Given the extremely strong negative reaction to alcohol that patients who are taking Disulfiram experience and given that this is apparently the sole effect that alcohol abuse cessation treatment using it relies on, it is my belief that the treatment is unconscionable and inhumane.
I quit drinking after more than 25 years of problematic drinking using naltrexone (The Sinclair Method) and, given my experience with alcohol, it was the easiest thing I've ever done.
I urge people who have a problem with drinking and wish to quit, who for whatever reason do not feel that 12 step programs like Alcoholics Anonymous are right for them to find a doctor who is willing and able to prescribe naltrexone and have a serious discussion with them. Had I known it was effective as it is I probably would have been able to stop drinking 20 years sooner than I did.
"I urge people who have a problem with drinking and wish to quit, who for whatever reason do not feel that 12 step programs like Alcoholics Anonymous"
I urge people to see an addiction specialist first. Do not see AA first. See a doctor asap. This disease is serious and has a high fatality rate. AA meetings are like a club after you have it under control (EG. don't attend drunk).
Disulfiram: An old military drug. This will stop you drinking but you need a significant other or parent involved. Each morning you must take the pill and your significant other needs watch to double check. Doctors are scared to prescribe this and the drug companies are ramping down it's production. Hoarding the drug is common.
naltrexone: This comes in two forms. The pill and the shot. When you first take this you should do the shot form. The shot lasts 30 days and there is not a possibility of skipping out on pills. Naltrexone will ruin the Euphoria feeling of alcohol and opioids (so it's a kind of two for one). No addiction specialists back the 'the Sinclair Method' but do back daily use of Naltrexone.
Rehab: Good short term, bad long term. Rehab failure rate is over %90. A normal rehab will run 10-30k per incident. Do not leave unless you had a Naltrexone shot. Longer stays will impact work, an unemployed Alcoholic is dangerous.
Alcoholics Anonymous: Very* difficult for people with social anxiety. People that succeed here find a sponsor which is like dating. You will be rejected literally by tens of potential sponsors until one says yes (hang in there!). AA has a very high success rate for extroverts who become a sponsor - caring over others going through alcoholism seems to rewire the brain.
Baker Acted/Marchman: If you have a family member (or a friend but you have family contacts) drinking to a point where they are unable to make decisions - you can file a Baker act. [Name varies wildly state to state]. A court can determine the individual needs intervention and can use state authorities to detain. Depending on your court appearance after 72 hours (don't be drunk lol) - the judge orders more jail time or programs.
Another problem with AA is you don't know who is there voluntarily trying to get better, and who is there because they're a physically abusive alcoholic that was court-ordered to be there.
There was also an uncomfortable amount of "thirteenth stepping" going on in my groups, where the single males running them ended up in relationships with women in the groups.
Kind of like vcs and startup founders who use their status to “mentor” women in tech just to try and get in their pants. Predation is not unique or exclusive to any organization or group.
> No addiction specialists back the 'the Sinclair Method' but do back daily use of Naltrexone.
This is definitely not true having worked with addiction specialists on TSM myself. Plus I think it is safe to consider Sinclair himself as an addiction specialist
I think s/he meant that finding a sponsor with whom you have a good rapport and willing to give you the time you need is the difficult part (hence, like "dating").
"Rehab: Good short term, bad long term. Rehab failure rate is over %90."
That's if you can even get the person into rehab at all! Just before last Christmas we buried a good longtime friend and colleague who'd died of liver cirrhosis. Nothing we did could get him into rehab.
'So what' you may say - he was just one more of many thousands. The trouble was that he was also an organic chemist by training yet even with this insight he couldn't stop his alcohol consumption. It was tragic really.
I've come to the conclusion that those of us who aren't alcoholics have little or no conception of how the mind of an alcoholic works or why he/she finds it necessary to consume alcohol in such damaging quantities. Simply, we cannot get into their minds and perceive the world from their perspective. This is a huge problem as it often stops friends and or family from being effective helpers.
As I see it, there's a perceptual barrier that separates alcoholics from those who aren't alcoholic. It's not a simple matter for a person who is not an alcoholic to put himself/herself into an alcoholic's mindset especially so if the alcoholic has no serious underlying psychological problems (if he/she did have then perhaps the person who's trying to help could envisage the alcoholic's state of mind - that of, say, depression, etc.).
