![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 39. This is the beginning of the thread.
Posted by waterfall on November 27, 2006, at 17:59:01
My pdoc has been prescribing Ativan and Klonopin for me for anxiety for 12 years without question. I was recently prescribed Valium in the ER when I pulled a muscle in my back and found that I much preferred it to Ativan. When I asked my pdoc for Valium she wrote a script for ten pills on the condition that I would never ask her for it again - Ativan and Klonopin continue to be just fine. I've never had an addiction problem. What's the difference between Ativan and Valium that she is treating the two so differently?
Posted by valene on November 27, 2006, at 18:17:00
In reply to Difference between Ativan and Valium?, posted by waterfall on November 27, 2006, at 17:59:01
> My pdoc has been prescribing Ativan and Klonopin for me for anxiety for 12 years without question. I was recently prescribed Valium in the ER when I pulled a muscle in my back and found that I much preferred it to Ativan. When I asked my pdoc for Valium she wrote a script for ten pills on the condition that I would never ask her for it again - Ativan and Klonopin continue to be just fine. I've never had an addiction problem. What's the difference between Ativan and Valium that she is treating the two so differently?
I think that your doctor is of the old school where 30 years ago Valium was abused extensively and passed out like candy.
The only difference in benzos is that valium has a longer half-life than ativan or klonopin, and is not as strong; therefore .5mg. of ativan equals 5mg. of valium or something like that. Your doctor appears to be lacking in knowledge of benzos. All benzos, ativan, xanax, valium, klonopin, can cause dependence and physical and psychological symptoms when withdrawn.
Posted by ace on November 27, 2006, at 19:20:50
In reply to Re: Difference between Ativan and Valium?, posted by valene on November 27, 2006, at 18:17:00
> > My pdoc has been prescribing Ativan and Klonopin for me for anxiety for 12 years without question. I was recently prescribed Valium in the ER when I pulled a muscle in my back and found that I much preferred it to Ativan. When I asked my pdoc for Valium she wrote a script for ten pills on the condition that I would never ask her for it again - Ativan and Klonopin continue to be just fine. I've never had an addiction problem. What's the difference between Ativan and Valium that she is treating the two so differently?
>
> I think that your doctor is of the old school where 30 years ago Valium was abused extensively and passed out like candy.
> The only difference in benzos is that valium has a longer half-life than ativan or klonopin, and is not as strong; therefore .5mg. of ativan equals 5mg. of valium or something like that. Your doctor appears to be lacking in knowledge of benzos. All benzos, ativan, xanax, valium, klonopin, can cause dependence and physical and psychological symptoms when withdrawn.I'm sorry will have to disagree with this last comment. When used sensibly, users tend to voluntarily LOWER their dose over time. In addition, if titrated at a very slow rate, sometimes no w/drawal sx, or only a modicum, are felt.
Posted by Quintal on November 27, 2006, at 19:38:42
In reply to Re: Difference between Ativan and Valium? » valene, posted by ace on November 27, 2006, at 19:20:50
>I'm sorry will have to disagree with this last comment. When used sensibly, users tend to voluntarily LOWER their dose over time. In addition, if titrated at a very slow rate, sometimes no w/drawal sx, or only a modicum, are felt.
I don't mean to be argumentative, but that statement by Valene is true as far as I'm aware ace. Which benzo out of ativan, xanax, valium, klonopin are proven *not* to cause dependence and physical and psychological symptoms when withdrawn? Just curious, because if you know of one I'll be dashing right along to my pdoc and asking him to re-prescribe one of the benzos that he is now denying me on grounds of dependence and addiction ;-)
Q
Posted by ace on November 27, 2006, at 20:08:43
In reply to Re: Difference between Ativan and Valium? ?ace, posted by Quintal on November 27, 2006, at 19:38:42
> >I'm sorry will have to disagree with this last comment. When used sensibly, users tend to voluntarily LOWER their dose over time. In addition, if titrated at a very slow rate, sometimes no w/drawal sx, or only a modicum, are felt.
>
> I don't mean to be argumentative, but that statement by Valene is true as far as I'm aware ace. Which benzo out of ativan, xanax, valium, klonopin are proven *not* to cause dependence and physical and psychological symptoms when withdrawn? Just curious, because if you know of one I'll be dashing right along to my pdoc and asking him to re-prescribe one of the benzos that he is now denying me on grounds of dependence and addiction ;-)
>
> QNone of them cause dependence when used properly and at therapetic dosage. The term 'dependance' denotes compulsive or chronic need; an addiction, i.e. an alcohol dependence. Also addiction (within the context of dependence) denotes that the user needs higher and higher doses to sustain efficay. Their is no scientific basis to this. As I state, when properly used, most users, tend to voluntarily lower their doses. Also, like any other drug, when withdraw and a very very slow rate their is hardly any withdrawal symptoms. People go from 2mg to 1mg and then wonder why they have these w/drawal sx! Taper off at .25mg fortnightly.
