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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by Krazy Kat on November 26, 2001, at 20:39:22
Hmmm, as often happens, I believe this could go on either board.
I'm having trouble stopping drinking this time 'round. I want to stop completely for awhile and then see if I can come back moderately (I know that's controversial, but there it is).
Anyhoo, I think part of it is a residual anxiety that is either from Prozac or is a part of my depression I haven't really recognized before.
So, am I taking the easy way out by suggesting a benzo to my pdoc? How do I bring it up? Is there anything else that is more effective to stop alcohol cravings? I haven't heard very good things about Naltrexone (sp?).
I currently take Prozac, 40 mg, and Depakote, 1000 mg.
Thanks!!
- KK
Posted by judy1 on November 26, 2001, at 21:06:08
In reply to Am I copping out by asking for a Benzo?, posted by Krazy Kat on November 26, 2001, at 20:39:22
Hi KK,
I don't think you will have any difficulty having a benzo prescribed, especially since klonopin is often used as a secondary mood stabilizer. I do think you would have better luck saying prozac is causing anxiety (and it probably is) then to say you want a benzo to help stop alcoholic cravings (which it will). It's just pdocs know 60% of their bp patients abuse substances and are vigilent about prescribing certain meds. Anyway good luck- judy
Posted by jay on November 27, 2001, at 3:10:45
In reply to Am I copping out by asking for a Benzo?, posted by Krazy Kat on November 26, 2001, at 20:39:22
Absolutely NOT! Why is there so much benzophobia around here? Benzos are what got me out of both anxiety and depression, and an added bonus when used with an a.d.Unlike a.d's, you feel yourself, much lighter, and it feels like strees is much more easily navigated.
I, my father, and many friends I know of have been on and off benzos over the past 10-12 years, NO problems with start or stop. In tough times, especially a REALLY stressful situation, and I would even include suicidal feelings, a benzo can be life a life-saving potion.
I take it when I want...I can go weeks...months..without it.
In Europe, there is now a new combination drug, one which is made of a few mg's of Xanax, and 25 mgs of Zoloft, because doctors where not prescribing this massively effective combo enough because of prejudice.
I have a good load of scientific info, not these hooky stories of people saying they got brain damage from these meds, that show how long they have been in use, their EXCELLENT safety, and wonderful efficacy. Many Canadian Medical Research Centers have started to strongly advocate the good and strong use of benzos. It seems more to be of a silly political and moral problem in the U.S. (In England, from what I hear too.)
Go for it, you will find *no* medication that comes CLOSE or equals benzos for anxiety AND even certain parts of depression.
Best wishes....and be happy because you are getting an excellent option, and will do well.
Jay :-)
> Hmmm, as often happens, I believe this could go on either board.
>
> I'm having trouble stopping drinking this time 'round. I want to stop completely for awhile and then see if I can come back moderately (I know that's controversial, but there it is).
>
> Anyhoo, I think part of it is a residual anxiety that is either from Prozac or is a part of my depression I haven't really recognized before.
>
> So, am I taking the easy way out by suggesting a benzo to my pdoc? How do I bring it up? Is there anything else that is more effective to stop alcohol cravings? I haven't heard very good things about Naltrexone (sp?).
>
> I currently take Prozac, 40 mg, and Depakote, 1000 mg.
>
> Thanks!!
>
> - KK
Posted by jay on November 27, 2001, at 3:21:20
In reply to Re: Am I copping out by asking for a Benzo? » Krazy Kat , posted by judy1 on November 26, 2001, at 21:06:08
> Hi KK,
> I don't think you will have any difficulty having a benzo prescribed, especially since klonopin is often used as a secondary mood stabilizer. I do think you would have better luck saying prozac is causing anxiety (and it probably is) then to say you want a benzo to help stop alcoholic cravings (which it will). It's just pdocs know 60% of their bp patients abuse substances and are vigilent about prescribing certain meds. Anyway good luck- judyIs not asking for ever increasing doses of Effexor or Prozac, and saying you need to be on them permanently, the same type of 'abuse'? I really don't understand where people can draw the line of 'abuse' between an a.d. and a benzo. If I take 4mg's of Xanax a day for the rest of my life, and take 40 mg's of Prozac for the rest of my life, there IS no difference. People also develop tolerance to a.d's more often than not. I take the same benzo dose I did twelve years ago, and get the same efficacy. I do work in both detox and drug rehab, and have seen hundreds of cases first-hand.
