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2nd step

16
May

A Fallen Pastor’s Story, Part 15: Do meds play a role in recovery?

I finished my 2nd step about the same time that my psychologist referred me to a psychiatrist to do a medication check. After the separation and divorce, Doctors prescribed Wellbutrin for me which changes patient’s moods by affecting our dopamine and norepinephrine. Wellbutrin is a unique medication as it does not fit nicely into other anti-depressant categories. While it is a second generation antidepressant, it does not address serotonin levels and so is unique in its field. There were several good reasons my psychiatric nurse practitioner prescribed it. I was obviously overweight, and Wellbutrin is an appetite suppressant as well as an anti-depressant, and it would help alleviate some of my ADHD symptoms as well.

The issue for me, however, was Wellbutrin is a sexual stimulant. As a sex addict trying to get clean, taking a sexual stimulant is probably not a good idea. It certainly wasn’t for me. When my counselor did extra reading on my case and discovered that Wellbutrin was a sexual stimulant, he was astounded that my nurse practitioner prescribed it for me and wanted to see if a psychiatrist would approach my case differently. As a lay person in the field of medications, he thought that eliminating the extra sexual stimulation, and perhaps even adding a sexual depressant could help me.

Though it is hard to find a psychiatrist who could fit me into their schedule; once I did, he agreed with my therapist and began to search for the right medication for me. It was a long process. As nearly all psychiatric providers explain. Prescribing psychiatric meds is as much art, as it is science.

My psychiatrist wanted to find a drug in the SSRI anti-depressant category. SSRi stands for “Selective serotonin reuptake inhibitors. SSRi’s are “Second wave” antidepressants and are generally more effective with fewer side effects than first wave anti-depressants. They work by inhibiting serotonin levels in the brain. There is an extensive list of SSRI’s to try. They all work slightly differently to achieve the same ends, and effect different people in different ways.

First, we tried Prozac. I do not remember if it didn’t work, why I didn’t like it, or why we decided to try something else, but we did. We tried Paxil which I took for nearly 2 years. it had the desired effect of creating space and slowing my mind but slowly, its effects waned. So we pivoted to Zoloft. I hated Zoloft. It made everything fuzzy. It was as if my mind was running through knee-deep, wet cement. This surprised me because most of my recovery friends were on Zoloft. Indeed, it could have been that fact that led me to urge my psychiatrist to take me off Paxil to try it. My friends referred to Zoloft as “Vitamin Z;” and it worked for them. So, I wanted to try it too. It didn’t work for me like it did for them, though.

Celexa ended up being my long-term solution. I stayed on it for over eight years. It took a few weeks to find the right dosage, but once we found it, I noticed, just like with the Paxil before it, that I had immediate freedom from compulsions of any kind.

My shrink told me that his goal was to give me a split-second gap between my thoughts and my actions. The speed on which I moved was one of my biggest strengths. It helped me get ahead. I was afraid to lose it and gave voice to those fears to both my Psychiatrist and therapist. But they convinced me that what I relied upon on as a strength and viewed as integral to my being was also killing me. My ADHD mind didn’t provide me the psychic space I needed to overcome my compulsivity. That needed to change and I needed to surrender my quick thinking if I was going to survive.

If my wife reads this, she will be surprised because she still sees me as an extremely quick thinker. Indeed, what I feared I was going to lose wasn’t lost at all. I merely gained a measure of sanity.

Looking back, I understand now that my early traumas led to some neural disruption and/or disconnections in my prefrontal cortex where my behavioural inhibitors and filters reside. In prescribing the SSRi’s my psychiatrist attempted to help stimulate those neural connections enabling them to give me clarity about my actions and their consequences. And while medications were not the whole answer for me, they were a major piece of my sobriety pie.

My parents and church raised me to be suspicious of medications being a reasonable response to mental and emotional issues. In their world view, the need for medication somehow diminished humanity’s moral responsibility. We blamed original sin for peoples’ poor choices and felt that people needed to take full responsibility for their actions. While we were not completely anti-psychiatry; seeing the need for people struggling with psychosis, schizophrenic disorders and the like; we frowned upon antidepressants as medications that displaced the Holy Spirit’s role in discipleship, etc…

I needed to repent of that belief. And I hope that cultural reality is shifting given all that we know about the mind/ body connection. It is surprising to me how much the suspicion of psychiatry exists in AA & NA 12-step recovery rooms. Anyone that was addicted to a mood altering substance has every right to be suspicious, and yet they also need to heed what research is revealing. While neurobiology is still in its infancy; I, for one, can hardly wait to see what advances we make as we unlock more of our mind’s secrets.

