Have you changed from the cut and hold method to microtapering?

[[bu...]]

Cut-and-hold is NOT a universal solution to benzo WD. 

 

I no longer use the term "cut-and-suffer" since some members apparently found it  demeaning, but trust me, for me, cut-and-suffer was an accurate description.

 

At my peak I was at 15 mg/day of V.  I started cutting .5 mg every 2 weeks, and each cut was predictably followed after 8 days by 36-48 hours of "suffering".  But I felt like I could handle 36-48 hours of sxs every other week.  But when I got to 9 mg and tried to drop to 8.5, the sxs didn't go away, even after a week or even 10 days.  Over the next 2 years, I made 4 attempts to get below 9 mg, using several variations of pill cutting and water titration.  Each time, my sxs were more than I could tolerate.  My pdoc said  that simply indicated that 9 mg/day was my "minimum therapeutic dose" even though 22.5 mg/day of Remeron had very effectively controlled my GAD for over 2 years.  (I stopped Remeron in Oct 2011)

 

I started daily cuts in Sept 2012 using pills and liquid V.  So in about 4 months I am down from 9 mg to 6.125 and had no significant sxs at anytime.  Once or twice a month, I have some sleep difficulties, but a small dose of Remeron quickly fixes that problem.  (Yeah, Remeron is a very effective sleep aid for me.)

 

I have no idea what will happen when I get down to lower doses (2-3 mg) but I do know that thus far, tiny daily cuts have accomplished what I could never have done with cut-and-hold.  For those that find success with cut-and-hold, I'm happy for you, but it was not the answer for me.

 

We all need to find our own path.

 

 

[[Vr...]]

I don't know what there is to disagree with Ashton about.  She recognizes benzo withdrawal, tries to help by coming up with a taper schedule, a rough guide, and says again and again, its INDIVIDUAL, and by all means GO SLOWER if need be.  What's to disagree with?

 

I used her taper chart as a guideline and simply slowed it down a bit.  She wouldn't have a problem with people going slower or even cutting more frequently.  I don't know how many times she has to say go as slowly as you want - that it is an individual process.  Nothing secret and patent pending - she's just trying to help.

 

I prefer the cut and hold method myself but don't have a problem with those who micro taper.  Go as slowly as you want. 

 

I jumped 5 days ago and have next to no wd sxs.  If you want to stay on a benzo for years to get off a benzo, feel free. 

 

Ibblesworth

[[jo...]]

Hi Diaz-Pam

 

I like your post, and wish I had the mental energy to post such a post. Psych meds have sapped all my mental energy.

 

I cut daily and am a week into a hold period, as I tapered at slightly too high a cut rate, but ignored symptoms for a few weeks, when I should have reduced my cut size.

 

I could probably start tapering again, but I am still a bit traumatised by withdrawal and probably the cut-and-hold method, so am still holding.

I cut-and-held till about 3.5-ish mg and then I started the daily cuts style of taper, after having read posts on here and BDR.

I have communicated with Jana but I could not do BMTpp due to being on other meds and smoking, as these things mean that there are fluctuations of benzo in me, as pills and smoking both alter the cyp enzyme activity in the liver, making guaging symptoms and cuts etc more of a guess.

Still wanting to cut daily, I started at a really low cut size and increased it in small steps.

 

Doing the cut-and-hold style taper added more stress to me, because each time I cut, I could not help but worry about being clobbered further down the line with symptoms, and I was absolutely dreading the lower doses because most people who I had read about had suffered more on the lower doses.

With my daily cuts, at 2.4mg, so far, the lower doses have been the opposite for me, much better.

 

I think that benzo tapering has been linked with suffering for so long, because people have been doing Ashton style tapers as they knew no better, given that Ashton had done so much work on it, and was the 'expert' in her field, until the daily cut style tapers came along. Not saying the daily cutters are expert, just that, after Ashton's pioneering research, came along taperers who wanted to try very small cuts with very small hold periods, i.e. daily and some daily cutters are doing better like me.

I also read some cut-and-holders who never tried cutting daily, but did ok with cut and hold, like Vribble.

 

Reading Jana's posts over at BDR, it sounds as if she were her own guinea pig. If you make your cuts smaller and your hold periods shorter, and take that to the extreme, you get daily cuts.

Daily cut style tapers are often quicker than cut and hold style tapers, but I don't know why that is.

I know that I have been able to taper at a much faster rate by daily cutting than I could ever hope to achieve by cut and hold.

 

Having been able to taper quicker with less symptoms by doing the daily cutting, I have, more than once, suggested it to those who are suffering.

It's like I think "What have you got to lose by giving the daily taper a try for, say, a month, you won't look back, kind of thing", but then people on this thread have said that daily tapers have not helped some people.

If a daily taper is not helping someone, I would imagine it is because that person is using daily cuts that are too big, or, they may be injesting foods/herbs/spices/drugs that either induce or inhibit cyp enzyme activity, thus, altering the metabolism of benzo from the system, and causing the taper to be bumpy.

Smooth consistency is what daily cutters aim for.

 

I lingered on hold for months before trying daily cuts, I wanted to see how othes got on with it, and after reading their progress and liking what I read, I jumped on the daily cut smooth ride downwards, and don't plan on going back to cut-and-hold.

 

[[Co...]]

Hello everyone,

 

I will reply with some specific comments a little later, but just to ask that you wind back some of the rhetoric. It is fine to disagree, or even be forthright in your opinions, but this is becoming unnecessarily heated.

 

Thanks.

[[...]]

Thank you Colin or is it wrong for me to do this, has I may be saying the wrong thing.

 

I personally am getting really so fed up with this topic and so wish I had not got involved, hubby has said it sounds like a bunch of school kids, does it really matter which way we taper, and for the individual how long it takes.

