Tag: prescription drug use

  • Help for Ambien Withdrawal

    Help for Ambien Withdrawal

    ARTICLE OVERVIEW: Ambien is pretty addictive. Users can develop a dependence within just a couple of weeks of daily dosing. Withdrawal can be difficult. This article outlines what to expect during withdrawal and ways to treat symptoms medically.


    ESTIMATED READ TIME: Less than 10 minutes.


    Table of Contents:

    Ambien and the Brain

    Zolpidem is the main active ingredient in Ambien. Its chemical structure is very similar to the benzodiazepine class of drugs, but zolpidem is officially called a “hypnotic”. Benzodiazepines are prescribed for a variety of reasons and attach to neurons within our brain responsible for sensations, emotions, muscle movements, and cognition.

    Because of this, zolpidem causes its user to become sedated without experiencing the other qualities of benzodiazepines. However, after regular or daily use, you can become physically dependent on zolpidem. This makes quitting Ambien both hard and potentially dangerous.

    Is Ambien Withdrawal Hard?

    Yes, quitting Ambien isn’t going to be easy.

    To begin, you need to take the following facts about yourself into account:

    •  Dosage
    •  Metabolism
    •  Overall health state
    •  Time length and frequency of use

    In general, the long you’ve been using Ambien … the harder detox will be.  If you’ve been using it for a longer time and taking high doses, then you can expect to experience a longer withdrawal process with more possible difficulties.

    Still, it is difficult to know how long withdrawal will last or how difficult it be. Why? Because we are individuals. We each use drugs for different reasons. Likewise, use patterns and dependency differ.

    Is Ambien Withdrawal Dangerous?

    Again, people with higher levels of dependence are more likely to experience dangerous withdrawal symptoms. Severe seizures might occur and even be fatal. People with certain mental health issues are also at risk. For these reasons, Ambien withdrawals should always be carried out under medical supervision. 

    You should never quit cold turkey. Doctors will taper your dose, thereby your body can gradually resume normal functioning.

    A List of Withdrawal Symptoms

    Withdrawal symptoms begin within approximately 48 hours after your last Ambien dose. Some people have experienced symptoms as early as a few hours later.

    Withdrawal symptoms may include:

    •  Abdominal cramps and discomfort.
    •  Anxiety.
    •  Cravings for Ambien.
    •  Delirium.
    •  Depression.
    •  Fatigue.
    •  Flushing.
    •  Irritability.
    •  Mood swings.
    •  Nausea and/or vomiting.
    •  Panic attacks.
    •  Rapid heart rate and breathing.
    •  Rebound insomnia.
    •  Seizures.
    •  Sweating.
    •  Tremoring.
    •  Uncontrollable crying.

    The Basic Timeline

    The timeline after your last dose of Ambien can be divided into five stages.:

    1. The First 24 to 72 Hours. During this period, your symptoms begin their peak and are most uncomfortable. Usually, you can expect to feel both physical and psychological symptoms.

    Physical Withdrawal Symptoms:

    • Shaking
    • Vomiting

    Psychological Withdrawal Symptoms:

    • Anxiety
    • Confusion
    • Fearfulness
    • Hallucinations
    • Memory loss
    • Mood swings
    • Psychosis
    • Sleeping disorder

    2.Week 1. After the first week, acute withdrawal tends to resolve. Symptoms have lessened to a great extent, but not the cravings. Also, many people find themselves experiencing depression and paranoia during this period. A tendency to experience trouble sleeping, or nightmares, is still present; in particular, for those experiencing mental trauma (in general or due to the withdrawal). So, it’s important to undergo psychotherapy treatment in order to get help for coping with this situation.

    3.Week 2. Cravings, depression and paranoia are not as strong as they were the week before. During this week you might feel foggy as though you can’t think straight. For this reason, it’s possible to experience mood swings. However, your sleep begins to stabilize.

    4.Week 3. Your cravings have further decreased. You might still experience sleeping disorders.

    5.Week 4. You definitely begin feeling better, though there may be still some traces of anxiety and/or irritability. Your sleep starts becoming really stable. Your body and brain are noticeably getting back to their normal functioning.

    After the first month of Ambien withdrawal, heavier users possibly may experience post acute withdrawal syndrome (PAWS). This is when withdrawal symptoms last for a much longer period of time, about six months after cessation.

