![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 41 to 65 of 72. Go back in thread:
Posted by Elizabeth on October 15, 2001, at 19:39:22
In reply to Misuse of Drugs » Elizabeth, posted by Rosa on October 15, 2001, at 8:13:59
> Does this group have any such guidelines concerning what they consider to be misuse of drugs or a slip?
This group? You mean Psycho-Social-Babble? I think that, with the exception of nonsupportive (i.e., mean or rude) remarks (and certain other types of content, such as encouraging people to do something that's illegal), there are no rules governing post content. I think it's generally agreed that each individual needs his own treatment and that it's ultimately between the individual and his treater(s).
> A slip is when after having abstained from alcohol or drugs for a period of time, while in a 12-step program, one goes back out and uses alcohol or drugs.
I would leave out the 12-step part and say that if a person uses his DOC (and not just any drug)while trying to abstain as part of a program of recovery, that would be a slip. There are addiction treatments that have been proven effective and that don't require or use a 12-step approach.
> How do you describe self-medication?
Many people don't receive any treatment (or don't receive adequate treatment) for mood and anxiety disorders (and other psych disorders, but these are the primary ones). When they come across and try "hard" drugs (i.e., addictive drugs such as alcohol, opioid agonists (heroin, etc.), cocaine, amphetamine (and similar drugs), and some of the older types of "minor tranquilizers" such as methaqualone or barbiturates), they discover that the drugs seem to fix whatever problem they're having (depression, chronic pain, panic attacks, social phobia, posttraumatic stress, anger-control problems associated with various conditions (such as bipolar disorder and ADHD), etc.), so they start using it regularly. Because their drug use is not supervised by a doctor, it's hard for them to keep a limit on the amount they use, and they often (perhaps almost always) end up becoming addicted. (Even if they're not addicted, though, it's still self-medication.)
Some people do this because they aren't aware (or don't want to believe) that what they have is a psychiatric disorder which can be treated. Others, however, have tried to get treatment, but it has not worked, often because doctors are reluctant to prescribe the most effective treatments (such as benzodiazepines for anxiety disorders or stimulants for ADHD) or only prescribe them in sub-effective doses. In some cases the effective treatment is not recognized as "legitimate" by the medical establishment (e.g., opioids for certain cases of treatment-resistant depression)
I am not an addict; but I do love a former addict, and I can appreciate what he goes through. I've been clinically depressed (on and off) since I was 14 years old, and there's no doubt in my mind that if I'd had a mind to, I would have sought out heroin myself as an adolescent and probably would have become addicted. After trying many, many treatments, none of which had been completely effective, I finally happened upon hydrocodone (when I had my wisdom teeth removed). When I mentioned this to a psychopharmacologist who I was seeing for a consultation (after phenelzine pooped out on me), he thought of buprenorphine, an opioid that is relatively non-addictive (it's in the lowest controlled-substance category in the US, Schedule V) and is safe in overdose. The drug, which is used in many other countries as substitution therapy for opioid addiction and is approved here for pain, had recently been the subject of a paper that this consultant had published in the Journal of Clinical Psychopharmacology about a small clinical trial in depressed patients for whom other treatments had failed to work. A couple of years after I first met with the consultant, I had tried practically everything that my doctor and I could think of, and we decided it was time to try buprenorphine. My doctor spoke to the consultant, who had more experience using opioids in depression than just about any other psychiatrist, and decided that he was comfortable prescribing it to me. It works, although it has all the typical side effects of full-agonist opioids (nausea, constipation, dry mouth, pruritis). I am pretty sure I'm not unique in being preferentially responsive to opioids; I can only assume that others like me usually take the other path and become heroin addicts. My aforementioned boyfriend is one of these people. I do not see him as weak or immoral. He is what I could have been if I hadn't been lucky enough to live within walking distance of Harvard Medical School. And yes, it angers me when people say that addicts are decadent, evil, subhuman. They are not.
> Here are some guidelines concerning the misuse of drugs for alcoholics.
I think that these rules are a good template to start from for a person who's trying to design a treatment program for addiction, although there is no single program that will work for everybody. (Addicts are unique human beings too.)
> 1. Remember that as a recovering alcoholic your automatic response will be to turn to chemical relief for uncomfortable feelings and to take more than the usual, prescribed amount. Look for nonchemical solutions for the aches and discomforts of everyday living.
I'm not convinced that it's that simple. Many addicts lack resilience, the natural ability to cope and adapt. Learning coping skills can help, but in the end it may not be enough. For others, their drug use relieves daily stress or pain due to a situation that nobody could tolerate by themselves, or to a trauma from which they have never fully recovered. In these cases, help is needed to get out of the intolerable situation or to heal the injury caused by trauma; and again, medical treatment may still be needed.
> 2. Remember that the best safeguard against drug-related relapse is an active participation in a program of recovery.
Always a good idea. But I've noticed that there are very few such programs in which the addicts are treated as the suffering human beings they are. Much of "treatment" seems to consist of convincing the addict that he is a bad person.
> 3. No member plays doctor.
"Member" of...?
Generally it's a good idea for people in support groups not to "play doctor;" but this can mean different things to different people. I think it's fine for people to share information with other group members. I don't think it's okay to pressure another person to become involved in a particular type of treatment. (Of course, I don't think it's okay for doctors to pressure or coerce patients into a particular type of treatment, either.)
Doctors can become addicts -- anesthesiologists, for obvious reasons, seem especially vulnerable. I think it's certainly fine for a doctor in a support group to share medical knowledge with other group members.
> 4. Be completely honest with yourself and your physician regarding use of medication.
