![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by verne on February 21, 2002, at 13:06:16
I've been diagnosed with BPD and PTSD among other things. Lately I seem to be having panic attacks (in clusters) but pdoc won't prescribe benzos because of past misuse of alcohol.
Pdoc reasons that if alcohol has ever been a problem, benzos are not indicated.
I haven't taken a benzo in over 7 years. I've gone over 2 years without drinking but only a month currently. When I took benzos I didn't drink. But the pdoc dismisses all that and claims any sort of alcohol abuse rules benzos out.
I would argue that just about anyone who would benefit from benzos has used alcohol to self-medicate.
I've been in a lot of emotional pain since November - the minutes have turned to hours at times. I've been prescribed neurotin, zyprexa, wellbutrin, serzone, depakote, and some sort of anti-emetic that may decrease anxiety.
I guess depakote with all its side-effects, hospitalization or even suicide are preferable to a small dose of benzos. This is insane.
Posted by Greg on February 21, 2002, at 14:04:03
In reply to benzos for alcoholics?, posted by verne on February 21, 2002, at 13:06:16
Verne,
Interesting subject. I am an alcoholic also; I have been sober for 14 years and on benzos for almost 2. My psych is well aware of my alcoholism, but he and I see my depression and my alcoholism as two separate issues. Many doctors don’t, and there may be others here that would disagree as well. But I don’t think that because you have abused alcohol automatically means that you will abuse your medication. I have yet to take any med that makes me want to drink, or that makes me feel like when I did. We both know how debilitating anxiety can be, and to suffer needlessly is beyond my comprehension. My psych monitors me closely, he knows how often I fill my scrips. I’ve never given him reason to believe I was abusing my meds. I recently had my doc switch me from Xanax to Klonopin because I found myself taking more and more Xanax to get the desired result. I was becoming concerned about addiction. The Klonopin is longer acting and I often don’t even take the recommended dose. The point is that I recognized the problem and brought it to my doc’s attention. The doctor and patient have to work together and build that “trust factor”.
In my opinion, I think it’s very unfair for your pdoc to at not at least give you a “trial run” with a benzo if that's what you want to try, especially if you've had success with them in the past. If he/she sees that you’re not handling it, he/she takes you off. No harm, no foul. I hope if nothing else, you’ll consider finding a doc who’s a little more open minded. This one may think he/she has your best interests at heart, but every coin has two sides.
Good luck with this and your sobriety. I hope you don’t have to continue to suffer, you’re right, it is insane.
Greg
> I've been diagnosed with BPD and PTSD among other things. Lately I seem to be having panic attacks (in clusters) but pdoc won't prescribe benzos because of past misuse of alcohol.
>
> Pdoc reasons that if alcohol has ever been a problem, benzos are not indicated.
>
> I haven't taken a benzo in over 7 years. I've gone over 2 years without drinking but only a month currently. When I took benzos I didn't drink. But the pdoc dismisses all that and claims any sort of alcohol abuse rules benzos out.
>
> I would argue that just about anyone who would benefit from benzos has used alcohol to self-medicate.
>
> I've been in a lot of emotional pain since November - the minutes have turned to hours at times. I've been prescribed neurotin, zyprexa, wellbutrin, serzone, depakote, and some sort of anti-emetic that may decrease anxiety.
>
> I guess depakote with all its side-effects, hospitalization or even suicide are preferable to a small dose of benzos. This is insane.
Posted by Elizabeth on February 22, 2002, at 12:01:36
In reply to benzos for alcoholics?, posted by verne on February 21, 2002, at 13:06:16
Hi. It's right for doctors to be concerned about benzo abuse in treating alcoholics (especially considering the nasty things that can happen when large amounts of benzos and alcohol are combined), but it shouldn't be absolutely contraindicated, as your pdoc seems to believe.
A lot of people with anxiety disorders abuse alcohol in an effort to self-medicate. Benzos are a safer, more effective treatment for anxiety. I can understand your pdoc wanting to be cautious with them and try other things that work for panic disorder (many different kinds of antidepressants, for instance), but if those aren't working, a benzo should be considered. Klonopin would be my choice: it seems to be among the least-preferred benzos among people who abuse benzos.
Another concern that your pdoc might have is the possibility of behavioral disinhibition which has been documented in people with BPD who were given Xanax. I think a low dose of Klonopin would not be likely to cause this problem, but it's still something to watch out for (especially if you have a history of impulsivity).
Is there a family member who is not an alcoholic and who could be trusted to hold on to your medication and give you only the amount prescribed? That might be an idea to present to your pdoc that could make him/her more willing to consider benzos.
> I would argue that just about anyone who would benefit from benzos has used alcohol to self-medicate.
I haven't self-medicated with alcohol, but I take benzos. (to provide a counterexample) :-)
> I've been in a lot of emotional pain since November - the minutes have turned to hours at times. I've been prescribed neurotin, zyprexa, wellbutrin, serzone, depakote, and some sort of anti-emetic that may decrease anxiety.
Wellbutrin is not very good for anxiety disorders. Serzone, Neurontin, and Depakote might help with the panic disorder. Zyprexa is probably aimed at treating BPD symptoms. (Was the antiemetic promethazine or Compazine or something else ending in -zine, perchance?)