    The most common PAWS symptoms associated with Ambien are:

    •  Anxiety
    •  Cravings
    •  Depression
    •  Insomnia
    •  Nightmares

    When planning to quit Ambien, always seek medical consultation with a doctor who is experienced in tapering doses of zolpidem in order to get a customized plan. 


    Medicines that Help

    Usually doctors don’t prescribe other medications during Ambien withdrawal. Instead, they taper Ambien doses to fully resolve dependence and address insomnia simultaneously. In these cases, it can take weeks to months for a gentle taper. You can find benzo equivalent dosing schedule on Dr. Heather Ashton’s website. However, if insomnia is severe and a lack of Ambien causes it to come back, you may be prescribed a medication solely for that reason.

    To date, there are very few medications available for Ambien withdrawals. Doctors don’t want to risk further addiction, so they tend to prescribe short term therapies for the instances of anxiety and depression as mental withdrawal symptoms.

    Natural Remedies that Help

    What can you do to get a better night sleep without the drug?

    Since chronic insomnia is probably an issue for some of you, a few different natural remedies are offered below that not only help with withdrawals but also with sleep.

    Acupuncture. While this is still being researched, a more recent study found that  acupuncture had positive effects on reducing withdrawal symptoms, in particular for those dealing with great discomfort from withdrawal.

    Distractions. When you’re going through withdrawal – particularly, psychological withdrawal – you’ll want to keep your mind occupied to outwit cravings. There are a variety of ways to do this and it all depends on who you are as an individual. Some find help in the arts (such as playing music, drawing, or writing in a journal) while others find new habits to be very beneficial (such as cooking or gardening). Don’t be afraid to experiment around while you’re in treatment. You might just learn something new about yourself.

    Exercise. At most medical detox clinics, exercise is highly recommended to those going through detox because it promotes natural dopamine and endorphins. In case of Ambien withdrawal, exercise has been shown to help people get a better night’s rest. Though this isn’t true for everyone, it may just be the secret you’ve been missing out on.

    Meditation and Yoga. Withdrawal can bring a lot of stress . Meditation and yoga not only mitigate withdrawal symptoms, but also help reducing cravings. These types of alternative therapies are also beneficial for those dealing with mental illness alongside their addiction, such as anxiety and depression.

    Nutrition. While not the case for everyone, some drug users find themselves with a poor diet. However, an even bigger issue is that many drugs have the effect of absorbing much of what people eat. Drugs like Ambien can also cause loss of appetite. While in recovery, it’s vital to get your body back on track with water and healthy foods.

    All of the above have potential to promote better sleep. Of course, people with chronic insomnia might need more than a natural remedy to benefit them. If this is your case, the best thing to do is to consult your doctor. Chances are they will figure out the solution right for you.

    Where to Go for Help

    If you need help for Ambien dependence, you are not alone.In 2015, the estimated number of Ambien and other sedatives users was 446,000. So where can you start?Dr. Heather Ashton wrote the book, “The Ashton Manual” that outlined withdrawal procedure and protocols for benzodiazepines. While Ambien IS NOT A BENZO, it can be helpful to read the book and to adapt some if its principles in your own case.Where else can you look?

    You’ll also want to reach out to family and friends. As you try to quit Ambien, you’re going to be in need of a support system. The people you can always turn back to when things get difficult. Furthermore, even after treatment when recovery is still ongoing, you’ll have people there when need be. If you’re a family member or friend of someone who’s addicted to Ambien there are a variety of options for you to seek help for your loved one.

    When you do find the right treatment, you can give us a call. We’re always happy to help.

    Where to Find Local Help

    To find where you find local help during Ambien withdrawal, start with your family doctor and work your way out to other connections. Seek information from:

    While you may be concerned about anonymity, also know that Americans are increasingly destigmatizing issues with prescription medications, especially through advocacy groups like Facing Addiction. In fact, an estimated one in three American families experiences a problem with drugs or alcohol through one close family member. So, your friends and family can also be a source of help.

    Your Questions

    If you have any further questions pertaining to Ambien withdrawal, we invite you to ask them in the comments section below. If you have any advice to give for people currently withdrawing, we’d also love to hear from you. We try to provide a personal response to each comment and get back to you promptly.