Essentially, even those of us who aren't alcoholics but who've experienced the effects of alcohol can't use that experience (of say, being drunk) as an analog to understand the alcoholic's mindset as both perceptions of the effects of alcohol are fundamentally different.
Take my experience, I recall getting badly drunk in my student days and it was very unpleasant, since then on rare ocassions I've been what you'd call 'merry' from the effects of alcohol. Nevertheless, I find the effect of even a little alcohol both disturbing and mind-dulling and I deliberately avoid getting into that state. On the other hand, the alcoholic either experiences different physical effects from alcohol than I do and or his/her visceral perception of those physical effects of the alcohol are very different to mine.
It seems to me that this difference in percetion between the alcoholic and us who aren't alcoholics is one of the reasons why we're often unsuccessful in helping them. If we cannot communicate on their level then we're at a disadvantage when we try to help them and or offer them support.
That was what I experienced when I tried to help my former friend and colleague. Even though I knew him well and had done so for many years, it was clear to me that when it came to discussing alcohol that we spoke a different language. I'd hasten to add that at no time did I patronize him, nor was I intrusively paternalistic towards him. Essentially there was no effective communication between us on the matter of alcohol.
I have been in and out of AA (thankfully in a good place currently) and I think this idea that addicts are fundamentally different from everyone else is a complete myth that only makes people with addiction problems feel more hopeless and separate from society. Have you ever had a harmful habit you have had difficulty breaking, or been unable to do something that you know will improve your health? Then you can relate to an addict. Their habit is likely a lot more harmful than yours, and affects their brain chemistry, but it’s the same mechanism that prevents you both from stopping even though you know it would help you.
Judson Brewer is a psychiatrist and neuroscientist who researches addiction and advocates this view. I found his book The Craving Mind[1] to be incredibly illuminating and true to my experience as a person who has struggled with drug use.
"...I think this idea that addicts are fundamentally different from everyone else is a complete myth"
That's absolutely not what I said, nor what I intended. Of course, addicts aren't any different to anyone else in the general sense (that of being human beings).
Nevertheless, their worldview is different to mine and to that of others - no two worldviews are the same, everyone has a fundamentally different worldview or we'd all be clones.
Yes, like everyone else, I have my addictions - cravings for certain foods, rich cheeses, certain types of cakes and so on but I simply never buy them or my belt would be about four notches larger. I'm constantly aware that I can't afford to give in to temptation and it's stressful.
However, that doesn't stop me looking at these foods and drooling over them whenever I go shopping.
Same with coffee: I drink coffee so strong that no normal person would ever touch it. Unlike those other foods mentioned, I do imbibe in this superstrong coffee and I have no intention of giving it up even though I know that it is not good for me.
The difference between my food addictions and alcohol addiction is the sheer scale of the damage alcohol does to the individuals involved not to mention the havoc it does to their families and to society at large.
Comparing my food addictions to alcohol or full-blown opiate addiction is a non sequitur, essentially there is no comparison even though they all initially started out as the cravings of one's mind. By comparison, my food addiction compared to alcohol or opiate addiction is like comparing a pop gun to an AK47.
We must be very careful when we equate all addictions down to a commom cause - one's craving mind and then proceed to imply that in the end there's little to differentiate between them. To say there's little between them is postmodernist nonsense in its extreme and it's very dangerous thinking. In the end, black is black and white is white and not some shade of nondescript amorphous gray.
That said, I'll restate the fact that I've just watched a longtime friend die of alcoholic poisoning and I've great sympathy for anyone who's in the grip of alcoholism.
If you think I'm being a righteous bastard for saying what I've just said then I can only say that it's definitely not true. I am only too well aware that there's the thinnest of thin lines between me (and most of us) and the alcoholic or opiate addict - or the haplessly addicted and desperate gambler.
As the old truism states, it is only but for the grace of one's deity go thee.
>”I find the effect of even a little alcohol both disturbing and mind-dulling and I deliberately avoid getting into that state. On the other hand, the alcoholic either experiences different physical effects from alcohol than I do and or his/her visceral perception of those physical effects of the alcohol are very different to mine.”