I believe it is the treater's responsibility to prove to the patient that he will not be punished for honesty. This is the only way that a trusting therapeutic alliance can be formed.
> 5. If in doubt, consult a physician with demonstrated experience in the treatment of alcoholism.
Always a good idea, although who you should consult probably depends what exactly your "doubts" are about.
> 6. Be frank about your alcoholism with any physician or dentist you consult. Such confidence will be respected and is most helpful to the doctor.
Unfortunately, too often patients are punished for honesty.
> 7. Inform the physician at once if you experience side effects from prescribed drugs.
Another good idea, although it's probably not wise to make a big fuss about minor side effects! :-)
> 8. Consider consulting another doctor if a personal physician refuses or fails to recognize the peculiar susceptibility of alcoholics to sedatives, tranquilizers, and stimulants.
...or if the physician rules out the use of these drugs as treatments, based on a history of alcoholism. I think I went into this issue earlier.
I'm not convinced that alcoholics are especially liable to abuse tranquilizers, although they are probably liable to use more than the prescribed amount if the prescribed amount is inadequate! And I don't see any reason why they would be prone to stimulant abuse.
> I believe that the guidelines for drug addicts is more strict.
Alcoholics are drug addicts. Alcohol happens to be a legal drug; for some reason, the federal government acknowledged that a Constitutional amendment was required in order to prohibit alcohol, but they argue (in support of the Controlled Substances Act and successive drug legislation) that the commerce clause permits criminalization of other drugs, including some substances which occur naturally in the human body! Very inconsistent and intellectually (not to say legally) dishonest, IMO.
So, you still didn't answer my question: what do you mean when you ask, "What is your policy concerning the misuse of drugs?" (I don't have a lot of "policies," seeing as I'm not a government or a corporation. :-) )
-elizabeth
Posted by galtin on October 16, 2001, at 6:12:44
In reply to Misuse of Drugs » Elizabeth, posted by Rosa on October 15, 2001, at 8:13:59
> Does this group have any such guidelines concerning what they consider to be misuse of drugs or a slip?
>
> A slip is when after having abstained from alcohol or drugs for a period of time, while in a 12-step program, one goes back out and uses alcohol or drugs.
>
> How do you describe self-medication?
>
> Here are some guidelines concerning the misuse of drugs for alcoholics.
>
> 1. Remember that as a recovering alcoholic your automatic response will be to turn to chemical relief for uncomfortable feelings and to take more than the usual, prescribed amount. Look for nonchemical solutions for the aches and discomforts of everyday living.
>
> 2. Remember that the best safeguard against drug-related relapse is an active participation in a program of recovery.
>
> 3. No member plays doctor.
>
> 4. Be completely honest with yourself and your physician regarding use of medication.
>
> 5. If in doubt, consult a physician with demonstrated experience in the treatment of alcoholism.
>
> 6. Be frank about your alcoholism with any physician or dentist you consult. Such confidence will be respected and is most helpful to the doctor.
>
> 7. Inform the physician at once if you experience side effects from prescribed drugs.
>
> 8. Consider consulting another doctor if a personal physician refuses or fails to recognize the peculiar susceptibility of alcoholics to sedatives, tranquilizers, and stimulants.
>
> I believe that the guidelines for drug addicts is more strict.
>
> ^^^^^
>
> > > What is your policy concerning the misuse of drugs? What do you consider a slip?
> >
> > Can you be clearer as to what your question is? "Policy concerning the misuse of drugs" is awfully broad.
> >
> > -eThe general guidelines for the use/non-use of prescription meds by recovering alcoholics is as follows.
1. Any use of psychoactive substances without a prescription is a relapse.
2. Obtaining and using such substances from a doctor under false pretenses is a relapse.
3.At times alcoholics/drug addicts may need to take pain medication.
4.But some will refuse.
5. Exceeding the prescribed dose of a medication can be considered a relapse, depending on how much, how often, the FDA schedule of the medication,and whose talking.
6. The term "slip" refers to a short-term relapse, several days to a week or two. A relapse usually characterizes a prolonged return to substance/alcohol abuse.
6. Most alcoholics today are "dually" addicted -- "a drug is a drug is a drug,"as the saying goes.
7.Many alcoholics will give potentially addictive medications to a family member or a friend for dispensation and discuss the situation with other recovering alcoholics. Secrecy breeds slips and relapses.
8.A number of recovering alcoholics will disagree with one or more of the above statements, and there is no authoritative tribunal to resolve these differences.
galtin
Posted by Rosa on October 16, 2001, at 7:37:12
In reply to Re: Misuse of Drugs Elizabeth, posted by galtin on October 16, 2001, at 6:12:44
> The general guidelines for the use/non-use of prescription meds by recovering alcoholics is as follows.
>
> 1. Any use of psychoactive substances without a prescription is a relapse.
>
> 2. Obtaining and using such substances from a doctor under false pretenses is a relapse.
>
> 3.At times alcoholics/drug addicts may need to take pain medication.
>
> 4.But some will refuse.
>
> 5. Exceeding the prescribed dose of a medication can be considered a relapse, depending on how much, how often, the FDA schedule of the medication,and whose talking.
>
> 6. The term "slip" refers to a short-term relapse, several days to a week or two. A relapse usually characterizes a prolonged return to substance/alcohol abuse.
>
> 6. Most alcoholics today are "dually" addicted -- "a drug is a drug is a drug,"as the saying goes.
>
> 7.Many alcoholics will give potentially addictive medications to a family member or a friend for dispensation and discuss the situation with other recovering alcoholics. Secrecy breeds slips and relapses.
>
> 8.A number of recovering alcoholics will disagree with one or more of the above statements, and there is no authoritative tribunal to resolve these differences.
