Abstinence vs Medication Assisted Treatment for AUD

I think that was a perfectly valid post, congratulations on finding a way of breaking free from AUD! 

Well said, Joanna! Thanks!

I dont think I could have stopped without taking something - OK I know what I take is a bit extreme, but while it works I'm taking it.

AUD is complex because it does appear to be possible to go for ages without wanting to drink, and even when I do - SOMETIMES - managing to drink just a few units, then stop.

The trouble is that getting really stressed about something seems to put turning to alcohol at the top of the list of solutions at the time. Its mainly a build up of stress which is the trigger for me. 

Since thats not the behaviour of a 'classic' alcoholic I sometimes have fooled myself into actually believing that I'm not one - an alcoholic. I know people who drink everyday, some an amount which they can function with and still go to work, and some who drink so much their lives have done or are falling apart.

I have to somehow hold on to the feeling I have now - that I know my weakness, and its not going to change, and no matter how long I manage to be dry for - it will always be there. 

Yes, there seems to be this idea that there's one type of alcoholic, where there are at least three. The Daily Drinker who generally has a "start time" and won't drink before that. The Maintenence Drinker, who drinks all day (frequently "topping up" throught the day to stop withdrawal symptoms), then drinks more heavily after the work day is done. The Binge Drinker, who can go days, weeks or even months without a drink, but then has heavy drinking episodes that often culminate in blackouts. 

It appears that there is at least one common mechanism driving all three types that involves the opioid pathways in the brain. These pathways get reinforced every time a drink is taken, until they are quite strong and begin to generate craving that can predictably move a person from "trigger" to "tipple".

The tendency for this pathway (located in the area of the brain called the Striatum) to become reinforced to this point is what seems to set the 90% apart from the 10% that can manage via different methods of abstinence.

Medication Assisted Treatment is evolving to address the craving and TSM is one way of doing this. It has the advantage of being able to be applied while one is still drinking, but there are other ways as well. We need to keep asking what we can do to effectively help people maintain a normal relationship towards alcohol and deliver treatments that restore their free choice in the matter. 

Ursula, your weakness can change. Therapies like TSM can help you erase the craving that is so powerful that it moves you to drink against your better judgement. Your choice in the matter can be restored and what used to trigger drinking can trigger healthy and beneficial responses that actually address the stress and anxiety instead of just causing more of it.

I know I am the binge drinker type. 

I used to be pretty controlled about drinking and never drink more than the people I was drinking with - went to parties, clubs, pubs etc. and noone thought of me as an alcoholic, and I used to keep a count of my units and try to stay under the 'recommended limit', which I did alot of the time.  I saw drinking as a treat to wait for at the end of the week. If I drank in the week, it would be a few halves in the pub.

This all changed when I was in my mid-thirties, when I started drinking alot just to alleviate stress, and at different times of the day - not waiting until a fixed time.  I did have a baby at this time, but having him was planned by me and my husband, and we had a good stable set up and support from family and firends.

I dont know what changed in me - its just weird.  Whatever it is, I wish I could switch it back again!  I presume by TSM you mean Transcendental Meditation?  I'm sure we have a local group - I'll look up when their meetings are.

By TSM I mean The Sincliar Method:

https://patient.info/health/sinclair-method-for-alcohol-use-disorder

Did you start any medications about the time you started drinking more?

Oh sorry - The Sinclair Method - right!

Yes, when I started drinking dysfunctionally I had been put on anti-depressants. They never seemed to mix well with alcohol, although they worked quite well for me at first.

There are posts on the internet about antidepressants driving cravings up, down or making no difference at all. It's a good one to keep an eye on just in case there seems to be such a negative side effect, might be cause for the doc to change the prescription.

The other day I came across an article on a blood pressure med called isradipine that seemed to have a beneficial effect on excessive drinking. The studies were small and few, but if one had a drinking problem and a blood pressure problem that was controlled just as well by by isradipine, seems there would be little to lose.

I know that fluoxetine and other anti-depressants can 'disagree' with alcohol. I dont know if there are controlled studies on this. Obviously alcohol can reduce any beneficial effect of the anti-depressant. I also have heard pure anecdotal evidence that people on things like SSRI's can become more agressive after drinking than they used to. 

Being on fluoxetine helps to cut out the depression and feelings of 'doom and gloom', but it also seems to reduce feelings of sadness and sometimes guilt.

I find it almost impossible to cry when on prozac, which can be a huge relief, but the general dampening down of emotional response isnt always a good thing. 

Overall its been a good thing for me as I used to waste alot of time getting upset about things. I believe SSRI's dont go well with alcohol, but this is just an opinion, not based on scientific evidence!

I think you'll find warnings against using them with alcohol on most of the package inserts, so you're not far off at all, though some are used off-label to help people cut back their drinking. 

Youre not supposed to drink on them, but I know alot of people who do. Drs will often just keep prescribing SSRI's for years, and alot of people simply dont have the discipline not to drink with them. The trouble is that taking them seems to be normalised to the extent that no one is suprised when they find out someone takes them and if someone is feeling a bit low, the first thing alot of people suggest is to go on antidepressants.

 

I imagine some of that should clear up as MAT becomes more widely adopted and people with AUD get proper treatment the first time around. The anecdotal reports of antidepressants actually causing AUD are concerning, I don't know what's being done to inform patients and the medical community about that. 

Yes, Misssy! Whatever gets people there and increases net health is without a doubt a step in the right direction.