![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 181 to 205 of 251. Go back in thread:
Posted by gdog on June 22, 2001, at 15:24:32
In reply to Re: Addictive meds in general, posted by gilbert on June 22, 2001, at 10:30:37
gil,
thanks very much for posting your thoughts on this. i am recovering alcoholic and addict, clean and sober 4.5 years. when i was prescibed ativan for my panic and anxiety, i went through a lot of issues with it. i stopped using it (even when i did use it, i dosed at a much lower dose than prescribed) for a couple of months. but my anxiety/panic got worse (partially due to the other meds i was/am on) and i had to resort to ativan just to stay in my own skin. however, i constanty second guess myself, do i need it, or am i just wanting to change the way i feel so i dont have to deal with things. its a real struggle, and definitely adds to my anxiety. plus, i usally wait until i'm way far into the anxiety/panic and have suffered for a couple of days before i take the ativan. which isnt the best thing for me mentally or emotionally. i appreciate that someone else out there has these issues and is willing to post them.
Posted by Sulpicia on June 22, 2001, at 17:04:48
In reply to Addictive meds in general, posted by JCB on June 22, 2001, at 0:58:18
Gil and Gdog -- ditto on this end. Over a decade in recovery myself.
Addiction is simply a common comorbid of many disorders and we can and do
recover to live healthy lives.JCB -- I don't know where you trained or what you're field is, and I totally
agree with you that a good chemical dependancy treatment program can help an
addict, this statement leaves me confused, especially coming from a mental
health professional who treats addicts:
"As far as the benzos (klonapin, xanax, valium, etc) withdrawal is serious if you've taken
a high enough dose for a long enough time. I've had clients that were taking 6-10 pills a day if not more for years.
They usually get detoxed in a hospital over a 2 week period and are given a comperable drug to help manage the
withdrawal symptoms. Here is my point. I've had MANY clients VERY addicted to benzos and most of their
addiction (after being detoxed of course) was purely psychological addiction. I'm not saying they didn't feel anxiety,
I'm sure they were, but it wasn't withdrawal, but rather their perception of life's struggles w/out anti-anxiety
medication to buffer normal day to day stress that we all otherwise learn to deal with w/out medication."
"Physical" addiction does NOT consist entirely of withdrawal nor is "psychological" addiction limited to self-medication and
coping skills. To reduce a complex problem like addiction into physical and psychological components is questionable, and
rather unusual in light of what we know about the brain.
Tho perhaps I'm misunderstanding you??? Entirely possible today!
S.
Posted by Daveman on June 22, 2001, at 22:09:37
In reply to Re: Addictive meds in general:Gdog, Gilbert JCB, posted by Sulpicia on June 22, 2001, at 17:04:48
Based on what I've read; discussions with my doc; and my own somewhat limited experience; I do think it is an oversimplification to state that dependency on benzos is psychological not physiological. It does seem clear that the main mechanism of action of the benzos is to bind to the GABA-A receptor sites in the brain and heighten the effect of GABA (Gamma-amino butyric acid); therefore it is also logical that, at high enough doses over long enough periods, the brain would adjust to the presence of the effectuating agent by reducing the amount of GABA naturally produced. Thus the logic of tapering slowly; so that the brain can adjust to the deprivation of the effectuating agent and begin producing more natural GABA. (This is a very rough understanding, feel free to correct me:))
I also would not necessarily discount the horror stories some people have about the benzos. Consider that there have been many millions of scripts written for these medications; it is a statistical inevitability that there will be some adverse reactions. I liken it to being killed in a plane crash; the statistical odds of this happening are astronomically small, but that makes you no less dead if you're the one killed in such a crash. Similarly, the likelihood is that if you take benzos under careful monitoring of a knowledgeable pdoc, the odds of a truly bad outcome are small, but the people in that group suffer no less because the odds were against it.
There are risks in any endeavor. Driving is a good example. Any medication entails some risk, the key is whether the patient is properly advised of the potential risks, and is properly monitored and follows their doctor's advice to reduce the odds of an adverse outcome even further.
Dave
Posted by JCB on June 22, 2001, at 22:24:27
In reply to Re: Addictive meds in general:Gdog, Gilbert JCB, posted by Sulpicia on June 22, 2001, at 17:04:48
Sulpicia, I'm afraid I was misunderstood, because I agree with your comments. Maybe this example will help clear up the point I was trying to make about addiction/dependency/physical/psychological and their relationship to each other. I often have clients who are addicted to pain killers. When they stop taking them, their body reacts with a compensatory response of hypersensitized physical pain. Pain from the injury they originally sought medication to treat AND new pain manafested in muscle crams, aches & pains, etc. This is purely Physical Withdrawal symptoms from a physical addiction. Too often, however, over the course of taking pain medication to, lets say alleviate back pain, they inadvertantly find out that the pain killers also kill emotional pain (i.e. the kids are less frustrating, mother-in-laws are more tolerable, you get the picture) During accute withdrawal, people experience their original pain hypersensitized as well as additional aches and pains. These usually become manageable throught other treatments (we refer our clients to pain management clinics if indicated). Just as the pain medication killed emotional pain, the post-accute withdrawal from pain medication is usually a difficulty coping with day to day life stresses. This is completely understandable. Its also the bodies compensatory response to the absence of the drug. Here is where people either go back to their drug or continue to recover. People need to be around other people who understand what they are going through, thats why 12-step programs are so very popular and effective. I also recommend individual counseling, if applicable, to address possible personal issues that may not be appropriate for group discussion (i.e. past abuse issues, childhood trauma, etc.) I chose this example because I believe it more clearly illustrates my philosophy in treating chemical addiction. However, these basic concepts are appropriately generalized to most other drugs, especially CNS depressants (benzos, alcohol, opioids, etc.) I've found when treating people with stimulant addictions, the dynamics are somewhat different. The treatment, however is quite similar. I hope this has been helpful. For the record, I'm a licenced mental health counselor and certified chemical dependency counselor with 5 years experience in working with chemically dependent adults and their families in a hospital outpatient setting.
