The article “Don’t Harm Them Twice: When the Language Surrounding Benzodiazepines Adds Insult to Injury” was published on Mad in America on November 12, 2015. This is Part II.
When language has been ingrained in a culture for a long time, it takes a concerted effort to change it. How do we stop using the word “addiction” in relation to cases of iatrogenic benzodiazepine dependence? Here are a few suggestions.
For victims, advocates, and activists
Educate yourself and others and start using (and insist that others start using) the appropriate language and terminology to describe benzodiazepine use, dependence, tolerance, and withdrawal. This needs to happen whether you’re a benzo victim telling your personal story in print or on film, a patient attempting to educate your medical professional, an advocate speaking for or about a benzo victim, an author writing about benzo dependence, or a filmmaker documenting the issue. There are many reasons why using appropriate terminology in these instances is imperative.
First, if you use addiction language, you may fail to reach some of your target audience. People taking benzodiazepines as directed by their providers do not identify with being addicts. So if you write or tell a story about “benzo addiction” or “benzo addicts,” people who are personally affected may not be reached, because they are likely to think: “I’m not an addict. This story must be about someone who abused drugs, and I’m just taking a benzo that my doctor told me to take as directed, so this doesn’t apply to me.” Just like that, you will lose the ability to reach an audience that is at risk. And what are we telling these stories for if not to warn others?
Secondly, some people are repelled by or uninterested in stories about “addiction” (even if they are unknowingly dependent themselves, or know someone who is) because of the unfortunate stigma that sometimes surrounds addiction or because they feel detached from the subject. But if they understood that the situation being described is one that could happen to themselves or a family member simply by taking their drugs as prescribed, they would be more likely to pay attention. Using the right terminology keeps relevant people engaged in a story and helps to dispel the myth that benzo dependency happens only to people who abuse drugs.
Third, using incorrect terminology risks insulting or offending the very people you may be advocating for, limiting the reach of your work and the support for it. I am aware of many iatrogenic benzodiazepine sufferers (myself included) who will not distribute or support material that perpetuates the use of addiction terminology when discussing benzodiazepine dependence because it promotes misdiagnosis and mistreatment.
Fourth, when you misdescribe the iatrogenic dependence problem by using addiction language, you are, whether you intend to or not, victim-blaming and shifting the blame from where it should lie: with pharma, with the DEA, and with medical providers who fail to give informed consent, misdiagnose dependence as addiction, and mistreat patients by forcing a too-rapid or cold-turkey withdrawal, causing outcomes that can include protracted withdrawal syndrome, seizures, and death. How can we educate or evoke change if we don’t stop blaming the victims of this iatrogenic epidemic by calling them “addicts”? Many people who have experienced benzo withdrawal feel violated and horribly harmed by a once-trusted medical professional. To mislabel or mistreat them as addicts is another violation. Just as it is intolerable to turn rape victims into the accused, it is also wrong to treat iatrogenic benzo sufferers as if they deserve their suffering by using terminology that implies that they brought it upon themselves.
I myself have participated, along with other like-minded members of the benzo community, in discussions with authors and filmmakers who say that they want to use the word “addict” or “addiction” in their work about benzodiazepine dependence because they want to “grab people’s attention” and reach a wider audience. They argue that “the public is unfamiliar with what dependence is, but are aware of addiction.” While it’s everyone’s creative right to make projects using whatever language they wish, my argument has always been that anyone speaking out about benzo dependence and withdrawal carries a responsibility to honor and appropriately represent the people affected. Some may say that any kind of attention is good attention. But my opinion is no—not in a case like this, where incorrect terminology has created so much misunderstanding, leading to misdiagnosis and outcomes of harm. Sustaining wrong terminology is only counterproductive and contributes to the problem. Efforts could be better directed by using the appropriate language and defining it for readers and viewers if need be, giving them the opportunity to truly learn about iatrogenic dependence and the suffering it leads to. That is the whole point of activism—to educate and elicit change.
There are other positive steps that activists and advocates can take toward the adoption of accurate terminology, labeling, and proper diagnosis. One possibility might be to join an activist effort specific to the cause (or create one of your own). An example is Ashton Syndrome, whose mission includes establishing “Ashton Syndrome” as a formal clinical diagnosis to be treated as an iatrogenic medical illness and not a substance-abuse or mental-health issue. This group is currently supporting a proposal in the WHO ICD-11 portal to obtain a diagnosis code under their proposed moniker. Other ideas for activism include appealing to medical and regulatory bodies such as the American Medical Association (AMA), American Psychiatric Association (APA), Drug Enforcement Administration (DEA), and/or State Boards of Medicine to institute consistent and proper language and treatment protocols for benzo dependence and withdrawal.
Another hugely important step is to educate medical providers, if they are not already aware, about the complexities of iatrogenic benzodiazepine dependence and how it differs from addiction, abuse, or substance-abuse disorders (SUD) so that it’s treated as a legitimate medical problem as opposed to a behavioral issue. Many medical providers are unaware or misinformed, and unless the victims of benzo dependence and withdrawal provide them with the appropriate information, how will they learn?
Finally, in some cases, filing a complaint about negligent medical providers to your State Medical Board (or other regulatory agency, depending on where you live) may be in order, as may the pursuit of litigation and exposing any settlements publicly. Avoiding formal complaints and litigation can be a significant motivator for providers to get quickly educated about the difference between addiction and iatrogenic benzo dependence. As Malcolm H. Lader, a professor of clinical psychopharmacology at the Institute of Psychiatry at the University of London, concedes: “It’s very difficult to come off these drugs . . . and the great scandal is that the NHS [National Health Service] claims to be dealing with these people by referring them to addiction centres, where essentially they’ll sit next to a street user who’s injecting heroine, and of course a housewife who’s been put on tranquillisers by her doctor is very upset by this. . . . There is a change taking place, which is that if a general practitioner prescribes for longer than the agreed time—two weeks or four weeks—they can be sued by the patient for substandard clinical care, and I suspect in the longer term the prescribing of these drugs will be as much dependent on lawyers’ attitudes as it will be on doctors’ attitudes.”
For the medical community
First and foremost, educate yourself and start using (and insist that others start using) proper terminology that makes a distinction between addiction and dependence, and learn the correct use of terms such as tolerance. It is also paramount that you learn to recognize the symptoms of iatrogenic benzodiazepine dependence, tolerance, and withdrawal in patients and know how to manage these conditions appropriately to minimize further harm. Being informed about the true risks of iatrogenic dependence allows providers to give informed consent to patients, something every patient deserves. And if you are already educated, please educate ill-informed colleagues when the opportunity arises. For example, should you encounter iatrogenically benzo-dependent patients who have been medically mismanaged or misdiagnosed, inquire about who mismanaged them and contact those providers with accurate information to prevent the problem from being perpetuated.
Secondly, once you have familiarized yourself with the correct terminology, STOP (please!) managing iatrogenically dependent benzo patients like addicts by insisting that they rapidly taper or sending them to detox centers, as this is medically dangerous. (If patients who have been subjected to over-rapid tapers or cold-turkeys from benzos could somehow transmit their suffering to the medical profession, I am certain this problem would be quickly remedied.) If you are not familiar with slow withdrawal schedules, learn about them by reading The Ashton Manual by Dr. Heather Ashton, the world’s most respected source on benzo withdrawal. But—and this is crucial—be open-minded to patients’ own suggestions, since even the Ashton Manual’s slow protocol can be too rapid for many patients, depending on genetics, dosage, length of use, age, general health, life stressors, and other factors. Many patients learn how to taper appropriately through forums and support groups administered by people who have withdrawn over time with success, and this painstakingly-obtained anecdotal evidence should be seen as the invaluable resource that it is.
Third, be open-minded and listen to what your patients are telling you and/or read the information they present to you. I have encountered a few published pieces by physicians in which they admit to joining online patient forums and support groups for certain conditions in an attempt to learn more from patients and/or advocates for the patients. When people are suffering from debilitating health conditions, especially ones that are rare or misunderstood by the medical community, they tend to spend an immense amount of time researching medical literature and other available resources and collaborating with other afflicted individuals, making them good resources. Consider joining the online support group Benzo Buddies or similar forums as a guest, and/or read any available resources for professionals in addition to relevant medical literature.
Don’t jump to conclusions and assume that because a patient is physically dependent on a benzo, that he or she is addicted. If an incorrect assumption is made out of ignorance, it greatly benefits the doctor-patient relationship to apologize and attempt to remedy the mistake if possible. If you are suspicious but want to avoid making a wrong accusation, use tools available to you to determine the patient’s history, such as requesting past records (if you’re not the prescribing clinician) or using your state’s prescription monitoring program.
Above all, show compassion to your patients. People who are iatrogenically dependent on benzodiazepines have often been harmed by both the drugs and the medical community, most times without informed consent. Validation, empathy, patience, and support go a long way in attempting to right this wrong.
And finally, work with victims, advocates, activists, and other medical professionals to promote the changes in terminology and diagnosis coding necessary for adopting a universal language related to iatrogenic benzodiazepine use and withdrawal. Changing the language is a crucial step toward instituting the appropriate treatment protocols that are needed to create more favorable patient outcomes—making it a win-win situation for everyone.
You’re right, J Doe. Words matter. I’ve referred to myself in the comments section of your last article as having lived with an “addiction” to psychiatric drugs. Fortunately, another commenter gently reminded me to correct myself. Mad people’s habit of self-stigmatization fuels our habit of trusting clinicians who have proven themselves to be unable or unwilling to, at least, be honest with us about the dangers of psychiatric “care”.
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J Doe,
These points about the power of language are interesting and very relevant to the whole mental health debate. I and others on this forum frequently critique articles which call life problems “mental illnesses”, patterns of problematic relating “disorders”, and so on… because these terms are not only inaccurate, concretized, reified, medicalized descriptions of the individualized and subjective ways that people experience life challenges…. but they are stigmatizing in that they lead people to misleadingly view said problems as life-long, innate, unchangeable, biologically determined, and so on. Good examples of such pseudo-illnesses would be bipolar disorder, borderline personality disorder, ADHD, and schizophrenia. I do not have so much experience myself with addiction… scratch that :-)… dependence… to benzos, but I see the parallels between problematic terminology with benzos and terminology with other mental health issues.
Oldhead, if you are reading this, in looking through this article I went to the BenzoBuddies forum. And I see that it has an attractive design which uses a free forum setup; see here – http://www.benzobuddies.org/forum/index.php
While I was looking at this, I was envisioning how a site run by psychiatric survivors and antipsychiatrists could replicate this look and create a gathering place for people wishing to radically reject the existing medicalized psychiatric system. It could have a forum and then articles by survivors/antipsychiatrist with position papers about what we want instead of the current system. I am going to post about this now in the MIA forums.
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We have legal drug dealers and legal clients consuming drugs. If both parties are adults and happy, I have no problem with the transaction.
You can only save people who want to be saved.
You wrote “(people) are likely to think: “I’m not an addict.”
Who gets to decide who is an addict?
