![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 47. Go back in thread:
Posted by Squiggles on August 20, 2002, at 7:51:26
In reply to Re: To...Addiction vs. Medical dependence, posted by hiba on August 20, 2002, at 1:54:20
Hi Hiba,
You ask me what other thing can be done, but
to give addictive or habituating drugs for
certain serious afflictions; 'should we give
opium and antidepressants for anxiety' for
example. This is a rhetorical question and
not a scientific one. For all i know opium
may have less long-term dangerous effects if
given at a small dose, as well as antidepressants,
maybe even lithium - this is a medical question.
At the end of the day, one has to measure the
cumulative adverse effects against the advantages --
that would be the right thing to do.
Ideally, it would not be JUST the symptom (turned
into a disease through language and lack of
scientific perception) that is treated but the the
cause. So, that you do not get cases such as
my friend's for example, who never used to have
anxiety in her life, but given a certain AD which
stimulates the serotonin uptake or some such,
has life wrecking anxiety every day; and for which
the drug companies see as an opportunity to develop
another drug to treat that symptom, and on and on.Ideally, a symptom would be recognized by a doctor
as just that a symptom and NOT a disease. So, that
if a person has Graves' disease and exhibits exophthalmia,
he wand hyperactivivity, he would not be treated with Valium
without considering an endocrinological cause of that
symptom first.Ideally, the course of the drug, in due time, resulting
in tolerance and resulting in panic attacks and anxiety
of a greater and heitherto, unknown degree would not
be considered as evidence of an underlying condition
getting worse, but the drug itself having an effect.But this is not an ideal world.
I said before - I am not against benzos - i have
recommended them to my friend for anxiety which
is a side effect of another drug she is taking.
Nor, do i think that all benzos have the same
qualities.As for Klonopin and bipolar disorder,
two grave questions have plagued me about this
prescription - first was i correctly diagnosed
as bipolar (since i was taking Valium and there is
a real possibility i was withdrawing without knowing
and mimicking the signs of bipolar disorder, and two -
is Klonopin as an anti-convulsant prescribed to bipolars
because they are believed to be in the class of
epileptics. And here is the coup de gras - even
if that were the case, i can no longer get off
these drugs after so many years; i cannot reverse
a possible mistake. This is the sad case with
many drugs which change your CNS after a long time,
including benzos.I got off Xanax and i no longer
have panic attacks which were induced by reaching
tolerance; i was not so lucky with Klonopin and i
believe the attempt almost killed me through seizure
or stroke or both. I know that the same is the
case with beta blockers, and many other drugs which
do not even fall in the narcotic category. I am not
sure what pharamaceutical class they are in. The point
is that anxiety, treated with anxiolytics is a condition
with a myridad causes and thus, the benzos are far more
frequently prescribed than any other psychiatric drug.I do agree with you on this though: when a drug is
necessary for an illness, then one must tolerate
its side effects, in a minimal risk/maximum gain
kind of plan.Squiggles
Posted by hiba on August 20, 2002, at 10:11:37
In reply to Re: To...Addiction vs. Medical dependence » hiba, posted by Squiggles on August 20, 2002, at 7:51:26
"You ask me what other thing can be done, but
to give addictive or habituating drugs for
certain serious afflictions; 'should we give
opium and antidepressants for anxiety' for
example."First of all opium is not a tranquilizer, it is a pain killer, which some docs still hesitate to give terminally ill patients, because of the fear "They will get addicted" A terminally sick patient getting addicted. What sense does it make?
Secondly prescribing antidepressants to anxious patients. Your question should be directed to docs and not to me. All I was trying all this time is questioning this practice. When safer anxiolytics are available why should a doc prefer to put his patient on hard antidepressants?
Anxiety can have devastating effects in one's life. It can cause loss of jobs, loss of friends or relationships, and if it is more than excess, patients try or commit suicide. Virginia Woolf commit suicide and many psychiatrists believe she was suffering from severe panic attacks which led her into suicide. Now tell me what is better? Living a hellish life or keep going well on a drug?
This is an era where we can buy once daily antibiotics. So don't expect any more cures for diseases. Great Alexander Fleming invented penicillin and it was a cure. It cured infections. But now pharmaceutical companies want to put us on once daily antibiotics. They have their justification. Treatment resistant infections. There is no scarcity for justifications.
Posted by alan on August 20, 2002, at 13:41:45
In reply to Re: To...Addiction vs. Medical dependence » alan, posted by Squiggles on August 20, 2002, at 1:48:20
> Your use of words and their meaning is "pragmatic",
> i.e. it is used where convenient for the pharmaceutical
> companies.
>
> I do not have a "squabble" with the medical profession,
> i simply think that they have been taken in by some
> of the misleading rhetoric of "slight of hand" lingo,
> for a very real physical problem of addiction.Then as I thought, you do believe that pharmecuticals are confusing the medical profession - those at least that are specialists treating anxiety disorders.
It is the medical specialists that have to make distinctions such as these, not the pharmecuticals. Otherwise, there would be NO prescription of bzd's permitted at all - that is, if there were no distinction made between them and modern non-medical classifications such as alcohol, cocaine, and heroin, not to mention inappropriately prescribed drugs such as phenobarbital, seconal, or other barbituates.
