It can be scary for HIVers in recovery from addiction to consider taking potentially mood-altering or habit-forming medications—from marijuana for wasting to painkillers for neuropathy—even when they are your last resort. Here, RICHARD ELOVICH (see “Clean, Sober...and Medicated?”), in consultation with therapist Michael Lipson, PhD, and HIV doc Howard Grossman, MD, offers some sobering advice:

  1. Find a doctor or therapist who you can talk with honestly about your substance use history and recovery process—before you start the med.
  2. Talk it through with someone else in recovery before making the med decision. Discuss your expectations about how the med might draw you into an old pattern of thinking or threaten your sobriety. Be specific: Are you likely to take more when less would suffice?
  3. Set clear limits before you start the new medication. The crucial distinction is between what was prescribed by a doctor and what you self-prescribe. Identify what the med’s prescribed use is, including defining the vague term “take as needed.” Spell out where you will use it, with whom and what you will or won’t do while under its effect (for example, no parties). Some people find it helpful to “bookend” doses by checking in with someone else in recovery before and after taking the med.
  4. Know the warning signs, which can include breaking your routine, isolating yourself, keeping a change in medication or dosage a secret, or using the medication impulsively.
  5. Be kind to yourself. You’re not taking the meds to feel high, but if that happens, how will you deal? Will you feel guilty? Can you be comfortable with the high without succumbing to the urge for more? Avoid places and activities that you associate with drug use.
  6. Avoid isolation. Secrecy is a fertile breeding ground for drug abuse. Shine a light on troubling thoughts by talking regularly with a friend who is also in recovery and giving him or her explicit permission to check in with you often, ask you probing questions and provide you with feedback. Join or start a support group whose members are taking similarly problematic meds. Get together at regular times, create rituals, and set rules that allow people to speak without cross-talk.
  7. Integrate. Keep counting your days in sobriety right through the time you’re following the prescribed med regimen. If you pray or meditate, bring your medication issues into this practice. Faced with new challenges brought on by meds, renew your commitment to sobriety: Volunteer to do service at a meeting, become a sponsor, or make a list of things you’re grateful for. Stay involved with the program that helped to get you sober.
  8. What if I slip? A slip need not become a slide. Get on the phone to your sponsor or recovery network or get to a meeting and discuss it. Talk through what psychologist Alan Marlatt calls “SUDS”—seemingly unimportant decisions—that led to the slip. You may want to talk with doc about the possibility of going off the problem med for a while, or for good. Get back on track by adding more meetings or seeking out the types of honest conversations you might have avoided before.