INDIFFERENCE!!! Now need some help and feedback, please!

[TX Git Slinger]

Hi all,
I haven't posted much, if at all, since first starting on the Baclofen protocol. 23 DAYS AGO I HIT "INDIFFERENCE!!!! I put indifference in quotes because it did take a bit of effort to put down the booze. One morning after an all night binge of cocaine and bourbon, I just decided "this is it," no more alcohol. I haven't drunk anything since.

I will attest that there is NO WAY I could've quit that abruptly--or at all--without the Bac. I do still have some cravings but they are minimal and are fleeting.

I titrated up to 350 mg. I was about to give up and had all but lost hope, but something snapped and I quit. The side effects were almost unbearable at times. I finally set up and appt w/ Dr Levin two weeks after "indifference."

He maintains that the "side effects" are not so much from the Bac as they are my brain and body adjusting to the new "re-wiring." He suggested I take my last dose at least two hours before bed and said that, in doing so, the side effects would abate. They have a bit, but I'm still feeling loopy most of the time and have this incessant fluttering in my ears.

One thing he said that concerned me: that I will have to stay at the 350mg dose and will not be able to titrate down. I was so hoping to get down to the level that Ameisen titrated down to (30 to 50 mg). Levin said that that was just a wishful prophecy on Ameisen's part and that he found that he had to go back up to his high dose--which he said was in the mid-300's (I had read 280mg).

Anyway, I"m looking for some feedback from others who have titrated down. Success? Failure? The other thing that is annoying is the weight gain I have experienced. I have gone back to working out, yoga 5 days a week and swimming and have yet to see the weight I gained go down :-(. I got incredibly atrophied and out of shape during the last few months of my heavy drinking.

All in all, I am very very pleased and amazed that the stuff worked! Hallelujah!

[RudyB]

INDIFFERENCE!!! Now need some help and feedback, please!

hey TX! welcome and congrats! don't worry about your weight, it'll slide right off without the booze! promise. (i've gone down two sizes in five months, for example. without really changing much in my routine.)

i, too, was hoping to drop way down after indifference, but so far concensus seems to be that we must stay at our near or switch dose, alas... (don't know if that's set in stone, though.) the good news is that you won't be a drunk anymore, and the se's, they say, do abate.

good luck!
rudy

[Road to Recovery]

INDIFFERENCE!!! Now need some help and feedback, please!

Slinger,
I stayed on my switch dose for about 2-3 months before I started titrating back down. I went down slow in case the beast tried to take over again. I was bale to sucessfully titrate all the way off bac without any changes in my feelings toward AL. I have been off bac since October of 2010 and am still indifferent. I have also comitted to abstaining.

[GingerDust]

INDIFFERENCE!!! Now need some help and feedback, please!

Hi TX. :welcome:

Congrats on quitting drinking. That's Wonderful!

I'm confused about what the doctors say and it seems they're confused about what each other says?

It seems to me that most people here take a more fluid approach and decrease/increase the dose as needed.

D&T bumped a thread for you about people who went low dose after hitting the switch. It's here

https://www.mywayout.org/community/f2...age-52627.html

[tiptronic_ct]

INDIFFERENCE!!! Now need some help and feedback, please!

RudyB;1192395 wrote:
i, too, was hoping to drop way down after indifference, but so far concensus seems to be that we must stay at our near or switch dose, alas... (don't know if that's set in stone, though.) the good news is that you won't be a drunk anymore, and the se's, they say, do abate.

There is no such consensus. Lots of people have successfully tapered down to a so-called maintenance dose.

Fundamental to this discussion is this: do you opt for abstinence or moderation post switch. If it's the latter, you'd be a fool to taper down from the switch dose, because you risk a return to full-blown alcoholism. If it's the former, you can safely taper down. IMO.

[Cassander]

INDIFFERENCE!!! Now need some help and feedback, please!

tiptronic_ct;1192446 wrote: There is no such consensus. Lots of people have successfully tapered down to a so-called maintenance dose.