Posted by gilbert on June 22, 2001, at 22:32:46
In reply to Re: Addictive meds in general:Gdog, Gilbert JCB, posted by Sulpicia on June 22, 2001, at 17:04:48
Sulpicia,
It is almost the chicken and the egg question.....as I am sure now that my primary illness is probably not alcoholism but that drinking was used to self medicate agoraphobia, panic and some depression. I never felt good sober like many people do in AA. They get sober and start normal lives etc. I got sober lost my medicine.....booze and almost immediatley began to have problems functioning in the outside world. I believe this is why so many relapse and drink again. They never get medicated or help for the underlying illnesses. I busted my butt at AA for 10 years. I would do open talks while panicking to the point of doing damage to my heart from elevated blood pressure from anxiety. I worked the steps over and over and over trying to find comfort all the while blaming myself for not getting well or not having enough faith to turn it over. I worked with new cummers endlessly at one time I was sponsoring 10 people. Everyone thought I was the perfect AA and I was dying inside. Five years ago upon my 10th AA birthday I was so dissapointed in my progress I actually contemplated suicide. I then went into therapy and tried that for 3 years and still go but yet still I was nonfunctional due to panic and agoraphobia. I finally have started trying meds. I am still trying to get the luvox to work but am doubtfull. I have tried everything under the sun to not take benzos. Xanax makes me functional yet I still have a tremendous amount of guilt over using it. My wife loves me on xanax I am a new person. She thinks I am nuts torturing myself with AD's so I can be accepted at AA. I had to see a cardiologist because of a heart murmur. He told my doc get this guy on something to calm his heart down he is doing damage. You would think this would alleviate the guilt. Still I feel guilty like I am betraying AA. I am stuck between feeling like I belong in AA versus being menatlly and physically healthy. I even tried a beta blocker for my heart but my pulse got to slow plus it made me impotent. So I will torture myself a little more with the luvox and then I am sure will just have to take the xanax because it works. This is why I get so defensive about benzos....sometimes they are all that works. The attitude towards some of these meds can really hurt peoples feelings and chances of getting well. I finally against the wishes of my sponsor told some people at a table last night that I was on benzos because nothing else worked. I got some support and I got the usual AA oldtimer advice about how I was going down the path to self destruction. Well I have been on that path for 1.5 years at 2 to 3 peach xanax a day. No progressive usage. No using to get high. No unusual behavior after taking xanax. No withdrawal..I can stop at random without side effects. It is time we enter the 21st century and realize some people can use this stuff responibly without going down the tubes......frankly the thought of trying to just work the steps without the help of some of these wonderfull drugs including the ssri's makes me want to suck vodka for breakfast again.
Thanks,
Gil
Posted by gilbert on June 22, 2001, at 22:59:41
In reply to Re: Staying Sober and taking meds, posted by gilbert on June 22, 2001, at 22:32:46
JCB,
I have been in the trenches since 1979 in and around 12 step groups and in and out of 3 inpatient rehabs plus 3 outpatient rehabs....have been sober 15 years and am still very active. I have personally taken about 100 drunks or addicts to hospitals for detox on 12 step calls. I have enrolled at leat half of those people in half way houses. I think AA is miraculous.....that being said. I think statistically it is a failure. About 1 out of 10 stay sober and of those who don't relapse probably only about 1 out of 15 stay sober permanantly. Of all the people I have tried to help some are dead, few are sober, most are missing. I believe 12 step groups to be a great assest but there is much dangerous advice and much dangerous misconceptions in and around AA. Many many people are advised not to take meds to just work the steps. I have a friend who in the early 80's was advised not to take lithium if he just worked the steps he would be fine. This almost cost him his life. I think with the new found spirituality and God like fervor that is felt when sharing with other suffering humans some feel that the hand of God will come down and fix their underlying mental illnesses. Or if they only do a good enough 4th step they will be free from this bondage of depression......you know all the slogans and cliches that sound so good but don't work for all.
