![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 47. This is the beginning of the thread.
Posted by Squiggles on August 17, 2002, at 12:57:59
I just got my clonazepam refilled and the pharmacist
also provided a little info form with it:Among other helpful hints, i was very gratified
to see the following:"This medication may be habit-forming. Do not
take it for longer than necessary. If you have
problems discontinuing its use, discuss it
with your pharmacist."God bless you dear pharmacists - you got it!
I only wish you weren't quite so coy and just
came out and said "this medication IS addicting".
Squiggles
Montreal, CANADA
Posted by alan on August 17, 2002, at 20:17:06
In reply to To Canadian Pharmaceutical Association - thank you, posted by Squiggles on August 17, 2002, at 12:57:59
> I just got my clonazepam refilled and the pharmacist
> also provided a little info form with it:
>
> Among other helpful hints, i was very gratified
> to see the following:
>
> "This medication may be habit-forming. Do not
> take it for longer than necessary. If you have
> problems discontinuing its use, discuss it
> with your pharmacist."
>
> God bless you dear pharmacists - you got it!
> I only wish you weren't quite so coy and just
> came out and said "this medication IS addicting".
>
>
> Squiggles
> Montreal, CANADA
-------------------------------------------------That would be a misuse of the word "addicting" - that's why they chose not to present it that way. You are in essence thanking them for NOT using the inflammitory term "addictive". The term does not apply to medical substances used to treat medical conditions.
Please read:
http://panicdisorder.about.com/library/weekly/aa031997.htm
Any drug needs to be tapered (as we are also finding with ssri's, etc,) and bzd's are no exception. That's all the warning means. Please stop misleading vulnerable anxiety sufferers that may need these valuable medications or are scared into not taking them because of the act of equating cocaine and heroin with benzodiazapine therapy.
Thank you.
Alan
Posted by hiba on August 18, 2002, at 0:41:47
In reply to To Canadian Pharmaceutical Association - thank you, posted by Squiggles on August 17, 2002, at 12:57:59
Congrats for getting your klonopin prescription refilled. Now let us look at the factsheet.
There are mainly Four kind of medications used in psychiatric practice in our modern era. Antidepressants, Minor tranquilizers, Major tranquilizers and Mood stabilizers. None of these medications, actually cure or eradicate a mental illness, rather they act only as a temporary fix. No matter what your physician or drug companies say, there is no proven cure for a mental illness. What medicines do is temporarily altering some chemicals in our brain to ease the pain of symptoms. Unfortunately if you are affected with a mental illness with a chronic nature, there is no way to get off the medicines you take. You will have to make a choice. Suffer the awful symptoms of the illness or take a medication to fix it. I had my first depressive episode more than ten years ago. But I am still on an antidepressant, because I belong to the category of unlucky chronic depressives. It was very hard for me to admit the fact at first, that I should be on a chemical substance for my entire life. But now I am used to the reality. I have desperately tried to get off antidepressants and benzos I take, but only to succumb. In this fast paced world, it is not easy to conceal anxiety (which is more than excess) and depression. It is not easy to keep going without an aid. So there is no shame in having an aid in ourselves, rather than depending our friends and relatives and telling them our story of pain and monopolizing their time.
Psychotropic medicines are good enough if you use them rationally. The term "rationally" must sound a lot. If your illness or symptoms (anxiety is often regarded as a symptom and not an illness) are of a chronic nature, don't expect a short term therapy and fixation. You will have to use the drug as long as you need it.
Long before, when I was on xanax, my doc advised me not to keep myself on xanax because of the fear of addicton. What it means? Addiction? It means you will have to take this drug for your entire life and will never be able to get off it. Now my doc says don't try to get off antidepressants and I must be on it for my entire life. Isn't it laughable?
So best of luck squiggles, Please keep on the effectiveness of the medication you take, rather than bothering how to get off it.
