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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by simcha on August 22, 2010, at 23:59:39
OK, I know this is an old topic. And I saw that the substance use board has been moved back onto this board (I think) so I hope that this is in the right place. I just want to have this discussion to see what others are thinking these days. I haven't been around here in years so I don't know many of you yet.
I am medically dependent on Sotalol to keep my heart rate at a normal rate. Without it my heart can race at 160bpm. I wouldn't call this addiction.
I'm medically dependent on BuproprionXL and Cymbalta. Even though I'm depressed again, I know it would be much worse without these meds. I still haven't reached my all time low with depression since I've been taking anti-depressants. I don't feel like I'm addicted to my anti-depressants.
I'd say I'm medically dependent on Clonazepam at 0.5mg per night. It is the only thing that has worked for my restless legs syndrome, honestly. I did a good run of Neurontin (Gabapentin) for years so I wouldn't be on a benzo but it didn't work. For me quitting Clonazepam, which I took for years at 1mg per night for restless legs, was easy. I just followed the taper schedule and had no real cravings or side effects. Of course I was ramping up on Neurontin at the same time so I don't know if that was a factor. However, if I miss a dose these days for a night or two I do get my restless legs back but I don't feel like I'm fiending for Clonazepam. I don't have any of the withdrawal symptoms that others describe when they have stopped Clonazepam. Maybe I'm just lucky? I don't feel like my use of Clonazepam could be classified as addiction.
I'm medically dependent on Trazodone. It's the only thing that has worked for my chronic insomnia (with my breathing machine for mild sleep apnea). I have sleep onset insomnia with the sleep apnea. It's a killer combination. I have been doing so much better healthwise since I've been on Trazodone steadily and using my machine and sleeping better. I don't feel like I'm addicted to Trazodone.
I may become medically dependent on Lamictal as I titrate up to a therapeutic dose, if it works to boost the anti-depressant effect of the BuproprionXL. Maybe it will help me get off of Cymbalta which gives me some side effects I'd rather not live with such as uncontrollable sweating and anorgasmia at times. If I were to become medically dependent on Lamictal, I wouldn't feel like I was addicted to it.
I am not addicted to or medically dependent on Ambien. I can take it or leave it. I take it maybe once every other month when the insomnia hits like a freight train. I've never felt a need to continue taking it and I've never had cravings. I don't believe I'm addicted to Ambien.
In my point of view, every medication I'm on that is prescribed to me for specific conditions makes me medically dependent on that medication to do what it's intended to do. Yes, some of the medications I'm on have caused horrible withdrawal side effects when I've had to stop. EffexorXR was a nightmare to stop, literally. I'd rather quit Clonazepam any day cold turkey than taper down to quit EffexorXR again. Quitting Clonazepam for my several year experiment with Neurontin was a piece of cake for me. Quitting EffexorXR made me realize what Hell must people go through when trying to quit drugs. Even though it was Hell to quit EffexorXR, I don't feel I was addicted to it because I needed it at the time I took it for my depression.
So, at when does medical dependence become addiction? I'm curious at what others have to say about your own experiences and opinions. Thanks, Simcha.
Posted by Christ_empowered on August 23, 2010, at 1:09:32
In reply to Meds: Addiction vs. Medical Dependence, posted by simcha on August 22, 2010, at 23:59:39
I don't think there's any dose at which meds (usually controlled substances) used for treatment become "addictive" or ongoing use indicates "addiction," although higher doses would probably set off more whistles than lower doses.
I seem to recall reading an article written back when they were still using lots of amphetamines and barbiturates about "therapeutic addiction." Basically, the doc writing the piece (wish I could find a link, sorry) thought that the important thing was that the "therapeutic addiction" resulted in a) an improved quality of life and b) prevented something worse than being "hooked" on the substance(s) prescribed. So, if you're on Klonopin and the klonopin improves your quality of life, reduces your suicide risk, and keeps you from, say, drinking heavily or doing something else that could be damaging to your health and well-being, then this "therapeutic addiction" is OK b/c benefits outweigh the (rather socially acceptable) addiction/dependence. I like the "therapeutic addiction" model b/c it doesn't require you to differentiate between "dependence" and "addiction"; it just asks you to look at the pros and cons.
