Disclaimer: This post discusses topics related to drug use and addiction. I encourage you to recognize and respect your limitations in consuming sensitive content.
Working with people who used CNS (central nervous system) depressants (drugs that slow down your brain function, like alcohol, alprazolam (Xanax), and barbiturates), I’ve seen how easily benzodiazepines can be abused in treating anxiety. This is the story of a woman who self-medicated her anxiety and learned to associate feeling numb with feeling okay. This is a story of survival.
Benzos and the Brain
Benzodiazepines (or “benzos”) act on specific receptors in the brain (called gamma-aminobutyric acid-A (GABA-A) receptors), making the brain less sensitive to stimulation and producing a calming effect. They can be used to treat anxiety as well as other conditions such as alcohol withdrawal, panic disorder, and seizures. Common benzos include diazepam (Valium), clonazepam (Klonopin), and lorazepam (Ativan). Benzos have high potential for abuse and physical dependence, and can easily lead to overdose when combined with other CNS depressants. When used as prescribed, they can be beneficial in managing severe anxiety. However, when abused they can lead to a very different outcome.
I worked with a thirty-two-year-old White woman, whom I’ll refer to as “B,” whose desire to self-medicate her anxiety ultimately fueled a self-destructive pursuit of numbness. Like others who fall into the grip of addiction, B’s substance use began as benign. Prior to “hitting rock bottom,” she described herself as being a teacher, soccer mom, and happy.
“Sana, if you saw me five years ago, you wouldn’t believe it.”
Numbness as a Cure
B had dealt with anxiety for as long as she could remember. “It got worse after my husband divorced me,” she said. She recounted a custody-battle that soon followed, financial instability, and a deep depression. Since she was in her twenties, B had been prescribed Ativan from a psychiatrist whom she met with for years. However, one day her psychiatrist no longer felt comfortable prescribing her medication. He noticed that she began to miss sessions, and when she did show up, she’d appear drowsy and impaired. The loss of her psychiatrist, and the consequent desperation to self-medicate, began an arduous journey of self-destruction.
My work with B began when she was on methadone, a medication-assisted-treatment for opioid dependence. When used as prescribed, methadone is an opioid that acts on the same brain receptors as heroin or morphine without the euphoric effects. B’s struggle to alleviate her anxiety with benzodiazepines, the only treatment that she’d ever known, quickly led to polysubstance abuse from the street. In no time, her daily use included benzos of some kind, a sedative, and methadone. This was extremely dangerous and led to multiple blackouts and a handful of overdoses.
Side note: Many people who buy drugs off of the street strive to self-medicate mental illness. They may not utilize formal mental healthcare for reasons such as: homelessness, being black-listed from clinics, or mistrust in mental health providers. While it can be easy to judge those that we see in the throes of addiction, the precipitants to their addiction may have been similar to issues that you and I have experienced. Although B was convinced that she was properly medicating herself, in reality she was drugging herself to the point of numbness.
Chipping Away at Denial
It can be difficult to sit with clients who are visibly suffering. With B, each of our sessions seemed to wring me of my mental and emotional resources. Although she was thirty-two, she presented as a child. The numbness that she experienced everyday, on account of various drugs, rendered her unaware of how she presented to others. Working with her stretched me in my efforts to be gentle, patient, and honest.
“B, you’ve been barely conscious when you come to the clinic. We can’t safely administer you methadone when you come in like that,” I said to her, gauging her reaction as I spoke.
“No, I haven’t! What are you talking about?!” she said with indignation.
During times like these, I’d tell myself to take a deep breath. We had many, many moments like these. Part of the work as an addictions counselor involves helping clients move past the phase of denial and gain some self-awareness before they can begin to heal and change harmful behaviors. With B, we slowly chipped away at her denial over the course of many meetings.
Held Together by an Illusion
“Why don’t we talk about ways you can help calm yourself down when you don’t have benzos?” I cautiously suggested to her during one of our sessions.
“No! I’ve tried everything and none of it works. I need my meds — that’s what they’re for, anyway.”
When dealing with an addiction, a common experience is an inability to “remember” a functioning life prior to using a substance to cope. This is addiction — the dependence on something to function and feel like oneself. Somewhere along the line, B learned to equate feeling numb with feeling okay. We talked about what it meant to treat one’s anxiety compared to numbing and incapacitating oneself. Is it possible to have one without the other? For many who struggle with chronic anxiety and mental illness, they may believe the answer is “no.”
As her life spiraled out of control — losing parental rights to her child, experiencing homelessness year after year, and worsening mental health — it became easier to completely numb herself than face the truth of her situation. Over time she had moments of realization that the way she’d learn to survive helped her do only that — survive, yet distanced her from her goals of reunification with her son, financial stability, and good relationships with her family.
Tenacity in Face of Addiction
At times it was challenging for me to work with B because she attached to me very quickly and would refuse to meet with other treatment providers such as her group counselor. Part of being a counselor is building strong, trusting relationships with clients while maintaining healthy boundaries and helping them help themselves. Don’t get me wrong — there were plenty of times that I wanted to do more for B and to believe everything she said without question. However, I had to check myself and remember that this would only indirectly enable her addiction.
As much as I didn’t support the ways in which she tried to cope with her anxiety, I admired her tenacity to treat her anxiety. Although she was black-listed from multiple mental health centers, she persisted and was prescribed medications that were successful for her in the past. Don’t be mistaken, she proceeded to struggle with managing her medication — but she was determined to provide herself with a chance to get back on her feet. There were a few sessions that I commended her for being clear, alert, and insightful while on her newly prescribed medication. Before she transitioned to another counselor due to my relocation, our relationship ended while she strived to maintain stability amidst multiple life stressors.
Numbness can be a means to survival. While it allows one to escape a painful reality, it fails to address the pain itself. B persisted along the path of accepting her reality. No matter where you are on the path of addressing your own pain, you must persist.