Paxil causes more w/drawal problems!
BUT when abused, these drugs can cause major problems.
Just my opinion!
Posted by laima on November 27, 2006, at 20:15:57
In reply to Re: Difference between Ativan and Valium? » Quintal, posted by ace on November 27, 2006, at 20:08:43
>Also addiction (within the context of dependence) denotes that the user needs higher and higher doses to sustain efficay.
Actually, this IS possible with benzos used long-term.
And a lot of people just go up on their dosage indefinately.
Posted by ace on November 27, 2006, at 20:26:53
In reply to Re: Difference between Ativan and Valium?, posted by laima on November 27, 2006, at 20:15:57
> >Also addiction (within the context of dependence) denotes that the user needs higher and higher doses to sustain efficay.
>
> Actually, this IS possible with benzos used long-term.
> And a lot of people just go up on their dosage indefinately.I personally have never seen any evidence of this - only when Benzo's are used as street drugs. I have read a lot of clinical and anecdotal literature and the use of higher doses
does not correlate with responsible medical usage.
Posted by ace on November 27, 2006, at 20:29:07
In reply to Re: Difference between Ativan and Valium?, posted by laima on November 27, 2006, at 20:15:57
Lack of relationship between long-term use
of benzodiazepines and escalation to high dosages
by
Soumerai SB, Simoni-Wastila L, Singer C,
Mah C, Gao X, Salzman C, Ross-Degnan D.
Psychiatr Serv. 2003 Jul;54(7):1006-11ABSTRACT
OBJECTIVE: The objective of this study was to determine whether long-term benzodiazepine use is associated with dose escalation. METHOD:S: The authors examined changes in dose and the frequency of dose escalation among new and continuing (at least two years) recipients of benzodiazepines identified from a database containing drug-dispensing and health care use data for all New Jersey Medicaid patients for 39 months. Independent variables included age; Medicaid eligibility category; gender; race or ethnicity; neighborhood socioeconomic variables; chronic illnesses, such as schizophrenia, bipolar illness, panic disorder, and seizure disorder; and predominant benzodiazepine received. Logistic regression analyses were conducted to determine the association between the independent variables and escalation to a high dosage (at least 20 diazepam milligram equivalents [DMEs] per day for elderly patients and at least 40 DMEs per day for younger patients). RESULTS: A total of 2,440 patients were identified, comprising 460 new and 1,980 continuing recipients. Seventy-one percent of continuing recipients had a permanent disability. Among all groups of continuing recipients, the median daily dosage remained constant at 10 DMEs during two years of continuous use. No clinically or statistically significant changes in dosage were observed over time. The incidence of escalation to a high dosage was 1.6 percent. Subgroups with a higher risk of dose escalation included antidepressant recipients and patients who filled duplicate prescriptions for benzodiazepines at different pharmacies within seven days. Elderly and disabled persons had a lower risk of dose escalation than younger patients. CONCLUSION: The results of this study did not support the hypothesis that long-term use of benzodiazepines frequently results in notable dose escalation.
Posted by Quintal on November 27, 2006, at 20:38:48
In reply to Re: Difference between Ativan and Valium? » Quintal, posted by ace on November 27, 2006, at 20:08:43
>None of them cause dependence when used properly and at therapeutic dosage.Many of the regular posters on this board are dependant on benzos because they have been taking then as prescribed (at recommended therapeutic doses) but for so many years they no longer have the original effect. If these people were to withdraw abruptly they would almost certainly suffer withdrawal symptoms as their brain struggled to readjust its GABA balance. In other words their brain had been *depending* partly on the effect of benzos to maintain its equilibrium.
>The term 'dependance' denotes compulsive or chronic need
Isn't that addiction?
>Also addiction (within the context of dependence) denotes that the user needs higher and higher doses to sustain efficacy
Is that not tolerance?
>As I state, when properly used, most users, tend to voluntarily lower their doses.
I've certainly heard of this and managed it myself at one point with Klonopin, but I'm not convinced it is the typical pattern of benzo use. I have always had the impression that secretly taking more tablets p.r.n to cope with anticipated stress or anxiety, or simply to regain efficiency as tolerance developed, was the more common.
>Paxil causes more w/drawal problems!
>BUT when abused, these drugs can cause major problems.
I agree. Antidepressants caused some of the harshest withdrawals for me. I found opiates were the easier to quit than Klonopin and SSRIs.Q
Posted by ace on November 27, 2006, at 21:09:43
In reply to Re: Difference between Ativan and Valium? ?ace, posted by Quintal on November 27, 2006, at 20:38:48
>
> >None of them cause dependence when used properly and at therapeutic dosage.
>
> Many of the regular posters on this board are dependant on benzos because they have been taking then as prescribed (at recommended therapeutic doses) but for so many years they no longer have the original effect.This statement defies the metabolism of the drug.