 

I read today that reinstating after 2/4 weeks may not be a good idea, I was reinstated by the medical profession after around 4 months what is my chance of recovery once off, can anyone out there please tell me the answer will probably be no I really don't know myself.

 

DD

[[jo...]]

Thank you Colin or is it wrong for me to do this, has I may be saying the wrong thing.

 

I personally am getting really so fed up with this topic and so wish I had not got involved, hubby has said it sounds like a bunch of school kids, does it really matter which way we taper, and for the individual how long it takes.

 

I read today that reinstating after 2/4 weeks may not be a good idea, I was reinstated by the medical profession after around 4 months what is my chance of recovery once off, can anyone out there please tell me the answer will probably be no I really don't know myself.

 

DD

I think personally that you will definitely recover from benzos, provided you taper the last bit slow enough.

 

[[...]]

Thank you Journey

 

For me it will take as long as it takes and as much that I can cut will be up to me.

 

I have said it before and I will say it again, we are all different, what suits one will not suit another.

 

DD

[[Di...]]

Intend,

 

I was addressing Diaz and using an example of real life members who are managing to cut from under 5mgs in reply to her post. I have no idea what your agenda is and nor do I care.  I support Colin's post.  Where and who said it was a bad idea not to improvise with tapers using ones own discretion?

 

To be honest, it is also quite possible that the cut and hold people who are on the higher doses, and who have also claimed that the daily reduction people have criticised them or treated them unfairly, will also find that their cut and hold method won’t work for them when they also get down to the lower doses.

 

This is the quote that I take exception to - who made Diaz the authority on whether a person will be able to cut and hold from 5mgs?  With all due respect I think Colin might have just a tad more experience than Diaz.

 

FFS Intend, I've done the daily cutting and the MT Pat Pending, now back to cut and hold,  and I am coming down from a large dose, so I think I am entitled to comment on a blanket statement.

 

Diaz directly stated that those of us who come down from high doses won't be able to do it when we get lower,(as in the cut and hold method, hence my reference to David and Marina),  I posted a rebuttal to that.  There is absolutely no way anyone can know that, unless of course you are the Queen of Narcissism.

 

Get your facts straight and instead of aiming your thinly veiled problem with Colin's post at me, take it up with him.

 

Hope that clears up your 'just wondering'. 

 

StaffyGirl

 

 

 

 

Well actually, Staffy, maybe you should also get you facts straight too. Instead of just highlighting the part that most suits you, maybe it would be good to highlight my complete quote which is ........

 

To be honest, it is also quite possible that the cut and hold people who are on the higher doses, and who have also claimed that the daily reduction people have criticised them or treated them unfairly, will also find that their cut and hold method won’t work for them when they also get down to the lower doses. Time will tell with that. I honestly hope everyone can find a reduction plan that gives them few s/x, regardless of what level their dosage is.

 

Nowhere did I say that it was a given that this would happen. For your sake, I honestly hope it doesn't happen, but no one can say categorically that it won't. As I said - time will tell.

 

As for your reference to the posts on the valium support thread, I never saw the "sheer disdain" that you claim. All I saw were people saying that for them that was how they felt when doing a cut and hold method. No one told you that what you were doing was wrong or unnecessary. Everyone also took what you said on board, and frankly I haven't seen anyone use the "cut and suffer" term since.

 

Personally, I have always shown great respect to any method that anyone chooses, and I don't recall ever using the "cut and suffer" term, unless it was when I first joined and before I realised it was offensive to some. You have asked for "courtesy and respect for all tapering methods". All I'm asking is that the same respect is shown towards the method and I, and many others, choose to use.

 

I also ask that people stick with the facts of what I've posted and don't quote things out of context.

[[Di...]]

I don't know what there is to disagree with Ashton about.  She recognizes benzo withdrawal, tries to help by coming up with a taper schedule, a rough guide, and says again and again, its INDIVIDUAL, and by all means GO SLOWER if need be.  What's to disagree with?

 

I used her taper chart as a guideline and simply slowed it down a bit.  She wouldn't have a problem with people going slower or even cutting more frequently.  I don't know how many times she has to say go as slowly as you want - that it is an individual process.  Nothing secret and patent pending - she's just trying to help.

 

I prefer the cut and hold method myself but don't have a problem with those who micro taper.  Go as slowly as you want. 

 

I jumped 5 days ago and have next to no wd sxs.  If you want to stay on a benzo for years to get off a benzo, feel free. 

 

Ibblesworth

 

I'm not specifically disagreeing with Ashton's Method, or any method for that matter. I'm disagreeing with Colin's interpretation of it's use in the lower doses.

 

As I keep repeatedly saying, all these methods should be used as guides only. If you want to cut and hold at the lower doses then do it. If you want to do a slow daily titration at the lower doses then do that too. I just got offended at the remark that is was "unnecessary".

[[Di...]]

Hi Journey & Builder

 

I know there are a lot of people who wanted to say what I said, but either weren't able to or weren't brave enough (or stupid enough) to do it. I had my own reservations about disagreeing with Colin, but then we are all entitled to express our points of view here - or at least I hope we are. I am also someone who will usually say what I think about things. Most of the time I try to keep my opinions very moderate because of the nature of this forum, but there are times when I feel I need to make my POV known more strongly, and this is one of those times.

 

I don't agree with a lot of what Colin said, and he may not agree with what I have said, but that's the way the world is. He has been through his own personal journey and I know he is a wealth of information, and I totally respect that, but at the same time I am also going through my own personal journey, and I've also gained a lot of information about how my body reacts to tapering. I also speak constantly with people whose personal journey is very similar to mine, and I know that most of them won't agree that it is "unnecessary" to titrate from the lower doses.

 

Cut and hold is not the solution for a lot (dare I say "most") people who are on the lower doses. I'm sure that when Ashton's method first came out it was a revelation to a lot of people, but things have progressed since then, and some people have simply found a way that betters suits their needs. There shouldn't be any argument about that. Horses for courses - just don't "tell" someone how they are supposed to do it.