HIBA
Posted by Squiggles on August 18, 2002, at 7:33:15
In reply to Re: SQUIGGLES, PLEASE READ THIS CAREFULLY, posted by hiba on August 18, 2002, at 0:41:47
I know all that. I should never have tried
to get off K after 15 or so yrs of consumption
every day. Also, my dr. raised the dose after
some yrs. because i was reaching tolerance.
My dr. never really wanted me to get off K
because it he knew it would be hard. The Xanax
was different story. I was actually supported
with a schedule from the Chief of Psychiatry of
a hospital which shall remain unnamed, and when
i got off, my dr. congratulated me. I no longer
have panic attacks in 10 yrs of taking Xanax
at a min. therapeutic dose. The stuff is prescribed
for acute anxiety, once in a while, for panic, NOT
for every day consumption - but it is addicting
very quickly, and soon you find that if you don't
take it you get the very same effect for which
you took it to avoid.As I said, I am not against benzos, and at this
point i will never dare try to get off Klonopin
again, whether I need it or not.
Squiggles
Posted by Squiggles on August 18, 2002, at 10:51:03
In reply to Re: To...Addiction vs. Medical dependence, posted by alan on August 17, 2002, at 20:17:06
Thank you Alan for the hyperlink and
the book suggestion on this subject.I notice that recently the medical community
has begun to use a neologism: "discontinuation
syndrome", referring to the effects which
follow the quitting, cessation, discontinuation
(abrupt or slow) of various drugs. There
are of course old synonyms for this concept, i.e.
"withdrawal syndrome", "dependence", "hooked",
"habituated", "addicted", suggesting that the
person has become accustomed to a certain
dose of the drug every day, and suffers the lack
of the dose if the substance is withdrawn from his
usual daily intake.I think that the term "discontinuation syndrome"
whether it is associated with the concept
of "addiction" or not, is of great help to
people who have been using certain drugs and
having difficult weaning off or getting off,
or withdrawing. I am glad that it has come to
use.I hope you will allow me some more time to
do further research in the purported distinction
between "addiction" and "dependence", as i would
like to reply with a more carefully written
post. Right now, i have personal affairs to
attend to, so i'm sorry i have to interrupt the
discussion.Cheers,
Squiggles
Posted by Squiggles on August 19, 2002, at 16:54:32
In reply to Re: To...Addiction vs. Medical dependence, posted by alan on August 17, 2002, at 20:17:06
Alan,
Just to let you know i have not forgotten your
message; i am thinking about an intelligent
answer to you. On the one hand, i have my personal
experience and quite a bit of reading, testimonials,
and influence from the BENZO group to rely on
in representing one side of the story about benzos,
and in some cases other drugs.On the other hand I sympathize with your point
that benzos are definitely necessary for acute
anxiety, epilepsy, general anxiety of unknown
source, phobias, etc.I still need some time to answer the question
on dependence and addiction (which btw i do not
find anything but a linquistic squabble). But
anyway, i do agree that the heavy narcotics, such
as heroin, cocaine, should not be compared with
such zeal by such groups as the Benzo group.Ah, the benzo group - yes it has left its mark on
me. After working so closely together with
Ray Nimmo who has just won a $40,000 lawsuit in the
U.K. for benzo brain damage (not bad); and
Mr. David Woolfe who acted as more of a mentor
and teacher in asking me to write the FAQ for him,
there is no doubt that a trace of bias may have
been left, regardless of their own personal
experience with benzos.But i have always been an independent spirit
(my husband just adopted a pit bull for me and
likens my character to her stealth (hee hee), so
you can be assured that when I give you my
answer, it will be my own.For now, I have to rearrange my brain for a week
or two or as they say in medical jargon, stabilize.:-)
Squiggles
Posted by alan on August 19, 2002, at 20:13:04
In reply to Re: To...Addiction vs. Medical dependence » alan, posted by Squiggles on August 19, 2002, at 16:54:32
>
> I still need some time to answer the question
> on dependence and addiction (which btw i do not
> find anything but a linquistic squabble). But
> anyway, i do agree that the heavy narcotics, such
> as heroin, cocaine, should not be compared with
> such zeal by such groups as the Benzo group.