>
> Though i have never done heroin or hard drugs and
> cannot say what the withdrawal is like, i can assure
> you that if you are not an epileptic getting on Klonopin,
> you may very well become one getting off. The significance
> of that is, that although addiction is slower and
> imperceptible with the benzos, the withdrawal may infact
> be harder and more dangerous. Whether you choose
> to call that medical dependence or addiction is secondary
> in my view, to the required recognition of the long term
> effects of these drugs.Actually, what is primary in proper diagnosis and treatment is the disorder or disease, not the drug. Of course, slow withdrawl is paramount when discontinuing any drug - as it turns out, especially the ssri's - a non-habit-forming drug. What's the euphemism? Oh yes, "discontinuation syndrome".
Again, there is no medical evidence or credible scientific study that me or my doctors are aware of that shows long term bzd use for chonic anxiety disorders is any more inappropriate or causes more problems than short term therapy.
That does not mean that there isn't the occasional bad reaction to these drugs just like any other. But to extrapolate for the entire population based on personal experience is simply unsound thinking as well as unsound medicine.
>
> Also, i am not so sure of your point that using
> hard drugs would be worse in terms of addiction
> than the benzos vis a vis withdrawal, spiralling
> increase in dose, etc. In Victorial times these
> drugs such as cocaine and morphine derivatives, as
> well as quinine were commonly used throughout one's
> lifetime and IF the dosage were controlled, though
> dependence would grow, it would not necessarily
> be worse than the class of barbituates and benzos.
> This is also the case with alcohol, where many
> cultures use 1 glass per day for many yrs. without
> a necessary increase for tolerance.
>
> Infact, the addiction to Rivotril in my case of
> a nature which may be new to the pharamamatorium -
> i suspect that after 15 yrs or so of use - there
> have been changes in the brain, such that they
> cannot be reversed and the drug must now be taken
> indefinitely to avoid seizure and inability to
> reinstate a physical equilibrium which once existed.All studies of the panic/anxiety population who are or have been under extended bzd monotherapy for their disorder that do not have past history of abuse or who have a predisposition or behaivour towards drugs that incline them towards drug seeking behaivour show that dosages stay the same or move downward. Rarely is there a member of this poulation that ever abuses their drug or has to discontinue because of the escallating dosage boogie monster.
"Neuroadaptation" is a whole area of emerging science that best addresses the problem of Revotril that you mention.
>
>
> As far as the drs. go, i believe most have just not
> been informed and perhaps this class of drugs being
> new after all, the drug companies themselves may
> have something new to learn about their creation.
> After all, the tests were not forecasted for 50 yrs
> into the future.I agree that physicians - mostly GP's and non specialists have a lot to learn about appropriate prescribing and diagnosing - not to mention follow-up. That is why the distinction IS important to them. Then perhaps valium won't be prescribed inappropriately for back spasms for instance which was the type of prescribing practices that got patients into trouble in the first place.
Prescribing practices that present ALL of the options for psychotropic drug therapy to the patient is what is needed along with unbiased cost/benefit analysis. This includes the presentation of AD's, bzds, and others on an equal footing. This is all the more important considering that patient reaction to a drug therapy is highly individualised in the first place.
What I am saying is that the deliberate witholding of bzds as an equivalent option to the anxiety sufferer is doing them harm by taking away their right to know and have at their disposal what is available to relieve their suffering.
The practice of witholding this option is based on misinformation, moralistic and political pressure, and doctors that prescribe psychotropics based on commercially driven pressures.
>
> I am also rather pissed off with the benzo group
> for its zeal to get off benzos. In a pardoxical
> way, I think I am far more anti-benzo than they
> are under certain conditions, i.e. when the withdrawal
> becomes dangerous to the health of the patient he should
> not be permitted to take further risks, but be
> reinstated, and started on a slower schedule, or
> not stopped at all.Yes, but this is not a reason to blame the medicine itself. One can not and should not extapolate for the entire population based on a personal experience or a small minority of cases.
If one digs a little deeper into many of these cases, there is misdiagnosis, misprescribing, and mismangement due to a lack of understanding of these drugs and of the patients themselves.
>
> Here is one of many articles that explains the situation.
>While interesting, I prefer to get my information from a broader based and more comprehensive view of the use of bzds. This is available in the review of 40+ years of study of an amalgamation of ALL of the studies on bzds in a report on "The Rational Use of Benzodazapines" by the prestigious World Health Organisation. They concluded in their summary that the short AND long term application of bzd monotherapy for anxiety disorders is by far the most safe and showed the highest rate of efficacy of all drugs used to treat anxiety disorders.
So indeed, let's be clear about the cost/benefit analysis when providing patients with their real alternatives when it comes to reducing their suffering.
Let's not exclusively scare people about bzds just because they have a tolerance/withdrawl phenomenon found in all drugs in some form or another. It is uncommon to have difficulties with this phenomenon id done properly. It places unreasonable doubt into the mind of an already med-phobic sufferer at a time of high psychological vulnerability - preventing them from assessing their options comprehensively and with perspective.
This tactic is used as a trump card as is presently represented by the anti-benzo movement - manifestly so by sites such a benzo.org and scaremongering groups such as TURN and DAWN.