As an alcoholic I think an often overlooked aspect is the opposite of this: how it feels to NOT have the alcohol.
Right, what you said makes sense. Essentially, it's the same thing, that is, we're feeling at our best in opposite states.
My perception of the world and state of mind seems better to me sans ethanol, yours is the opposite. But that doesn't mean it's a bed of roses for me, it's just that ethanol doesn't work for me to make things better. This is a very complex matter of which millions of words have already been written and clearly I'm not going to come up with any new insights.
What I've tried to say is that these differering worldviews make it difficult to make life easier for alcoholics.
It's strange really why different people have such different responses to alcohol. Despite what I said about the negative effects of alcohol on me I nevertheless love the taste of good wine and I reckon it's a damn cruel act of fate that alcoholic drinks are so nice and yet at the same time alcohol is far from being just another innocuous additive.
Trouble is that the level of alcohol in many alcoholic drinks has increased in recent years when it ought to have been decreasing. For example, a top Bordeaux traditionally has 12.5% alcohol-that is, the world's best wine needs only that amount of alcohol, yet on the shelves of liquor stores where I live almost all wines now have 14.5% or more alcohol. It used not be like this but winemakers found that if they increased the level of alcohol then the wines needed almost no ageing and could be turned over more quickly.
That's a sore point with me, wines may be sold more quickly by increasing their alcohol content but good wines must still be aged. Again the quick buck has gotten in the way of better health and governments have done stuff-all about it.
I hope that alcohol eventually becomes much less of a problem for you.
Not sure how your missing the fact that people drink to shut off or dull their senses. No one drinks to become smarter or more perceptive. The very point is to get your brain to chill out in a sense, unwind, relax, etc.
Also a 2% increase in alcohol content isn't noticeable in any way other than MAYBE taste (and I'm sure most people wouldn't even notice that).
I haven't missed that point, see my comment to heavyset. It's not possible to cover every topic in these posts. If you want a more extensive view of my thoughs on these matters then you could search through my long-winded boring posts on the opioid epidemic, oxycontin, Purdue and the Sacklers and the miscarriage of justice - and the abject failure of the FDA to stop the epidemic (there are many of them). Better still, just take my word that I'm well aware of the issues.
I will disagree with you over the matter of the 2%. This extra ethanol does make a considerable difference and has been shown to do so for a number of reasons some quite complex that I cannot do justice to here. However, I'll mention a quick one for starters: the extra few percent spitit is significant as it often masks the high level of acids in young wine (malic, latic, bytric, sorbic, tartaric, etc.) with the consequence that many people drink considerably more wine in one go. Thus, they not only get the extra 2% ethanol but also an addotional amount from the extra wine they've consumed (and remember this wine already 2% stronger).
The acid levels drops significantly in older wines that have been left to age so that problem doesn't happen with them. Winemakers now actively cultivate and promote this high-alcohol, soft-style wine and they've been very successful in doing so over the last 30 or so years. It saves huge inventories of wine from being stored by over three years or more (there's much saved moolah there).
This then actively discourages research into producing flavorsome wines with much lower alcohol (at present, reducing the ethanol content to 10% or lower makes the wine thinnish in character and it spoils easily). Much oenological research is needed to boost the body and flavor in low alcohol wines and at the moment there's precious little incentive to provide money for this research. It urgently needs government intervention and regulation to overcome the problem.
BTW, decades ago I worked in a vinyard/winery for a short while.
With regard to your point, most alcoholics and addicts will tell you that their substances of choice end up making them feel "normal", whereas other people can feel "normal" without substances.
Like others I've no additional wisdom to add except to say we need science to urgently find a less dangerous psychotropic substitute for ethanol - if such a substitute is actually possible.
Alcohol acts a lot like benzodiazepines in the brain, and it inhibits the serotonin transporter like SSRIs do, and it has NDRI-like action, as well. Personally, I think a lot of alcohol consumption is self-medicating to treat symptoms that could be treated with drugs with better safety profiles. Of course, self-medication with addictive substances leads to physical dependence, making it harder to substitute other drugs for alcohol after awhile.
