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Alcoholism and Anxiety - the missing link

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    Alcoholism and Anxiety - the missing link

    I found this on Dr. Amanda Stafford's site about anxiety being the key to understanding why baclofen works:

    Olivier Ameisen’s book “The End of my Addiction” showed me something I had never really considered before – the reason many alcoholics are so hard to treat is that their alcoholism is driven by anxiety.

    Like many doctors, I assumed that anxiety was a RESULT of the alcoholism rather than the underlying cause. The classic wisdom was that depression and anxiety in alcoholics should firstly be dealt with by treating the alcoholism. When the patient stopped drinking, the psychiatric issues would resolve spontaneously.

    I think it’s clear that alcoholism makes depression worse– alcohol is a depressant after the initial euphoria wears off. We are all familiar with the tears and melancholy which set in after too much alcohol. But alcohol has the opposite effect on anxiety. It HELPS anxiety – this why most people drink alcohol, alcoholic or not. It calms us down, helps us to relax and feel more at ease.

    Reading Olivier Ameisen’s book “The End of my Addiction” was a revelation. I encourage you to read it too as it’s a rare and valuable insight into alcoholism through the eyes of a doctor who lived the problem.

    Ameisen is able to clearly explain what alcoholism is and isn’t and why so many patients fail to get well with current treatments. He emphasised the role of his own severe anxiety in driving his alcoholism.

    This made sense of something which had perplexed me over many years of ED practice –why did so many alcoholic patients relapse into heavy drinking so rapidly, often within days or even hours of leaving hospital, detox or even long term rehabilitation? These patients were no longer in withdrawal, were much healthier than on admission and left with a firm intention to stop drinking forever. The length of time they had been in hospital or rehab made little difference. They had seemed well, motivated and in control. When I asked patients why they had relapsed, it was some variation on “ I couldn’t help myself”.

    In his book, Ameisen described how easy it was to stay sober and calm in hospital and rehab environments – he described rehabilitation as giving “respite” rather than rehabilitation. This resonated with what many patients had said to me over the years. It was easy to stay sober while in rehab but it didn’t help them to deal with the world outside. It wasn’t that anything terribly wrong happened when they got out of rehab, they just couldn’t seem to manage without alcohol in ordinary life.

    The information gleaned from Ameisen’s book prompted me to ask alcoholic patients about WHY they drank alcohol, what it “did” for them. In their current situations, many alcoholic patients described drinking in response to cravings, to stave off withdrawal symptoms and to blot out pain and shame about the life they lived. They said that there was no pleasure in drinking, it was not a choice but a compulsion despite clearly understanding what harm the alcohol had done and was doing and the gloomy future which awaited them.

    It was very revealing to ask about their life long relationship with alcohol: family history, alcohol in the home during their childhood, what their personality as a child was, when they first drank and how it made them feel, their pattern of drinking as they went through teen and young adult years and what role alcohol played in social and professional circles, what events affected their alcohol intake, what caused their drinking to get out of control and so on.

    When I asked, what emerged was anxiety which these patients self treated with alcohol. It was either a primary anxiety disorder without an obvious cause but more often had arisen from traumatic events in childhood or later life that sapped the person’s confidence and resilience in the face of life’s difficult times. The anxiety might have arisen as the consequence of an abusive or unstable childhood, physical or sexual assault, military service or the death of critical people in a person’s life. For these people, life was not easy without something to dampen down their anxiety.

    And alcohol is a wonderfully effective for anxiety. It’s also cheap, legal, very easily accessed, socially acceptable and rapidly effective for anxiety. None of the alternative anxiolytics like cannabis and benzodiazepines have all these advantages.

    In fact we have pretty much all experienced the relaxing effects of alcohol– at the end of a stressful day’s work, at an awkward social gathering or before a public performance.

    Now transpose that into the world of a chronically anxious patient and it’s easy to see how many fall into the trap of alcohol addiction trying to medicate their anxiety. Alcohol starts by helping to manage the anxiety. But if used too often, especially if daily, the patient needs to increase the amount of alcohol over time to get the same relaxing effect. As this happens, the addiction sets in. Any attempt to reduce or stop the alcohol now produces unpleasant withdrawal symptoms. These are the symptoms of anxiety – sweating, tremors, palpitations which alcohol will rapidly fix.

    Many alcohol addicted people can keep partial control over alcohol, drinking only after work or only once the kids have gone to bed. But it doesn’t take much to cross the line to uncontrolled drinking. It could be the loss of a job, a relationship breakup or a death in the family. Life becomes more frightening and alcohol makes it more bearable.

    When first assessing a patient, it can be hard to tell how much of their need to drink now is anxiety and how much is addiction. In reality it doesn’t really matter because both need to be addressed. This is one of the major advantages of baclofen – it treats both anxiety and cravings so is more likely to help this hard to treat group, the anxious alcoholic. Importantly the anxiolytic effect is felt at the lowest doses of baclofen, often well before the anticraving effect kicks in. This encourages the patient to stay on the baclofen while it is titrated up over a period of weeks, because they can feel a beneficial effect on their anxiety right from the start.