Some people successfully use alcohol to cope with life’s problems, and some people use legally prescribed drugs to stay functional in the world.
The words “medicine” and “drug” have to be defined and taught in school is all that needs to be done.
BUT with so many children on DRUGS this isn’t going to happen.
A medicine has a start and finish date, a drug does not have a finish date.
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In the case of iatrogenic benzodiazepine dependence/tolerance/withdrawal and protracted withdrawal/drug neurotoxicity – the victims who did not receive informed consent and are left in a horrific state of suffering, sometimes for years, are NOT happy- quite the contrary, actually, as the suffering can be indescribably bad (sometimes to the point where people become suicidal). They’re not always adults either- there are children in the withdrawal support groups who are suffering horribly as well (as their parents were not given informed consent about the outcomes of long-term use of these drugs on their children).
As for your question on who gets to decide who is an addict, you might want to refer to the hyperlinked Part I of this article (at the very top of this article). The diagnostic criteria for determining addiction and definitions are spelled out there at length and in detail.
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And the tolerance, toxicity, withdrawal, and damage from the negligent long-term prescription of benzos doesn’t keep people “functional in the world”. Quite the opposite.
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I see the process of becoming addicted to alcohol or drugs, either recreational or prescribed, and becoming dependant on psychiatric drugs as quite similar.
The drug and alcohol business are in it for profit and do not warn their clients about the problems of dependance and tolerance. They do not provide support for people who wish to come off them and they do not look at why people might want to take them long term.
Psychaitry does the same.
I realise psychological craving, which is at the heart of addiction, is not the same of withdrawal reactions which are at the heart of benzo dependancy and that is very important to stress. But the financial processses and the lack of care are at the heart of both processes.
I do however support people using whatever label they are most comfortable with.
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John,
There are warnings all over cigarette boxes and alcohol containers as well as TV commercials warning of their harms and dangers. I think it’s pretty well known by someone addicted to/abusing something regularly that they’re engaging in unhealthy choices and behaviors.
That’s completely different than a doctor/medical provider handing you a prescription and telling you that this is “medication” that you “need” and to take it every day as he/she told you to – and you thinking and believing (and being reassured and backed up in those thoughts) that you’re helping yourself or doing something for your health (be it a physical problem, a so-called mental health problem, etc) because you’re following your doctors orders. Not to mention that some people not only aren’t warned about the risks/possible harms, but are instead told the benzos are “safe and effective” and “not addictive” by their prescriber as well.
I see the parallel you’re trying to draw, but I think the above is an important distinction.
Also, I don’t think making the distinction b/c addiction and dependence in the case of benzos is about being comfortable, so much as it is about educating people to the risks/potential harms when these meds are taken even as directed for longer than 2-4 weeks and hoping for change/a platform for change with the use of proper terminology around how the iatrogenic benzo victims are treated so that more harm is not done to them (due to misunderstandings from the use of improper terminology) which can cause much more suffering and even sometimes death.
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RE ” They’re not always adults either- there are children”
Yes, child psychiatry should be illegal. No drugs should be put into otherwise physically healthy children.
infantilism
https://youtu.be/1LoSgdpHnUk?t=10m22s
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We are speaking different languages, with the same words. When I write the children are on drugs, I mean what normal people call “medicines”.
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The language really does matter. I recoil every time i read the word “addiction.” It is so frustrating to see well-meaning media reporters get it wrong and report on the abuse angle. This harms the victim and lets the doctor off the hook. I’ll bet 90% of news articles on the subject get this wrong.
I’ll also add that it is not just benzos that cause this illness. The same problem and symptoms occur with all psych drugs. They all cause CNS injury to receptor systems. It actually is not a withdrawal phenomena at all – it’s an injury and it can take years to heal.
Good job. Thanks for writing this.
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“The same problem and symptoms occur with all psych drugs. They all cause CNS injury to receptor systems. It actually is not a withdrawal phenomena at all – it’s an injury and it can take years to heal.”
Couldn’t agree more! Thanks for your commentary. I do know it happens w/ other psych meds as well but chose to focus on benzos specifically b/c I am a benzo victim (as well as polydrug as a result of the benzo tolerance/toxicity being misdiagnosed as so-called “mental illness) so it’s something I want to advocate for change around, but also because iatrogenically dependent benzo victims seem to be more likely to put in the “addict” box and refused repeat prescriptions of the drug to safely taper than, say, iatrogenically dependent SSRI victims. But you’re right- the way it all occurs is the very similar, save the receptors involved.
I do hope that somehow there can be a platform for this garnering attention as a legitimate medical problem as opposed to being seen as “withdrawal” or “addiction”. It is injury/damage/neurotoxicity. I’ve met people (and personally experienced it myself) who, when withdrawn too quickly from benzos, developed dangerously high blood pressure, had seizures, abnormal heart rhythms, etc which can be real medical emergencies- it is so much more than “withdrawal”, I agree.
Thank you for your comments.
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We’re on the same page for sure, J. Doe. I’m a benzo victim too – still disabled and recovering 33 months after a brutal 30-month taper. And I agree with and fully support everything you wrote in your articles. Well researched and thoughtful.
Unlike ADs (and the other psych drugs) benzos have a “street profile” (well, I guess ADD drugs might too) and are easily conflated with drug abuse. Heck, they are even tracked by the DEA (which I don’t think ADs are?). In that sense they live a double life as a street drug and as a mundane medicine along side ADs and the other psych drugs. I never once in 21 years had any desire to take more than my prescribed dose. On the contrary, I spent 21 years wishing I didn’t have to take them at all.
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JDoe
Just as I responded to Part 1 enthusiastically and very supportive, I once again commend you on the work you are doing and on the important content of your main arguments in this blog. You have helped educate me and others about the scientific AND political importance of using the words “addiction” and ‘iatrogenic dependence” correctly.
I believe I totally get the significance of what you are advocating for and how this can be an extremely valuable organizing campaign to help support benzo victims/survivors and also expose those responsible for these crimes.
What I am about to say should not be viewed as any type of criticism or counter current to the work you are doing. I am seeking greater clarity on the broader issues connected to this blog including the question of 1) who is ultimately responsible for the benzodiazepine crisis? and 2) Is it necessary and correct to put up an IMPENITRABLE wall between the problems of iatrogenic benzo dependence and the issue of addiction in society, and how addiction victims/survivors are treated by the System?
First off on the issue of blame, you stated that it mainly lies with “…pharma, with the DEA, and the medical providers…”
I believe the principle responsibility for the benzo crisis involves the collusion between Big Pharma AND the American Psychiatric Association (APA) ( and Psychiatry in general). Robert Whitaker’s and Lisa Cosgrove’s new book “Psychiatry Under the Influence” clearly exposes the early history of the benzo explosion in this country by showing the KEY role that the APA played (in collusion with Big Pharma) to promote Xanax and other benzos for the treatment of Panic Disorder and other Anxiety Disorders. Without this collusion between these two entities there would not be 90 plus million prescriptions for these drugs throughout the U.S.
It is very critical to identify and target the principle role of Psychiatry in these crimes, not only because it is true, but also, because it influences how we strategize and conduct the struggle to end these abuses in the future of our movement.
Secondly, We must be very careful in our delineation of the differences between “addiction” and “iatrogenic dependence” that we don’t end up stigmatizing people with addiction problems and ignore the fact they are ALSO victimized by the medical establishment and the current mental health system.
JDoe, you stated the following:
” To mislabel or mistreat them as addicts is another violation. Just as it is intolerable to turn rape victims into the accused, it is also wrong to treat iatrogenic benzo sufferers as if they deserve their suffering by using terminology that implies that they brought it upon themselves.”
I would like you to rethink how you characterized those people with addiction problems in the above statement. I know there was no intention to stigmatize people, but this statement could be viewed with very negative and misleading implications.
Nobody chooses to become an addict. It is often a process that creeps up on a person and takes over their lives without them being fully aware of what is actually going on until it ‘s too late. People often believe they are taking their alcohol or drugs recreationally as “prescribed” by the common or similar actions of their peers.
Some people never seem to develop a problem with these substances (although I believe anyone can become addicted in the right circumstances). We don’t know exactly why others seem to unknowingly cross that “line” into addiction where the substance seems to control them more than they can control “it.”
Nobody “deserves” to suffer with addiction problems nor did they “bring it on themselves.” These are problems fundamentally rooted in conditions of a poverty laden and trauma based society. People with addiction problems are NOT masochists who deliberately go on harming themselves. They are of “two minds”; one being a strong desire to stop if possible, as well as, the other that wants to continue the behavior or sees no possibility of stopping..
People with addiction issues do make bad “choices” especially AFTER they become aware of their problem and have been exposed to the options related to seeking recovery. Recovery is usually a process leading to an “event”; the decision to finally stop, once and for all. However, bad habits are hard to break (with physical and mental cravings and urges) and relapses are often part of this learning process.
People with addiction problems in this society are treated horribly by the System. Billions of dollars (legal and illegal) are made off of substance addiction within our society – both the sale of the substances and the mistreatment of the people seeking help. Addiction victims/survivors have become major guinea pigs for a host of psychiatric labels and psychiatric drugs prescribed as “magic bullets” for imaginary “diseases.”
Psychiatry has played a major role in seizing on the culture of addiction in our society as a way to expand the public’s iatrogenic dependence on a whole different category of mind altering substances. It is here where we want to be careful about creating an IMPENETRABLE WALL between the concepts of “addiction” and “iatrogenic dependence.”
Benzodiazepines are, in reality, highly addictive drugs even though that is NOT how the overwhelming majority of people prescribed them are in fact USING them. However, many people with already established addiction problems are also prescribed benzos and other psychiatric drugs that cause iatrogenic dependence. Because they have a history of misusing and playing mind games with the use of various substances they will frequently use their new prescriptions in a similar way as they did their main “drug of choice.” Here again we would have to clearly place the “blame” on the prescribers for recklessly promoting the use of these legal drugs, but the new drug problem also very much dovetails with the nature of their troubled relationship with other substances.
This becomes very complicated when examining the connection between the opiate epidemic and the benzo crisis in this country. People dependent and/or addicted to opiates very often seek out benzodiazepines (at least 60% of opiate users) to magnify their “high” or drug effect. These people do experience anxiety in their lives and have too easy of a time acquiring legally prescribed benzos from doctors. Keep in mind also that today most people (60%) become heroin addicts through the prolonged use of legally prescribed opiates by irresponsible doctors and the related criminal actions of Big Pharms.
Once again, in this case shouldn’t these opiate addicted people be viewed as victims of the System even before they start adding benzos to their drug cocktail? And I need to remind people again just how deadly this whole process becomes – when AT LEAST 30% OF ALL FATAL OPIATE OVERDOSES INVOLVE THE DECISIVE COMPONENT OF BENZODIAZEPINES IN THE DEADLY MIX OF DRUGS.
