Rehab facilities don't get it!

[[Ho...]]

When I was trying to find info on Benzo withdrawal, I came across a site, it was a Federation of Psyciatrists in a state in the US, (I don't know if I can post it, that's why I'm being vaque.  If I get permission, I'll give more exact details.) who talked about "office based outpatient withdrawal techniques", and actually helping patients come off Benzo's and other similiar meds without having to "hospitalize" them, and doing it in a similar way suggested by Dr. Ashton.

 

In fact, at the bottom of the introductory page, Dr. Heather Ashton's work is cited as the first resource they went off of.  The main premise of the site is to actually educate Doctors in that state in how to help patients safely taper off of their meds with as little side-effects and withdrawal symptoms as possible.

 

The taper method suggested is a bit fast... HOWEVER, nowhere near what they do in inpatient programs.  They do say there is no need to hurry the taper schedule along and suggest going very slowly off the last several weeks.

 

Perfect?  No.  Helpful??  Very much so, especially in the need to educate more Doctors of the need to SLOWLY taper us off of these horrible, horrible drugs.

 

PS to the Mods: Let me know if it's OK to post more info about that site.

[[Co...]]

PS to the Mods: Let me know if it's OK to post more info about that site.

 

Generally speaking, you can post links. Links to commercial sites are often problematical, as this encourages spam to be posted at this forum. Rarely is a link to an informational site any kind of problem. Post your link.

 

If, in the unlikely even we disapprove of the content of the target site (just because we disagree with content, it does necessarily mean we will remove the link, but we might in extreme circumstances), we will remove the link and let you know about.

 

Links posted in good faith (even if we decide to remove the link) are not going to cause any kind of moderation issue that will result in sanctions upon you. Again, post your link.

[[st...]]

If the link is posted it can then be printed out for our doctors to see.  The US doctors told me they don't read anything from the UK.

 

Patty  xo

[[Ho...]]

PS to the Mods: Let me know if it's OK to post more info about that site.

 

Generally speaking, you can post links. Links to commercial sites are often problematical, as this encourages spam to be posted at this forum. Rarely is a link to an informational site any kind of problem. Post your link.

 

If, in the unlikely even we disapprove of the content of the target site (just because we disagree with content, it does necessarily mean we will remove the link, but we might in extreme circumstances), we will remove the link and let you know about.

 

Links posted in good faith (even if we decide to remove the link) are not going to cause any kind of moderation issue that will result in sanctions upon you. Again, post your link.

 

Thanks, Colin!   I just wanted to get approval first.  (And sorry it's been awhile since I've been on.  So many things going on.)

 

http://www.txpsych.org/guidelinesanxiolyticsedativehypnotic.htm The link is to the "Federation of Texas Psychiatry".  It takes you to the page that talks about the "outpatient taper plan", and if you scroll to the bottom, it lists the sources they used in deciding upon the plan, citing Dr. Ashton's work first.

 

In my opinion, this is something important for us in the States, because it gives us a leg, at least a little bit, to stand on, and say, "Hey! Here is the Federation of Texas Psychiatry who is really taking a look at this.  Why can't you, as my Doctor, do the same?!"

 

As I said before, the taper schedule is much faster compared to what some of us really need...  They are giving it about 8 weeks.  However, they are stating that, "There is no need to hurry the tapering schedule" and "Tapering can be slowed as necessary".

 

They also talk about the rebound effects of the anxiety coming back after getting off the meds.  So far, it is the most thorough plan and explanation I have seen yet that is in the U.S., and that is actually being used to educate doctors about the need to slowly get their patients off these drugs.

 

As I said before, this isn't a "perfect plan".  However they are going in the right direction, which is huge step for us who are having to fight our Dr's at every turn to not just rip us off these drugs cold-turkey or in a few days, OR keep us drugged up forever.

 

In any case, this particular site might be helpful to those of us in the States, as Stoneyco said, since the US Doc's seem hesitant to read anything from Doc's in the UK.

 

If anyone has any other thoughts about this site, please share.

 

 

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Hi.  Just chiming in here. Did you see that they don't accept Ashton's equivalency tables?  They say:

 

Diazepam (Valium) Substitution

• Determine the equivalent dosage of diazepam from Table 2.

• The longer-acting Clonazepam (Klonopin) can be used rather than diazepam. (5 mg of diazepam = 1 mg of Clonazepam).

 

That could be a real problem for some who may switch to V from Klon.    ~~mbr

[[Co...]]

Hi.  Just chiming in here. Did you see that they don't accept Ashton's equivalency tables?  They say:

 

Diazepam (Valium) Substitution

• Determine the equivalent dosage of diazepam from Table 2.