Within 2 months liver enzymes settle down and therapeutic efficacy is achieved at the same dose.
If these people were to withdraw abruptly they would almost certainly suffer withdrawal symptoms as their brain struggled to readjust its GABA balance.I agree. Long term benzo use usually, but not always, requires slow cessation. If not, I have heard of such extreme sx as seizures taking place, and certain anxiety paroxysms of an unknown origin.
In other words their brain had been *depending* partly on the effect of benzos to maintain its equilibrium.are you stating the brain's old equilibrium was superseded by a benzo-induced equilibrium?
> >The term 'dependance' denotes compulsive or chronic need
>
> Isn't that addiction?Not by the medical dictionary I have. But, there always seems to be some semantic confusion with these two terms.
> >Also addiction (within the context of dependence) denotes that the user needs higher and higher doses to sustain efficacy
>
> Is that not tolerance?See above.
> >As I state, when properly used, most users, tend to voluntarily lower their doses.
>
> I've certainly heard of this and managed it myself at one point with Klonopin, but I'm not convinced it is the typical pattern of benzo use. I have always had the impression that secretly taking more tablets p.r.n to cope with anticipated stress or anxiety, or simply to regain efficiency as tolerance developed, was the more common.
>
> >Paxil causes more w/drawal problems!
>
> >BUT when abused, these drugs can cause major problems.
>
>
> I agree. Antidepressants caused some of the harshest withdrawals for me. I found opiates were the easier to quit than Klonopin and SSRIs.
>
> Q
>Well, i can only state what I have experienced, read and seen.
I certainly could be wrong!
But I do think benzo's are wonderful agents and should be issued more. Maybe one day I will see certain phenomena with regards to benzo's that steers my mind, but for the moment, I am definately a strong advocate of the drugs.Ace.
Ace.
Posted by Quintal on November 27, 2006, at 21:10:25
In reply to Re: Difference between Ativan and Valium? » laima, posted by ace on November 27, 2006, at 20:26:53
>I personally have never seen any evidence of this - only when Benzo's are used as street drugs. I have read a lot of clinical and anecdotal literature and the use of higher doses
does not correlate with responsible medical usage.Ace, I don't like the way this is starting to feel like an attack on you, because it isn't. Could I just add a bit of my own experience with benzos to this debate?
I got my first script for lorazepam when I was 19. It was for 4mg/day, no titration, and the doc supplied it at my request on the basis of an internet printout. She told me she had never heard of this drug before. I soon moved on to other benzos, obtaining scripts for different benzos from different doctors and taking them all at the same time - I was abusing them. Six months after I began Ativan I managed to get a script for Klonopin (actually the trade name is Rivotril here in the UK) from a locum doctor, again on the basis of an internet printout and heavy persuasion on my part.
Soon after this when my supply of Rivotril no longer kept me satisfied I forged a prescription (taking huge doses of Rivotirl to calm my nerves) and was caught. I live in a small village, so you can imagine the humiliation when the Rivotril worse off and I was left facing the hard reality of what I'd done.
Eventually I began buying my supply of benzos from online pharmacies and I think this gradually eroded my self-esteem. I considered myself an addict (which I was) and no better than a street drug pusher, so maybe this was the reason I accepted without hesitation when I was offered my first line of coke? The Quintal of old would have shied away from any such dealings.
I'm now off all meds and street drugs and hope to stay that way so long as I can be healthy and functional. I'm no benzophobe and I've written some venomous retorts to Ms. Ashton's propaganda during my benzo years. Now I find I'm left with little choice but to admit though, that benzos *do* cause dependence, they *are* addictive, and in some rare cases they *may* trigger compulsive drug taking behaviour that *may* lead to experimenting with stronger substances.
Non of this diminishes my view of people who responsibly take benzos for decades at a time. I hope they keep working just as well for all you guys who are in that position, and I hope you are able to resist the people who will try to coerce you into quitting only to create further dependence on the (IMHO) inferior SSRIs.
Q
Posted by ace on November 27, 2006, at 21:33:57
In reply to Re: Difference between Ativan and Valium? ?laima ?ace, posted by Quintal on November 27, 2006, at 21:10:25
> >I personally have never seen any evidence of this - only when Benzo's are used as street drugs. I have read a lot of clinical and anecdotal literature and the use of higher doses
> does not correlate with responsible medical usage.
>
> Ace, I don't like the way this is starting to feel like an attack on you, because it isn't.No no, it's all cool!
Could I just add a bit of my own experience with benzos to this debate?
>
> I got my first script for lorazepam when I was 19. It was for 4mg/day, no titration, and the doc supplied it at my request on the basis of an internet printout.This should have been titrated slowely up to that level. That is a very ethically dubious thing to do.
