A little bit of information is a dangerous thing. That’s true, but I’m hoping a little bit of information can also be a good thing. I’m hoping the little bit of information I share with you below will clear up some misinformation about the safe and effective use of medication in the treatment of behavior problems in dogs.
Medication gets a bad rap
In the aftermath of the recent school and theatre shootings in the United States a wave of anti-drug propaganda has swept across the pages of alternative media websites where readers are quick to point a finger at “psychotropic” drugs as the common link and causative agent in these tragedies. The category of psychotropic drugs is actually quite broad and includes medications that act differently and are used for a variety of purposes.
Correlation vs. causation
While medication may be a commonality in these incidents it is important to understand that just because the shooters were on medication that doesn’t mean that the medication caused the shooters to behave like homicidal maniacs. Many other factors need to be considered, and the only way to determine causation is through scientific study and analysis.
For example, although there may be a correlation between the use of medication and the shooting incidents, meaning that each of the shooters in recent incidents was on some type of psychotropic medication, the fact that the shooters were mentally ill also bears a direct correlation to these incidents and requires consideration.
We would also need to look at more than just a couple of these incidents in order to draw any kind of reasonable conclusion about causality – or even a correlation. In other words, we need a lot more data to draw any conclusions about psychotropic medication and aggressive behavior.
The fact is, medication plays an important role in the treatment of illness, mental as well as physical, and while it plays a valuable role, professionals recognize the potential for side effects and adverse reactions.
While there may arguably be some drugs that reach the market before they are thoroughly and adequately tested to determine safety, there is a standard process for testing new medications before making them widely available for prescription.
As an experienced medical professional as well as a consumer I am educated in pharmacology as well as physiology and pathophysiology and understand the role of medication in the treatment of disease. I am not saying that the pharmaceutical industry is without fault or that medications are without risk, but I recognize the life-saving value of medication in the practice of human and animal medicine.
Potential for adverse effects
In my previous work as a registered nurse I was licensed to administer medication and was responsible for knowing the actions, interactions, contraindications, and side effects of each drug I administered in order to monitor the patient’s response, report significant findings to the physician and intervene as appropriate.
For example, when working with patients recovering from open heart surgery, I was responsible for titrating various potent intravenous drugs to maintain hemodynamic values within parameters which promoted optimal physiologic functioning. I was also responsible for initiating emergency drug treatment as necessary. Hence, a clue about how I came to believe that drugs can be life-saving.
Importance of observation and assessment
This knowledge of physiology and pharmacology comes in handy in my current profession of dog training. In addition to dog training my work includes behavior consultations with owners of dogs that have serious behavior issues such as fear and aggression.
I have had many years experience performing assessments and making critical observations of behavior, physical signs of illness and responses to treatment. This background proves invaluable in looking at and understanding the interrelatedness of biology and behavior.
The medical model
Using the “medical model” of treatment based on assessment and diagnosis is a natural transition for me in my work with animals with behavior problems. It provides a logical framework for proceeding from chief complaint(s) to history taking and assessment to the development of a behavior modification plan based on findings.
The nursing process
Although nurses are not licensed to make medical diagnoses (neither are dog trainers – in fact, they are not licensed at all), they do make nursing diagnoses based on assessments.
The nursing process is similar to the medical model used by physicians and is based on scientific method. It includes assessment, diagnosis, outcome identification, planning, implementation and evaluation.
These steps are very similar to the steps I use in teaching so my background in scientific method, nursing and education blend very well to aid me in my consultations with dog owners.
When I am first called for a consultation on a dog with fear or aggression, I perform an in depth assessment which lasts about two hours. Based on this assessment I develop a detailed behavior modification plan which includes a combination of basic training exercises, non-invasive therapeutic modalities such as an Anxiety Wrap and behavioral interventions such as desensitization and counter conditioning.
Desensitization is the process of gradually exposing the dog to the aggravating stimulus at low and then increasing levels until the dog is able to tolerate the stimulus at full intensity.