I'm friends with someone who went from multiple organ failure in the hospital from chronic alcoholism, to recovery with psychiatric treatment, and it seems like GABAergics like gabapentin and an SSRI help them feel okay without alcohol. At least in the US, this can be prohibitively expensive, and they're stuck with tens of thousands of dollars of medical debt, but that beats being dead.
I think there's little doubt that those who consume excessive alcohol regularly over long periods are self medicating. I'm almost certain this was so with my aforementioned friend and colleague who died from the effects of alcohol.
Decades earlier he'd been hooked on benzodiazepines and could never seem to get enough of them. He was always concerned about being caught short without them and that his supply might run out before he could get a renewal of his prescription (supply became a problem in the '70s/'80's when doctors became aware that they were addictive and that too many people were abusing them). As he was an organic chemist by training, I used to joke with him that he should concoct up a supply in his kitchen.
For him, benzodiazepines where highly effective (at least so over the short term). I've seen him in a jittering state of nervous anxiety and being totally unable to function yet an hour or so after swallowing a couple of 5mg Valium tablets he'd be as normal and calm as everyone else around him. Of course, by then, it was impossible for me to determine how much of his anxiety etc. was part of his condition and how much was attributable to benzodiazepine withdrawal.
You are lucky that your friend was saved from multiple organ failure just in time with proper care, but that wasn't to be with him. Two or three years ago it would have still been so technically, but in the end his medicos, psychiatrist and his friends were unable to help—as essentially he refused to help himself.
Obviously, good medical care often helps but it seems to me we've still a long way to go before we've alcoholism licked for good.
As long as it's voluntary, it should remain a tool for those who choose to use it.
I don't like the idea of court compelled psychiatric or addiction treatment possibly putting people in situations where they might have to take it or otherwise be considered non-compliant to the courts.
The Marchman Act in Florida is particularly worrying in that aspect, as it doesn't require someone to have committed a crime at all to be involuntarily ordered into rehab, and non-compliance can mean being in contempt of court.
It's cliche, but it reminds me a little too much of the Ludovico technique.
"...it is my belief that the treatment is unconscionable and inhumane."
Likewise. Fortunately, I'm not an alcoholic nor have I ever been one but it's always been my understanding that disulfiram was a pretty brutal way of dealing with the problem. I've seen pharmacology texts written in the 1960s warn of the dangers of disulfiram (I had the impression that by the end of the 1950s it was already recognized as a brute force method that was not that effective).
Moreover, as disulfiram inhibits acetaldehyde dehydrogenase, the build up of acetaldehyde in the body alone is pretty nasty and ought to be avoided (there's nothing subtle about this chemical. (I hesitate to use the word 'drug' even though it may have effective uses in completely different areas of medicine.)
Making someone feel ill by essentially 'pickling' - or should that be 'poisoning' - him/her from the inside strikes me as a treatment that should have gone out with Galen.
I use Disulfiram and it has been a godsend for me. It takes away the choice, I am physically unable to drink, my mind makes this easy for me, it's simply not an option so I don't even consider it. I realize it's not for everyone but it has saved me.
I had to go out of country for it, doctors do not like to prescribe it. I hoard it.
I'm truly glad it works for you and nothing that I or others say should distract you from that course.
I know it works for some people and I knew that before I posted that comment. Again, that's truly great for them. However, it's my understanding that all too many do not have your level of self-perception nor do they have the same level of self-control that you do and so they end up on a horrible carousel ride until they fall off - big-time.
This seems to be the major reason why doctors do not want to prescribe it. The fact that these concerns about disulfiram have been reoccurring in the literature since the 1960s is pretty much proof of the fact.
I suppose the real problem is the difficulty in determining who will actually benefit from it and who will not, and that's an age old problem that medicine hasn't solved as yet (or as I reckon won't take the necessary time with individual patients to determine those who are suitable - thus it all gets chucked into the 'too-hard' basket).
I did not mean to dismiss it's negative side effects , this is a dangerous drug. For a general purpose anti anxiety it's a down right terrible choice, even to suggest it feels irresponsible. Chugging a bunch of alcohol while on this ( if say you forgot your anti-anxiety meds were also an anti alcohol drug ), might literally kill you.