    REFERENCE SOURCES:

    SAMHSA: Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health

    NCBI: Five-Factor Model personality profiles of drug users

    NCBI: Zolpidem Dependency and Withdrawal Seizure: A Case Report Study

    NCBI:Zolpidem Withdrawal Delirium

    NIDA: Misuse of Prescription Drug

    DailyMed: Ambien

    NCBI: Benzodiazepines and Zolpidem for Chronic Insomnia: A Meta-Analysis of Treatment Efficacy.

    NCBI: Modest Abuse-Related Subjective Effects of Zolpidem in Drug-Naïve Volunteers

    SAMHSA: Substance Use Treatment Advisory

    NCBI: Using Medication: What Can Help When Trying to Stop Taking Sleeping Pills and Sedatives?

    NCBI: Exercise as a Potential Treatment for Drug Abuse: Evidence from Preclinical Studies

    NCBI: Exercise Effects on Sleep Physiology

    BMJ Journals: Acupuncture in Medicine: Trials of Acupuncture for Drug Dependence: A Recommendation for Hypotheses Based on the Literature

    NIDA: Drugs, Brains, and Behavior: The Science of Addiction

    NIH: U.S. National Library of Medicine Substance Use Recovery and Diet

    Addiction Blog: The Ambien Withdrawal Timeline Chart

    View the original article at addictionblog.org

  • How to Talk with Clients about Chronic Pain and Opioids

    How to Talk with Clients about Chronic Pain and Opioids

     

    ARTICLE SUMMARY: These guidelines will help you bring hope and healing to clients who may be in the midst of a battle with opioid addiction and dependency, stemming from chronic pain.

    ESTIMATED READING TIME: 7 Minutes.

    TABLE OF CONTENTS

    The Need to Talk

     Although I have written at length about The Opioid Crisis, it remains a long-term public health concern for Americans. In fact, the latest death toll estimates from the CDC put the number at 72,000 fatalities from overdose in the first half of this year.

    Chronic pain, which is one of the leading drivers of opioid overprescribing and subsequent addiction, affects 133 million Americans and 65% of them seek care for persistent pain at some point in their lives, reports the American Cancer Society. And the National Institutes of Health reports that an estimated $100 billion is spent annually to manage pain, including healthcare expenses, lost income, and lost productivity at work and home.

    Since this is an issue that impacts many families, friends colleagues, and loved ones in every stretch of the country, I’ve developed some tips for opening honest dialogue about this issue for healthcare professionals, clinicians and therapists to talk with their clients.

    Guidelines for Talking to Clients

    As a clinician and interventionist, I know first-hand how it can be difficult to broach this topic in an informed and compassionate manner. However, with these guidelines you’ll be able to bring hope and healing to clients who may be in the midst of a battle with opioid addiction and dependency, stemming from chronic pain.

    1. Meet Your Client Where They Are.

     I recently wrote The Definitive Guide to Addiction Intervention: Collective Strategies. In this textbook, I discuss the importance of starting where your client is. This means understanding who they are, where they come from, their family dynamics, experiences and their place in the world. The best theory in the world won’t take into account this human element. With unique people, a multitude of cultures, gender expressions and the changes in our genetic diversity, we must embrace difference as a teacher. That way you can help plan a strategy that meets their unique needs, not a preconceived cereal box of a model.

    This approach also leaves judgment at the door. Addiction – in all its forms – is a disease, not a moral failing, and should be discussed in terms of the best way to bring healing to the person experiencing the disease. When we do this, we see the person for who they are and that can open the door to recovery.

    2. Understand Your Client’s Trauma and Talk About It.

     Trauma is defined as an overwhelming experience that cannot be integrated and elicits animal defense mechanisms and dysregulated arousal. It can come from a host of experiences – a car accident, a dislocated knee or strained back, physical and sexual abuse, etc.

    Trauma can be both objective and subjective:

    • Objective trauma is the event that took place
    • Subjective trauma is how the person perceives what took place and the emotional aftershocks

    When we understand and discuss the trauma that took place, we then see how the door was opened to an opioid misuse problem. For example, a client may be a collegiate baseball player who tore his rotator cuff during a game. He undergoes two surgeries to fix the rotator cuff and is prescribed pain killers to aid in the healing process. But the player does not want to miss any more games, so he misuses the amount of painkillers he should take in order to “play through the pain” and stay in the game. As such, he develops an addiction and continues to take pills long after the rotator cuff healed. That you discuss the trauma in relation to the client’s pressure to succeed as a baseball player illuminates a detailed treatment plan for recovery.

