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The Pink Elephant called Tolerance Withdrawal


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I’ve been told different things about TW. Many veterans say it can’t happen when tapering because the true definition of TW is different from Withdrawal effects, or even tolerance itself. Others say that they reached tolerance then TW while tapering. Most people don’t seem to go into TW, but a few report this happened to them, and it scares the rest of us and in some cases makes us taper faster than we can handle, whether it is true or not. 

 

Nomenclature aside, what is the consensus on here? Does TW exist while tapering or do we just hit a wall at which the med dosage is below our tolerance level so we can’t stabilize and just call it TW? If TW can’t happen while tapering, what is the objective reason for this besides just the nomenclature behind the definition of TW? While tapering, and hopeful healing our receptors, does TW just stop due to some pharmacological mechanism taking place during withdrawal, or should we be aware of holding too long during a long window or when our brain has stabilized for a substantial amount of time?

 

And…can TW continue to increase to the point where you can actually get sicker and sicker while holding? If so, does a cut somehow negate TW and put us back into “regular” Withdrawal? Get what I’m saying?

 

I know much of us have a subjective experience about this, so please share these too. I’m not siding one way or the other, but am very curious and think everyone, esp new buddies can benefit from knowing if Tolerance Withdrawal is something to worry about if they haven’t developed it already while steady on the medication.

 

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Well I'll throw in my thoughts about this based on my experience, and the reading that I have done.

 

Tolerance is a medical term that is used when we continue to take a med for long periods of time, the body becomes tolerant to the effects of the med and we require more and more of the med to get the same response.

If we continue to take the same amount  of med after we have reached a point of tolerance then we start having sxs of withdrawal.  The body is in w/d from not having enough of the medication to do what it needs it to do: it has reached tolerance and it is having sxs of w/d.

 

We also get w/d sxs if we lower the dose of a medication that the body has become dependant upon -- the body requires the medication to stay stable and starts to react to consuming less of the substance.  This interferes with the homeostasis of many systems within the body (in the case of benzos) not just the GABA/glutamte sxs.  There's a great post by Parker about all the systems affected.

 

Tolerance withdrawal is a term that I believe was coined by Ashton in the work that she was doing ( She is a hero in many regards!!!!) But she had an idea that if people were withdrawing and held at a lower dose they would go into tolerance w/d -- a term that was never defined in anything I have read  - please if anyone has read differently let us know!  I'm not saying I know her stuff all that well....

 

For many people withdrawing from benzos as we lower the dose then we go into w/d and have sxs of varying severity.  If we continue to lower the dose while symptomatic then the symptoms increase.  If we hold then the sxs may decrease but if we have been tapering at too fast a pace for our own bodies healing then we may need to hold for awhile until the w/d sxs subside and the body stabilizes.

 

This is often when we are told that we will go into "tolerance withdrawal" if we hold for too long while our bodies are having sxs of w/d -- but I've not found that to be true for me or my body. 

 

Holding has helped tremendously with sxs and then tapering can be an easier task.  I know that my body is feeling better and better as I go into month 3 of this planned 3 month hold.... my whole CNS is stabilizing a much easier place to taper from - a stable CNS.

 

The term tolerance w/d just doesn't make any sense to me.  Being in tolerance and being in w/d can feel similar but we must look at the big picture to know if the sxs we are having are due to tolerance or to w/d. How can I be in tolerance if I've come way down in dosage?  withdrawal yes, but tolerance, not so likely....

 

Ashton is considered far too fast a schedule for many people now, and we also know that healing does occur as we taper off, so the idea that we need to jump off while in the midst of sxs and then go into acute w/d sxs has been proven to be faulty for many people.  Lots of people have tapered very slowly and walked off without going into acute w/d.

 

Don't get me wrong here, without Ashton we wouldn't have tapering at all!  She did amazing work at a time when we had so little knowledge of how these things work. But luckily things have evolved from her original and very compassionate stance.

 

So what do others think of this idea of the definitions etc.....