>
> Ah, the benzo group - yes it has left its mark on
> me. After working so closely together with
> Ray Nimmo who has just won a $40,000 lawsuit in the
> U.K. for benzo brain damage (not bad);
----------------------------------------------
Then your "squabble" is with the medical profession itself, not with mere words...that is unless one has a gripe or vendetta with the profession in general.It is what the medical profession uses to distinguish legitimate medications from illicit or improper medication. Otherwise, if no distinction were made, why not prescribe inappropriate CNS depressants for anxiety disorders like seconal, alcohol, etc? Because even though those two have a dependence and withdrawl period, they have health ramifications that are, down the road, dilitorious. They are not appropriate medicines. They are not appropriately equated with bzds just because bzds initially build tolerance and have a withdrawl period.
If those that equate bzds with heroin and cocaine (benzo.org) aknowledged the distinction, the entire case that they make would evaporate.
To blur the distinction IS their cornerstone. You can count on that to be incorporated in any inquiry one would make on the subject.That is, bzd's are bad medications to take short or long term because they have a tolerance and withdrawl phenomenon for the overall population
- irrespective that they are used for legitimate medical conditions - and successfully for the overall population *without* spiraling dosages and withdrawls like heroin.To trash an entire classification of medicine by deliberately ignoring these distinctions is what the bzd.org does so well.
PS. The 40,000 pounds lawsuit was awarded to a patient for physician incompentency for having misprescribed. It is not, as Ray and his friends would like it to seem to portray it, an indictment of bzds.
As a matter of fact, the case is a fine example illustrating a physician NOT knowing the difference between "addiction" and medical dependence.
I'm sure that Ray will have lots to say on the subject. There seem to be one or two of this group's followers on every med bboard one goes to. Whether they are indeed different posters is another matter.
Posted by Squiggles on August 20, 2002, at 1:48:20
In reply to Re: To...Addiction vs. Medical dependence » Squiggles, posted by alan on August 19, 2002, at 20:13:04
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.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.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.
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 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.Here is one of many articles that explains the situation.
British Medical Journal
Vol 288 No 6424: 1101-1102
London, Saturday 14 April 1984Benzodiazepines on trial
Peter J Tyrer
Consultant Psychiatrist
Mapperley Hospital
Nottingham NG3 6AAAnyone who believes that a drug treatment can combine sound efficacy with no adverse effects whatsoever must be due for a nasty fall. The benzodiazepines are excellent antianxiety drugs and hypnotics,[1,2] superior in
efficacy to other antianxiety drugs, including the barbiturates,[3,4] and indubitably safer.[5] As soon as they became available prescriptions for benzodiazepines rose steadily, exceeding those for barbiturates in 1965, and they
continued to climb dramatically during the 1970s. Their popularity provoked some concern,[6] but careful investigations suggested that the drugs are being prescribed more or less responsibly,[7] though patients tended to
receive them for unduly long periods.[8]With the discovery of specific binding sites for benzodiazepines in the central nervous system the reasons for their specificity in anxiety became clear.[9] An endogenous substance similar in structure to the benzodiazepines
must be concerned in the physiological control of anxiety: perhaps, their supporters claimed, exogenous benzodiazepines only mimicked a natural process.In recent years, however, the pendulum of approval has swung dramatically against the benzodiazepines. Ashton's careful study [p1135] is the latest of several investigations that have shown quite unequivocally that
benzodiazepines may produce pharmacological dependence in therapeutic dosage.[10-14] The typical pattern of a drug dependence syndrome, with drug seeking behaviour, rapid tolerance, and escalation of dosage, is rare
(according to Marks's calculations, one in every 5 million patient months "at risk"[15]) but the occurrence of dependence after therapeutic dosage is more frequent and more alarming. This danger has been recognised for several