    The other anti-craving medications currently used for alcohol addiction, naltrexone and acamprosate, don’t help anxiety. Diazepam is sometimes prescribed long term to anxious alcohol addicted patients on the basis that it’s preferable to replace the more harmful alcohol with less harmful benzodiazepine. However although benzodiazepines are effective for anxiety, they also have exactly the same problems as alcohol in terms of addiction risk and poor functioning.

    Treating the anxious alcohol addicted patient can require baclofen alone but most benefit from additional treatments – these include SSRI or SNRI antidepressants or mirtazapine. Equally important are non-pharmacological treatments to help the patient deal with anxiety such as exercise, counselling, relaxation techniques, mindfulness techniques and re-framing techniques like CBT and DBT. The key is finding the right combination of treatments for each patient. Pharmacological and non-pharmacological treatments are not mutually exclusive at all – medication can support a patient through difficult times and until non-medication techniques can be learnt and established for coping with anxiety in daily life.

    #2
    i was definintely in the camp of falling into alcohol because of anxiety, working in an office did my head in social anxiety wise, alcohol really made me unwind after a day, i posted this years ago, but alcohol in the long term drives anxiety to be worse, most people don't even realise because it occurs so slowly
    I've touched on here a few times about alcohol giving me crippling anxiety and paranoia the morning after drinking. i found out today that it has a name. Alcohol Anxiety not exactly an official title, but its definition really resonates to my experience exactly.

    Alcohol Anxiety

    Typically experienced the day after drinking, the condition is characterized by symptoms ranging from mild anxiety and shakiness to severe paranoia with shortness of breath and a racing heart rate. This can often result in feeling like a complete nervous wreck! Linked to social anxiety, alcohol anxiety can then impact into other areas of a sufferer’s life. Alcohol anxiety seems to develop slowly – often over months or even years – and unless drinking is reduced or ceased, it tends to only get worse as time goes on. As there is a lack of general knowledge about this issue, symptoms can go on for a while before a sufferer is even able to make the connection between their drinking and the negative physical and mental effects they experience. This is exacerbated by the rarity of the condition – feelings of isolation are common, as sufferers feel alienated from their friends who do not experience the same effects and cannot understand that it even exists.
    The section i bolded really stood out to me. That was my exact experience. I threw away a great job because of paranoid delusions. but it was a blessing in disguise, it got me sober, and now i have a new job thats better.

    I wonder if anyone experienced similar? Is this really a rare phenomenon as the article suggests?
    01-01-2014 - Indifference reached, success with high dose Baclofen 295mg.

    Baclofen prescribing guide

    Baclofen for alcoholism - Consolidated Information - Studies, prescribing guides, links

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      #3
      Anxiety and all of the other excuses for a so called 'recovered' alcoholic to relapse are good reading yet offer no hope.
      The brain of an active or formerly active alcoholic must experience a revolutionary (total) change or it will always be subject to relapse.
      Some-thing must happen to re-wire the brain of the alcoholic so that it can feel peace and happiness within it self. Baclofen does not do this.

      NEO, by the way, have you heard from Otter lately?
      Last edited by Wilson1; November 20, 2016, 07:27 PM.

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        #4
        Umpa -have you heard from Otter lately?
        Nothing shows up when you look up his user name. Nothing?
        Last edited by Wilson1; November 20, 2016, 07:36 PM.

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          #5
          bump

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            #6
            Originally posted by Wilson1 View Post
            Anxiety and all of the other excuses for a so called 'recovered' alcoholic to relapse are good reading yet offer no hope.
            The brain of an active or formerly active alcoholic must experience a revolutionary (total) change or it will always be subject to relapse.
            Some-thing must happen to re-wire the brain of the alcoholic so that it can feel peace and happiness within it self. Baclofen does not do this.

            NEO, by the way, have you heard from Otter lately?
            anxiety is a legitimate reason for relapse since alcohol under the influence is an anxiolytic, once the alcohol wears off glutamate rebound exacerbates anxiety, which is why people tend to wake up a nervous wreck after drinking the night before and a "hair of the dog" helps calm their nerves.

            you speak of drastic rewriting of the brain, based on previous posts sounds like you are again alluding to psychedelics. well actually the brain does get rewired in the case of baclofen, extinguishing desire to drink because the euphoria is no longer there, causes one to no longer want to drink and slowly the ritual of drinking ceases. That is brain rewiring, your brain is constantly being rewired.

            no i have not heard from Otter lately, he takes breaks from this forum every so often, and i can understand why
            01-01-2014 - Indifference reached, success with high dose Baclofen 295mg.

            Baclofen prescribing guide

            Baclofen for alcoholism - Consolidated Information - Studies, prescribing guides, links

            Comment


              #7
              Bump

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