I would dare say if all the depressives and all the anxiety sufferers were to be medicated and getting proper pychiatric help prior to using alcohol as medicine.....AA would be quite empty. There are very few pure alcohlics out there who simply do not suffer from some form of mental illness. I would remind all of my fellow recovery AA members who visit this board that Bill W. the founder of this program suffered from sever depression until his death. He also had much trouble in the fidelity area......One could say after alcohol was no longer his medicine....sex than became his new medicine. He finally resorted to dropping acid LSD to try and get some comfort. This does not sound like the kind of sober life I would wish to live. I think 12 step groups need to realize they need some input and need to be very openminded in pychiatric concepts. The meetings are shrinking in my area. They have gotten smaller and smaller. I don't think it is coincidence that after the invention of some tolerable effective medicines people no longer have to keep drinking to the point or level I did in order to stop. I think people are getting their underlying illnesses treated prior to getting in trouble because of all the advances in medicine and therefore the numbers at 12 step groups have dropped. I am gratefull to be sober and to have AA......I also realize without my meds I would be drunk or dead..........I use both to live my AA alone would not sustain me. I think many in the program pay painfull lessons and even lose their lives trying to 12 step something that can't be.Sincerely,
Gil
Posted by JCB on June 23, 2001, at 7:40:35
In reply to 12 step group effectiveness, posted by gilbert on June 22, 2001, at 22:59:41
Gilbert,
I understand that many of the people reading this who are in recovery are concerned about AA's acceptance, or rather lack there of, of psychiatric medication being taking while working AA's program of recovery. I can tell you that, in general, it has been my experience that AA has come a long way since it's beginnings and much less "militant," for lack of a better word, about not taking ANY medications. Its unfortunate that there are people out there that suffer more from going to AA (stopping all their medications) than getting the support they desparately need. I'd like to make just 2 points on the subject.
First of all, for those of you in recovery who feel guilty about taking psychiatric medication AS PRESCRIBED by your doctor, please DON'T. AA continues to hold to the disease model in their teachings of addiction, however, I've found that even AA is realizing that there are some people who, for whatever reason, will need to be on some kind of psychiatric medication, at least throughout therapy, if not perminantly. Here is where I'd like to distinguish between someone who, I believe to be "cheating," and someone who is honestly in need of psychiatric medications. All psychiatric medications are mood altering, otherwise, they wouldn't be psychiatric medication. However, not all psychiatric medications give a "buzz." We call these non-addictive mood altering drugs (i.e. lithium, depakote, prozac, wellbutrin, etc.). How many times have you heard of someone coming into a chemical dependency treatment center saying "hey, I've got a real prozac problem...last night I did hit after hit all night long"? I know this sounds rediculous, but it makes my point. For this reason, AA should have no problem with recovering people taking these kinds of drugs. They were designed to correct chemical imbalances in the brain, which they do very well.
Now, as far as recovering people who are taking classes of drugs that DO give you a "buzz" (maybe not in low doses, but if you take enough they will), (i.e. valium, xanax, klonopin, percodan, darvocet, basically all benzodiazapines and opioits). Here is my opinion on the subject. I have no flat rule/advice for people who are taking these drugs and working a program of recovery. I take each person, their personality, and lifestyle into consideration before giving them my opinion on whether they should try to get off these drugs or not. First of all, I'm not a doctor and would never advised a a client to go against their doctor's recommendations. I do, however, often work with clients who, in time, feel comfortable suggesting to their doctor that they be weaned off their medication (remember I'm strictly speaking of the mood altering addictive types). I'm a firm believer in the benefits of talk therapies, or else I wouldn't be one I guess! Sometimes, especially with clients who have extreme anxiety that appears to continue, even after a significant period of abstinance, I will recommend they seek anti-anxiety medication from a psychatrist, at least to help them calm down so they can focus and gain more benefit from our therapy sessions. Often the drugs that are prescribed are the ones I mentioned that people can abuse to "get high" (klonopin, valium, xanax, etc.) Here is my final point. If a person is taking these kind of medications, AS PRESCRIBED, AND honestly seeking behavioral change through 12-step and/or individual psychotherapy, I don't see anything wrong with it. In fact, I think its how I would prefer to work with my clients who suffer from chronic anxiety. If this is you, please don't feel guilty. However, if you are just using the anti-anxiety medication alone, without any kind of talk therapy, I would caution you against using these medications as a "crutch." I think you know what I mean. This could actually prevent your growth in recovery and either lead you back to your drug of choice, or develop a new addiction.
I know this was a very long message, but I hope it helps those of you who seem to be struggling with this idea of taking psychiatric medication while working a program of recovery that is based on abstinence.
PS- on a lighter note, I live about 3 blocks down from Dr. Bob's house in Akron, Ohio, where AA was founded. Neat, huh?
Posted by gilbert on June 23, 2001, at 17:23:21
In reply to Re: 12 step group effectiveness, posted by JCB on June 23, 2001, at 7:40:35
JCB,
Thank you for the kind words. Your message felt like a little bit of a double message though. Even at higher doses in the middle of a panic xanax never gave me a buzz for the sake of a better word. As far as talk therapy goes....I have spent the better part of my sober life in talk therapy. I find if you do have a chronic condition that talk therapy to be very ineffective for certain disorders. I do not believe as AA and some others espouse that if I take xanax and don't go to therapy I may well be drinking again because of the xanax use. There are some very reputable studies on ex-alcoholics and panic patients in regards to benzo use..... abuse of the meds is very very low and there is no indication that they fall back off the wagon because of the benzo use. Most street druggies don't get high on benzos they combo it with coke or eight balls or heroin. It is very rare to just find a purely xanax junkie that isn't mixing the drug or trying to use it to bridge time between highs. Threre are sober benzo users epileptics, or people with MVP who are on maintenance klonopin to relieve their symptoms. Are they to believe that without proper therapy they will be destined to drink again. There has always been and will always be the typical AA stereotype messages about doom and gloom and how you will come to your demise. Something that has always bothered me about AA is some would warn you about drinking again so often and for so many reasons it's as if the threat of drinking will somehow keep you coming to meetings. I think maybe being gratefull for what I have will keep me sober much longer than fear or drinking. You mentioned that people don't come to clinics saying they have a prozac problem. Well ask some of these people on this board what it is like to go off some of these ssris after long term use. The withrawal symptoms get so bad they run screeming for their ssris to avert the rebound effects. They make junkies look calm. The detox periods and side effects from these so called non-buzz agents make my vodka withdrawl look like a trip to Disney World. The societal low brow view of benzos is parallel with the advent of ssris. I have to tell you in my entire 22 years of meetings I have never met a benzo addict in either program or in the prisons I went into to for 12 step work or in the hospitals or rehab centers. The closest I can even think of is qualude users in the late 70"s.
