How would you feel if someone took this away from you....

[Peanut]

I have a question. My seperated husband has a psychiatrist (who oddly enough has a sort of homeopathic approach). I urged him to tell the psychiatrist about the fact that he smokes lots of pot. My motivation was kind of selfish because I am in the same boat and wanted to know if it was problematic in the doctor's opinion. Based on information I've read and heard, from this website, school, and other places I expected the psychiatrist to at least consider this to be somewhat problematic. I guess all he did was asked how much was smoked at one time and if it caused problems in our relationship. Since it hadn't (in fact, sometimes I think it was the only thing that kept us together). Then all he asked was "How would you feel if someone took that away from you?"....now here's my question. I have heard variations on that statement from professionals, like "I won't take that away from you" and so forth. So I want to know, do you think that this doctor really does think this is an issue and perhaps will address it later again, or does he think there really is no problem since it's not interfering with anything? I was a bit suprised that the issue was glazed over given that I thought psychiatrists specialize in the brain and how chemicals can manipulate its function. What does this phrase mean? When do therapists use "How would you feel if someone took that away from you?" and does it likely mean that he will try to take it away later on? After looking at all the psych information on drug use maybe I was beginning to think it was more harmful that it is?? The other thing I was thinking was that maybe the psychiatrist didn't want to overreact and scare him after he told him that or are some therapists fine with certain types of drug use as long as it is not interfering with occupation and relationships?

I was really taken aback by this whole thing...and kept thinking that I've heard that phrase before

 

[David Baxter PhD]

A lot of times it's a matter of timing and readiness on the part if the client to hear what the therapist might want to say.

I may think something is problematical in the long run but if it isn't immediately dangerous or destructive (in the shrot run) and I think there are issues of higher priority I'll intentionally leave it for another time. There is no point in trying to pressure a client to go where s/he is not ready to go... all in good time.

 

[Peanut]

Thank you so much for clarifying that. That's what I thought it probably was, but I wasn't sure because it seemed (to my husband) like he was giving approval or at least indifference from what I was told. I guess he also asked what he smoked it out of, and then listed off several methods and my spouse said he used all of them. I couldn't figure out what in the world that would tell him. I mean, what difference would that make from a psychological standpoint anyway? Then I thought maybe the psychiatrist was fine with it because, of course, my spouse unreported how much he smoked (as he did with drinking at his first session, which the doc did not seem to think was a problem either). Now my husband has taken all this as reassurance that the whole thing is nothing to worry about. If you have a chance to answer, how can you tell if someone is ready to work on that and what treatment is used? 12 step programs seem like overkill for pot in my opinion...is regular psychotherapy used? Is it possible that some therapists are alright with these types of behaviors or is it unethical to condone drugs just because they are illegal?

Anyway, sorry about the rambling and thanks for answering my question...I was dying to know what was really going on (because I'm still too chicken to go see someone myself!). Thanks again and I'm still loving the website...I think it's the best one on the entire internet!

 

[David Baxter PhD]

First, I think most therapists who work with substance abuse issues assume that most clients will underreport actual use.

Second, there is a balance between client confidentiality and legality which is sometimes hard to navigate. I tell clients that there are three conditions under which I cannot guarantee confidentiality (Ontario, Canada laws... they may differ in other locations):

1. if I receive any information indicating a significant risk of imminent harm to self or others, I must act to try to prevent that

2. if I receive evidence of recent or ongoing child abuse or risk of child abuse, I must by law report that to child protection authorities

3. if I receive a subpoena from a court of law for clinical records, I have no legal right to refuse that court order

Beyond that, my role is to help the client make informed choices and to try to help him/her increase awareness of self-destructive or risky or maladaptive behavior. But I am not a policeman. Nor am I an officer of the court. I can tell someone I think it's a bad idea to drive over the speed limit or to write cheques when they don't have money in the account to cover it but if they choose to do that anyway they can do it and simply not tell me they're doing it. On the other hand, if I see a client leaving my office seriously intoxicated and getting into his vehicle to drive, I would do what I could to prevent that,

 

[madinstinct]

