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Addiction vs withdrawal syndrome recovery -- AA, NA, ACA


moonbow0202
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Alto asked me to start this topic after I posted about there being similarities and differences between recovery from addiction and recovery form ADs. Writing is hard for me but I am posting some of my thoughts.

 

I've actually been thinking about this topic quite a bit after my last visit to the psychiatrist. She told me that It didn't matter how long i spent tapering and that it would take a year from the time I was totally off ADs for me to recover. Later, I realized that what she said was classic addiction recovery theory. I believe that the term "discontinuation" is and pharmaceutical company attempt to downplay the severity of AD WD. However, I think my doc's comment illustrates a downside to the use of "withdrawal".

 

What follows are some of my thoughts on the subject.

 

In my experience, thebiggest difference has been in the area of support.

 

The decision to quitdrugs/alcohol is supported by medical professionals, friends, and family. Thedestructive behavior that accompanies active addiction makes the necessity ofstopping obvious to everyone but the addict. Eventually, the addict will seethe necessity but may not be able to stop. Quitting is viewed as a responsibleaction.

 

Deciding to quit psych meds/antidepressants is not widelysupported. The person making this decision is frequently compared to a diabeticwho has stopped taking their insulin. Quitting is viewed as an irresponsibleaction by many.

 

 

Drugs/alcohol are usuallystopped as quickly as possible without killing the addict.

 

The destructive behavior will only stop when the drugs arestopped. Addicts cannot control theiruse, using a little will intensify cravings and probably result in using a lot.Active addiction carries a risk of overdose (this includes alcohol).

 

The exception to this is a replacement program such asmethadone or suboxone. Many addicts have found lasting sobriety this way.

 

 

Long Term Syndromes

 

PAWS (post acute withdrawal syndrome ) is well recognizedfor addicts/alcoholics. A similar syndrome for those of us gettingoff antidepressants is not widelyrecognized. There are a lot of similar symptoms but it feels much worse withthe Ads.

15+ years on various ADs and combos. Spent 3 yrs tapering (off & on ) off 225mg Effexor venlafaxine) XR & Remeron (mirtazapine). Finished tapering Oct 2014.

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These are good points, Moonbow.

 

Are you in addiction recovery yourself?

 

I've been to a lot of 12-step meetings and rehab even so I know a bit about that end of it.

 

The largest of the differences is that close to 100% of your friends, family, colleagues understand and support addiction recovery. Close to 0% understand/support psychiatric drug dependency. For me this is the most impactful difference. Without understanding and support, I find my challenges more difficult to want to face. I live a more separate life and can not be honest with many.

 

The hardest single thing for me is to have suffered an unfortunate, unnecessary and tragic calamity -- basically been perpretrated against -- but largely stay quiet about it because the disbelief and 'prove it to me' attitude I have encountered is unbelievably diminishing.

 

I talked to my brother once a few months ago. And he asked me if I was sure I was unwell, like is there proof on a medical test? And that he is a firm believer that all I needed was eating right 'n exercising. Having to prove it is why I've checkde out. It is sooooooo tough to hear people open their mouth holes and talk about me from sheer ignorance.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Thank you for this fascinating topic, moonbow.

 

It seems that the thinking of doctors who are clued about psychiatric drug withdrawal syndromes are confused by what they know about addiction withdrawal. (Example, Robert Lefever http://survivingantidepressants.org/index.php?/topic/988-recommended-doctors-therapists-or-clinics/page__view__findpost__p__23929 )

 

Heather Ashton's injunction against updosing benzos is based on the assumption that once the person is given permission to increase, the addiction will get out of hand. This is where the idea of continuing to aggressively reduce dosage no matter what comes from.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Heather Ashton's injunction against updosing benzos is based on the assumption that once the person is given permission to increase, the addiction will get out of hand. This is where the idea of continuing to aggressively reduce dosage no matter what comes from.

Thanks for this Moonbow and Alto. Unfortunately Ashton's injunctions are instilled into many of the protocols she influenced. This is the real reason the tolerance withdrawal paradigm so fully took hold, and not because of the physiological reason usually given. "Always forward movement, it does not matter how small a cut, but keep cutting." It's almost a mantra!

As always, LISTEN TO YOUR BODY! A proud supporter of the 10% (or slower) rule.

 

Requip - 3/16 ZERO  Total time on 25 years.

 

Lyrica: 8/15 ZERO Total time on 7 or 8 yrs.

BENZO FREE 10/13 (started tapering 7/10)  Total time on 25 years.

 

Read my intro thread here, and check the about me section.  "No matter how cynical you get, it's almost impossible to keep up." Lily Tomlin

 

 

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Are you in addiction recovery yourself?

 

I've been to a lot of 12-step meetings and rehab even so I know a bit about that end of it.

 

The largest of the differences is that close to 100% of your friends, family, colleagues understand and support addiction recovery. Close to 0% understand/support psychiatric drug dependency. For me this is the most impactful difference. Without understanding and support, I find my challenges more difficult to want to face. I live a more separate life and can not be honest with many.

 

 

Yes I am in addiction recovery. 11 years clean/sober.

15+ years on various ADs and combos. Spent 3 yrs tapering (off & on ) off 225mg Effexor venlafaxine) XR & Remeron (mirtazapine). Finished tapering Oct 2014.

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i think it is important to note that drug/alcohol withdrawal has a well recognised biochemical basis and that AD withdrawal follows a similar pattern. If someone has many abrupt alcohol withdrawals that are not managed with judicious use of benzo's then they can sensitise their system to be kindled into withdrawal even during sobriety.