Alan
Posted by Squiggles on August 21, 2002, at 8:53:18
In reply to Re: To...Addiction vs. Medical dependence » Squiggles, posted by alan on August 20, 2002, at 13:41:45
Alan,
You know a lot about this subject. I appreciate
being able to speak to you. I am at this point
at a crossroad regarding interpretation of
facts - you may have experienced this if you
have been studying conflicting ideologies and
explanations; if not in my experience it is very
anxiety provoking in itself.The reason i joined the benzo group was on account
of the relentless panic attacks that followed
some years after taking XANAX at the same therapeutic
dose, and its interaction with RIVOTRIL (dyspnea),
and other adverse effects. I think that my
dr. believed this increasing anxiety and panic
(which i never had before nor for which Xanax was
prescribed - it was prescribed for anxiety alone)
was "endogenous". And thus, the dosage was not
increased, nor the drug changed.I had to find out myself why i kept having panic
attacks 3 or 4 times a day. And to be honest,
as i am not medically trained, the Synthroid dose
may also have been too high.In any event after studying the net I more or less
demanded to be taken off the Xanax, as I thought
(and i turned out to be right) the Xanax had reached
tolerance at that dose after so many years. My dr.
was very nice and let wean off the Xanax. Sure enough,
the panic attacks ceased. This was very important
to me, as it played havoc with my day to day life and
required me to leave my job.I have not had any panic attacks since getting off
Xanax. I know that they were the effect of tolerance
or inter-dose withdrawals. That is one thing i
am certain.Not the case with Rivotril. However, having joined
the Benzo group and also the mass criticism of
benzos in general, i fell for the idea that ALL
benzos are bad, including Rivotril; infact it was
even considered that my diagnosis of bipolar may
have been a misdiagnosis. A misdiagnosis which resulted
from Valium withdrawal. Even now, i have received
messages saying that Rivotril is not the right
drug for bipolar, if i am bipolar. Right or not,
I should never have tried to get off it. What you
say about neurological adaptation gives me hope
that it will be studies and shed light on the
truly horrendous withdrawal from this drug.You can understand my heightened state of alarm
at all this and my growing fear about the ignorance
both of drug companies and the medical establishment.
Yes, I generalized and so does the group - infact
there is a general anti-psychiatric med bias on
the whole - which btw I do not share at all, as
my enthusiasm and set up of a site for lithium would
show.But i don't wish to tire you - just to make this
point and to ask: Should the Xanax have been increased
in dose over time? (the Rivotril was once); why
did i have panic attacks after taking it for some
time and yet cease to have them when i weaned off?
If it were increased, for how much longer would it have
to be increased in the lifetime of a person?Well, i'll stop here - i hope i have not tired you.
I will be looking at the World Health Organization
and their perspective on benzos.Again, i appreciate discussing this with you.
Thanks for reading.
Squiggles
Posted by alan on August 22, 2002, at 15:43:16
In reply to Re: To...Addiction vs. Medical dependence » alan, posted by Squiggles on August 21, 2002, at 8:53:18
Should the Xanax have been increased
> in dose over time? (the Rivotril was once); why
> did i have panic attacks after taking it for some
> time and yet cease to have them when i weaned off?
> If it were increased, for how much longer would it have
> to be increased in the lifetime of a person?
>
-----------------------------------------------Are you sure of the diagnosis? I get the sense that parts of it remains somewhat uncertain. Or at the very least that the reasons for your panic are unclear (Synthroid). Did you adjust any other medications while, or after tapering off of xanax?
There is too much vague about what you are saying for one to come to the conclusion that xanax was causing panic. Interaction with the Revotril? Fluctuating levels of anxiety that may have led to panic when needing to be dosed higher to treat the symptoms (dosages do need to fluctuate to trace fluctuating anxiety/panic levels and frequency)?
What level of xanax were you taking? What was considered too high - high enough for you and your doctors to conclude that the anxiolytic effect was not lasting long enough for it to appear that you needed to ramp the dosage down? "Interdose withdrawl" is just shorthand for needing to increase the frequency of dosing and therefore the overall dose.
Sure there are rare cases of dosages escallating way above the top doses in the PDR. But to an experienced physician that knows their medicines, not just to an addictionologist that sees everything through that prism only, increasing a dosage is not the end of the world. It may make them inqisitive as to why the dose is increasing but there are so many other factors to consider.
I too have distrust for many physicians now after having been through 3 docs that only wanted to restrict my bzd dosage (or take it away altogether for no reason) while polypharmacing me to death with AD's, neuroleptics, mood stabilisers, in every and all combinations. It just about fried my brain. All I needed was to have had a doctor that offered bzds on an equal footing with the rest of all of the plethora of other psycotropics rammed down my gullet and 6 or so years wouldn't have been wasted of my life.
And all for the reason of being afraid of the bzd.
Now that's medical negligence.Alan
Posted by Squiggles on August 22, 2002, at 16:07:36
In reply to Re: To...Addiction vs. Medical dependence » Squiggles, posted by alan on August 22, 2002, at 15:43:16
I'm sorry Alan. As much as i hate
Scientology, there is no doubt about
it - XANAX became addicting and i hit
tolerance - you do not like to read the
old books, but they will confirm it, as
well as the American Family Physician.It was the XANAX taken for a long time
that caused the panic attacks.Squiggles
Posted by alan on August 22, 2002, at 20:43:50
In reply to Re: To...Addiction vs. Medical dependence, posted by Squiggles on August 22, 2002, at 16:07:36
> I'm sorry Alan. As much as i hate
> Scientology, there is no doubt about
> it - XANAX became addicting and i hit
> tolerance - you do not like to read the
> old books, but they will confirm it, as
> well as the American Family Physician.
