Telling Doctors About Drug Use If I Can Get Sober On My Own?

[Steep Degeneration]

Hello Bluelight Community,

I would first like to thank all of you for the immense amount of information shared freely on Bluelight, this community has truly been a blessing to me, and I’m sure, many others. I have been browsing the forum for years now, and had it not been for the many of you who dedicate your time in an effort to provide accurate and helpful information about harm reduction, it is more than possible I would be in a far worse position than I am right now. Truly, this forum is a blessing.

Anyway, I come before you today seeking advice about my current predicament. A bit of backstory might be appropriate before asking my essential question, but I understand if you do not have the time to read such a lengthy post, and I advise those who do not, to skip to the bottom where the heart of this bulk will be.

I entered the world of intoxicating substances at the perfectly appropriate age of twelve. My introduction to this world started first with opiates; given to me by my father for reasons I really do not want to go into too deeply. (I was an incredibly anxious kid, always have been, and my father is a substance abusing loony, so naturally he gave me hydrocodone to help me cope whenever I saw him. He is a great human being in many respects and I love him with all my heart, as he does me, but he has many faults, most of which are out of his control.). By age thirteen I tried marijuana for the first time, and by age fourteen I was using it multiple times a day, every single day. It helped with many of my mental health issues which, for a long time, my mother refused to allow me to seek treatment for. Somewhere down the line that same year I discovered Adderall, and from there on out I quickly spiraled downward into addiction. I dropped out of school my freshman year due to an inability to, not only, cope with everyday living, but also because attending school is very very difficult while in the midst of amphetamine psychosis brought on by repeated 3-4 day benders without sleep. I used various CNS stimulants almost every day for the next two years, and within that two years I also managed to both get hooked on, and quit, opiates; which I developed a mild dependency on due to using them for the speed comedown.

Anyhow, the night before I turned sixteen, I got into a car wreck while driving on a cocktail of amphetamine, kratom, and oxycodone. At this point in my life I was so hopelessly fucked up that I only have a very vague recollection of the few months prior to this. After the wreck, I realized something had to change, and I slowly but surely cut amphetamines out my life over the next couple of months. I am now seventeen, and have been clean from all stimulants for roughly ten months. Here’s the catch though, even though I’m clean from speed, I don’t remember the last time I was sober for an entire week within the last three years (I really don’t think I have been). Up until just three days ago, I was using marijuana daily, and various opioids about fourteen days out of the month. And if not marijuana or opioids it was always something. Whether it be benzos, booze, psychs, whatever… I have basically been fucked off my gourd for the last three years of my life. I know that doesn’t seem like too long to some of you, but considering that 3 years is 5 and 3/5ths of my lifetime, and those three years were some of the most crucial in my brain’s development, I feel a little fucked up about the whole thing.

That said, I’m getting sober completely. I haven’t touched shit since Monday and I plan to keep it that way. Well, other than cigarettes, but I’m not gonna drop a four year smoke habit and all other substances all at the same time. As of right now, I am back in school, almost caught up on all my classes, have a 4.00 gpa, am looking for a job, and really getting back on track. I’ve also finally scheduled an appointment with a therapist for next week, which brings me to my question.

Should I tell them the full extent of my drug use? I know it’ll have to be mentioned somewhere down the line, but do I need to go into detail? Other than my sister and father, not a soul knows about my full drug history, and I really do not feel comfortable opening up fully about it. I’m terrified that they’re going to label me a junkie, and treat me like sub-human street garbage before ultimately giving me the boot. That, or forcing me into outpatient treatment, which I really don’t think is necessary. I’m really fuckin’ serious about putting substances down, and I think it’s something I can do on my own. What I need help with is the mental health problems that I believe my drug use stems from, but is it really possible to receive that help without first giving them a truly accurate picture of the last few years of my life? Is it ever a good idea to tell your doctor you use drugs?

I apologize for the longevity of this post, that entire thing may have been completely unnecessary, but I felt it needed to be put out there. Maybe it was moreso for me than it was for you guys. I don’t really know. Anyway, once again, I’m sorry it was long and structured so poorly, I’m a bit wigged right now. Thank you for taking the time to read this, I will be impatiently awaiting response.