Also, I think clonazepam is crud as far as benzos for anxiety and depression go. It is very weak, and just *depressing*. Xanax, Lectopam, and Ativan are proven fighters not surpassed by ANY a.d. for anxiety, anxiety underlying depression, and agitation.
Jay
Posted by Krazy Kat on November 27, 2001, at 7:52:30
In reply to Re: Am I copping out by asking for a Benzo? » Krazy Kat , posted by judy1 on November 26, 2001, at 21:06:08
Thanks, Judy. You've been such a help.
How is your pregnancy going?
- K.
Posted by Krazy Kat on November 27, 2001, at 7:57:12
In reply to Re: Am I copping out by asking for a Benzo? No!!!! » judy1, posted by jay on November 27, 2001, at 3:21:20
Jay:
I think Judy was just commenting on the prejudice of some pdocs, and the need to sometimes "fudge" it, which I asked about. Even though I have a fairly open relationship with my doctor, I worry that he, too, would be prejudiced about that use.
Thanks for your comments.
- K.
Posted by judy1 on November 27, 2001, at 13:04:48
In reply to Re: Am I copping out by asking for a Benzo? No!!!! » judy1, posted by jay on November 27, 2001, at 3:21:20
Hi Jay,
I know KK understood what I meant. I also think diffrent benzos affect people differently; ativan did nothing for me, while xanax and klonopin were really beneficial. Take care- judy
Posted by judy1 on November 27, 2001, at 13:06:17
In reply to Re: Am I copping out by asking for a Benzo? » judy1, posted by Krazy Kat on November 27, 2001, at 7:52:30
I feel like a beached whale ;-), but thanks for asking. Less than 2 months to go, so I may be posting less but I wish you well- judy
Posted by jay on November 27, 2001, at 15:40:29
In reply to Re: Am I copping out by asking for a Benzo? No!!!! » jay, posted by Krazy Kat on November 27, 2001, at 7:57:12
Judy/Kat:I am sorry, I didn't mean to be so patronizing or the least bit nasty. It is hard to write something without hearing expression of my voice, and it was all in supportive encouragement.
I hope you guys understand...
Thanks..jay
> Jay:
>
> I think Judy was just commenting on the prejudice of some pdocs, and the need to sometimes "fudge" it, which I asked about. Even though I have a fairly open relationship with my doctor, I worry that he, too, would be prejudiced about that use.
>
> Thanks for your comments.
>
> - K.
Posted by Noa on November 27, 2001, at 17:01:37
In reply to Re: Am I copping out by asking for a BenzoJudy/Kat, posted by jay on November 27, 2001, at 15:40:29
Kat, I don't think taking a benzo is necessarily a cop-out. I think framing the question that way might not be so helpful--it becomes a choice between suffering and self-flagellation, no? Perhaps it would be more helpful to ask whether a benzo would be likely to help you meet the goal you are after (which I think is something about not being alcohol dependent, but addressing your anxiety problem, yes?). And if not, what would? Or, if a benzo would help, would it be sufficient to address the problem adequately or could it be part of a more comprehensive approach?
The only concern that I feel when reading your post, is, to put it simply, about putting all the eggs in one basket--the benzo could help the anxiety, but I'd monitor for whether it addresses the alcohol issue adequately, and if you seem prone to developing increased cravings for the benzo, etc. It might be what works, though, who knows.
Each of us is different. IMHO, some people seem more prone to transferring an addiction from one substance to another, while others can and have been on benzos for years without increasing the dose much or getting addicted.
Do you have a good relationship with your pdoc so that you can discuss these things openly? IMHO that is a key to good treatment.
Posted by judy1 on November 27, 2001, at 18:19:52
In reply to Re: Am I copping out by asking for a Benzo, posted by Noa on November 27, 2001, at 17:01:37
Hi Noa,
First, I'm just happy to see you back and I hope all is going well for you. From my perspective (as someone who has abused drugs in the past) I think a lot of alcoholics are simply self-medicating their anxiety disorders. Maybe that's over-generalizing, but I know in my case, once I started klonopin for my panic disorder I never increased my dose after 4 years . My pdoc claims the vast majority of his patients haven't abused benzos for their panic disorder either. I agree with Jay though that a lot of pdocs are hesitant in prescribing them (over AD's which can really hurt bp patients). Just my thoughts... Take care, judy
Posted by Krazy Kat on November 27, 2001, at 19:36:50
In reply to Re: Am I copping out by asking for a Benzo, posted by Noa on November 27, 2001, at 17:01:37
> Noa:
You're right. I am hopeful that my pdoc will be open to the situation, but am going to approach it cautiously. I've heard horror stories of Dr.'s discontinuing meds b/c a patient is drinking. That may seem far fetched, but I don't want to get caught in that situation. The Depakote has helped tremendously - I just need to get the anxiety in line.