• The longer-acting Clonazepam (Klonopin) can be used rather than diazepam. (5 mg of diazepam = 1 mg of Clonazepam).

 

That could be a real problem for some who may switch to V from Klon.    ~~mbr

 

Standard equivalent doses of diazepam:clonazepam is 10:1 in the US. Ashton suggests 20:1. The above txpsych website suggests 5:1. The reality is that it is not possible to dictate an equivalent dose, even if they were to carry out the most exacting research into equivalent doses. Blood levels are highly dependent upon the half-life of benzodiazepines. The range of blood levels for short half-life benzos varies relatively little with differing half-life values within the individual, but the variation becomes much more pronounced with the half-life value range of long half-life benzos. In short, those that metabolise benzodiazepines relatively quickly will require more diazepam in substitution for their short half-life benzo; whereas those who metabolise benzos relatively slowly will require less diazepam in substitution (because the diazepam will accumulate to a much greater degree).

 

I'd be glad to explain some of the maths to these doctors, if any of them would care to listen.

 

Every time I see a table that states an equivalent dose, I know it is wrong. Never do they explain that there is variability or that the equivalent dose is an "average", or some such caveat. It is possible (with the right research) to determine equivalent doses for the individual. Such a table would express an euivalent dose as a range, and the equivalent dose will depend upon how quickly they metabolise their present benzodiazepine. However, it would require detailed research and a blood samples taken from the patient to determine how rapidly they metabolise benzodiazepines. I am supposing that if a patient metabolises one benzodiazepine relatively quickly or slowly, they will metabolise all benzodiazepines relatively quickly or slowly. As far as I know, all benzos use the same metabolisation pathways.

 

In the real world, as it stands, it should still be possible to run a tailored substitution plan. All that is required is that the doctor accepts that what constitutes an equivalent dose is very variable, that rapid changes in benzodiazepine dose can have very negative consequences for their patient (as can occur with a wrong substitution dose), and that the doctor is willing to alter the substitution dose on a (near) daily basis according to how their patient reacts. They should also carry out substitution gradually over many weeks, so that each substituted dose accounts for only a small fraction of their total dose. This way any inaccuracies in the applicable substitution dose accounts for only a small fraction of their total benzodiazepine dose. Additionally, doctors should be aware that when switching from a relatively short half-life benzo to a relatively long half-life benzo, the short half-life benzo will leave their system very quickly. Whereas the long half-life benzo will, typically, take a few weeks to build up to full blood levels for a given dose. This is another reason to perform substitution gradually.

 

All this is overkill for many people, but it should be remembered that if a patient is substituting from a short half-life benzodiazepine to a long half-life benzodiazepine because they found it difficult to taper the short half-life benzo, they have already demonstrated a particular sensitivity to cuts of their benzodiazepine.

[[...]]

Colin, thanks for that sensible explanation.  ~~mbr

[[Ho...]]

Yeah, the fast taper, and suggesting Klonopin rather than Valium was something that concerned me.  You can't cut Klonopin into small enough doses (without titrating) to reduce the withdrawals to tolerable levels (is that an oxy-moron? , and as we know, the Dr.'s aren't going to recommend or support titrating.

 

Obviously, there is a LOT wrong with their schedule.  I do, wonder, however, how they are doing in helping those like us come off of the Benzo's.  What is there success rate?  Have some of the Doc's realized that plan is WAY too fast? And that Klonopin is not a good option to cross-taper with?  I wish we could pick their brains to find out the what and why's of why they chose to do it this way.  Was there a rhyme or reason? Or did they just pull a number out of a hat.  Looking at the data, it seems to be the latter, as they have no scientific studies of their own.

 

I don't know...  I would think that in some ways they are at least TRYING to do better than the inpatient programs that rip you off the meds in a couple of weeks.

 

From those of you who've been through inpatient programs, does this look any better to you?  Just wondering.

 

Thanks for taking a close look, Colin.  Mbr, with the cross-taper w/Klonopin.  Having come off of K, I wouldn't recommend it to my worst enemy...I'm sure we're in the same boat. 

[[...]]

Yeah, the fast taper, and suggesting Klonopin rather than Valium was something that concerned me.  You can't cut Klonopin into small enough doses (without titrating) to reduce the withdrawals to tolerable levels (is that an oxy-moron? , and as we know, the Dr.'s aren't going to recommend or support titrating.