[[jo...]]

Hi Diaz-Pam

 

I have always wanted to be able to speak my mind, so I admire that trait.

We are all adults, so we are allowed to disagree.

Yes, if someone told me how I should taper, it would really pi$$ me off.

It used to pi$$ me off when people tried to encourage me to reduce my dose quicker.

Therefore, I can see how others would be angry about being told how to taper.

I share similar views and experiences to you in that I have got to know how I handle benzos and I have got to know how much I can cut by.

I just feel so thankful that I finally started to improve, three years after the wd saga started, I wanted for everyone to feel the same releif I did, which is why I recommended daily cuts.

A distinction has to be made, though, as in I was not intending to force my way down people's throat, but to share my joy.

 

 

[[Di...]]

Hi Journey

 

I'm really so happy that you are starting to improve. You found the way to achieve that by doing it "your way", and that's the way it should always be. I would be just as happy for you if your way had been doing a cut and hold method.

 

From my own personal experiences I will always prefer daily reductions too. However, other's have different opinions and that's perfectly fine. Just don't tell me how I'm supposed to handle my reduction plan, or that what I'm doing is "unnecessary", because that will be the quickest way to see the dark side of Diaz-Pam...lol.....

[[zo...]]

I know that I have been able to taper at a much faster rate by daily cutting than I could ever hope to achieve by cut and hold.

 

Hello Journey. Unfortunately I simply don't have the stamina to comment on the various important points being made on this thread but I can say I too have found using a daily taper lets me reduce more quickly than by making discrete cuts.

 

Daily tapering is more work and one needs to have a clear head in order to avoid errors. I often get fuzzy headed, so I always have someone with me to check I'm preparing each day's dose correctly.  They're almost worn out by the effort!

 

-Zoner

[[...]]

I used a cut and hold method with an Ativan to Valium crossover and stayed with it down to below 2mg where I hit a pretty nasty wall. I did an updose and switched to daily small cuts. My symptoms seem to be less with this method but I go really slow. I'm able to work, exercise and lead a fairly normal life doing it this way. I feel I would have been miserable and nonfunctional had I continued cutting at .5-1mg of Valium every 1-2 weeks. I don't know how long this condition would have lasted. Now, when a wave hits I just hold and/or do a one time updose which usually helps. I have gotten a little relief of symptoms from supplements, exercise, and meditation. There is no scientific data comparing the various methods of tapering, just anecdotal experiences.

[[Co...]]

Hello Diaz-pam,

 

I do not have the time to go through all my posts to the this thread, to look up my comments in their full context, but even with what you have quoted, I believe I was equivocal in my phrasing. I would also like to point out that part of the reason for my post was to inject some balance to the promotion of Hill's titration method as being somehow optimal.

 

Although you chose the specific comments, I think it suffice for me to take your quotes (with your added emphasis), and underscore certain sections to add my own emphasis.

 

Since you are already following a successful method (titration), a method that works for you, why change it? Especially as you are pretty close to the end. I would just question [the] validity of tapering off at the rate suggested by Hill. Since Hills suggests a rate slower than 100 days per 1mg Valium (at doses below 5mg/day), and you are at a dose of 2.3mg, this means it would take you more than 230 days to complete your taper. If we assume a rate of something like 200 days per milligram Valium (this would seem like a reasonable interpretation of Hill's patent), this would translate to the remainder of your taper taking 460 days (15 months) to complete. Following the Ashton protocols, you probably would be off in 3-5 weeks (though mileage will vary). It should be remembered that, on the whole, Ashton's patients were tougher cases. There should be no expectation by our members that they need to follow taper plans lasting much longer than the ones devised by Ashton for her patients.

 

'Question', 'mileage will vary', and 'on the whole' are all equivocal statements.

 

If you are happy with your present system, there is no reason to go back. It is not 'wrong' to titrate Valium, it is just unnecessary (although it might be useful for those without access to 2mg Valium tablets).

 

See, below, my 'buffer' analogies.

 

As I explained in my main post, Valium has 'in-built microtapering'. When you make a cut to your Valium (by pill-splitting), the corresponding drop in blood levels will occur gradually (over a week or more).

 

There is a buffer effect when taking a long half-life drug like Valium. Input =/= output. For analogies, think of (or look up) how a data buffer, water reservoirs, or (a better analogy) smoothing capacitors work. With all these systems, variations to the input (the dose you take, time of day, inter-dose falls in blood concentrations, etc.) are reduced/removed (blood levels do no rise and fall in concert with variances with dose).

 

Yes, it is perfectly possible to cut from 2mg to 1mg Valium - this is what most people do when following Ashton's schedules. Many members at BB prefer to make 0.5mg cuts at low doses of Valium - this would seem reasonable. Of course, the[y] might make more frequent cuts if the size of their cut is halved. I just question the validity (for the vast majority of people) of titrating Valium (unless they do not have access to 2mg tablets).

 

'Perfectly possible', 'most', 'might make', 'I just question', and 'majority' are all equivocal statements.

 

If this slow taper plan works for you, good for you. I just wish to curtail the expectation by members that they need or should taper off very slowly (many months or years to quit a small dose of Valium). There should be no expectation of this. Most people can taper off as per Ashton or faster (though not necessarily by a typical member of our self-selecting group).

 

'Most', 'though not necessarily' and 'no expectation' are all equivocal statements.

 

I would not tell you that it is taking you 'too long'. I am just trying to prevent seeds being planted that suggest that tapering off at incredibly slow rates is somehow optimal. The optimal rate of withdrawal is the fastest one that can be reasonably achieved without causing intolerable withdrawal symptoms. There will be great variability in this, but most people can taper off as per Ashton's protocols or faster. If you need to take it more slowly, so be it.

