How My Drinking Was Used to Deny Me Treatment for Depression

    Five years ago, I called the hotline for adult psychological services at a major university hospital’s psychiatry department. After completing a half-hour intake, during which I had disclosed problematic alcohol consumption, I was informed I could not receive treatment for my crippling depression because I must first “graduate” from addiction treatment. They quickly me routed into group services for alcohol use disorder.

    I received a dual diagnosis, but the solution to both of them was apparently to stop drinking. By the department’s reasoning, I couldn’t worry about being depressed if I was dead from alcohol use. This was a strange logic; I had been suicidally depressed since I was 11, and at times alcohol was the only tether tying me to this Earth—a force of vitality, joy and desire amidst my anhedonia.

    The treatment plan, the development of which I was not involved in, had a secondary focus on SSRIs and cognitive behavioral therapy. The priority was getting me sober. Still, I attended the recommended groups and classes. Over the course of the next few months, I reduced my alcohol consumption as well as improving my mental health.

    But while I felt I was making progress, the treatment providers disagreed. They became increasingly frustrated that my goal was to manage my alcohol use rather than abstaining; that I continued to use marijuana with no goal of modifying that behavior at all; and that I had additionally begun to pursue self-healing with psychedelics.

    Marijuana had never caused me harm or brought any consequences to my health. No one in my life was concerned about it. Why would I stop? Conventional medications hadn’t brought me relief from my depression or alcohol cravings, and psychedelics seemed to promise that. Why wouldn’t I try something new?

    Ultimately, I was discharged for non-compliance with the treatment plan.

    The clinician I was working with suggested I enroll in a psychedelics research study, but everything I could find excluded participants with “comorbidities” like depression or substance use. It was the same reasoning the department itself gave me when I first accessed services: that a condition can only be evaluated and treated when it’s isolated as a single variable.

    Since I couldn’t access psychedelics in a therapeutic setting, I pursued them on my own. Ultimately, I was discharged for non-compliance with the treatment plan.

    In what other area of medicine would a patient be denied all medical services due to their partial non-compliance with a prescribed treatment, or use of an alternative treatment? Diabetes care isn’t withheld because a patient ate dessert. Antibiotics wouldn’t be denied to someone who’s also trying homeopathics or a salt lamp at home. And yet substance use is considered a valid reason to deny medical treatment, including treatment for substance use disorders.

    Disclosing substance use instead of lying about it disqualified me from treatment of what was, in my case, the root cause. The stereotype is that people who use drugs are manipulative liars, but frequently the health care system leaves us no other choice.

    Once alcohol use disorder was stamped onto my medical records, along with non-problematic consumption of two of the least-stigmatized controlled substances, medical appointments rarely focused on anything else. It didn’t matter if the visit was for an ear infection. I’d greet the provider as a person, and then my medical record would transform me into an “addict.”

    I remember the look in one psychiatrist’s eye when I told him I’d relapsed. I’ve never seen more glee.

    I’ve worked with wonderful providers, but they have not been my predominant experience. Most required a confessional, unwilling to move on from the alcohol use disorder part of my medical history until I’d satisfied them with a salacious story.

    I came to learn which anecdotes and word choices got the biggest reactions for the least emotional labor. Over the years I developed a tight routine, as though I was a traveling road comic who tells dark jokes at which no one laughs. It feels fair to say that the persistence with which clinicians pursued and felt entitled to these preconceived narratives kept me mired in my addiction.

    Patients should not be forced to relive (or invent) addiction-related traumas during every clinical encounter before they can be offered care. I remember the look in one particular addiction psychiatrist’s eye when I told him I’d relapsed over the weekend. I’ve never seen more glee. He furiously scribbled a script for Antabuse. “This’ll teach ya! I’m gonna make you so sick from alcohol, you’ll never want it again!”

    Another spent the majority of our interactions asking about every conceivable instance in which cannabis might have caused me harm, searching for symptoms to justify a diagnosis that didn’t exist. Eventually, he gave up and declared that I was lying or in denial.

    Mandatory treatment is known to be harmful, not helpful. It demands adherence to a prohibitionist code under which drugs are associated with pleasure, making all abstinence virtuous and all use harmful without allowing for nuance or individual experience.

    The treatment plan that would later work for me ended up being psychedelic use, and therapy from a queer-focused practice. Which makes sense, because these were the things that I had chosen and pursued according to my needs.



    Photograph by jarmoluk via Pixabay

    • Derek is a Ph.D. candidate in English Language and Literature at the University of Michigan, Ann Arbor, where he’s also policy director for Students for Sensible Drug Policy. He’s a regional research consultant and author of the North America chapter of Harm Reduction International’s 2022 Global State of Harm Reduction report.

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