When it comes to future exposure of psychiatric abuse and today’s oppressive mental health system I believe it would be a mistake to unnecessarily wall off some of the intimate connections between the current benzodiazepine crisis and the epidemic of opiate overdose fatalities that is raging throughout the country. IF anything we need to HIGHLIGHT the connection between these two separate BUT related institutional and systemic crimes. This is, in my view, Psychiatry’s weakest link at the present time.
Should we unnecessarily separate or wall off these issues because we fear that people who have been become iatrogenically dependent on benzos will somehow be lumped in with societies’ other victims of addiction? I think this would be a mistake on several different levels.
I am prepared to make it very clear and use the language of iatrogenic dependence when describing anyone whom Psychiatry and the medical establishment have caused to become dependent on any prescribed drug (psychiatric or otherwise). I grasp the importance of the use of this particular language in this situation.
While I plan to fight for these changes in language I am acutely aware of what’s at stake for Psychiatry and Big Pharma, and how desperate they will be to avoid criticism, and how they will continue to promote a narrative of “unstable patients” who are misusing potentially “addictive” drugs when benzo dependence takes over. We have our work cut out for us as we do with many other issues related to the System’s distortions about “mental illness” and their so-called curative “medications.”
We shouldn’t hesitate to make the distinctions between iatrogenic dependence and addictions, NOR should we avoid dealing with some of the connections between the ways the System creates and then stigmatizes both benzo dependent people and those with addiction problems. In the end their reasons for doing this have similar origins as well as a similar purpose for preserving their oppressive System.
JDoe, I hope you can appreciate the importance of some of the questions I am raising about how we ultimately seek to address OR avoid the issue of addictions when if comes to the multiple forms of oppression spewed out by this system and its resulting victims. I hope this is received as comradely feedback for I have deep respect for the important work you are doing and thank you again for the education you have provided. I believe If we find a way to address both these issues in a clear AND connected way I think we can advance each individual struggle as well as weaken the source of our mutual oppression.
In that spirit I was wondering what your response and feedback would be to my recent blog titled “Benzodiazepines: Psychiatry’s Weakest Link”?
Richard
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I agree with the gist of what you are saying but just because someone wants to avoid stigma doesn’t mean that they are perpetuating it. I have more respect and compassion for people who have found themselves addicted to drugs since I have learned more about it while dealing with benzo related damage but at the end of the day people who are addicted to drugs often do engage in self destructive behavior over which they have control, and although I don’t believe that they should be stigmatized as they are I also do not believe that it is fair to lump me into that category, as my benzo dependence didn’t result from any kind of control issues.
The problem I see is that people who identify as addicts tend to take the dependence/addiction distinction as a personal jab when it really isn’t about that. Just because one of the reasons I don’t want to be called an addict is because I don’t want to be stigmatized as an addict doesn’t mean that I condone the stigma or that I am looking down on someone who has addiction issues.
For the sake of benzo issues I think it is important to focus on the distinction. For most of us benzo victims addiction isn’t part of the problem so we have nothing to gain by trying to find connections and I would even go so far as to say that it is in our best interest to go out of our way to distance ourselves from it. I didn’t create the stigma, I don’t condone it and I sympathize with people who find themselves a victim of the stigma but at the end of the day it doesn’t help me to allow myself to be victimized by it as well.
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I agree with all of your points FG! Thank you for the comment.
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So well said, FG. I agree as well. As someone who is suffering a difficult and prolonged withdrawal from a “low dose” of benzos that were taken as prescribed by a doctor, I had to wince at this suggestion: “People often believe they are taking their alcohol or drugs recreationally as “prescribed” by the common or similar actions of their peers.” Seriously?
Both Richard’s advocacy for addicts and JDoe’s advocacy for those of us who are not addicts can exist simultaneously and with mutual respect. There is no need to conflate the two, and doing so only re-entangles a situation that JDoe is trying very hard to remediate.
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Richard-
1. Yes, psychiatry/the APA should also take some blame for the reasons you state. But, don’t forget that a lot of these drugs are also prescribed by PCPs and internists and non-psychiatric fields of medicine.
2. If you read part I, which I believe you did, as you commented there as well, I was CLEAR that the stigma against addicts is not something I support or condone and that in making these distinctions, I was NOT trying to perpetuate the unfortunate stigma against addicts that exists, but rather to make a very clear distinction where benzodiazepine iatrogensis occurs. I agree with everything the first commenter, FG, said on this topic above in their comments to you and couldn’t have said it better myself.
I also understand that addicts aren’t always treated well by the system and that’s unfortunate, but that’s not what this article was about. AND, I’d argue that addicts have FAR MORE support and resources available to them than the people who suffer from iatrogenic benzo dependence and find themselves with NOWHERE to turn b/c they’re either misdiagnosed or mismanaged at every corner b/c no one understands this or knows how to manage it appropriately.
As for the part that you quoted me on, I was NOT implying that it’s OK to treat addicts poorly either. Again, we’re talking solely about iatrogenic benzo dependence in this article. And my point was only that it’s NOT OK to treat these victims of iatrogenic benzo dependence like they brought it upon themselves and deserve this (as many people do treat us that way) which is yet another reason that we need to separate ourselves from the behavior of addiction, as it is a completely different animal. As FG so eloquently stated above: “Just because one of the reasons I don’t want to be called an addict is because I don’t want to be stigmatized as an addict doesn’t mean that I condone the stigma or that I am looking down on someone who has addiction issues.”
I understand your education, focus and work primarily revolves around addiction- but in this case, it’s beginning to feel like you’re the hammer (and everyone else the nail) that I spoke of in Part I. I think you’re comparing apples and oranges here, Richard. You’re mixing two COMPLETELY different topics together and attempting to muddy the waters which I don’t think is helpful at all.
People who abuse pain meds and then toss in benzos (alcohol, other drugs, anything they can get their hands on) to make their high better (and then sometimes go on to become heroin addicts) have absolutely NOTHING to do with what this article is about- which is iatrogenic illness from AS PRESCRIBED benzodiazepine use. YES, we should wall off these issues b/c they are COMPLETELY DIFFERENT.
Opiates are scheduled differently by the DEA b/c they have a very high risk of abuse/addiction. Iatrogenic benzo dependence patients typically don’t report cravings or a “high” and typically sit on their same dose until they’re in tolerance withdrawal (and have no idea what’s happening to themselves) as opposed to abusing them. Part of the reason we finally figure it out that it’s the drugs is b/c tolerance w/d kicks in from NOT increasing the dose over time. It’s not even close to the same thing or similar as to what’s happening in opiate addiction/abuse mixed with abused benzos, even if the person initially was started on opiates by an MD. One involves the behavior of abuse/addiction- the other does not.
Go back and read some of the quotes from Ashton in Part I. Talk to some (and actually LISTEN) victims of iatrogenic benzodiazepine dependence/toxicity/neurotoxicity and hear what their stories are and how this happened to them and what it was like and I think you’ll see just how different a scenario this is.
If you were a victim of this iatrogenic illness from as-prescribed use of benzos yourself, it would be VERY clear to you how different they are, as it is for all of us who are living it every day ourselves. (It’s not all that different from the prescribed SSRI dependence/withdrawal/neurotoxicity which doesn’t involve the behavior of abuse or addiction either).
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Brighid
In the quote of mine that caused you to wince, notice that I put the word “prescribed” in quotes. I was NOT equating doctor’s *prescribing* drugs with people *deciding* to use drugs in peer groups.
My main point in that comment was that the use of these substances often seems like a normal consequence of life for the people using them at the time. They have no intention or desire to do any harm to themselves or become addicted. And based on what they may observe in their immediate peer group (at that moment) they have little reason to believe they are taking a great risk to their well being. In that sense they are kind of “socially prescribed” by the commonly accepted behavior and norms of a larger peer group.
Of course this all begins to change as they become more involved with a substance on a regular basis and begin to feel the increase in negative consequences. Then this analogy no longer accurately applies to the circumstances.
Brighid, you stated the following: “Both Richard’s advocacy for addicts and JDoe’s advocacy for those of us who are not addicts can exist simultaneously and with mutual respect. There is no need to conflate the two, and doing so only re-entangles a situation that JDoe is trying very hard to remediate.”
My comment was NOT principally some type of advocacy for addicts. My overall point is focused on how best for all of us to take on the overall damage done by benzodiazepines and their reckless and damaging promotion in our society.
I’m sort of saying in another way: “make the necessary distinctions between addiction and iatrogenic dependence but unite ALL who can be united in this struggle.”
All the victim/survivors of iatrogenic benzo dependence have a lot in common with the thousands of family members who lost a loved one THIS year from an opiate/benzo cocktail.
And unfortunately 99% of those family members have NO idea that benzodiazepines had anything to do with their loved ones death. In fact, many do not even know what a “benzo is.
We need to collectively find a way to change this reality for the millions of potential benzo victims out there so they can know ALL the ways benzos harm human beings.
Respectfully, Richard
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JDoe
It is clear that the tone of this discussion has shifted to something that I , in no way, wanted to happen. I have been nothing but supportive of your blog and the work you are trying to do. I have stated that several times, and also made some self criticism about how I have misused language in the past.
If you could point out for me one sentence or phrase where I somehow became adversarial or overcritical in my past comments (or acted like a “hammer”) it would be helpful to me for future discussion.
On the stigma issue, I only asked you to reconsider some of the content of one small paragraph which I even indicated that I knew that the possible negative connotations were NOT your intention. A simple retraction or acknowledgement of some problems with certain word choices would have ended that part of the discussion.
As to the issue of pointing out the role of Psychiatry, as an anti-psychiatrist activist, I thought it was important to highlight the key role of the APA in the overall benzodiazepine crisis. While it is true that 70% of all psych drugs are NOW prescribed by primary care physicians this situation would never have developed to this point without Psychiatry’s development of the DSM and their overall collusion with Big Pharma.
Yes, while the focus of some of my past work in the mental health system has been trying to help people with addiction, my main identity is focused on work as a political activist who wants to end all forms of human oppression, and in this case psychiatric and medical oppression.
My intent in raising some of the broader implications of doing work around the benzodiazepine crisis (including building alliances with other aspects of the struggle) was NOT meant to misdirect this discussion away from the essential issues you are raising. I try to do this type of “broadening the scope of analysis ” in all my comments at MIA. My intention is to add to the discussion NOT derail or misdirect it. If you think that this is now happening perhaps I will step back a bit and listen and let others join the conversation.
I do VERY MUCH want the main points of the blog regarding the essential difference between addiction and iatrogenic dependence get across to the readership so I will pay close future attention to the drift of the comment discussion.
Based on some of the replies here, I don’t believe my attempts to articulate broader strategic issues related to this battle have been understood, I hope people will read the entirety of my efforts here before drawing conclusions about my position on this issue.
I hope you can believe that my intention in participating in this blog discussion was for no other reason that to advance the cause for which you are so passionately and eloquently articulating here. I wish you nothing but success and true liberation from those/that which has caused you great harm.
Respectfully, Richard
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FG and JDoe
I have agreed with the position that people who suffer from iatrogenic dependence from benzodiazepines should be viewed completely different than people with an addiction. This distinction is very important to make for all the reasons stated.