Have you tried SSRIs or other antidepressants that are effective in PD (Serzone and Remeron might help, Wellbutrin doesn't and may actually make symptoms worse)? TCAs might not be such a hot idea (because of the BPD), but MAOIs work very well too. Some people with PD get very bad anxiety when starting SSRIs; the way to deal with this is to start at a very low dose (5 mg of Prozac or Paxil, or equivalent) and increase gradually as tolerated. SSRIs and MAOIs can also help with some BPD symptoms (aggression, rejection-sensitivity, moodiness, impuslive behaviors, etc.).
> I guess depakote with all its side-effects, hospitalization or even suicide are preferable to a small dose of benzos. This is insane.
And you thought *you* were insane...! Yeah, it is absurd. I hope I've been able to help a bit. I don't know much about the kind of situation you're in, but I have a pretty good understanding of the dilemma that your doctor faces, and I wish I could help reassure him/her.
-elizabeth
Posted by verne on February 22, 2002, at 14:37:08
In reply to benzos for alcoholics?, posted by verne on February 21, 2002, at 13:06:16
I see the doc Monday. Meanwhile, he prescribed seroquil. I will suggest klonopin when I see him.
Seroquil just knocks me out and leaves me hung over. One way to deal with anxiety is to be unconsious.
Since seroquil isn't really an option, I revisited the health food store and came away with:
Suma Root
Kava/Passion Flower/Valerian extract (non-alcohol formula)
Melatonin (sublingual tablets)I will add these to my collection of herbs and supplements.
thanks for the help, Elizabeth and Greg.
Posted by jazzdog on February 22, 2002, at 21:13:03
In reply to benzos for alcoholics?, posted by verne on February 21, 2002, at 13:06:16
Hi Verne -
Sorry to cast a dissenting vote, but as an alcoholic who's worked in addiction, I've seen a number of cases where benzo use has triggered cravings for alcohol that have resulted in relapse. They work on the same receptors - that's why a benzo can kill a hangover. Normal people can handle them, but alcoholics, including me, don't seem to be able to. Whatever you decide, good luck -
- Jane
Posted by Elizabeth on February 22, 2002, at 22:43:08
In reply to Re: benzos for alcoholics? » verne, posted by jazzdog on February 22, 2002, at 21:13:03
> Sorry to cast a dissenting vote
Jane,
No apologies needed. :-) I think we should all recognize that there are people who have different experiences than our own -- even, sometimes, opposite to our own -- and that their experiences are just as valid.
I've met former alcoholics who were fine taking benzos, but it is true that some people, like yourself, get triggered by them. On the other hand, for others, benzos are an effective substitute for alcohol -- when they take benzos, they don't feel a need for alcohol because their anxiety is treated effectively.
I do think that it's important to keep one's mind open to the option of trying benzos for anxiety (even in alcoholics), especially if other things have failed to help. It's important to exercise caution, especially in the beginning, but I really do think it's worth a try.
> They work on the same receptors - that's why a benzo can kill a hangover.
They don't exactly have the same effects, but it is true that they're both GABAergic drugs. And that's also why they have the same beneficial effects, which makes benzos a viable substitute for alcohol in the treatment of anxiety. (Benzos are also much safer than alcohol and lack unpleasant side effects such as nausea.)
> Normal people can handle them, but alcoholics, including me, don't seem to be able to.
As you've pointed out, it's an individual thing. Some alcoholics have problems -- but not all. It'd be interesting to find out if there are any statistics regarding this.
-elizabeth
Posted by jazzdog on February 23, 2002, at 14:57:14
In reply to Re: benzos for alcoholics? » jazzdog, posted by Elizabeth on February 22, 2002, at 22:43:08
I have dealt with hundreds of alcoholics over the last twenty years, including myself, my ex, and several members of my family. Six friends have suicided, one lies in a coma after falling drunk down a staircase, another couldn't stop drinking with hep c and now has cirrhosis, two died in car accidents, and another set herself on fire when she passed out with a lit cigarette. Alcoholism is a fatal disease, and I have seen dozens of cases of benzo use leading to relapse, and not one case of it not doing so, though it's sometimes taken a few years. Sure, if someone jumps off a hundred foot cliff into a raging current, they might survive. But to do so is, in my opinion, foolhardy in the extreme. Also, in my opinion, anyone who has not spent many years locked in the desperate, life-and-death battle to get sober is not really in a position to advocate the use of drugs that would endanger that oh-so-precarious sobriety.
- Jane
Posted by gilbert on February 23, 2002, at 17:25:57
In reply to Re: benzos for alcoholics? » Elizabeth, posted by jazzdog on February 23, 2002, at 14:57:14
I never thought I would say this but I agree with jane. My benzo use after 3 years has lead me down a path of having to increase dosages with less effect. I have not picked up a drink....yet. But the benzos defintely lower the threshold for my defense against a drink. I have been very carefull to attend many AA meetings and still consider myself sober.....I will be xanax free within 2 months and am hoping this gives me the ability to feel spiritual again. One of the major draw backs to benzos and ssri's alike is they seem to take something from your soul even though they give comfort emotionally. I don't mean to get too sappy but I really have been completely unable to connect with God the way I used to prior to benzo use. Of course I was panicking much less on benzos too so there always is the flip side. Currently on low dose beta blockers which are helpfull and may try neurontin if the doc says o.k.
