Typical Addiction Story

I am posting this message from the ‘comments’ section for a couple reasons; first because it highlights a couple things that go on with addiction, but second because it is from a person who is clearly hurting and in trouble– and is in a place where many of us have been before. This is a typical addiction story.

The message:

I have been an opiate addict for about 5 years now. I started off on prescription pain pills like Vicodin, Percocet, Lorocet, etc.. Then when that wasn’t good enough, I moved onto Oxycontin. I have an extremely high tolerance to pain pills. Last summer I checked myself into a 7 day in-patient detox hospital, and they put me on Suboxone. Starting at 8mg/day and tapering down to 4mg/day. I stayed on the 4mg/day for quite awhile. I then tapered off the Suboxone by myself. It took me about 2 weeks to really start feeling ok. About 3 months after I was clean of everything, I relapsed on Heroin. I did Heroin for about 5 or so months. I was doing about 10 bags/day at $20/bag. When I realized I couldn’t go cold turkey off the Heroin, I reached out for help again. I went back to my Suboxone Dr. and he put me on 16mgs/day to start. I tapered down eventually to 4 mgs/day. I stayed on the 4 mgs for about 5 months and about 4 days ago, I came off of the Suboxone totally again. I tapered of course. Well, when I came off of the Suboxone, I just so happened to run out of my Xanax at the same time. So I was going through Opiate and Benzo withdrawal at the same time. It was pure hell. I thought I was going to lose my mind. I was going to go to the hospital, but thank God my Dr. wrote me a script for 150 0.5 Xanax’s with me taking up to 5 per day. The Xanax is really helping me a lot with the Suboxone withdrawal. But I know it’s just another Narcotic drug, and just another crutch. I seem to be in a vicious cycle here. Should I stay on the Xanax for the time being while I’m coming off the Suboxone? So far, I’ve been taking Xanax for about 4 months. And before when I was a very active drug user, I took benzos whenever I could get them. So I have an extremely high tolerance for them as well. Am I making this worse on myself by continuing to take the Xanax, or is it ok until my Suboxone withdrawal is all gone. I know I can’t come off the Suboxone cold turkey. I’ll have to taper for sure. Any feedback from anyone is greatly appreciated. Thank you.

My reply:

First, understand that many of us have been where you are; there are several ‘solutions’ that range from temporary fixes (not a great term in this setting!) to life changes that have the potential to help you find a much better life.  I want to point out a couple things for you and for other readers before getting into treatment issues.

You have been using for ‘about five years’.  There is an opiate addict ‘inside’ of you; your use has been fueled by a combination of genetics, psychodynamic personality factors, conditioning, fear of withdrawal…  what makes you think that Suboxone will make any of these things go away?  You go on Suboxone– it treats your cravings and prevents withdrawal, and things stabilize… but when you go off if it you are right back to where you started.  Nothing has changed, and in such cases opiate use always returns.  Why wouldn’t it?

I think that the way you have used Suboxone (perhaps the fault lies in your doctor) invites disaster;  We know that people who take a break from using and then return often pick up at a higher level of use– such as going from oxy to heroin, or going from snorting to needles. Subxone does nothing by itself to ‘fix’ the underlying factors that result in addiction.  So my first suggestion is to get back on Suboxone and stay there until significant changes have occurred in your life– including getting off the Xanax. You have things backward in stopping the Suboxone and then stopping Xanax;  you should stay on Suboxone until the other things are changed– which may not happen for a long, long time.

Xanax has been addressed in other notes.  It is a bad med for many reasons (as are all of the benzos); the tolerance results in ever-increasing dosages; the withdrawal consists of severe anxiety, which patients mistake for an anxiety disorder;  it is very hard to get off of; benzos interfere with cognition in people who often have ADD; benzos ‘fire up’ the addictive pathways in the brain, and finally, opiate addicts tend to focus too much on how their bodies ‘feel’, and it is important that they learn to direct their attention ‘outward’… but benzos reinforce paying attention to physical feelings.  People on benzos long-term tend to get worse and worse, as they become more and more tolerant to benzos:  after each dosing cycle the anxiety returns, fueled by benzo withdrawal… the anxiety becomes more and more the center of their attention… benzos cause their sleep to fall apart… and eventually you have a big mess.

I do recommend getting off benzos, but benzo withdrawal can be fatal– so consider getting assistance from your doc.  It is often easier to go on a longer-acting benzo like clonazepam and then taper that down.

The doc that gave you 150 Xanax tablets is a fool.  You wrote that you were greatful, but that is the type of practice that kills people– either quickly or slowly.

Suboxone will keep things stable and treat addiction just as medications treat hypertension.  Addiction and hypertension are both chronic disorders;  they both respond to medication, and many times they both can be treated by other things.  For hypertension we recommend diet changes and exercise.  For addiction the only proven treatment is ‘step-based’.  In our modern culture people like the quick solutions that come in pill form; for both hypertension and addiction the best answers lie in taking the longer path.  I have mentioned AA and NA before;  I strongly encourage you to look into them.  If you can ‘get it’ through meetings– find the ability to let go and change– then you can think about stopping Suboxone.

The alternative is to stay off Suboxone and get to a meeting TODAY… I recommend getting to one soon, before another relapse, as each relapse tends to be a bit worse.