>
>
>
> galtin^^^^^
Thanks for your comments, I agree.
Posted by Rosa on October 16, 2001, at 8:08:45
In reply to addiction and recovery » Rosa, posted by Elizabeth on October 15, 2001, at 19:39:22
> > Does this group have any such guidelines concerning what they consider to be misuse of drugs or a slip?
>
> This group? You mean Psycho-Social-Babble?Yes, PSB.
> > How do you describe self-medication?
I was primarily referring to increasing or decreasing the dose.
> > 3. No member plays doctor.
>
> "Member" of...?
Psycho-Social-Babble.
>
> Generally it's a good idea for people in support groups not to "play doctor;" but this can mean different things to different people. I think it's fine for people to share information with other group members. I don't think it's okay to pressure another person to become involved in a particular type of treatment. (Of course, I don't think it's okay for doctors to pressure or coerce patients into a particular type of treatment, either.)I agree.
>
My question was "Does Psycho-Babble have a policy concerning the use/misuse of drugs?"What do members of Psycho-Social-Babble consider to be a slip (relapse)?
Posted by Elizabeth on October 16, 2001, at 13:23:02
In reply to Re: addiction and recovery » Elizabeth, posted by Rosa on October 16, 2001, at 8:08:45
> > > Does this group have any such guidelines concerning what they consider to be misuse of drugs or a slip?
> >
> > This group? You mean Psycho-Social-Babble?
>
> Yes, PSB.No, although it's considered bad form to post telling people how to get drugs without a prescription. (This includes drugs with no abuse potential, such as antidepressants.)
> > > How do you describe self-medication?
>
> I was primarily referring to increasing or decreasing the dose.People do self-medicate with illegal drugs, not just the stuff they get from the doctor. But you're right, changing the dose of a prescribed drug on one's own can be self-medication.
> > > 3. No member plays doctor.
> >
> > "Member" of...?
>
> Psycho-Social-Babble.So you are making or suggesting new rules for this forum? I am confused. What do you think constitutes "playing doctor?"
> My question was "Does Psycho-Babble have a policy concerning the use/misuse of drugs?"
No, I don't think so. Members of this group are allowed to have and express their own opinions, in general.
> What do members of Psycho-Social-Babble consider to be a slip (relapse)?
Well, I gave my thoughts on this one.
-elizabeth
Posted by galtin on October 16, 2001, at 18:46:33
In reply to addiction and recovery » Rosa, posted by Elizabeth on October 15, 2001, at 19:39:22
> I'm not convinced that alcoholics are especially liable to abuse tranquilizers, although they are probably liable to use more than the prescribed amount if the prescribed amount is inadequate! And I don't see any reason why they would be prone to stimulant abuse.
Elizabeth-
You said a lot of good things and this is the only place where I feel more cautious than you. I assume that "especially liable" is in contrast with the non-alcoholic population. In my experience, the majority of alcoholics are inclined to abuse either sedatives/painkillers or stimulants. After all, most alcoholics are prone to abuse anything ingestable that alters their mood.
galtin
Posted by Greg on October 17, 2001, at 8:37:42
In reply to Re: addiction and recovery Elizabeth, posted by galtin on October 16, 2001, at 18:46:33
> > I'm not convinced that alcoholics are especially liable to abuse tranquilizers, although they are probably liable to use more than the prescribed amount if the prescribed amount is inadequate! And I don't see any reason why they would be prone to stimulant abuse.
>
>
>
>
> Elizabeth-
>
>
> You said a lot of good things and this is the only place where I feel more cautious than you. I assume that "especially liable" is in contrast with the non-alcoholic population. In my experience, the majority of alcoholics are inclined to abuse either sedatives/painkillers or stimulants. After all, most alcoholics are prone to abuse anything ingestable that alters their mood.
>
>
> galtinElizabeth,
I would have to agree with galtin's statement, at least in my case. As an alcoholic in recovery I am prone to the use of mood altering meds. I have to watch my Xanax intake very closely as there is a fine line between the use for anxiety, and just "getting high" for me. Also, I've had numerous surgeries and almost every time I've become addicted to the pain killers given to me afterward. I could have stopped before it became a problem, but quite frankly I liked the euphoric feeling I got from them. I attribute this in part to my alcoholic addictive personality. I have seen many in my situation exhibit this same behavior. I don't think it's at all uncommon. This is just my opinion of course and I don't speak for anyone else.
As far as stims go, I do have an rx for Adderall, but I use it very rarely. Only when I'm extremely fatigued. I really don't care for stims much.
Greg
Posted by Elizabeth on October 19, 2001, at 13:42:01
In reply to Re: addiction and recovery - Elizabeth, posted by Greg on October 17, 2001, at 8:37:42
You guys (galtin and Greg) are right. I should have said: "not all alcoholics are especially liable to abuse tranquilizers." Certainly some -- perhaps most -- are (and indeed, nearly all abusers of benzodiazepines are also abusing other drugs, such as alcohol).
My particular concern is that patients with anxiety who have self-medicated with alcohol in the past often don't receive adequate treatment for the anxiety. Instead they are often given ineffective treatments on the grounds that they are "addicts" (and that it is therefore presumed that they will abuse anything they can get their hands on).
A note to Greg:
> I have to watch my Xanax intake very closely as there is a fine line between the use for anxiety, and just "getting high" for me.I've heard that Klonopin isn't very good for getting high, so it might be better than Xanax. (I personally am not impressed with either of them in the "getting high" department :-) ). Librium is another benzo that also has this reputation.