David, I just don't think that generalizing a profession is very productive. Saying MOST addiction professionals assume people under-report their use without explaining that nearly everyone entering treatment for the first time DOES under-report their use, is ignorant. True, it takes a certain readiness for treatment for the a person to come clean with their usage patterns. But most interpersonal problems are extremely difficult to address when a person's relationship with themself is messed-up and their not being honest about the effect chemicals are having in their life. Addiction tends to prevent genuine, unclouded emotion and thought. How can anyone be clear-headeed enough to go where they need to go in treatment/psychotherapy if they are engaging in addictive behavior of any kind... I don't care what drug/substance it is a person abuses, any drug can become a person's compulsive defense and comfort zone, where often in treatment a person's defenses MUST be broken down/removed, or no progress can be made. It is only in rare instances that people can make long-lasting progress in treatment while continuing to avoid their emotions and don't touch base with the natural ebb and flow of real-life.

Now, toeless, it may be that the professional doesn't feel competant to address addiction or realizes it is extremely difficult to work with addiction. And will accept the fee for your husbands sessions anyhow. In repeating what has already been said in an above post, if the patient/client is not there under any force (court/probation, etc.) or isn't "ready" to address their chemical use then the psychotherapist really isn't supposed to address anything the client doesn't want. Your husband is avoidant and you and he appear to be denying the fact that without the pot, you wouldn't be together. If you want to get rid of that third leg, you both need to learn to live with eachother without it. Some find that without the drug, there was no relationship to begin with. I hope you find otherwise, good luck.

 

[David Baxter PhD]

David, I just don't think that generalizing a profession is very productive. Saying MOST addiction professionals assume people under-report their use without explaining that nearly everyone entering treatment for the first time DOES under-report their use, is ignorant.

I think "ignorant" is rather a strong word here, don't you think? As for "generalizing a profession", I would agree that there are exceptions to almost any generalization but I have been in this profession for almost 30 years so I think my comment is pretty accurate.

 

[Peanut]

Actually I think I was looking for generalizations because obviously nobody knows exactly what the situation is in my specific situation. I agree that most people underreport their use and I was thinking that would be taken under consideration but then with the lack of the doctor pursuing the topic made me unsure. I'm actually really glad that you generalized Dr. Baxter, because I think when people get overly afraid of generalizations, the only answer that you could ever give someone would be to go get therapy. That would be pretty dull if that's all the advice that was ever given on every thread=) I'm also really interested in not only my specific situation but how the issue is handled in general.

madinstinct, thank you for your input. I don't really think that it is a competency or money taking issue though (with the therapist). This doctor seems very competent and experienced and really pretty keen on several fronts and he's a psychiatrist. I think if he didn't think it was a problem I would tend to believe him actually. Which is the reason that I asked my original question about trying to figure out what he really thought about it. So far the only problem it's really seemed to cause is a sore throat. No other symptoms.

Anyway, i wish I could have figured out how to quote other people's posts in the white box but maybe I don't have that capability as a member. I also wanted to say that I don't think that Dr. Baxter is ignorant at all, I think he's very intelligent and generous for donating so much time to this website.

Thanks to both for responding.

 

[David Baxter PhD]

Anyway, i wish I could have figured out how to quote other people's posts in the white box but maybe I don't have that capability as a member.

All members can do that.

You can either copy and paste (Ctrl-C and Ctrl-V in Windows) into the Quick Reply box and then put [ quote ] before and [ /quote ] after the part you want to quote (without the spaces before and after the square brackets), OR if you click on the "Quote" button above each post it will do that automatically for you on the regular reply page.

 

[Peanut]

if you click on the "Quote" button above each post it will do that automatically for you on the regular reply page.

Do you have to quote the entire post if you use the quote button? That's what keeps happening.