 

'Most' is an equivocal statement. 'There will be great variability' is, technically, an unequivocal statement, but is non-absolutist.

 

[...]

 

However, I read your posts a few of days ago, and quite frankly some of the things that you have said have been bothering me ever since. Being someone who has to speak their mind, I think I really need to point out some of the (above) quotes which are concerning me, because I believe they are a bit misleading, especially to those who are new to a benzo reduction plan.

 

I think you misunderstand some of my statements and language I use in them. Additionally, a large part of the reason for me posting my comments to this thread was to inject some balance to the promotion of Hill's titration method, both away from this site and through our forum boards. I appreciate your comments - this allows me to clarify my position.

 

I am probably considered someone who started out on a low dose (5mg valium) and I can categorically tell you that there is no way I could follow Ashton’s Method of tablet cutting. I couldn’t even do a straight tablet cut of 0.25mg from that dose. Before I found BB I tried and failed that method so many times that I was starting to feel like a complete freak, and completely desperate and hopeless as well.

 

I am not one for judging the size of dose taken as a (strong) indicator for the depth of dependency or the withdrawal symptoms an individual might experience when withdrawing from benzodiazepines. On the contrary, some people can withdraw, rapidly, from high doses with few ill-effects (they just tend to not join BenzoBuddies or similar groups - ours is a 'self-selecting' group). Our members are those that struggle with benzodiazeopines, irrespective of the actual dose they take.

 

I doubt that I will ever try doing it again, even when I’m down to a very low dose, because quite frankly it scares the bejesus out of me, after the hell I've already been through trying to do it. When I get a lot lower I will still continue to do a daily reduction. However, at this point, who knows what the daily rate will be. Maybe it will be more or less than what I’m currently doing. I will make that judgement for myself when I get there, depending on how I feel. I don’t want to be told what kind of reduction I “should” be able to do.

 

Ashton has written about the fear generated from earlier attempts at quitting. Irrespective, I make no judgement regarding the taper rate adopted by individual members. It is the 'promotion' of a particular rate, or ridiculously long schedules (many years to quit a small dose) that is the problem. However, having said this, since Ashton's protocols are based upon extensive clinical experience, and since her patients (like most BB members) were 'tougher' cases (most had already and failed in their attempt to quit benzodiazepines), her protocols would seem to be the most sensible starting point. I would stress, though, Ashton intends her suggested protocols as guidelines - mileage will vary. It is also worth noting that some medical sources disagree with Ashton's scgedules as being unnecessarily drawn out (others, like you, feel they are too fast). The point is that there is great individual variability - members should taper off at the rate that suits them and their individual needs.

 

My current dose is around 3.4mg and the only way I have gotten there is by doing a slow daily titration. I started out reducing 0.02mg per day, but found that was too much. So I then reduced that to 0.015mg. That went very well for a while, so I decided to experiment with doing a 3 day rotation of 2 days @ 0.015mg and 1 day @ 0.02mg. That also worked very well. So then I decided I’d experiment with 1 day @ 0.015mg and 1 day @ 0.02mg. However that was too much.

 

If this works for you, then this is what you should do. Let me reiterate my comments earlier to this thread. With a long half-life benzodiazepine, you should be looking more at the overall taper rate. Daily fluctuations do not have a direct effect upon blood levels (changes are gradual). Try to look at the drop over a period of about a week as a better indicator. For all the reasons I posted out earlier to this thread, your dose and blood levels vary a lot more than you can control by titration to the accuracy you attempt. You might attempt to measure a dose to 0.01mg Valium, but the true dose is likely to vary by an order of magnitude greater than you seek (of the order of 0.1mg - just a guestimate). This is because the dose of individual pills will vary, (other factors, such as the food you eat, will add to such variances). If we assume a rather tight tolerance of +/- 5% of stated dose, this would be 0.1mg of a 2mg pill. What's the point of attempting to measure to the accuracy of 0.01mg, or 0.02mg or 0.015mg? each day? Now, if you instead take daily reductions of dose over a week or ten days, this provides a more reasonable perspective. For example, if you determine that a reduction of 0.15mg Valium over 10 days (an extrapolation of your figures) - (note to others: this is an extremely slow taper, way outside of the range suggested by Ashton - you do not need to make a daily (equivalent) reduction of 0.015mg to achieve your goal. The reason for this is because of Valium's relatively long half life.

 

When I used to write up titration schedules for members (based upon their very specific requirements of me), I suggested that they obtain a 100ml cylinder with 1ml increments (as this covered all eventualities). However, they could instead use other volumes and increments. For example, some might have a 50ml cylinder with 2ml increments, or 100ml with 5ml increments, even fewer divisions. The schedule would take account of this and vary the frequency of cuts so that they overall taper rate was unchanged by the size of these tiny individual cuts. And this was nearly always for benzodiazepines other than Valium (with shorter half-life values), where individual dosing value would be more critical.

 

For example, an attempted daily reduction of 0.05mg Valium would be equivalent to 0.5mg over 10 days, or 1mg over 20 days (Ashton's protocols, at low doses, suggest reductions of about 1mg every 7-14 days, so this is slower than what Ashton's suggests). If instead 0.2mg was cut every four days (a more realistic attempt at accuracy - a tenth of a 2mg tablet), the overall taper rate would remain at 0.5mg every 10 days. Because of all the barriers affecting such attempts at measuring to this kind of accuracy, and because of Valium's in-built smoothing effects upon blood levels, there is no way that you could notice or measure an difference between 0.05mg per day and 0.2mg every four days. You attempt to measure accuracy to an order in magnitude greater than this - this is unrealistic. I stress though, it will cause you no harm. It does, however, demonstrate that you cope with variances in dose fare greater than you realise. I would go further, with Valium, for most members, there probably would be no noticeable difference between attempts at a daily reduction rate of 0.05mg and a reduction of 0.5mg every 10 days. However, this is not necessarily true when tapering off benzodiazpines with shorter half-life values, where there might be some benefit in attempting to measuring more accurately (where there is little buffering effect upon blood levels). Still, attempts at accuracy need to be kept within a realistic range. For these reasons, members should not worry unduly tiny variations in dose.