When you distinguish mood altering drugs in two categories like you did antidepressants and benzos you automatically make the judgement that the benzos aren't O >K >. I think that the same could be said for ssris. I am on both classes of drugs and if I miss my luvox dose you better get out of my way but half the time I don't even know whether or not I took the xanax. I appreciate your message and don't want to be too critical but I still feel that AA and many of the therpists and centers affiliated with the program are in the dark ages when it comes to meds. I would be drunk if I had not been availed the use of xanax. The only time in my life I was not panicking was drunk. I have seen 4 therapists, gone to Recovery Inc, gone to AIM(agoraphobics in Motion) I have gone to church every morning to pray it away, I have worked the steps over and over and over,I have bought all the tapes and books, I have been desensitised and CBT'd to death and still I get panics. I even had one therapist tell me I must need them because I am hanging on to them. That was the best he could say. I would love to give them to him for a day or two. I have spent most of my life unable to go and do things most people do spontanouesly. I have busted my butt. I would put myself in scary situations just to pratice harnessing the fears or feeling the fears or wahtever the therapy du jour was. So please make sure when you run into someone like me the differnce between life and death may not be about drinking.....it may be about having the chance to be functional. I know without the meds I would surely not be here. My life was that unbearable. I find myself being pushed out of AA and feeling quite inferior due to the "medical condition" and mental illness. This from a guy who has been a very active 15 years and I dare say has done more 12 step work than most drunks could shake a stick at.Thanks for the spirited conversation,
Gil
Posted by JCB on June 23, 2001, at 21:58:26
In reply to JCB, posted by gilbert on June 23, 2001, at 17:23:21
Wow, Gil, sounds like you've really been through the wringer so to speak. I feel here, again, I'm being misunderstood with respects to benzos. I have no problem with my clients taking them (clients with or without alcohol/drug problems) when it is indicated by a psychiatrist. I also have had quite a few clients, although not a majority, who were strictly benzo addicts and were not using any other substances when they sought treatment. As far as AA being affiliated with counseling agencies, AA is very careful to remain NON-affiliated with any other organization, from its original design. You misunderstood my point with the Prozac example. I never said people would be exempt from negative mood changes if abruptly discontinued (although its mostly the return of a chemical imbalance and not a compensatory response of traditional withdrawal). I was simply saying that people do not take SSRI's to "get high." Many people, however, DO take benzos to get high. I also agree with you that if you have a serious anxiety disorder, benzos would probably not induce this kind of euphoria that others might get who were not suffering from similar anxiety. That makes sense. On a personal note, my main goal in treating chemically dependent clients is to IMPROVE THEIR QUALITY OF LIFE. Learning good coping skills without the use of mood altering drugs is a very basic premise, but NOT an iron clad rule in my book (despite what AA may or may not say on the subject). If a client is leading a more healthy, productive, satisfying life, while taking certain psychatric medications, then I would consider this to be a treatment success. Chemical dependency is a chronic relapsing disease, so occasional relapses are definately not treatment failures. The important thing is to keep trying, keep talking, and stay focused on what you want out of life. I hope this has cleared up any inconsistancies you've perceived in my previous postings. A little plug here for therapists/counselors/psychiatrists. There are good and bad ones in every profession. If you've had bad experiences with some, don't throw the baby out with the bath water. Finding a good therapist is like finding a good pair of shoes. Some of them are going to fit, some are not. For psychotherapy to REALLY work, you need to work with someone who is right for YOU.
Gil, I appreciate your insights, experiences, and wish you well in your continued recovery.
Posted by JCB on June 23, 2001, at 22:19:00
In reply to JCB, posted by gilbert on June 23, 2001, at 17:23:21
Gil,
I just wanted to say that I AGREE with you, after hearing your story in previous messages, that taking yourself off of your meds (SSRI & Benzos I think) would not only aggrivate your anxiety & depression, but quite possibly lead you back to drinking/druging in an attempt to self-medicate. I also believe that, in your case, the alcoholism/drug addiction was SECONDARY to your agoraphobia/anxiety/depression. You drank to function, right? This concept will certainly ruffle a few feathers in certain AA circles, BUT, I have to tell you, AA as a whole is becoming more and more liberal and understanding of the complexities of addiction and other co-morbid disorders. Maybe this is unique to my geographic location (Akron, Ohio), but I suspect that it isn't. I recall a client with similar guilt feelings about taking xanax who asked his AA sponser his opinion on the subject. His sponsor told him to take it like MEDICINE and there is nothing to feel guilt about. It does, however, sound to me like the meetings that you attend continue to adhere to very strict AA abstinence principles..."no excuses to use anything!!" This is unfortunate and could possibly be harming people in the long run. I'd suggest attending other meetings and bring up the subject in discussion meetings. I think you might be surprised at how many other people share you're concerns and frustrations on this subject. Good luck!