> As far as stims go, I do have an rx for Adderall, but I use it very rarely. Only when I'm extremely fatigued. I really don't care for stims much.
I think this shows that you don't have a generalized "addictive personality," but rather that you prefer tranquilizing drugs to activating ones. I don't get any kicks out of stimulants or benzodiazepines, but opioids are very effective mood-elevators for me and even though I don't have an "addictive personality," I could see myself getting addicted to opioids if I self-medicated with them for more than a brief time. (I'm fortunate in that I don't have a history of self-medicating, so doctors are more willing to prescribe "abusable" drugs to me than they might be otherwise.)
-elizabeth
Posted by MB on October 20, 2001, at 14:21:35
In reply to Re: addiction and recovery, posted by Elizabeth on October 19, 2001, at 13:42:01
Here are a few questions for everybody...just to stimulate conversation. These are tough questions, and I don't really expect hard and fast answers to them, but they are questions that, as an alcoholic in recovery, I have often asked myself.
OK, presupposing that we agree to separate *addiction* from *dependence*, and that we define addiction as "a psychological obsession with (and a compulsive use of) a drug," while defining dependence as "the developement of tolorance to a drug accompanied by withdrawal symptoms upon cessation of that drug"...and presupposing that we agree that dependence often accompanies addiction, while addiction does not necessarily accompany dependence, how would you answer these questions? (OK, that's a lot of presupposing. If anyone takes exception with the above definitions, by all means, please share your opinions). Anyway...
A) What is the differenece between a person who self-medicates a depressive/anxiety disorder and an addict (whom AA refers to as needing alcohol because of a natural tendency to be "irritable, restless, and discontent")?
B) Is there a difference between i) a self-medicater who becomes psychologically attatched to a drug because of the relief it offers, and ii) an addict who becomes "obsessed" (psychologically attatched) to a drug because his/her state is naturally "irritible, restless, and discontent" without it?
C) Are the differences between these two sets of people (and the way in which these people are treated) simply semantic, or are there deeper differences?
D) There is evidence that both addiction and mood/anxiety disorders are heritable. Could it be that inheritance of an addiction to a particular substance is the same thing as inheritance of a "subset" of mood/anxiety disorder for which the use of that drug is particularly efficacious (for the short-term) in alleviating?
In the AA group I attend, there is a dichotomy of people. There are the ones who, after getting clean and "working the steps," seem to flourish. They are depressed at first as they withdrawal, but then they glow. On the other hand, there is the group that, after getting clean and "working the steps," continues to struggle and struggle and struggle.
E) Could it be that one group comprises the "addicts" (getting better once withdrawn) while the other group comprises the "self-medicaters" (declining due to lack of pharmacological treatment)?
There is a selfish reason that I am asking these questions. I've suffered with depression and anxiety since early adolescence, and I'm also a recovering addict. I am really struggling to understand myself and to see where I fit into these groups. There are two polarized opinions I've encountered:
a) that I'm just an irritable person with character flaws who used drugs because I was selfish and too ungrateful for the life "God" had given me; andb) that I suffer from a wholly physiological brain disorder which I attemped to self-medicate with drugs...and that with the proper biological treatment my affinity to illegal drugs and alcohol would become a non-issue.
The first model appeals to my tendency for self loathing, and the second model appeals to my tendency to abdicate responsibility, but both seem completely myopic and inadequate.
I feel like Jackie Chan standing and screaming "who am I??!!" in the extremely cheesy movie by the same name. Or, more philosophically, I want to scream "WHAT am I?"
Posted by Rosa on October 20, 2001, at 19:09:31
In reply to Re: addiction and recovery, posted by MB on October 20, 2001, at 14:21:35
I think that your questions could just as easily apply to drug addicts as alcoholics.
I believe many of us are in denial about self-medicating, not just alcoholics and addicts but also the elderly. How many bottles of pills do your parents have on the shelf?
Our natural tendency to be "irritable, restless, and discontent" may be the cause rather than the result of alcohol/drug abuse. This makes it psychological or emotional in nature.
It may also be the result of growing up in an alcoholic or dysfunctional home. The word dysfunctional includes emotional illness. Our attitudes are shaped by our surroundings.
Acceptance and approval is a significant factor in our attitude. Perfection and helplessness are only two of the masks we hide behind. How many of us experienced "unconditional love" when we were children?
^^^^^
Here are a few questions for everybody...just to stimulate conversation. These are tough questions, and I don't really expect hard and fast answers to them, but they are questions that, as an alcoholic in recovery, I have often asked myself.
>
> OK, presupposing that we agree to separate *addiction* from *dependence*, and that we define addiction as "a psychological obsession with (and a compulsive use of) a drug," while defining dependence as "the developement of tolorance to a drug accompanied by withdrawal symptoms upon cessation of that drug"...and presupposing that we agree that dependence often accompanies addiction, while addiction does not necessarily accompany dependence, how would you answer these questions? (OK, that's a lot of presupposing. If anyone takes exception with the above definitions, by all means, please share your opinions). Anyway...
>
[snip]
Posted by Krazy Kat on October 20, 2001, at 22:38:01
In reply to Re: addiction and recovery, posted by MB on October 20, 2001, at 14:21:35
Depression and Manic Depression are CNS disorders, just like MS or Alzheimers. We just don't have the studies yet to undertand them.
I do think "depression" can arise from other illnesses, but all in all, it must be treated medically.
Any guilt associated with depression or manic depression is unfair and ridiculous. Rather strong but I stand by it!
Re: self-medication - there are both - there are people who want to be high all the time. There are people who want to alleviate the pain they feel due to these illnesses. Do you see the difference?
I felt So bad for So long about my use of alcohol until I realized how it played a role in keeping me here.
