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I posted this in a recovery forum but got no replies. This has always been a friendlier busier subred.
I made a longer post about this, but somehow there was a system glitch and it could not be found. This post will be shorter.
I’m on what psychonaut wiki calls a threshold dose of an rc benzo that is long acting. I take it at night for sleep and still feel mild effects through the next day, and therefore only need it again the next night. There’s around 6 mths daily use at this level.
I’m currently going through a stressful time so I wonder if I should even bother starting a final taper now, or just wait until life situations settle down. My thinking is to wait. I also used to drink too much, but have moderated that, and believe I should be off it completely. Alcohol has the crappiest short half life, plus the hangover!
So maybe 30 days completely alcohol free before beginning a final taper off rc benzos. What do you all think?
Poor sleep is very debilitating to me, so that’s a factor here. It’s one of the main reasons for wanting to quit alcohol.
Edit: I also have a short acting rc benzo similar to xanax that I could use in a taper combination if anyone thinks that’s a good idea.
something i’ve noticed in my own life: there’s always something going on, always some stress to give me a reason to wait. whether life is just stressful or i’m making up excuses not to quit— it’s better to just say fuck it and quit sometimes.
I agree with that in general. I have a friend that cites ordinary life issues as too stressful to consider halting a substance, and it is just a light prescription. The same is true for those who use tobacco. However right now I really do have out of the ordinary stress.
Short acting benzos aren’t very good for tapering. I’d look for something that will get you some sleep that’s not a benzo. Remeron works pretty well for me, and let me quit benzos without the horrible insomnia so the only thing I had to worry about was the rebound anxiety and physical addiction. Remeron is also good for anxiety, but it is tetracyclic and can interact with certain drugs in a fashion typical to antidepressants.
I’m with you on the caffeine thing. At one time I wondered why I slept fitfully at night, and it turned out to be any caffeine after noon. I’m sensitive to it I guess. I actually did a caffeine taper, and am down to the equivalent of just one 8oz coffee and only in the morning. Some days I don’t have any.
It sounds like a good idea to wait until you’ve been alcohol free for at least a few weeks before going down on the benzo. Are you familiar with post-acute withdrawal syndrome (PAWS)? I totally don’t mean it as a judgment on your drinking, it’s just a medical term, and even if you weren’t drinking daily or physically dependent, if you were drinking to excess on a regular basis your brain chemistry is likely going to take a while to adjust and level out once you’re alcohol free. Alcohol and benzos work very similarly, and the symptoms you experience when abstaining from them are equally similar. If taking the benzo isn’t making it more difficult to abstain from alcohol, I don’t think it’s worth the risk of added discomfort and potential backsliding.
Some of the common symptoms of PAWS from alcohol are anxiety and insomnia, and tapering off benzos at the same time risks exacerbating the symptoms. It’s good idea to look into another medication like an atypical antidepressant, TCA, or SSRI. I think I saw someone else recommend remeron? Seroquel is another viable option, it can be very effective to help with sleep, and has a long half life so it will help during the day with anxiety and mood. You could also look into amitriptyline. Older antidepressants like these tend to be overlooked by many people in favor of the newer SSRI’s and SNRI’s, but I’ve seen several recent meta-analyses which indicate that many of these older ones are just as, and sometimes more effective. They also tend to be more sedating, whereas SSRI’s and SNRI’s are often more activating. Most of them are not very safe to mix with alcohol though, and can be a recipe for blackouts.
I’ve also been impressed with some recent studies published on CBD reducing alcohol cravings. I haven’t come across anything specific on benzos & CBD, but I haven’t looked either. My educated guess is that it could be worth trying as a PRN to help ease the transition.
It’s late and I’m too brain dead to link to sources backing up what I’m saying. But if you want to see sources let me know and I’ll dig them up on my computer tomorrow. I’m lucky enough to have access to academic databases like pubmed right now, so I try to download & save all the interesting studies I come across cuz a lot of them are behind paywalls.
I’ve lowered alcohol gradually over a couple years to the point where I even notice mild hangover symptoms from 2 beers. This could really just be the sleep interruption it causes. Many hangover symptoms for me are exactly the same as poor sleep symptoms. I don’t get the classic headache and nausea. I just feel burned out all day from a hangover. Do you think it is important to stop alcohol completely, even if one can get down to just 2 light binges per month or something? Does a single usage re-open the old channels in the brain I am trying to close? I am at a point of self discipline where I see it as easy to quit alcohol. I have many negative associations with it. It’s not medicinal at all. Benzos are medicinal to some degree at least, and there’s no hangover.
I would like to stay away from SSRIs if I can.
actually in the field of addiction medicine they say any use reopens old channels of addictive thinking. The way it was described to me is that through drug addiction we create new pathways in our limbic/reward system that are reinforced every time we use a drug we’re addicted to. I don’t know the validity of this biologically, but it follows for me that when I was always thinking I had to have something to deal with certain parts of life, those impossible to deal with circumstances continued growing in scope and scale, necessitating ever growing use of helper drugs.