 

[Peanut]

I also just wanted to clarify that statement I made about having no psychological symptoms (only sore throat) is that one major concern is that lately I keep hearing that smoking predisposes people to schizophrenia and sometimes after stopping people come down with these things. My dad (who I barely know or see) has major psychotic symptoms like delusions (he says that when white cars pass that means he's doing well, black cars mean he's doing bad and red cars mean stop smoking cigarettes, also thinks he's being taped by FBI, he told me all of this in one of our extremely rare phone conversations). I think his symptoms are drug induced (by much more seriuos drugs). Anyway, if my options are keep smoking or become psychotic I think I would choose the former. Of course I didn't find all this out until after I'd beens smoking for like five years so it was too late to do anything about it. I thought it was an improvement on alcohol because of the lack of hang overs. Sorry I just felt the need to clarify why I thought there may be an issue when there are no psychological symptoms. Also the fact that there have been numerous failed resolutions when we tried to stop (for various reasons). Since a psychiatrist is supposed to be an expert in brain chemistry I thought that if he wasn't concerned maybe some of the mental health warnings could be exaggerated. Plus the anti anxiety and stomach settling benefits make it a complicated choice with pros and cons. OK-thanks for letting me get that out...it helps me to organize my feelings better.

 

[Peanut]

But I am not a policeman.

Furthermore, after mulling your comments over, I just wanted to add one more thing (sorry if this is getting annoying everyone!). A couple of months back I called a psychologist to make an appointment and did actually make one, but after making it, I looked on the website and found out that the psychologist was a former police officer and former youth pastor. That prospect frightened me quite a bit, because who knows where the loyalty is, and I called and cancelled the appointment. The downside was that the guy sounded really nice. But there is no way to trust someone when they have an affiliation with law enforcement. I thought this was unusual but then I also just read this book written by a psychiatrist in Portland who is also a member of law enforcement. It seems like it is sort of common. Not to mention that my husband's psychiatrist is also a obgyn. It seems like the line of authority is pretty blurry sometimes and that is why I'm nervous to choose someone....what if I hadn't looked at the website and chose the police officer? Then what. That is why I only trust the anonyminity of the internet.

 

[madinstinct]

Something to remember is that there is a strong emphasis on ethical behavior in the psychology profession. This includes the separation of entities and confidentiality of information shared in sessions. If you have concerns that your information will be shared with authorities, they are unfounded and should not prevent you from getting the help you need.
One thing to remember is that help is help. Bottom line. Your reservations and fears tell me that you're venturing into scary territory, having to share your life secrets with an outside person. Next time you make an appointment with a professional for any kind of treatment, ask them to review with you their confidentiality policy, and if it doesn't satisfy you, don't pursue. In my experience, patients are ALWAYS given the option to prevent ANY AND ALL information from leaving the therapeutic relationship. You can sign or not release forms that would serve as the only way a therapist could legally discuss your case with anyone else.

Please, don't allow your fear that the "authorities" will find out, stop you from reaching out. Just make sure you ask all of your questions about confidentiality before sharing anything.

 

[madinstinct]

oh, and make sure you're not justifying your continued marijuana use by thinking that it is your best treatment for settling your stomach as well as preventing psychotic symptoms. Think about all that cash you spend on the pot compared to how much you will save by using peppermint as a stomach settling tool and let health insurance pay for the appropriate antipsychotics. But you are right, keep off the booze, it is much more physically damaging to your body and the state of your brain chemicals.

 

[Peanut]

let health insurance pay for the appropriate antipsychotics

Do you really think that antipsychotics are better? Personally I don't. I have extremely bad reactions to most medications (including antipsychotics, SSRIs, buspar). In fact, once I was put on an anti psychotic for anxiety when I was 16 and I got what I think were symptoms of TD....my jaw started spasming really bad, going off to the side uncontrollably. I also stared drooling which I have never done before. I had to take benadryl to relieve the spasms and never took the medication again. With SSRIs I get total sexual dysfunction (I've tried about six different ones), not to mention a host of other affects as you try each one. The psychiatrist told me that all the medications would have the same effect and there were no other options. The only thing that works for me in terms of anti anxiety prescription meds are benzos and apparenty everyone thinks that those are the devil. That is why I need something that I can regulate my own dose of. Of course today I woke up with a horrible sore throat and so that is a problem with the smoking. The peppermint suggestion just doesn't sound very fun though!