That will get a lot of negative replies. :) But it's true.
- KK
p.s. Not advocating alcohol as the solution - still working on eliminating it completely from my diet. It definitely interfers with the meds. Just ruminating...
Posted by MB on October 21, 2001, at 11:39:15
In reply to Re: addiction and recovery » MB, posted by Krazy Kat on October 20, 2001, at 22:38:01
< snip >
> Re: self-medication - there are both - there are people who want to be high all the time. There are people who want to alleviate the pain they feel due to these illnesses. Do you see the difference?
< snip >I hear what you're saying, and, when you put it that way, I do see that there would be a difference between someone who just wanted to be high all the time and someone who just wanted to alleviate the pain they feel do to illness. And I think in some cases, the difference might be that cut and dry. My case doesn't seem to fit nicely into either category, though. When I drank and did drugs, people used to ask me why I wanted to be so "f***ed up all the time," and the truth was that I didn't. I would tell them that if there was a drug that alleviated depression as well as booze or heroin (in the short term, at least) but that didn't alter my senses, I would definitely choose the one that didn't alter my senses. People couldn't understand. I didn't drink and do drugs so I could stumble around and pass out. Those effects were just unfortunate side effects. I drank and did drugs because they gave me temporary relief from the horrible depression and anxiety I suffered/suffer from. The only problem was that drugs (especially alcohol) would send me into a really bad mood cycle. I'd drink a beer, feel totally on top of the world like God was flowing right trough my heart, and fifteen minutes later, I'd crash into the worst, suicidal depression ever. Of course another beer would take that depression away again, the second time for only ten minutes, etc, etc, until I was TRASHED!! So I did want to be drunk all the time. But *not* because I liked slurring my words and stumbling and passing out...and *not* because I enjoyed distortion of the senses...but because I thought I was getting somewhere in the illusory process of chasing depression away by consuming larger and larger amounts of alcohol. I have a friend who smokes enormous amounts of pot...not because he has mental illnes, but because he likes getting wasted. He can't quit. I think he is an addict. Then there's my dad. He has anxiety problems. He used to drink too much. Then he was given Xanax, he quit drinking, he got counsiling, and he's doing better. He no longer drinks or takes Xanax. When he was drinking, I would say it was purly self-medication, not addiction. I don't think I fit into either category. I wouldn't have used drugs if I hadn't been suffering with mental illness, but I wasn't simply a self-medicater like my dad. He'd drink until the anxiety went away and then quit. I, on the other hand, because of the mood cycle alcohol would set into motion, drank until I passed out. So in that sense, I was very much an alcoholic. Maybe I'm just both. Maybe I need to quit trying so much to put myself in a nicly defined and labeled box and just concentrate on what makes me feel better. It's been two years since I've had a drink, and I don't feel better. I'm not on medication because that didn't seem to help either. I'm going to get a SPECT scan to see if they can find something that the other doctors missed. I hope the SPECT *scan* doesn't turn out to be a SPECT *scam*. BLAH BLAH BLAH thinks for letting me ramble. I can't shut up.
Posted by Krazy Kat on October 21, 2001, at 12:40:56
In reply to Re: addiction and recovery » Krazy Kat , posted by MB on October 21, 2001, at 11:39:15
MB:
Good luck! I'm sure you've heard it many times here before, but there are so many meds - don't give up if you still feel bad, mho. I feel better now than I did two years when I started the process.
I understand your post. I imagine that some of us really do have the physical propensity to be addicted to drugs and alcohol, unlike others.
Take care.
- K.
Posted by Elizabeth on October 26, 2001, at 17:34:03
In reply to Re: addiction and recovery, posted by MB on October 20, 2001, at 14:21:35
> A) What is the differenece between a person who self-medicates a depressive/anxiety disorder and an addict (whom AA refers to as needing alcohol because of a natural tendency to be "irritable, restless, and discontent")?
I wouldn't take the AA definition too seriously. But people taking medication (with or without a doctor's permission) do not necessarily have psychological "cravings" (similar to pressing hunger) for drugs. A person can become addicted to a medication; this is rare when the medication is being supervised by a doctor but probably happens a lot when people try to self-medicate with potentially addictive drugs.
> B) Is there a difference between i) a self-medicater who becomes psychologically attatched to a drug because of the relief it offers, and ii) an addict who becomes "obsessed" (psychologically attatched) to a drug because his/her state is naturally "irritible, restless, and discontent" without it?
Yes. If the condition being medicated goes away, a nonaddicted self-medicating person will no longer feel a need for the drug.
> C) Are the differences between these two sets of people (and the way in which these people are treated) simply semantic, or are there deeper differences?
I think the difference is significant.
> D) There is evidence that both addiction and mood/anxiety disorders are heritable. Could it be that inheritance of an addiction to a particular substance is the same thing as inheritance of a "subset" of mood/anxiety disorder for which the use of that drug is particularly efficacious (for the short-term) in alleviating?
Yes, that is quite possible.
> In the AA group I attend, there is a dichotomy of people. There are the ones who, after getting clean and "working the steps," seem to flourish. They are depressed at first as they withdrawal, but then they glow. On the other hand, there is the group that, after getting clean and "working the steps," continues to struggle and struggle and struggle.
>
> E) Could it be that one group comprises the "addicts" (getting better once withdrawn) while the other group comprises the "self-medicaters" (declining due to lack of pharmacological treatment)?I think both sets of people were addicted to begin with, but you may well be right that the people who aren't able to stay off the drug once they detox actually have a chronic condition for which they require the drug (or some other effective treatment). Other factors that could be related to relapsing include the length of time that the person was addicted, psychological resilience, stability of lifestyle (e.g., a job, a home, etc.), and social support (family, friends, etc.).