Just my experience. Everyone is different as far as their terms of what addiction or habituation or dependence is. They also told me in rehab that every drug was the same as far as addictive potential in someone predisposed/activated to alcohol or drug addiction…except coffee and nicotine, who’s use was rampant in rehab.
I don’t really buy that. I get addicted to benzos and most opioids super easily, I just want to feel that way forever. And pyrovalerones own me. But I’ve been taking kratom every couple of days for two weeks or so, and while there is some tolerance, it’s not the “have to redose constantly or get terribly sick” the way fentanyl was.
Sorry for rambling.
You are not rambling. Your post is helpful to me. While a caffeine addiction seems not so bad to me if it keeps someone off drugs, I hate seeing heavy tobacco use due to how debilitating it is to the health, and having never smoked tobacco myself.
I’ve tried kratom before; several different types. It seems to have almost no effect on me at all, except for a bit of dry mouth. However, opoids also have little effect on me as well except for the side effects, so that may be why kratom does nothing. I do know several people who feel very much helped by kratom, but all had been on opoids and none on benzos.
I totally get wanting to avoid SSRI’s, I think something like Remeron or Seroquel often works better for issues on the anxiety end of the spectrum anyway.
The thing about alcohol (and anything that works on the dopamine reward pathway) is that using it is going to continue to maintain that pathway.
You can think about neural pathways like worn footpaths in grass. They were formed by people walking the same path over and over. Now, everyone takes it because it’s the easiest most obvious route. Throwing down some grass seed isn’t going to work, because it will just get worn down before it can grow. You have to fence off the whole area until the grass grows back completely.
I’m not saying you can’t EVER drink again, I’m just saying it’s worth taking some time completely alcohol free to let your brain form different neural pathways. You can reevaluate later if staying alcohol free is of value.
When I first quit drinking I found that oral prescription Naltrexone was helpful in reducing my alcohol cravings (I think it might help for benzos too?). I was also prescribed Trazodone initially but switched to Seroquel which I found helped more with the jittery daytime anxiety I had from no longer drinking or being on prescription Xanax. I had a PRN for clonidine, a beta blocker and antihypertensive too which was helpful. It’s worth trying as long as you don’t have issues with low blood pressure. Propranolol is similar to clonidine and some people respond better to that.
I stayed on those for about 6 months before tapering off of them. Then I took about 12 months on nothing to get a sense of my baseline. It was definitely very hard, but I think it was worth it. I had my Dr put me on drug screening to hold me accountable and it helped get me through it. My brain chemistry is completely different and I respond to medications completely differently than I did before. I honestly think the worst of my anxiety was a result of alcohol use, and PAWS. Now I’m surprisingly doing well on prescription Adderall, which I would not have thought a few years ago, and I use medical marijuana for sleep. I actually just passed my 4 year mark alcohol free.
Feel free to keep asking questions man. I’ve been where you are and it seems like most info out there is either AA abstinence only shit or drug-you-till-you-drool harm reduction. I had a hard time finding a healthy in between.
Thanks for the awesome post. I want to address practically every every point.
First I like your neural pathway analogy. I developed one of my own years ago more along the line of flood waters seeking the low ground, and the more water that goes down the channel, the deeper the channel becomes, thus allowing even more water. To stop the flow you would have to dam that channel and let the waters find another route. Anyway your analogy is easier to explain to people. I like the idea of gating off the alcohol path for at least 30 days. I only had 4 beers over the last 7 days but had a suspicion that even that was not good for me.
Ive heard about Naltrexone for alcohol, and I know they make a monthly injection type of opoids. I know someone who turned his life around really quick with that. Your mention of it sparked a search, and you may be interested in this article. Apparently, flumazenil is the drug that works for benzo addiction.
I was already looking into Propanalol. I’ll research Clonidine too. I heard beta blockers eliminate physical symptoms of withdrawal. Plus they would be good to have on hand for occasional panic attacks. What do you think of GABA? It’s sold as a supplement on Amazon and elsewhere. Amazon reviews are mixed. Some say it eliminated most PTSD symptoms, and that they could finally sleep. Others were not happy with it. I think the majority were, though.
I’m ok with AA for the fellowship aspect but I am against the practice of introducing oneself with “I am an alcoholic.” To me it is really, “I developed an addiction.” To identify with the addiction puts undue focus on it, which tends to keep the pathway open. I also don’t like the way one can “ruin” 10 years of sobriety because they had one glass of champagne at their daughter’s wedding. What are your thoughts?
Also I had another post about severity of addiction. I wondered whether dose trumped time span of consumption. I gave an example of 20mg Valium daily for a few mths vs 5mg daily for a year(with no escalation). Most seemed to agree that the time span caused greater severity, but they were also citing tolerance and escalation when I specifically said “5mg per day for one year.” My instinct is that is it high dose levels that create severity when done daily. What do you think?
That’s all for now. I want to finish that article on flumazenil.