    3. Teach Your Clients About Opioids and Chronic Pain.

    • The National Survey on Drug Use & Health found that 92 million US adults, or about 38 percent of the population, took a legitimately prescribed opioid like OxyContin or Percocet in 2015. Prescription opioids are easy to come by and are impacting people from all walks of life.
    • 11.5 million people, or nearly 5 percent of the population, misused prescription opioids they obtained through illicit means.
    • In 2015 more than one third of all adults were prescribed opioids.
    • Over 259 million prescriptions were written in 2012, which is enough to give nearly every person in the US regardless of their age their own prescription bottle
    • A study authored by Bradley Martin, a professor of pharmaceutical evaluation and policy at the University of Arkansas for Medical Science, found that with a one-day supply of prescription painkillers, there’s about a six percent chance “of being on opioids for a year or longer.” A five-day supply jumps to 10 percent. And a ten-day supply bumps the user to a 20 percent chance they’ll still be using a year later.
    • Pain has been considered the fifth vital sign. That being said, 90 percent of all pain is emotion.
    • The differences between acute & chronic pain. See chart below:

    4. Educate Your Clients on Alternative Pain Management Solutions.

     There are emerging evidenced based methods to help individuals, including:
    •  CBT
    • Breathing exercises
    • Qi chong
    • Physical therapy
    • Acupuncture
    • Mindfulness

    A study published in the journal Addiction in 2016 by a team from the Veterans Administration Ann Arbor Healthcare System’s Center for Clinical Management Research found a non-drug approach that combines psychological therapies with a social element. In the study, 55 veterans took part in therapy rooted in the psychological theories of pain and felt the effects last up to a year.

    The theory behind this approach is a self-management of pain. According to Medline Plus, the person experiencing the chronic pain needs help learning to think, feel, and do better, despite the persistence of pain. Self-management programs engage the individual in problem-solving, pacing, decision-making, and taking action to manage their pain. And they do it in a supportive environment where the social element plays a huge role because research shows that there is a link between pain and depression. Pain is responsive to mood and mood is responsive to social support, thus working through pain in a social environment posts strong results in healing.

    With research showing that the support of others aids in recovery, centers willing to address the issues of pain management and recovery, and the medical community rethinking how opioids are prescribed, there are new ways developing to more effectively deal with chronic pain and the mental health and lifestyle issues that arise from these conditions.

    Another alternative pain management solution that is gaining traction is meditation. Scott Weiss, clinical director at Bodhizone Physical Therapy and Wellness in New York City, who works with professional athletes, regularly prescribes meditation. “People often find meditation hard to swallow,” Weiss tells Outside Magazine, “but with the right instructor, they can start finding relief in just one session.” In fact, Weiss claims that half of the injured athletes he sees use meditation, and of those, 80% report reduced pain.

    A Call to Action

     I urge all of my colleagues in behavioral health care to rethink how we talk to our clients about opioids. We must educate them on the risks of taking prescription opioids, open up honest dialogue, and work with friends, families, coworkers and communities to promote lasting change. Lastly, since chronic pain is a leading driver of opioid use and opens the door to addiction, we must educate our clients in alternative pain management forms to promote healthier ways of living. These changes begin with open dialogue with our clients, so we can work through this crisis together.

    If you have a client that is experiencing difficulty with depression, anxiety ,chronic pain and/or opioid misuse, please give me a call. There is hope and solutions!

     

    View the original article at addictionblog.org

  • How Can I Explain Pill Addiction to My Child?

    How Can I Explain Pill Addiction to My Child?

    Addiction is Medical!

    Dealing with pill addiction? Are you looking for a way to explain it to your child or a family member?  There is a medical way to explain to loved ones how you are dealing with health difficulties such as addiction. But in order to talk about addiction, you must understand it first.

    This article gives you the basics on:

    1. How addiction influences your system.
    2. The reasons behind it.
    3. Tips for how to talk about it with your child.