Posted by Dan_MI on August 23, 2010, at 1:25:29
In reply to Meds: Addiction vs. Medical Dependence, posted by simcha on August 22, 2010, at 23:59:39
All I know is I am completely unable to sleep without some kind of Mother's Little Helper. God help me if society ever crumbles and I can't get my trazodone anymore.
> OK, I know this is an old topic. And I saw that the substance use board has been moved back onto this board (I think) so I hope that this is in the right place. I just want to have this discussion to see what others are thinking these days. I haven't been around here in years so I don't know many of you yet.
>
> I am medically dependent on Sotalol to keep my heart rate at a normal rate. Without it my heart can race at 160bpm. I wouldn't call this addiction.
>
> I'm medically dependent on BuproprionXL and Cymbalta. Even though I'm depressed again, I know it would be much worse without these meds. I still haven't reached my all time low with depression since I've been taking anti-depressants. I don't feel like I'm addicted to my anti-depressants.
>
> I'd say I'm medically dependent on Clonazepam at 0.5mg per night. It is the only thing that has worked for my restless legs syndrome, honestly. I did a good run of Neurontin (Gabapentin) for years so I wouldn't be on a benzo but it didn't work. For me quitting Clonazepam, which I took for years at 1mg per night for restless legs, was easy. I just followed the taper schedule and had no real cravings or side effects. Of course I was ramping up on Neurontin at the same time so I don't know if that was a factor. However, if I miss a dose these days for a night or two I do get my restless legs back but I don't feel like I'm fiending for Clonazepam. I don't have any of the withdrawal symptoms that others describe when they have stopped Clonazepam. Maybe I'm just lucky? I don't feel like my use of Clonazepam could be classified as addiction.
>
> I'm medically dependent on Trazodone. It's the only thing that has worked for my chronic insomnia (with my breathing machine for mild sleep apnea). I have sleep onset insomnia with the sleep apnea. It's a killer combination. I have been doing so much better healthwise since I've been on Trazodone steadily and using my machine and sleeping better. I don't feel like I'm addicted to Trazodone.
>
> I may become medically dependent on Lamictal as I titrate up to a therapeutic dose, if it works to boost the anti-depressant effect of the BuproprionXL. Maybe it will help me get off of Cymbalta which gives me some side effects I'd rather not live with such as uncontrollable sweating and anorgasmia at times. If I were to become medically dependent on Lamictal, I wouldn't feel like I was addicted to it.
>
> I am not addicted to or medically dependent on Ambien. I can take it or leave it. I take it maybe once every other month when the insomnia hits like a freight train. I've never felt a need to continue taking it and I've never had cravings. I don't believe I'm addicted to Ambien.
>
> In my point of view, every medication I'm on that is prescribed to me for specific conditions makes me medically dependent on that medication to do what it's intended to do. Yes, some of the medications I'm on have caused horrible withdrawal side effects when I've had to stop. EffexorXR was a nightmare to stop, literally. I'd rather quit Clonazepam any day cold turkey than taper down to quit EffexorXR again. Quitting Clonazepam for my several year experiment with Neurontin was a piece of cake for me. Quitting EffexorXR made me realize what Hell must people go through when trying to quit drugs. Even though it was Hell to quit EffexorXR, I don't feel I was addicted to it because I needed it at the time I took it for my depression.
>
> So, at when does medical dependence become addiction? I'm curious at what others have to say about your own experiences and opinions. Thanks, Simcha.
Posted by Phillipa on August 23, 2010, at 10:49:02
In reply to Re: Meds: Addiction vs. Medical Dependence, posted by Dan_MI on August 23, 2010, at 1:25:29
Since you have included all categories of meds here I will add my synthroid which I must take due to a medical condition. So some meds are necessary to live. Think of heart medications or insulin same to me. Phillipa
Posted by linkadge on August 23, 2010, at 12:32:51
In reply to Re: Meds: Addiction vs. Medical Dependence, posted by Phillipa on August 23, 2010, at 10:49:02
Good question. Christ_Empowered made some good points.
