I sat in my office in the middle of Provo, Utah (home of BYU) on a scorching hot Wasatch mountain day. I was taking a brief professional hiatus there from life in the Pacific Northwest beginning in 2008.
Hiring for a Utah company, in walked a young lady looking for work in her related field of psychology. It was summer 2009 and I have been a psychotherapist myself for many decades. I have seen my share of cases related to substance abuse over the years but would hardly describe myself as a specialist in that area. Although, as a matter of course, I have helped numerous clients on and off of psychiatric prescriptions.
The young lady I was interviewing launched into a description of her current internship at a local inpatient rehab center for addicted mothers and their children. They all live together in recovery. Not a stranger to recovery issues, I listened closely with great interest even though it was my company she was interviewing for. I was aware that prescription drug abuse was the number one health problem in Utah, due in large part to the fact that the Mormon culture disallows the consumption of alcohol. As the intern described her work at the rehab facility it became clear ‘doctor shopping’ and prescription drug addiction were front and center there. Going from doctor to doctor seeking renewed prescriptions for painkillers and benzodiazepines was something I had heard a good deal about in Utah. I was unaware it was becoming a national pastime.
Quite frankly I loved my life in the Pacific Northwest and had been wondering almost on a daily basis what I was doing in Utah. Surrounded by wondrous beauty everywhere it was easy to settle in. But not unusually for me, I remained unsettled.
As the job interview with the psychology intern was drawing to a close she said something that startled me. “The rehab center has been looking for a Clinical Director for quite some time. You would be perfect for the job and should contact them,” she said. Turn about is fair play. I don’t know about you, but when something like this jumps out—it gets your attention. Or it should. I said, “thank you I will think about it,” and then she left the interview.
The very last thing I ever imagined I would be doing was rehab work. I could not get the interns voice out of my head. And you don’t ever know what life will bring. I had great respect for the 12-Step recovery programs but always identified myself as a systems therapist. I was really more of a marriage and family therapist at the end of the day. Still, the voice would simply not go away.
So, fatefully, I took the job at the rehab center which housed twenty or so addicted mothers and their children. The learning curve was steep and fast. I tried to bring all of my skills to the situation and did a good deal of group therapy, typical of inpatient rehab. Mostly I was an acute observer and a fascinated sponge, soaking up this new and crazy world which centered around addiction and withdrawal from prescription drug misuse.
As the Clinical Director I had never seen or handled more prescription drug bottles. It was dizzying.
I didn’t and don’t consider myself an expert in pharmacology. In my career I mostly steered away from it—having been largely skeptical from the beginning of what appeared to be a grand experiment in treatment. Many clients over the years, though, have told me that prescriptions saved their lives. Personally, I have depression in my family history and have had many opportunities to try antidepressants or anti-anxiety medications. I always took a pass, worried about side effects, adverse events, and the marketing .
On the one hand the rehab center was helping clients recover from prescription drug use but, at the same time, using drugs like Seroquel (the antipsychotic) and Methadone (the synthetic opioid) as a part of treatment. That befuddled me. Of course, I knew of harm reduction. That is not what this was. I noticed quite quickly that underlying causes were mostly avoided. The harm from the drug use was often extensive requiring the relearning of basic life skills. Something did seem missing though. I kept hearing the same refrain from the clients, “you’re the only one who does therapy here.”
The clients were moving and great teachers. Nothing was what it seemed. Of course, it rarely is.
One thing that was certain about my time at the rehab center, the issue of prescription drug recovery was getting under my skin. There was something compelling calling me to the work. But what was it? I couldn’t put my finger on it. I had deep feeling for the quest of the brave clients attempting to return to life unencumbered by the beast they often referred to. They were trying to save their lives in the face of relapse after relapse, having to cope with the stigma and deep shame accompanying the trials of recovery and reentry into the community.
During my two year adventure in Utah I made several car trips between Salt Lake City and Seattle. The landscape in Idaho, Oregon, and Washington is widespread and varied. The amount of open space is striking and holds inside of it a quiet and solitude difficult to find in modern life. I came to realize that I was destined to return to Seattle and my friends, family and practice there. And in 2010 I did just that.
I knew that I was not done with the world of addiction and prescription drugs. But I had no idea what was in store. I sensed whatever it was would turn my professional world on its proverbial head and land me square in the middle of a revolutionary shift.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.