However, the reality is that the benzodiazepine crisis in this country is wreaking havoc within many sectors of our society. It has created pain, disabling forms of dysfunction, and tragic death in increasing numbers. Its connection to the opiate overdose epidemic is one of those areas where worsening addiction and death is a common outcome. My estimates made in a recent blog were that at least 15 people a day die possibly connected to opiate/benzo overdoses. The total figure for daily fatalities connected to benzos is probably much higher when you look at suicides, or the inadvertent combination of benzos with other sedative hypnotics and/or barbiturates.
As we continue to clearly make the distinction between iatrogenic dependence and addiction, the point of our broader struggle should be to expose ALL the ways benzos (especially the irresponsible role of Psychiatry, Big Pharma, and the medical establishment in promoting them) are causing great damage throughout our entire society.
Am I the only one who had a problem with the following sentence?:
“To mislabel or mistreat them as addicts is another violation. Just as it is intolerable to turn rape victims into the accused, it is also wrong to treat iatrogenic benzo sufferers as if they deserve their suffering by using terminology that implies that they brought it upon themselves.”
Is it not important to critically question or review such a statement? This should not have to take anything away from such an overall valuable and important blog.
Richard
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As to the cited statement, I would agree that, whatever an “addict” is, he/she is demeaned by the above reference, which projects a judgemental moral tone which implicitly blames “addicts” for their addictions.
I’m going out on a limb having missed most of this, but I feel like it would cut to the chase to characterize the conflict here as being over how we are to view those who exhibit “addiction” vs. those who have “iatrogenic dependence.” While the distinctions being made are not unimportant, if the outcome is pitting groups of people with essentially the same basic problem against each other based on such labels there’s a problem here. Addressing that doesn’t detract from the article, it expands the discussion.
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Richard,
It think part of the problem here is that the ignorance surrounding this subject is so pervasive that us benzo victims have no choice but to take a stern stance in distancing ourselves from addiction.
So while I agree with you that the problem with benzos is not only that they can create debilitating dependence that can last for years on end (I will be 5 years off next month and still suffer from some significant symptoms), but that is indeed the main issue with these drugs and it is the only issue that most of us who have had the hammer dropped on us by these drugs are really invested in. So although it may be beneficial to some people to expose the other dangers with this class of drugs, the most important thing for us is to focus on the dependence issue, especially considering that any tie in with addiction is likely to create more confusion regrading dependence and cause more people to simply tune out.
Ideally we would be able to explore all angles of this simultaneously but the reality is that as long as the ignorance is so prevalent we can’t afford to confuse people even more by exploring these other issues. Benzo withdrawal is too big of a bite to chew in and of itself when ignorance prevails.
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Being an ‘addict’ is sorta like being a psych patient; no one takes you or your symptoms seriously, and more harm just gets piled on.
People who experience Ashton Syndrome often lose everything; no one believes what they are experiencing as being ‘real’…havoc ensues…misdiagnosis happens, more meds are piled on compounding the problems…the psychological and physical torture of PAWS is truly unimaginable for family members, friends, employers…people lose everything and have no where to turn to for support.
“Addicts” do…it’s pretty straightforward, and there are resources available.
Sorry it offends those of you who advocate for ‘addicts’ but our experience is totally different, and totally misunderstood by *everyone* who hasn’t ever had this horrible experience.
It’s very lonely.
In the almost 2 years I’ve participated on the BenzoBuddies site I have seen newcomers just about universally go thru the same stages of agony.
Suicide is often contemplated.
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Thank you for writing this amazing article. I have been saying this for a couple of years now and I don’t think that even most people in the benzo support communities were really grasping how important it is to use the proper terminology. I am glad that I now have an article that I can direct people to when I am trying to make these points. It says everything I have been saying and then some and with all of these points being clearly addressed I don’t know how anyone could continue to argue against the need to use the right terminology.
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oldhead, no one is pitting anyone against anyone else. I was very clear in an article (that was SPECIFIC to iatrogenic benzodiazepine dependence) that this was NOT about stigmatizing addicts.
Part One of my article made this clear: “Appealing for the proper use of terminology here—“dependence” instead of “addiction”—is in no way calling for addicts to be stigmatized or treated poorly or for people who are made iatrogenically dependent to be treated superior. Instead, it’s calling for a clear distinction between the two terms that is already made (if not always understood or followed) in most respected specialties of medicine, ensuring that individuals who have iatrogenic physical dependence are treated appropriately.”
I think what’s going on here is what FG pointed out in their comment above: “The problem I see is that people who identify as addicts tend to take the dependence/addiction distinction as a personal jab when it really isn’t about that. Just because one of the reasons I don’t want to be called an addict is because I don’t want to be stigmatized as an addict doesn’t mean that I condone the stigma or that I am looking down on someone who has addiction issues.”
I’m not going to comment further on this issue, as I feel there is an agenda being played out here on this particular section of the comments which is detracting from what the topic of this particular article is about- specifically the problems around prescribed, taken as-directed iatrogenic benzodiazepine dependence and not the other issues/problems to include benzodiazepine abuse when used in conjunction with opiates.
Best, J. Doe
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This isn’t my specialty; I was just trying to get a handle on what the argument was about, as everyone involved is highly committed to helping people who have chemical or drug dependencies of one sort or another. You should all realize you’re on the same side and try to find a synthesis.
That said, no argument with your limiting the discussion to a specific aspect of all this, go for it! 🙂
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FG,
All great comments. You totally get it and the importance of what I was hoping to achieve w/ this article. Finding myself saying “yes, yes, yes!” to your comments. Thank you.
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Richard,
When I said “the hammer” I was referring to the proverb- “if all you have is a hammer, everything looks like a nail”. Meaning, if a person is familiar with a certain, single subject (in this case-addiction), or has with them a certain, single instrument, they may have a confirmation bias to believe that it is the answer to/involved in everything.
As for the stigma “issue” you pointed out, I stand behind what I wrote and think the problem lies with your emotional interpretation as opposed to the meaning that I intended in the context in which I said it. Again, I was meaning that, while the stigma is unfortunate, iatrogenic benzodiazepine victims are being subject to it and that is one unfortunate element of using incorrect terminology here. I wasn’t calling for the stigma against addicts to continue or saying that it was OK. As I said before, I went out of my way to make that clear, as I knew ahead of time writing this that there would be at least one response that tried to twist this into something it’s not.
I understand your intent in raising some of your concerns with the broader implications, but you did that in your own blog post and I feel like you’re trying to carry that over here to a topic where we are trying desperately to have our own platform for this one specific cause that desperately needs understanding and change so that people stop being harmed by the ignorance that currently surrounds iatrogenic benzo dependence alone. I don’t wish to intermix the two issues, as I feel they are better addressed separately and are completely different. FG’s comments on this issue in their 7:47 pm 11/21/15 comment are spot on as to why this needs to remain separate.
I appreciate your support. Thank you.
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J. Doe, thank you very much for these very well-written articles. I have been in withdrawal for almost two years now. Although my symptoms are lessening to a great extent, there are still parts of my mind that feel like empty spaces. Will joy and excitement about my life ever return? I wonder.
Unfortunately, I previously used the word “addiction” when explaining what I’ve been going through. That has stopped. I notice that some (or most?) articles on benzos also tend to use the word “craving” when speaking about these drugs. What craving? What feeling of pleasure? I didn’t ever have those. So that word usage connected with benzos has to be changed completely as well.
I wish all doctors would read your articles. It’s baffled me that the uncontrolled prescriptions for benzos has continued to go on for over 50 years. But having read “Psychiatry Under The Influence,” about the misleading information concerning a Xanax trial that was mentioned, it seems clear to me now why Xanax has become the top-selling benzo drug. Doctors have unwittingly used this botched information to prescribe the drug to their patients. The result has been untold misery for many people. And I’m betting that a great deal more are in tolerance but are not aware that the reason is due to the benzo pills AND NOTHING ELSE. How many of these people have been or will be put on multiple drugs for symptoms that are due to benzos only? And why do doctors continue to have their heads in the sand?
I’m optimistic that more articles are coming out about benzos. Yours are excellent.
Thank you, J. Doe!
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drt,
Thank you for your kind comments.
I didn’t have cravings either. I think some people confuse interdose withdrawal (that develops when the benzo victim hits tolerance- especially, but not limited to, the shorter half-life drugs) where the drug dose is no longer efficacious in “covering” the emerging symptoms of tolerance withdrawal for as long a period of time as it was when initially taken, and the person then experiences emerging withdrawal symptoms in between scheduled doses.
I never had a feeling of pleasure either- quite the contrary. It has been misery and chasing my tail since the few months after they were prescribed.
I do think the joy and excitement in your life will return and the fact that your symptoms are lessening already is a small glimpse into what’s to come in time. The great frustration is the duration and not knowing, as well as, of course, being forced to endure the agonizing suffering in the interim while we wait on the hope that healing is coming because it did for others before us.
Best to you and thank you again for your kind commentary, J. Doe
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It is possible for people to be “addicted” to benzos, I gather, as they are a drug of abuse, but this is not the majority. Not by a long shot. For most people the benzo is a medicine your doctor told you to take every day, just like an AD. For 21 years I did this as a daily routine as I trusted my doctor who said I need them daily. There was no desire or craving. I disliked having to take them, but saw it as needed medicine.
When I tried to stop it became a huge problem – I Literally COULD NOT get rid of them without damaging my CNS. Or, stating that more accurately, without unmasking the damage they had already done to my CNS through what Whitaker called “opposition tolerance.” All psych drugs do this, not just benzos.
And this huge problem is happening quietly in isolation in homes, one person at a time. No headlines in the news, but it is a much bigger problem than abuse. I think it dwarfs the abuse problem, actually. Five years of my life down the drain so far and it will probably be six or seven before I am clear of it.
But no matter if a person is addicted or not, they now have a physical CNS injury requiring very slow removal. Detox centers and fast tapers are never appropriate, even for someone who is addicted and craving.
Richard, thanks for your comments. I get where you are coming from and appreciate your effort to understand this issue.
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Spatler I agree with you completely that “taken as your doctor directed” benzos have caused a silent crisis that is so widespread yet so completely ignored or misbelieved by the medical community and by society as to be surreal. Recognition, validation, encouragement, and resources to help with the nightmarish process of withdrawal are so badly needed. And yes, benzos (and other psych meds) don’t discriminate–for many people, physical dependency on this class of drug, however it comes about, requires an exquisitely slow taper that lasts far, far longer than a six-week detox.
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There are some people even in the benzo support community who take issue with separating addiction from dependence despite there being different medical definitions for both.
It took me awhile but I am starting to understand where this is coming from. I think some of it stems from 12 step dogma, and I understand how that might cause some folks to look at this a little differently. I don’t agree with conflating these terms under any circumstances as I believe that it only serves to cause people more harm, but I understand how some people might be a little misguided on this subject from dealing with their own issues.