SS

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A ditto from me, SS, I agree with your definitions as well as the questioning of "tolerance withdrawal".  :thumbsup:

thanks abcd, that's means a lot to me coming from you!  I'm learning  ;) !

:)

SS

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SS--thanks so much for taking the time to respond with such a well-thought out reply. I still don't have an opinion (and want to stay neutral) but I seriously hope what you wrote is true! I'm also hoping we get some more thoughts on here. I feel like this should be addressed once and for all  :)
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Thanks for the original post & the replies to date. I plan to hold for now until I get these concepts straightened out at least in my mind because I would prefer not to go into acute/protracted withdrawal if I can help it. In addition to the comments already made regarding terminology, aren't the 1/2 life of the benzo & blood serum level also associated with withdrawal and tolerance? I look forward to reading input from others too!
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This is a very important question in our aspirations to achieve the optimal taper but not easily resolved IMO.

 

In general terms, I agree with SS, particularly that it is better to taper from a point of stability. I’m not so sure that tolerance withdrawal can be totally dismissed as a phenomenon, (or in 2018 terms, is not a thing).

 

OTOH, it seems likely that in some people, significant receptor changes can occur in as little as 3 weeks while reversal of those adaptations can take longer than it does for BBs who have been on benzos for many years.

 

If this means that the receptor changes are locked in early, then long holds theoretically may not cause tolerance. There is a group of BBs like SS who are having successful symptom based tapers.

 

OTOH, there are BBs who after an individual period of time, start having break through withdrawals, although not currently  tapering, find that they have to increase their dose , (sometimes several times), to get stable again.

 

Other than to significantly prolong the time on benzos, this may be the best harm minimisation for an individual. However, it does depend on a sympathetic medical professional as I suspect the number of doctors who support updosing are in the minority.

 

 

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OTOH, there are BBs who after an individual period of time, start having break through withdrawals, although not currently  tapering, find that they have to increase their dose , (sometimes several times), to get stable again.

 

Other than to significantly prolong the time on benzos, this may be the best harm minimisation for an individual. However, it does depend on a sympathetic medical professional as I suspect the number of doctors who support updosing are in the minority.

I wonder ihope if some of those people are having the the "break through w/d" are in a place about a month or so out from a long acting benzo when the last of the half-life is finally out of the sxs.  In that scenario -- I haven't tapered from Valium yet  so I am speculating here and basing it on what others have written  -- holding for a while longer can actually allow those sxs to settle as well.  So I guess I'm saying that is still w/d and that the long acting nature of some of the benzos create some weird time frames for it all.  It's all theory, in my case as i haven't personally dealt with it -- yet....and of course we know that the whole thing is so very very personal and has many factors in life style that add to the mix....

 

It's an idea that I'm thinking I'll have to deal with when I taper the Valium that is part of my dose....

:)

SS

 

 

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FWIW, the phrase, tolerance withdrawal, does not seem to be used anywhere except here on BB (and similar websites/message boards).  I have  done searches and have never seen it use in any scholarly reports, including Ashton's work.

 

So, yeah, IMO, the term "pink elephant" is probably appropriate.

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FWIW, the phrase, tolerance withdrawal, does not seem to be used anywhere except here on BB (and similar websites/message boards).  I have  done searches and have never seen it use in any scholarly reports, including Ashton's work.

 

So, yeah, IMO, the term "pink elephant" is probably appropriate.

 

thanks for clearing that up for me builder..... I though as it was used here so much-- in an almost threatening tone--  that I had read it there...

 

Yup the elephant in the room....

 

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Hi folks l am going to give you my opinion through my own experience.Firstly there is no such thing as tolerance withdrawal tolerance l would imagine we all hit a long time ago.

    Now a few people have withdrawal symptoms on a steady dose however not everyone has that nor will tapering make that happen.l found over years l developed nerve pain in my teeth, the undulating floor sensation and agrophobia now these are all classic symptoms of withdrawal.

    This is not wide spread and not everyone gets withdrawal symptoms when on a steady dose of benzo and I wish people would stop using that term to push people through acute withdrawal symptoms.

