Posted by Deus_Abscondis on September 8, 2007, at 9:00:59
In reply to Pain pills Pain pills Pain pills!, posted by coley on July 8, 2006, at 2:59:42
Hi people,
Without knowing how and why you started using the substances it is difficult to know what to say. Are they being used to eleviate depression, anxiety or to get high? Treatment options for opioid use are better understood than crack and ice.
It is interesting to hear 'that if psych meds make you feel good as opioids do then they would be problematic too'. The main difference is that, in general, psych meds don't give an increasing feel good response as the dose is escalated or they have limited therapeutic ranges and tolerance effects are not as simple. Indeed many of the anti-depressants I've tried give no mood brightening effect whatsoever and seem to act as emotional anesthetics or clamps - limiting both lows and highs and may achieve the results from indirect effects such as improving appetite, sleep, resistance to cortisol and possibly memory.
Hypnotism and CBT are good for some to help identify and deal with cravings and cues. There is good evidence that physical exercise - the harder you can go the better - is useful in a wide range of mental health problems as is enriching one's lifestyle but may require a lot of support - e.g., personal coaches
The euphoria associated with stimulants (injectable or smokable) are very powerful and set the reward centres to a high level such that ordinary life experiences seem dull by comparison - resetting means finding joy in the ordinary and the subtleties of everday life experiences - this requires ongoing retraining, goal setting and self rewarding that requires sustained effort and sustained support. Meditation (including guided meditation is a useful adjunct).
There is growing evidence that some people have deficiencies in their reward 'circuits' and are effectively unable, without the use of supportive medication, of feeling as 'good' as 'normal' people. This presents a challenge to medicine, therapists and policy makers as what may be an abusable recreational drug for some normalises these people. For example I can take 15mg of dexamphetamine and sleep soundly for 8 hours waking refreshed (I don't do this as a normal regime - I use a smaller dose - interestingly caffeine interferes more with my sleep than dex).
Of course therapeutic doses are usually a lot smaller than recreational doses if the user gives into dose escalation - i.e., they aren't managed.
Unfortunately gene therapy is a long way off.I was shocked to find out that a very intelligent and functional work acquaintance of mine who is an expert in their field used heroin daily and had done so for over the ten years I knew them without ill health effects and with no-one being wise to the fact. This is the exception rather than the rule but it illustrates my point. Nor should it be taken as an advocacy that anyone should try.
My personal belief is that very slow taper rates off a drug together with a supportive, systematic, comprehensive, holistic program (group therapy is one component) that may include transitional replacement medication (e.g., buprenorphine for opioids) has a better chance of success than cold turkey approaches. Stimulant withdrawal is trickier but initial replacement with pharmaceutical grade medications (e.g., Adderall, noradrenaline re-uptake inhibitors, dopamine agoinists/re-uptake inhibitors) is far preferable than street drugs as it removes the behavioral cues and re-inforcers of the addiction, doses can be accurately measured and harm minimised. Dosing could be sustained - vis a vis ADHD or morning dose.The notion of dependency in the light of a deficient underlying mechanism stigmatises medicine use. No one would question a diabetics use of insulin.
D
poster:Deus_Abscondis
thread:665042
URL: http://www.dr-bob.org/babble/subs/20070626/msgs/781582.html