The Benzo Bends

This article explores the potential problems with long-term use of anti-anxiety medication and the importance of re-humanising the treatment of emotional distress. The original article, published in the Irish Examiner can be read here

 

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By Liz Dunphy

Every morning Carmel wakes up from a fitful, toxic sleep in her Tipperary home. Her whole body vibrates like an internal jackhammer is belting her from inside — a loud sharp tinnitus floods her brain with distracting noise, her muscles forget how to function and her skin feels too tight for her body.

These are just some of the symptoms that have plagued Carmel for 19 long months since she stopped taking low daily doses of Valium which she was prescribed since August 2007.

Valium (or diazepam) is a benzodiazepine, a drug mostly used to treat anxiety disorders and muscle spasms. Benzodiazepines enhance the effect of the brain’s tranquilising neurotransmitter GABA which slows down over-activity to reduce symptoms of anxiety.

Many others could be experiencing Carmel’s painful and isolating withdrawal symptoms in Ireland today. The 2012 HSE PCRS report which lists the 100 medications most frequently prescribed to medical card patients ranked diazepam as the 26th most prescribed drug in Ireland, having dropped one place in Ireland’s drug popularity stakes from 25th place in 2011.

There is no official data on how frequently private prescriptions for benzodiazepines are issued, but Minister Kathleen Lynch says benzodiazepines are being excessively prescribed.

“We have to take a serious look at prescribing practices across the whole Department of Health, the problem is not just limited to psychiatric illnesses,” says Minister Lynch.

Ivor Browne is Professor Emeritus of Psychiatry at UCD, he was the Chief Psychiatrist of the Eastern Health Board and he is an eminent author on mental health.

Browne believes that benzodiazepines can be useful for relieving temporary anxiety but they should not be used on any regular or long-term basis because they are habit-forming.

“Anything that removes anxiety will be potentially addictive,” says Browne.

“Valium or its generic form Anxicalm can be effective, but all of these drugs are grossly overused, the person experiencing difficulties must work to overcome the traumas they have suffered with the support of a therapist.

“Psychotherapy, when it’s effectively undertaken, is the only real therapy. And Prozac and all other SSRIs (Selective Serotonin Reuptake Inhibitors, used as antidepressants) are actually dangerous and in my opinion should never be used,” says Browne.

“Everything is disconnected in our society when everything in reality is interconnected, this needs to change to solve our societal problems.

“We need to recognise that the heart is our real centre, not the brain. All our emotional life is centred in the heart and there are more messages going from the heart to the brain than vice-versa. There’s an awful lot yet to be understood,” says Browne.

Prof David Healy is the Professor of Psychopharmacology at Bangor University in Wales, he is Irish and his innovative website www.RxISK.org  invites people to research and report the benefits and side effects experienced when using prescription drugs. People can record their experiences on the website which will generate a free RxISK report that they can bring to their own doctor.

The gathered accounts form a database that aims to make medicine safer for patients. Healy believes it can also help to equalise power between doctors and patients by giving patients an option to record their symptoms with other medical professionals for free. And Healy believes that equalising that power is vital to improving our healthcare system.

“In the 1960s drugs were viewed as poisons. The magic of medicine was that doctors could use poison to produce good. Industry has changed this model, turning pharmaceuticals into something to be used as a fertiliser, to be sprinkled widely, but these drugs are generally tested on people for four to six weeks, not for the months or years that people are actually prescribed them for.

“The human body can take poisons for a month — but not for indefinite, constant periods of time without doing damage,” says Healy.

Bridget Hayes, a mother of three is from Limerick, she was prescribed Xanax for 20 years to treat anxiety which began when she experienced thyroid problems.

“I feel like I’ve lost 20 years of my life. I was turned into an addict. I went to hospital as a day patient for years and no one said that I shouldn’t be on all these medications for so long, no one ever mentioned that they could be addictive either,” says Hayes.

“And they never offered counselling, even though they had a psychotherapist in that hospital. They just dish out tablets, and there are obviously reasons why people feel anxious or depressed which they need to talk about and understand. Psychotherapy should be the first port of call for these problems.”

Echoing concerns voiced by Prof Healy and Prof Browne about the additional dangers of SSRIs, Hayes noted that when an SSRI called Seroxat was added to her drug cocktail things got even worse.

“On Seroxat I lost all emotion, I couldn’t feel anything and I didn’t care about anyone, least of all myself. I had never had depression before but this anti-depressant made me feel suicidal. I started drinking heavily and I tried to kill myself a few times.”

Hayes realised that the medication was making her worse, and asked to stop.