    We encourage you to post additional questions in the comments section at the end. We’ll make sure to provide you with a personal and prompt response. Or, if we can answer your questions…we’ll refer you to someone who can.

    What Is Addiction, Really?

    Addiction, or substance use disorder, is a condition recognized as a brain disorder. It is a chronic disease with severe implications on a person’s health.

    When we are addicted to a pill, brain chemistry changes and we start to behave unconsciously and act out of control. This is because many medications can temporarily alter:

    • Decision-making centers in the brain.
    • Motivation.
    • Our ability to feel pleasure.

    When we begin to rely on our prescription pills to feel normal, however, we can develop a disorder which can’t simply be overcome with self-help. This is why prescription pill addiction often requires intervention by doctors and addiction professionals, especially when:

    • You have tried to quit on your own but can’t.
    • Are physically dependent on a prescription medication.
    • Experience multiple negative consequences to health, home, work, or social life.

    Brain Chemistry Changes

    In short, long term prescription use affects brain functions such as:

    • Behavior.
    • Decision-making.
    • Judgment.
    • Learning.
    • Memory.
    • Stress.

    Pills and other prescription medications are designed to change brain chemistry to treat physical and mental conditions. They are actually called “psychoactive drugs” because they affect the brain directly. There are several categories of prescriptions which are target of abuse. These can include central nervous system depressants prescribed for anxiety and sleep disorders, opioids prescribed for pain relief, or stimulants prescribed for attention disorders.

    Examples of drugs that cause brain chemistry changes include:

    • Benzodiazepines like Ativan, Xanax, or Valium.
    • Pain killers like Vicodin, OxyContin, or Percocet.
    • Stimulants like Adderall or Ritalin.

    Our brain functions as a result of a delicate balance of chemical messengers called neurotransmitters. When a prescribed medication enters our system, it directly affect the natural balance of neurotransmitters in the brain. Long term use and/or abuse makes the brain adapt to a new, unnatural neurotransmitter balance.  And when the desire to take pills becomes a pathological craving … it transforms into addiction.

    The Reasons Behind Addiction

    We can never say that people become addicts by choice. On the contrary, when the effects from the drug of choice no longer bring pleasure people desperately want to stop…only they are not able to, at least not on their own.

    Further, addiction is not a disease caused by a single factor. This is why it’s referred as a complex disease. The word “complex” is associated with the multiple factors which contribute to the foundation of addiction.

    According to research and studies by scientists, psychologists, and other professionals in the field of addiction, this disorder has a biological, psychological and environmental background.

    Addiction carries a great burden because it’s a compulsive disorder. Recovering from it requires monitoring from professionals and a controlled environment such as treatment centers. Pill addicted individuals can’t quit using by themselves because they often experience strong and unbearable withdrawal symptoms. This discomfort brings them back into the circle of taking pills over and over again to numb the pain and avoid further withdrawal.

    Genetics And Environmental Factors

    Many scientist and researchers in the field of addiction have questioned themselves why do some people become addicted while others don’t? The results of their studies have proven that there is not a single factor which can predict that a person has the possibility to become a drug addict. Instead, results of addiction studies have discovered that addiction is influenced by a combination of biological psychological and environmental factors.

    Biological factors outline the importance of the genes that people are born with. Genetic predispositions carry a 50% risk for addiction. The presence of other mental disorders may also influence risk for drug use and addiction. Knowing your family history of diseases can help you pay an extra care and attention when trying and reaching out for drugs, alcohol and prescription medications.

    Environmental factors include everyday influences, from family and friends, social groups, economic status and overall your general life quality. Among the most common environmental factors that can contribute to the occurrence of addiction are:

    • Early exposure to stress.
    • Parental modeling.
    • Peer pressure.
    • Physical and sexual abuse.

    More on Biological Factors

    Before an individual develops addiction to prescriptions, they often pass through several stages of physical change. Some people can develop physical dependence on a drug, for example. This means that the brain adapts to the drug and provokes withdrawal symptoms when doses are lowered to stopped. Others even become tolerant of the effects of medication, needing more medicine more frequently for initial effect.

    When explaining tolerance and dependence, it is important to know that they are referred to the physical consequences of drug use. In contrast, addiction is a term referred to the need of engaging in harmful, abusive behaviors. Moreover, addiction develops when a person becomes physically, psychologically and emotionally dependent to pills.