She told me she had never heard of this drug before.Therefore she should not have dispensed it.
I soon moved on to other benzos, obtaining scripts for different benzos from different doctors and taking them all at the same time - I was abusing them. Six months after I began Ativan I managed to get a script for Klonopin (actually the trade name is Rivotril here in the UK) from a locum doctor, again on the basis of an internet printout and heavy persuasion on my part.So, you were abusing them, as by your own admition.
> Soon after this when my supply of Rivotril no longer kept me satisfied I forged a prescription (taking huge doses of Rivotirl to calm my nerves) and was caught. I live in a small village, so you can imagine the humiliation when the Rivotril worse off and I was left facing the hard reality of what I'd done.
>
> Eventually I began buying my supply of benzos from online pharmacies and I think this gradually eroded my self-esteem. I considered myself an addict (which I was) and no better than a street drug pusher, so maybe this was the reason I accepted without hesitation when I was offered my first line of coke?
The Quintal of old would have shied away from any such dealings.
>
> I'm now off all meds and street drugs and hope to stay that way so long as I can be healthy and functional. I'm no benzophobe and I've written some venomous retorts to Ms. Ashton's propaganda during my benzo years. Now I find I'm left with little choice but to admit though, that benzos *do* cause dependence, they *are* addictive, and in some rare cases they *may* trigger compulsive drug taking behaviour that *may* lead to experimenting with stronger substances.I think the CAN cause dependence (when used in a nonchalent fashion)
When used responsible I just personally can't see how they can be called addictive. If they are 'addictive' per se, we must then call ALL psychoactive drugs used in psychiatry addictive.
> Non of this diminishes my view of people who responsibly take benzos for decades at a time. I hope they keep working just as well for all you guys who are in that position, and I hope you are able to resist the people who will try to coerce you into quitting only to create further dependence on the (IMHO) inferior SSRIs.
>
> QWell I agree with you on the SSRI's!!!!
No, I can understand your points fully, and i DO respect them. Obviously we have a different spin on this issue as we have had different experieneces and what not.
I feel in no way you are attacking me: on the contrary, you are being very diplomatic and polite in stating your view.
I mean, this is ongoing research for me, so, as aforementioned, I well might see evidence which sways me to another position. But at the moment I am preety staunch in my views.
I appreciate this dialogue...in a way it's cool we disagree to some extent, it would be a boring world if we all agreed on everything!
Ace:)
Posted by zmg on November 27, 2006, at 22:50:47
In reply to Re: Difference between Ativan and Valium? » Quintal, posted by ace on November 27, 2006, at 21:33:57
How about the difference of short versus long acting benzos. I've been taking Valium, 30-40 mg a day for about a year and a half. I imagine this is a high dose (I hadn't been seeing a doctor).
I recently stopped the Valium, gradually over the course of at least a month. I was grouchy for about a week, a few transient headaches (might have had a little cold). Aside from the way different benzos effect different people (always the Xanax vs. Valium arguments, etc) it seems to me the most important difference would be half-life.
I'm glad Diazepam has such a long half-life as I'm sure it made the titration much smoother and was more 'forgiving' when I'd miss a dose or forget and take the next days (coming off the Valium I notice I became more forgetful then normal).
FTR I started out at about 10-20 mg's. I was never using it exactly responsibly, but I never felt the need to go above 40 and the times that I did it only seemed to decrease my coordination, not alleviate any excess anxiety (or buoy my mood).
All and all it was a very useful drug for me.
Posted by Quintal on November 27, 2006, at 22:56:24
In reply to Re: Difference between Ativan and Valium? » Quintal, posted by ace on November 27, 2006, at 21:33:57
Ace, I agree with you that the first prescription was dispensed on shaky medical and ethical grounds, and that's part of the point I'm putting forward. When addictive drugs are prescribed in sensible manner to stable, sensible people they rarely seem to cause serious problems, but what causes that reaction we call addiction between certain people and certain substances?
Is it the person or the substance that has the addictive nature, or both? (I know I irritate Squiggles when I use this 'pedagogical' tone *apologies*, but I think it lies at the crux of the debate).
> think the CAN cause dependence (when used in a nonchalant fashion)
>When used responsible I just personally can't see how they can be called addictive. If they are 'addictive' per se, we must then call ALL psychoactive drugs used in psychiatry addictive.So if I were to take Lexapro for instance in a nonchalant fashion, do you think I would become addicted? Would I be able to abuse it at all? Even when used sensibly, when benzos are taken continuously over a long period of time there is still the issue of dependence. I don't have the exact figures and I suspect it's hard to estimate accurately, but I know from experience with other family members and from reading message boards like this that dependence is a frequent occurrence. The benzos are no longer as efficient as they were at the beginning of treatment and to quit abruptly would cause withdrawal syndromes in many people.