Haha sounds like we have similar ways of thinking about the world. I’m glad you found my analogy useful. I would have to look back through my research on PAWS, but I think it takes between 6-12 months for your brain structure & chemistry to stabilize. Where I’m at right now, I don’t think I’ll ever drink again. But not because I’m an alcoholic who will lose everything with my first sip of beer. It’s because alcohol does not work well with my brain chemistry. It makes me feel better when the effects are rising, but as soon as it begins to wear off the anxiety, restlessness, etc that I was trying to treat comes back even worse. I’ve found a lot of other things that work better in the long run but aren’t the powerful & addictive rush of relief you get with alcohol. I have gotten also better at using behavioral techniques to manage the intensity of my symptoms.
I’ve found a lot of the mindfulness/breathing/relaxation techniques out there don’t work for me. I stumbled across some data that people with trauma/C-PTSD related anxiety are often not well suited for quiet relaxation type meditation and mindfulness. It can encourage some people to ruminate and stay disregulated. I found that busier, more engaging forms of mindfulness were more helpful for me. Things that involved my mind and physical movement- like ATVing, building a stone wall, outside, physically active & requires constant thinking and attention.
I will have to read that article on Flumazenil when I have more time, I’m sure it’s going to be very interesting! It would be incredible to have some more effective options for treating benzo cravings. The shot is called Vivitrol, and I also know many people who prefer that. It’s actually like a little string they inject into your butt and it dissolves over the month. So if for some reason you needed emergency surgery or something they can remove the ‘string’ and you’ll be able to be safely given opiates. I know a lot of people who went straight on the shot, but they were all prescribed it at public health clinics. The insanely high-end Manhattan psychologist that I was worked with (through a random stroke of luck and timing) said that he prefers to start patients off with tapering up on oral naltrexone because there are some adverse side effects and common allergic reactions that people have and are easier to manage when tapering up orally than with the injection.
I have been on prazosin, clonidine and propranolol. I think clonidine worked the best for me at night, and propranolol was a bit better for a daytime PRN. They definitely help with the symptoms from going off a benzo. Prazosin is ehhh. It’s got a short half life, and for me it was difficult to find an effective dose that didn’t leave me hypotensive. I blacked out twice when I stood up too quickly to go pee in the middle of the night. It could happen with other beta blockers as well, but prazosin apparently kicks my ass.
GABA I have not tried, I’m not totally comfortable with it. I’ve known enough people who’ve ended up abusing their gabapentin & Lyrica scripts that I stay away from GABA agonists. It just doesn’t seem worth the risk to me. I have taken valerian root for sleep and even though it smells like ass it was good stuff. Don’t mix it with prescriptions or booze though.
I love the fellowship of AA. I think AA has a lot of great things to offer, and was very helpful to me a few years ago. I still love going to a small meeting when I need some face-to-face human kindness and understanding. I don’t think AA is the complete solution that it’s billed as. A lot of people in AA have other untreated issues that they ignore to focus on AA. For me, I identify as someone with mental illness who developed a reliance on alcohol as a means of self medicating. Alcohol was one of my most harmful maladaptive strategies, but it’s not really accurate to identify my main issue as alcoholism. I do think AA does many people a disservice by essentially discouraging them from seeking other forms of treatment because they identify as alcoholics and not as having an underlying & often treatable mental health condition. So I stay away from the serious big-book thumping all-psych-meds-are-cheating mentality that some groups have. I also was really bothered by the whole ‘one sip ruins everything you’ll lose all control’ mentality. About a year after I quit drinking I actually took a teeny tiny sip of beer, not enough that I could feel any effects. I wanted to know that one accidental sip of a drink I didn’t know had alcohol in it would magically transform me back into an alcoholic monster. It didn’t. I haven’t had another sip since.
I agree that length of time is probably a slightly bigger factor than dose, but it’s really the combo of the two. That is definitely how it works with opioids like suboxone or methadone which is what most of the data is on. There are a lot more similarities between booze, alcohol and opioids than most people realize. In fact, you likely already have a higher than average tolerance for opioids because of your alcohol and benzo use.
You definitely need to be careful tapering benzos. Those and alcohol are the only two drugs that can be fatal to withdraw from because of seizures. You might feel like you will die withdrawing from heroin or meth, but only booze and benzos will actually kill you.
Ok I’m going outside in the sun now! Can’t wait to read that article you shared later, and I look forward to hearing your response.
I have not gotten in deep with meditation but it has been helpful to me, as well as has some progressive relaxation techniques and breathing techniques that relax the cardio system and the muscles.
I finished the article on Flumazenil. Interesting stuff but hard to get in the US for our purposes as it is just used to bring people up from the benzo part of their anesthesia.
This morning I was thinking about looking up some AA meetings and may attend one just to see what it is like. Have you heard of Sinclair Method? I think their members use Naltrexone that you spoke about. I think they have groups too but they may be only online.
I know about the dangers of cold turkey on both alc and benz. If I was not on any benz, the amount of alc I used was never enough to cause severe withdrawal symptoms. The benz dose by itself might not either. It’s the combo of the 2 that I am concerned about and the reason I only cold-turkeyed the alcohol.