 

Alcohol and benzo withdrawal has a well defined and clinical picture - elevated temperature, anxiety, sweating, tremor, insomnia and possible seizures along with intense craving and other emotional symptoms. AD withdrawal doesn't usually have the cravings but has many of the other symptoms and is just as likely to have even more debilitating longer term problems that are still not recognised by many doctors.

Started in 2000 - On 150mg most of the time, (but up to 225mg at highest dose for 6 months in the beginning)
Reduced off easily first time - but got depressed (not too much anxiety) 6 months later
Back on effexor for another 9 months.
Reduced off again with no immediate w/d - suddenly got depressed and anxious ++ again 3 or 4 months later.
Back on effexor - this time for 3 years
Reduced off over a month - 6 weeks later terrible anxiety - back on.
Rinse and repeat 4 more times - each time the period before the anxiety comes back got shorter and shorter
Jan - July 2012 75mg down to 37.5mg;, 8/3/12 - 35mg. 8/25/12 - 32mg. 9/11- 28mg, 10/2 - 25mg, 10/29 - 22mg, 11/19 - 19.8mg; 12/11 - 17m,
1/1- 15.5mg; 1/22 -14mg, 2/7 14.9mg, 2/18 - 17.8mg - crashed big time: back to 75mg where i sat for 2 years....

4th  March 2015 - 67.5mg;   31st March - 60mg;  24th April - 53mg; 13th May - 48mg; 26th May - 45mg;  9th June - 41mg; 1 July- 37.5mg; 20 July - 34mg; 11 August - 31mg; 1st Sept - 28mg;  1st Dec - 25.8mg;  28th Dec - 23.2mg; 23rd Jan-21.9mg; Feb 7th- 21mg; March 1st - 20.1mg, March 30th - 18mg

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i think it is important to note that drug/alcohol withdrawal has a well recognised biochemical basis and that AD withdrawal follows a similar pattern. If someone has many abrupt alcohol withdrawals that are not managed with judicious use of benzo's then they can sensitise their system to be kindled into withdrawal even during sobriety.

 

I'm not sure I follow your point here. You mean if a bad alcoholic stops drinking without medical intervention that they may experience ongoing withdrawal after they stop drinking?

 

Alcohol and benzo withdrawal has a well defined and clinical picture - elevated temperature, anxiety, sweating, tremor, insomnia and possible seizures along with intense craving and other emotional symptoms. AD withdrawal doesn't usually have the cravings but has many of the other symptoms and is just as likely to have even more debilitating longer term problems that are still not recognised by many doctors.

 

Good point. If someone shows up in the ER with DTs, the medical staff knows the drill. AD withdrawal draws blank stares.

 

My experience, I've never craved a benzo. I only know of one individual who's primary drug of choice was a benzodiazepine -- he used to hook me up with my klonopin (prescriptions).

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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i think it is important to note that drug/alcohol withdrawal has a well recognised biochemical basis and that AD withdrawal follows a similar pattern. If someone has many abrupt alcohol withdrawals that are not managed with judicious use of benzo's then they can sensitise their system to be kindled into withdrawal even during sobriety.

 

I'm not sure I follow your point here. You mean if a bad alcoholic stops drinking without medical intervention that they may experience ongoing withdrawal after they stop drinking?

 

not quite ongoing withdrawal, but a 'conditioned withdrawal response'

 

During a conditioned withdrawal response, environmental stimuli that are repeatedly associated with with- drawal symptoms (e.g., a physician’s office or hospital) may themselves become cues that trigger the neuro- chemical changes resulting in the physical and psychological withdrawal symptoms. Conditioned withdrawal- related responses, which reflect a kindlinglike process, may represent the biological basis for cue-induced alcohol craving in these circumstances.

from:kindling in alcohol withdrawal

 

this article is very good and i think we can draw parallels to AD withdrawal

Started in 2000 - On 150mg most of the time, (but up to 225mg at highest dose for 6 months in the beginning)
Reduced off easily first time - but got depressed (not too much anxiety) 6 months later
Back on effexor for another 9 months.
Reduced off again with no immediate w/d - suddenly got depressed and anxious ++ again 3 or 4 months later.
Back on effexor - this time for 3 years
Reduced off over a month - 6 weeks later terrible anxiety - back on.
Rinse and repeat 4 more times - each time the period before the anxiety comes back got shorter and shorter
Jan - July 2012 75mg down to 37.5mg;, 8/3/12 - 35mg. 8/25/12 - 32mg. 9/11- 28mg, 10/2 - 25mg, 10/29 - 22mg, 11/19 - 19.8mg; 12/11 - 17m,
1/1- 15.5mg; 1/22 -14mg, 2/7 14.9mg, 2/18 - 17.8mg - crashed big time: back to 75mg where i sat for 2 years....

4th  March 2015 - 67.5mg;   31st March - 60mg;  24th April - 53mg; 13th May - 48mg; 26th May - 45mg;  9th June - 41mg; 1 July- 37.5mg; 20 July - 34mg; 11 August - 31mg; 1st Sept - 28mg;  1st Dec - 25.8mg;  28th Dec - 23.2mg; 23rd Jan-21.9mg; Feb 7th- 21mg; March 1st - 20.1mg, March 30th - 18mg

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That is interesting. I know some alcoholics are triggered to drink by attending AA meetings, but most are not.

 

It's also interesting, as I just came from my psychiatrist's office, how visiting my psychiatrist triggers all sorts of issues for me. Of course, she doesn't make me want to get back on anti-depressants but I sure do get pissed off and also self-pity my misfortune.

 

On a barely related note: Everytime addiction and psychiatric-med dependecy/w.d is brought up, I always want to compare and declare addiction the easier, less disastrous of the two. Always. I am very angry today.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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