It seems to me that most of the drugs used in psychiatry produce some form of dependence. At the very least I could say nearly all are capable of producing psychological dependence, and many also produce physical dependence and have severe withdrawal syndromes (SSRIs et al), with only a few being truly addictive. I think benzos belong in the latter category because they have the capacity to trigger that reaction between the addictive personality and the addictive substance where many, despite being utterly repellent in every other way (IMHO), lack this potential.
Q
Posted by Phillipa on November 27, 2006, at 23:18:08
In reply to Re: Difference between Ativan and Valium? » ace, posted by Quintal on November 27, 2006, at 22:56:24
Oldest users of benzos on this site I bet. My experience was when stress was low I naturally lowered the dose by myself. In my twenties yes it valium was handed out like candy so why did I cut down on my own? And been on them all. Xanax was so easy to stop just switched. And when I moved to NC before my thyroid I was on .l25 a day of xanax. The pdoc thought it was a joke and a placebo. Anyway I'm on the valium now cause of the thyroid and my doc said to. I can't take ad's the side effects are too bad and I once took l0mg of paxil thought I would die when I stopped it. Had to start again and nibble a bit off for weeks before I could stop it. So in my experience it's easier to wean off a benzo. Love Phillipa ps plus they have no lawsuits on them or black box warnings.
Posted by Quintal on November 27, 2006, at 23:28:05
In reply to Re: Difference between Ativan and Valium? » Quintal, posted by ace on November 27, 2006, at 21:09:43
> >Also addiction (within the context of dependence) denotes that the user needs higher and higher doses to sustain efficacy
>
> Is that not tolerance?>See above.
--------------------------------------------------
The American Heritage® Dictionary of the English Language: Fourth Edition. 2000.
TOLERANCE
SYLLABICATION: tol·er·ance
PRONUNCIATION: tlr-ns
NOUN: The capacity to absorb a drug continuously or in large doses without adverse effect; diminution in the response to a drug after prolonged use. <Hence requiring a progressive *increase* in dose.>--------------------------------------------------
>> >The term 'dependence denotes compulsive or chronic need
>
> Isn't that addiction?>Not by the medical dictionary I have. But, there always seems to be some semantic confusion with these two terms.
--------------------------------------------------The American Heritage® Dictionary of the English Language: Fourth Edition. 2000.
ADDICTION
SYLLABICATION: ad·dic·tion
PRONUNCIATION: -dkshn
NOUN: 1a. Compulsive physiological and psychological need for a habit-forming substance: a drug used in the treatment of heroin addiction. b. An instance of this: a person with multiple chemical addictions. 2a. The condition of being habitually or compulsively occupied with or or involved in something.
--------------------------------------------------
Yes, it seems there is a semantic overlap between addiction and dependence putting it loosely, in the sense that dependence is a chronic need for the substance and addiction is the compulsive desire. It's hard to tease out addiction from tolerance, since there is often a craving for a stronger 'hit', but that may not reflect changes in physical tolerance to the drug, rather a mental desire for a stronger effect. Tolerance being changes in the amount needed to produce the same effect.>But I do think benzo's are wonderful agents and should be issued more. Maybe one day I will see certain phenomena with regards to benzo's that steers my mind, but for the moment, I am definitely a strong advocate of the drugs.
Agreed!!!
Q
Posted by Quintal on November 27, 2006, at 23:46:17
In reply to Re: Difference between Ativan and Valium?, posted by Phillipa on November 27, 2006, at 23:18:08
Hi Phillipa,
>My experience was when stress was low I naturally lowered the dose by myself.
When stress was high, did your benzo dose ever rise to compensate?
>In my twenties yes it valium was handed out like candy so why did I cut down on my own?
I did this myself while on clonazepam for a short while. I even came off them completely and voluntarily for a little while, but I still went on to abuse them later when I felt the urge. I guess it depends on your state of mind at the time?
Q
Posted by yxibow on November 28, 2006, at 3:06:53
In reply to Re: Difference between Ativan and Valium? » ace, posted by Quintal on November 27, 2006, at 23:28:05
> > >Also addiction (within the context of dependence) denotes that the user needs higher and higher doses to sustain efficacy
> >
> > Is that not tolerance?
>
> >See above.
> --------------------------------------------------
> The American Heritage® Dictionary of the English Language: Fourth Edition. 2000.
>
> TOLERANCE
>
> SYLLABICATION: tol·er·ance
> PRONUNCIATION: tlr-ns
> NOUN: The capacity to absorb a drug continuously or in large doses without adverse effect; diminution in the response to a drug after prolonged use. <Hence requiring a progressive *increase* in dose.>
>
> --------------------------------------------------
>
> >> >The term 'dependence denotes compulsive or chronic need
> >
> > Isn't that addiction?
>
> >Not by the medical dictionary I have. But, there always seems to be some semantic confusion with these two terms.