What I truly have no tolerance though for is the people who try desperately to lump as many people as possible under the addiction umbrella. Now that I feel like I truly understand the gravity of the issue I am starting to realize that this is a horribly selfish thing for people to do. I doubt most of them have malicious intent, but many of them don’t seem to care that muddying the waters will only result in more pain and suffering for others and to me that is inexcusable.
It is one thing to identify yourself as an addict but I get the impression that some folks desperately want to create confusion on this issue to help them feel better about themselves. They have decided that anyone who is harmed by a class of drugs that is deemed to be “addictive” just has to suffer from the same stigma right along with everyone else. And you can’t reason with these people at all. The fact that other people will continue to suffer in part because they don’t want anyone who took “addictive” drugs to feel or act superior to them means nothing to them. All they care about is making sure that everyone sees that “an addict is an addict”, even if it means that more and more people who are physically dependent on a drug (or more accurately were physically damaged by it) continue to suffer. Any attempt to clarify the difference between addiction and dependence is met with hostility and the premise for their anger is the idea that anyone who tries to distance themselves from the addict label is only doing so to help them to feel better about themselves, and this only serves to add fuel to the stigma surrounding addiction.
To me this is deplorable. It’s one thing to formulate an opinion when you don’t have all the facts, but it is another thing to ignore the evidence when it is put in front of you just to suit your own agenda.
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FG
Thank you for the spirit of your response to my efforts to contribute to this discussion, even though we still have some disagreements about who we can and should seek out as allies in this struggle.
As to your comments about 12 Step dogma standing as an obstacle to understanding addiction versus dependence, I completely agree with your analysis.
People who are stuck in very one sided 12 Step dogma refuse to accept any experience or evidence that does not support their whole “disease” concept of addiction. They will repeat the phrase “a drug is a drug is a drug” ad nausea, and if a person was able to successfully taper off of a drug like benzodiazepines WITHOUT using 12 Step groups they would somehow claim they couldn’t have actually had a serious dependency issue in the first place. For these zealots, “addiction (as they would call it) and/or dependency is the disease and AA/NA is the medicine.You don’t take your medicine and you will relapse; end of story.”
I don’t believe your/our efforts will ever get much support from hardcore 12 Step members.
Richard
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About those “12 Steps”: I attended my first A.A. meeting in 1980, at 21 years old. I’ve been sober since June, 1991. Had several years total sobriety during 1980 – 1991. Was more casual about the steps, until 1991. During the early 1980’s, I actually had at least 2 older “sponsors” who had met, and talked with, A.A.’s co-founder, Bill Wilson. (“Bill W.”). Unless A.A. World Headquarters has changed recently, A.A. has NEVER claimed that “alcoholism is a disease”. True, yes, A.A. helped develop and popularize, and publicize the *DISEASE*CONCEPT*, or “model” of alcoholism, almost solely to combat pervasive anti-alcoholic STIGMA. The whole point back then, was to make recovery easier, or at least possible. As for A.A., it’s own literature says that if somebody can “recover” without A.A. – then more power to them. A.A. neither endorses nor opposes any causes. A.A. members don’t get much more “hardcore” than myself, Mr. Lewis. I call myself an “orthodox” A.A. It’s obvious to me, that despite your protestations, you are NOT at all familiar with either A.A. as a whole, or the 12 Steps in particular. While your characterization of *SOME* A.A. members *IS* accurate, when you paint ALL A.A. members with that same broad brush, you show that your artistic abilities are somewhat less than Mr. Schickelgruber’s. Personally, I think you owe A.A. a huge apology, and no, I don’t think you understand the A.A. program anywhere near as well as YOU THINK you do….
Dr. Bob’s last words to Bill Wilson were, “Let’s not louse this thing up.” He meant *professionalism*….But YOU can Read “A.A. Comes of Age”, or some OTHER A.A. books…. Oh, BTW, what are you doing to ensure defeat of the “Murphy Bill”….????….
(c)2015, Tom Clancy, Jr., *NON-fiction
ps: I was arrested in 2014, and “charged” with a “crime”, because the local
“Community Mental Health Center”, and its’ quack shrinks, want me badly…. Have YOU ever stood in a *criminal*court*, and had the Police Persecutor claim that you have “mental health issues”? And that she wanted you taken to the State Loony-bin in handcuffs and shackles, by the Sheriff’s deputy? That almost happened to me – *again* – and it DID happen to my close friend recently. She suffers from near-fatal akathisia, but again, the local “CMHC” refuses to see the iatrogenic TORTURE they are inflicting on her. So, yeah, my benzo story is very personal….
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JG–
Your comments are absolutely spot-on, and your discussion about the need for some addicts or recovering addicts to draw everyone under the same umbrella is hugely important and serves to uncover the elephant in the room.
The fact is that NOT making clear distinctions between iatrogenic benzo dependency and addiction behaviors harms and endangers everybody. Why? Because the excruciatingly slow withdrawal taper that benzos require–no shortcuts available–can only happen with a continuing prescription for the drug. Doctors who suspect addictive behaviors in a patient are not likely to keep writing scripts. Many people who have taken benzos ONLY as prescribed find themselves in this situation and are gravely harmed.
Equating those of us in this population with addicts in ANY way does NOT help us. And it also does not help those who may BE addicts (most often abusing other drugs as well) but find themselves physically dependent on benzos. Because the fact is that those people will need prescriptions for a long-term taper too–and they can only benefit if we are allowed to advocate, clearly and separately, for appropriate treatment unique to prescribed benzos.
In short: the best way to help in this situation is to allow those of us who are iatrogenically dependent on benzos to have our own voice without trying to co-opt it and shoehorn it into some other agenda.
Please, those who want to impose some broader ideology around the issues JDoe describes–allow these articles to find their footing first. Allow those of us in the community JD represents to find support and solidarity and solace together as we try to bring these facts to the world. Unlike the problem of addiction, ours is an invisible crisis, and we have found no support anywhere except among ourselves. Let us find it here without diverting the discussion in a way that, I would argue, does not benefit anyone.
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To all
Brighid said: “Please, those who want to impose some broader ideology around the issues JDoe describes–allow these articles to find their footing first. Allow those of us in the community JD represents to find support and solidarity and solace together as we try to bring these facts to the world. Unlike the problem of addiction, ours is an invisible crisis, and we have found no support anywhere except among ourselves. Let us find it here without diverting the discussion in a way that, I would argue, does not benefit anyone.”
I have deeply reflected on the above statement and Do grasp the importance of a certain community of the oppressed coming together with common cause and newly defined language. I agree that this is a process and that you may be in the early stages of making this happen, and also need (and desire) to remain focused and NOT sidetracked with extraneous issues.
However, there is a very fine and vulnerable line here regarding the nature of the MIA website where this blog on benzos is now published. There are many “communities of the oppressed” participating here who have suffered various forms of psychiatric/medical abuse and want desperately to make ALL of it stop. And there are also some at MIA who would like to see a broader human rights movement around these issues come together to facilitate a desperately needed radical change. It is within THIS CONTEXT that that Part 1 and 2 of this very important blog arises.
In this context – who has a right to speak, how much should they say, and how should they say it??? Not easy answers.
I, personally, have never had a psychiatric diagnosis, any addiction problems, and nor have I ever been dependent or *physically* damaged by benzos. So some might ask why I even bother to participate at MIA?
Actually (4 yrs ago) I carefully read MIA and the narratives of survivors for several months (learning from each and every one) before I even dared to make comments or write blogs here.
So what are my so-called “credentials” for speaking out. Besides being just another fellow human being, I have the following human experience:
1) I have been fighting (since the late 1960’s) multiple forms of human oppression; I am now almost 69 yrs old.
2) I worked for over 22 yrs in community mental health and witnessed (and resisted in many ways) the complete takeover by Biological Psychiatry and their medical/diseased/psych drug based model that today dominates all aspects of medicine.
3) I have witnessed people’s lives being shattered by the dependency and overall harm caused by psychiatric drugs (they are NOT medications) and some of my clients ( that I worked with for years) died from suicide or some type of overdose. I knew back in 1991 that these drugs were bad but had to helplessly watch minds and overall lives being destroyed.
4) I have a dear close friend (of 45 years) who has suffered severe iatrogenic damage on a cocktail of psychiatric drugs for almost 25 years. Her damage began with benzos, and she is now two years into withdrawal with probably several years to go and struggles mightily everyday with neurotoxic effects. I have done my best to support and educate her and her husband to find the knowledge and support they need.
5) In 1998 I discovered Heather Ashton and wrote a strict benzo policy for the agency where I worked which was rejected by clinic leadership.
6) For over 22 yrs I handed doctors, other therapists, and clients many educational articles and scientific evidence regarding the harm caused by benzos and other psych drugs, often at great risk to my job.
7) Two yrs ago, at great risk, I started a concerted campaign to challenge prescribing patterns at my clinic writing a 5 page challenge to clinic leadership with benzodiazepines being the number one problem addressed.
8) I followed this up with two open letters (on benzo prescription abuse) sent to the medical department and clinic leadership, and wrote two OP-Ed pieces published in a local newspaper.
9) When I received no significant response to these efforts, I filed a formal complaint (in May 2015) to the Mass Dept. of Mental Health and the Dept. of Public Health detailing specific examples of prescription abuse and possible deaths related to these abuses. There was almost zero response. Yes, the system is broken!!!
10) In Sept. of this year I finally resigned from my agency in protest by giving all related evidence and documents to the board of directors , again with no response.
For two years I lived with the daily reality of looking over my shoulder regarding the possibility of being fired at any moment.
11) For the past 4 yrs I have been a dedicated activist at MIA and beyond fighting all aspects of psychiatric abuse.
It is for you to decide how all of these experiences have affected me, especially watching the daily, weekly, yearly destructive toll of psychiatric drugs (especially benzos) on my friends, clients, and the overall cumulative effect of reading those emotionally shattering narratives published at MIA.
I would NEVER compare my experiences ( including traumatic like effects of bearing witness) with those who have suffered iatrogenic neurotoxicity from benzos or other psych drugs. But it is because of all these experiences that I speak out and believe that I, also, have a stake in how this struggle ultimately plays out.
With that being said, I will say that I have learned tremendously from each and every comment by survivors and others who have participated in this discussion. I thank you for that, even those who have disagreed with me at times.
I hope you are all open to the possibility that my experience and views on these issues could also impart some remote piece of knowledge or insight your way as well.
I can assure you that I am down for the Long March in the battle against psychiatric abuse and the oppression caused by the benzodiazepine crisis. I hope to stand next to you at the barricades – your struggle is indeed very important and must be supported.
And finally, to all, on the issue of using correct language, many who have been long time commenters at MIA have made great efforts to NOT call any psychiatric drugs “medications.” Just as with the word “addiction” as it applies to “iatrogenic dependence” – “medications” is not scientifically correct and politically its continued use serves to reinforce the oppressive narrative promoted by Biological Psychiatry and Big Pharma. Please reconsider your use of this term.
All the best, onward to victory.