No, you're not wrong if you're referring to methanol, you could well say methanol 'pickles' the liver and you'd be correct. With ethanol it's somewhat different, chimeracoder is correct when he says alcohol (i.e.: ethanol) is metabolized into acetaldehyde. Here's a slightly more detailed account:
From my understanding acetaldehyde is formed in the body by the partial oxidation of ethanol—if one's body oxidized it completely then I guess there would be little problem (but it doesn't)! Instead, the body has two goes at 'neutralizing' ethanol, acetaldehyde being the first metabolite and the second is that acetaldehyde is converted into vinegar (acetic acid) which is essentially harmless.
Methanol is worse—much more so. It's first-pass metabolite is formaldehyde (right, it's an excellent 'pickling' preservative), and the second-pass metabolite is formic acid (that's the stuff ants sting you with). Thus methanol double-whammies you and unfortunately it does it par excellence.
Methanol is damn horrible stuff really, less than 100ml can kill one outright and if you survive then, as chimeracoder says correctly, you'll likely be left permanently blind not to mention ending up with other serious problems. In fact, one of the emergency procedures for methanol poisoning is to repeatedly give copious quantities of ethanol for quite some length of time—as in the first instance it substitutes for methanol, ethanol's delaying action then gives the body much longer to metabolize methanol and this delay has the effect of ameliorating some of the damage it causes. Here, ethanol is much the lesser of two evils.
That said, acetaldehyde is more toxic than ethanol and it's far from being benign (for starters it's what gives you your hangover but that's not the end of it). Whilst it doesn't have the immediate punch of formaldehyde, acetaldehyde is nevertheless still dangerous for several reasons, first the body is capable of metabolizing ethanol in the liver with the enzyme acetaldehyde dehydrogenase however this process is not exactly straightforward nor is the metabolism of ethanol completely benign; second, the dangerous aspects of acetaldehyde dehydrogenase's metabolism of ethanol is that it often results in cumulative damage to the liver over the long-term, especially so when ethanol is taken in large amounts.
There's a few Wikis on this but they're a bit complicated for a quick understanding, nevertheless the second link on alcoholic liver disease has a nice diagram that illustrates how long-term liver damage happens:
Right, I shouldn't have used the word 'pickling' but I was using it in the vernacular and, as here, I did actually use it in inverted commas.
Another way of looking at it is that long-term ethanol/acetaldehyde damage to the liver leads to cirrhosis of the liver—and cirrhosis is in effect the death of liver cells which are then replaced by scar tissue (that's close enough to 'pickling' methinks).
Antabuse is a way to stop drinking for a period for whatever reason, maybe you have surgery in two weeks and the doctor says you must stop but you can't. No one in danger of having seizures from withdrawels should suddenly stop. I took Antabuse when I wasn't a very bad alcoholic and I stopped for two weeks. Later, when I was much worse, I would shake in the morning until I got a drink. At that point cessation therapy would be dangerous. I did a medical detox.
Antabuse helped me quiting few years a go. It wasn't THE solution but one of the components in my success. It felt liberating that I didn't have to think that could/should I have a drink. That door was closed.
Alcoholism and opiate addiction have some underlying biochemical similarities that a lot of people seem unaware of, even though this explains the effectiveness of naltrexone. For background:
> "Opioid Systems. Endogenous opioids are small molecules naturally produced in the body that resemble morphine and have long been implicated in the actions of opiate drugs and alcohol. There are three classes of endogenous opioids: endorphins, enkephalins, and dynorphins. They all exert their effects by interacting with three subtypes of opioid receptors—μ, δ, and κ. Researchers have hypothesized that positive alcohol reinforcement is mediated at least in part by the release of endogenous opioids in the brain. This hypothesis is supported by numerous studies demonstrating that opioid antagonists acting either at all opioid receptor subtypes or only at specific subtypes suppress alcohol drinking in a variety of species and models (for a review, see Ulm et al. 1995). Moreover, complete inactivation (i.e., knockout) of the μ-opioid receptor blocks alcohol self-administration in mice (Roberts et al. 2000b). The agent naltrexone, a subtype-nonspecific opioid receptor antagonist, currently is approved as a treatment for alcoholism in humans and is particularly effective in reducing heavy drinking."