Much Love.

P.S I also apologize if this is the wrong forum, I wasn’t completely sure where to put this. Please feel free to move it if needed

 

[Jabberwocky]

No worries, this is a fine place for your thread. This may turn into a good addition to our new directory, so I thank you for your contribution to the community. And WELCOME to BL!!!

The costs of getting that scarlet letter in your medical files can be quite steep, so I'm wondering, what would the potential benefits to you be by opening up to your MD.

However, you're not dealing with a GP, you're dealing with a therapist. Generally they are safer to open up to about substance use, but still it tends to lead to that scarlet letter and getting branded as a drug user/addict/deviant, which is often very unhelpful to have in one's medical record except for the most extreme cases (which you my friend, at least at this point, definitely do not qualify as).

I guess now I'd like to ask, how did you find/choose this therapist you've scheduled an appointment with. Was it a referral, and if so from who?

What are your goals for and what do you hope to achieve by working with a therapist?

Honestly, unless you're going there specifically to deal with substance use, and you're instead more interested on working with other issues, there isn't a real need to open up about substance use right off the bat. It all comes down to the individual therapist though, how much they actually understand about substance use and substance use disorder. Sadly few seem to be educated about it at all, and get their understanding from essentially popular recovery moment culture (which itself is hardly very enlightened when it comes to substance use disorder, kinda ironically).

I'd put off coming out right away with your concerns/issues/history of substance use regardless of your goals or needs working with the therapist. First establish a productive relationship with them and let them get to know you beyond such limiting areas like our substance use. I'd also spend at least a few sessions gauging their thinking on substance use before coming out about it, if that is what you decide you want to do. It can be tricky to do this of course, but you seem fairly educated on the topic. And if you don't feel prepared, go educate yourself some more. For one thing, try and see what specific words they use to describe drug/substance use. And how they talk about it.

Perhaps a few sessions in, ask them directly what they think about substance use and substance use disorder (particularly related to your DOCs). But, like I said, if you are concerned more with address the underlying issues driving your substance use, with tend to be what folks need to end up working on in therapy anyways, stick to that and just don't go down drug use discussion rode.

The vast, vast, VAST majority of therapists are in no way qualified to talk about substance use disorder or its treatment anyways... But perhaps you'll find one.

Focus on the underlying issues surrounding and driving your substance use, not the substance use per se. That would be my advice. Best of luck!

 

[Burnt Offerings]

Only tell them if you're willing never to be prescribed any kind of "potentially addictive" drug ever again (other than ORT)

 

[Jabberwocky]

Yeah, that is certainly one of the many concerns about opening up with the medical establishment about one's use. The other is being treated like a junky every time you go to a hospital or see a new doctor.

But like I said, the decision to do so should not be taken lightly and should only be made after weighing the potential cost of doing so against the potential benefits. I'd definitely go slowly with this decision and err on the side of caution.

 

[Steep Degeneration]

Thank you for the response and input! I more than appreciate it.

After thinking about it long and hard last night and today, I think I've decided to keep it low key. In the long run I think the negatives outweigh the positives, and I don't want to do anything that I will regret down the line. If I, for whatever reason, change my mind I will definitely wait until I understand his ideas surrounding the topic, and we have a well established relationship.

The medical industry's attitude toward drug use is so counterproductive it's pathetic. Why is everyone so horrified by substance abuse, but yet completely dismissive of the conditional issues that create it? I know that's a whole different topic, and I know I already know the answer when I really think about it, but it's hard to come to terms with.

Once again, thank you so much for the advice! It's really nice to know it's there when you need it. @toothpastedog

 

[Jabberwocky]

That's the treatment industry (and most of the medical instrustry) for you: primarily driven by profit maximization, not treatment outcomes. Big, big money is to be made in the recovery industry...

 

[simco]

I'll repeat TPD's point: I think how/when you tell him about your substance use depends largely on what kind of relationship you're planning to have with this therapist.

