Sober Day #67- No Drama

Overuse of Alcohol is always accompanied by Drama.  (I think this is true- although 'always statements always make me nervous, lol).  For many the drama is overt, out in the open- noisy fights, door-slamming disagreements, drunk driving, etc.  For me, however- and many others, I am finding out- the drama was always covert, quiet, secret.  And I think it is harder to see the damage from this type of drama, harder perhaps to admit there is a problem with alcohol.

I liked drinking at home, by myself.  An old favorite book or some new magazines was great-  and I would quietly sip glass after glass of wine until I fell asleep.

So where's the drama in this scenario?  Inside!

It was the daily focus on:  What wine is in the house?  Do I need to buy more?  If so, where and when?  The avoidance of other evening activities that might cut into this drinking time.  The dropping out, bit by bit, of other enjoyable activities that didn't involve wine.  The morning fogginess, the butt-dragging approach to each new day.  It became a tunnel-vision version of wine, wine, wine- with everything else, everyone else being only of peripheral interest.  And althoughthis happened while I was continuing to function well professionally, working out and remaining fit, keeping the house functioning well-

There was always this internal drama, this continuing back-chatter of avoidance, alcohol-focus, recrimination, shame:  almost like living a second hidden life along with my outer functional one.  This was a huge energy-suck, and having no energy left for creativity and non-alcohol fun compounded the dominant role of alcohol in my life.

At just over 2 months sober, this is incredibly different now.  I awaken thinking of what awesome things I can tackle this day- rather than how little I can do and still function well.  I bounce out of bed- almost literally- rather than slowly dragging my feet to the floor.  I have energy and enthusiasm - not all the time, but the majority of the time.  My mind runs in fruitful circles around itself, devising new things to try and finding fun and satisfaction in things I'm already doing- even as simple as seeing a cardinal on a snowy tree out my kitchen window while washing dishes.

I have to admit that, to my surprise, this ability to spend time here and now, without all energy being sucked up by internal alcohol-related drama, is amazingly satisfying and nourishing.

So I have a new guideline for myself:  If something feels dramatic, compelling in a soap-opera sort of way, or becomes  an energy-suck type of focus?  It's time for me to examine it very closely, and see what lies I may be telling myself about this event/situation/thoughts.

Since a lot of early sobriety involves dealing with pains and dysfunctions that we drank to escape, there is a lot of sitting-through-pain and dealing with distasteful reality and non-productive adaptations we've developed over time.  Finding clues like:  Examine the Dramas-  seems to help me dig out those dark roots and mal-adaptive behaviours that I have probably been feeling/using since childhood.

I find I very much like these no-drama moments, and they reinforce my decision never to be a daily drinker, and over-user of alcohol again!

Sober Day #58- Medication help for Quitting Alcohol (long post!)

All of us who have struggled with addiction are wary of adding another medication to our intake- wary of another dependence, wary of in-authenticity, wary of adding to our woes.  But a recently-published study offers a potentially axis-altering option for making quitting a bit easier.  (The full reference is below)

This was a 12 week randomized double-blinded placebo-controlled trial  (DBPCRT).  This is the gold standard for clinical studies:

Randomized:  Participants are randomly assigned to treatment (in this case, active medication) or control (placebo, inactive medication) arms.  This avoids the potential bias of patients ending up in a group because of their own or the researchers expectations of which arm they'll do better in.

Double Blinded:  Neither the participants nor the researchers interacting with the patients are aware of which ones are getting active vs. placebo medication.  This is important because many many studies have shown that expectations (on the part of the patient or the research) can subtly influence interactions, and actually affect outcome.

Like one study of grade school kids and their teachers.  The teachers were told that tests showed certain students were expected to excel during this school year.  Analysis at the end of the year showed that these students had indeed done very well, achieving excellent grades and great evaluations from the teachers.  EXCEPT:  There was no testing.  The students were randomly chosen for the 'expected to excel group'.  Which means this group included the extra-smart and the not-so-smart, the previous-thrivers and the previously-indifferent students.  Expectations of excellence on the part of the teacher apparently helped each student to achieve his/her best.

The medication used in this study was gabapentin (trade name Neurontin), basically an anti-seizure medication.  It has, however, proved useful for lots of other problems.  Chronic cough and laryngeal sensory disorder are areas I have experience with using it, and it can work very well for these.  One really important thing about this medication in the alcohol-context is that is has no abuse potential.  Unlike the benzodiazepenes (valium, klonopin, xanax, etc) frequently used for alcohol withdrawal, and sometimes for help with anxiety in early sobriety, which have major abuse potential.  People have inadvertently replaced an alcohol addiction with a pill addiction!  Other medications like Antabuse cause physical sickness (nausea, vomiting) when alcohol is consumed while taking them.  So these options make Neurontin look like a less disagreeable or dangerous option!