>
> It was the XANAX taken for a long time
> that caused the panic attacks.
>
> Squiggles
------------------------------------------------Huh? Scientology? I must have missed something.
Your statement that xanax "became" "addicting" and you hit "tolerance" makes no sense - especially after having asked what dose you were up to along with a whole host of other questions that may be illustrative as to how all of the variables you mentioned played into your particular case (Valium, diagnosis, lithium, synthroid, xanax dosage, etc.)
Bzd's, or other drugs that build up tolerance and have withdrawl don't "become" addicting, they simply always have had the tolerance/withdrawl phenomenon as part of the body's reaction to them. Hitting a "tolerance" or tolerance point implies some sort of arbitrary limit.
Xanax does not cause panic attacks per se, but if one doesn't keep a steady state blood level, withdrawl will begin to occur which if too fast, will increase anxiety and lead to panic. If your need for more xanax because of fluctuating anxiety levels was not being met, it could be misinterpreted as the xanax causing panic rather than properly, the lack of it.
I'm sorry, but I am clueless about your point regarding old books and especially the book mentioned. Does this have anything to do with relying on older texts for the understanding of how these medications work and should or shouldn't be prescribed? Just curious.
Posted by Squiggles on August 22, 2002, at 21:05:16
In reply to Re: To...Addiction vs. Medical dependence » Squiggles, posted by alan on August 22, 2002, at 20:43:50
>------------------------------------
Hi Alan,I better be more careful in my response - i apologize
for being so short - i was distracted with some
other work and thought i could nevertheless be
clear.
> Huh? Scientology?I mention Scientology, because the group
has a notorious reputation for anti-psychiatric
stances, including the nature of benzos, with
a tendency to be overzealous and enthusiastic
in encouraging complete cessation of psychiatric
drugs, sometimes when this is unwise and dangerous.I must have missed something.
>That is what i meant.
> Your statement that xanax "became" "addicting" and you hit "tolerance" makes no sense - especially after having asked what dose you were up to along with a whole host of other questions that may be illustrative as to how all of the variables you mentioned played into your particular case (Valium, diagnosis, lithium, synthroid, xanax dosage, etc.)
Oy vey - it's a long story - perhaps i should hunt my letter to
the Health Minister of Canada where things are described in detail;
for the present moment, i will give you a brief rundown;- i was on Xanax from 0.25 to 1.0 and not ever higher
than 3.0 over a great many years - maybe 12; the panic
attacks increased as time went on, and i felt the need
to take the "as needed" dosages more and more often to
stop the panic attacks; but as soon as the panic attack
went away, very soon i would have to take another Xanax as
a more severe panic attack would come after a couple of hours;
as you many know the half-life of Xanax is not long and the
panic attacks were very much associated with this short
interval between taking them.As for the Valium, that is a story that began everything;
Valium came before lithium, before my marriage, before
my thesis defence; Valium was taken erratically and without
supersion really (then being a popular drug); when i was
studying for my Ph.D. and a year or so before when
i was taking the Valium erratically, for the first time
in my life i experienced anxiety and panic.... eventually
i had a crash (a week of not eating, constantly crying,
terrible anxiety, nervousness - just inexplicable breakdown)This may have been concurrent with stress of graduate
studies, but it was like nothing i had ever experienced
before - it led to mania and deep suicidal depression,
as well as something like personality breakdown.That was when I was given lithium. The $64 million
dollar question is - did the Valium cause withdrawal
mimicking manic depression. I don't know.
> Bzd's, or other drugs that build up tolerance and have withdrawl don't "become" addicting, they simply always have had the tolerance/withdrawl phenomenon as part of the body's reaction to them.
In that case the dose on X should have been raised, just
as it was with clonazepam.
Hitting a "tolerance" or tolerance point implies some sort of arbitrary limit.Perhaps i needed more and had become adjusted to that dose, and it
no longer worked, as in the case of alcohol for example.
>
> Xanax does not cause panic attacks per se, but if one doesn't keep a steady state blood level, withdrawl will begin to occur which if too fast, will increase anxiety and lead to panic.
I don't think that we are disagreeing substantially here.
Yes, that is probably what happened.
If your need for more xanax because of fluctuating anxiety levels was not being met, it could be misinterpreted as the xanax causing panic rather than properly, the lack of it.
I am afraid that your fluctuating theory does not hold water.
The cycles of the anxiety were so dead on with the dose
of X and its diminuition of half-life that you would really
have to stretch this scenario to blame fluctuating anxiety.
