Medication in early recovery?

[mattcake79]

My pdoc knows about my alcoholism, and that I've currently started withdrawing. She said she couldn't really diagnose any other comorbid conditions until I've completed alcohol withdrawal first - probably two months from now. She seems to trust me a lot, I've been taking Klonopin for anxiety for a few years now, and she also just game me several Ativan for the acute withdrawal (plus a few other general health meds and other recommendations). That's fine by me. But:
She also wants me to start on a low dose of Lexapro as a prophylactic measure, to ease any acute anxiety/depression that may arise during the transitional period towards sobriety. I'm very ambivalent because my past experience with ADs wasnt's exactly stellar (of course I was drunk all the time) and, on a more "philosophical" note, it plain feels like "cheating" [please don't flame me, I'm very aware that some people need ADs to function properly, and that these meds are life-saviours for some]. So I reluctantly filled that prescription too, although I haven't actually taken the pill. Does anyone have any insight on this?

[eastcoastscott]

Any mood altering drug is a no-no. These include all the benzos (ativan etc). Any drugs we take mustn't be habit forming. For example, I take Wellbutrin for depression and Trazodone to help sleep. Both totally safe for me, prescribed by a Doctor who specializes in addiction (ASAM)

Scott

[mattcake79]

Hi Scott,

I'm not familiar with the medications you take. Aren't they mood-altering?

When I insisted on withdrawing at home, my psychiatrist explained to me that the benzos are non-negotiable at this point because withdrawal can be life-threatening, and the only way to prevent this is by taking benzodiazepines. She plans to taper me off in a week - 10 days.

[historyteach]

Matt;

None of us are doctors here. So, I would do exactly as your doctor suggests.

Please do not accept medical advice over the internet from strangers; even well meaning ones. They do not know your medical background, and do not have the knowledge to speak about it from a *medical* standpoint. Too many well meaning people in programs have led others down a dark road, against needed medication. Unfortunately, there have been relapses and even suicides as a result of such advice. My own son was one of them. Only your doctor and you have the knowledge necessary to make these types of personal decisions.

Having said that, if you have such reservations, why are you not speaking to your doctor about them? An open and honest communication with your doctor is the best way to maintain your mental health.

I might just add, too, but, isn't it your best thinking that got you where you are?
(An old AA saying, aimed at your "philosophical" note about cheating.) Perhaps it's time to listen to someone else for a bit, till you learn how to do it yourself?
Just a thought....

Wishing you the best. Please continue to let us know how it's going.

Shalom!

[mattcake79]

historyteach,

Thank you. Very sorry to hear about your son. Your point is very well taken and much appreciated. Just got off the phone my pdoc, I've decided to follow her instructions. About the "cheating" thing, boy, isn't it amazing how we look for excuses to hamper our own progress. I've only recently begun to discover what a rationalization junkie I really am!

Thanks again,
Matt

[nandm]

You will find a variety of opinions anywhere you pose this question.

I have been sober 7 years next month through the program of AA. In that time I have had people tell me that if I was taking any mind altering medication that I was not sober. I have also had people say that AA is about alcohol and therefore if one is taking medications even if there are abusing them it doesn't affect their alcohol sobriety date.

I finally researched on my own just what the Big Book does and does not say about medications.

Below are the areas that reference drugs (page number followed by sentance number)
7:1

Next day found me drinking both gin and sedative.

22:2-5

As matters grow worse, he begins to use a combination of highpowered sedative and liquor to quiet his nerves so he can go to work. Then comes the day when he simply cannot make it and gets drunk all over again. Perhaps he goes to a doctor who gives him morphine or some sedative with which to taper off. Then he begins to appear at hospitals and sanitariums.

133:11-16

But this does not mean that we disregard human health measures. God has abundantly supplied this world with fine doctors, psyhcologists, and practitioners of various kinds. Do not hesitate to take your health problems to such persons. MOst of them give freely of themselves, that their fellows may enjoy sound MINDS and bodies. Try to remember that though God has wrought miracles amond us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and following his case afterward.

Doctor Bob used sedatives, this is described in "The Doctor's Nightmare" story in the back of the Big Book.

Although I can not recall the page number and sentance number right now, I do know the BB talks about seeking outside help when needed. When I find that passage again I will post it here for your reference.

Ultimately, what I learned from the BB is that taking medications prescribed by a doctor to treat an illness is not against anything in the BB that I can find.