Psychedelic drugs have also been used very effectively under controlled conditions (clinical settings) to break both opiate and alcohol addiction with remarkably high success rates. This is an entirely different approach than using blockers like naltrexone. For example:
> "It is believed that these agents allow for the reorganization of disordered neural pathways in the default mode network and attenuate maladaptive signaling in mesolimbic reward circuitry. The aim of this review is to examine the current standing of evidence regarding psychedelic psychopharmacology and to provide an overview of the use and effectiveness of these drugs in the treatment of SUD, alcohol use disorder, and for smoking cessation."
One anecdote to another: Naltrexone isn't all that different from what you're describing Disulfiram as here - it's an opiod blocker so when you drink you get the poison and not the happy chemicals. That doesn't help with addiction, it's subjecting yourself to negative effects / conditioning for drinking.
Naltrexone doesn't work for me. It is not very effective for some people.
Naltrexone and disulfram are incredibly different, both in terms of pharmacology and subjective experience. Naltrexone hangovers are an awful experience, but that's due to neurochemistry. It doesn't short citcuit metabolic pathways so you literally poison yourself when you drink alcohol.
Oh sure the process with how they work is very different. My point was more towards the 'this is unethical treatment' sentiment. I don't have experience with disulfram, but I'm familiar with a few different methods to treat addiction. Most of them make you feel like shit when you drink as a sort of skinner-style negative conditioning.
So yes, taking the one that doesn't actually make the poison _more toxic_ - just a less pleasant experience - is probably the preferred route so you don't endanger yourself. But it's still forcing yourself to extreme negative consequences and conditioning your brain to associate alcohol with misery.
I knew a guy who swapped his World of Warcraft addiction with heroin. It worked surprisingly well, he never played WoW again. Last time I saw him, he tried 'borrowing' some money from me for 'medicine for his mom'.
Yes, there’s a protocol and it’s called the alcohol withdrawal scale. Advocating for people to switch from alcohol to xanax to quit drinking… this is utter madness and I strongly advise anyone who reads this to completely disregard this advice.
> Advocating for people to switch from alcohol to xanax to quit drinking… this is utter madness and I strongly advise anyone who reads this to completely disregard this advice.
Yeah, absolutely.
This recently happened to someone I knew who was addicted to alcohol, 9 months later they died from a combo of alcohol, Xanax and Fentanyl.
Let me preface this with I'm not a doctor, I also never tried Xanax / Fentanyl and I don't "really" drink alcohol. The air quotes mean I drink about a handful of beers a year at assorted family events and occasionally when socializing. I'm not saying that to brag or be like "look at me, I'm above that!", I just want to paint the picture here that I don't have first hand experience on how easily it is to get addicted to this stuff, know what it feels like or how hard it must be to quit.
Anyways, here's 1 potential formula for how someone ends up dying after being prescribed Xanax when a doctor knows the patient has addictive behaviors and drinks a lot:
1. They're addicted to alcohol to the point where they feel compelled to drink very often. Not just a beer a day, but more like lots and lots of Vodka.
2. They try going to rehab multiple times and it fails every time within a month or 2 after returning.
3. They get prescribed Xanax by a doctor.
4. They have an addictive personality in general and get addicted to Xanax.
5. This helps for a brief amount of time (weeks or months perhaps).
6. They end up drinking again.
7. They very quickly discover drinking while taking Xanax has a whole new effect.
8. They run out of prescribed Xanax.
9. They attempt to find it on the street and do.
10. They enter a world of street drugs and now Xanax turns into Xanax plus Fentanyl (intentional or not, I don't know how it becomes laced, etc.).
11. They do this combo for a bit and one day they go-to sleep and never wake up from heart failure.
The question I ask myself all the time now is if step 3 didn't happen, would the outcome have been the same? My gut tells me no way, being introduced to Xanax started the chain of events that lead to death.
Any of them work, and it probably depends how deep you're in.
If you can't fall asleep without a drink, xanax would be a good choice. If you need a drink in your hand all day, I'd guess librium. If you're drinking from shift end until you pass out, probably ativan.
Alcoholism takes a lot of different forms, and obviously a doctor should come up with a taper plan.
