History of Excessive Drinking Blocking Treatment in the Community

Reader’s Question

I have recently had suicidal ideations this college semester, possibly a consequence of using Adderall in conjunction with alcohol. I was prescribed Adderall a year ago by my family physician not because of an ADHD diagnosis but rather my complaint of difficulty with anxiety and stress management. His rationale was that by using Adderall I would accomplish many tasks, thus alleviating anxiety due to procrastination. I am sure anyone reading this sees the flaw in his rationale. However, I was a pre-med and an honors student in a bind and was willing to sacrifice my health for what I thought was a ticket into medical school. I couldn’t have been more wrong — I was suicidal and my grades got much worse.

After excessive drinking and a mental break down, I turned to a therapist for help. Upon consultation, they believed I needed to be evaluated for substance abuse problems in order to better treat me. As such, I went along with the evaluation and was ‘recommended’ to attend a substance abuse program which I refused — I was then turned away from my psychologist. I was also seeking the school psychologist and I signed a release form early on. When they were informed of the recommendation, they too refused to see me. I have been sober for two months, but I desperately need help with my anxiety and depression. I am NOT going to a program and because of this it seems no one will see me unless I agree. What are my rights? What are the code of ethics and can I get around them?

Our Consulting Clinical Psychologist’s Reply

First…it’s not a good idea to ask a psychologist how to get around the code of ethics! Having said that, the issue here is not ethics but probably policy or professional preference. Honestly, when you arrive with a combination of having taken Adderall, had suicidal thoughts, and dragging a history of excessive drinking — you’ll be considered high-risk by most mental health professionals. In these situations, a requirement for drug/alcohol assessment and treatment is often an agency or personal requirement as continued drinking significantly increases the risk for suicide and decreases chances for a good response in treatment.

In your community, you will have mental health professionals in various locations. Those in agencies are bound by the policies of that agency (mental health centers, college counseling centers, etc.). The requirement for a substance abuse program is stronger in agencies. You’ll also find MH professionals in group practices where some of them may have a standing formal or informal policy about treating folks with accompanying substance abuse issues. Lastly, you’ll have individual providers. An individual psychiatrist, psychologist, etc. has his/her own beliefs and informal policies about substance abuse treatment requirements. An individual provider is your best bet as they can make a clinical decision regarding your current need for additional treatment. They are not bound by agency policies. I would approach any provider with an honest history and assurances of your continued avoidance of alcohol.

You can still return to your original course for pre-med. Depression and anxiety don’t lower our IQ. However, I would consider this experience your first course in community medicine…and ethics.