the 2.7 million children currently on medication for Attention-Deficit / Hyperactivity Disorder, overmedication is invading all areas of health care in the United States. As the New York Times recently revealed in a searing exposé, this is especially problematic within group homes for the developmentally disabled. Men and women in these facilities are often given excessive dosages of potent psychotropic drugs, leaving them lethargic and, in some cases, causing irreversible physical symptoms. In fact, records show that these residents are more likely to be given Ativan, a potent, addictive muscle relaxer, than multivitamins. As the mother of one group-home resident put it, the common strategy has been, “Let’s sedate…instead of trying to solve the problem.”
Although we don’t treat developmentally disabled people at Phoenix House, we do treat clients who struggle with a dual diagnosis of substance abuse and mental illness. A majority of these clients come to us from institutions—prisons, state hospitals, or mental health facilities—where they often appear to have been significantly overmedicated. They arrive sluggish and quiet, which doesn’t often match up with the reports we’ve received on their prior behavior. When we evaluate the medications they’ve taken that day, we have to wonder if they’ve been notably sedated so they’ll appear compliant for their admissions interview. Over time, we try to decrease the amount and sedating effects of these meds—and that’s when the real treatment can start.
Of course, medications such as anti-psychotics, mood stabilizers, and anti-depressants can help treat the symptoms of mental illness and we believe in their use. But the goal should always be to prescribe the minimum amount necessary for a person to function healthily, not to sedate them just so they won’t cause any trouble. To achieve this balanced regimen, it’s all about treating the whole person—a strategy that requires doctors, clinicians, recovery support specialists, and other skilled healthcare professionals to work together. A psychiatrist, for example, can replace narcotic medications with ones that have fewer side effects, while a counselor can help a client realize that he or she doesn’t need such potent meds. At the same time, a wellness program can teach him or her drug-free ways to cope with anxiety.
At Phoenix House, we see the benefits of well-managed medication and integrated holistic treatment every day. Just this morning we had an alumnus visit who had been severely overmedicated when he first came to us. But now, thanks to the treatment program, he’s back out in the world, working and doing really great. All of us just thought, “Wow! Remember that guy? What a change!” As we move forward with prescription monitoring on a national level, I’m hoping to see more and more folks like that alumnus who are able to escape the cloud of over-medication and live a happy, productive life.
I’m also hopeful that as healthcare reform brings substance abuse treatment into the realm of mainstream medical care, more treatment centers will have the resources to offer holistic programming. The trend of overmedication in institutions is often rooted in a lack of funding for well-trained, experienced clinical staff. Consequently, those who monitor clients are often entry-level staff with limited experience to deal with violent behavior and other difficult situations. Programs often overmedicate clients out of desperation, hoping to control their behavior when too few or inadequately trained staff have the responsibility for overseeing a large number of difficult-to-manage clients.
We’re lucky to have our share of trained, experienced clinicians here at Phoenix House, but we too face the challenge of limited funding. However, what’s most important is that we continue to make the best of the resources we have. This means really listening to clients who are mentally ill and understanding their symptoms and their concerns. It means taking the time to examine the whole person, rather than trying to medicate clients into good behavior. Medications are just one avenue we should offer to assist someone, and he or she should always be provided with adequate clinical and support services to help him or her achieve a better quality of life.
Traci Donnelly, M.S.
Senior Vice President, Director
Phoenix Houses of New York