“Dr Terry Lynch saved me. I read his book Beyond Prozac and I recognised myself in it. I started the Ashton method with Dr Lynch to come off Xanax, he taught me coping strategies and he’s a huge support,” says Hayes.

The Ashton method is a protocol for benzodiazepine withdrawal developed by Professor Heather Ashton, an Emeritus Professor of Clinical Psycho-pharmacology at the University of Newcastle upon Tyne, England, in which you slowly reduce your dose while managing your symptoms. The Ashton Manual, which includes tapering schedules, is available on www.benzo.org.uk

“Once I came off Xanax and only took small doses of Valium I suddenly regained feelings and memories,” says Hayes. “My parents died a few years ago but I cried over their deaths for the first time recently, I had been so numbed by medication that I couldn’t feel any emotions.”

Hayes still has good and bad days but she has learned coping mechanisms, like deep breathing to deal with anxiety without medication.

“I feel cheated from so many years of my life. I have to go through hell to get off the medication and the people who put me on it can’t help me. The receptors in my brain are still damaged from the medication and it will take time to heal,” says Hayes.

“And it’s such a contradiction, these drugs are known to cause depression and anxiety as a side effect, yet people are prescribed them to treat those very symptoms.”

Dr Terry Lynch who helped Hayes with her benzodiazepine withdrawal, practiced as a GP before noticing problems in how medicine addressed mental health issues. He writes books on the topic (including a best seller Beyond Prozac, and a new book Depression Delusion, Vol.

One: The Myth of the Brain Chemical Imbalance, published this month). He now works full time helping people to improve their mental health through a combination of emotional, psychological and physical interventions, including medication.

“The existence of brain chemical imbalances, which psychiatric drugs are supposedly designed to correct, has never been scientifically verified. It’s a widely promoted and accepted myth. The pain and distress are very real but the chemical imbalance is not.

“These problems need to be addressed from a broader perspective, one that includes the emotional and psychological aspects of the person as well as the physical.

“The starting point should be seeking to make sense of people’s experiences and emotions at a human level,” says Lynch.

“Generally the medical profession now accept that benzodiazepines can be addictive and can cause difficult withdrawal symptoms but that awareness came belatedly.”

Lynch is concerned that a similarly delayed recognition of the potential problems with SSRIs may be currently unfolding. “As a society, we need to reconsider whether a biologically-dominated model for emotional and mental health and wellbeing is best for people or not,” he says.

Unexpected journeys can begin in the most mundane of ways. Mary*, a young mother from Tipperary fell off a slide while on holiday when holding her four-year-old on her lap.

“I got burning nerve pains after the fall, I thought that I had a degenerative neurological disease and I got quite depressed. My GP gave me an anti-depressant called sertraline (a SSRI), Xanax (alprazolam — a benzodiazepine) and the sleeping pill zopiclone ( a Z drug that works in a very similar way to benzodiazepines).

“Four weeks later I experienced severe, deep twitching in my legs and I still had burning nerve pains. I went to see a consultant who prescribed amitriptyline which worked well and ended my nerve pain, but afterwards I was hospitalised for tachycardia, which was actually quite lucky because the hospital diagnosed drug-induced arrhythmia, so I knew then that the medication was causing problems.”

Mary* only took the medication for six weeks but she has battled withdrawal symptoms for 13 months. “I asked to come off the medication and I didn’t crave it at all but my body and brain just couldn’t adapt quickly to functioning without them. But my cousin took them for three to four months and stopped taking them with no problems, so we all react differently,” says Mary*.

“I found that my symptoms matched the benzodiazepine withdrawal symptoms others reported on the internet. I learned that certain substances, like sugar and alcohol really aggravated my symptoms because they excite the nervous system, and MSG is a neurotoxin anyway so this worsens my symptoms too.

“Once I had information I felt more in control of what was happening. But Baylissa Frederick really saved me, she set up great online resources http://www.RecoveryRoad.org and a counselling website http://www.baylissa.co.uk. Without Baylissa’s help and support I’d either be on a very hard, painful, lonely road or else I’d be dead.”

Baylissa Frederick, the woman that Mary* attributes with helping her to cope with withdrawal, was first prescribed the benzodiazepine clonazepam in early 1998 for dystonia, a movement disorder.

“I didn’t know the drug was addictive until I started feeling unwell, I exhausted diagnostic tests and had multiple emergency visits to casualty, before I found the Ashton Manual online.”

“Of all the people I’ve supported, 90% found out the drug was the cause of their problems via the internet and asked their doctors to come off it. They print off tapering schedules from the Ashton Manual to bring to their doctors.