 

Obviously, there is a LOT wrong with their schedule.  I do, wonder, however, how they are doing in helping those like us come off of the Benzo's.  What is there success rate?  Have some of the Doc's realized that plan is WAY too fast? And that Klonopin is not a good option to cross-taper with?  I wish we could pick their brains to find out the what and why's of why they chose to do it this way.  Was there a rhyme or reason? Or did they just pull a number out of a hat.  Looking at the data, it seems to be the latter, as they have no scientific studies of their own.

 

I don't know...  I would think that in some ways they are at least TRYING to do better than the inpatient programs that rip you off the meds in a couple of weeks.

 

From those of you who've been through inpatient programs, does this look any better to you?  Just wondering.

 

Thanks for taking a close look, Colin.  Mbr, with the cross-taper w/Klonopin.  Having come off of K, I wouldn't recommend it to my worst enemy...I'm sure we're in the same boat. 

 

Hi, Hope4Me.  Yes, I am tapering Klon, and I wouldn't wish it on my worst enemy either.  Trying to find the sweet spot (odd words to use in the same sentence with Klonopin!) between too slow a water titration and too fast a water titration.  You crossed over to V, right?  My doctors wouldn't do it, so I'm stuck with this devil of a drug and struggling every step of the way.  But, I'm at .91 mgs. as of today, down from 3 mgs. last fall.  Heading in the right direction anyway...  ~~mbr

[[ch...]]

I was in a rehab for 30 days.  I am not a drug addict.  I was physically dependent on benzos.  After I left, my withdrawal got worse.  The other clients there were fine within a few days to a week.  I kept getting worse.  I went to their meetings and kept saying I'm still in detox and was scoffed at, basically.  No one understood and the worst of it was the sober staff that kept insisting that I was an addict.

 

The whole situation really upset it.  We need benzo w/d clinics here in the states.  I am a licensed therapist and I would LOVE to work in a benzo w/d clinic.  Why doesn't anyone get this?  Why don't doctors recognize how difficult these withdrawals are and how long they last?  Because the medical community doesn't recognize it, our friends/family don't recognize it.  We are already suffering but then to make us feel like we're making this up is just adding salt to the wound. 

 

Anyone else have rehab experiences you'd like to share?  Also, anyone have any ideas about a benzo withdrawal clinic I'm all ears!

 

Leslie

 

 

 

Wow, it's really scary how much your story just reminded me of my own.  I had the exact same thoughts and feelings as you.  I couldn't believe that no one in the rehab I was in had a clue about what I was experiencing. They even went as far as to tell me my 2nd week off that I should have been feeling better. It was sooooo bad that the ignorance displayed by staff made me even more livid. I have been telling family and Dr.'s about symptoms I was having for most of the time I was on benzos before I knew it was tolerance and they just said it was in my head. You are far from alone with your story.

[[...]]

Hey Chris,

 

I'm glad Pamster directed you to this thread.  Unfortunately, you and I aren't the only ones here with that similar horror story.  Ziggy had the same experience, too...and there are others. 

 

I have never told anyone this particular story while in rehab....One of the CA's (client advocates that are usually in recovery themselves) had been on vacation the first three weeks I was there.  Apparently the director took a liking to me and kind of allowed me to skip many of the AA meetings that were just not helpful in my situation.  I also think this director knew more about benzo w/d than most. 

 

Well, this woman didn't get the memo.  I was resting in my room when she barged in insisting I attend the next meeting.  Well, as you all probably understand, ANY conflict after a benzo c/t causes the heart rate to shoot through the roof.  She refused my polite "no" and that I wasn't feeling well and continued acting like a drill sargeant!  Oh wow...I think it took a good three hours for my heart rate to return to normal.

 

Now anyone who was knowledgeable about benzo w/ds would never tolerate that kind of behavior from staff. 

 

Which is, again, why I emphatically state...rehabs just do not get it!

 

Best wishes to you, Chris, on your continued healing.  I believe somehow our tormented days in rehab will be transformed into stories that can help others in the future.  I don't exactly know how, yet...but I refuse to let that experience go to waste. 

 

Leslie

[[ch...]]

"I believe somehow our tormented days in rehab will be transformed into stories that can help others in the future.  I don't exactly know how, yet...but I refuse to let that experience go to waste."

 

I totally agree. Thanks for the story. My heart rate went up on the part where the staff member busted into your room. Same thing happened to me. They said I was letting the group down by staying in my room and that the group was talking about me. As if I couldn't feel worse already.   

 

[[Pa...]]

I'm glad I left AMA 9 hours after I checked in.  The bad part about my experience was that when I tried to find a Dr to help me understand what was happening, they all referred me to the rehab I'd walked out of. 

[[...]]

Chris... 

 

 

right back atcha. 

[[...]]

Pam,

 

Well, rehab or not, looks like all three of us got the c/t...and wow is that rough.