Gil
Posted by Elizabeth on February 24, 2002, at 23:52:49
In reply to Re: benzos for alcoholics? » Elizabeth, posted by jazzdog on February 23, 2002, at 14:57:14
Well, the medical consensus (based on clinical psychiatry and pharmacology textbooks and reviewing the literature, as well as personal impressions and individual physicians' opinions) seems to be that some persons who have abused alcohol in the past can be treated safely with benzodiazepines. In particular, research findings appear to contradict the supposition that benzodiazepines are likely to induce relapse in alcohol-dependent patients.
A physician charged with deciding whether to treat an alcoholic anxiety-disordered patient with benzodiazepines has a number of pros and cons to consider; there's no black-and-white, deterministic algorithm that will produce a certain answer. A lot depends on the patient's strengths and weaknesses: severity and duration of alcohol abuse, past tendencies to relapse, duration of remission, presence or absence of social supports, lifestyle, participation in relapse prevention therapy, etc. The extent of the individual's need for benzodiazepines should also be considered: are there other treatments that might work, and have they been tried? is the anxiety disorder mild enough that it can be tolerated while waiting for a less rapid-acting treatment (such as antidepressants or CBT) to take effect? etc.
If the decision is made to use benzodiazepines, the patient should be monitored closely and the treatment program should include regular individual therapy sessions with a therapist who has a good rapport with the patient. If possible, the patient's family (esp. spouse or partner) should be involved in treatment. In some cases where there are both serious need of fast treatment and serious risk of relapse, the treatment might even be initiated in an inpatient setting.
One thing that physicians *shouldn't* do is make blanket assumptions about what will happen without considering the patient's individual needs. Seldom is the outcome of any medical treatment predetermined, and this is all the more true in psychiatry. The belief that all alcoholics who are prescribed benzodiazepines will relapse or abuse the benzos is such a blanket assumption. When physicians adopt this attitude, they do a disservice to patients who have a serious need for these medications. Making generalizations is intellectually lazy, and in this case it is harmful, too.
I'm sure that some recovering alcoholics experience cravings if they take benzodiazepines; this sort of phenomenon is well documented. I'm also sure that some do not (indeed, as noted above, the available evidence suggests that benzodiazepine-triggered relapse is the exception, not the rule). In any case, there are ways to minimize the risk of a relapse of the addiction without withholding treatment for the anxiety disorder. You seem to believe that if *any* former alcohol abuser takes a benzodiazepine, then that person's relapse is inevitable (or nearly so). The available facts don't support this belief.
It is a good idea for any recovering alcoholic to take steps to minimize the probability of a relapse. If a person being treated for anxiety is concerned that benzodiazepines will trigger cravings, there are lots of things that s/he can do to protect against a relapse: taking a antiaddiction medication a sensitizing agent (e.g., disulfiram) or an anticraving agent (e.g., naltrexone); selecting a benzodiazepine that may be less likely to feel like alcohol (e.g., Klonopin instead of Xanax; Librium instead of Valium); using blood and/or urine tests to make sure that if the person abuses the benzodiazepine or drinks, the doctor will know about it; designating a person (therapist, relative) who the patient could get in touch with any time for help and support if the patient started to experience cravings; involving family members (for example, having the patient's spouse hold on to the medication and watch for signs of drinking); and, in some cases, initiating benzodiazepine treatment in an inpatient setting so that if there are cravings, there won't be a risk of relapse and the patient can let staff know. There are many nonpharmacological therapies that could be helpful in reducing risk of relapse; for example, Marsha Linehan's dialectical behavior therapy has demonstrated efficacy in reducing a variety of impulsive behaviors. (I'm sure there are lots of other steps that could be taken; these are just a few examples.) There is no way to reduce the risk of relapse to zero, regardless of whether the patient is taking a benzodiazepine, short of locking him or her up permanently. As you are no doubt well aware, relapse is a risk that all alcoholics live with every day.
As with all decisions, one has to weigh the risks against the benefits. This has to be done on a case-by-case basis. Alcoholics are as diverse as any group of people. Some are at greater risk of relapse than others; and on the other hand, some have a greater need for benzodiazepines than others.
Can I ask in what settings you've encountered the many alcoholics you have known? I wonder if there might not be some sample bias working there. I'd also be interested to know what benzodiazepine(s) you believe triggered alcoholic relapses. I think that some benzodiazepines probably have greater abuse potential than others, and that these may also be more likely to trigger alcohol cravings.
Alcoholism has an extraordinarily high relapse rate, and exposure to alcohol-related cues is only one possible antecedent to relapse; life stressors and other factors may lead to relapse in the absence of any such cue. As such, it's difficult to swallow the idea that if a person relapses while on benzodiazepines then the benzodiazepine must have triggered the relapse, even if the person had been taking the benzodiazepine for years without relapsing.
I'm sure you didn't mean it this way, but your suggestion that a person who hasn't "been there" doesn't have right to have an opinion on the subject -- that the only valid information is that obtained by first-hand experience -- came across as pretentious and self-righteous. We've all experienced suffering here, and I believe that all or most of us are able to empathize with others' suffering. The idea that a certain group has known a degree of suffering that is much greater than anything the rest of us could comprehend seems quite disrespectful and invalidating of what others go through (again, I'm sure that you didn't mean it to sound that way). This board doesn't need to be a one-downsmanship contest. Could you please try to exercise more care and consideration about what you say about other people in the future? Thanks.