Fundamental to this discussion is this: do you opt for abstinence or moderation post switch. If it's the latter, you'd be a fool to taper down from the switch dose, because you risk a return to full-blown alcoholism. If it's the former, you can safely taper down. IMO.

Tip --

I'm sure you are right. But isn't one of the (many) miracles of baclofen that once having reached indifference, an alcoholic can see whether abstinence or moderation suits him/her, and can "play" with her/his dose and find a comfort zone. And (here's the miracle) if one attempts moderation at low doses of bac, and fails, there is still the possibility of titrating back up and "recovering" indifference. Before bac the range of outcomes from relapse were not nearly so promising. Do you agree?

Cass

[tiptronic_ct]

INDIFFERENCE!!! Now need some help and feedback, please!

Cassander;1192466 wrote: Tip --

I'm sure you are right. But isn't one of the (many) miracles of baclofen that once having reached indifference, an alcoholic can see whether abstinence or moderation suits him/her, and can "play" with her/his dose and find a comfort zone. And (here's the miracle) if one attempts moderation at low doses of bac, and fails, there is still the possibility of titrating back up and "recovering" indifference. Before bac the range of outcomes from relapse were not nearly so promising. Do you agree?

Cass

Yes, there is that possibility, and we've seen people returning to MWO after having failed at their attempts at moderation at lower doses to start their bac titrations again.

For me, the choice was a simple and stark one: literally life or death. I was in terrible shape when I found this place and started taking baclofen. I chose life, and I also choose not to risk it again. Abstinence is a no-brainer for me.

I recently managed to stop smoking after 26 years. I also don't intend moderating nicotine. I don't believe moderation works. But that's just me.

[Cassander]

INDIFFERENCE!!! Now need some help and feedback, please!

tiptronic_ct;1192477 wrote: Yes, there is that possibility, and we've seen people returning to MWO after having failed at their attempts at moderation at lower doses to start their bac titrations again.

For me, the choice was a simple and stark one: literally life or death. I was in terrible shape when I found this place and started taking baclofen. I chose life, and I also choose not to risk it again. Abstinence is a no-brainer for me.

I recently managed to stop smoking after 26 years. I also don't intend moderating nicotine. I don't believe moderation works. But that's just me.

Hey Tip --

Thanks for your response. Let me ask you another question.

A big issue -- maybe the big issue --- in baclofen therapy seems to be side effects. For some, side effects are minimal (and for a small number, non-existent) but for many they are a big concern, bigger than Dr A seems to have experienced and bigger than Dr L seems to be advising his patients.

One reason for the discrepancy may be speed of titration...the SEs may be worse the faster one goes up...but indifference may be achieved faster. Perhaps a reasonable trade off. (I think I know there is no unanimous agreement on whether SEs are better or worse based on speed of titration)

Another reason why side effects may differ (it seems to me) is the amount of alcohol (or other chemicals) one is ingesting while titrating up. Do you agree? Do you think SEs are exacerbated the more you're drinking during titration up? Do you think benzos, cannabis, SSRIs, etc affect SEs? One reason I ask is that the studies of baclofen for muscle spasticity do not seem to show the extent of SEs that people report on MWO.

So, it makes me wonder (and I know I am drifting afield here) whether the ideal baclofen therapy would be in a controlled environment where alcohol is reduced/moderated/eliminated while bac is titrated up?

I have been wondering what is the future of Hazelden, Betty Ford and Caron (and hundreds of other rehab centers) if (when!) it is proven that baclofen therapy is more effective than traditional AA-based rehab/recovery. Perhaps these centers could reinvent themselves and their 28-day rehab treatment as in-patient baclofen treatment facilities where patients could undergo a titration course under medical supervision and with professional support. And as a result perhaps indifference could be achieved more quickly and with fewer side effects.

Just thinking...What do you think?