    Even though I have suffered this l still find holds helpful and perhaps l don't get the relief that some get from a hold l refuse to push through and suffer more than l need to.

    So it does happen in my opinion however it shouldn't be used as a term that is used to scare people who are already petrified.

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Hi folks l am going to give you my opinion through my own experience.Firstly there is no such thing as tolerance withdrawal tolerance l would imagine we all hit a long time ago.

    Now a few people have withdrawal symptoms on a steady dose however not everyone has that nor will tapering make that happen.l found over years l developed nerve pain in my teeth, the undulating floor sensation and agrophobia now these are all classic symptoms of withdrawal.

    This is not wide spread and not everyone gets withdrawal symptoms when on a steady dose of benzo and I wish people would stop using that term to push people through acute withdrawal symptoms.

    Even though I have suffered this l still find holds helpful and perhaps l don't get the relief that some get from a hold l refuse to push through and suffer more than l need to.

    So it does happen in my opinion however it shouldn't be used as a term that is used to scare people who are already petrified.

 

:thumbsup: :thumbsup:

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Check 'relative withdrawal' as the phrase used by Colin somewhere on this forum,

Can you give more information about this liberty?  I looked it up but there seems to be reams of threads to wade through....

SS

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Check 'relative withdrawal' as the phrase used by Colin somewhere on this forum,

Can you give more information about this liberty?  I looked it up but there seems to be reams of threads to wade through....

SS

 

SS: Is this a partial reference to your inquiry?

http://www.benzobuddies.org/forum/index.php?topic=122450.msg1624827#msg1624827

 

Here's what Colin (owner of BenzoBuddies) wrote about tolerance/relative withdrawal:

 

Quote

If you are unfortunate enough to develop Relative Withdrawal symptoms, you will not gain relief through stabilising your dose. If you experience withdrawal symptoms before starting your taper - that is to say, Relative Withdrawal symptoms - all you can do is withdraw at a sensible taper rate. If once you have started your taper you then develop withdrawal symptoms, it can be difficult to determine if you are suffering withdrawal symptoms because your withdrawal is too rapid, or if it is the result of developing Relative Withdrawal. If you experience no relief after stabilising your dose for some time, you have probably developed Relative Withdrawal symptoms. In this unfortunate situation, all you can do is continue to taper off at a reasonable and tolerable rate.

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Trust/god It seems like a big part of what you asked was whether tolerance Withdrawal is responsible for those who get stuck at some point in their withdrawal and never stabilize. I can't answer that for sure or even how often that actually happens But that may also happen more often to those who have kindled, who have polydrugged, or are continuing on certain medications while trying to taper off one It seems like a general rule that those who have hit tolerance have a tougher time than those who don't but the phenomenon of near permanent stuckedness in tapering could have many more causes than just tolerance withdrawal.
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Check 'relative withdrawal' as the phrase used by Colin somewhere on this forum,

Can you give more information about this liberty?  I looked it up but there seems to be reams of threads to wade through....

SS

 

 

Here it is:  www.benzobuddies.org/forum/index.php?topic=9706.0

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Re: Here it is:  www.benzobuddies.org/forum/index.php?topic=9706.0

 

:.If one is of the same opinion, Tolerance & Relative Withdrawal are one & the same with this definition: "Relative Withdrawal refers to withdrawal effects that some people experience once they have become tolerant of their benzodiazepines. Although they are not reducing their dose, they nevertheless experience withdrawal-type symptoms. As with 'tolerance', increasing their dose might alleviate the symptoms, but they are likely to again become tolerant of the increased dose. The only good solution is to taper off at a sensible rate and allow enough time for the GABA system to recover. We should point out that only a small number of people develop Relative Withdrawal symptoms."

 

 

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Thanks for the links! I think he is corroborating what I think. Or I’m echoing back what I read from his posts.  :D:laugh:

I disagree with the idea that if you reach relative tolerance the only thing to do is taper off completely. Ithink for me I had to taper, and I was in horrible tolerance when I began tapering— but at some point absolutely had to hold too..