Please note that I do not want to suggest in any of this that I was not and am not entirely responsible for the choices I made before seeking medical intervention. And without medical intervention, I would not have been able to enjoy long-lasting sobriety.


Previous Posts (linked)

3
May

A Fallen Pastor’s Story, Part 14: Who Do You Think God Is?

I couldn’t get sober and I couldn’t take the third step.They say, if you are having a rough time working a step, it means you didn’t take the previous one. I discovered at the International Convention for my fellowship that I was primarily struggling because though I thought I had taken the second step, I’d missed it entirely. The second step simply states,

“We came to believe that a power greater than ourselves could restore us to sanity.”

Sitting in meetings, you’d hear an old timer explain the second step like this: The first step states, “We admitted we were powerless, and that our lives had become unmanageable.”  ”

“The first step states, ‘We admitted we were powerless, and that our lives had become unmanageable.’  So, first, we came. Then, we came to. Then we came to believe.”

For many addicts, God (or a higher power) is a brand new concept and so the old timers cliche says it all: We started coming to meetings, woke up, and realized that we couldn’t recover by ourselves. When an addict gets to this point, they are ready for the second step. “If I can’t fix myself, I choose to believe that something more powerful than me can fix me.” However, for many of us religious types — especially those of us in sexual recovery — there is necessary deconstruction that needs to occur.

At my fellowship’s International Conference, as I sat in the conference room at the PDX Sheraton, the 12 step seminar leader asked us to open our spiral notebooks (that we’d all been invited to bring) so that there were two blank pages open. He asked us to reinforce the pink line that ran down the left page to create two columns on the left page. At the top of the narrow one on the left he said, “In this column, I want you to create a list of all the people that were higher powers in your life as you grew up. It will probably include your parents. It might include a brother, sister, aunt or uncle. There might be coaches, pastors, babysitters or teachers on the list. Think about all the people that had power over you and impacted you growing up. They are the higher powers in your life. Don’t be afraid to add to the list as others come to mind as you write. ” My list wasn’t very long: Mom, Dad, some pastors, some coaches, and a couple of teachers.

“The second column is harder,” he said. “At this point, you may find it easier to work across the page. For each higher power, write about times that events occurred that taught you something about what your higher power was like. Were there specific things that come to mind that they did? List both what they did and what that action taught you about what a higher power must be like.”

This column was harder for me. As you’ve already read, my Mom was an angry depressive who directed her anger at my brother and me. Meanwhile, my Dad was on the road more than he was home when I was little. I knew that there were things much more important than me to him. And so my list went on and on. The more I wrote, the more I realized how much God often resembled the people who had been my higher powers growing up.

The third column lined up with the second. Where my God always abandoned me to rescue someone else who needed saving more than me, I chose to believe something different, and I wrote it down. Where I thought God was moody, angry, and disappointed with me, I opted to believe something else, and I wrote it in the third column opposite the corresponding action from the higher powers from my youth.

In the final column, our “old timer” directed us to create either a pithy phrase (affirmation) or prayer that we could look at every day to remember who our God was. I taped one copy of my right column list to my bathroom mirror and carried the other with me in my wallet. Throughout the day, I began catching myself believing in the God of my childhood. Looking back with twenty/twenty vision, He resembled an alcoholic.

A template for working the 2nd step

A template for working the 2nd step

Without working this step, I’d never have come to understand how wonky my view of God was. If someone argued that I thought my God was an alcoholic, I’d have laughed in their face. Nothing was further from the truth. Or was it? Working the second step is the first example I cite where it’s obvious I needed to work the steps to find faith, Jesus, and life.  Following the steps led me to Him. It was after working this step that God granted me sobriety.

There is still more to come.

For more of the story try these previous posts:

Part 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 /12 /13