Posted by Sulpicia on June 23, 2001, at 22:36:36
In reply to Re: Staying Sober and taking meds, posted by gilbert on June 22, 2001, at 22:32:46
> Gilbert--
well said! I'm sorry that you found AA incompatible with appropriate medical treatment: it's nowhere in the literature, and tho I'm sure your sponsor meant well, it certainly isn't his business to dictate your medical treatment, even if he had vast experience with your symptoms -- about which he was no doubt clueless.
I've seen a lot of friction in certain groups about this issue and I think it needlessly harms people, especially chronic painers who *must* balance sobriety with legitimate opiate therapy. A difficult task indeed.
Like you, I self-medicated with alcohol, tho for depression. AD meds are fairly acceptable in the world of AA but it never occured to me to look to AA to tell me about my medical problems, nor interfere in somebody else's.
Many years later I learned that a significant part of my depression was due to attention deficit disorder -- so now in addition to AD med, I take adderall.
This is a huge issue for many adults in recovery who are diagnosed with ADHD. The psychiatric consensus, born out by several years of experience, is that NOT treating symptoms greatly increases the risk of relapse. It scared me too, but ulimately it was the correct choice for me.
I'm glad it worked for you too.
I just have a really low tolerance for glib statements about addiction and I'm hoping that I misunderstood the original post ...
Liz
Posted by Sulpicia on June 23, 2001, at 23:06:20
In reply to Re: Addictive meds in general:Gdog, Gilbert JCB, posted by JCB on June 22, 2001, at 22:24:27
> JCB --
sorry about the tone and I didn't mean to challenge your credentials. It's unfair to expect perfection about such a complicated issue as addiction.
Now, granted that I'm unfamiliar with your patient population, it seems like the face of addiction is becoming more complex. People with chronic pain have long been plagued with addiction but one cannot simply withdraw them from opiates and substitute nsaids or massage: as medicine advances [some might use another verb] one of the costs is that many people survive major problems but live with chronic pain. If the pain is not relieved, and in some cases only opiates will do so, they will surely relapse. Many conditions are part of the self-medication-to-addiction/abuse dynamic, and these conditions MUST be treated if the patient is to have any hope of recovery or quality of life.
I take your point about meds being used as a crutch but please remember there is not one shred of research that demonstrates talk therapy without effective pharmacology has any efficacy whatsoever on disorders such as chronic severe depression, biopolar disorder, or ADHD -- I could probably think of more too.
And you know the cormorbity statistics as well as I do -- it is statistically impossible that the majority of your clients do not have one or more of these disorders.
Much like those recovering from eating disorders who must constantly face the substance they abuse, addiction treatment *needs* to accomodate the realities of psychiatric illness, and treat the patient accordingly. I don't envy you the complexity of your job.
Thanks for an interesting discussion.
And just for the record, benzo withdrawal is done inpatient because of the risk of seizures, which can be fatal, right??
S.
Posted by JCB on June 23, 2001, at 23:27:44
In reply to Re: Addictive meds in general:Gdog, Gilbert JCB » JCB, posted by Sulpicia on June 23, 2001, at 23:06:20
s.,
Yes, detox from benzos are done in the hospital because of the high risk of seizures. Its usually a long detox compared to alcohol as well, typically 2-4 weeks.
I certainly never meant to imply that talk therapies take the place of medication in treating disorders such as major depression, bi-polor, or ADHD. On the contrary, medication is the PRIMARY treatment for these above mentioned disorders. I do recall a study, however, that compared the efficacy of 3 types of treatment for major depressive disorder. One group received cognative-behavioral therapy alone, one group received anti-depressants only, and the other group received a combination of both. As I recall, all improved compared to the control group that received nothing. Big surprise :-) Interestingly enough, however, cognative-behavioral therapy in conjunction with anti-depressant therapy was shown to be superior to either cognative-behavioral or anti-depressant therapy alone. I think this shows that maximum benefit can be gained from a combination of both. I also suffer from dysthymic disorder (mild chronic depression) and was in therapy for months before I was put on anti-depressant medication. From my own experience, the counseling helped, but the medication changed my entire life (for the better of course)! I do, however, find the need for occasional "boosters" where I will see a counselor from time to time. So as you see, on many of these issues, my opinions come from my experiences as being both a mental health professional and a patient.