years,[16] but until recently clinicians have been reluctant to accept that the problem seen in patients taking benzodiazepines constitute true pharmacological dependence - partly because the dependence is manifested primarily
by an abstinence syndrome occurring after the dose of the drug is reduced or treatment is stopped.Much of the difficulty stems from the early symptoms of withdrawal being those of anxiety, so that when a patient becomes anxious after withdrawal of benzodiazepines this may be mistaken simply for a return of pre-existing
anxiety. The full constellation of withdrawal features-including peculiar forms of perceptual disturbance (well exemplified by Ashton's cases), unusual somatic symptoms such as muscle stiffness, twitchings and paraesthesiae,
dysphoria, psychotic disturbance, and epileptic fits - cannot be explained in this way. In its less florid form, however, the syndrome of dependence may develop insidiously and apparently unknown to the patient, so an increase of
symptoms after reducing dosage of the drug may easily be interpreted as a return of anxiety, when treatment will be maintained rather than withdrawn.Is the syndrome of benzodiazepine dependence qualitatively distinct from other drug dependence syndromes? The symptoms overlap considerably with other drug dependent states, but the perceptual disturbance seems to be a
constant and unusual feature that may be specific. The more usual symptoms of withdrawal are greatly affected by expectation and may not always be reliable: for example, in one recent study 22% of patients experienced
withdrawal symptoms at a time when they thought that their drugs were being withdrawn but the dosage had remained constant.[14] In my clinical experience the diversity and severity of withdrawal symptoms have increased
considerably in the past two years, but this may indicate only greater public awareness of the problem - any strange symptom may now be labelled a withdrawal reaction. Personality seems important in the aetiology of the
withdrawal syndrome: patients with passive and dependent personality characteristics are more liable to develop symptoms.[14] By contrast, many patients can stop benzodiazepines after many years without any withdrawal
symptoms. Though in Ashton's study (and that of Petursson and Lader[13]) all the patients studied had withdrawal symptoms, they had all tried previously to reduce or stop their benzodiazepines and only when they had failed
were they referred for specialist treatment. In the more typical settings of general practice or psychiatric outpatient clinics many patients take benzodiazepines regularly and unnecessarily - and more than half can stop treatment
without any important withdrawal symptoms.[12,14]The best management for benzodiazepine dependence is far from clear. Treatment should not be stopped abruptly, for this is more likely to lead to serious withdrawal symptoms including epileptic seizures. Though gradual
withdrawal may not prevent symptoms from developing, it may reduce their severity. If possible treatment with a short acting benzodiazepine should be changed to a long acting preparation before withdrawal. A balance has to be
struck between slow withdrawal, which prolongs the symptoms but tends to make them less severe, and fast withdrawal, which leads to more intense symptoms lasting for a shorter time. Though no pharmacological treatment will
abort the withdrawal symptoms, propranolol will attenuate some features,[12] and on the basis of experience with withdrawal of alcohol and opiates clonidine might be expected to have a place in treatment. In low dosage
antipsychotic drugs are effective tranquillisers and have no risk of pharmacological dependence; but unfortunately they seem to have no value in treating the withdrawal syndrome. Indeed, one study with oxypertine suggested
that such drugs might accentuate the withdrawal symptoms, possibly through their action in blocking dopamine receptors.[17] On the other hand, simultaneous treatment with a sedative antidepressant such as trimipramine or
amitriptyline seems to lessen many of the symptoms. The place of psychological treatment also needs investigating, but group therapy has little effect in helping patients to stop their benzodiazepines.[18]In terms of public policy, now that benzodiazepines have been shown to cause drug dependence should their use be more closely controlled - or even banned? We need to remember that these drugs have an important place in