[Road to Recovery]

INDIFFERENCE!!! Now need some help and feedback, please!

I agree Totally with you Tip. Alcohol was destroying my life - why would I want to give it a second chance?
Cassander:
Correct me if I am wrong but with muscle spasticity treatment - I believe the highest dose perscribed would be 80mg, hence the reason most DRs will only perscribe a maximum of 80mg for alcohol abuse.

[Cassander]

INDIFFERENCE!!! Now need some help and feedback, please!

Road to Recovery;1192536 wrote: ...
Cassander:
Correct me if I am wrong but with muscle spasticity treatment - I believe the highest dose perscribed would be 80mg, hence the reason most DRs will only perscribe a maximum of 80mg for alcohol abuse.

Hi Road

I'm going totally on foggy recall here, but I think there are reports and/or studies of docs prescribing bac in doses above 80 for spasticity without the extent of side effects reported here. But I'll have to dig back to see if that recollection holds up.

Cass

EDIT: PS Yes, I believe the reluctance of docs to prescribe HDB is based on safety limits established for spasticity treatment. That and baclofen for alchoholism is "off label". Do others agree?

[tiptronic_ct]

INDIFFERENCE!!! Now need some help and feedback, please!

Cassander;1192510 wrote: Hey Tip --

Thanks for your response. Let me ask you another question.

A big issue -- maybe the big issue --- in baclofen therapy seems to be side effects. For some, side effects are minimal (and for a small number, non-existent) but for many they are a big concern, bigger than Dr A seems to have experienced and bigger than Dr L seems to be advising his patients.

One reason for the discrepancy may be speed of titration...the SEs may be worse the faster one goes up...but indifference may be achieved faster. Perhaps a reasonable trade off. (I think I know there is no unanimous agreement on whether SEs are better or worse based on speed of titration)
There might not be unanimity, but a majority would support the notion that a slower titration is likely to result in fewer SEs. But yes: reasonable trade off is a good description. Depends on how ill the patient is, I guess.

Cassander;1192510 wrote:

Another reason why side effects may differ (it seems to me) is the amount of alcohol (or other chemicals) one is ingesting while titrating up. Do you agree? Do you think SEs are exacerbated the more you're drinking during titration up? Do you think benzos, cannabis, SSRIs, etc affect SEs? One reason I ask is that the studies of baclofen for muscle spasticity do not seem to show the extent of SEs that people report on MWO.

I don't know to what extent all these permutations and scenarios can affect SEs. Collectively, we've spent months discussing it. The reactions seem to be very individual with very few distinct trends.

To me, it seemed intuitive to deliberately taper my alcohol intake as I titrated up on baclofen. It lessened the risk of serious AWD and seemed to be the kinder, gentler option - compared to cold turkey.

As a general principle, I'd say the idea is to reduce harm as far and as quickly as possible and even kick-start the healing process.


Cassander;1192510 wrote: So, it makes me wonder (and I know I am drifting afield here) whether the ideal baclofen therapy would be in a controlled environment where alcohol is reduced/moderated/eliminated while bac is titrated up? I have been wondering what is the future of Hazelden, Betty Ford and Caron (and hundreds of other rehab centers) if (when!) it is proven that baclofen therapy is more effective than traditional AA-based rehab/recovery. Perhaps these centers could reinvent themselves and their 28-day rehab treatment as in-patient baclofen treatment facilities where patients could undergo a titration course under medical supervision and with professional support. And as a result perhaps indifference could be achieved more quickly and with fewer side effects.

Just thinking...What do you think?

I've given this only superficial thought, simply because it hasn't been relevant to my own recovery and we're so far off from having bac recognised as a valid / preferred treatment for alcoholism here in South Africa, that my energies have been focussed elsewhere.

The potential is huge, though. But it will also be a minefield: allowing a severy ill alcoholic to drink despite looming hepatic failure, for example? Issues of liability etc. will become problematic.