> --------------------------------------------------
>
> The American Heritage® Dictionary of the English Language: Fourth Edition. 2000.
>
> ADDICTION
>
> SYLLABICATION: ad·dic·tion
> PRONUNCIATION: -dkshn
> NOUN: 1a. Compulsive physiological and psychological need for a habit-forming substance: a drug used in the treatment of heroin addiction. b. An instance of this: a person with multiple chemical addictions. 2a. The condition of being habitually or compulsively occupied with or or involved in something.
> --------------------------------------------------
> Yes, it seems there is a semantic overlap between addiction and dependence putting it loosely, in the sense that dependence is a chronic need for the substance and addiction is the compulsive desire. It's hard to tease out addiction from tolerance, since there is often a craving for a stronger 'hit', but that may not reflect changes in physical tolerance to the drug, rather a mental desire for a stronger effect. Tolerance being changes in the amount needed to produce the same effect.
>
> >But I do think benzo's are wonderful agents and should be issued more. Maybe one day I will see certain phenomena with regards to benzo's that steers my mind, but for the moment, I am definitely a strong advocate of the drugs.
>
> Agreed!!!
>
> Q
>
This has been discussed ad nauseum, to paraphrase a Ratherism, the semantics are "a ding dong battle back and forth". And I completely agree with the above -- there are definite distinctions between addiction, tolerance, and habituation, all three of which can occur at the same time.
Addiction, in its primary sense is the non-medical use of medical (or street obtained) substances for non prescribed purposes -- recreation gone too far, to be crude.
I have no issue one way or the other with personal recreational use of drugs -- I think the law enforcement community has better things to do, at least with "soft" substances like marijuana. If it were legalized like alcohol (not too strangely the roaring 20s were another period of pot use and the movie Grass features clips from anti-pot movies made by the government that are rather hilarious in todays context.)
Granted there are non hilarious mexican mafias behind some marijuana usage but of course that is because of enforcement (mind you I've never tried but have no particular mindset on the substance), it equally flows from Canada and there is a relative lack of machinegun use in the northwest... anyhow I'm straying from the point -- if it were made like alcohol, 21 (or 18 or whatever) this would all go away.Now I'm not talking the same thing about crack and heroin and meth, etc... one can get the point.
Getting back to addiction -- it is a medical phenomenon that we are finding is primarily a biochemical based issue -- and possibly quite genetic as well. So addiction would be the forging of prescriptions, and as I said since it can occur at the same time as habituation and tolerance, the hiding of just how much one is actually taking of a substance from a doctor or doctor shopping until it reaches a point that it can't be hidden.
Tolerance and habituation are close synonyms -- habituation occurs when tolerance to a substance happens. This is why long half life benzodiazepines are much safer than short half life ones for long term therapy. Ativan requires twice daily dosing for a number of people and is generally more of a PRN (as needed) medication usually, as is Xanax.Valium has gotten an old 1960s Valley of the Dolls, Mother's Little Helper reputation, when in fact its 24+ hour half life means that adjustment of dosages are smoother and less harsh on the patient because there is a standing blood level at a high steady state. Medications that require 2, 3, and 4x dosing can have interdosal withdrawals.
Either Valium or Klonopin (sometimes 2x daily for Klonopin) are good long term benzodiazepines -- some people here have claimed Klonopin can cause depression, although this is a possibility of most benzodiazepines in those who already suffer from depression in the first place and they are CNS depressants themselves.
There have been people on benzodiazepines since they came out in the early 1960s. This is not to say they're candy, but proper dosing with observation for tolerance is probably among the safest psychiatric drug regimes; they also have a high LD50 (morbidity) which I am not going to note for obvious reasons. This also probably varies for those who are used to a higher level of benzodiazepines in the first place or are fast metabolizers.So to sum it up I would actually say that Valium is a better choice for long term than Ativan, but I am not your doctor and I cannot advise that medically. It is just a personal opinion.
-- tidings
Jay
Posted by Quintal on November 28, 2006, at 9:55:29
In reply to Re: Difference between Ativan and Valium? » Quintal, posted by yxibow on November 28, 2006, at 3:06:53
>Granted there are non hilarious mexican mafias behind some marijuana usage but of course that is because of enforcement (mind you I've never tried but have no particular mindset on the substance), it equally flows from Canada and there is a relative lack of machinegun use in the northwest...
Ironic that violence is associated with Marijuana considering its typical pacifying effect.
>if it were made like alcohol, 21 (or 18 or whatever) this would all go away.
I agree on the whole, but I suspect there would still be a black market for Marijuana as there is for contraband cigarettes and cheap Vodka and other spirits where I live. The effect of regular long term Marijuana use on the ability to drive operate machinery safely is also a concern.
>Addiction, in its primary sense is the non-medical use of medical (or street obtained) substances for non prescribed purposes -- recreation gone too far, to be crude.