For instance, if this person is a psychiatrist and you're seeing him mainly for medication management, then the substance use--to my thinking--can remain undiscussed for a while. (Of course, there are some drug combinations you need to be careful about, but if you're abstaining from non-prescribed drugs, the doc should have most of the info he needs to keep those at bay.)

But, if you're going to see this person for talk therapy, you could really undermine the relationship by leaving out behaviors, compulsions, etc. that may be really important to making good progress. By no means do I think you need to tell him right away...make sure you like/trust him. And make sure he doesn't seem ignorant about drug use. But if therapy that you care about is on the agenda, withholding info is counter-productive.

There's no right answer here. Personally, I've handled the same issue in various ways at different times and have never had a particularly bad experience. So I recommend, getting a read on the guy/woman and then proceeding however your intuition guides you.

 

[aihfl]

Does this therapist specialize in addiction treatment? If not, my two cents would be to find one that does, that way there will be no stigma involved. Addiction is a unique disorder in that the disorder and the symptoms are one and the same. To try to separate out the two is impossible IMO. I've only had two therapists (both were ironically addiction therapists) that truly sucked. One is a recovering alcoholic who got sober in AA and just could not fathom why 12 step recovery doesn't work for everyone. Plus, she discussed my case with another IOP patient violating HIPAA but that's a story for another day. The other (inpatient rehab) was just condescending as fuck. However, if this therapist you're going to see is worth their salt, there's no reason to withhold anything, but you have to make that determination first.

EDIT: Also, you say you think you can get sober on your own, but you still need support. Personally, I fucking despise twelve step meetings and choose instead to be accountable to friends, activity partners, my personal trainer, etc.

 

[Jabberwocky]

When it comes to the overwhelming majority of addictions specialists I've worked with and come across in a more professional capacity, I've found them to be just as affected by stigma surrounding problematic patterns of substance use and the whole ethos of the thieving junkbox, albeit in more subtle ways, as the majority of people who work in the field.

Why? I believe it is largely a result of how pervasive and effectively demonized the junkie stereotype has become over the last hundred years in our culture. Another big reason is how much of a joke it is when it come to what is required to become a doctor who "specialized in addiction" in terms of next to no specific training or formal education on the subject of substance use disorder. Hell, it says a lot that they're still generally labeled as "addiction" doctors (when even medicine has become to see the follies of that particular concept).

It is both sad and ironic how the majority of so called addiction specialists do a hell of a lot to promote the myths and misunderstanding surrounding substance use disorders.

That all said, there are some truly AMAZING psychiatrists and doctors who, while not always professionally labeled "addiction specialist," have a very large minded and thorough understanding of substance use disorder and the various treatment options out there. After trying many, many various doctors, I eventually found my way to a truly compassionate and very professional doctor. Wouldn't have made it off methadone without his support.

The only thing is, he was the one I found after trying over ten others...

What do you mean by "the disorder and the symptoms are one in the same"? You mean something like how the symptoms defined the disorder? Strikes me that that could be said for many of nearly all (if not all) behavioral disorders in the DSM5.

As the whole situation with opioid use become something that is less and less something people are compelled to keep in the shadows however, I've noticed some very positive improvement in overall quality of treatment over the last decade. Lets help keep things improving.

 

[Nicholai]

It's possible to find a good doctor that is understanding. I found a new one, but before I saw him, I had to sign a paper for something like, "Patients with previous substance abuse problems," basically a medication contract, and will have to pass a piss test before they'll give me any scheduled medications. Which is fine with me! I really need some kind of benzo to keep away the anxiety, otherwise I just drink, or will use whatever is handy, but when I have some benzos, I'm totally cool. I just have to see their counselor first; they seem to be really quite thorough.

This doc is rather young though. But there's hope! Not every doctor is stuck in the typical mindset, and actually wants to help his/her patients.

 

[Jabberwocky]

And those that are not stuff in that particular mindset are indeed gems. I have begun to notice recently that the new generations of doctors (between the ages of 25 and the last 30's), seem to have a better grasp on the nature of this particular disorder and its connections with associated, co-occuring conditions.