Also I wanted to ask you, although I do understand that, say a therapist/police officer would have to abide by confidentiality laws, don't you think that the dual roles may complicate the issue and/or taint the therapist's views and treatment? Or, do you think that they can effectively split the two professions? It seems to me it would lend itself to at least a personal bias or something like that. Honestly, I don't know what I'm going to do...I alternate between thinking I have no problems and everything is fabulous and lately I think I have all kinds of problems (me thinking that is probably part of my problem since I am kind of a hypochondriac). I'm so confused I just can't wait for the next chunk of time where I am on top of the world and have no problems. About two months ago I thought everything was perfect (even despite the marital seperation). And since I think I have all these problems I find myself intentionally contimplating self destructive behavior, which I have done and carried out before, and I really don't want to lose everything again. I just wish I could stop thinking about this stuff and start being more productive (although so far I am still productive, like i don't think that anyone knows that I'm thinking about this stuff). It's not like I'm depressed, just really, really anxious.

madinstinct, are you a chemical/substance abuse therapist? I was just wondering because after reading your posts it kind of sounded like it. Thanks for your advice. I actually just really appreciate getting the opportunity to talk about some of the story openly and anonymously. I'm also glad to hear that I was right about smoking being better than drinking...it definitely feels that way to the body. The drinking is partly what I needed the anti nausea for. I had pretty much cut out the drinking for a couple of years but now I'm dabbling in it again since I can hardly feel the affects of the other anymore and I've been such an internal wreck lately. Drinking is also so much more socially acceptable. Hard choices. Oh well, I'm sure I'll snap out of this. I always do and then it will be back to good times again=) Thanks for letting me vent about this. So far I have not done anything today so that's a step in the right direction I think. After all, don't they always say to take it one step at a time=)

Oh and one more thing, I think that all of this may sound worse than it is just because I'm telling the truth. I think that probably a lot of people, like mentioned earlier, downplay things, so when someone says the truth it sounds more unusual than it is (I'm hoping anyway).

 

[David Baxter PhD]

With SSRIs I get total sexual dysfunction (I've tried about six different ones), not to mention a host of other affects as you try each one. The psychiatrist told me that all the medications would have the same effect

That's incorrect.

and there were no other options.

That's also incorrect.

The only thing that works for me in terms of anti anxiety prescription meds are benzos and apparenty everyone thinks that those are the devil.

That's also incorrect.

There are always options. Not all doctors know about all of them, though, and some don't take patient complaints about side-effects seriously enough.

 

[David Baxter PhD]

if you click on the "Quote" button above each post it will do that automatically for you on the regular reply page.

Do you have to quote the entire post if you use the quote button? That's what keeps happening.

It will give you the entire post by default. Just delete the parts you don't want to keep in your reply.

If you use the "quote" function in Quick Reply, the only option is the whole post...

 

[Peanut]

Would you care to venture as to what is correct then? ?I mean, I have extreme dislike for this doctor, but, time and time again, as she said, I had the same side effect, not to mention many, many, many others. ?I tried Zoloft (I was awake and paranoid all night), Effexor, Luvox, buspar, Risperdyl and a couple others I can't think of their name. ?I was given Paxil but didn't take it because of the potential weight gain (the last thing I need is to be stressed out and out of shape). I tried so many my mom used to keep the sample boxes to keep track. ?The kicker to all of these is that not a single one of them helped treat my anxiety or OCD...in fact I think it made it worse. ?Nothing helped the anxiety until I finally got some Valium and then Ativan (which I finally got because I had a sore throat and went to the doctor and just happened to be in the throws somewhat of a panic attack type of thing) so the doctor could see that I needed relief. ?In fact, she thought I made up the sore throat to get in for the anxiety until she looked at my throat and saw how red it was (from smoking but I didn't tell her that). ?My regular doctor does not like meds so she gave me a script for Ativan but told me no more and that I should be able to be completely pill free since I had been for about three years and a home remedy to rinse my throat with salt water. ?I guess I'm just freaking out because I'm almost out of Ativan, I don't really want to go down this 'I've got a mental problem' route again, and now my throat is chronically sore, and especially bad today, so my 'home remedy' is perhaps wearing out it's effectiveness. ?I'm scared to go see someone because of how bad that's been in the past...my mom used to force me to go to therapy until the therapist eventually refused to see me (and would just tell me, "this is your last session" and not say anything to my mom, at which point my mom would get extremely pissed at the therapist. ?Nothing good has ever, ever come of this. ?I have learned that I can do a better job of controlling my symptoms on my own through unconventional methods. ?I feel like I'm slipping and I thought that maybe it was because I had a break from school and wasn't as busy but now school started and I'm still in the same position and getting really agitated about my homework (like doing all the assignments twice to make sure they are perfect). ?Thank goodness at least work is going well. ?I think this forum is helping though because since writing all this stuff I haven't smoked at all or drank today which is extremely unusual for me. ?