And yes to whomever said those of us who reached a place of tolerance or interdose w/d have a harder time.

But I think if we find a place to hold after tapering some, then we can get out CNS to calm down.

It’s worked for me and I learned it here on B.B. And I’m really kindled meaning that in my life I was prescribed benzodiazepines 5 different times for insomnia..... came off them relatively easily... maybe.

Thanks for starting this thread!

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For me from experiences, I'm inclined to agree with SS re: not having to continue the withdrawal process without stabilizing. Additionally, I question this statement: "As with 'tolerance', increasing their dose might alleviate the symptoms, but they are likely to again become tolerant of the increased dose. The only good solution is to taper off at a sensible rate and allow enough time for the GABA system to recover."  for these reasons: 1) increasing the dose has been the established practice for patients who become tolerant because it usually does alleviate the symptoms. I am not aware of any upper limit for doses other than the manufacture's suggested maximum limits. 2) Tapering off often worsens the symptoms and causes more. and 3) I have yet to find any evidence other than anecdotal that the GABA system ever does recover (heal).
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F1,

I think that it is anecdotal that the GABA and al the other systmems in the body that are affected by benzos do heal, in that there are no further sxs for people who do a slow taper and walk off rather than do any "jumping."

 

There is a thread under the chewing the fat section that explains in through scientific papers that have valid research being them how the body heals and all the processes that need to realign.  It's "how do you explain this to a layperson"

It's been immensely valuable to me even though many of the papers are far above my head.  I can get the gist and the more i read the more I understand the earlier papers.

 

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Check 'relative withdrawal' as the phrase used by Colin somewhere on this forum,

 

Yes. I found it.

 

http://www.benzobuddies.org/benzodiazepine-information/tolerance-and-dependency/

The longer you take benzodiazepines, the greater the chance that you will develop tolerance. Most people develop tolerance, and it is a gradual process. For some, this may occur and develop very rapidly, within a few weeks of their first dose. It is probably easier and wiser to taper off benzos before developing tolerance, and particularly before developing 'Tolerance Withdrawal' symptoms - we prefer the term Relative Withdrawal.

 

Relative Withdrawal refers to withdrawal effects that some people experience once they have become tolerant to their benzodiazepines. Although they are not reducing their dose, they nevertheless experience withdrawal-type symptoms. As with 'tolerance', increasing their dose might alleviate the symptoms, but they are likely to again become tolerant of the increased dose. The only good solution is to taper off at a sensible rate and allow enough time for the GABA system to recover. We should point out that only a small number of people develop Relative Withdrawal symptoms.

 

A popular myth is that Relative Withdrawal is dose-specific. In fact, only an increase in dose might alleviate symptoms; a decrease in dose cannot! The longer you stay on benzodiazepines (whether or not you have started your taper), the more likely you are to develop Relative Withdrawal symptoms. For this reason, it is better to taper off sooner rather than later. It is sometimes said of Relative Withdrawal that by staying at a particular dose for too long, you will develop 'Relative Withdrawal' effects to this specific dose, whereas if you were instead tapering, this would not occur - this not how Relative Withdrawal occurs! Whilst it is true that by stretching out your taper longer than necessary you might increase your chances of developing Relative Withdrawal symptoms, it is not the result of you sticking at a particular dose for too long. Rather, it is the result of protracted use of benzos, whether or not you are withdrawing at the time, which can lead to Relative Withdrawal symptoms.

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Thanks for all the really good and thought out replies! So for those who agree with the concept of Relative Withdrawal....

 

Does this relative withdrawal and symptoms  continue to get worse and worse as times goes on while on the medicine? Does the threshold for what our brain needs continue to rise and rise? If that’s the case, doesn’t it make sense to do a more rapid taper? Why hold and or taper at a “sensible rate” if we are just increasing time on the benzo and making this worse? Perhaps I’m understanding this wrong.

 

Is this why Ashton doesn’t recommend tapering to minuscule amounts? Or is that because doing so could sensitize our systems? Perhaps stepping off isn’t ideal for someone in Relative/Tolerance withdrawal...

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