“For those on the drug who plan to stop taking it, never stop abruptly. Speak to your doctor and find a tapering schedule that is safe and not rushed.”

Frederick believes that normal emotions such as grief and stress are now pathologised.

Instead of allowing people to process these feelings and deal with them through talking and human support, people visit their GPs and end up with a prescription to a drug that could potentially cause them further problems.

“Many of the people I support were put on benzos, z-drugs and antidepressants for normal reactions to grief. At first I was shocked at how many had become dependent on these meds because of a bereavement,” says Frederick.

“Benzodiazepines basically put a chemical cushion between you and reality,” says Dr John Dunphy, a GP in Carrigaline, Co Cork, “that cushion can be very useful if you hit a rocky patch that is too uncomfortable to bear temporarily — but the problem is that that cushion can also smother you if it’s not closely monitored.”

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Challenging perceptions of addiction

Do we need to alter our understanding of addiction to tackle it effectively as a society?

This article from the Irish Examiner explores alternative perceptions of addiction and interviews people who have conquered their addiction. The original article can be also read here.

Heroin users and the effect drugs had on them

By Liz Dunphy

 As addiction insidiously strangles our streets and often targets vulnerable youth, new perceptions of addiction, and policies designed to target it are gaining international traction.

Portugal has de-criminalised all drug possession to seemingly positive effect, and even some US states are de-criminalising and legalising drug use amid a growing realisation that the ‘war on drugs’ is failing.

Recently even a fashion trend that was criticised for glamourising everything from drug-use to dirty hair, extreme skinniness to extreme kohl eyeliner has influenced an effecting video project which adds to these new narratives on addiction.

 

Downtown Divas contrasts the high fashion photographed in the ‘Heroin Chic’ look that dominated the 90s with real-life contemporary heroin addiction and the physical, mental and emotional toll that the drug takes on users.

Gigi Ben Artzi and Loral Amir’s project shows women in designer clothes talking about their hopes and dreams, their loves and memories. (https://vimeo.com/108770583 )

These women are addicted to drugs, living dangerous and chaotic lives but the project focuses on their humanity rather than reducing them to their addiction or to the prostitution which helps fund it.

This intimacy and honesty helps viewers to break through the wall that addiction can erect around an individual, which often bars us from recognising our similarities and shared vulnerabilities. Fashion is used as a vehicle to re-contextualise these women’s stories and to subvert prejudices, and the concept of fashion, which is so often concerned with escapism ironically resonates with the escapism inherent in drug use while temporarily allowing these women to escape from their dangerous lives.

Heroin Chic as a sartorial trend originally arose in the 90s as a stark reaction to the glamour-on-amphetamines, hyper-consumerism of the 1980s.

Created largely by fashion photographer Corrine Day and the then adolescent Kate Moss, the photographs that started the ‘Heroin Chic’ aesthetic were often shot in dingy apartments and began Moss’ speedy rise to become arguably the iconic face of that generation and the next.

That it is still spawning influences now, from the resurgence in 90s fashion in 2014 to this intimate portrayal of women suffering from heroin addiction is a reminder of the potency that images can have when they tap into the zeitgeist, especially in today’s hyper-mediated societies where images have become so dominant that we’re arguably moving towards a hybrid form of hieroglyphic communications.

And perhaps this honest and intimate glimpse inside the minds of some of the most marginalised in our society can remind us of our shared humanity and help mount pressure to improve services and perhaps to better understand and relate to addiction.

Tony Duffin, Director of the Ana Liffey Drug Project which is currently calling to legalise medically supervised centres where addicts can inject and have their habits better monitored (and hopefully reduced) while also taking needles and drug use off the streets, believes that such portrayals may be useful.

“We work with thousands of people who are affected by addiction in Ireland and they all have hopes, fears and dreams like anyone else. People who use drugs need to be portrayed as human beings and not merely as drug users.

It is important that the lived experience of people affected by addiction is portrayed and the stigma they encounter is challenged. It is also important that this is done in such a way that promotes the dignity and respect of those people who are telling their story,” says Duffin.

James from Cork, now 18 months free from heroin, also believes that it is important to amplify marginalised voices in our community.

“Hearing people’s stories allows to you to empathise with those people on the streets who are often easy to ignore. When you hear their stories you recognise that it could have been you, had your circumstances been different.”

Bruce Alexander, a psychologist and professor emeritus at Simon Fraser University, Canada has found that it may be those societal circumstances that predict addictive behaviours in the first place.