Aside from that, there are other ways of learning about something besides experiencing it. I've known a number of people -- some of them close friends -- who have suffered a lot as a result of addictions. I think it's tragic that people feel like they have to turn to dangerous drugs like alcohol and heroin in order to feel okay. I am not in any way minimizing the seriousness of addictions. But I recognize that anxiety disorders (which often lead people to turn to drugs) need to be taken seriously as well.
-elizabeth
Posted by Elizabeth on February 25, 2002, at 0:27:58
In reply to Re: benzos for alcoholics?, posted by gilbert on February 23, 2002, at 17:25:57
> My benzo use after 3 years has lead me down a path of having to increase dosages with less effect.
This isn't typical for people taking benzodiazepines for panic disorder. I think that if you find yourself continually increasing the dose, it's probably a sign that you're on a medication that's not right for you. My suggestion to you would be to try and taper off the benzos, if possible.
Did you ever feel that benzos caused alcohol cravings? Did you find yourself taking extra doses compulsively?
Also...you mentioned Xanax. Have you tried other benzos, like Klonopin?
> One of the major draw backs to benzos and ssri's alike is they seem to take something from your soul even though they give comfort emotionally.
I never had this problem (feeling empty) with benzos -- or SSRIs, for that matter (I took Prozac for two years when I was in high school). Can you say more about what you mean?
> Of course I was panicking much less on benzos too so there always is the flip side.
A lot of people with untreated panic disorder are very impaired, especially those with agoraphobia. For me, benzos are a nice convenience -- I have to take antidepressants anyway, and they seem to prevent the attacks pretty well, mostly -- but many people are disabled by panic attacks and can't tolerate the activation syndrome that often goes along with antidepressants. I don't know where you are on the spectrum, but I hope you find something else that works for you.
> Currently on low dose beta blockers which are helpfull and may try neurontin if the doc says o.k.
Neurontin strikes me as a good idea. I'm not so impressed by beta blockers for full-blown panic attacks, although propranolol helps when I get these odd and uncomfortable feelings of inner shakiness. (It's also good for tremor, of course.)
-e
Posted by jazzdog on February 25, 2002, at 15:24:12
In reply to Re: benzos for alcoholics? » jazzdog, posted by Elizabeth on February 24, 2002, at 23:52:49
My long experience in addiction counselling has taught me never to waste time attempting to convince those who have already made up their minds. Especially when they might be dealing with their own denial issues. So I'll withdraw from this debate.Best wishes - Jane
Posted by Alan on February 25, 2002, at 22:09:59
In reply to Re: benzos for alcoholics? » jazzdog, posted by Elizabeth on February 24, 2002, at 23:52:49
> Well, the medical consensus (based on clinical psychiatry and pharmacology textbooks and reviewing the literature, as well as personal impressions and individual physicians' opinions) seems to be that some persons who have abused alcohol in the past can be treated safely with benzodiazepines. In particular, research findings appear to contradict the supposition that benzodiazepines are likely to induce relapse in alcohol-dependent patients.
>
> A physician charged with deciding whether to treat an alcoholic anxiety-disordered patient with benzodiazepines has a number of pros and cons to consider; there's no black-and-white, deterministic algorithm that will produce a certain answer. A lot depends on the patient's strengths and weaknesses: severity and duration of alcohol abuse, past tendencies to relapse, duration of remission, presence or absence of social supports, lifestyle, participation in relapse prevention therapy, etc. The extent of the individual's need for benzodiazepines should also be considered: are there other treatments that might work, and have they been tried? is the anxiety disorder mild enough that it can be tolerated while waiting for a less rapid-acting treatment (such as antidepressants or CBT) to take effect? etc.
>
> If the decision is made to use benzodiazepines, the patient should be monitored closely and the treatment program should include regular individual therapy sessions with a therapist who has a good rapport with the patient. If possible, the patient's family (esp. spouse or partner) should be involved in treatment. In some cases where there are both serious need of fast treatment and serious risk of relapse, the treatment might even be initiated in an inpatient setting.
>
> One thing that physicians *shouldn't* do is make blanket assumptions about what will happen without considering the patient's individual needs. Seldom is the outcome of any medical treatment predetermined, and this is all the more true in psychiatry. The belief that all alcoholics who are prescribed benzodiazepines will relapse or abuse the benzos is such a blanket assumption. When physicians adopt this attitude, they do a disservice to patients who have a serious need for these medications. Making generalizations is intellectually lazy, and in this case it is harmful, too.
>
> I'm sure that some recovering alcoholics experience cravings if they take benzodiazepines; this sort of phenomenon is well documented. I'm also sure that some do not (indeed, as noted above, the available evidence suggests that benzodiazepine-triggered relapse is the exception, not the rule). In any case, there are ways to minimize the risk of a relapse of the addiction without withholding treatment for the anxiety disorder. You seem to believe that if *any* former alcohol abuser takes a benzodiazepine, then that person's relapse is inevitable (or nearly so). The available facts don't support this belief.