This current study included 150 men and women who were alcohol-dependent, and lasted for 12 weeks.  The participants were divided into 3 groups.  One received placebo tablets, the second received a total of 900 mg of gabapentin daily, and the third received 1800 mg daily.  (The pharmacy prepared special versions of the medication so that the pills received by each of the three groups appeared identical, even though the active medication was different).

The outcomes measures tabulated by the researchers were whether complete abstinence occurred.  And if not complete abstinence,  did the patient at least have no episodes of heavy drinking.  They also looked at some secondary outcomes like changes in mood, sleep, cravings.

Here's where the results get fascinating:

Abstinence rates were 4.1% for the placebo group, 11.1% for the 900 mg a day group, and 17% for the 1800 mg a day group.  This shows a dose-dependent improvement in abstinence, that is, more of the medication was associated with higher abstinence rates.  Further statistical analysis showed that there was a very small chance of such a result occurring by chance alone, allowing presumption of a cause and effect relationship between more medication and better abstinence rates.

Occurrence of No Heavy Drinking showed a similar spread:  22.5% in the placebo group, 29.6% in the 900 mg a day group, and 44.7% in the 1800 mg per day group.

My editorializing:  that means that over 12 weeks,  over 60%, nearly two thirds, of the alcohol-dependent subjects in the 1800 mg per day group made a major change in their alcohol consumption:  17% did not drink at all, and another 44.7% did no heavy drinking.  Wow!

My Epocrates iPhone app says that the maximum dose per day of neurontin is 3600 mg, which obviously leaves more room for research about the optimal dose.

There is no Magic Bullet for quitting alcohol.  And Neurontin (Gabapentin) is not one either.  But perhaps, especially for those who have cycled through Day #1 of Abstinence again and again, getting more and more frustrated-  maybe, just maybe, this could be the little shove over the top that is needed to get to longer abstinence.

CAVEAT:  Although I am a medical doctor, I do not know you individually.  I have not sat with you, listened to your medical history, and examined you.  So this post is tantalizing information to consider, not a prescription for you to start taking Neurontin on your own.  Although impressive, this study mainly opens the door to further questions that need to be answered before this medication is recommended on a routine basis.  What is the best dose?  How long should the medication be continued?  What ancillary services best reinforce this anti-alcohol effect?  Are there particular types of people/drinking patterns for whom this works better/doesn't work?

In the US, at least, this remains a prescription-required medication.   Even if you could get some on your own, it would be A VERY BAD IDEA to experiment with this without the approval of your personal physician!!

Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A.  Gabapentin treatment for alcohol dependence:  a randomized controlled trial.  JAMA Int Med 2013.  doi: 10.1001/jamaintmed.2013.11950

Day #14- Is it really TWO WHOLE WEEKS??

Wow.  I am surprised.

I had always intended to stop drinking for a while, but the date which I was imagining doing this was always a few months in the future (kinda like Middle Age is always 5 years older that one is, lol).  I didn't really intend to quit now. I just had that one day of alcohol-related bad experiences, and found the words coming out of my mouth:  That's it.  I'm done.

That first evening I discovered the world of sober blogs, and was amazed to find out that I wasn't the baddest, most worthless person who ever lived- just because two glasses of wine was NEVER enough.  There is a whole community of people who are struggling with the same issues I am.  Wow.

In that vulnerable and open state, I came across Belle's blog, and her 100 day challenge.  Without really making a decision, I found myself signing up for this, sending her the original email.  And here I am at two weeks into it.

I'm a bit worried because it hasn't really been all that hard.  I had no withdrawal symptoms that I could notice- and I was watching pretty closely.

Things I am liking: (1)  great sleep (2) more energy and clarity in the mornings (3) not spending all that time figuring out when and where to buy wine, when it was OK to drink (ie, not needing to drive anywhere) (4) getting a whole lot more done around the house and for work, in that variable time formerly occupied by being half-present, half in a bottle of wine.

Maybe I am a fraud- or maybe I am doing something wrong?  I read of others' agonizing struggles through the first days, the first weeks.  Maybe I am just on a giant pink cloud, and the awful reality is going to hit me soon.  Maybe-  I don't know what else.  It is not often that I am uncertain or at a loss for words, but this is definitely how I'd describe my mental state at present.

In the meantime, however, tomorrow will be Day #15, and the day after that (U"bermorgan, as the Germans say) will be Day #16, and I will be continuing my trek toward Day #100.