Posted by gilbert on June 24, 2001, at 10:35:36
In reply to Re: Addictive meds in general:Gdog, Gilbert JCB, posted by JCB on June 23, 2001, at 23:27:44
JCB,
I would agree with what you said in your previous post. I have been helped significantly witht talk therapy in areas like family dysfunction, self acceptance etc. I have been very dissapointed lately though to realize all the talk therapy in the world won't stop my panics. I went through these same feelings about AA when I realized it would not fix some things for me....was I to forever remain broken. I think the meds help but they are not without side effects. The xanax will make you tired and can give you a mild dose of depression. I am currently on low dose luvox trying to abait the xanax due to tremendous guilt and feelings of inferiority....especially around AA. I may have to accept xanax in my life as the only solution to the physiological symptoms of panic. I am very tired of trying to solve this problem with what ever technique or therapy is availed me. I have been wired this way since age 4 since my little brother died. I am not sure therapy can rewire circuits that entact or that old. I am now 42. You did mention that therpists and counselors etc. were not affiliated with AA. I know the literature and how it states it's non affilation mantra yet.......the therpay boom was a direct result of the popularity of treatment centers and in house counseling to be continued on outpatient basis. I have been around meetings since the late 70's. The therpay field has grown leaps and bounds as a direct result of affiliations to AA. Only since insurance companies getting greedieer has the pace slowed. The invention of AA was self supporting only in the first 30 years. The last 25 to 30 has seen the rise and fall of treatment centers, the rise and fall of pyschological phases...inner child issues, codependency issues, etc. Most of these offshoot industries especially therpy has been a direct result of treatment center mantra. Most people are referred to a therapist from a loving member in AA or Alanon. The therapist I see I always know someone in the lobby from meetings. The comingling of therapy and 12 step groups is furthered by lecture series at alano clubs, open talks, etc. Now don't get me wrong I think this is a good thing. The more help the merrier. But the days of AA as a self supporting institution have been gone since the late seventies boom of rehab centers.
P >S > I always thought we should visit Lois's grave on founders day. She stood by a man who couldn't hold down a job, brought drunken strangers home, chased other women even after sobriety, Did Bill even have a real job after getting sober? Lois must have made more coffee than Mrs. Folger.....I credit her with founding AA. If Bill didn't have her money, her home, her work ethic or her loyalty....me thinks AA would not be here.
Gil
Posted by JCB on June 24, 2001, at 11:35:30
In reply to Addictive meds in general, posted by JCB on June 22, 2001, at 0:58:18
Well, I may be wrong, but as mentioned at the beginning of every AA meeting I've attended, they claim to be self supporting and not allowed to be affiliated with any other organization. The treatment center where I work donates a room for the meetings to take place (we don't charge them rent). I realize that referals are made back and forth between treatment centers and AA, but unless something has changed that I'm not aware of, AA is NOT permitted to affiliate their name with any other organization or vica verca. Just an FYI.
Posted by gilbert on June 24, 2001, at 11:59:59
In reply to Re: Addictive meds in general, posted by JCB on June 24, 2001, at 11:35:30
JCB,
Thank you for the discussion even though we agree to disagree. You are proving my point in your last post. AA is not supposed to take donated time from any facility. This makes them supported by you and not self supporting. This was warned against in the early literature. They then owe you something. The meetings are supposed to fly on their own no matter how well intentioned the purpose. This is why the founders turned down Rockefeller's offer of money. This is how we get comingled with outside facilities. The favor is well meaning but the fellowship as a whole than becomes dependent on your facility to have that meeting. Would they exist if a fair market rent was charged. Does your treatment center use the meeting as a tool for their inpatient members......You see this is how the treatment centers all have worked. Now I don't know of any friend in AA who sees a therapist or counselor that was not a referral from another AA member. So their is alot of unintended comingling. Simply because it is read that AA ought to be self supporting does not make it true. The patients of your rehab cneter who pay or insurance companies who pay for their stay are footing the rent bill for that particular group,. This is definetly a tradition breaker.
Again this is starting to be like tennis but I do enjoy the debate
Thanks,
Gil
Posted by JCB on June 24, 2001, at 12:08:44
In reply to Re: Addictive meds in general, posted by gilbert on June 24, 2001, at 11:59:59
I never thought of it that way, but you're absolutely right. What else can I say :-) Thanks for enlightening me to this latent relationship.
Posted by Zo on June 24, 2001, at 15:55:33
In reply to mood disorders/klonopin,depakote,neurontin etc...., posted by paul on November 26, 1998, at 8:21:48
. . as depakote, or Klonopin. It is not addictive, or habit-forming, and while no med can be ruled out as having a negative effect on someone, Neurontin works for many conditions such as anxiety, TLE and pain by caliming the excitable GABA receptor sites. Altho it was hell to get on and ramp up, because of daytime fogginess, it has been nothing but beneficial to me, and is remarkably non-toxic. No comparison to other anticonvulsants, which can be nasty buggers.
Posted by Elizabeth on June 25, 2001, at 2:50:07
In reply to Addictive meds in general, posted by JCB on June 22, 2001, at 0:58:18
The term "addiction" is confusing. This is due, in part, to changing definitions. Twenty years ago, any drug that had a characteristic withdrawal syndrome was considered "addictive," and people who took such drugs (regardless of how they took them) were uniformly considered "drug addicts." It was a relatively simplistic and objective definition.
Today, "addiction" refers to the psychological disorder classified as "substance dependence" in DSM-IV. The tolerance/withdrawal syndrome is more properly identified as "pharmacologic dependence." It is not a disease, but a normal response to taking drugs for a long enough period of time. It is recognised that people who take drugs that have virtually no abuse potential (including many antidepressants) do often experience withdrawal symptoms if they discontinue the drug abruptly or miss a dose. This phenomenon, it is recognised, is not properly considered to be a drug addiction, and people who use antidepressants, anticonvulsants (including benzodiazepines), certain cardiac drugs, stimulants, glucocorticoids, opioids, etc., on a daily basis are not automatically classified as "drug addicts." It is understood that these drugs can and are used in a nonpathological way in the treatment of such conditions as depression, bipolar disorder, anxiety disorders, chronic pain, hypertension, tremor, attention deficit disorder, narcolepsy and some other sleep disorders, inflammatory conditions, autoimmune diseases, organ transplantation, etc.
