Medication

Medication was an issue for all participants. Antidepressants and antipsychotic medication were referred to more frequently than other medications such as mood stabilisers or those taken to relieve side effects from antipsychotics. The views on medication (prescribed psychotropic drugs); its effectiveness and frequency of use (or compliance to treatment regime) were often as varied as those views expressed in relation to illicit or psychoactive drug use.

Where a participant preferred cannabis to alleviate intrusive auditory hallucinations another would suggest alcohol. When heroin was cited as helpful in blanking out painful memories another would say crack cocaine was more so. Subjectively then individuals found a variety of drugs useful in meeting a common need; relief. Attitudes towards medication demonstrated similar variances. Context, circumstances, level and type of illness were among a number of explanations for the range in views. However, three chief factors emerged.

One. Did they want the medication?

Two. Were any conditions attached to taking it?

Three. What interaction would it have with their drug or alcohol use?

Its not too bad now, I’m on injections now and that seems to have calmed it all down, but I have trouble with the voices from the outside when people are out here, they are making my life hell. Tormenting me. (Sid)

What features here is a strong sense of desperation. The distress generated by psychotic symptoms (voices) fluctuates yet a discernable positive effect from medication is conveyed. Medication in this instance has been helpful but fails to alleviate illness-orientated distress completely; subsequently drug use has potential to continue. This suggested that medication and drug use had become a combined coping method for mental distress. Arguably Sid is using medication as an adjunct to his drug use. The helpfulness of both is limited and the two combined not fully effective, in fact it is likely to be counterproductive. The constant search for fully effective combinations or new drugs / medications therefore continued, illustrating the longitudinal nature of dual diagnosis.

I think erm, the erm….. I think the problems like gone away now, my nightmares have gone away but some nightmares are still there, but there just odd dreams that I have really, not as bad – I'm taking the clozapine but I think at the time when I (first) took the clozapine I thought well erm, the nightmares have gone, I thought that was the end of the nightmare and I took the trip (drug use) with a best friend of mine and I went to, I started infant school with him, and we took it as two grown men, yeah, and my brain wasn’t strong enough and he got the better of me and he got into my head… (Connor)

A repeated experience of partial effectiveness of medication is demonstrated in the quotation above. Medication effectiveness was viewed as limited. Medication viewed as helpful consisted of a clearly demonstrable subjective benefit, such as reducing the intrusivity of delusional beliefs, the volume of offensive auditory hallucinations or preoccupation with bizarre thoughts.

I just say drinking is fine in moderation if you know you can stop. Personally I wouldn’t have done anything different in my early years than I did because I wasn’t out of control and my life was alright through drink, just having a couple in the evening but in terms of looking at drink to solve your anxiety or stress I’d say no, I’d say not, I’d look for other ways, because no matter, even on things like medication, and OK I understand people need certain drugs for medical conditions but I don’t necessarily think that’s the case for anxiety I think you are just delaying it and making it far worse when you do stop and it does hit you. (Simon)

Although the quote above refers to a ‘milder’ form of mental illness (anxiety), this had no bearing on the prevailing attitude that medication was limited in its power. Participants who sought to use medication in combination with alcohol or other psychoactive substances often found the pattern was erratic depending upon its availability and their underlying level of health or distress.

Psychosis was a long-term condition for three quarters of people who participated. They had marked sustained symptoms and as a result medication, usually antipsychotics were prescribed and encouraged throughout service contact. The limited effectiveness of medication as experienced by participants was counterbalanced by a constant flow of encouragement from their practitioners and doctors. A strong element of forced or coerced compliance was detected; conversely participants frequently conveyed a faith in their practitioner’s judgement about the helpfulness of medication that conflicted with negative subjective experiences. This remained unexplained but intimated two factors; (i) the persuasive ability of practitioners and (ii) the desperation of service users to obtain relief.

A paradoxical conclusion was reached that medication was of limited helpfulness yet not disregarded; moreover it was considered a source of help not fully realised. It may

also have been the vehicle for conveying and receiving empathy, a prerequisite for care, as presented in the following sections.