Posted by viridis on March 2, 2003, at 19:12:31
In reply to Tolerance more to sedative and anticonvulsive , posted by mattdds on March 2, 2003, at 18:45:23
I'll just second Matt on pretty much all of his points. It's frustrating to hear the word "addiction" used so casually (and inappropriately) -- one person in this thread even had a doctor comparing Klonopin to heroin!
Here are some definitions, from the American Society of Addiction Medicine website:
The American Society of Addiction Medicine (ASAM), the American Academy of Pain Medicine (AAPM), and the American Pain Society (APS) recognize the following definitions and recommend their use:
Addiction: Addiction is a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
Physical Dependence: Physical dependence is a state of adaptation that often includes tolerance and is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
Tolerance: Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.
What people are describing with Klonopin is almost always physical dependence. This is common with many drugs that are used for all kinds of conditions. In the list of "hardest-to-quit" meds recently released by the World Health Organization, SSRIs and Effexor figured prominently in the top 10 (benzos didn't), with Paxil at #1, as I recall. It's just that with meds that are still under patent, the preferred term for withdrawal is "discontinuation syndrome", and no one would suggest you were ever addicted.
When I started Klonopin about a year and a half ago, my psychiatrist told me that if I took it for an extended period of time I would have to slowly taper off it. Early on, I talked about quitting it, and he said fine, but chances are I'd go back to my previous, frequent high anxiety state. He considers this much worse for my mental and physical health than use of Klonopin, and I agree. I quickly developed complete tolerance to the sedative and dulling effects, but the same dose (1 mg/day) continues to have the same anxiolytic effect as in the beginning. Apparently, this pattern is pretty standard for people with anxiety disorders, and many take the same dose for years.
If I'm an addict, I sure don't feel like one.
poster:viridis
thread:205179
URL: http://www.dr-bob.org/babble/20030301/msgs/205351.html