I think it really just boils down to whether your doctor wants to portray your predicament as a "good thing" or a "bad thing". This, of course, depends on what is considered good medical practice at the time.
The problem is that, with many agents, it is possible to be both medically dependant and addicted.
Take paxil for instance. There are people who are medically dependant on paxil i.e. they need to keep taking it or else true return of the depression disease will occur. There are also people who are addicted to paxil. These people don't need the drug for depression any longer. However, they cannot stop because withdrawl symptoms are too severe.
In the latter case however, doctors still tend to refrain from referring to this being addiction. After all, to do so would be to classify paxil as an addictive substance, which would be a bad thing for the buisness.
Because of the whole antidepressant addiciton/dependance argumnet, the current tendancy is to classify addiction as using a substance which:
-loses effectiveness at a consistant dose, and requries dosage escalation for effect.
-gets people "high". The patient "likes" the high effect, which is biologically seperable from the medicinal effect.
There are other drugs which can fall into either category or both categories.
- benzodiazapines
- stimulants
- opiates
- certain anticonvulsants (like gabapentin)
- antidepressants *I personally believe that antidepressants meet all the criteria for addictive substances in some patients.
For instance, some patients "like" the effect of antidepressants, i.e. the drugs give them a bit of a high. Some patients need dosage escalation to maintain the theraputic effect. Some patients have severe withdrawl if drug use is interupted.
With the advent of the SSRIs, there is a tendancy to consider benzodiazapines addictive or habbit forming. In studies of new anxiolytic agents, I have seen researchers refer to the new substance as not producing withdrawl symptoms like the SSRI agents. So, over time, doctors may change their classification of a substance based on which agents are used to treat a condition.
I think the bottom line is whether you are taking the substance for a legitimate medical condition and whether you are taking the medication as instructed. If so, doctors tend not to use the word addiction.
Linkadge
Posted by simcha on August 23, 2010, at 18:42:09
In reply to Re: Meds: Addiction vs. Medical Dependence, posted by linkadge on August 23, 2010, at 12:32:51
Thanks everyone for your thoughtful responses. I struggle with this topic sometimes when I hear people talking about not wanting to go on a benzo for anxiety or some other legitimate use, use an opiate for pain, or use an anti-depressant because they don't want to become "addicted" or "dependent."
I don't like being dependent on medication in order to have a decent quality of life. And I continue to choose to take my medications because they allow me to have a decent quality of life.
Sometimes I worry that if we have a terrible disaster (I'm in the Bay Area, think earthquakes) and I can't get my meds, what would happen. Also, I sometimes worry that if our country's economy and politics crash, I won't be able to get my medication. And I wonder what it would be like to run out of medication and be forced to stop cold turkey due to lack of supply. These thoughts don't dominate my life. They are there though like birds chirping in the trees as I walk down a forest path on a summer day.
To me, addiction involves way more than simply taking a drug/medication and becoming dependent on it. To me, addiction means that there are other underlying psychological issues that cause people to use substances, food, sex, gambling, shopping, etc. in order to blot out reality because reality is too painful. I believe that a true addict receives real negative consequences for their behaviors including the use of whatever it is that they are using as an object of their addiction.
In my point of view, the difference between addiction and medical dependence on drugs/medications boils down to this: Addiction to drugs/medications makes one's life unmanageable. It makes one's life miserable and one's ability to function in the world is impaired. Medical dependence to drugs/medications entails being dependent on these substances in order to improve one's condition and functioning in the world. In medical dependence the consequences of quitting these medications/drugs would be decreased functioning and a lessened quality of life.
Well, that's my two cents.
