105 The Professional Counselor™ Volume 12, Issue 2, Pages 105–122 http://tpcjournal.nbcc.org © 2022 NBCC, Inc. and Affiliates doi: 10.15241/srdv.12.2.105 Sabina Remmers de Vries, Christine D. Gonzales-Wong Herbal Remedies, Over-the-Counter Drugs, and Dietary Supplements: A Primer for Counselors U.S. consumers are spending billions on complementary and alternative medicines, and nearly half of those consumers on psychiatric prescription drugs also use herbal remedies. Clients may take herbaceuticals, overthe-counter drugs, and dietary supplements instead of, or in combination with, prescription drugs. This frequently occurs without the input or knowledge of prescribers, which can create significant problems for clients. There is a growing need for counselors to be familiar with herbal remedies, over-the-counter drugs, and dietary supplements. It is vital that counselors understand the potential interaction of these substances with prescribed medications, as well as their impact on clients’ emotions, thoughts, and behaviors. This article reviews relevant research and professional publications in order to provide an overview of the most commonly used psychoactive non-prescription products, counselor roles, client concerns, associated counseling ethics, diversity and cultural considerations, and counselor supervision concerns. Keywords: counseling ethics, herbaceuticals, over-the-counter drugs, dietary supplements, diversity A recent survey by the World Health Organization (WHO) World Mental Health Survey Consortium reported inadequate treatment of mental health conditions, especially in disadvantaged populations (Borges et al., 2020). In 2019, an estimated 20.6% of adults in the United States (51.5 million adults) experienced some type of mental health problem (National Institute of Mental Health, 2019). In an attempt to address mental health concerns, clients may take a variety of drugs, which can range from prescribed psychotropic medications to self-administered herbal remedies, over-the-counter drugs (OTCs), and dietary supplements (Ravven et al., 2011). Researchers have found that older adults, particularly, use prescription drugs, herbal remedies, and dietary supplements concurrently (Agbabiaka et al., 2017; Kaufman et al., 2002). Herbal remedies and dietary supplements are part of complementary and alternative medicines (CAMs), which consist of various products and practices (Nahin et al., 2009). In terms of mental health diagnoses (e.g., major depressive disorder, bipolar disorder, schizophrenia, anxiety disorder), prescription medication noncompliance can range between 28%–72% (Julius et al., 2009). There are many reasons clients do not adhere to their psychotropic medication regimens, including client-specific factors (psychological factors, habits, and beliefs), drug-specific factors (side effects), social/environmental factors (support system issues), and financial considerations (cost of medications, copays, and deductibles; Freudenberg-Hua et al., 2019; Julius et al., 2009; Phillips et al., 2016). There are clients who want to take their medication as prescribed but may not be able to afford it (Wang et al. 2015). Researchers found that clients might be prone to reduce use of prescription medication or substitute with OTCs and CAMs when experiencing financial pressures (Agbabiaka et al., 2017; Gibson, 2005; Wang et al., 2015). Another concern is lack of client knowledge pertaining to medications and diagnoses. Makaryus and Friedman (2005) found that only 27.9% of surveyed patients knew the names of all of the medications they had been prescribed, only 37.2% knew the purpose of all of their prescribed drugs, and only 14% knew the most frequent side effects. Sabina Remmers de Vries, PhD, NCC, LPC-S, is an associate professor at Texas A&M University–San Antonio. Christine D. Gonzales-Wong, PhD, NCC, LPC, is an assistant professor at Texas A&M University–San Antonio. Correspondence may be addressed to Sabina de Vries, One University Way, San Antonio, TX 78224, sabina.devries@tamusa.edu.
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