> I'm sorry, but I am clueless about your point regarding old books and especially the book mentioned. Does this have anything to do with relying on older texts for the understanding of how these medications work and should or shouldn't be prescribed? Just curious.I think that there is information that is ignored in
modern statistical studies, which may be more explanatory
from a pharmaceutical point of view. And i will be glad to
quote from them, if you will allow me some time.I hope my message clarifies some earlier vagueness.
cheers,
Squiggles
Posted by Squiggles on August 23, 2002, at 11:28:04
In reply to Re: To...Addiction vs. Medical dependence » Squiggles, posted by alan on August 22, 2002, at 20:43:50
Alan,
You asked about variables - i forgot
to mention the fact that the Synthroid
was lowered from 0.155 to 0.112, and before
that had even been at a higher level; it
definitely contributed to anxiety. My dr.
knows this as presently i am kept slightly
hypo for that reason.However, it was not the only contributing
factor to anxiety - Xanax addiction/dependence
was as well, as dr. guided cessation of that
stopped the panic attacks.I regret that i do not recall the temporal
sequence of these events- i think Synth. adjustment
came first, and Xanax w/d came later.Squiggles
Posted by CLS on August 24, 2002, at 2:29:38
In reply to Re: To...Addiction vs. Medical dependence » Squiggles, posted by alan on August 22, 2002, at 20:43:50
This is very enlighteniong since tonight I went through pure h*ll. I have been on Xanax for several years and also different antidepressents, antipsychotics. I just started taking Geodon, which works great but the side effects of anxieties is bothersome. I didn't realize how addictied Xanax can be until I decided today to only take 1 pill and switch to Seroquel to help calm me down. The withdrawl symptoms was so great I almost callled 911. My husband asked me what meds I was taking and then quickly did research on the Internet, while I was moaning on the couch. Once he realized that I was going through withdrawl symptoms he quickly got my Xanax and had me take 1 1/2 pills. And after another 45 minutes of agony I finaly felt normal (so to speak). So I learned a leason tonight 1) Xanax is very addicting and 2) I need to work with my pdoc to slowly reduce it and take something less addicting for my nervousness.
Posted by hiba on August 24, 2002, at 3:51:16
In reply to Re: To...Addiction vs. Medical dependence, posted by CLS on August 24, 2002, at 2:29:38
Dear CLS,
You didn't mention the strength of xanax you were on and simply calling it addictive doesn't make any sense. If you are on a high dosage of an antihypertensive medication and stopping or cutting the dosage to half abruptly, you will feel horrible withdrawal symptoms. Does this mean that the drug is addictive?
It is always patient's awkwardness that makes them moan benzos are addictive. You will have to taper the medication and your doc and pharmacist will surely have warned you over stopping or cutting the xanax dosage abruptly. Doing it without consulting with your doc or pharmacist and complaining the drug is addictive is not making enough fun. If you are on a medication especially on a psychotropic for a long time, your brain will need some time to adjust to the lack of that substance. It is quite rational. Again I like to quote great Shakespeare. 'THE FAULT DEAR BRUTUS IS NOT IN OUR STARS; BUT IN OURSELVES"
Thank you and hoping you will see your doc and taper the dose of xanax. But if it is working well, why should you quit it?
HIBA
Posted by Squiggles on August 24, 2002, at 8:08:41
In reply to Re: To...Addiction vs. Medical dependence » Squiggles, posted by alan on August 22, 2002, at 15:43:16
Alan, and anyone interested,
here is the Merck's description of addiction
and withdrawal of benzodiazepines:http://www.merck.com/pubs/mmanual/section15/chapter195/195d.htm
Squiggles
Posted by Squiggles on August 24, 2002, at 8:15:56
In reply to Re: To...Addiction vs. Medical dependence » Squiggles, posted by alan on August 22, 2002, at 20:43:50
Here is a guide for detoxification from
addiction to benzos. I could add the
voluminous collection that exists at benzo.org
(much of it from Dr. Heather Ashton) but i
think you have probably gone there yourself.http://www.vh.org/Providers/Conferences/CPS/33.html
Squiggles
Posted by Squiggles on August 24, 2002, at 8:20:31
In reply to Re: To...Addiction vs. Medical dependence » Squiggles, posted by alan on August 22, 2002, at 20:43:50
A description of the effects, withdrawals, and
dependence/addiction of benzos from a physician's
reference manual - about as MOR as you can get:http://www.aafp.org/afp/20000401/2121.html
Squiggles
Posted by alan on August 24, 2002, at 11:07:06
In reply to Re: Addiction- benzos ( American Family Physician) » alan, posted by Squiggles on August 24, 2002, at 8:20:31
These references are all well and good (with several points that are self-admittedly speculative and inconclusive) but these references do not address the theme of my original interjection about the difference between "addiction" and "medical dependence".
Alan
Posted by Squiggles on August 24, 2002, at 11:46:36
In reply to Re: Addiction- benzos ( American Family Physician) » Squiggles, posted by alan on August 24, 2002, at 11:07:06
Here is the reason for the distinction:
Straight from a very intelligent horses's mouth:
infact if you wish to read anything really good
on this topic i recommend Charles Medawar -http://www.socialaudit.org.uk/4200peha.htm
Squiggles
Posted by alan on August 24, 2002, at 16:27:53
In reply to Re: To...Addiction vs. Medical dependence, posted by Squiggles on August 22, 2002, at 16:07:36
I've read throughly the link that you have provided. I see much reference to "discontinuation syndrome" as used (or misused) by the pharmecutical co's appropos AD's and do not see but an oblique reference in passing to bzds - one that didn't directly address the distinction as far as I am aware of.
Perhaps you will quote from what section of this link that directly addresses the issue of addiction vs. medical dependence as it relates to bzds.
Alan
Posted by Squiggles on August 24, 2002, at 16:56:11
In reply to Re: To...Addiction vs. Medical dependence » Squiggles, posted by alan on August 24, 2002, at 16:27:53
Right,
You remind me of some profs i had:
ok - here is something hopefully more pertinent:
"Benzodiazepines were classified as drugs of dependence, in the early to mid 1980s, essentially because of their tendency
to cause withdrawal reactions, even when taken at the usual recommended dosage, though especially after long-term use.