Posted by Phillipa on August 23, 2010, at 20:33:11
In reply to Re: Meds: Addiction vs. Medical Dependence, posted by simcha on August 23, 2010, at 18:42:09
If only my body would let me give up this dumb 50mg of luvox been on for so many years feel nothing from it but try to get off? And of course SSRI. Phillipa
Posted by emmanuel98 on August 23, 2010, at 21:35:49
In reply to Re: Meds: Addiction vs. Medical Dependence » simcha, posted by Phillipa on August 23, 2010, at 20:33:11
The medical literature differentiates between dependence and addiction, even for addictive substances like benzos and stimulants and opiates. All cause dependence. Unlike SSRIs or syntrhoid, people become habituated and need higher and higher dosages to achieve the same effect. For example, people who are on opiates for chronic cancer pain might start out with 20mg oxycontin and end up with 80mg twice a day.
Addicts, on the other hand, usually self-prescribe and do not take the drug for a medically recognized problem. Opiate addicts, for example, suffer no physical pain (unless they try to stop the opiates), do not obtain the drugs legally, but buy them on the street or doctor-shop or forge prescriptions.
I am dependent on parnate for depression and ativan and trazadone for sleep, but I don't use higher dosages than prescribed, don't sneak around behind my doc's back to get more. The ativan causes physical dependence such that attempts with withdraw suddenly can be life-threatening. But I am not addicted.
I was addicted, however, to opiates. I started out using them as prescribed for a legitimate medical reason. The pain condition ended, but I lied to my doctor about it, bought them on the street and over the internet, got habituated and needed higher and higher dosages to obtain the same "high", was using them for the euphoria rather than for pain relief. That's addiction in a nutshell.
Posted by Phillipa on August 23, 2010, at 22:09:24
In reply to Re: Meds: Addiction vs. Medical Dependence, posted by emmanuel98 on August 23, 2010, at 21:35:49
Sad our bodies require meds and once on them can't do without them. Phillipa
Posted by linkadge on August 24, 2010, at 10:24:42
In reply to Re: Meds: Addiction vs. Medical Dependence, posted by emmanuel98 on August 23, 2010, at 21:35:49
>unlike SSRIs or syntrhoid, people become >habituated and need higher and higher dosages to >achieve the same effect.
poppycock. Its well known that SSRIs and other antidepressants can loose their effectiveness (poop out) and require ever increasing doses to regain the initial therapeutic effect. Also, I know of people who have been on therapeutic doses of opiates or benzodiazapines for years without any dosage adjustment needed. Some people grow tolerant to stimulants, others can use the same dose consistently for years.
The point is that the lines can easily blur.
Linkadge
Posted by linkadge on August 24, 2010, at 10:36:49
In reply to Re: Meds: Addiction vs. Medical Dependence, posted by emmanuel98 on August 23, 2010, at 21:35:49
You also cannot always associate addiction with addict.
The medical community speaks candidly about "nicotine addiction". This is in spite of the fact that most people do not require ever increasing doses of nicotine and there can be some therapeutic effects from nicotine (i.e. anxiolysis).
How is paxil any less addictive? You see its all about whether the medical community wants you on the drug or off the drug.
Many years ago, the cigarette companies argued "Smoking is not addictive. Its habbit forming, but not addictive". Why? Because they were protecting their profits.
Now, the drug companies argue, "paxil is not addictive, you may not be able to discontinue (i.e. habbit forming) but its not addictive"
Why? Because they are protecting their profits.The only difference between a pack a day smoker and a 20mg a day paxiler is that one is at elevated risk of getting cancer. That, and that alone is why people get away with classifying smoking as addictive, simply because it is deemed by the medical community as a "bad thing", and hence diserving of a word with more negative connotation.
Linkadge
Posted by sigismund on August 24, 2010, at 17:33:13
In reply to Re: Meds: Addiction vs. Medical Dependence, posted by linkadge on August 24, 2010, at 10:36:49
>The medical community speaks candidly about "nicotine addiction".
Yes, there is a certain lack of candidness in the medical professions line.
In the 70s addiction simply meant that without it you would withdraw.
IMO, the line has been changed to allow for the contemporary practice of drug prescription.
Posted by Phillipa on August 24, 2010, at 20:09:44
In reply to Re: Meds: Addiction vs. Medical Dependence, posted by linkadge on August 24, 2010, at 10:36:49
Link I feel you're points are very valid. Phillipa
This is the end of the thread.
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