 

For the record, I should explain a little more about the titration schedules I would draw up for members. The member would decide upon an overall taper rate (typically, stated as over 7, 10, or 14 days, or to any number of days they desired). Then, I'd produce a schedule (generated through a spreadsheet) that translated this into (near) daily reductions, based upon the overall taper rate, and the size (and increment size) of their cylinder (it would round to the nearest marked increment on their cylinder). If this meant that they reduce by 1ml one day, and 2ml on another, or no reduction on some days, it did not matter. It is the overall rate and pattern that is important. I should point out, when I make mention of 1ml reductions, these were generally much more potent benzodiazepines than Valium. With Valium, daily reductions of many milliliters (from a 100ml cylinder)  would be more typical. You might look over some of the titration schedules I generated for members.

 

So I’m back to the 3 day rotation plan, which works out to be roughly a 0.0166mg reduction per day. That seems to be my limit. That would work out to being around 0.25mg every 15 days. This is sort of in keeping with the Ashton Method (I think – I honestly don’t take much notice of the various “methods” – I just do my own thing). However there is no way I could actually do a tablet cut of that amount all in one go. Been there, done that. Not doing it again. The s/x are too horrible.

 

At low doses, Ashton's schedules suggest reductions of 1mg about every 7-14 days. That's between 4 and 8 times that rate of your taper. However, you should do what works for you. Again, I stress, Ashton's protocols are suggestions - there will be outlier cases for a variety of reasons.

 

If I can keep doing this reduction it will take me at least 7 months to finish my taper, yet I’m theoretically on a “low dose”. Maybe it will take me longer, because I have no idea how I will cope on the very low doses, so yes that is “many” months. Of course there is a train of thought that some people can increase their taper once they get below 2mg, but that is by no means a definite rule, and there are a number of people I know of on BB who have had to do tiny reductions right to the very end. I'm sure they did that because they had to, not because they wanted to, or for the fun of it.

 

If you are more comfortable tapering off over a period seven months, then that is what you should do.

 

People do not 'increase' their taper rate when they reach a low dose. The percentage cut might rise, but since their benzodiazepine has a small effect upon GABA functioning at low doses, this is not a problem. All that happens is that they no longer continue to reduce the size of their cuts (instead, typically, for Valium, reducing their dose by a set amount of 1 or 0.5mg). Even in an extreme example (reductions of 0.005mg Valium, as per Hill), you inevitably make greater reductions to dose (in terms of percentage) when you reach the end of the taper. After all, no matter how small your last dose, your cut to 0mg is always a reduction of dose of 100%.

 

Yes we all know about valium’s half-life qualities, however that doesn’t mean that it automatically has an “inbuilt microtaper”. If you are doing a daily reduction, and that daily reduction is more than your body can handle, YOU WILL suffer s/x eventually. I have, and everyone else I speak to has also experienced this when their reduction rate has been too high. From my experience there is no “corresponding drop in blood levels occuring gradually over a week or more”. I will get hit with s/x at around the 4-6 day mark and I need to hold and adjust. There is nothing gradual about it at all.

 

Just because you state it is not true, this does not invalidate my comment about Valium possessing 'in-built microtpareing' or 'buffering' qualities. You might have quibbled with my choice of words, but you instead denied my assertion without any argument as to why you disagree.

 

When you make mention of daily reductions being more than you can handle, I again point you to my comments (in this post and before) about the overall taper rate as being what is important with Valium. It is not that you could not stand a cut of 0.01mg Valium (you cannot possibly perceive this cut, which is vastly overridden by inaccuracies anyway), it is the accumulation of cuts over time that is relevant. My whole point is that it is pointless to attempt to  measure to such exactitudes (you will get nowhere near the accuracy you desire) and Valium will buffer changes anyway. Please do not misunderstand me, I do not mean this as an accusation (it is meant to better inform all those reading my words): although such slow taper rates and attempts at 'accuracy' will cause no medical harm (excepting that the longer we take benzodiazepines, the greater likelihood of deepened dependency), unnecessary obsession with such attempts at accuracy could be counterproductive for some. If, on the other hand, you and some others feel more empowered by following such a controlled regimen, than that's fine. Members should follow whatever method and regimen that best works for them.

 

There have been some complaints levelled at people doing daily reduction methods from those who prefer to do a cut and hold method. Supposedly we have criticised these people for doing a cut and hold method, or we've made them feel like a failure because they can’t, or don't want to, do daily cuts. We have been criticised for using the tongue in cheek term of “cut and suffer”, but the only people I’ve seen use that term have only been referring to their own experience with that method, and have not actually criticised anyone else who has preferred to use that method.

 

Actually, 'cut and suffer' is a very loaded and judgemental term. And, unless I'm mistaken, a phrase that was coined and is in general used at Hill's forum. I don't really appreciate it being used around here, 'tongue-n-cheek' or otherwise.

 

I’ve personally never seen any of this “criticism”. All the people I speak with always emphasise that everyone should use a tapering method they feel the most comfortable with. Yet the inference that is being made here, from some of the things that you have said, is that daily titration isn’t necessary if you are on the lower doses, but to be very blunt, it most certainly is necessary.

 

Actually, for many years, we've had a dedicated titration board and have provided information about titration through our webpages. Further, I provided direct help with generating titration schedules for members (check out the titration board). There is no 'inference' that I am against titration. However, I have posted my explicit concerns (no inference) regarding some aspects of Hill's patented titration method. These concerns range from the application itself (Prior Art objections), the suggestion of taper rates which would result taper schedules lasting very many years (even from a low dose), and the downright dangerous suggestion of using grapefruit juice as dosage error correction device.