> a) that I'm just an irritable person with character flaws who used drugs because I was selfish and too ungrateful for the life "God" had given me; and
I'm predisposed to become skeptical when people invoke the supernatural to justify their opinions. :-)
> b) that I suffer from a wholly physiological brain disorder which I attemped to self-medicate with drugs...and that with the proper biological treatment my affinity to illegal drugs and alcohol would become a non-issue.
Well, let me first say that I think the dichotomy between "physiological" and "psychological" conditions is a false one, so the whole question is a bit nonsensical.
But anyway, think about why you started using drugs in the first place. What did they seem to help with, what was their appeal?
I learned when I first took hydrocodone that it made me feel "normal," "okay" -- it was like I'd found something that had been missing all my life. I was lucky enough to be living in Boston, a city where a lot of psychiatric research goes on, so I was able to meet with doctors who had experience treating depression with opioids. I feel lucky; if my circumstances had been different, I might well have gotten into trouble with heroin. As it was, I went through just about all the conventional treatments there are (though not all the possible combinations, of course) before my doctor and I started seriously considering buprenorphine as a potential treatment. If I hadn't had the degree of social support and education that I did, I'm not sure I would have been able to muster up the patience to go through all those trials.
> The first model appeals to my tendency for self loathing, and the second model appeals to my tendency to abdicate responsibility, but both seem completely myopic and inadequate.
Both models are based on a fallacy; IMO, that's the problem. Both models require a black-and-white view of human behaviour and experience.
> I feel like Jackie Chan standing and screaming "who am I??!!" in the extremely cheesy movie by the same name. Or, more philosophically, I want to scream "WHAT am I?"
You're a human being, dude.
Hey, let me know about the results of the SPECT scan -- I'd be interested.
-elizabeth
Posted by Elizabeth on October 26, 2001, at 17:41:03
In reply to Re: addiction and recovery » MB, posted by Krazy Kat on October 20, 2001, at 22:38:01
> Any guilt associated with depression or manic depression is unfair and ridiculous. Rather strong but I stand by it!
Dude, excessive or inappropriate guilt is a symptom of depression! :-) Depression is unfair, sure, but ridiculous?
> Re: self-medication - there are both - there are people who want to be high all the time. There are people who want to alleviate the pain they feel due to these illnesses. Do you see the difference?
The best high in the world for me is being able to function normally, having the will to care for myself, etc. It sounds like you are the same.
-elizabeth
Posted by galtin on October 26, 2001, at 20:44:57
In reply to Re: addiction and recovery » Krazy Kat , posted by MB on October 21, 2001, at 11:39:15
Dear MB,
> > Re: self-medication - there are both - there are people who want to be high all the time. There are people who want to alleviate the pain they feel due to these illnesses. Do you see the difference?
> < snip >
>
> I hear what you're saying, and, when you put it that way, I do see that there would be a difference between someone who just wanted to be high all the time and someone who just wanted to alleviate the pain they feel do to illness. And I think in some cases, the difference might be that cut and dry. My case doesn't seem to fit nicely into either category, though. When I drank and did drugs, people used to ask me why I wanted to be so "f***ed up all the time," and the truth was that I didn't. I would tell them that if there was a drug that alleviated depression as well as booze or heroin (in the short term, at least) but that didn't alter my senses, I would definitely choose the one that didn't alter my senses. People couldn't understand. I didn't drink and do drugs so I could stumble around and pass out. Those effects were just unfortunate side effects. I drank and did drugs because they gave me temporary relief from the horrible depression and anxiety I suffered/suffer from. The only problem was that drugs (especially alcohol) would send me into a really bad mood cycle. I'd drink a beer, feel totally on top of the world like God was flowing right trough my heart, and fifteen minutes later, I'd crash into the worst, suicidal depression ever. Of course another beer would take that depression away again, the second time for only ten minutes, etc, etc, until I was TRASHED!! So I did want to be drunk all the time. But *not* because I liked slurring my words and stumbling and passing out...and *not* because I enjoyed distortion of the senses...but because I thought I was getting somewhere in the illusory process of chasing depression away by consuming larger and larger amounts of alcohol. I have a friend who smokes enormous amounts of pot...not because he has mental illnes, but because he likes getting wasted. He can't quit. I think he is an addict. Then there's my dad. He has anxiety problems. He used to drink too much. Then he was given Xanax, he quit drinking, he got counsiling, and he's doing better. He no longer drinks or takes Xanax. When he was drinking, I would say it was purly self-medication, not addiction. I don't think I fit into either category. I wouldn't have used drugs if I hadn't been suffering with mental illness, but I wasn't simply a self-medicater like my dad. He'd drink until the anxiety went away and then quit. I, on the other hand, because of the mood cycle alcohol would set into motion, drank until I passed out. So in that sense, I was very much an alcoholic. Maybe I'm just both. Maybe I need to quit trying so much to put myself in a nicly defined and labeled box and just concentrate on what makes me feel better. It's been two years since I've had a drink, and I don't feel better. I'm not on medication because that didn't seem to help either. I'm going to get a SPECT scan to see if they can find something that the other doctors missed. I hope the SPECT *scan* doesn't turn out to be a SPECT *scam*. BLAH BLAH BLAH thinks for letting me ramble. I can't shut up.MB,
All the speculation and theorizing in this post and in yesterday's is interesting and beside the point. There is rarely, if ever, one identifiable reason to explain why an addict behaves addictively. The psychological, physiological, and environmental factor are all intertwined.Recently, however, I did have a revelation on the causes of alcoholism, at least my alcoholism. A non-alchoholic friend asked me why it is that I am an alcoholic. After a moment's thought, I replied that the root cause of my alcoholism is that I drink too much. My friend turned the question around: "Why do you drink so much?" This time I did not need a moment: "Because I am an alcoholic." This is all I need to know, partly because it does not matter why I drank so much for 20 years. In fact, there was a considerable period of time near the end of that 20 years during which my trying to figure out the why of my alcoholism was just a way I could avoid doing something about it. Whatever the causes of alcoholism for any given person, they are irrelevant to getting better.