>
> It is a good idea for any recovering alcoholic to take steps to minimize the probability of a relapse. If a person being treated for anxiety is concerned that benzodiazepines will trigger cravings, there are lots of things that s/he can do to protect against a relapse: taking a antiaddiction medication a sensitizing agent (e.g., disulfiram) or an anticraving agent (e.g., naltrexone); selecting a benzodiazepine that may be less likely to feel like alcohol (e.g., Klonopin instead of Xanax; Librium instead of Valium); using blood and/or urine tests to make sure that if the person abuses the benzodiazepine or drinks, the doctor will know about it; designating a person (therapist, relative) who the patient could get in touch with any time for help and support if the patient started to experience cravings; involving family members (for example, having the patient's spouse hold on to the medication and watch for signs of drinking); and, in some cases, initiating benzodiazepine treatment in an inpatient setting so that if there are cravings, there won't be a risk of relapse and the patient can let staff know. There are many nonpharmacological therapies that could be helpful in reducing risk of relapse; for example, Marsha Linehan's dialectical behavior therapy has demonstrated efficacy in reducing a variety of impulsive behaviors. (I'm sure there are lots of other steps that could be taken; these are just a few examples.) There is no way to reduce the risk of relapse to zero, regardless of whether the patient is taking a benzodiazepine, short of locking him or her up permanently. As you are no doubt well aware, relapse is a risk that all alcoholics live with every day.
>
> As with all decisions, one has to weigh the risks against the benefits. This has to be done on a case-by-case basis. Alcoholics are as diverse as any group of people. Some are at greater risk of relapse than others; and on the other hand, some have a greater need for benzodiazepines than others.
>
> Can I ask in what settings you've encountered the many alcoholics you have known? I wonder if there might not be some sample bias working there. I'd also be interested to know what benzodiazepine(s) you believe triggered alcoholic relapses. I think that some benzodiazepines probably have greater abuse potential than others, and that these may also be more likely to trigger alcohol cravings.
>
> Alcoholism has an extraordinarily high relapse rate, and exposure to alcohol-related cues is only one possible antecedent to relapse; life stressors and other factors may lead to relapse in the absence of any such cue. As such, it's difficult to swallow the idea that if a person relapses while on benzodiazepines then the benzodiazepine must have triggered the relapse, even if the person had been taking the benzodiazepine for years without relapsing.
>
> I'm sure you didn't mean it this way, but your suggestion that a person who hasn't "been there" doesn't have right to have an opinion on the subject -- that the only valid information is that obtained by first-hand experience -- came across as pretentious and self-righteous. We've all experienced suffering here, and I believe that all or most of us are able to empathize with others' suffering. The idea that a certain group has known a degree of suffering that is much greater than anything the rest of us could comprehend seems quite disrespectful and invalidating of what others go through (again, I'm sure that you didn't mean it to sound that way). This board doesn't need to be a one-downsmanship contest. Could you please try to exercise more care and consideration about what you say about other people in the future? Thanks.
>
> Aside from that, there are other ways of learning about something besides experiencing it. I've known a number of people -- some of them close friends -- who have suffered a lot as a result of addictions. I think it's tragic that people feel like they have to turn to dangerous drugs like alcohol and heroin in order to feel okay. I am not in any way minimizing the seriousness of addictions. But I recognize that anxiety disorders (which often lead people to turn to drugs) need to be taken seriously as well.
>
> -elizabeth
**********************************************BRAVO and well said elizabeth!
Your command of the facts (not anecdotal or personal experience within one's own hemisphere) and your persuasive writing style has me turning green with envy. You said everthing I would have liked to have said but probably more clearly many times over.
Do you think and type spontaneously like that? Are you an author? Or do you do alot of editing along the way like I do?
Just wondering...
Alan
Posted by Alan on February 25, 2002, at 22:20:18
In reply to Re: benzos for alcoholics? » Elizabeth, posted by jazzdog on February 25, 2002, at 15:24:12
>
> My long experience in addiction counselling has taught me never to waste time attempting to convince those who have already made up their minds. Especially when they might be dealing with their own denial issues. So I'll withdraw from this debate.
>
> Best wishes - Jane
************************************************I agree with elizabeth - that the facts and research show otherwise - and also that one-downsmanship is a quality we want to keep off of this bboard.
Generalising based on one's own personal experience is a sure path to an ideological and zealous style of thinking which leads to unnecessary conflict. Unless I'm misreading things, let's try to disagree without being "disagreeable". OK?
Alan
Posted by gilbert on February 26, 2002, at 22:59:24
In reply to Re: benzos for alcoholics?, posted by Alan on February 25, 2002, at 22:20:18
Elizabeth,
I did try klonopin but still had panics I needed huge doses to get by. I am working within my own hemisphere here as Alan would say and do not want to project my experiences on others. I do think for me benzos are off limits. I did lovvvve my xanax and will miss it.
On the spiritual side I guess what I am trying to say is I wish I could find a med that just made me feel normal for use of a better word. The xanax kind of dulled my existence never really got too excited about anything, the prozac kind of dulls my emotions like I can't cry sometimes when I am sad.....it's weird like all meds seem to take something from my original personna.
Today I am going thru a long depressive episode and I am forced to take the prozac I have been on it for 3 weeks. I could not have a panic if I tried I am too low right now. I am beginning to wonder if I am bi polar I go from tons of panics to depresssion in cycles but my mania is not like other bi polars who get high and active mine is loaded up on fear and panic. I think the depression is my way of my body wearing out after many panics. So for now my problem is trying to stay motivated to stay alive.
