Posted by yxibow on November 28, 2006, at 3:06:53
In reply to Re: Difference between Ativan and Valium? » ace, posted by Quintal on November 27, 2006, at 23:28:05
> > >Also addiction (within the context of dependence) denotes that the user needs higher and higher doses to sustain efficacy
> >
> > Is that not tolerance?
>
> >See above.
> --------------------------------------------------
> The American Heritage® Dictionary of the English Language: Fourth Edition. 2000.
>
> TOLERANCE
>
> SYLLABICATION: tol·er·ance
> PRONUNCIATION: tlr-ns
> NOUN: The capacity to absorb a drug continuously or in large doses without adverse effect; diminution in the response to a drug after prolonged use. <Hence requiring a progressive *increase* in dose.>
>
> --------------------------------------------------
>
> >> >The term 'dependence denotes compulsive or chronic need
> >
> > Isn't that addiction?
>
> >Not by the medical dictionary I have. But, there always seems to be some semantic confusion with these two terms.
> --------------------------------------------------
>
> The American Heritage® Dictionary of the English Language: Fourth Edition. 2000.
>
> ADDICTION
>
> SYLLABICATION: ad·dic·tion
> PRONUNCIATION: -dkshn
> NOUN: 1a. Compulsive physiological and psychological need for a habit-forming substance: a drug used in the treatment of heroin addiction. b. An instance of this: a person with multiple chemical addictions. 2a. The condition of being habitually or compulsively occupied with or or involved in something.
> --------------------------------------------------
> Yes, it seems there is a semantic overlap between addiction and dependence putting it loosely, in the sense that dependence is a chronic need for the substance and addiction is the compulsive desire. It's hard to tease out addiction from tolerance, since there is often a craving for a stronger 'hit', but that may not reflect changes in physical tolerance to the drug, rather a mental desire for a stronger effect. Tolerance being changes in the amount needed to produce the same effect.
>
> >But I do think benzo's are wonderful agents and should be issued more. Maybe one day I will see certain phenomena with regards to benzo's that steers my mind, but for the moment, I am definitely a strong advocate of the drugs.
>
> Agreed!!!
>
> Q
>
This has been discussed ad nauseum, to paraphrase a Ratherism, the semantics are "a ding dong battle back and forth". And I completely agree with the above -- there are definite distinctions between addiction, tolerance, and habituation, all three of which can occur at the same time.
Addiction, in its primary sense is the non-medical use of medical (or street obtained) substances for non prescribed purposes -- recreation gone too far, to be crude.
I have no issue one way or the other with personal recreational use of drugs -- I think the law enforcement community has better things to do, at least with "soft" substances like marijuana. If it were legalized like alcohol (not too strangely the roaring 20s were another period of pot use and the movie Grass features clips from anti-pot movies made by the government that are rather hilarious in todays context.)
Granted there are non hilarious mexican mafias behind some marijuana usage but of course that is because of enforcement (mind you I've never tried but have no particular mindset on the substance), it equally flows from Canada and there is a relative lack of machinegun use in the northwest... anyhow I'm straying from the point -- if it were made like alcohol, 21 (or 18 or whatever) this would all go away.Now I'm not talking the same thing about crack and heroin and meth, etc... one can get the point.
Getting back to addiction -- it is a medical phenomenon that we are finding is primarily a biochemical based issue -- and possibly quite genetic as well. So addiction would be the forging of prescriptions, and as I said since it can occur at the same time as habituation and tolerance, the hiding of just how much one is actually taking of a substance from a doctor or doctor shopping until it reaches a point that it can't be hidden.
Tolerance and habituation are close synonyms -- habituation occurs when tolerance to a substance happens. This is why long half life benzodiazepines are much safer than short half life ones for long term therapy. Ativan requires twice daily dosing for a number of people and is generally more of a PRN (as needed) medication usually, as is Xanax.Valium has gotten an old 1960s Valley of the Dolls, Mother's Little Helper reputation, when in fact its 24+ hour half life means that adjustment of dosages are smoother and less harsh on the patient because there is a standing blood level at a high steady state. Medications that require 2, 3, and 4x dosing can have interdosal withdrawals.
Either Valium or Klonopin (sometimes 2x daily for Klonopin) are good long term benzodiazepines -- some people here have claimed Klonopin can cause depression, although this is a possibility of most benzodiazepines in those who already suffer from depression in the first place and they are CNS depressants themselves.
There have been people on benzodiazepines since they came out in the early 1960s. This is not to say they're candy, but proper dosing with observation for tolerance is probably among the safest psychiatric drug regimes; they also have a high LD50 (morbidity) which I am not going to note for obvious reasons. This also probably varies for those who are used to a higher level of benzodiazepines in the first place or are fast metabolizers.So to sum it up I would actually say that Valium is a better choice for long term than Ativan, but I am not your doctor and I cannot advise that medically. It is just a personal opinion.
-- tidings
Jay
poster:yxibow
thread:707968
URL: http://www.dr-bob.org/babble/20061123/msgs/708110.html