the short term treatment of anxiety and insomnia and are often invaluable in anaesthesia and epilepsy. What is needed is for them to be prescribed more carefully and with better awareness of their dangers. A course of treatment
lasting for only several weeks is not likely to lead to dependence - though the "safe" period of drug prescription before the risk of dependence is not yet known. Flexible dosage given up to an agreed maximum dose a day also
helps to keep total drug dosage down.[19] Although short term treatment is officially recommended,[20] this advice is often ignored, and far too many repeat prescriptions are given without adequate assessment. Cross tolerance
occurs among benzodiazepines, so that if dependence occurs with one it is likely to be transferred to another. Diazepam is the most commonly prescribed benzodiazepine and has attracted more adverse publicity than other
compounds, but this opprobrium may be misplaced. Benzodiazepines with shorter duration of action, such as triazolam and lorazepam, may carry a greater risk of dependence than their longer acting relatives: certainly their
withdrawal symptoms occur earlier and are more severe than those of long acting compounds.[12,21,22] The explanation may be that withdrawal symptoms are more likely when blood concentrations of benzodiazepines fall
rapidly after stopping the drug.[12] Indeed, the paradox may be that the attempt to make the prescription of benzodiazepines more acceptable by shortening their duration of action has led to a greater incidence of
pharmacological dependence.Finally, we should not assume that the long term prescription of benzodiazepines and the consequent high risk of dependence are evils to be avoided at all costs. No permanent consequences of dependence on benzodiazepines
have been described, although Lader's findings of possible psychological impairment and neuroradiological changes after prolonged treatment need to be followed up.[23] Cigarette smoking probably represents the closest
pharmacological cousin of benzodiazepine dependence and is far more dangerous - as is the addiction to alcohol that the patient may take up as an alternative. Many patients can stop regular consumption of benzodiazepines
but find it difficult to cope without the occasional tablet, and this practice may be condoned if not formally encouraged.[24] Banning benzodiazepines is no answer to the problem of dependence. The response should be period of
probation and reassessment, not punishment.1.Randall LO, Schallek W, Heise GA, Keith EF, Bagdon RE. The psychosedative properties of methaminodiazepoxide. J Pharmacol Exp Ther 1960;120:163-71.
2.Randall LO, Heise GA, Schallek W, et al. Pharmacological and clinical studies on Valium, a new psychotherapeutic agent of the benzodiazepine class. Current Therapeutic Research 1961;3:405-25.
3.Jenner FA, Kelly RJ, Parkin D. A controlled comparison of methaminodiazepoxide and amylobarbitone in the treatment of anxiety in neurotic patients. Journal of Mental Science 1961;107:583-9.
4.McDowall A Owen S, Robin AA. A controlled comparison of diazepam and amylobarbitone in anxiety states. Br J Psychiatry 1966;112:629-31.
5.Matthew H, Proudfoot AT, Aitken RCB, Raeburn JA, Wright N. Nitrazepam - a safe hypnotic. BR Med J 1969;iii:23-5.
6.Trethowan W. Pills for personal problems. Br Med J 1975;iii:749-51.
7.Mellinger GD, Balter MB, Manheimer DI, Cisin IH, Parry HJ. Psychic distress, life crisis, and use of psychotherapeutic medication. Arch Gen Psychiatry 1978;35:1045-52.
8.Tyrer P. Drug treatment of psychiatric patients in general practice. Br Med J 1978;ii:1008-10.
9.Möhler H, Okada T. Benzodiazepine receptor: demonstration in the central nervous system. Science 1977;198:849-51.
10.Pevnick JS, Jasinski DR, Haertzen CA. Abrupt withdrawal from therapeutically administered diazepam. Arch Gen Psychiatry 1978;35: 995-8.
11.Winokur A, Rickels K, Greenblatt DJ, Snyder PJ, Schatz NJ. Withdrawal reaction from long term, low dosage, administration of diazepam. Arch Gen Psychiatry 1980;37:101-5.
12.Tyrer P, Rutherford D, Huggett T. Benzodiazepine withdrawal symptoms and propranolol. Lancet 1981;i:520-2.
13.Petursson H, Lader MH. Withdrawal from long-term benzodiazepine treatment Br Med J 1981;283:643-5.
14.Tyrer P, Owen R, Dawling S. Gradual withdrawal of diazepam after chronic therapy. Lancet 1983;i:1402-6.
15.Marks J. The benzodiazepines: use, overuse, misuse, abuse. Lancaster: MTP Press, 1978.
16.Owen RT, Tyrer P. Benzodiazepine dependence: a review of the evidence. Drugs 1983;2a:385-98.