The realisation that many classes of drugs thought to be virtually free of abuse potential -- such as SSRIs, tricyclics, MAOIs, centrally-acting alpha-adrenergic agonists, glucocorticoids, and anticonvulsants other than barbiturates and benzodiazepines -- can cause characteristic withdrawal syndromes and/or rebound symptoms is clinically important, because it is extremely important that these drugs be abruptly only in emergencies.
The distinction between true addiction and pharmacologic dependence is also important because "addiction" is such a loaded word today. Most people who take benzodiazepines for anxiety, stimulants for ADHD or narcolepsy, opioids for pain, etc., do *NOT* become drug addicts. Withdrawal symptoms are normal responses to discontinuation of these drugs, just as it should not surprise a pdoc (or other medical professional or counselor) if a person suffers withdrawal symptoms when he or she tries to stop taking Paxil or Effexor.
It is incorrect and misleading to label a person a "drug addict" based solely upon the manifestation of the substance-specific withdrawal syndrome upon discontinuation of the drug. Although most addicts do suffer withdrawal symptoms, there is much more to addiction than that.
Although I don't generally think that the DSM-IV definitions of mental disorders are very useful or precise, the definitions of substance dependence and substance abuse are worth careful examination -- *especially* by mental health professionals. A MHP who is unaware of the difference between true addiction and pharmacologic dependence runs the risk of placing people in "treatment" programs which will, at best, be of no benefit; indeed, the stigmatising label of "addict" may be harmful to these people in many cases.
It might be of interest that a standard medical school pharmacology textbook (Goodman & Gilman's _Pharmacological Basis of Therapeutics_) recommends doing away with the word "addiction" altogether because of its pejorative connotations and the confusion surrounding its meaning.
-elizabeth
Posted by Elizabeth on June 25, 2001, at 3:30:29
In reply to Re: Addictive meds in general, posted by gilbert on June 22, 2001, at 10:30:37
Gil,
Like you, most people taking doses within the accepted therapeutic range can taper off benzos without suffering significant withdrawal symptoms. With appropriately cautious tapering, seizures are almost unheard of. The discontinuation process often has to be an extremely slow one, though, especially with short-acting benzos such as Xanax or if the person has been taking the benzos for a very long time.
I've encountered 12-steppers who express the sort of attitude you mention, that the use of benzodiazepines (or even, sometimes, of antidepressants!) jeopardises the sobriety of a recovering addict. Although addiction history should be considered, my own opinion is that alcoholism and other addictions should *never* be seen as absolute contraindications for the use of benzos in the treatment of anxiety disorders.
Although people who are currently abusing other drugs are the most likely to abuse prescribed benzos (otherwise, abuse is almost unheard of), many people originally *became* addicts (alcoholics in particular) when they realised that they could use drugs to "self-medicate" lifelong anxiety disorders. Denying these people BZDs may actually put them at *increased* risk of relapse. Such patients should be carefully monitored, of course, but benzos are extremely safe and effective for anxiety, while alcohol carries all sorts of health risks as well as the general risk of addiction associated with unmonitored self-medication.
SSRIs have been touted for anxiety disorders, but many anxiety patients find the side effects *very* hard to tolerate. Benzos, in contrast, are almost invariably well-tolerated. Personally I have never experienced any adverse side effects from my intermittent use of benzos or for the month or so that I took Klonopin daily.)
> I also have never wanted to take them to get high in fact I don't feel high at all from taking them...they just get rid of the panics and make me feel normal.
Same here. I have a hard time believing that *anyone* would find benzos a "high." I suspect that, more often, people who use unprescribed benzos are using them to stave off withdrawal symptoms from other drugs such as heroin and alcohol.
> Even though tolerance may appear after the initial dose most people can maintenace dose with the same amount year after year.
Tolerance to the anxiolytic effects is the exception, not the rule, with benzos. (People do grow tolerant to side effects like sedation, dizziness, and appetite stimulation, though.)
> I will tell you all drugs cause dependence at some level.
Yes, this is just what I was getting at ("physical" or "pharmacologic" dependence). Unfortunately, even many mental health professionals do not understand the difference. As a result, many non-drug-abusing anxiety patients are pressured to stop taking benzos, and some are even pushed into "rehab" programs where they don't belong at all!
> Even blood pressure drug removal causes rebound.
Very true. Clonidine, an antihypertensive often used for ADD-associated hyperactivity, is particularly notorious for this (something which child psychiatrists too often fail to mention to the parents!). People who take glucocorticoids (cortisol-like steroids such as prednisone, dexamethasone, etc.) can suffer severe, even fatal, withdrawal reactions if the drug is suddenly discontinued. And benzos and barbiturates aren't the only anticonvulsants that can cause rebound seizures; all anticonvulsants have this potential (which makes me rather concerned about the extremely liberal use of these drugs in off-label conditions).
> I have never thought wow why don't I take a bunch of xanax and go hang out downtown and party. They just don't feel or work that way. I have been able to take xanax and do things I was always afraid to do ....
I know exactly what you mean; buprenorphine is similar for me. When used responsibly, these two drugs (which generally have low potentials for abuse anyway) are, as you say, life-savers. There are many people out there like us who can function on a day-to-day basis because of these medications.
