“But I don’t want to go among mad people,” Alice remarked.
“Oh, you can’t help that,” said the Cat: “we’re all mad here. I’m mad. You’re mad.”
“How do you know I’m mad?” said Alice.
“You must be,” said the Cat, “or you wouldn’t have come here.”
― Lewis Carroll, Alice in Wonderland
In this blog, I want to share my experience using various drugs, namely alcohol and different prescription medications, throughout my academic career. I also want to acknowledge that people use drugs—both legal and illegal—for many different reasons, often at the same time. Sometimes they just want to enjoy themselves. Sometimes they want to relax. Sometimes they do those around them are engaging in drug use. And sometimes, drugs are used as a coping mechanism in the context of mental illness, which is my experience. Looking back, I believe that my substance use was appropriate during some periods, and clearly problematic during others. I believe that problematic substance use is a hidden and largely taboo topic in academia, and that we need to acknowledge that it exists.
Before I share my story, I want to provide some context. Firstly, a society, our relationship with drugs is complicated. Across different countries, studies show that the majority of adults enjoy a drink or two, and many people drink enough each week to warrant concern from health authorities. Although “hard” drugs such as ice and cocaine tend to grab the headlines, alcohol is one of the most abused drugs in the world and has some of the most serious health consequences overall. We know that approximately one in five people experiences a mental illness, and around 50% of people with a mental illness will have a co-occurring substance use disorder at some point in their lives. And while we tend to focus on the harm from drugs such as heroin, cocaine, the misuse of prescription drugs is both common and potentially deadly. In the United States, deaths from drug-involved overdoses—including prescribed medication—have been climbing for the last decade. The opioid epidemic in particular has devasted families and entire communities, leading to long-term public health consequences.
What about those who use (and abuse) illicit drugs? If you ask the average person, they are likely to tell you that “junkies” deserve whatever they get. There is a prevailing view in society that those with substance use disorders brought it on themselves and that they simply need to grow up and take responsibility for their behavior. (In reality, this view is simplistic and has no support in the neuroscience research). The legal consequences for illicit drug use, however, differ significantly across the world. While many countries adopt a punitive approach, in other countries drug users are frequently referred to rehabilitation programs rather than jail. Increasingly, researchers and health professionals are recognizing that adopting an approach that focuses on care and compassion is more likely to lead to healing than punishment. As leading author Johann Hari has argued,
“The opposite of addiction isn’t sobriety. It’s connection. It’s all I can offer. It’s all that will help [you] in the end. If you are alone, you cannot escape addiction. If you are loved, you have a chance.”
The Beginning: My PhD and Booze
Looking back, depression and anxiety have been present throughout my life, and I struggled with both throughout my academic career. Even as an undergraduate student, I recall vomiting with anxiety before exams and hyperventilating in the moments before important presentations. And while I was known as a top performer, who was pretty highly strung, I was able to hide the anxiety fairly well. After completing my undergraduate and Masters degrees, I worked in a lab for several years before starting my PhD at a top institution. I had graduated with excellent grades and, being a perfectionist, much of my self-worth was tied up in my performance at work.
Like many cases of addiction, mine started slowly—namely, with a glass of wine after a long and stressful day at work. To my delight, I realized that alcohol helped me relax a few hours before bedtime. My anxiety about work would gradually fade and I would start feeling pleasantly numb. Ignoring the fact that I would often wake up two or three hours later unable to go back to sleep, it seemed like a wonderful tonic. Unfortunately, however, I began needing more than a glass of wine to feel pleasantly relaxed. This is known as ‘tolerance’ and is a key criterion for problematic substance use (or abuse).
After almost a year, as my drinking escalated, I would wake up feeling nauseous and shaky every day. I gained weight and started to look physically unwell, although I was still able to maintain satisfactory performance at work. My cheeks became puffy and slightly red and my skin was constantly dry and covered in blemishes. At first, I was adamant that I did not have a problem. After all, I was still showing up at work every day, teaching my classes, and coordinating multiple research projects. Yes, I was having the odd panic attack and I would sleep for hours every weekend, physically exhausted from the effort to get through the week, but I was still working. As long as I could do that, surely I was fine. As the late Elizabeth Wurtzel wrote in her first award-winning memoir, Prozac Nation:
“The measure of our mindfulness, the touchstone for sanity in this society, is our level of productivity, our attention to responsibility, our ability to plain and simple hold down a job. If you’re still at the point when you’re even just barely going through the motions–showing up at work, paying the bills–you are still okay or okay enough.”
Unfortunately, I was definitely not okay. After several close friends pulled me aside and expressed their concern about my increasingly disheveled appearance, I promised with some reluctance to see a doctor. As it turned out, my regular doctor was unavailable on the day that I booked my appointment and I saw one of her colleagues instead. Although I didn’t disclose the full extent of my difficulties, I admitted that I was feeling anxious, enjoying several drinks each night, and having trouble sleeping. Instead of referring me to a psychologist, the doctor looked at me thoughtfully and said, “Have you ever tried Xanax? You might find it helpful.”