My experience has been:
* The Steps are great tools that do lead to a spiritual experience and help resolve the alcohol problem.
* The Steps when applied to most any problem faced in life help.
* There are things that the Steps and the program do not solve.
* My PTSD, chronic anxiety, and chemical depression are all examples of things that the program does not solve nor was it intended to solve.
* To treat those medical conditions I need medical help which for me includes not only medications and yes, one of those is Klonopin for the anxiety, but also psychological counseling to help me to deal with the underlying issues creating the PTSD and anxiety problem.
* Some forms of depression need to be treated chemically. Situational depression can be relieved by working the Steps, in fact they are a great tool for relieving that type of depression. But a depression with a chemical component needs chemical intervention to relieve it.
* I have watched someone who was told that they should stop taking their mental health meds and just work the program better wind up in a mental ward. She still has not gotten back to the person she was prior to stopping the medications. She was someone who worked the program in all aspects of her life but unfortunatly allowed herself to believe someone else's opinion. That opinion nearly killed her.
* I have taken morphine, oxycontin, Klonopin, and oxycodone in sobriety. All are addictive "mind altering" medications that were prescribed for medical conditions. I took the medications as prescribed and quit them with no problem. I do still take oxycodone as needed for my back pain but a 30 day supply usually lasts me 3 months as I only take it when I am unable to resolve it any other way. My Klonopin I am also as careful with. I only take it when I have to. I still consider myself sober.
* I have learned that the medications I take are between me, my doctor, and my Higher Power. What others think is irrellevant to me.


Many people do go through a period of increased depression and anxiety when they stop alcohol. There are many doctors who believe that providing a medication to help prevent a person from experiencing that is beneficial to them as they then can concentrate on learning the tools that they need to stay sober. Personally I agree with this.

[pedagogue]

Originally Posted by historyteach

Please do not accept medical advice over the internet from strangers; even well meaning ones. They do not know your medical background, and do not have the knowledge to speak about it from a *medical* standpoint.

Very well said.

I'll just add that there is a reason for each one of those meds, and the best thing to do is to keep an open dialogue with your pdoc. Some people in recovery may not agree with using certain meds, but if there is a medical reason....I'd definite err on the side of the doctor. If you are on a taper for withdrawal, it is *REALLY* important to too exactly what the doc says, as it can be very dangerous to stop too abruptly.

[mattcake79]

Nandm, thank you for very interesting reading. I'm still ambivalent about the medication, but I'm trying to be practical for once: I have a problem (one that can cost me my life/lives of others no less), and I shall use all the help I can get to come to terms with it. I'm fond of idealism, but too much of it brought me here in the first place.

Pedagogue, fortunately I've happened upon a very open and trusting pdoc - I'm trying to match those qualities myself. We'll be coming up with a reasonable taper plan for the Klonopin once I feel up to it, but the supply of Ativan is limited. She explained to me that, in her experience, Ativan is the best suited benzo for alcohol withdrawal, and the amount she gave me can safely be added to Klonopin. Once I run out of pills (using a 10 day schedule) she won't be renewing the prescription.

[TiredMama]

I don't have much to add but I am very happy your doc is open with you and knows about your alcoholism. I would trust her with your road to recovery.

[eastcoastscott]

Hi Matt,

No, the meds I take are non addictive and non mood altering. All narcotics (pain meds) and benzos are addictive and mood altering. They hit the same receptors of the brain that alcohol does. In fact, the brain doesn't differentiate between these substances, therefore, when I got demerol and morphine etc. after surgery, it was like I was drinking... this caused the powerful urges and cravings that partially caused my relapse.

[mattcake79]

Scott, I'm pretty scared of the pain meds you mention - i can easily see myself becoming addicted to them. Never tried them, and hope I'll never have to take them. But I supposed they're impossible to avoid during surgery...

Benzos are another story, I started taking Klonopin because I was having panic attacks so bad that I was practically suicidal (couldn't leave my bed for 5 *weeks*). I take a low dose, closely monitored by my pdoc and will hopefully drop them after having some clean sobriety under my belt.

I guess the weird thing of starting medication (Lexapro) in the early days is that you don't know what symptoms are from alcohol withdrawal and which ones are caused by the med itself. At this point, I'm just following instructions.

[eastcoastscott]

One thing is for sure, there are times that we absolutely need meds that we know could affect our sobriety, Doctors have a code of ethics to administer pain meds for example. I think the only thing we can do is to be aware of this and when we feel cravings for our drug of choice (or others) we can identify these cravings and deal with them to the best of our abilities. Myself, I can't tell you how much I love pain meds. When prescribed by Doctors, this makes it all OK for me, after all, they are Doctors,LOL. I especially loved the time where I had a clicker in my hospital bed, that I could grab any time, click the button myself and get that warm and fuzzy feeling as the morphine entered my bloodstream. Of course, I abused it severely. Next time, I will have to handle the whole situation completely differently.

Scott

[nandm]

Originally Posted by eastcoastscott

Hi Matt,

No, the meds I take are non addictive and non mood altering. All narcotics (pain meds) and benzos are addictive and mood altering. They hit the same receptors of the brain that alcohol does. In fact, the brain doesn't differentiate between these substances, therefore, when I got demerol and morphine etc. after surgery, it was like I was drinking... this caused the powerful urges and cravings that partially caused my relapse.