Respectfully, Richard
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“…“medications” is not scientifically correct and politically its continued use serves to reinforce the oppressive narrative promoted by Biological Psychiatry and Big Pharma. Please reconsider your use of this term.”
Thank you for pointing this out, Richard. I have filed that one away and will no longer refer to these drugs as “medicine.”
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Richard’s views should not be dismissed as those of someone who just doesn’t “get it”; I know that the damage caused by “benzos” is one of his primary foci in the work he does.
One thing about the whole semantic question — while it is totally understandable wanting to avoid the social repercussions of charged terms like “addiction,” I think it’s also necessary to recognize that the cultural prejudice associated with such terms is an issue to be dealt with in & of itself, and that our analyses should not be altered simply to appease public ignorance.
I won’t jump into the whole debate about the term “addiction.” However it’s a slippery slope, and if this logic is stretched to the point that these drugs are referred to as “medications” to avoid the social “stigma” of the word “drug” — that is going too far. We need to be honest about what we’re dealing with.
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Oldhead,
I know in your last comment you admitted you hadn’t even really read part I and part II and were just popping in to comment, so I’m just curious to know if your comments stem from having read both pieces in their entirety, as the articles explain in great detail why the terminology isn’t not just a matter of semantics.
To my knowledge, no one is using the term medications, except perhaps in the comments or in quotes to imply they’re not *really* medications but are presented that way by the medical community to patients when they’re prescribed to imply they’re “treating” something or that the patients are helping themselves in some way by taking them. If by chance it showed up in the article itself, it was most likely an oversight in the editing process. There was no purposeful intention to use that word in an attempt to avoid any stigma around the word drug.
I didn’t see Richard’s views being dismissed as someone who doesn’t “get it”, although he admittedly has never been through it, so I’d go so far as to say he can never truly “get it” to the extent someone who has lived it would. He was certainly challenged on some of his comments and given very good (in my opinion) feedback as to why his thoughts are a separate issue (that he’s already made his own entire blog post about, yet brought over to this article on an entirely different subject) and seemed to detract from the very specific point of this particular article itself in an attempt to take it in a whole other direction that the people in the iatrogenic benzo community aren’t really willing to take on/and wish to distance ourselves from for the reasons stated in the article and also in the comments by FG specifically.
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Oldhead,
Actually, I just did a word-find of the entire piece, and the word “medication” was used only in quoted excerpts–with one exception (in the DSM section, under the chart on substance-induced disorders: “These include withdrawal as well as intoxication and other substance/medication-induced “mental disorders” (e.g., sleep disorders, neurocognitive disorders, sexual dysfunction, anxiety disorder, or depressive disorder).”
That one use of the word is language that carried over from the DSM itself in an attempt to explain how the DSM classifies people w/ iatrogenic benzo dependence.
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Well said, Brighid. I would even go so far as to call it “iatrogenic damage” or “iatrogenic poisoning” instead of “iatrogenic dependency” as that is what it truly is. I feel that even the words “withdrawal” and “dependency” hinder us, as uninformed minds who hear these words will default to equating it to addiction. These words connote drug abuse culture. Even doctors, who should know better, do this, and as you have clearly pointed out, that is dangerous for all – -even the abuser. Getting it coded as a billable physical illness would go a long way.
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Thank you, Spatler, and I agree that even the “appropriate” language leaves much to be desired. Ultimately it would be ideal to assign a separate term–e.g. damage, neurotoxicity–that completely takes things out of the realm of addiction and into the realm of physical illness and makes it crystal clear that the drugs themselves, and those who prescribe them long-term, are responsible.
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Agreed. Hopefully more advocacy efforts crop up around this point, spatler. However, without us gaining a platform for the terms that better describe this condition *and* formal recognition/widespread use of those terms as diagnoses in the medical community in regards to the iatrogenic benzo issue, we might just be preaching to the choir. For now, dependence is all that’s defined and formally recognized, so there’s work to be done. I believe that’s why this issue is so important to be highlighted and advocated for.
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I also agree that dependence is technically not the right word for the damage we have suffered. After a certain period of time reinstating the drug usually doesn’t work, so how can I be “dependent” on something that doesn’t help me? And I know that technically receptor downregulation isn’t “damage” in the sense that downregulation on a smaller scale is a a natural thing, but make no mistake- it certainly is brain damage in the sense that whatever these drugs do to the brain and CNS of the unlucky souls like us it is VERY HARMFUL to the body and absolutely needs to be acknowledged as such.
Regardless of these facts the first step is to get everyone on board with the currently accepted definitions. Hopefully this push to label benzo dependence as “Heather Ashton Syndrome” is successful because that should go a long way towards allowing this to be recognized for what it is.
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Richard said:
I have a problem with that sentence, too. It does imply that addicts have “brought addiction on themselves,” as oldhead has pointed out above. I think it is good to point that out, as I don’t think J. Doe intended it to read that way.
Other than that, I agree with the other commenters who have been pointing out that these two articles by J. Doe were expressly written to differentiate between iatrogenic dependence and addiction, and that, therefore, this particular discussion is not the most appropriate place to be seeking to emphasize commonalities between these two conditions.
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There is a difference between saying “addicts bring it on themselves” and “it is also wrong to treat iatrogenic benzo sufferers as if they deserve their suffering by using terminology that implies that they brought it upon themselves”.
We didn’t create the stigma and ignorance, we are simply trying to avoid that ignorance being used against us. Right or wrong the word “addiction” does imply that you brought it on yourself. But that is another issue altogether, and one that we have to distance ourselves from if we want any chance of benzo dependence/damage to be taken seriously.
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I don’t make that implication or inference when I use or hear the term “addiction.” Not to reignite the whole argument, just sayin’…
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I appreciate the distinction you’ve drawn, but I still feel that the passage in question is confusing at best and I’m not comfortable with it.
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The comparison in this much-discussed sentence is between “rape victims turned into the accused” and “iatrogenic benzo sufferers” being treated as if they deserve their suffering.
In the previous sentence, I read “mistreat” as “mis-treat”–that is, to treat someone wrongly or inappropriately, as when iatrogenic benzo victims are first labeled as addicts and then subjected to a detox-type treatment protocol that is harmful on every level.
Sometimes we bring subjective reactions to something that truly isn’t there.
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Yes, and other times we read passages that inadvertently perpetuate discrimination against people with addictions.
I stand by my praise for part one of this blog and I think that part two is crucial as well; I just find that one passage to be problematic.
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Uprising
I think you may have missed my essential point on the issue of “commonality.”
Based on *my* reading of JDoe’s two blogs, the more overt and implied goals for the struggle they are courageously waging seem to be the following:
1) Educate people about the history of how “addiction” and “dependence” have been used by the medical establishment and codified in the DSM, and detail how this has negatively impacted victim/survivors of iatrogenic benzodiazepine dependence.
2) Advocate for a clear distinction to be made between addiction and medically induced iatrogenic benzo dependence so that people suffering from this form of neurotoxicity will not be labeled as addicts and endure the implied judgments in society related to drug seeking behaviors or impulsive self harm, and most importantly not be “treated” with any of the standard addiction protocols for tapering/withdrawal/recovery which are extremely harmful in the cases of benzo dependence (and I would add other psych drugs as well).
3) Build awareness and support for reclassifying iatrogenic benzo dependence as Ashton Syndrome, acknowledging the tremendous work done and protocols for recovery developed by the renown (at least in our circles) British doctor, Heather Ashton.
4) Raise awareness regarding the reckless nature of benzodiazepine prescribing in society beyond the 2-4 week (more scientific) standard and create conditions for safer prescribing protocols so as to end the damage and deaths caused by these dangerous medical practices.
5) Continue to build a community of support to help the millions of people damaged by benzodiazepine drugs to safely reduce their dependence and improve their daily functioning in the world.
I hope I did justice to the purpose and meaning of these 2 blogs (JDoe, please correct my interpretation if I misrepresented any of the implied goals). And to accomplish these goals there seem to be a strong desire in the implied and stated goals (especially in the comments) to completely distance themselves from the addiction community (including the devastating effects these drugs have had related to opiate overdose epidemic) due to professional and public confusion between these two issues.
My point on the issue of “commonality” relates more to the issue of WHAT WILL IT TAKE to even come close to achieving any of these type of goals given the nature of the system we are going up against?
The power and money behind Psychiatry, the DSM, Big Pharma etc. is NOT going to allow their heavily promoted and profitable narrative about the necessity for benzo prescriptions for the “treatment” of anxiety “disorders” and insomnia, and whatever other brain disease processes, to change EASILY.
They are heavily invested, as usual, in blaming the victims and describing all these kind of complaints as part of people’s “mental illness.” They will fight these changes (as they already are) with many forms of media, celebrities, and various strategies to promote confusion and division in our ranks and demean our own attempts to create a *new* more scientific and liberating narrative.
In fact, this is not fundamentally different than Biological Psychiatry’s other narratives related to “chemical imbalances,” depression and SSRI’s, psychosis and antipsychotics, and kids being kids with stimulants. These narratives are all now deeply entrenched in the lexicon of speech and within people’s more backward understanding of the nature of extreme forms of psychological distress.
We know from history that “divide and conquer” is one of the hallmarks of how those in power try to preserve the status quo. Yes, there are clear differences between addiction and iatrogenic dependence and yes , those difference need to be sharply stated with education carried out broadly. But it would be a mistake to believe that in this case the “powers that be” are going to very soon announce “oh, we get it, we’re sorry for our mistakes, and we will implement your goals for changes in all these false narratives that have harmed so many people.”
Let me be clear, I am NOT suggesting that anyone here believes that this will be an easy struggle, NOR am I trying to promote pessimism about taking up this battle. It is a noble battle and definitely capable of being won some time in the future.
People can try all sorts of things, including distancing themselves from the addiction community and any concepts related to addiction, but this approach may isolate this part of the movement from important potential allies and end up keeping the numbers of activists rather small, thus making it even more difficult to change the publically accepted narrative about addiction and iatrogenic benzodiazepine dependence.
Why not *consider* trying to “blow the top off” the entire benzodiazepine crisis by exposing ALL the ways benzodiazepines are wreaking havoc throughout our society. That is, detailing all sectors of society that are suffering great physical and mental damage and increasing numbers of deaths. Looking at shear numbers harmed and the broad scale of damage done, these drugs (benzos) may represent the Psychiatric/Pharmaceutical Industrial Complex’s greatest crime to date.
Don’t the “powers that be” want us all to be divided into separate groups unable to gather any unified strength of will and purpose. A situation where each group is declaring how they are different from the other, and desperately trying to avoid any of societally imposed stigma or commonly accepted prejudices associated with one identified group of people
Question: If an organized group of mothers and family members of deceased victims of opiate/benzo overdoses planned a public event trying to educate and expose the dangers of these drugs and target those responsible in society for recklessly prescribing them, what should our approach be to this struggle?