It's tough to be honest with yourself re: alcohol - I have never had a problem with "addiction" with any other substance, that I can say for certain. So that bodes well.
Thanks for your input.
- K.
Posted by Remi on November 27, 2001, at 22:17:05
In reply to Re: Am I copping out by asking for a Benzo? » judy1, posted by Krazy Kat on November 27, 2001, at 7:52:30
Go for the benzo. I have also used them on and off for over a decade. Routine physicals with full bloodwork have revealed no problems. You just can't beat them for sudden anxiety/panic. They knock it right down. I carry some with me everywhere. For your case klonopin might be too strong if you slip up. It is quite powerful with alcohol. Try valium. Be wise about. It should calm the jitters as you make your transition. Just don't abuse it or use it with alcohol. Keep the dose as low as possible. The bad rap benzos got from some high profile abuse stories is unfortunately depriving some from a very useful tool.
Posted by jazzdog on November 27, 2001, at 22:36:50
In reply to Am I copping out by asking for a Benzo?, posted by Krazy Kat on November 26, 2001, at 20:39:22
I know that people on this thread are very pro-benzo, but I feel I'd be remiss if I didn't tell you what any accredited rehab, such as Hazeldon or Betty Ford, as well as AA, has to say about alcoholism and benzos. Basically, benzos are considered alcohol in pill form - they access the same receptors in the brain and can substitute for one another. That's why a benzo will kill a hangover. An alcoholic can substitute benzos for booze, but sooner or later a cross-addiction will kick in - the person will either become addicted to benzos or revert to alcohol or - and this is very possible - end up addicted to both. As a recovering alcoholic-addict, I can tell you that this is what happened to me. As someone who has worked with alcoholic-addicts for several years, I can tell you that I have seen this cross-addiction occur dozens of times. I do not know a single reputable addiction counsellor who would say otherwise.- Jane
Posted by Alan on November 28, 2001, at 9:23:21
In reply to Re: Am I copping out by asking for a Benzo? » Krazy Kat , posted by jazzdog on November 27, 2001, at 22:36:50
>
> I know that people on this thread are very pro-benzo, but I feel I'd be remiss if I didn't tell you what any accredited rehab, such as Hazeldon or Betty Ford, as well as AA, has to say about alcoholism and benzos. Basically, benzos are considered alcohol in pill form - they access the same receptors in the brain and can substitute for one another. That's why a benzo will kill a hangover. An alcoholic can substitute benzos for booze, but sooner or later a cross-addiction will kick in - the person will either become addicted to benzos or revert to alcohol or - and this is very possible - end up addicted to both. As a recovering alcoholic-addict, I can tell you that this is what happened to me. As someone who has worked with alcoholic-addicts for several years, I can tell you that I have seen this cross-addiction occur dozens of times. I do not know a single reputable addiction counsellor who would say otherwise.
>
> - JaneSo the patient ends up self medicating (with BZD's) the self medication (original alcoholism). I don't see how that makes the two inextricably interlinked. To say that the two drugs access the same receptors in the brain is only part of the picture. Alcohol is a bazooka compared to a laser beam like BZD's (which work on the GABA receptor sites exclusively).
I understand the need to be careful when using BZD's after someone has sobered up such as careful management and supervision but the generalised idea that BZD's are "alcohol in pill form" is misleading to say the least.
When someone "reverts" permanently to BZD's and can slowly taper to a dosage in a reasonably theraputic range with effective results, that's simply being medicated properly. There is a difference between "addictive" and "medically dependent" as I'm sure that you're aware?
This distinction seems to be lost in your above explanation. Unless you would like to further clarify.