On the whole benzo issue for drunks I found them a bit disinhibiting. I do know other alcoholics doing just fine on them and I do know some who have not. I do think withhin 10 years the issue will be moot due to new gabba antagonist coming out like pagloclone and other in the pipelines. Hopefully we will have viable alternatives to benzos and ssri's both.
Gil
Posted by Elizabeth on February 28, 2002, at 0:01:09
In reply to Re: benzos for alcoholics?, posted by gilbert on February 26, 2002, at 22:59:24
> I did try klonopin but still had panics I needed huge doses to get by.
Huh, that's weird. What dose of Klonopin did you need, and what dose of Xanax worked comparably?
Did you find that benzos felt like alcohol in a way that was triggering, and if so, was there any difference between X and K in this regard? I've heard some people say that they don't "feel" Klonopin when it starts to work the way that they "feel" Xanax kick in. I'd expect this to influence the abuse/addiction potential, and the tendency to cause alcohol cravings.
> I am working within my own hemisphere here as Alan would say and do not want to project my experiences on others.
I can tell. You've been perfectly rational, even though you're going through something that has to be very difficult for you (having to stop taking your Xanax). You certainly haven't said anything that suggests that you believe your experience applies to everybody else. And I absolutely agree, based on what you've said, that benzos probably aren't for you. I just hope you can find an adequate substitute.
> I do think for me benzos are off limits. I did lovvvve my xanax and will miss it.
Heh. That weirds me out, when people say they feel good on benzos. For me, benzos just feel like of "slowing down" drugs (which makes sense, since they are CNS depressants). Calming, maybe a little bit sedating, but definitely not euphoric! Just one more example of how different we all are, eh?
> On the spiritual side I guess what I am trying to say is I wish I could find a med that just made me feel normal for use of a better word.
I understand. Normal was my holy grail for quite a while, too. (Now I'm trying to figure out how to get normal without the side effects.) I think that the desire to feel normal is what drives a lot of people to abuse drugs.
> The xanax kind of dulled my existence never really got too excited about anything, the prozac kind of dulls my emotions like I can't cry sometimes when I am sad.....it's weird like all meds seem to take something from my original personna.
I've heard of that happening with SSRIs and mood stabilizers (i.e., antimanic drugs), but never benzos. I wonder how common it is.
> Today I am going thru a long depressive episode and I am forced to take the prozac I have been on it for 3 weeks.
That sounds really awful. How long have you been feeling depressed? Other than the emotional dulling, is Prozac causing you any problems?
> I am beginning to wonder if I am bi polar I go from tons of panics to depresssion in cycles but my mania is not like other bi polars who get high and active mine is loaded up on fear and panic.
Well, there is something called dysphoric or mixed mania (or hypomania) which is characterized by symptoms of both depression and mania (or hypomania). (Mixed hypomania isn't recognized in DSM-IV, but it's generally accepted that it happens.) A typical presentation might include agitation, insomnia, anger or irritability, anxiety, and suicidal thoughts. I don't know if that's what's going on for you. You might talk to your pdoc about it if you think that you're cycling between depression and panic.
> So for now my problem is trying to stay motivated to stay alive.
Just make sure that you get enough fluids. It takes motivation to attempt suicide too, after all. Do you live alone, or is there someone else there?
> On the whole benzo issue for drunks I found them a bit disinhibiting.
This doesn't just happen to alcoholics. Some people have been known to have bad things happen on benzos because of disinhibition (in particular, people with a lot of impulsivity and/or aggression).
> I do know other alcoholics doing just fine on them and I do know some who have not.
Yes, that's consistent with what I know from reading and personal experience. Benzos aren't absolutely contraindicated for alcoholics, you just have to exercise some extra caution.
> I do think withhin 10 years the issue will be moot due to new gabba antagonist coming out like pagloclone and other in the pipelines. Hopefully we will have viable alternatives to benzos and ssri's both.
That'd be pretty cool. I think pagoclone is a partial agonist at the benzodiazepine receptor -- who knows what that will mean in regard to efficacy, but it probably will have milder side effects and withdrawal symptoms than the benzos. On the down side, I have no doubt whatsoever that it will be unbelievably expensive (another common characteristic of partial agonists <g>).
-elizabeth
Posted by Elizabeth on February 28, 2002, at 1:06:19
In reply to Re: benzos for alcoholics? » Elizabeth, posted by jazzdog on February 25, 2002, at 15:24:12
> My long experience in addiction counselling has taught me never to waste time attempting to convince those who have already made up their minds. Especially when they might be dealing with their own denial issues. So I'll withdraw from this debate.
Jane, don't be coy. What exactly is it that you're accusing me of? What makes you think I have "denial issues?"
Aren't *you* the person who has already made up her mind, who doesn't want to hear anything that doesn't support her rigid, uncompromising opinion? Which one of us was it who did not respond to any of the arguments and questions in the other's post, but instead, made some nasty insinuations and announced that it wasn't worthwhile to discuss the issue further? Not I.