What if they invited some one like JDoe, or some other activists in the benzo support community to speak at the event in order to share other experiences of oppression from these drugs and the medical establishment? Should these benzo activists attend and support such an event AND speak out, OR should they avoid the event for fear that the two very different but related issues will be conflated , and in their minds, possiblyweaken their separate struggle?
And in a reverse scenario, if benzo support activists were organizing an event to promote their cause as I summarized above (I hope accurately), at some point in their struggle (when they have some organization and numbers) would it make sense for them to invite people from the addiction community that may have suffered great harm from the very same drugs and sources of oppression that have caused them so much damage and pain?
I know what answers I would give to these strategic questions. Once again, I am guided by the mantra of “unite all who can be united.” Don’t let them separate us. Carefully explain and articulate the science behind addiction and dependence and any other key point of reference, but ultimately join in a common struggle against the same forces in society that harm us and want us to remain separate and powerless.
The benzodiazepine crisis in this country is literally seething beneath the surface while negatively affecting millions of people. The “powers that be” cannot turn back or reverse the tide of their widespread promotion, enforced dependency and the resulting tragic misuse of these drugs on such a broad scale. With the development of the right kind of conditions and organized efforts this situation has the potential to blow wide open.
If the benzo crisis were to “blow wide open” it would create favorable conditions for each and every sector of society harmed by these drugs to advance their particular agendas, including changing medical protocols and maximizing the kinds of support available to all the victims of this category of drug.
I know every group and struggle has to find its own identity, and has to evolve at its own pace in the early stages of its development. I understand and respect that. I have deep respect for what these people/you are dealing with and what efforts they/you are making to achieve some type of liberation.
I hope you can also appreciate that there are others here at MIA who see all this in a larger context and are seeking any (and every) way possible to advance the common cause against all forms of psychiatric abuse. Hopefully mutual respect and positive exchanges of ideas and strategies can advance all of our efforts in these struggles.
Richard
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Maybe I did misunderstand, Richard. All I meant to say is that understanding about long-term iatrogenic harm from benzos is abysmal at both the societal level and among medical professionals, and I agree with J. Doe and others that it’s necessary to clearly distinguish between iatrogenic dependence and addiction in order to change that situation.
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Don’t the “powers that be” want us all to be divided into separate groups unable to gather any unified strength of will and purpose(?) A situation where each group is declaring how they are different from the other, and desperately trying to avoid any of societally imposed stigma or commonly accepted prejudices associated with one identified group of people(/)
Yes.
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Richard said: “People can try all sorts of things, including distancing themselves from the addiction community and any concepts related to addiction, but this approach may isolate this part of the movement from important potential allies and end up keeping the numbers of activists rather small, thus making it even more difficult to change the publically accepted narrative about addiction and iatrogenic benzodiazepine dependence.”
There are some 20,000 members of benzo buddies alone, and countless more iatrogenic benzo victims who don’t realize that they are yet—in part because most people who take drugs “as prescribed” are inclined to distance themselves from any notion that they are addicts. I don’t think “keeping the numbers of activists rather small” is the problem here.
Richard said: “Don’t the “powers that be” want us all to be divided into separate groups unable to gather any unified strength of will and purpose(?) A situation where each group is declaring how they are different from the other, and desperately trying to avoid any of societally imposed stigma or commonly accepted prejudices associated with one identified group of people?”
JDoe’s articles make it clear that the overriding impetus is not “avoiding stigma or prejudices” but avoiding misdiagnosis and mistreatment—as in medical “treatment”—that is harmful and even fatal. Those who look at this as a “cause” and not as an every day lived experience cannot truly understand what that means. And using the word “desperately” here in relation to JDoe’s carefully researched and well-argued points is offensive.
For the sake of honoring JD’s efforts—which are already, by the way, being praised by iatrogenic benzo activists and passed along to doctors—let’s try to move this back from the realm of specious theory into the realm of practical reality. Who are the “powers that be”? Drug manufacturers, as we know, just want to sell drugs. As JD points out, if a drug gets a “bad rap,” big pharma will simply repackage and re-market, just as “mother’s little helper” became the anxiolytics with the deceptively “small doses.”
Prescribing doctors, meanwhile, want to prescribe drugs to “fix” a perceived “problem” without complications (especially to themselves) and without the risk of being sued. When opiates garner more and more attention in the media for their addictive potential—that is, their potential for being abused by addicts—doctors concerned about litigation stop prescribing them and yank prescriptions from people who are already physically dependent on the drugs. Throwing patients into withdrawal is always horrible, and the only saving grace for those who are dependent on opiates is the fact that opiate withdrawal (to the best of my knowledge) is self-limiting—once it is over, in a few weeks, patients can emerge back at their starting point, provided there are no continuing issues with craving the drug.
Let’s extend that same scenario to benzos. Let’s imagine that we all join hands and publicize all the ways that benzos harm people, emphasizing solidarity between those who take their drugs as prescribed and addicts who abuse benzos illicitly in combination with other drugs. What will be the response of prescribing doctors? Will it be, “Wow, I’d better start working on a slow and safe taper with *all* the people I’ve prescribed these drugs to”? (You know, that slow and safe taper they don’t even realize is necessary?) Or will it be “Uh oh, I’d better stop prescribing benzos altogether—they’re bad news like opiates”?
Because let’s be clear—as much as we all want the same thing—for doctors to stop prescribing benzos for longer than the two to four week window—if doctors start yanking prescriptions from people who are physically dependent on them and need continuing prescriptions for a safe taper off of them, even MORE people will die. Even more people will find themselves in a protracted neurotoxicity that will rob them of years of their lives. When it comes to prescribed drugs that have the potential to be abused by addicts, it cannot be said often enough: benzos are a beast unlike any other—there is no shortcut to coming off of them.
As I said before, PLEASE allow JDoe’s articles the light of day! The effort here is a very specific one—to educate everyone who needs to be on board to effect change, a very specific kind of change that will benefit *everyone* who is affected by these drugs. An enormous amount of thought and a great deal of lived suffering has gone into JDoe’s work, and a fruitful discussion was beginning to formulate here before it was co-opted, over and over again. If you have never experienced iatrogenic benzo damage, you have no idea what it takes to make an effort like this in spite of it. Please, please, let go of the talking stick for five seconds and allow others to have a voice here unimpeded.
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Brighid
Thanks for the thoughtful response.
I am not trying to dominate “the talking stick” and I don’t believe I have prevented others from joining in this important discussion at this point.
Unlike Part 1 of this blog, nobody I’m aware of has continued to use the word “addiction” where “iatrogenic dependence” should be used. And nobody is advocating anything other than supporting the essence of JDoe’s blogs; I have been one of the biggest supporters.
When new people join in and discuss other related issues, including broader strategic issues around this cause and refer specifically to my comments and words (sometimes misunderstanding my meaning) I believe it is appropriate and necessary for me to respond.
Very soon this blog will leave the front page of MIA and this particular discussion will wither away. There are many different levels to understanding the negative impact of benzodiazepines in the world and they all need to be addressed, including the interpenetration of various aspects of this struggle.
I will soon introduce some other related topics because they are important to understanding the benzo crisis. And you and the others fighting this cause will definitely hear them from others if I didn’t raise them first here at MIA. I hope this helps you think more comprehensively on the subject; I know I have learned an enormous amount from reading these blogs and participating in the following discussion.
Richard
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note: When I said that maybe I misunderstood I was being polite.
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As I said before, PLEASE allow JDoe’s articles the light of day!
What the hell is this supposed to mean? Richard is not a “troll” and his comments are not preventing this discussion from taking place. He is as qualified as many, and more than most, to discuss the benzo issue and has put his career on the line trying to fight the use of these horrid drugs. He understands the points being made and specifies his disagreement with some of them. That’s what a discussion forum is for. People can ignore him if they so choose, and others are free to agree or disagree. But some people seem to have a problem with their own thoughts not being considered as written in stone.
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Oldhead, I think it’s important to take a look at the fact that, by sheer volume of words, someone claiming expert status has been drowning out the voices of survivors. When a commenter pays lip service to the letter of a written piece while continually overriding the spirit of it in the service of a different agenda, that is disingenuous at best. To my mind, that is not the function of a comments section, it is an exercise in subversion.
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Fantastic response Brighid.
Yes, first and foremost it is important to separate addiction from dependence in order to protect people from the effects of these dangerous drugs. Avoiding the stigma of addiction is secondary.
I was peripherally aware that these drugs can be “addictive” when they were first prescribed to me. I asked my doctor about this and she said “I’m not worried about that with you”. She thought that as long as I wasn’t abusing them that nothing could go wrong.
My doctor obviously was clueless about the true dangers of these drugs, so here I am, almost 5 years after my last dose and still dealing with some significant symptoms that cause me pain at times and prevent me from being able to live a “normal” life.
Had my doctor not been a victim of this ignorance I have to wonder if I would have had 5+ years of my life destroyed.
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FG, thank you so much for your comment of November 24. I feel that your story goes to the heart of what JDoe’s articles are saying and demonstrates that the point here is not one of semantics. In a medical setting, where language and terminology determine treatment protocols, if the terminology is confusing, it is the patients who suffer. As your anecdote makes it clear, doctors also can be muddled when the terminology they are expected to follow is misleading.
When it comes to benzos, eliminating the language of “addiction” (a word that is inextricably associated with behaviors) and focusing on the fact that the drugs THEMSELVES cause neuro-physiological effects and damage that can require years of suffering to begin to undo—that is the point, I believe, that needs to be hammered home and shared with medical providers and the public at large.
My story is similar to yours, although I am still in the midst of what seems like an excruciatingly slow taper. In my case, I thought my prescribing doctor was one of the “good ones”—a smart, Harvard-trained psychopharmacologist who developed an outside interest in nonconventional practices such as meditation and energy healing. When he first prescribed me a “low dose” of a benzo for sleep, it was “as needed,” and while he told me that the drug had addictive potential, he said that that was only a risk if I took it 30 days in a row. I honestly felt that if I took the drug for 29 days and skipped a night or two, I would be OK.
That was 25 years ago. Eventually, although I had no idea what was happening, interdose withdrawal caused me terrible back pain, and my doc gave me his blessing to split my dose and take the drug twice a day, every day, to relieve it. He assured me that any risk of addiction outweighed the benefits.
When the light finally dawned (like for so many, after reading “Anatomy of an Epidemic”), I went back to my doc to ask for help tapering off. He was aware of the Ashton method, but was surprisingly discouraging about my prospects of succeeding with it. He told me about a patient of his—a high-profile successful guy who had everything going for him, he said—who had tried for a year to get off Klonopin and “couldn’t do it.” Stunned, I asked the doc if he had any resources to suggest. He told me to go to a meditation class. Not long after, this doctor had a medical event and opted not to return to his practice as planned, riding off into the sunset without so much as a goodbye.
More recently, I looked at my records from years ago and discovered that this doctor had made a note, at the time that he prescribed a daily dose of Klonopin, that he had “discussed the risks” with me. I was floored. I had no recollection of any such conversation. A dear friend who had also been prescribed a benzo for sleep by this same doctor, for many years, agreed that she had never been told of its risks either. That friend is now fighting cancer and feels that she can’t take on the rigors of a withdrawal process, so she will likely be on the drug for the rest of her life.