The professor, a psychologist gave me a baby rat to hold, and I progressed to holding an adolescent and finally a friendly adult rat.
I never liked holding the rats, but I was able to do the work, and today I do not have a fear of holding a pet rat.
Counter conditioning is pairing the frightening or aggravating stimulus with something the dog likes, usually food to cause the dog to develop a new, positive emotional response to the stimulus.
The role of the veterinarian
When I am taking the history on a dog I can determine whether the owner of the dog needs to consult a veterinarian for the issue if they have not already. There are many medical conditions that can cause behavior issues such as aggression.
It is also the veterinarian’s responsibility to provide a diagnosis and treatment plan, although general practitioners do not often feel comfortable making a behavioral diagnosis other than general anxiety. They do have specialists they can consult if needed however who can assist with the diagnosis and treatment plan.
The treatment plan
A treatment plan includes non-pharmacological interventions such as desensitization and counter conditioning but it may also include medication.
Oftentimes if there are no indications of a need for immediate veterinary involvement, I will begin treatment for fear or aggression using standard behavior modification protocols, although I would prefer to have veterinary involvement from the outset.
If after the first visit or two I see progress I will continue with the current plan, but if the dog’s anxiety level does not diminish with the current plan, I recommend the client consult his or her veterinarian for the purpose of a medical examination and evaluation of a need for medication.
The purpose of medication
It is important to understand that the purpose of medication is to facilitate behavior modification. Medication alone does not change behavior, at least for the long term. What medication does is allow the dog to relax enough for learning to occur. When anxiety is high, learning is inhibited and the dog cannot learn new ways of coping with and responding to his environment.
The treatment team
I like to work with the veterinarian the same way I have worked with physicians over the years but unfortunately very few veterinarians are versed in behavior modification and used to working with trainers as treatment team members. This makes my work a bit challenging because the veterinarian plays a key role in diagnosis and treatment.
Once a dog has been placed on medication, it is important for all members of the treatment team – veterinarian, client, trainer and veterinary behavior specialist, if one has been consulted to communicate regularly as needed about the dog’s response to treatment and any changes in the treatment plan.
The ideal is that medication will be a temporary adjunct in behavior modification, and that it can be weaned off once the dog has learned new ways of coping with and responding to his environment.
As the trainer I must continually evaluate learning, not only of the dog but of my client, because it is the client who is responsible for the daily management and training of the dog and will be for the rest of the dog’s life, long after I am out of the picture.
My goal is to give the client the knowledge and tools necessary to function independently, much like I did in my previous work as a registered nurse.
Weighing risks and benefits
Medication is not without risk. That’s why it must be prescribed by a licensed professional. In any decision to prescribe medication to aid in the treatment of illness, the prescriber makes the decision based on a risk/benefit analysis and discussion of options with the patient or client.
There are always potential side effects, allergic reactions and idiosyncratic reactions, but in all my years experience in the medical field I can say that in the vast majority of circumstances I have seen medication prescribed appropriately with careful consideration of risks, benefits and alternatives.
Medication facilitates learning
Medication alone is not effective in causing permanent behavior change in animals, and sometimes behavior change cannot occur as a result of behavior modification protocols alone because the dog is too anxious. When non-pharmacological interventions fail to reduce anxiety, medication is usually necessary.
The same scenario occurs in human psychiatry. Sometimes medication without counseling may help, for example short term use of an anti-anxiety agent or sleeping aid for a period of stress that is not the result of underlying mental illness, and sometimes counseling alone may be effective, but for serious mental issues that don’t respond to counseling alone medication may be indicated.
In animals as well as people the goal is to keep the animal on medication long enough but not forever if not necessary. Careful monitoring of the dog’s response to the medication is necessary to see if an adjustment in dose is needed, and to wean the dog off the medication as soon as possible.
Medications are chemicals which have undergone laboratory and clinical testing and shown to be effective in the treatment of illness. They are not without risk, but they are generally safe as well as effective in the treatment of disease in both animals and people when prescribed judiciously by a knowledgeable licensed professional.