Blue Pills: The Road to Tenure
As it turned out, I found Xanax very helpful. So helpful, in fact, that I relied on it (and other benzodiazepines) to function for the next 15 years. After graduating with my PhD, I accepted a tenure-track position at one of the top universities in the country. During this time, I was grateful for the relief that the medication provided.
While Xanax certainly helped me to reduce my drinking, it created another problem. From the moment I swallowed the first tablet and starting feeling its effects within fifteen minutes, I knew it was what I had been looking for my whole life. All of a sudden, everything felt okay. The anxiety disappeared like a puff of smoke on a gentle breeze. Everything was pleasant and calm. Suddenly I was able to function more effectively at work, particularly giving lectures and presentations, without having a panic attack in the bathroom beforehand. Unlike other benzos, like diazepam, Xanax (or alprazolam) provides relief relatively quickly, which is why it is ideal for treating panic attacks. In fact, in Australia it is now only recommended to treat panic disorder and acute, short-term symptoms of depression and anxiety, and new prescriptions usually require review from a psychiatrist. Data from around the world also reveals that Xanax can be deadly when mixed with alcohol, and especially with alcohol and opiates.
I won’t go into the details of those fifteen years, except to say that I used Xanax intermittently for a long time, and it had both positive and negative consequences. If I knew that I had an exceptionally stressful event at work coming up, I would take a low dose beforehand. Usually this was enough to keep me calm and functional—except for the meetings in which I would fall asleep, unable to stay awake because I was both sedated and exhausted. When I had a terrible day at work, I would come home in tears and take my little white pills—which over the years turned blue, then pink—and curl up in bed, secure in the knowledge that I would be asleep soon. There were a few times when I had to step in and do a presentation at the last minute, something that I would usually find very anxiety-inducing; but with the medication in my bloodstream, I was cool, calm and collected. Once, I did three huge job interviews in one day, then headed home on a train and fell asleep only to wake up in the late evening with no idea where I was. I received job offers from all three interviews, and no one knew that I was medicated the whole time.
The downside of using benzodiazepines, of course, was that I never really learned how to manage the anxiety. Certainly, there were real benefits, as I gradually became a very confident speaker and job candidate and ceased using the medication at work. As mentioned, I also stopped using alcohol to self-medicate and this had positive consequences for me in many ways. But the anxiety still haunted me in many situations and it never went away entirely.
It wasn’t until my doctor happened to be away for six months and I saw yet another physician that I began to understand that anxiety, like all mental illnesses, needs to be addressed using multiple tools and techniques. After hearing my history, this doctor refused to give me another Xanax prescription. Instead, he allowed me small doses of Diazepam (Valium) as needed and monitored my use carefully. While I was frustrated and very unhappy at losing access to the medication that had sustained me for so long, I was secretly relieved. Even though I only took the medication intermittently (and luckily avoided the excruciating experience of benzodiazepine withdrawal), deep down I knew that things had to change. A part of me wanted to reduce my dependence on the pills, and with the support of an excellent psychologist I began making small changes. I spent hours learning CBT techniques, practiced mindfulness, started to engage in regular self-care, scheduled regular therapy sessions, and commenced treatment with several anti-depressants. My battle with anxiety is ongoing, and I’m not sure it will ever go away. I still take Diazepam on the very worst days, so I still rely on medication to an extent. But like so many others, it is something that I have now learned to live with. There will be good days and there be bad days, but taking care of myself is always something I can control.
While it is encouraging to see that we are starting to talk openly about mental health and mental illness in academic settings, there is still limited research about problematic substance use and its antecedents and consequences in academic samples. In my experience, however, I suspect that it is prevalent and likely co-occurs with the high rates of depression and anxiety, especially in PhD students and those on the tenure track. I also believe that using alcohol to medicate, in particular, is normalized in academia. How many jokes have you heard about PhD students or tenure-track academics needing wine after a stressful day of work? Why do so many networking events at conferences involve alcohol? Why do we often serve drinks along with canapés after work meetings? And why are we not talking about this more?
In many ways, I feel that I was lucky. While my drinking certainly affected my health and overall well-being, I was still able to keep functioning. Although I was dependent at times, I never actively abused benzodiazepines and now, with the support from my treating team, I am careful with how and when I use them. But there were times as a PhD student and tenure-track academic when the medication felt like a lifeline. I can completely understand why people begin to rely on the drugs to function, and how addiction can become consuming. Academia can be a very challenging profession, and the work-related distress can have profound negative implications for our mental health. While drinking is fine in moderation, and benzodiazepines are useful when prescribed for short periods of time, neither provides a solution to the stressful environment present in so many institutions.
Given the high rates of mental illness in the academic population, I have no doubt that there are many of us who are suffering in silence and shame. For those of you that have never considered that people can become dependent on alcohol and pills: We exist. For those of us battling our own demons: You are not alone. You can recover. You are deserving of help.