It's clear that you want your readers to accept you as an expert on the subject of addiction, and therefore to believe your opinion without any reason other than that it is yours. Appeal to authority is generally a weak form of argument, but it is especially weak when the putative authority is the person trying to make the argument ("you should believe me because I'm an expert"). It's nice that you've known some addicts, but drawing solely on that information is a mistake, particularly since the conclusion you are trying to draw is a generalization. "Always" propositions are dangerous because it's all too easy for a counterexample to creep up and bite you on the *ss.
Other people (including myself) have posted information that directly contradicts your beliefs, and furthermore, we have been able to do so without having to resort to personal attacks. I think that your expertise would be more impressive if you were to express interest in new information rather than taking offense at it. Making snide comments about me because I disagree with you, and then ducking out of the debate (without responding to any of the arguments that challenged your opinion), smacks of something other than expertise. If this is your style of debate, you aren't going to convince too many people. The people on this board are, by and large, smarter than that.
You are of course free to ignore this post rather than responding. Maybe you really have convinced yourself that the people who disagree with you "have already made up their minds" and have "denial issues." But I think it's safe to say that you're the only person who believes that (if indeed you do). You've already tried to back out; it just looks like you're avoiding having to admit that you're wrong. If you have an argument beyond an appeal to your own putative authority, please, by all means, post it.
-elizabeth
Posted by gilbert on February 28, 2002, at 8:11:05
In reply to Re: benzos for alcoholics? » gilbert, posted by Elizabeth on February 28, 2002, at 0:01:09
Elizabeth
>
> Huh, that's weird. What dose of Klonopin did you need, and what dose of Xanax worked comparably?
>
>4-5mg per day klonpin 4 mg xanaxDid you find that benzos felt like alcohol in a way that was triggering, and if so, was there any difference between X and K in this regard? I've heard some people say that they don't "feel" Klonopin when it starts to work the way that they "feel" Xanax kick in. I'd expect this to influence the abuse/addiction potential, and the tendency to cause alcohol cravings.
>
>No way did it feel like alcohol I dosed on regular schedules never abused the med to get high, I have already dumped the prozac I felt higher on an ssri than I do a benzo. The doc would not give me neurontin yet but told me to try trazadone and I take it in the morning it seems to block my panics but yowza I feel farily stoned on this drug it really slams you into a dizzying fog. I will not tolerate the sexual side effects and accept that as a apart of my life after 3 weeks on 10mg prozac I am sexual only sprodicallly instead of spermatically....lol. The xanax defintely felt stronger and for me was way more effective. I suppose I could try to find a doc willing to prescribe 5-6mg per day yet I have worked so hard I am down to 1.5mg per day so I want at least try a couple of new drugs first. But no more ssris, never ever never ever never.>
> I can tell. You've been perfectly rational, even though you're going through something that has to be very difficult for you (having to stop taking your Xanax). You certainly haven't said anything that suggests that you believe your experience applies to everybody else. And I absolutely agree, based on what you've said, that benzos probably aren't for you. I just hope you can find an adequate substitute.
>
>Thank you Elizabeth I hope so too.
>
> Heh. That weirds me out, when people say they feel good on benzos. For me, benzos just feel like of "slowing down" drugs (which makes sense, since they are CNS depressants). Calming, maybe a little bit sedating, but definitely not euphoric! Just one more example of how different we all are, eh?
>
The smaller doses of xanax 2mg and under made me feel normal and God how I wish I could have stayed there I got 2 years on that dose then wammo no good. Larger doses made me feel not stoned but detached from life ....like a voyeur instead of a participant.
>
> I understand. Normal was my holy grail for quite a while, too. (Now I'm trying to figure out how to get normal without the side effects.) I think that the desire to feel normal is what drives a lot of people to abuse drugs.
>
> I've heard of that happening with SSRIs and mood stabilizers (i.e., antimanic drugs), but never benzos. I wonder how common it is.
>
>God I wish everyone who attacks benzos and I have a little bit the past 2 weeks but honestly it just a greiveing process for me having to let go of the only med that has ever truly helped me. I do not need to be anti benzo because I am losing them like if I can't have them you can't either....fairly immature attitude. Anyways anyone who wants to attack benzos go on ssri's for a couple of months tell us about your quality of life. Has your wife left yet with the UPS man, as a male is the pride of loss of erection and argasm taken up most of your thinking day....I just can;t believe that people are willingly givng up their seuality in order to be in the ssri zombie like state.....makes no sense to me. I will try everything in the GNC before I go back on an ssri......Does trazadone rob you of your sex life as well,,,,I know about the priapism thing but am always suspiscious of drug companies who list this as a side effect like they say oh yeah as a side effect a permanent boner may occur......what a seductive sales pitch to sucker us into what may be drug enhancing sexual qualities of an antidepressant.
>
> That sounds really awful. How long have you been feeling depressed? Other than the emotional dulling, is Prozac causing you any problems?
>
Yes prozac blows. After 3 weeks semi impotence already setting in at 10mg per day. I feel speedy agitated and I want to crawl out of my skin...I am jumpy and feel not manic but panic. I would equate it to shoting up a double expresso every 2 hours.
I may end up as you say with a form of bipolar but the mood stabilzers......seems as scarry as the ssri's. I need a med that knocks me down a notch not levels me out not takes me up. I really believe many of my agitated panic states have been a direct result of ingesting ssri's.Odd recently switched my blood pressure med fron beta blocker to cardizem and feel less depresseed already.
