Monday, January 17, 2011

Is my friend addicted to her medication?

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Question:  For years a friend of mine had anxiety issues.  It gradually got worse and worse to the point where she had a hard time driving (ex. she couldn't make left turns and would start to freak out if she had to go to a stop light).  Recently she started taking anti-anxiety medication and she is doing great, better than she's been in years, but is she stuck taking them forever?  Will she ever be able to be independent of the medication or is she now addicted to it?  

Answer:  There is a difference between reliance and addiction.  My wife relies heavily on her glasses, without them she could not see well enough to drive or distinguish faces across a room.  My wife is not addicted to her glasses.  

Many people who are reliant on any external source of aide or support can become psychologically dependent on it.  They may feel that without Mom to pack their lunch for them, or the walker they use to get to the car, they will simply not be able to function.  In some cases this is detrimental to a person's development and independence, we often speak of learned helplessness when a person simply gives up without the external support they are used to.  In most cases, however, as long as a person remembers that even without support they can function, it might be really uncomfortable or inconvenient but they will get by, then it is not a problem.

Something becomes an addiction when the relationship with a substance, behavior, person, becomes a priority out of balance with all other priorities.  If a friend would risk your relationship by lying to you to protect their relationship with drugs, gambling, sex, etc.. then they may have an addiction or a Dependence Problem.

Often I deal with parents who are afraid to allow their children to use medication for ADHD, Depression, Anxiety, etc... They worry that the child will use this as a crutch and will not push themselves through tough times instead relying on the medication.  The fear is legitimate if the medication is presented as an answer instead of as part of a process of healing and coping.  

When a person has anxiety their brain has stopped perceiving the world as it actually is and chemical signals are being sent around the brain telling it that there is grave danger when really there is little or none.  The brain can be re-calibrated without medication using a number of different therapies, from relaxation techniques to exposure therapy which helps to react appropriately to stimuli.  This can be a long and really uncomfortable process particularly without medication.

There are two ways medications are used to treat anxiety.  The more healthy way is using medications like SSRI's which build up slowly in the system and help the brain to see the world as it is.  The more immediate way is to use medications when an anxiety or panic attack flares up.   These PRN (as needed) medications hold a high risk of addiction and doctor's like to avoid them if possible because they reinforce a negative notion that when I have a problem I pop a pill and I feel better.  These are medications that tend to get abused and are very dangerous when combined with alcohol or other drugs.

If your friend is working with a doctor and a therapist there is a very good chance she will be able to go off the medication some day.  If she is not doing any therapy she may always be dependent on medication but again that will not be an addiction unless she begins to put her reliance on the medication ahead of other things.  For example if she risks driving under the influence because she cannot bare the idea of driving without a prn anxiety medication even though she has been drinking.

Ultimately medications are a tool to help us live as if we did not have the impairment which triggered their use.   So long as the medication is being used as prescribed by a doctor and is leading to more healthy and typical functioning than life without it then support your friend and worry instead about whose turn it is to drive.

Saturday, January 1, 2011

My friend is a horrible, awful, wonderful LIAR, I think.

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Question: My friend is really smart and funny and I love hanging out with her but lately I don't feel like I can trust her.  She always has these really dramatic things happening to her that she won't allow us to talk to anyone about to verify, like she said she has cancer but we are not allowed to mention it around her parents.  Things have gotten worse in this area since we started high school and me and most of our friends went to public school and she went to a small private school in our community.  I think she tells lies so that we will stay with her and keep caring about her, but I don't like being manipulated.  On the other hand I think what if she is telling the truth and I am just the worlds worst friend for questioning her when she really needs my understanding.  How do I confront her without offending her?  

Answer: Liars lie because they do not have the confidence that if they tell the truth they will not be rejected.  You need to confront your friend with all the good things you think about her, how much she matters to you and why.  Then you can express your confusion about how all the bad things keep happening to one person and why it stretches your belief. 

Imagine she is telling the truth and you don't confront her.  Eventually you will grow more and more distant from her as your discomfort with her incredible life situation and the way she tries to compartmentalize it.  Regardless something needs to change or else this you will lose this friendship.  

So often people try to avoid conflict to save a friendship, most often we see this when romantic feelings are held by one member of a friendship and they do not express them to avoid conflict and tension.  Well guess what?  A real friendship can survive some tension, and if it can't then how strong can it really be?  

In my experience every time I have avoided conflict in a relationship that relationship has withered on the vine and other relationships began to demand more of my time and attention.  In cases where I avoided expressing romantic feelings for a female friend eventually one of us started dating somebody else and the friendship was difficult to make time for.  What really got saved? 

So write your friend a note or speak to her one on one in a venue where she will not be embarrassed.  Start by bringing up an image of a time you felt really close to her so that you both have a good vibe going into a more difficult concept.  Tell her this is how you want to feel again but right now you don't.

Then you use the Ask Maigler patented 4 point method for discussing difficult subjects.  1.) How I'm feeling 2.) What I think the problem is 3.)  What I'm afraid of (both by bringing this issue up and if I didn't bring this issue up) 4.) What I hope will happen next.

There is a 99% chance your friend has been lying and this is one of the most difficult habits to change.  So part 4 is the most crucial.  DO NOT ask your friend to confess she is a liar.  Instead tell her that when she tells some of these stories that stretch credulity you have a hard time relating to her.  Ask her permission for you to say that when you are feeling uncomfortable. 

When she tells a lie what is she really asking for?  She really wants to know that she is cared for.  Well ask her to simply cut to the chase and rather than telling you the details express that you just want to know how she is feeling and what she needs from you.  By doing this you are less likely to get caught up in the BS and you will give her what she really needs.  If this is successful in time she will be able to break her habit of lying because she will realize she doesn't need it anymore, at least not with you.

Be aware however, for this to work, if she does call you and tells you she is sad and she doesn't know why, you cannot just blow her off and tell her that you really have to study right now.  If you do she will be reinforced in her belief that she needs to create a fantastic circumstance to get anyone to listen to her.

Good luck, it sounds like this friend has some really good qualities, hopefully her bad habit doesn't end up driving all her friends away.