    As the brain adapts to the presence of prescription pills over time, chronic users may begin to respond to their prescription differently than those who have used it in accordance with physician’s guidance. They may start to:

    • Increase dosing.
    • Increase frequency of use.
    • Doctor shop.
    • Hide or lie about Rx drug use.
    • Prioritize the drug use above other activities.

    Addiction: A Brain Disease – Not A Choice!

    Prescriptions drugs and substances influence the brain’s “reward circuit” by interfering with the quantity of neurochemical messenger called dopamine. Dopamine neurotransmitters influence our centers for pleasure together with the reward system and motivates individuals to repeat behaviors in order to keep their level of happiness. The natural activities which increase our level of dopamine are: eating, sleeping, having sex, spending time with loved ones…etc. Abusing prescriptions over stimulates the reward circuit causing the intensely pleasurable “high” that often times leads people to repeated drug abuse.

    As a person continues to abuse their prescribed pills, the brain readjusts to the new state of excess dopamine by producing less of it. This is how abusers feel a reduction in their ability to experience high and feel pleasure in comparison with when they first started taking prescription— effect known as tolerance. They might take more pills, trying to achieve the same dopamine high.

    Not only that…. prescription drug users feel a reduction in the effects from their pills, but they also lose their ability to enjoy every day activities which use to bring them natural pleasure such as food or social activities. Depression can appear shortly afterwards.

    Explaining Pill Addiction to a Child

    Deciding to talk to your child about your pill addiction already shows a great level of courage and consciousness. In fact, your child may have already noticed you are not well. They are probably curious and concerned about why you are not feeling yourself.

    Honesty can be the best place to start. Before you begin, you’ll need to consider the age and maturity of your child before talking to them. Keeping the conversation age appropriate is important because younger children simply can’t understand the meaning of the term “addiction”, so you may need to replace the term with “illness” in order to bring this subject closer to them.

    As for teenager and older kids it’s best to be completely honest and say what going on directly. Teenagers and older kids value honesty. Telling them the truth will make them feel as if you feel they are old and mature enough to know about addiction.

    Here are some suggested tips of what to have in mind when you want to approach your child and explain your pill addiction:

    TIP #1. Use comparison with other illnesses in order to bring closer the subject of pill addiction to your little child. You might want to compare your illness with a very bad headache, or a stomach flu that just doesn’t go away. For older children, you might compare drug use with smoking. Whatever you choose, make the model tangible and relate-able.

    TIP #2. Listen to your kids. Ask them what they’ve observed in your behavior. Be prepared to answer their questions and concerns regarding your condition. Encourage them to tell you what they think.

    TIP #3. Make sure to provide your children with a strong support system. Or, set up family counseling sessions with a child psychologist who has experience in family addiction issues. They need to have someone to lean on when you leave for recovery. And professional help can guide you through the entire process.

    TIP #4. Take away any guilt. Make sure that your child understands that s/he is not responsible for your pill addiction.

    TIP #5. Prepare your recovery plans in advance and share them with you child. Share the plan with them. If you are leaving for an inpatient rehab stay, outline the visiting days. Talk about rehab like a camp for adults.

    Who else might you advise?

    • A licensed addiction counselor.
    • A licensed clinical social worker.
    • Family psychologists.
    • A psychiatrist.

    Seriously consider the process of family counseling. With the help of family therapy, members revalue the way they communicate and react to one another. Together, you and your child(ren) can look at how you conduct yourselves in ways that are hurtful or helpful. During family therapy, members also learn how to modify their behaviors to support each person. You’ll learn how to better communicate with each other, and practice new ways of talking, relating, and behaving.

    Now, Your Questions

    Do you have additional questions about explaining an addiction to your child? Please share your questions and/or experiences with successful (or not) communication in the comments section below. We’ll try to respond to you personally and promptly.

    Reference Sources: NIH: Understanding Drug Use and Addiction
    NIH: How Do Prescription Drugs Work in the Brain?
    All About Counseling: Telling Your Kids About Your Addiction
    Huffington Post: As a Mom in Recovery, How Do I Explain My Addiction to My Kids?

    View the original article at prescription-drug.addictionblog.org