17.Petursson H. Clinical and laboratory studies of withdrawal from long-term benzodiazepine treatment. London: University of London, 1983. PhD thesis.
18.Cormack MA, Sinnott A. Psychological alternatives to long-term benzodiazepine use. J R Coll Gen Pract 1983;33:279-81.
19.Winstead DK, Anderson A, Eilers MK, Blackwell B, Zaremba AL. Diazepam on demand: drug seeking behavior in psychiatric in-patients. Arch Gen Psychiatry 1974;30:349-51.
20.Committee on the Review of Medicine. Systematic review of the benzodiazepines. Br Med J 1980;280:910-2.
21.Morgan R, Oswald I. Anxiety caused by a short-life hypnotic. Br Med J 1982;284:942.
22.Tyrer P, Seivewright N. Identification and management of benzodiazepine dependence. Postgrad Med J (in press).
23.Lader M. Benzodiazepines, psychological functioning and dementia. in: Trimble MR ed. Benzodiazepines divided: a multidisciplinary review.
Chichester: Wiley,1983:309-22.24.Tyrer P. Dependence on benzodiazepines. Br J Psychiatry 1980;137: 576-7.
Squiggles
Posted by hiba on August 20, 2002, at 1:54:20
In reply to Re: To...Addiction vs. Medical dependence » alan, posted by Squiggles on August 19, 2002, at 16:54:32
"On the other hand I sympathize with your point
that benzos are definitely necessary for acute
anxiety, epilepsy, general anxiety of unknown
source, phobias, etc"What does this sympathy mean dear Squiggles? Do you have anything better than benzos for acute anxiety ? Do you think much hailed antidepressants are better than benzos for generalized anxiety disorder? Do you believe MAOIs are better than benzos for phobias? I agree with you benzos are not the first line medicines for epilepsy. But what about the rest?
Benzos should have their drawbacks. I believe ,But they are much, much safer than ADs and other hard medications used in psychiatric practice. True, a dose of chlorpromazine or fluphenazine can effectively tranquilize you as benzos do, or better than benzos to some extent. But see the side effect profiles of such phenothiazine drugs. Look at the Merck manual please.
"Ah, the benzo group - yes it has left its mark on
me. After working so closely together with
Ray Nimmo who has just won a $40,000 lawsuit in the U.K. for benzo brain damage (not bad);"Pencillin saved millions of lives and killed some patients also. I have seen many cases nephrotoxicity because of the excessive use of antibiotics. Garamycin can irreversibly damage auditory neves. What do you suggest Squiggles? Antibiotics should be banned.. or reserved to research purposes only and leave those infected patients heel themselves without these wonderful drugs?
It is how and why you use a drug that makes the difference. And not ONLY the drug itself. Even water can be toxic if used excessively or inappropriately. If you ingest oxygen rectally it can kill you. Do you think oxygen is toxic?"I still need some time to answer the question
on dependence and addiction (which btw i do not
find anything but a linquistic squabble)"It is not merely a linguistic squabble my dear Squiggles, There is definitely an existing difference. If you are a hypertensive and using antihypertensive medications for a long time, you will not be able to come off those drugs, or if you do so, your hypertensive symptoms will come back with more strength and vengence. It is not an addiction but a medical dependence. So is the matter with diabetics and medications used to control glucose level. Like benzos these medications never cure the illness, but simply mask or halt the symptoms. The dependence which benzos cause should only be taken in this regard. We are not bothered to call a diabetic an insulin addict. But he or she is an insulin dependent person. So do those anxious patients who are on benzos.
A linguistic squabble is there where physicians describe the effects of benzos as masking rather than correcting the chemical imbalance as antidepressants do. The important point here is masking the symptoms and correcting the chemical imbalance, both doesn't make any difference in patients. The effect is the same or rather I like the effect of klonopin, no matter whether it masks or corrects.
Don't waste your precious time researching the difference of dependence and addiction. "Depending on a created necessity is truly an addiction." That is all I can say.
HIBA
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
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