Well I became addicted to benzos in a medical context and did not set out to abuse them however dubious the original prescription may seem. The irony is I knew all about these problems before I started but the benzos made me feel so good that I didn't care about the consequences. I was seeking instant gratification, became quite aggressive and domineering etc. A total personality change. I don't feel much like abusing drugs in my (now) sober state. I have access to some addictive substances but have no inclination to use them.
>There have been people on benzodiazepines since they came out in the early 1960s. This is not to say they're candy, but proper dosing with observation for tolerance is probably among the safest psychiatric drug regimes
My grandmother was one of those people I believe, although she did manage to withdraw from Valium. She still took temazepam at night until she died and I'm grateful she had that relief.
Q
Posted by laima on November 28, 2006, at 13:07:34
In reply to Re: Difference between Ativan and Valium? » laima, posted by ace on November 27, 2006, at 20:26:53
My experience fits your definitions of addiction unfortunately- so am I to conclude I am an unusually lame drug addict just plain utterly lacking in self control? Fully deserve what I brought upon my weak self?? I'm actually not into street drugs. Doctors, "experts", raised my dose over approximately 5 years in response to increasing tolerance, then decided to stop the escalation cycle, and I can't really use benzodiazapines again on any regular basis-at least not for a long while. ( "We don't normally prescribe much more than that, and it's time to bring this cycle to an end, the drugs are obviously not helping this way". ) I can't argue with that. It's a shame. What initially was way too much- a knock out- has zero effect on me now. ("Tolerance? Sure it's possible, you've been on it for a long time. It's probably not doing you any good any more.") I'd practically crave clonopin- not for any high or recreation, but to stave off withdrawal. Dream about benzodiazapines, wonder if I might not have an emergency stash somewhere, if there might not be overlooked bits on the floor from splitting them. Hoped the pharmacy wouldn't run out! No one ever asked, "Any history of addiction in your family?", or anything like that. So whose "fault" is it really? Everybody? Perhaps nobody? Not clear. And I wonder who exactly funded that study you quote for your position. I think it's useful to look at studies skeptically, and wonder what were their interests? Sure they're useful drugs- but not without risks. Perhaps best approached cautiously on a case by case basis. I think there no easy answer from them or about them. Fortunately, curiously, I've never experienced withdrawal symptoms of any kind from any stimulants or antidepressants. No cravings, either. Go figure, body chemistry differences.
> > >Also addiction (within the context of dependence) denotes that the user needs higher and higher doses to sustain efficay.
> >
> > Actually, this IS possible with benzos used long-term.
> > And a lot of people just go up on their dosage indefinately.
>
> I personally have never seen any evidence of this - only when Benzo's are used as street drugs. I have read a lot of clinical and anecdotal literature and the use of higher doses
> does not correlate with responsible medical usage.
>
>
Posted by Phillipa on November 28, 2006, at 17:49:56
In reply to Re: Difference between Ativan and Valium? » Phillipa, posted by Quintal on November 27, 2006, at 23:46:17
I've never raised the dose on my own. Only pdocs have over the last year. Many stresses. And I forgot there was a time when I was benzo free on my own. Love Phillipa
Posted by Quintal on November 28, 2006, at 18:51:06
In reply to Re: Difference between Ativan and Valium? » Quintal, posted by Phillipa on November 28, 2006, at 17:49:56
It seems that benzos are addictive mostly to people who are unstable or have personality disorders then as liama suggests?
When I think more carefully about this I find I was most likely to abuse benzos and other drugs when I was hypomanic. It was that hedonistic euphoria that says "What the hell, you only live once" and the loss of insight that I think lead to the benzo abuse and from benzos on to other drugs. Curiously I usually stop taking all drugs when I'm depressed - including antidepressants even though it is at that time I would benefit from them the most.
Has anyone else with bipolar tendencies found this pattern to substance use - alcohol etc?
As liama says, the pdocs do not ask if we have a history of addiction and of course I didn't have a history of substance misuse at that time so there was no way of knowing. This is my point about benzos - they're much the same as other addictive drugs. There are people who can take opiates for many years and withdraw successfully without major problems, but this does not mean they are not addictive.
Q
Posted by Quintal on November 28, 2006, at 18:54:54
In reply to Re: Difference between Ativan and Valium? » Phillipa, posted by Quintal on November 28, 2006, at 18:51:06
Posted by ace on November 28, 2006, at 20:14:04
In reply to Re: Difference between Ativan and Valium? » ace, posted by Quintal on November 27, 2006, at 23:28:05
> > >Also addiction (within the context of dependence) denotes that the user needs higher and higher doses to sustain efficacy
> >
> > Is that not tolerance?
>
> >See above.
> --------------------------------------------------
> The American Heritage® Dictionary of the English Language: Fourth Edition. 2000.