The term alcoholic has no clinical, diagnostic, or clinical standing, so the issue of whether somebody is or is not an alcoholic is at best a distraction. The most precise meaning that the term has is as a self-designation for people in AA. The meaningful question is that of whether drinking is fouling up your life. If so, the second question is, what are you going to do about it. If you want to stop and try to stop but fail, this merely confirms that you are addicted and probably need help.
I may be mistaken, but you sound addicted to me. It is right there in your rationale for drinking--to drive away the anxiety, etc. But in the next sentence you acknowledge that your respite is not only temporary, but then yields to a greater intensity of the feelings you initially tried to escape. A person who maitains this kind of drinking pattern would ordinarily be deterred by the increasingly painful consequences and would stop. To continue drinking in the face of repeated evidence that it not only doesn't "work," but produces worse suffering of the kind that the drinking was originally intended to sooth, strongly suggests a condition of addiction. The fact that you are trying to figure it all out instead of taking constructive action indicates the kind disordered thinking common to those who call themselves alcoholic. Whether you yourself are an alcoholic is irrelevant. Alcohol is screwing up your life.
I am sorry if I sound preachy. I am talking mostly out of my own painful experiences and as a very slooooowwwww learner myself. I hope you can accept your condition (whether it is a "disease or not is, again, irrelevant) and care about yourself enough to get help and support for getting out of your nightmarish cycle.
galtin
Posted by MB on October 31, 2001, at 14:10:48
In reply to Re: addiction and recovery » MB, posted by Elizabeth on October 26, 2001, at 17:34:03
Hey, thanks for the long response to my post...I just now read it...been away from the computer for a while. It's interesting that you mention that if a self-medicator is relieved of their symptoms they will stop medicating. I don't know how I would react if my sense of anxiety and hoplelessness were gone (they've only been gone when I've been on addictive drugs). So...if they were gone without the addictive drugs, would I lose my obsession with the drugs? I don't know. It's just one of those hypothetical questions I may never know the answer to. This SPECT scan will be intersting. I have to be off caffeine for them to get an accurate picture of my brain at "baseline" (gulp!)...
Posted by MB on October 31, 2001, at 14:22:11
In reply to Re: addiction and recovery MB, posted by galtin on October 26, 2001, at 20:44:57
> I may be mistaken, but you sound addicted to me.
I am an alcoholic. I admitted that when I joined AA. I don't think I'm still "addicted," but I think I soon would be if I took up drinking again.
> The fact that you are trying to figure it all out instead of taking constructive action indicates the kind disordered thinking common to those who call themselves alcoholic. Whether you yourself are an alcoholic is irrelevant. Alcohol is screwing up your life.Well its not screwing up my life anymore since I've been sober for two years. I think that's pretty constructive as far as action goes. As far as trying to "figure it out," you may have a point. Maybe, on an unconscious level, I'm trying to talk myself into not being an alcoholic (i.e., proving to myself that I'm something else). It could be an unconscious attempt to sabotage my sobriety, and I appreciate the point. On the other hand, humans are rational creatures, and I think it is natural that we try to understand ourselves. Socrates or Plato, or one of those Greek dudes said that an unexamined life was not worth living. So, I appreciate your warning, but I'm not going to go belly-up into zombie-hood by ceasing the self-investigative process.
Peace,
MB
Posted by Elizabeth on November 1, 2001, at 16:19:55
In reply to Re: addiction and recovery MB » galtin, posted by MB on October 31, 2001, at 14:22:11
> I am an alcoholic. I admitted that when I joined AA. I don't think I'm still "addicted," but I think I soon would be if I took up drinking again.
I thought that in AA, NA, etc. they consider you to be still addicted even if you're completely abstinent (once an addict, always an addict, that kind of thing)? (I'm not saying I agree with this attitude, mind you!)
-elizabeth
Posted by Rosa on November 2, 2001, at 6:16:04
In reply to Re: addiction and recovery » MB, posted by Elizabeth on November 1, 2001, at 16:19:55
Alcohol is a drug. There is no cure. If you are an alcoholic, you will always be an alcoholic. If you pick up a drink, you will pick up where you would be if you had never stopped.
> > I am an alcoholic. I admitted that when I joined AA. I don't think I'm still "addicted," but I think I soon would be if I took up drinking again.
>
> I thought that in AA, NA, etc. they consider you to be still addicted even if you're completely abstinent (once an addict, always an addict, that kind of thing)? (I'm not saying I agree with this attitude, mind you!)
>
> -elizabeth
Posted by MB on November 3, 2001, at 15:01:11
In reply to Re: addiction and recovery » MB, posted by Elizabeth on November 1, 2001, at 16:19:55
Yeah, they *do* say "once an addict always an addict." I think they say this because of how many people who, after a period of abstinence, try to go back to their drug of choice and use it "normally." Many of these people find that, even after long periods of abstinence, they quickly become re-addicted when they go back to their drugs of choice. Looking at it this way, I can see the usefulness of saying "once an addict always an addict," because it might prevent a person from saying, "well, I've gone a year without a drink, I think I'll go down to the bar for one beer" when, in fact, they won't ever be able to have just *one* beer. However, I find the statement also extremely annoying because...how can you be "addicted" to a drug if you aren't even taking that drug?