Alan
Posted by judy1 on November 28, 2001, at 10:25:45
In reply to Re: Am I copping out by asking for a Benzo? » jazzdog, posted by Alan on November 28, 2001, at 9:23:21
Alan,
I REALLY liked the laser beam-bazooka analogy; may I borrow it?- Take care, judy
Posted by jazzdog on November 28, 2001, at 10:43:08
In reply to Re: Am I copping out by asking for a Benzo? » jazzdog, posted by Alan on November 28, 2001, at 9:23:21
Some addiction research indicates that heavy drinking turns into alcoholism when a 'chemical switch' is triggered. After that point, the brain becomes so sensitized to alcohol that any exposure inevitably triggers a desire for more. It's a theory that certainly fits with my experience. Unfortunately, benzos have enough chemical similarity to alcohol that they trigger the same set of responses. The pattern goes something like this. An alcoholic tries to stop drinking and is faced with rebound anxiety which is exacerbated by the drying out process. A benzo provides temporary relief, but it also created rebound anxiety when it leaves the body. Now the alcoholic has two substances which the brain craves to stop the anxiety, both of which will work temporarily, then worsen anxiety as they leave the body. It's difficult to describe alcoholism for someone who hasn't suffered from it, but believe me, those cravings are so powerful that they will eventually obliterate everything else in a person's life - relationships, work, everything. I know how hard it is to stop that process in its tracks - a truly heroic struggle. But in my experience benzos prolong that struggle and make it even more wretched and difficult than it has to be.- Jane
Posted by jay on November 28, 2001, at 18:30:37
In reply to Re: Am I copping out by asking for a Benzo? » Krazy Kat , posted by jazzdog on November 27, 2001, at 22:36:50
Maybe somewhat true, and I can understand your horoor and pain. I am an addiction counsellor, so I have some different views on this. It doesn't make mine right or yours wrong.
The frame of mind you have to remember is, and this is VERY big in addictions, is 'Harm Reductiuon'. Alcohol may have SOME similarities to benzos, but I have never read any scientifc literature that indicates they act in the same way.
I f alcohol weren't so intoxicating, and so physically destructive, I don't think it would be such a bad thing. But benzos don't have most of those effects, and alcohol has been proven far more damaging than benzos.
In some ways, it's like Heroin users going to Methadone, but not quite on the same scope. I am honestly perplexed by all of this indication that benzo's "do this and cause that", when there is almost no scientific proof to back it up.
SO, no I don't think alcohol in a pill is a good analogy. In 20 or 30 years of use, we rarely heard stories similar to the prozac-backlash ones, on the same magnitude. Many on here have been on and off the Same dose, or smaller, of benzo's often 10+ years, and still earmark benxzos as being the "lifesaver" when all hell breaks loose.
Anyhow...best wishes..I hope you are getting the help you need, and not settling for second-best because of little fear.
Jay
>
> I know that people on this thread are very pro-benzo, but I feel I'd be remiss if I didn't tell you what any accredited rehab, such as Hazeldon or Betty Ford, as well as AA, has to say about alcoholism and benzos. Basically, benzos are considered alcohol in pill form - they access the same receptors in the brain and can substitute for one another. That's why a benzo will kill a hangover. An alcoholic can substitute benzos for booze, but sooner or later a cross-addiction will kick in - the person will either become addicted to benzos or revert to alcohol or - and this is very possible - end up addicted to both. As a recovering alcoholic-addict, I can tell you that this is what happened to me. As someone who has worked with alcoholic-addicts for several years, I can tell you that I have seen this cross-addiction occur dozens of times. I do not know a single reputable addiction counsellor who would say otherwise.
>
> - Jane
Posted by Mark H. on November 28, 2001, at 18:44:33
In reply to Am I copping out by asking for a Benzo?, posted by Krazy Kat on November 26, 2001, at 20:39:22
Be frank with your doctor. Ask for a 30 day supply of Valium to help you get through the withdrawal of quitting drinking. Don't expect him/her to refill your prescription, however.
I don't think it's a cop-out to get time-limited help to deal with the stress of healthy change, whether it's quitting smoking, stopping drinking, or even leaving a relationship that hasn't worked out.
I think it only becomes a crutch if you continue to keep taking it rather than going to therapy and working on the issues that influence your addictions to begin with. But for short-term use, hey!, that's what it's there for.
Best of luck,
Mark H.
Posted by Chloe on November 28, 2001, at 19:56:02
In reply to Am I copping out by asking for a Benzo?, posted by Krazy Kat on November 26, 2001, at 20:39:22
KK,
YOu may want to try a local AA meeting and see what it might be like to try obstaining from alcohol in a supportive "one day at a time" setting.When I was hospitalized in my 20's, every patient was required to go to alcohol awareness classes and AA meetings 2 times a week. I thought this was ridiculous! I was never a big drinker, but I did like to have a glass or two of wine every night, or I was pretty cranky. And friends/family used to say how it "relaxed" me. I look back on what they said and cringe on how they enabled me...