He conducted experiments which contradicted contemporary orthodoxies about addiction as far back as the 1980’s. Up until that point, studies on addiction had found that when rats isolated in cages were given access to morphine they would quickly develop addictions and consume the drug until it killed them.

This finding formed the still largely dominant theory that physically addictive substances such as opiates (like heroin) will turn most users into addicts.

Alexander interrogated this study by creating ‘Rat Park’, a veritable rat heaven where rats could play, mate, rest and feed in a pleasant, stimulating, clean environment. Rats were given access to two water sources, one contained morphine and one contained plain water.

None of these rats developed heroin habits despite having ready access to the drug. Even when Alexander and his team added sugar to the morphine laden water source, rats still chose the clean water.

And after he force-fed the rats morphine for two months they reverted to the clean water supply when given the choice, despite exhibiting withdrawal symptoms.

Alexander simultaneously monitored rats kept isolated in cages and these less fortunate subjects consistently chose morphine over clean water, leading Alexander to the conclusion that happy rats (and as a likely extension happy humans) choose to avoid opiates even when introduced to them, but isolated, unhappy rats self-medicate and presumably escape their miserable reality through addiction.

These findings led Alexander to theorise that addiction is caused by social fragmentation. As the historically close ties to family, culture and spirituality are loosened by a modern global society focused on individualism and unrelenting competition, his thesis contests that people adapt to this dislocation by finding substitutes which often manifests as addiction in all its chameleon guises.

So although differences in vulnerability are partially dictated by genetics, individual experiences and character, addiction in his view is more of a social problem than an individual disorder, caused by wider societal, cultural and political pressures.

And perhaps this is a more useful paradigm to help us understand (and hopefully tackle) addiction.

Brain plasticity – the brain’s ability to grow and change – was only fully accepted and understood in the past decade, so it seems conceivable that with the right support and will people can re-wire their brains to break addiction’s insidious grip.

James sees merit in Alexander’s theory.

“I remember looking in the mirror with tears rolling down my face, not wanting to use heroin but still feeling this compulsion to use. When I moved to a treatment centre in Carlow we were taught Cognitive Behaviour Therapy (CBT), we had councillors who helped us challenge our thought processes in a calm, peaceful environment on a farm close to nature. I didn’t feel that compulsion to use there.”

On leaving the treatment centre he was homeless.

“Cork Simon had just opened a rehabilitation house for recovering addicts. They took me in and they gave me work to do in the organisation. I would have been lost without them.” James is hugely grateful to Cork Simon.

He is now studying Social Studies and Applied Psychology (in the Cork College of Commerce) and plans to continue his studies in Social Science at UCC specialising in Youth and Community, so that he can use his experiences to help other young people.

James feels that the very nature of addiction depends on isolation.

“Addiction wants you alone and dead. And it’s the same mentality regardless of what you’re addicted to, whether it’s drugs, alcohol, food, whatever. That’s how my addiction was, I’d use alone and have suicidal thoughts but through Narcotics Anonymous (NA) I learned to control my thoughts which empowered me. Now I’m in college and the world is my oyster.”

Áine Duffy speaking for Alone, a charity that addresses homelessness and also recognises the link between social isolation and addiction.

“Studies show that isolation and loneliness makes it harder to regulate behaviour,” says Duffy.

Philip McCarthy, a successful film maker who beat a heroin addiction agrees.

“Even when I was young I had the makings of an addict but I didn’t recognise it. I had the best parents in the world but I always felt like I was an outsider looking in at my happy family, I didn’t really feel part of it.”

McCarthy says that suffering sustained sexual abuse and not telling anyone due to threats from the abuser from the age of nine made him turn to drugs to deaden the pain and confusion that the abuse caused. Both McCarthy and James are emphatic that heroin is unfortunately here to stay, and that the only way to prevent new users is through education and support.

“We need more workshops to make kids aware. Many now think that smoking heroin is ok, that you have to use needles to be an addict which is not true. If you have awareness you have choice,” says James.

McCarthy believes that it is vital to get people who have battled addiction and managed to turn their lives around into schools to talk to youths.

“I spoke to kids in Deerpark CBS in Cork and you could hear a pin drop. They listen to you because they know that you’ve been there. All kids will experiment so we need to give them the tools to deal with it,” says McCarthy.

He pours his energy into his films now, he is currently in pre-production on a film about gangland Ireland and he has already cast some Hollywood names and a few members of the RTÉ series Love/Hate in the production which is due to start filming in Cork this summer, and he is also writing his first book.

“The sense of achievement of seeing my films and all that hard work come alive on a screen gives me a rush that no drug ever could,” says McCarthy.

“That sense of achievement is unbeatable and utterly priceless.”

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