>
> TOLERANCE
>
> SYLLABICATION: tol·er·ance
> PRONUNCIATION: tlr-ns
> NOUN: The capacity to absorb a drug continuously or in large doses without adverse effect; diminution in the response to a drug after prolonged use. <Hence requiring a progressive *increase* in dose.>
>
> --------------------------------------------------
>
> >> >The term 'dependence denotes compulsive or chronic need
> >
> > Isn't that addiction?
>
> >Not by the medical dictionary I have. But, there always seems to be some semantic confusion with these two terms.
> --------------------------------------------------
>
> The American Heritage® Dictionary of the English Language: Fourth Edition. 2000.
>
> ADDICTION
>
> SYLLABICATION: ad·dic·tion
> PRONUNCIATION: -dkshn
> NOUN: 1a. Compulsive physiological and psychological need for a habit-forming substance: a drug used in the treatment of heroin addiction. b. An instance of this: a person with multiple chemical addictions. 2a. The condition of being habitually or compulsively occupied with or or involved in something.
> --------------------------------------------------
> Yes, it seems there is a semantic overlap between addiction and dependence putting it loosely, in the sense that dependence is a chronic need for the substance and addiction is the compulsive desire. It's hard to tease out addiction from tolerance, since there is often a craving for a stronger 'hit', but that may not reflect changes in physical tolerance to the drug, rather a mental desire for a stronger effect. Tolerance being changes in the amount needed to produce the same effect.
>
> >But I do think benzo's are wonderful agents and should be issued more. Maybe one day I will see certain phenomena with regards to benzo's that steers my mind, but for the moment, I am definitely a strong advocate of the drugs.
>
> Agreed!!!
>
> Q
>I can get the dictionary details I got my defintions from...but I think, to be honest, your citation is more closer to the truth than mine!
Posted by laima on November 28, 2006, at 20:46:33
In reply to Re: Difference between Ativan and Valium? » Phillipa, posted by Quintal on November 28, 2006, at 18:51:06
I'm not bipolar and I didn't know there would be a problem. Just wanted to avoid withdrawal symptoms. Never ever was diagnosed with any personality problem either. Didn't move on to "other drugs", l haven't had such issues on such a scale with other drugs. One would think stimulants, for example, would be very abuseable and problematic-not an issue here. Pot was always around me some years ago- I walked right away from it, no issue, no problem. Interesting. People in my family have had alcohol problems for several generations though. And of course, lots of people use alcohol without any issues- but probably no one will dispute it's a highly abusable, addictive substance. Insiduous, even. But somehow, I am able to take "drinking vacations" without too much effort once I am determined. That fortunately always feels more like a "psychological" craving rather than an "avoid unpleasantness" desperation. Sort of how giving up excessive cookie-eating (or whatever) doesn't lead to "unpleasantness" in any meaningful, physicological way, though it can be a drag. No breathing trouble, no blood pressure instability spells...no panic about "where's the drug!" Of course now I am wary not to develope an alcohol problem! And I've had opiate-like painkillers (ie, vicodine) after dental surgery, and that wasn't ever any issue either. Neither were were sleeping pills like ambien: yes I acted weird- because they didn't make me/induce me to go to sleep- but I never craved them or missed them after their brief trials. (Maybe "brief trial" is the key?) As for "unstable", I'd say I was very highly functional until about six months ago, when the so called max dose of clonopin konked out, and subsequently the hold-it-right-there, and then later the withdrawal efforts and rebound anxiety began. (Start and stop, over and over--I don't think a withdrawal determination would have to last any six months despite my own problems.) I don't get it why benzodiazapines have been so different. Now of course, there is anxiety, and little to do about it responsably other than yoga and "lifestyle changes". Unfortunately, at least for now, still way far more anxiety than before I ever heard of the easy "cure", or whatever it was supposed to be. Might be best to check one's genetics or family history? Maybe? Or just take breaks once in awhile to take assessment? Or maybe not always relevant? They definately are VERY effective drugs; that's a blessing and curse all at once. Such a shame that for some people, at least, there's that little "develope tolerance" problem.
> It seems that benzos are addictive mostly to people who are unstable or have personality disorders then as liama suggests?
>
> When I think more carefully about this I find I was most likely to abuse benzos and other drugs when I was hypomanic. It was that hedonistic euphoria that says "What the hell, you only live once" and the loss of insight that I think lead to the benzo abuse and from benzos on to other drugs. Curiously I usually stop taking all drugs when I'm depressed - including antidepressants even though it is at that time I would benefit from them the most.
>
> Has anyone else with bipolar tendencies found this pattern to substance use - alcohol etc?
>
> As liama says, the pdocs do not ask if we have a history of addiction and of course I didn't have a history of substance misuse at that time so there was no way of knowing. This is my point about benzos - they're much the same as other addictive drugs. There are people who can take opiates for many years and withdraw successfully without major problems, but this does not mean they are not addictive.
>
> Q
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