Posted by MB on November 3, 2001, at 15:07:32
In reply to Re: addiction and recovery » Elizabeth, posted by MB on November 3, 2001, at 15:01:11
Let me also cover my ass by saying that, yes, there *are* those few lucky bastards who can overcome their addiction and go back to drinking or smoking pot on a purely social level. My dad is one of those people. He used to get pretty drunk when I was a kid...fired from jobs, etc. Now he can have a drink and its no big deal...sometimes he'll get a glass of wine or scotch AND NOT EVEN FINISH IT!!!! I am jealose of people like this because, right now, I would like JUST ONE BEER to fill the emptiness inside of me...but I know I'd just end up drinking a case and puking....
Posted by galtin on November 4, 2001, at 22:22:55
In reply to Re: addiction and recovery » Elizabeth, posted by Rosa on November 2, 2001, at 6:16:04
> > I thought that in AA, NA, etc. they consider you to be still addicted even if you're completely abstinent (once an addict, always an addict, that kind of thing)? (I'm not saying I agree with this attitude, mind you!)
> > > > -elizabeth
Hi All,
Most alcoholics in AA refer to themselves as a "recovering" alcoholic. The reason for steering clear of the term "recovered" is two-fold. First, all the evidence suggests that AAers can never get over their addiction. In fact, people who "go out," even after 20 years free from alcohol, are soon drinking more than they did ever before. Second, AAers commit themselves to a program of recovery so that they can live a relatively happy and fulfilled life without alcohol. Again, the evidence is that recovering alcoholics who stop "working" the program and who drop away from meetings quickly become restless, irritable and discontent. In other words, they become like actively drinking alcoholics but without the drink. So,just as an AAers abstenance from alcohol must be lifelong, so must her dedication to AA's program of recovery. This is why critics of AA claim that members just trade one addiction for another.But AA doesn't have a monopoly on recovery. Other programs, like Rational Recovery and Women in Sobriety, believe in short-term treatment followed by graduation. Not to mention former AAers, especially women, who believe that AA is useful for a period of years but forces on the alcoholic too much of a loser self-conception. There are also other organizations that offer heavy drinkers a way back to moderate drinking.
I have no idea which approaches work best, but I suspect that there are different kinds of alcohol addicts. Some do well in AA, while others loath it and find answers in Rational Recovery. Then there are those alcoholics like my grandfather. He drank his way through 35 years and then just stopped. Not only that, but had a drink or two, never more, when the mood hit him.
Happily, I don't have to figure out all this multiplicity of addictive treatments and cures. I just need to know what works for the alcoholic I know best.
galtin
Posted by Elizabeth on November 9, 2001, at 21:25:54
In reply to Re: addiction and recovery » Elizabeth, posted by Rosa on November 2, 2001, at 6:16:04
> Alcohol is a drug. There is no cure. If you are an alcoholic, you will always be an alcoholic. If you pick up a drink, you will pick up where you would be if you had never stopped.
According to the 12-steppers, you're back to square one if you slip. It's not written in stone, nor does it qualify as scientific fact: it's *just* the dogma of the *-anonymous groups. Some respectable addiction medicine researchers have found that some alcoholics can learn to drink in moderation.
If a person has been indoctrinated (by AA or some other group) into believing that they can't learn to drink responsibly, then they probably won't be able to -- most likely, they won't even try to learn moderate and responsible drinking habits, and when they do slip they'll be more likely to give up and go back to their former pattern of excessive drinking.
(Same goes for other drugs, of course, not just alcohol.)
-e
Posted by galtin on November 10, 2001, at 6:04:41
In reply to Re: addiction and recovery, posted by Elizabeth on November 9, 2001, at 21:25:54
> > Alcohol is a drug. There is no cure. If you are an alcoholic, you will always be an alcoholic. If you pick up a drink, you will pick up where you would be if you had never stopped.
>
> According to the 12-steppers, you're back to square one if you slip. It's not written in stone, nor does it qualify as scientific fact: it's *just* the dogma of the *-anonymous groups. Some respectable addiction medicine researchers have found that some alcoholics can learn to drink in moderation.Some AA members have strong opinions, but there is no AA "dogma." Dogma is a belief or set of beliefs required for membership in a group. AA has no such beliefs.
> If a person has been indoctrinated (by AA or some other group) into believing that they can't learn to drink responsibly, then they probably won't be able to -- most likely, they won't even try to learn moderate and responsible drinking habits, and when they do slip they'll be more likely to give up and go back to their former pattern of excessive drinking.
Can people be "indoctrinated" when their attendance is voluntary?
The term "alcoholic" is not a medical or psychiatric term. It is a self-description that people in AA adopt for themselves, partly in order to identify themselves as among those who can't learn to drink moderately or "socially." They have demonstrated this to themselves well before setting sites on AA. The medical/psychiatric diagnoses are alcohol abuse and alcohol dependence. The former is akin to heavy drinking and the latter to what society equates with the term alcoholism.
Researchers like Stanton Peale believe they have demonstrated that "heavy" and "problem" drinkers can be taught to drink moderately. They have not claimed this of alcoholics, since alcoholics are not heavy drinkers, problem drinkers, alcohol abusers or dependents. They are those who have adopted the term alcoholic as a self-designation defining themselves precisely as those unable to drink moderately. Alcoholics are often members of AA, but not always.
galtin> (Same goes for other drugs, of course, not just alcohol.)
>
> -e
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