Something else to point out - I've noticed it is much easier to find a good, helpful, compassionate doctor when one's drug of choice isn't as demonized and misunderstood as opioids are. Alcohol and cannabis are primary examples. Much easier to find a higher quality of care if that is what one is primarily struggling with - especially when compared to the difficulty of finding a compassionate doctor to treat injection opioid use.

I think it also comes down to the specific substance use disorder one is seeking help for. It's quite a bit easier to find a good doctor to treat alcohol use disorder considering how much more socially acceptable the condition is, where it is much more difficult to find the same when trying to get severe opioid use disorder treated, given the significantly different nature of the stigma surrounding those particular drugs (and again, particularly when one is an injection drug user).

On an unrelate not Nicholai, have you ever looked into baclofen? It is a great alternative to benzodiazepine use to manage alcohol use disorder.

 

[aihfl]

On an unrelate not Nicholai, have you ever looked into baclofen? It is a great alternative to benzodiazepine use to manage alcohol use disorder.

For anyone interested in baclofen for AUD, "The End of My Addiction" by Olivier Ameisen MD is a must read. He was an alcoholic physician who experimented on himself and pioneered the use of baclofen for AUD. I was on it for several years and unfortunately it didn't do much for me but we all respond to medications differently.

Getting back to original discussion though, I'm going to play devil's advocate, and I'm not trying to be argumentative, but the title of the thread is "Telling doctors about drug use if I can get sober on my own." It sort of makes me wonder why the OP wants to see a therapist in the first place if their intention is to withhold information. Presumably if you can get sober on your own, you've overcome whatever issue(s) it was that was causing one to use in the first place. No issues/problems, no drug use. That is what I meant by the disorder and the symptoms being one and the same.

 

[cj]

Only tell them if you're willing never to be prescribed any kind of "potentially addictive" drug ever again (other than ORT)

This. My advice is not to tell them. With how young you are there is a large chance that this was just a phase

 

[Nicholai]

Toothpastedog and Aihfl, thanks for the feedback. I've actually thought about baclofen and campral, but I'm not actually physically addicted to booze, just heavily abuse it if I don't have something else to help me with pain and anxiety. I actually was a IVDU of heroin and dilaudid(and thusly lost my scripts and now have untreated chronic pain), and ended up hospitalized and had to have surgery for an abscess, but all the drug abuse is linked to anxiety, pain, and depression, which doctors have tried to treat for years unsuccessfully.

Didn't mean to derail the thread. One of these days I'll get around to posting my own thread and telling my own story. Thanks guys!

 

[Jabberwocky]

Where baclofen seems to shine most is actually with cravings more than dependency (at least, it isn't as good for managing dependency as something like diazepam would be, but seems to work as well if not better than diazepam at control cravings with minimal side effects).

And I'm going to check that book out, thanks aihfl!

Getting back to original discussion though, I'm going to play devil's advocate, and I'm not trying to be argumentative, but the title of the thread is "Telling doctors about drug use if I can get sober on my own." It sort of makes me wonder why the OP wants to see a therapist in the first place if their intention is to withhold information. Presumably if you can get sober on your own, you've overcome whatever issue(s) it was that was causing one to use in the first place. No issues/problems, no drug use. That is what I meant by the disorder and the symptoms being one and the same.

There are really great reasons to see a therapist even if you're not inclined to openly discuss substance use, especially at first. For instance, dealing with the issues that often co-occur prior to and alongside substance use disorder. I found that addressing my social phobia in particular, something I struggled with long, long before I ever touched any substances (and what I almost used substances exclusively to deal with) directly, without the equation being weighted or even really influenced by any discussion of substance use disorder, helped me far, far more than an overt focus on substance use disorder.

Ultimately, it doesn't matter which way one goes about addressing one's mental health and behavioral issues. But IME I tend to find far more success in putting the emphasis in how I devote my resources, time and energy mostly on the mental (and physical) health side of things as opposed to substance use disorder treatment side. Of course I've found it most effective to take a multi pronged approach and works on each aspect at the same time, but even then I still find an emphasis on the mental health side of things instead of the behavioral side of things to be more effective.