Sorry to write a book here. I just think that the more we share our stories—including stories of seemingly well-meaning doctors who may have been confused by language, but ultimately shirked the responsibility of offering true informed consent—the more we can begin to educate everyone who is affected by this insidious beast.
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Where is Britain on the issue of the benzodiazepine crisis? Some would say that they are way ahead of the United States on this issue. Is this really true?
After all, Britain has Dr. Heather Ashton, a heroic pioneer in the fight for all victims of benzodiazepines. She developed the science behind understanding the damage done by the prolonged use of benzos and she also developed the path breaking protocols for more successful tapering/withdrawal from these drugs; protocols that may have eventually saved thousands of lives in Britain and throughout the world She ran a recovery clinic for 12 years between 1982 and 1994, helping hundreds of victim/survivors which also allowed her to further develop scientific breakthroughs including the concepts of of iatrogenic dependence and neurotoxicity related to these drugs. I would also add that Britain has had survivors like Barry Haslam who have championed the cause and done great education and support work around this issue.
Britain also has had various Chief Medical Officers (CMOs are the equivalent to the Surgeon General in this country) put out major warning distributed publically to all doctors warning about the dangers of benzodiazepines and recommending the standard protocol of only 2-4 weeks for prescribing these drugs.
Yet, despite all this there are STILL millions of benzo prescriptions recklessly being prescribed in Britain, and on going damage being done related to iatrogenic dependence/neurotoxicity, worsening of addiction problems, and deaths related to opiate/benzo drug cocktails..
How can this still be the case given the work of Heather Ashton, Barry Haslam, and CMO warnings periodically given in Britain? I would argue that Britain is not QUALITATIVELY any better off than the U.S. on this issue despite these noted positive factors.
Would greater activism on the issue of the difference between iatrogenic dependence and addiction have helped the situation in Britain? Definitely yes, but I don’t believe it could ever have made a qualitative difference given the powerful forces we are up against.
Apparently in Britain and in most countries in the world the Psychiatric/Pharmaceutical/Industrial/Complex has just as much power and influence as it does in the U.S. Despite pioneering scientists, activists, and enlightened CMO’s in Britain, business as usual, (with DSM labels and psychiatric drugging, including benzodiazepines) continues to march on unabated. We must know our enemy (both who and what we are up against) to be able to win battles and ultimately defeat them.
The pharmaceutical industry’s vast promotion and distribution of psychiatric drugs would not exist WITHOUT the pseudoscientific façade provided by modern Psychiatry. And Psychiatry would NOT have the enormous power it wields (labeling, incarcerating, Electro-shocking, and drugging) in today’s world without the money and influence of the pharmaceutical industry.
We all have our work cut out for us in these future battles.
Richard
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Just exactly WHO has “MUDDIED THE WATERS” in this discussion AND what does the renown Doctor HEATHER ASHTON have to say on the issues of iatrogenic dependence and addiction?
First off, I have been told (accused might be too strong a word) in this discussion that I have “muddied the waters” by stating that we should not try to erect an “impenetrable wall” between the two concepts of *iatrogenic benzo dependence* and *addiction*, AND my advocacy for “blowing the top off” the benzodiazepine crisis by recognizing the value in uniting all sectors of society damaged by these drugs, including those affected in the opiate overdose epidemic. In other words, not allow the System to get away with another “divide and conquer” consequence to all the cultural barriers imposed on us in this crazy world.
My short answer to the question of “who muddied the waters?” is NOBODY! Nobody, that is, here in this blog or comment/discussion section.
In my view the waters were “muddied” long ago by an economic and political system that spews out enough trauma and stress on a daily basis to create fertile ground for a culture of addiction and dependence, and a profit based market place to promote and distribute mind altering substances (under the guise of medicine and medications) to treat fictitious brain diseases.
Now, here we are trying to bring some sanity and science to a complicated mess of experience and ideas. Iatrogenic dependence and addiction have clearly different meanings and experiential outcomes that need to be defined. BUT this does not mean there are not some “grey areas” that need to also be explored and understood. So what does HEATHER ASHTON have to say on one important aspect of these complicated issues?
On the Ashton website in her answer to the question #38 (Questions and answers). “Should I use a 12 Step program like Narcotics Anonymous to help me recover from my Benzodiazepine addiction?” Ashton responds as follows: (first off she does give a good explanation of iatrogenic dependence and certain downsides of the 12 Step approach) then she states:
“…It is important to note that a sizeable percentage of benzodiazepine dependents do exhibit patterns of abuse. The clearest sign is taking doses far in excess of what your doctor has prescribed and/or having a history of abusing other drugs in the past or simultaneously with your benzodiazepines.”
So I agree with the above statement and believe there are several subsets of people who are dependent on benzodiazepines in society, and it is important to understand both their differences along with some areas of commonality:
1) A sizeable subset of people (possibly the vast majority) with iatrogenic dependence, with no addictive history and no evidence of addictive use. (JDoe and others are an advocate for this group)
2) People with an addiction history (or active use) who at times, or on a regular basis, use benzos (prescribed or otherwise) to add to or supplement their addictive relationship with other drugs and/or alcohol. Here a form of iatrogenic dependence may develop and be interwoven with elements of addiction.
3) People who have iatrogenic dependence on opiates that was caused by organized medicine, and then migrate to street drugs as dependence and tolerance issues escalate and their doctors cut them off or abandon them. Many of these people also seek out benzos because of increased anxiety in their lives and a need/desire to offset opiate withdrawal. When full blown addiction behavior consumes their lives, benzos may become a regular additive to their opiate cocktail. Both those people in the 2 and 3 category are at greatest risk of dying from and opiate/benzo drug cocktail.
4)People who first develop an iatrogenic benzo dependence from reckless prescribing and then due to the horrible side or *main* effects the psychological conditions are now created for it to become a gateway drug for addiction to other substances like alcohol or opiates when seeking relief from withdrawal/tolerance. This is clearly one of the larger “grey areas” in understanding some of the connections between iatrogenic dependence and addiction.
5) People who are primarily addicted to benzos (they may have arrived at this status through iatrogenic dependence) and use these drugs in addictive ways and also supplement their addiction by using other addictive drugs.
People should be able to see that this issue is NOT clearly “black or white,” there is a lot of “grey” here. There is not, and cannot be, an impenetrable wall erected between these different but related concepts and specific drug related experiences. I am sure that the tens of thousands (perhaps hundreds of thousand) of people who use internet benzo support groups fall into some of these different (and overlapping) categories Use of any mind altering substance can (over time) create all types of mind games or confusing thoughts about one’s relationship with the drug. This is a complicated topic that requires far more time and space that we have here at this time
To deny or downplay the fact that these issues (related to benzodiazepine dependence) are very complicated and overlap in certain circumstances with addiction issues, will only undermine the credibility of those fighting this important cause and prevent more people from joining in the fight.
It is here where those people who view their problems mainly through a prism of addiction may especially need our help in sorting out all this complicated shit. Compassion, understanding, science, AND solidarity are all important in helping people deal with these issues.
I will repeat again that I fully support (and understand the reasons behind) the effort to draw a clear distinction between iatrogenic dependence and addiction. In fact, by clearly making this distinction, it actually adds weight to the overall political indictment of Psychiatry and Big Pharma and further highlights their criminal actions in damaging millions of unsuspecting victims in the world who are guilty of nothing more than putting their trust in the care of a psychiatrist or doctor.
My approach here has been to give constructive feedback regarding a more minor and secondary countercurrent of narrowness in a few parts of the blog as it relates to concepts and attitudes towards addiction and the approach to “uniting ALL who can be united” to achieve the goals of the struggle. In addition( for the broader MIA community) I have tried to broaden a discussion about how ALL of us might approach the opportunities afforded by the benzodiazepine crisis to advance the struggle against all forms of psychiatric abuse.
Respectfully, Richard
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FG, I’m agreeing strongly with your idea that your doctor didn’t have a clue. I was under pressure from a primary doctor, a psychiatric nurse practitioner, and a therapist to add a benzo to what I was already taking. My family’s strong history of alcohol over-use (on both sides of the family!) and some inner “feeling” that I should avoid it at all costs…..plus a stubborn streak a mile wide, allowed me to resist their claims of “you need this” and “no problem”. In searching for a better way to approach my difficulties, I found the world of Functional Medicine. Despite the psychiatric nurse practitioner’s directions to the contrary, I did a three month taper from an SSRI with nutritional support and direction from a Functional Medicine practitioner. J. Doe, thanks for educating all of us and Happy Thanksgiving.
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Hi, Nan. And whew! So glad to hear your inner feeling allowed you to escape ignorant and dangerous advice that could’ve turned out to be a very long and painful “journey” (it’s more like a long ride through hell). Congratulations on freeing yourself as well from the SSRI with the help of nutrition and functional medicine. Have a wonderful Thanksgiving yourself and thank you for your comments. -J.Doe
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Hi J Doe,
Can I say I think that these two articles are some of the most important I’ve read on MiA.
I watched my brother go through something for many years that was ugly. He was given benzos to treat “Agorophobia”. Your articles have completely changed my thinking about what I observed.
I think that there is a need for doctors and associated workers to be tested on the information contained in part 1, and should they fail, sanctions be applied.
I also wonder about the issue of the ‘status’ of benzos, and the way in which when they are administered without knowledge they are an “intoxicating substance”. And yet the mere fact that they are prescribed by a doctor and taken with knowledge makes them medicine? I’m not being clear coz i’m not that clever but, it seems to me there is also opportunity with the use of the legal framework to educate the public about these issues.
Make your voices loud. Take care Boans
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Boans,
You state:
“I watched my brother go through something for many years that was ugly. He was given benzos to treat “Agorophobia”. Your articles have completely changed my thinking about what I observed.”
This is a huge part of the reason why I wrote these two articles- in hopes that family members and friends (and maybe even, hopefully, a few medical providers) of iatrogenic benzo sufferers could better understand us and what exactly happened to us.
I, personally, was very misunderstood and it was incredibly painful, not to mention scary, when I was in such a severe state of cold-turkey withdrawal to where I could not effectively advocate for myself. Instead of helping me or believing me or realizing how serious this was, I was treated poorly (due to lack of education on everyone’s part) and my health and life were put at risk.
If these articles served to help you better understand what your brother went through, I am satisfied that they served their purpose- if only even to just help one person. So, thank you.
I plan to be persistent and quite loud with my voice on this topic, you got that right!
All the best, J. Doe
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These are quite possibly the 2 best pieces I’ve seen yet – thank you!
if not for the language surrounding these drugs I would NEVER have taken the RX from my Dr. To me – “dependency” came with “abuse” – something I knew would never be an issue – and it was not – had I understood that I could become physiologically dependent or harmed without a psychological component presenting – never would this have happened…..and of course, I wasn’t corrected or educated by my Dr or anyone else – Language…..you nailed it
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