 

Daily, minuscule reductions of Valium, are probably unnecessary, and this is true of any dose of Valium (note my use of the word, 'probably'). And, actually, there is a case for use of titration of Valium at low doses, where the member cannot obtain 2mg tablets. If members wish to titrate Valium, this is fine and their choice. However, I will make clear my reasons for why I think it is generally unnecessary (note my use of the word 'generally').

 

Some people on the lower doses find it better to do a cut and hold method, but that doesn't mean that it is suitable for everyone. In fact I would hazard a guess and say that the majority of people on the lower doses find daily tapering easier to cope with, but that is not levelling any criticism at anyone on a low dose who is successfully doing a cut and hold taper.

 

It is just a fact that the vast majority of people do not need to titrate benzodiazeines (even shorter half-life benzodiazepines). Valium buffers against changes to dose, so the need to titrate Valium would be unusual. Even with the self-selecting membership of BenzoBuddies, where you would expect 'tougher' cases, titration is a method utilised by a smallish minority. This does not mean that it is second rate, it is just that it should not be promoted as an optimal method. Like pill-splitting and substitution with Valium, it has benefits and downsides. Please read my overview of the three methods of withdrawal.

 

To be honest, it is also quite possible that the cut and hold people who are on the higher doses, and who have also claimed that the daily reduction people have criticised them or treated them unfairly, will also find that their cut and hold method won’t work for them when they also get down to the lower doses. Time will tell with that. I honestly hope everyone can find a reduction plan that gives them few s/x, regardless of what level their dosage is.

 

Yes, possible. Not only this, but I have written on may occasions that members might switch between methods as they progress their taper. However, most will not need to change their method of withdrawal.

 

I know you said a few times that people should titrate/reduce at their own rate, but then there is the return to the claim that titration of Valium "is just unnecessary". So it seems that maybe there is a bit of “reverse discrimination” of people doing a titration method. We seem to be getting told “well it’s okay to do it, but it’s not really necessary” (sorry, I’ve paraphrased you, but that's essentially what you said).

 

There is no excuse to paraphrase me or quote me out of context. Your quotes of me highlighted the parts to support your argument, but you have repeatedly claimed that I made unequivocal or absolute comments where I did not. I did not criticise titration as a valid method. Rather, I criticised a specific (patented) titration system for being hackneyed (nothing new), some suggested titration rates as being unnecessarily long, and a dangerous suggestion to use grapefruit juice as dose correction device.

 

A lot of the people I talk to on this forum all seem to say that the Ashton Method is unsuitable for them. I think I can categorically say that no one wants to draw out their reduction any longer than necessary, but most people have to weigh up “quality over quantity”. So I think it is very misleading to say that members should be able to “expect” to follow any particular method.

 

The Ashton Method is one of three basic methods. Members are free to use any method they choose. Ashton's protocols are not for everyone. And, of course, some people (particularly in the US) find it very difficult to obtain prescriptions for Valium.

 

The majority of people should indeed expect to taper off benzodiazepines by pill-splitting. This is because this how the vast majority of people quit! Of course, experience in individual cases will inform otherwise. Of course, BB will tend to attract tougher cases, so titration and substitution with Valium will be more popular here than in the general population. Still, even at BB, the majority of members to do not titrate, nor they do not switch to Valium.

 

While I agree that Hill’s method does seem to be exceptionally slow and unnecessary, Ashton’s Method isn't necessarily the “right” way either. Everyone has to find their own method, whether that be Ashton, TRAP, daily reduction or cut and hold, and no one should be told what method they “should” be able to follow, or what is, or isn’t, “necessary”.

 

How is it OK for you to use the word 'unnecessary', but not OK for me without me being accused of being unequivocal in my comments? Just something for you to consider.

 

Fortunately I’ve been on BB long enough now, and learned enough about my own tapering needs, to take what other people say with a grain of salt. I know how to work out my own tapering plan, and what to do if things aren’t going well. Frankly, I couldn’t care less about other people's opinions on how I should be able to taper, or about any of these specific methods, whether it be Hill’s, Ashton’s or TRAP’s. I really don't know the specifics of any of them anyway, because frankly I don’t care. I just do what I need to do to suit myself.

 

The truth is that some people way over-think their taper plans. This is to be expected - it part and parcel of benzodiazepine use and withdrawal for some. However, I think for me, or someone else in a similar position to me, to push ideas that only serve to make some people become obsessional about their taper rates and unrealistic exactitudes, does great a disservice.

 

However, I am concerned that if newbies read some of the comments you have made they will get very confused about what they “should” be able to do on their taper, especially when it is coming from someone in your position. They may try to follow a method that simply isn’t suitable for them. I don’t want to criticise you for the comments you have made. However, I have seen some generalisations which aren't correct, and that concerns me greatly. Everyone has to find their own way, without being influenced by someone, they could see as being "in charge", making generalised statements which aren't accurate.

 

Actually, you have wrongly accused me me of unequivocal comments. Where did I indicate that members "should" do anything? Where I have posted generalisations, I have characterised them as such. Point out where this is not the case, and I'll edit my comments.

 

I would hate to see a "them and us" mentality come into play between the daily reduction people and the cut and hold people. Frankly I have seen a little bit of an undercurrent of that floating around from some people who have felt they have been "criticised" for their choices, and I'm just worried that comments like "It is not 'wrong' to titrate Valium, it is just unnecessary" is just doing what the "daily reducers" have been (wrongly) criticised of doing. It is very unfair for anyone to be told what is "unnecessary" when they are tapering.

