Benzodiazepines

Questions In Early Sobriety

I want to share a letter I recently received from a guy in early sobriety, along with the response I gave.  The letter is SO typical of the cares and worries of people in early sobriety that I think most folks will be able to relate.  I edited a bit for brevity, believe it or not.  So…

Hey Bill,

I talked with you once before  when I was about 43 days clean. Today is day 68 and don’t get me wrong I am happy so far.

I have been exercising quite often, mostly running and some weight lifting in the days past, but I still have trouble sleeping at night; I have to wait till like 3 a.m to be able to fall asleep and then I sleep like a hibernating person. At times anxiety comes and attacks me just as depression sets in. From what I have read and researched it seems to point to p.a.w.s. I just really want to be back to normal and never touch the stuff I used to.

Even deep down inside I feel tremendous strength and confidence that I won’t go back to using, some people I know tell me not to be fooled by this deception. I know you have a lot of experience with your own sobriety so I am hoping things will eventually get better for me.

Every day that passes I realize how nice it is to just be alive in the moment even though I have lost everything I have ever owned to this drug. People I have known for ages have distanced themselves, acting as tho they have never known me. I will admit this does hurt, but I try not to let it get to me. Someone once told me that the day we start being clean is the day we start growing emotionally.

Never in my life would I ever think I would be sitting behind the screen typing this and actually counting the days that go by. I count each and every day because it serves me as a reminder of the time I have dedicated towards fighting this disease.

All I want to ask you Bill is if things will eventually get better because depression seems to always be around the corner. There are days when I am happy for most of the day and then there are those times when everything seems dull.

Peace, love and happiness. Take care.

Joe

Hi Joe,

Good to hear from you again, and congratulations on the 68 days and 136 nights!

Sorry you’re having trouble sleeping, but that’s pretty normal in early sobriety. You feel draggy, but rest assured that no one ever died from lack of sleep — at least not when they’re able to “sleep like a hibernating person” once they fall off. It sounds like you’re suffering as much from a disturbance in your sleep pattern as from actual lack of sleep.

Try limiting heavy exercise and caffeine to mid-afternoon at the latest. That may help. Also, never force yourself to stay awake. If you get sleepy during the evening, forget about TV or that book. Go to bed. Sometimes a little discipline on the waking side is all it takes. If you can’t sleep, get back up and do something: eat a light meal or snack, low on carbs with a bit of fat and protein (peanut butter on crackers works well for many) and then read or do something non-stimulating until you think you can sleep again. Lying in bed awake just accustoms you to lying in bed awake.

Your mood swings, likewise, are pretty typical. As long as the depression doesn’t become severe, or last for more than a day or so at a time, I wouldn’t be too concerned. Your brain is adjusting to an entirely new balance of neurotransmitters, and your dopamine production is almost certainly still below normal. As long as you’re not having thoughts of worthlessness, life not worth living, etc., you’re likely just going through normal swings. They will become less severe over time, as your brain chemistry slowly returns to normal.

HOWEVER, if the depressed feelings get worse than just feeling blue, you need to take them seriously and talk to a doctor. You might need an antidepressant for a while. Antidepressants won’t interfere with your recovery.

On the other hand, watch out for antianxiety drugs. The most popular ones are benzodiazepines (Ativan, etc.) and they are poison for recovering addicts. They will prevent your brain from recovering properly, and are highly addictive in themselves (regardless of what your doctor may think). Trust me: I spent three weeks in medical detox for benzos. If you need medication for anxiety, there are plenty of non-addictive alternatives. Mainly, though, you need to keep to your program of healthy living and meetings.  In most cases the anxiety will ease off as you begin to feel more comfortable in your recovery.

Your friends are right: overconfidence has killed many an addict. Relapse is a recognized symptom of addiction, and it can happen to anyone, even us old-timers. I know plenty of people with 10+ years who have relapsed — almost always because they got overconfident and stopped doing the things that kept them sober to start with. Don’t get too confident; it leads to carelessness.  That said, as long as you're working a program and doing what you need to do, you needn't worry.  Just remember that recovery is a process, not an event.  It's a sliding scale, and sometimes it's more slippery than others.

The person who told you about emotional growth is correct as well. If our emotional development wasn’t interrupted by some sort of trauma before we started using, it was most certainly brought to a screeching halt when we began getting high regularly. Then when we get sober — and just when our nerves are at their most jangly — along come all those suppressed emotions that we haven’t learned to handle. It can be unnerving, to say the least. This, too, shall pass. Therapy helps, as do the steps of the program. So does experience living clean and sober.