Some interesting information regarding chemical receptors and medications including the kind you are taking which do alter the brain chemistry just as benzos and narcotics.

There are so many neurotransmitters and receptors in the brain that they have not all been found or classified yet by our medical science. Each different narcotic and/or benzo acts on different neurotrasmitters/receptors just as antidepressants can act on several neurotransmitters so do narcotics/benzos. The bottom line is they all affect the brains chemistry. An anti-depressant of the SSRI type "alters the mood" because it affects the seretonin receptors, (ultimately, scott you are taking "mind altering" drugs) many also affect the dopamine receptors as well as several other receptors. A narcotic/benzo medication also can affect dopamine receptors as this is one of the receptors that deals with the pain response.

There is substantial research in this area if someone would like to do further reading but the bottom line of all the research is that all medications affect the brains chemistry in one way or anther, there is much we do not know about the brain or its chemistry, medications can and do affect different people in different ways, and a drug that is used for one thing can often also affect others areas of the brain without that being the intent or be known about.

One example of how medications affect people differently is the drug Welbutrin. This drug initially was presented as an antidepressant. It was later noticed by physicians that when many of their patients lost the desire to smoke cigarettes while being treated for their depression with this med. Ultimately it was determined through testing that the drug also binds with the nicotine receptors in the brain and helps many quit smoking. They then started manufacturing it as a stop smoking aid under the name of Zyban. Just like any drug there are people for whom it does not work.

My personal experience with drugs is that although I have taken morphine, oxycodone, oxycontin, valium, and klonopin over the past 7 years of sobriety, they have never once created the craving to drink in me. Granted I do work the program of AA in my life and that I am sure has had some effect on this but ultimately, IMHO, the bottom line is that if a medication is prescribed by a physician to treat a medical problem (which mental illness is) then as long as that medication is taken as prescribed and monitored by the patient and physician then the medication should not be a problem for someone's continued sobriety. The problems come in when the medication is either not monitored, or not taken as prescribed. Yes, there are people who are more sensitive to medication effects than others but that is why it is important for a physician and the patient to monitor what is going on with the medications.

IMHO, it is dangerous for anyone who is not a doctor, psychiatrist, or nurse practicioner to encourage or discourage the use of a prescribed medication. Too often it happens in AA that someone will decide that it is wrong to take "mind altering" medications while working the program of AA; so they try to tell someone else that those medications are wrong and that they will get drunk if they take them. I have seen people commit suicide, wind up in mental wards, get drunk, ect.... from believing some well meaning, misinformed person who told them they should not be taking their mental health drugs. I strongly encourage anyone who is considering stopping or starting any medication in sobriety to speak with thier physician/psychiatrist and be completely honest about there recovery and concerns then follow the physician/psychiatrists advice rather than taking advice from a non medical but well meaning person.

To me taking medical advice from anyone but a medical professional is like taking my car to a beauty parlour to have the engine rebuilt. Ultimately I am going to wind up with the same result a car that does not run; unless I wind up with that 1 in a million chance that the beautician is also a skilled mechanic.

[historyteach]

Judith!!!

Great analogy at the end,

Shalom!

[barb dwyer]

I love the handle 'mattcake' ... LOL

I wouldn't presume to know better than a doc -
mainly cuz they've got so much $$$ for lawyers and can play so much golf with judges ...

otherwise ... I would.

LOL!

[eastcoastscott]

Great points NANDM, these boards aren't really the place for prescription advice. If I would make any recommendation, it would be to seek a Doctor trained in Addiction Medicine. Mine is and is very helpful. They go here:

ASAM - American Society of Addiction Medicine

[mattcake79]

Hi all,

Thanks for the input. I realize that this is not the place to ask for medical advice, I was just asking for personal experiences with meds during recovery. For what it's worth, I decided to follow my doc's directions closely and as prescribed right after posting the original message. I no longer feel like I'm cheating, I've finally realized that alcoholism is a life-threatening disease and must be treated as such.

Also, as historyteach hinted (02-22), one of the hallmarks of addictive behaviour is insisting on doing things "your own way". Placing my health in my pdoc's hands and fully trusting her judgement was a leap of faith of sorts for me.

Matt

[PaperDolls]

Sounds like you're doing the right thing Matt.

Keep posting.

[Recycled Karma]

Matt, I think that an honest, open and possitive relationship with your caregivers is the key. If I didn't follow the advise and instruction of my physicians, I would have eaten a bullet, like my father did, several years ago! When you and the doc come up with a plan, stick to it...otherwise it could be your very life that you are gambling with!

When you are ready, find a sponsor who is understanding of your particular issues, it worked for me! All the best! -Recycled Karma

[mattcake79]

Thanks for the encouragement Karma, I'm sorry to hear about your father The plan is actually underway, I've been following my pdocs instructions for the past 9 -sober- days.
Still mulling the AA thing, I appreciate your input though. Thanks!

Matt