> > So for now my problem is trying to stay motivated to stay alive.......This was a little dramtic I just needed some attention from all of you lovely people. I have a loving wife and a gorgeous 8 year old boy and would never do anythign to hurt them...plus if the depression got worse I would check in somewhere...there is a difference between feeling suicidal and doing it. I have too many reasons not to do it....would never blow away my son with that ever...I would endure much much more mental torture and have in the past.....I have had close friends and relatives do the deed and refuse trail left behind is stunning and unbearable for the survivors.
>
I do know other alcoholics doing just fine on them and I do know some who have not. My sponsor 30 years sober take 2mg xanax per day for the past ten years has saved his ass he is doing great. An addiction therapist at the meeeting is bipolar and has to take the xanax to stay from getting manic only drug combo that works for him is sinequan and xanax. He had to go off lithium diue to kidney trouble and could not do depakote due to elevated liver enzymes. I think length of sobriety and therapy are important. The 12 steps do not fix everything and members who say so just haven't crashed yet. I do think that benzos are safe for long term sober alcohlics at a very high rate like 80-90%. I do think benzos may prevant relapse in those alcohlic who sufffer from panic and anxiety because booze was their original med. I think being sober longer like 5 years or more helps to treat the meds with more respect. This is also fine becuase most alcohlics don't even realize they have mental illness until they have been sober a while and many gor through sobriety thingking they 12 step away their bi polar or panic or personailty disorders and refuse medications...these are the ones I get te see layed out in caskest..Much like denying your alcoholic\sim it is so hard for an alcoholic to admit any dual diagnosis which is like 90% of the fellowship. Hey your drinking a fifth of vodka a day for a reason and I have rarely seen that occur on a pure addcition scale most are self nedcating for what is an underlying illness. The ones that awaken to this stand a chance of really getting well. If you take all the bi polars, unipolars, panic people schizophrenics and all other DSMV diagnoses out of an AA meeting you would be left with 2 hillbillies who just love to drink cuz they loved to drink. Most dramk to escape from the demaons of their mental illnesses ....let me qualify most of my friend and AA aquantenaces have been that way.I am sooo bummed out that I fall in that 20% who have to watch it....and again I did not like pop xanax and go look for hookers or get in bar room fights etc...I just had benzo poop out.
I apologize for some of my previous anti benzo posts again I am just venting if I can't have them damn it you can't either.....LOL
>> That'd be pretty cool. I think pagoclone is a partial agonist at the benzodiazepine receptor -- who knows what that will mean in regard to efficacy, but it probably will have milder side effects and withdrawal symptoms than the benzos. On the down side, I have no doubt whatsoever that it will be unbelievably expensive (another common characteristic of partial agonists <g>).
>
Of course it seems to be all part of the game look at the cost of neurontin. All the good new drugs with patents get pushed and wammo 200 per month. This part of the mental health medicine game irritaes me to no end. We are guinea pigs second and consumers first. The drug companies can't wait to get that new product out "Now coming annual prozac......You go to your docs he hooks jumper cables up to your scrotum makes you eat a green and white pill and bammo your just so damn happy for a year you need nothing else it's like heaven on earth...like those warm fuzzy paxil commercials which eerily look like a seen from Rosemary's Baby.....come,come back welcome back to our lair of deception, please..leave your sexuality at the door, there is no room for sex here on planet paxil, just be gretfull to alive and limp and eager to indulge in a dazzling array of carohydrates with us.Thanks E always appreciate yours and Alans post especially two very well written well informed people.
Gil
Posted by Dr. Bob on March 1, 2002, at 1:43:49
In reply to Re: benzos for alcoholics? » jazzdog, posted by Elizabeth on February 28, 2002, at 1:06:19
> Aren't *you* the person who has already made up her mind, who doesn't want to hear anything that doesn't support her rigid, uncompromising opinion?
Please don't jump to conclusions about others, post anything that they could take as accusatory, or put others down. You could've made your points without making it so personal, and that would've been fine.
Bob
PS: Follow-ups regarding posting policies should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by Azurebay on June 8, 2003, at 14:24:41
In reply to Re: please be civil » Elizabeth, posted by Dr. Bob on March 1, 2002, at 1:43:49
Indeed, I tend to agree with Elizabeth's consensus that we're all different (and I know this is an old post - just came up on a search). The truth is that the majority of the people in the "addiction" field have one line of very linear thinking, having personally worked in that area myself. Everything else is taboo.
The truth also is that I, a former drunk and addict (notice I didn't use the AA term "recovering alcoholic") take BENZOS with my doctors full support and agreement. And I've done so without any tendency to drink, drug, overuse or anything of the kind for years.
So in just a simple, civil comment on the whole debate that was raging about this issue... all I can say is that I'm one former addict who can and does responsibly use prescribed medications. Period.
I suspect I'm not alone in that category :)
Smiles Always,
Von
> > Aren't *you* the person who has already made up her mind, who doesn't want to hear anything that doesn't support her rigid, uncompromising opinion?
>
> Please don't jump to conclusions about others, post anything that they could take as accusatory, or put others down. You could've made your points without making it so personal, and that would've been fine.
>
> Bob
>
> PS: Follow-ups regarding posting policies should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.