 

As I made clear in my first post to this thread, all three methods are really just one method: the gradual reduction of dose. Switching to Valium (from a shorter half-life benzodiazepine) or utilising titration allowing for a 'smother' withdrawal schedule are valid and better for some, but are unnecessary for the majority. This is a statement of fact. This does not equate to me indicating that one method is better than another - they all have their place. However, since spill-splitting is the most straightforward method, it should indeed be considered before other options - this is plain common sense.

[[Di...]]

Thank you Colin for your response. I will let everyone read it for themselves and draw their own conclusions. I don't wish to continue this discussion any further because I have stated my POV, and you have stated yours.

 

I was/am concerned over some of the terminology you used, because there were numerous blanket statements that you made that don't become irrelvant just because you used "equivocal statements" in other parts of your posts. However, if you are comfortable with what you have posted, then so be it. I am also comfortable with everything I have posted. So, as we have freedom of speech, we will have to "agree to disagree". To continue to dissect everyone's comments to the enth degree will only prolong something that is pointless.

 

All I will add is that those people who posted that titration/daily reduction is something they find much preferable to following a cut and hold method, and that Ashton is not a method they care to follow, should just keep doing what is right for them. If you are comfortable with what you are doing, then do it. If you’re not, then change it.

 

***clarification edit made to para 2***

 

[[rh...]]

Thank you Colin for your response. I will let everyone read it for themselves and draw their own conclusions. I don't wish to continue this discussion any further because I have stated my POV, and you have stated yours.

 

I was/am concerned over some of the terminology you used, but if you are comfortable with what you have posted, then so be it. I am also comfortable with everything I have posted. So, as we have freedom of speech, we will have to "agree to disagree". To continue to dissect everyone's comments to the enth degree will only prolong something that is pointless.

 

All I will add is that those people who posted that titration/daily reduction is something they find much preferable to following a cut and hold method, and that Ashton is not a method they care to follow, should just keep doing what is right for them. If you are comfortable with what you are doing, then do it. If you’re not, then change it.

 

[[Di...]]

Thanks 

[[In...]]

Well, I do agree with Colin that this thread took on personal tones here on occasion as most of them tend to do here on BB from my observations.

 

Thus I will say, I do have my facts straight, I believe, although Im not sure what facts I was thought to not have straight. In addition, I do not have a hidden agenda here at all nor do I have a thinly veiled problem with anyones post, and I am still "just wondering" about why anyones "method" should be such a problem here for others if that method is working for them.

 

And I also will say again, that without the benefit of more current research by real, professional researchers, new methods of getting off benzos will come along naturally by the users of these drugs. That seems plainly evident to me, and it is happening whether anyone here or anywhere else likes or doesnt like it. People will do what works for them. These guidelines that Ashton provided many years ago, are to me, a good education on the dangers and difficulties of getting off benzos.

 

I do not think that any particular person is all over this forum promoting, or "shoving a method down anyones throat.' So yes, I do wonder what all the fuss has been about and is about. I frankly think it is human nature to not only want to discuss a subject, but to then debate it, then to contend over it, and then perhaps to argue over it, and lastly perhaps get personal and even attacking about it.

 

My "agenda" if any would be to allow the light of day into some of these newer methods without anyone person feeling the need to become defensive about the older methods that Ashton devised. I certainly could not argue as I have said before, that she did blaze the trail on these medications in a way that took these medications to task and by storm, but things have seemed to come to some sort of startling halt as far as anymore trail blazing. And we of all people know that this is simply ridiculous as I do believe that many more than just members of BB have much difficulty getting off these drugs.

 

I certainly do not make it a practice to discuss my situation with a ton of other people, and yet I have heard from my own previous doctor that "many people tell us these are very difficult to get off of." And I have asked my pharmacist about this also.  He has said that there are many Rxes given out for benzos, and he does not see hardly any get off of them that he fills. Whether this is because of difficulty or because of choice, I do not know, but he did also say that many, many do have difficulty.

 

So we may be self-selecting in that we have chosen to join this group, but we are not the only group, nor are we, IMO, the only people who have trouble getting off these drugs. So Im in favor of letting the other "methods" if they work for others, have and hold as much respect and weight as any that Ashton or anyone else has come up with.

 

Intend

[[Di...]]

 

My "agenda" if any would be to allow the light of day into some of these newer methods without anyone person feeling the need to become defensive about the older methods that Ashton devised. I certainly could not argue as I have said before, that she did blaze the trail on these medications in a way that took these medications to task and by storm, but things have seemed to come to some sort of startling halt as far as anymore trail blazing. And we of all people know that this is simply ridiculous as I do believe that many more than just members of BB have much difficulty getting off these drugs.

 

 

I suppose this is the bit that confuses me. For some reason there seems to be a lot of defensiveness about the Ashton Method, not only on this thread, but on many others too. Sure she was a trail-blazer, and we should all be very grateful for the work she did, but to constantly keep referring back to it just makes me wonder "why"? It's a guideline, that probably now needs updating. Nothing more, nothing less.

 

Sure, on one hand we get told that we can follow any tapering plan that we want to, but then on the other hand we are told "It is just a fact that the vast majority of people do not need to titrate benzodiazeines (even shorter half-life benzodiazepines). Valium buffers against changes to dose, so the need to titrate Valium would be unusual" (this is a direct quote). I'll try to remember that next time I do a 0.25mg tablet cut and I'm going out of my mind from the resulting insomnia, depression and anxiety.

 

So, it seems that those of us who need to follow a slower daily reduction method will just have to put ourselves in the category of being "the small minority" because the "vast majority" seem to be doing just fine on a cut and hold method or following Ashton's Method. I hope that makes you all feel a lot better about the "unusual" method you are using. Mind you, the number of posts I read everyday certainly does not support those statements, but who am I to offer an opinion when we have so many more learned and long-standing people here than me...... and yes that was sarcasm - and I'm ashamed of myself for using it because I find it to be lowest form of communication......