Recovery takes time, Joe. We spent years messing up our brains and (to a degree) our bodies. Because we’re addicts we expect immediate results when we stop using, just as we got them when we used, but it takes our bodies months to get back to something like normal. That’s what PAWS (Post-Acute Withdrawal Syndrome) is — the period of healing. It takes time, but it does get better.

Hang in there, and

Keep on keepin’ on!

Bill

I’m In Recovery. Should I Be Taking Ativan?

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Ativan 2 mg. - justice.gov

Q. I’m taking a benzo (Ativan®) for anxiety on the advice of my psychiatrist.  My sponsor says it’s an addictive drug, and that I need to stop taking it.  Do I?

A.  Your sponsor is correct.  There is no question that Ativan® (lorazepam) is a highly-addictive drug, and that long-term use by anyone is undesirable.  In fact, extended use of any benzo is problematic, and there are other anti-anxiety medications that are more appropriate.  The action of benzodiazepines in the brain is similar to that of other addictive drugs, and your central nervous system cannot recover to a normal state while they are in your body.  Thus, other addictions are prolonged, and there is great possibility of relapse to other drugs.

You would be well-advised to discuss this with your physician, and to make arrangements to detox safely from the lorazepam. The ideal scenario would be treatment in a specialized detox facility with 24-hour medical monitoring. That would give you access to addiction experts who are up to date on best practices.  The facility would also be able to provide referrals for aftercare.  Post-acute withdrawal from benzos can be prolonged and severe, and may require clinical attention after detox.

Do not, whatever you do, take it upon yourself to stop without medical monitoring. Withdrawal from lorazepam can be fatal, and you need to be under a physician’s watchful eye, and adhering to a strict detox protocol.

Is Medical Detox Really Necessary?

I received an email from a hard-nosed recovering addict/alcoholic who stated, in essence, that inpatient detox isn’t necessary, that he did it on his own, and that all anyone needs is a (little of this, little of that) to get through it just fine, and he knows a bunch of folks who did it that way, and…blah, blah, blah.

I replied, politely, that everyone is different, and that just because it worked for some does not mean that it will work for everyone, and that detox is too important to take a chance on getting it wrong (or killing someone).  I refrained from asking how many of his acquaintances had a successful detox, culminating in long-term happy sobriety with no relapse.

In my years around the 12-step rooms I’ve heard similar comments every now and then.  Some guy (it’s nearly always a guy) makes some remark to the effect that if it was good enough for him and Christopher Columbus, it ought to be good enough for all these young whippersnappers.  Somehow I don’t see how surviving the threat of seizures, heart attack, stroke, DTs, profound depression and a variety of other jackpots (depending on the drug or mixture of drugs) proves anything, except that you were one of the lucky ones, but maybe that’s just me.

Just about any drug that will alter your mood noticeably can be addictive, including weed.  Getting off any of them can create enough withdrawal symptoms that it can be really difficult to make it through a self-detox, although not all are physically dangerous.  (Of course you could argue that things like possible psychotic episodes and profound depression are physically dangerous, but we'll let that go for another time.)

The bottom line, though, is this: Under the supervision of medical personnel who are trained to administer the proper medication and equipped to handle any problems, detox can be surprisingly comfortable.  Lacking that, there can be some nasty surprises.  Not everyone has complications, which explains the position of the scoffers, but enough folks do that it’s not worth taking a chance if you don't have to.

Painkillers Aren’t The Only Rx Drugs To Worry About

When we speak of prescription drug abuse, addiction and the complications (including deaths) that accompany their use, we usually talk about Percodan, Percocet, Oxycontin and similar opioid drugs.  There is no question that these are the biggies in terms of unintended consequences — severe dependency, addiction, overdose and death.   There are, however other drugs that are cause for concern amongst professionals and those they treat.

Probably chief among these are the benzodiazepines, which are used for treatment of anxiety, as tranquilizers, to suppress seizures, and for a variety of other purposes.  There is the common perception (even among doctors) that these drugs are not addictive, and that long-term use is perfectly OK.  This is an interesting misconception, since every manufacturer of benzodiazepines provides specific information regarding their use.  This information is always adamant that the drugs should not be used for more than six weeks, except in unique circumstances to treat specific conditions.  We've mentioned before on these pages the need to check out medications with your pharmacist, not just blindly take what the doctor orders, and benzos are a prime example of the reason for that advice.  Benzodiazepines are especially dangerous when use in conjunction with alcohol or other drugs that depress the central nervous system (downers).