This point is underlined in the 1990 report of the American Psychiatric Association's Task Force report on Benzodiazepine
Dependency:"The presence of a predictable abstinence syndrome following abrupt discontinuance of benzodiazepines is
evidence of the development of physiological dependence" ..."Historically, long-term, high-dose, physiological dependence has been called addiction, a term that implies
recreational use. In recent years, however, it has become apparent that physiological adaptation develops and
discontinuance symptoms can appear after regular daily therapeutic dose administration ... in some cases after a
few days or weeks of administration. Since therapeutic prescribing is clearly not recreational abuse, the term
dependence is preferred to addiction, and the abstinence syndrome is called a discontinuance syndrome." (APA,
1990)Essentially the same point is made in the College's report, Benzodiazepines: risks, benefits or dependence (1997):
"Dependence on benzodiazepines is mainly manifest by withdrawal symptoms on cessation", and "Dependence is now
recognised as a significant risk in patients receiving treatment for longer than one month..."
taken fromhttp://www.socialaudit.org.uk/4400rcp.htm
I would like to know a little more about you since
you are drilling me so hard. :-)Squiggles
Posted by alan on August 24, 2002, at 18:58:29
In reply to Re: To...Addiction vs. Medical dependence » alan, posted by Squiggles on August 24, 2002, at 16:56:11
> Right,
>
> You remind me of some profs i had:
>
> ok - here is something hopefully more pertinent:
>
>
> "Benzodiazepines were classified as drugs of dependence, in the early to mid 1980s, essentially because of their tendency
> to cause withdrawal reactions, even when taken at the usual recommended dosage, though especially after long-term use.
> This point is underlined in the 1990 report of the American Psychiatric Association's Task Force report on Benzodiazepine
> Dependency:
>
> "The presence of a predictable abstinence syndrome following abrupt discontinuance of benzodiazepines is
> evidence of the development of physiological dependence" ...
>
> "Historically, long-term, high-dose, physiological dependence has been called addiction, a term that implies
> recreational use. In recent years, however, it has become apparent that physiological adaptation develops and
> discontinuance symptoms can appear after regular daily therapeutic dose administration ... in some cases after a
> few days or weeks of administration. Since therapeutic prescribing is clearly not recreational abuse, the term
> dependence is preferred to addiction, and the abstinence syndrome is called a discontinuance syndrome." (APA,
> 1990)
>
> Essentially the same point is made in the College's report, Benzodiazepines: risks, benefits or dependence (1997):
> "Dependence on benzodiazepines is mainly manifest by withdrawal symptoms on cessation", and "Dependence is now
> recognised as a significant risk in patients receiving treatment for longer than one month..."
>
>
> taken from
>
> http://www.socialaudit.org.uk/4400rcp.htm
>
> I would like to know a little more about you since
> you are drilling me so hard. :-)
>
> Squiggles
------------------------------------------------
Well, firstly I have taken bzds in short and long term therapy off and on for twenty years now - but only after research about the risks involved in doing so after having AD's (commercially motivated), pushed upon me for my anxiety disorder when they clearly were not in my case working for anxiety.In the many posts to you I have tried to convey my dismay at having not been offered bzds on an equal footing with the AD's and have told you why I think things progressed in this manner.
Well I, as well as many others I was reading about, were scared to death of taking an "addictive" drug, after hearing them related to heroin or cocaine and being totally unacceptable for prescription as told to me by my corporate-line psychopharmacologists.
Come to find out, the anti-benzo movement that I and others were falling for hook, line, and sinker, were exaggerating risk to the point that they were scaring away patientws from the very drug that would help them. No end to hassles and haranguing from AD corporate-line docs about the addictiveness of bzds kept me from the very med that changed my life around.
The real irony is that the co's promoting AD's that have a somewhat similar profile as to withdrawl effects, have, in order to gain cometitive advantage over the bzds, witheld information that AD's indeed have the need to be monitored for tolerance and withdrawl just like the bzd's.
There is no literature claiming "significant risks" to long or short bzd monotherapy as your link describes. In fact the latest and most comprehensive report on the saftey of bzd therapy appears in the amalgamated synopsis of
ALL studies about bzds summarised by the World Health Organisation in their recent report on "THE RATIONAL USE OF BENZODIAZAPINES".My point is that the use of the word "addiction", while in sterile definition is correct due strictly to the phenomenon of tolerance/withdrawl, in CONTEXT the more appropriate usage that is adopted for obvious reasons is medical dependence as outlined in this link:
http://panicdisorder.about.com/library/weekly/aa031997.htm
"Addiction" is reserved in the medical community to describe in a pragmatic usage, those drugs that are not appropriate for medical use. To use the word inappropriately for the general public, for which little or no distinction is made, is scaring them unnecessarily into thinking that they will be no different than drug addicts on heroin or cocaine and most assuredly will suffer the same consequences as the addict that is addicted to illicit drugs.
Of course this is rarely the case - contrary to what these anti-benzo websites irresponsibly convey.