Well, the awareness classes were pretty much a waste, but the AA meetings were very enlightening and helpful. Though I don't think I was an alcoholic, I was introduced to people who struggle daily to abstain from alcohol, despite the pain it caused them. And I also witnessed the destructive power of alcohol on the body, the human spirit, and relationships.
I did not stop drinking right away, but these meetings were very pivitol for me. I learned that everybody does NOT drink! And that I can survive a party or a happy hour without a drink in my hand and actually feel pretty good.
I also learned that I was making my depression worse with alcohol. Initially, it made me feel less anxious, but it came back in spades. I was often more irritable the next day, until "happy hour" the next day...I eventually figured out drinking was not worth it, I did not want to continue to numb myself. I wanted to find better ways of coping.
I have not really craved alcohol in years. There is just no room in my life for another depressant or mood DEstabilizer! The first few sips of wine were always so nice going down though! But mood wise, the price is just too high to pay, IMHO
Have you considered just going to an AA meeting before any med additions?
Just my thoughts.
Chloe
Posted by Alan on November 29, 2001, at 0:13:03
In reply to Re: Am I copping out by asking for a Benzo?, posted by Mark H. on November 28, 2001, at 18:44:33
> Be frank with your doctor. Ask for a 30 day supply of Valium to help you get through the withdrawal of quitting drinking. Don't expect him/her to refill your prescription, however.
>
> I don't think it's a cop-out to get time-limited help to deal with the stress of healthy change, whether it's quitting smoking, stopping drinking, or even leaving a relationship that hasn't worked out.
>
> I think it only becomes a crutch if you continue to keep taking it rather than going to therapy and working on the issues that influence your addictions to begin with. But for short-term use, hey!, that's what it's there for.
>
> Best of luck,
>
> Mark H.============================================
And they are also useful in long term treatment. There is no evidence that I know of that contraindicates long term BZD monotherapy - even in some addictive personalities. Even the World Health Organisation after examining all of the long term studies for 30 + years conclude such.
There is still this myth out there that the risks of taking long term BZD monotherapy is somehow riskier than with any other medication. They ALL come to find out need to be tapered - including the beloved ssri's (or should I say INCLUDING) and they don't even fit the catagory technically classified as "addictive" (BZD's).
Its a red herring born out of ignorance and misinformation - not to mention the shoving aside of these valuable meds by Pharm companies seeking to recoup their R&D by promoting the likes of Paxil and others while the BZD's are all off brand. It's a struggle in the marketplace right now - not medical science that's driving this thing.
BEN
Posted by Krazy Kat on November 29, 2001, at 10:11:32
In reply to Re: Am I copping out by asking for a Benzo?, posted by Alan on November 29, 2001, at 0:13:03
I agree.
Posted by Krazy Kat on November 29, 2001, at 10:13:20
In reply to Re: Am I copping out by asking for a Benzo? » Krazy Kat , posted by Chloe on November 28, 2001, at 19:56:02
Chloe:
I know you meant well, but I Am tired of hearing about AA. It is absolutely Not an option for me. I wouldn't have posted here if I were considering it.
There is a very high failure rate and I believe it to be similar to a cult.
I'll stop there.
- K.
Posted by Krazy Kat on November 29, 2001, at 10:16:03
In reply to Re: Am I copping out by asking for a Benzo? » Krazy Kat , posted by jazzdog on November 27, 2001, at 22:36:50
> I'm going to speak to my pdoc today and see what he thinks. I think the issue is that when I don't drink at night, I feel anxious. It's that simple.
I'm wondering if adding Neurontin might do it - it was a good adjunct with Topamax.
We'll see. Your info was very helpful.
- K.
Posted by jazzdog on November 29, 2001, at 11:37:52
In reply to Re: Am I copping out by asking for a Benzo? » Chloe, posted by Krazy Kat on November 29, 2001, at 10:13:20
AA has by far the highest success rate in helping people recover from alcoholism. In fact, every major successful treatment centre, including Betty Ford and Hazelden, is AA based. As far as its being a cult, nothing could be further from the truth. AA is the closest thing I've ever seen to functional anarchy. Nobody makes any money, nobody gets to hold any power, absolutely nothing, including money, is asked of members, and everyone is free to find their own understanding of a power greater than themselves.
I'm not suggesting you should go to AA - you'll do that if and when you're ready. But it would be a shame to let misconceptions poison your mind against it.
Best of luck - Jane
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