 

Anyway, I did say I didn't want to continue with this discussion, but I sometimes have trouble keeping my mouth shut, especially when I see comments that are very interesting, such as yours is Intend.

 

[[...]]

Hi Diaz-Pam

 

Don't feel unusual about having to take small cuts with your Valium. The effects of Valium are mostly related to its duration of action with its half life probably accounting  for some longer term subtle effects. The duration of action of Valium is around 6-12 hours for most people but can last up to 24 hours, whereas the half life of Valium including its active metabolites can be as long as 200 hours. For some individuals the half life can be much shorter but nowhere near the duration of action. Duration of action is defined as the length of time a particular drug exerts its clinical effect. I've written a longer piece on this including references a few posts back if anybody wants to read more. Some lay people apparently think that the degree of  clinical effect of Valium directly corresponds to its half life. This is incorrect. In a given individual if the half life of Valium is 100 hours, there is no way a given dose will still be exerting half of its clinical effect 100 hours later.

 

I think Ashton may have emphasized half life in her manual because it was aimed at the general public and she wanted to keep things more simple. I'm sure she knew all about this when she wrote her manual. In science, when dealing with the public it is best to not go too far into the weeds, but at times this can cause misunderstandings.

 

Bart

 

[[Di...]]

Very interesting comment Bart. I'll have to go back and read your other post. I'm sure I did at the time, but I can't remember what you said.

 

I will readily admit to not having a good grasp on "sciencey" stuff, but there's no doubt that there are a lot of other people like me who need to follow such an "unusual" method.

[[...]]

I also don't understand the need to take something as long-acting as Valium several times per day, in the name of smoothness.  Not sure that is in the secret method, but many Micro'ers on Valium or Librium are frequent, 4-6x per day dosers too.  It's not wrong, just unnecessary.

 

Taking Valium 4-6 times per day is certainly unnecessary, and probably counterproductive. If the point is to achieve some unobtainable constant blood concentration, then 6 times per day would mean taking equal doses 4 hours apart. I would suggest that a good night's sleep would be of much greater benefit. 2-3 times per day would seem sensible without being overly intrusive.

 

There might be some mileage in taking a relative short half-life benzodiazpine more than three times per day, perhaps taking a weighted dose at night (to help see you through the night). At the same time, those taking particular z-drugs with a very short half-life almost certainly should not chronically dose with their med. This is because infrequent use (this can mean as frequent as once a day) of such a short half-life drug probably will not result in dependency (it is out our system too quickly to cause the kind of GABA changes associated with dependency). So, switching to chronic dosing in such a situation would probably only result in dependency where there was little to none in the first place. Particular very short half-life z-drugs (when used infrequently) are almost certainly better tapered off over a few weeks (with no increase in dosing frequency), even after protracted use.

 

Hi guys

 

Colin:  Thanks for another great post. I never knew exactly what Hill's method was.

 

Vribble:  With regards to multiple daily dosing of Valium, unfortunately it is a little more complicated than basic half life. In pharmacology we have a term called duration of action which is defined as the length of time a given drug is clinically effective. Duration of action time for Valium is commonly 6-12 hours for most individuals but can range up to 24 hours. The exact time frame is dicey as it depends on several factors such as the drug action reversibility, the slope of the concentration-response curve, serum half and other variables. Also, Valium is distributed in what is known as a two compartment model wherein there is an initial rapid drop off in serum concentration and then a slower decline as the drug accumulates in tissues. Various studies have shown peak performance decline for the iv, im and oral routes as in the neighborhood of 15minutes-1hour  up to 2 hours and lasting as long as 3-4 hours. Also, Valium also undergoes biphasic metabolism which means it is metabolized rapidly at first and then slower later. From my reading the effects of Valium are said to correlate poorly with an individual's serum level. I know that Ashton pushes the idea of half life quite a bit in her manual, but I suspect this is to simplify things for lay people. She also has you dosing Valium multiple times per day earlier in your taper so I'm sure she knows all about duration of action as this is a basic pharmacological concept. There certainly are a lot of people on BB who will attest to interdose withdrawal symptoms with once a day Valium dosing.

 

http://www.inchem.org/documents/pims/pharm/pim181.htm#SectionTitle:6.3%20%20Biological%20half-life%20by%20route%20of%20exposure

http://www.ncbi.nlm.nih.gov/pubmed/7352385

http://www.ncbi.nlm.nih.gov/pubmed/7352385

http://www.nhtsa.gov/people/injury/research/job185drugs/diazepam.htm

http://www.mentalhealth.com/drug/p30-v01.html

 

Bart

 

Hi again Diaz-Pam

 

Above are the facts. It is duration of action not so much half life that matters most. It is entirely possible to experience daily interdose withdrawal with Valium.

 

By the way, here is a direct quote from Heather Ashton supporting the possibility that some people will require very long, slow tapers to get off of benzodiazepines:  "I should add that some benzodiazepines are available in liquid form and it is possible to withdraw from these directly, reducing dosage millilitre by millilitre or drop by drop."

http://www.psychmedaware.org/HistoryBenzodiazepines.html

 

Sounds to me that Ashton would be OK with a daily reduction of a very small amount of benzo in liquid form.

 

 

That entire presentation by Heather Ashton supports flexibility with taper plans as long as they keep moving forward. She discusses the importance of the individual patients input in determining the taper rate.

 

Bart

[[Di...]]

I should add that some benzodiazepines are available in liquid form and it is possible to withdraw from these directly, reducing dosage millilitre by millilitre or drop by drop.

 

Actually, now that you've posted that quote, I definitely remember reading it in the Ashton Method and that was one of the first clues to me that there was an easier method out there for me. So the good Doctor herself supports this method, and no one should be told it's "unusual".

 

[[Ho...]]

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