If this were indeed the case, bzds would have been jerked off of the market worldwide long ago - that is, if the risks were eqivalent to the hype surrounding them.
alan
Alan
Posted by Squiggles on August 24, 2002, at 19:39:29
In reply to Re: To...Addiction vs. Medical dependence » Squiggles, posted by alan on August 24, 2002, at 18:58:29
Alan,
I don't think you or anyone else should
be intimidated into not taking benzos -
i think that each benzo has its "rational"
use, and if given according to the prescriptions
and guidelines of experts in this area,
the chances of addiction are not ubiquitous;
i believe that the short life ones are more
prone to that; personally i have not have
the same experience with Rivotril (thought my
doctor did raise it once or twice due to
tolerance - but this is over many years.)Having said that, i believe that withdrawal
is a much more dangerous experience and fraught
with unexpected symptoms which may be confused
with another illness by a novice doctor.As for the status of the drugs themselves, i
believe that in Canada and Britain they have
been raised to a higher level of narcotic
substances due to the testimonials and reports
from the medical community.The pharmaceutical brochures also warn of
habituation.With the growing awareness on how these drugs
affect people after 25 yrs of consumption (they
are relatively new) i think you can rest assured
that your doctor will now be more informed than
he or she was say 7 years ago.Squiggles
Posted by CLS on August 24, 2002, at 23:47:26
In reply to Re: To...Addiction vs. Medical dependence CLS, posted by hiba on August 24, 2002, at 3:51:16
Dear HIBA --
Thanks for your response. I'm taking 4 tablets daily (.5mg) each of Xanax. I had increased it becasue I have just started taking Geodon. Geodon works fime except that after it wears off a bit I get really nervous, which adds to my already parinoid state. I guess I can get caught up in the media bliz about how bad they are and feel guilty for taking them. I am going to talk to my pdoc when he comes back from vacation (which is today). Hopefully he will answer my e-mail. I guess I was pretty stupid in substituting Seqruel with Xanax. I should stick with the regime and not miss a dose. But I have to admit I have not been fully functional mentally. But hopefully the Geodon will do the trick to that.
CLS
> Dear CLS,
>
> You didn't mention the strength of xanax you were on and simply calling it addictive doesn't make any sense. If you are on a high dosage of an antihypertensive medication and stopping or cutting the dosage to half abruptly, you will feel horrible withdrawal symptoms. Does this mean that the drug is addictive?
> It is always patient's awkwardness that makes them moan benzos are addictive. You will have to taper the medication and your doc and pharmacist will surely have warned you over stopping or cutting the xanax dosage abruptly. Doing it without consulting with your doc or pharmacist and complaining the drug is addictive is not making enough fun. If you are on a medication especially on a psychotropic for a long time, your brain will need some time to adjust to the lack of that substance. It is quite rational. Again I like to quote great Shakespeare. 'THE FAULT DEAR BRUTUS IS NOT IN OUR STARS; BUT IN OURSELVES"
> Thank you and hoping you will see your doc and taper the dose of xanax. But if it is working well, why should you quit it?
> HIBA
Posted by hiba on August 25, 2002, at 1:11:29
In reply to Re: To...Addiction vs. Medical dependence » alan, posted by Squiggles on August 24, 2002, at 19:39:29
Dear Squiggles,
I don't want to mess up with you and Mr. Alan and your war of words. But let me point something which will definitely be helpful to both of you.I have seen many links and quotings in both of your postings. And it is obvious both of you are speaking with the backing of personal experiences. I do have experiences with benzos and have used them. I definitely back Mr. Alan, he seems more rational and writes with a lot of sense. It doesn't mean you are senseless. You too have your liberty to express your findings.
Now let me also quote something."Although benzodiazepines are widely prescribed and used, most of this use is intermittent, brief, and for purposes of smptom relief. Research survey data indicate that long-term use of benzodiazepines is limited to a relatively small population of patients who take the drugs for legitimate, medically supervised symptom reduction. These patients tend to be older, to have chronic physical as well as psychiatric illness, and to have psychological distress, and these patients report that the drug use is therapeutic. THERE IS NO DATA TO SUGGEST THAT LONG-TERM THERAPEUTIC USE OF BENZODIAZEPINES BY PATIENTS COMMONLY LEADS TO DOSE ESCALATION OR TO RECREATIONAL USE.(Benzodiazepine: dependence, toxicity, and abuse. A task force report of the American Psychiatric Association p.55)
"There are significant differences between dependence in therapeutic use and abuse for socio-recreational purposes. Therapeutic dependence only very rarely leads on to abuse with dose escalation."(John Marks/ The benzodiazepines Use, overuse, misuse, abuse? p.114)
"People who receive prescriptions for benzodiazepines to treat medical problems rarely take more of the medication than their doctors recommend and do not often take it for periods longer than those required to treat their problems. There are certainly cases of benzodiazepine abuse, but considering the number of people who have taken this medication, THE NUMBER OF PEOPLE WHO HAVE ABUSED IT IS QUITE SMALL." (The encyclopedia of psychoactive drugs. Vol. 16 p.99-100)
"Because of the long half-lives and conversion to active metabolites with long durations of action, withdrawal or abstinence symptoms after prolonged use may not appear for a week or more after abrupt discontinuation of the drug and are likely to be mild. In most instances after tapered withdrawal of usual doses of long-acting agents, no abstinence syndrome occurs. (Goodman and Gilman's The Pharmacological basis of therapeutics vol.1 p.427)Instead of exchanging words and links I suggest you should read these books which are much reliable. There are many more to refer, but I only quote a few. Nowhere I could find the term "ADDICTION". Does it mean all these great psychiatists and scientists are misleading us with a linguistic squabble?