But I think the reason these drugs (which actually work) aren't first line treatments is puritanical. They feel good, so giving them to alcoholics to feel just as good (or better) than they did with their drinks feels uneasy. But it really works, and it can be much more easily tapered and controlled.
It's frustrating to watch after having seen multiple people successfully taper themselves off booze with other drugs (without doctor's supervision, sadly).
Even with drugs that are supposed to stop addiction, many people are still addicted after the treatment stops. Continuing with the drugs over a long time can lead to health problems, thus not solving the issue. Many studies show that a change in environment has a major influence on the change in behavior of patient.
"Also anecdote: the easiest way to quit alcohol is with xanax."
Ugh. Replacing addiction with addiction. Go this route if you have extreme medical conditions requiring it. EG. You are an alcoholic with serious liver issues, then by all means substitue xanax. Rehabs are full of people with xanax issues.
But we seem to have no issue, with Suboxone. That is, quite literally, replacing one addiction with another.
Opiate/oid withdrawal is pretty awful. You feel like you will die, but that seldom happens (unless you have other issues).
Withdrawal from alcohol, on the other hand, is, quite frequently, deadly (that's why medical alcohol detox is recommended).
Benzo withdrawals make alcohol withdrawals look like a case of the sniffles.
I think that we are best off, with no addiction to anything, but I also know that many folks can't seem to achieve that.
But deliberately addicting to benzos is crazy. They do use drugs like Librium to medically detox folks from alcohol, but that is quite short term, and is meant to keep you from dying.
Benzos are often given short term- 3-5 days on a taper schedule to someone in detox. It is not recommended to give a script to an alky. Benzos are not as dangerous to withdraw from as alcohol but are horrible to detox from as they are fat soluble.
Not sure if you are asking a question or not.
To clarify, my understanding is that there is a greater risk of death when detoxing from alcohol,although it is possible to die from benzo withdrawal it is not as common. My information comes from registered nurses who worked in Rehabs, and years of interaction with a lot of ex-drunks. I did a very light search last night, but did not find anything that gave good comparisons.
Well, I've known a lot of ex-everythings (over the last 40 years). I have never personally known anyone that has died from detox of alcohol, or anything else.
However, I have listened to many, many horror stories (and seen them, acted out, in front of me). In all cases, the benzo withdrawals took forever (like months and years), and included seizures, hallucinations, and neverending insomnia.
Ok. I think we are on the same page. I have never seen a detox death either. I have heard that benzo's are the hardest to withdraw from, and it does sound pretty frightening. For a lot of alcoholics the hardest thing to quit is nicotine. The really scary cases are the folks who start taking Valium to keep from shaking until they start drinking.
As a counterpoint, I tried Naltrexone 3 times in my life and it made no lasting effect on my drinking. I was religious about taking it before drinking as well.
I eventually quit last fall but I am not actually sure what I did differently that made it seem to “stick” this time. I didn’t take naltrexone though.
I absolutely agree that Disulfiram is an awful drug to treat alcohol abuse with, it feels like conversion therapy for taking a drink. Also, there is no fixing of the underlying issue at all with this drug (I'm pointly saying that conversion therapy is used to fix a problem that doesn exist).
I've seen a family member successfully win over an alcohol abuse issue by changing their job and getting therapy after detoxing safely in a hospital. Disulfiram should be bottom of the list for anyone, I've not heard of Naltrexone, but a quick google makes it sound like a superb option too.
There are anesthetics specifically designed to blow through opiate blockers or tolerance. They, coincidentally, are also some of the most dangerous opiods to consume. Fentanyl is an example.
This question is also why it's important to have your prescriptions you're taking up to date with your emergency information / contact.
I quit drinking after more than 25 years of problematic drinking using naltrexone (The Sinclair Method) and, given my experience with alcohol, it was the easiest thing I've ever done.
I urge people who have a problem with drinking and wish to quit, who for whatever reason do not feel that 12 step programs like Alcoholics Anonymous are right for them to find a doctor who is willing and able to prescribe naltrexone and have a serious discussion with them. Had I known it was effective as it is I probably would have been able to stop drinking 20 years sooner than I did.