So...what are the options? ?Do you think that I could get an ongoing perscription for Ativan from a psychiatrist? ? ?To me it seems like SSRIs are the 'new thing' and all the mental health professionals are all about them, meanwhile they don't work and have awful effects, but nobody even acknowledges that! ? I just don't think there is anything that can help me, and while you disagree, you're not naming anything specific so there's nothing I can do but chase after these allusive options. ?

I can't just pick a therapist out without talking to them first. ?How am I supposed to know who to choose? ?I'm totally stuck.

I mean, Dr. Baxter, your obviously very dedicated to psychology, to therapy, and educating yourself on the entire field of mental health, but unfortunately I don't think that is the norm. ?You are the only doctor that answers questions for free for anyone. ?I just don't think I'm going to find someone like you that could help me here in my area. ?It's just not that easy.

 

[Peanut]

It will give you the entire post by default. Just delete the parts you don't want to keep in your reply.

Thank you for the lessons! I like using the quoting function-it makes for very concise replies=)

 

[David Baxter PhD]

So...what are the options? Do you think that I could get an ongoing perscription for Ativan from a psychiatrist? It seems like benzos are taboo or something...I mean on another thread I mentioned I took them and someone accused me of abusing them while I was only taking them for anxiety as perscribed (which still irks me). To me it seems like SSRIs are the 'new thing' and all the mental health professionals are all about them, meanwhile they don't work and have awful effects, but nobody even acknowledges that! I just don't think there is anything that can help me, and while you disagree, you're not naming anything specific so there's nothing I can do but chase after these allusive options.

The SSRIs are wonderful medications for many people - even people who experience side effects can alleviate those either by switching to another one of the SSRIs or by reducing the dose and adding a small dose of Wellbutrin (or in some cases a small dose of the so-called "atypical antipsychotics") to counter the side effects. Sometimes, it does take a bit of trial and error and I know that can be frustrating.

But there are also a small number of people who simply cannot tolerate or do not react well to the SSRIs. For those, one of the older antidepressants can often do the trick. A competent psychiatrist should know this but I wouldn't be surprised if many family physicians do not.

I also acknowledge that the benzodiazepines are scary drugs to many physicians because of the addictive potential. Valium isn't one that most doctors would even consider, for that reason. But lorazepam (Ativan) and clonazepam (which has the lowest addictive potential) are safe drugs to take at commonly prescribed doses. If these work for you, the best advice I can give you is to find a doctor who is more knowledgeable about psychopharmacology. I don't know the physicians in Oregon - we are fortunate to have a specialist in psychopharmacology here in Ottawa who is excellent.

I can't just pick a therapist out without talking to them first. How am I supposed to know who to choose? I'm totally stuck. I don't want to be sick or dysfunctional so I'm on my own (except for this forum I guess) as far as psychological assistance.

Some therapists (although admittedly probably not many psychiatrists) are open to talking about their approach prior to making an appointment. You might ask the questions on the phone before making an appointment or ask if you can have a half-hour consult prior to making a commitment - some will do that too.

 

[Peanut]

Thank you very much for answering that. At first I had composed a message full of excuses why things wouldn't work, but I realized that I need to take that info you gave and use it productively. I really appreciate that you acknowledged that Ativan is the only thing that actually helps me. I am also very encouraged that you think there might be a psychopharmacology expert that might be able to work with me. I will try to find one on the internet. It also just occured to me that I could see a psychiatrist for Ativan and a psychologist or counselor for psychotherapy. That way I wouldn't feel so much pressure to get the perfect doctor. And then maybe I can find a psychologist that is approachable and friendly. I really liked the voice of the doctor that I had set up a therapy appointment with once, but it turned out he used to be a police officer. I'm tempted to call him again. When I cancelled he tried to call me twice but I never called back. Hmm...

Thanks again I feel a lot better now=)