Okay, leave all these behind. Use common sense. We depend on a lot of things in our life. Air, water, food, relationships.... This table will be much longer. But do you ever think you are addicted to oxygen, water? or your spouse? What makes the difference here is depending on a true necessity is not an addiction, but depending on a created necessity is definitely an addiction. For those overanxious, panic patients, benzos are not a created necessity, but a true necessity. And depending on these substances can never be regarded as an addiction.
Good luck Squiggles, I am waiting for a level headed reply.
HIBA
Posted by alan on August 25, 2002, at 2:01:25
In reply to Re: To...Addiction vs. Medical dependence » alan, posted by Squiggles on August 24, 2002, at 19:39:29
> Alan,
>
> I don't think you or anyone else should
> be intimidated into not taking benzos -
> i think that each benzo has its "rational"
> use, and if given according to the prescriptions
> and guidelines of experts in this area,
> the chances of addiction are not ubiquitous;
> i believe that the short life ones are more
> prone to that; personally i have not have
> the same experience with Rivotril (thought my
> doctor did raise it once or twice due to
> tolerance - but this is over many years.)
>
> Having said that, i believe that withdrawal
> is a much more dangerous experience and fraught
> with unexpected symptoms which may be confused
> with another illness by a novice doctor.
>
> As for the status of the drugs themselves, i
> believe that in Canada and Britain they have
> been raised to a higher level of narcotic
> substances due to the testimonials and reports
> from the medical community.
>
> The pharmaceutical brochures also warn of
> habituation.
>
> With the growing awareness on how these drugs
> affect people after 25 yrs of consumption (they
> are relatively new) i think you can rest assured
> that your doctor will now be more informed than
> he or she was say 7 years ago.
>
> Squiggles
----------------------------------------------
Yes, and that is why they are being prescribed now more than ever. If any trend is to be seen with prescribing habits of specialists that know and understand these medications, it is that the initial backlash to overprescribing when they first were introduced over 40 years ago (sound familiar - as in ssri's?) is now being supplanted by knowledgeable use of these drugs - despite the stigma that cult groups such as the backward looking benzo.org continue to attempt to inflict on these perfectly and overall safe drugs and the vulnerable med-phobic chronic anxiety sufferers that are in need of them.I've already debunked the big bad benzo monster in my mind...and after years of being deprived the medication by a couple of ill-informed, or just plain old idealogue benzophobic docs...but many others new to this pathetic game carried on by anti-benzo zealotry, don't stand a chance of escaping the same zeal of these highly political and moralistic organisations.
It's alright though. Websites such as this (psycobabble) where people can make up their own minds will eventually educate those that would otherwise fall victim to these far-from-medical, indeed unethical organisations.
There are enough obstacles standing between doctor and patient including commercialism, simple misinformation, and medical ideology. It's too bad that benzophobic evangilists have to further muddy the waters with politically motivated websites that mistakenly believe that scaremongering to make the end justify the means are somehow "legitimate" obstacles.
Pathetic.
Alan
Posted by Squiggles on August 25, 2002, at 8:28:07
In reply to Re: To...Addiction vs. Medical dependence, posted by hiba on August 25, 2002, at 1:11:29
Hiba,
Well, I am very sorry that the American Psychiatric
Association lacks data on this issue - perhaps with
future case reports they will acquire it.
Actually, it was not my dr. who got the information
about he addictive nature of Xanax given on a daily
basis that was troublesome - it was the pharmacist
who warned her that they are addictive given under
such circumstances.It was at that point that i realized i was addicted
and that he took measures from the Chief of Psychiatry
to change the situation.Squiggles
Posted by hiba on August 25, 2002, at 23:59:52
In reply to Re: To...Addiction vs. Medical dependence » hiba, posted by Squiggles on August 25, 2002, at 8:28:07
Dear Squiggles,
It is amazing, that you, your pdoc and pharmacist still possess the data which APA lacks.
I saw the term "addiction" attributed to benzos only on the net. And I have enough reason to believe it is a creation of patient awkwardness.Physicians have no other options than to believe their patients.So at least some of them are forced to assume the term "addictive"(that is why you can see in some websites physicians use this term to dub benzos.) Did you see the posting of CLS above? It is an ideal example of patient awkwardness. Consuming a psychotropic drug for years and insisting on abrupt withdrawal is not much reasonable.Most of those horror stories of benzo withdrawal I read on the net are definitely the results of inappropriate use and abrupt withdrawal.
There is no doubt benzos cause physiological and psychological dependence. But "sometimes to understand the evil, you will have to go evil in details." So if you go in details without a biased outlook you can make yourself sure that this dependence is much, much better than leading a hellish life. When there are no safer alternatives to calm agitation, what do you suggest to do? Should we go back to the primitive way of handcuffing the patient and fixing him or her in chains?
Once again, I emphasize benzos are much safer than alcohol, tobacco and Antidepressants(newer and older ones). Because benzos don't cause any long term damage as alcohol and tobacco do. They don't have nasty side effects like sexual dysfunction attributable to antidepressants.Take care Squiggles,
HIBA
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