Detox from benzodiazepines, which include Ativan, Valium, Xanax, Clonazepam (Klonopin), and about 20 other brands and compounds that are currently available, can take up to three weeks.  Sudden cessation of any of them can be traumatic, causing agitation, sleeplessness, jitters, nausea, and a number of other unpleasant side effects.  Withdrawal from several of the more common benzos can also trigger convulsions.  Chronic use can lead to tolerance, the need for more of the drug to avoid discomfort, and definite addiction.  Some benzos can lead to addiction at low doses, and in far less time than one would imagine.

Ambien (zolpidem) is another common drug that creates dependency problems among both legitimate users and abusers.  Properly prescribed, it is used for short-term adjustment of sleep cycles.  When used for longer periods a dependency on the drug develops rapidly, so that the user becomes unable to fall asleep without it.  Tolerance develops rapidly as well, causing users to need more and more of the drug to get to sleep.  Ambien, at higher doses, often causes severe sleepwalking episodes.  It is not unusual in these episodes for people to seem awake to others, even to drive, but to have no memory of it later.  The safety considerations here should be obvious.

There are a number of other drugs that are easily abused — too many to mention here.  Generally speaking, any substance that can be used for pleasure can cause psychological and/or physical addiction, and often both.  Don't depend on any one person to decide what medications you should be taking.  Doctors have a great deal of information to absorb, and most of them are not trained in pharmacology.  Your pharmacist is your best source.

 

Oklahoma Linebacker Died of “Mixed Drug Toxicity”

In another tragic example of legitimately prescribed pain medication leading to abuse, it was revealed yesterday that Oklahoma linebacker Austin Box had five different painkillers and a benzodiazepine anti-anxiety drug in his body at the time of his death.  Box was exposed to painkillers after multiple surgeries that followed football injuries.

In addition to the dangers of taking painkillers without medical supervision, this illustrates the potential deadly effects of mixing any depressant drug with other depressants.  The synergistic effects of the mixture are often greater than planned.

http://content.usatoday.com/communities/campusrivalry/post/2011/07/oklahoma-austin-box-autopsy-drugs/1

Drug abuse costs rival those of chronic diseases

Drug abuse in the US (not including alcohol) costs the economy $193 billion a year, according to a new report.  That figure equals or exceeds the cost of chronic diseases such as diabetes.

Read about it…

Strength? We don’t need no stinkin’ strength!

Nowadays I hear a lot of folks saying (to recovering people) things like “You’re so strong!” and “Be strong!”  I hear newcomers say “I pray for the strength to beat my addiction,” and other stuff like that.  While I understand the thinking behind such remarks (all too well), there are a few comments I’d like to make.

One of the first things we need to learn in recovery is our powerlessness.  We are powerless when it comes to our addictions as long as we are using our drugs of choice, and for some time afterward. If this were not true, we’d simply quit and no one would ever relapse.  The only strength we need is the strength to admit that unpleasant fact, accept it, and listen to people who know what they’re talking about — since we obviously don’t.

That does require a certain amount of guts.  We addicts and codependents hate to admit that we aren’t in control. In fact, though, weren’t most of our problems based on our illusions of control:  controlling our drinking or other drugging; controlling our addicts; controlling our kids; getting everything just right and then having it welded, as a friend of mine used to say?  (He was talking about tuning his 12-string, but the remark is so addict!)

When we have the strength to admit that we’ve lost control, that we’re whipped, that we can’t go on, then we have finally reached the point where recovery is possible. Without that realization of powerlessness, recovery is unlikely, if not impossible.  That’s why I worry when I hear folks speaking in terms of “strength.”  When we think that way, we are in danger of becoming convinced that we are no longer powerless, that we can control our using and keep it “social” this time, that he really isn’t a  rotten wife-beating s.o.b. when he’s drinking, that if we just took Muffy in off the street and give her a clean place to sleep, she’ll realize that she’s much better off and will quit using those nasty drugs.

In early recovery we don’t have much power, if any. We don’t need strength, we need the humility to learn from others the things that we were unable to learn on our own: how to handle our urges, our relationships, our jobs, our spiritual growth — in short, how to live lives of sobriety.  Then, after we’ve gone a good distance in that direction and our bodies and minds have begun to recover from the beating we gave them for all those months or years — at that point we begin having some power over our addictions.  As long as we don’t use.

Addiction is like a rattlesnake.  I can pick it up and haul it around wherever I please — all day long, if I like.  That’s strength.  But if I get careless, that’s when I find out what powerlessness is all about.