-elizabeth
Posted by Annabelle on June 25, 2001, at 5:37:57
In reply to Re: Addictive meds » JCB, posted by Elizabeth on June 25, 2001, at 2:50:07
> The term "addiction" is confusing. This is due, in part, to changing definitions. Twenty years ago, any drug that had a characteristic withdrawal syndrome was considered "addictive," and people who took such drugs (regardless of how they took them) were uniformly considered "drug addicts." It was a relatively simplistic and objective definition.
Thank you for your voice of WISDOM. I think I mentioned this, but my Dad, who is 91 does not want to take any sleeping meds, even though he has a life-long history of sleep problems (which my brother and I seem to have also)because he does not want to become ADDICTED! Dad also suffers from life long depression. In the 40s and 50s whenever he had some Benezedrine he felt better. He begged the family MD to let him have some 'only for when he felt 'lousey and down'', but that was looked upon as ADDICTIVE. He was born before the days of AntiD's, but if the doctors had let him have small doses of Benezedrine, I believe it would have made a great difference in his life, and our entire family.
Annie
Posted by Elizabeth on June 25, 2001, at 6:01:08
In reply to NEURONTIN is not in the same class. . ., posted by Zo on June 24, 2001, at 15:55:33
> . . as depakote, or Klonopin. It is not addictive, or habit-forming, and while no med can be ruled out as having a negative effect on someone, Neurontin works for many conditions such as anxiety, TLE and pain by caliming the excitable GABA receptor sites.
GABA is an *inhibitory* (not excitatory) neurotransmitter, so drugs that activate GABA receptors, inhibit the metabolism of GABA (e.g., Nardil and vigabatrin), block the GABA transporter (e.g., tiagabine), or potentiate the effects of endogenous GABA (e.g., benzodiazepines), cause *decreased* firing and CNS depression (*not* the same thing as "depressed mood"). This is thought to be the basis for their efficacy in the treatment of seizures, anxiety, and mania.
Neurontin's molecular structure resembles that of GABA, so it was natural for researchers to hypothesise that it might produce its effects through GABA-ergic actions. Last I checked, though, nobody had been able to figure out what the stuff does. It is not a GABA-A agonist or a promotor of GABA release. Some research suggests that it may be an agonist at certain GABA-B receptors, however. Another possibility is that it increases GABA activity and/or decreases glutamate activity via enzyme induction. It does seem to alter GABA turnover, a property shared by some other anxiolytic drugs.
Interestingly, I found that Neurontin actually *felt* sort of like Xanax, although it was not as effective for panic disorder. (I probably didn't try a high enough dose; since I didn't have problems with sedation, I've considered giving it another try.) It's not clear whether Neurontin is as effective for anxiety as the benzos are, but there are some studies and anecdotal reports suggesting that it may be worth trying for sufferers of anxiety or mixed anxiety/mood disorders.
> Altho it was hell to get on and ramp up, because of daytime fogginess, it has been nothing but beneficial to me, and is remarkably non-toxic. No comparison to other anticonvulsants, which can be nasty buggers.
Lamictal, which has gained some popularity as an antidepressant-anticonvulsant for people with bipolar-spectrum disorders, is also pretty much free of side effects (and usually isn't sedating the way that Neurontin can be for some people). Lamictal might be a better first choice for people whose problems are more associated with depression or mood swings, while Neurontin may be preferable for those with major anxiety disorders.
-elizabeth
Posted by gilbert on June 25, 2001, at 20:00:18
In reply to Re: Neurontin » Zo, posted by Elizabeth on June 25, 2001, at 6:01:08
Hi Elizabeth..........welcome back,
I have found xanax to have less side effects and to be more stable for panic than nerontin. I know some are getting good effetcs fromnerontin though.Gil.
Posted by Elizabeth on June 27, 2001, at 6:00:12
In reply to welcome back, posted by gilbert on June 25, 2001, at 20:00:18
> Hi Elizabeth..........welcome back,
Hi to you. I'm glad to be back.
> I have found xanax to have less side effects and to be more stable for panic than nerontin. I know some are getting good effetcs fromnerontin though.
That's about what I would expect. I don't have very frequent attacks (since I take ADs), and Neurontin seemed to do some good. It ended up not being worth it because it didn't help with the depression (the real tough problem for me) and I was getting the munchies a lot on it. (I had a real problem with weight gain on Nardil and don't want to repeat that.)
-elizabeth
Posted by Zo on June 28, 2001, at 1:46:20
In reply to Re: Neurontin » Zo, posted by Elizabeth on June 25, 2001, at 6:01:08
> Lamictal, which has gained some popularity as an antidepressant-anticonvulsant for people with bipolar-spectrum disorders, is also pretty much free of side effects (and usually isn't sedating the way that Neurontin can be for some people). Lamictal might be a better first choice for people whose problems are more associated with depression or mood swings, while Neurontin may be preferable for those with major anxiety disorders.
>What these drugs have in common, and what Bipolar, TLE (which I have) and certain other conditions have in common, and what Neurontin seems to "de-excite" is the interest effect of Kindling. It has also been of significant, life-changing help with my CFS / muscle pain / Stage 4 sleep.
Lamactil, interestingly, did not "feel" the same way at all, subjectively, and I never was able to find a good dose. . . for me, it wasn't tolerable.
Neurontin *can*, despite what you may have heard, be taken all at bed. Taken this way, I have no sedation during the day. . and have no break-thru pain or TLE.
Zo
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