Could you please give your opinion of Klonopin usage for alcoholics (in recovery)? There seems to be much controversy surrounding this issue.
People who are strict adherents of the recovery movement and the tenets of 12-step programs tend to frown upon the use of psychiatric medications. In fact, for many years, it was almost considered forbidden for someone in recovery to be taking an antidepressant or an anti-anxiety agent — this was seen as simply another addiction.
More recently, Alcoholics Anonymous and many other members of the recovery movement have weighed the scientific evidence and now agree that there are certain psychiatric disorders which have a neurobiologic component and respond well to pharmacologic treatment. Getting the right treatment, in fact, usually makes it easier for the individual to maintain sobriety and to effectively work their 12 steps.
I can no longer count the number of people I’ve treated with major depression, bipolar disorder or schizophrenia, who “self-medicated” with alcohol or other substances for many years, while their psychiatric illness was untreated and getting out of control. Once they received the correct medication and began to have an amelioration of their symptoms, they were more straightforward in committing to recovery and abstinence.
The question of Klonopin is a tricky one, however. Klonopin (clonazepam) is an anti-anxiety agent, a benzodiazepine from the same family as Valium and Librium. It does not target any specific psychiatric disorder, but is used for the treatment of anxiety and, occasionally, insomnia. The benzodiazepines all act on receptor systems in the brain that are the focus of alcohol, and their effects are quite analogous in many ways, though clonazepam seems to be less toxic overall to the body. Benzodiazepines can therefore be used to ameliorate the acute effects of alcohol withdrawal, including delirium tremens.
Most clinicians have found that people who are alcoholics (as well as other people) truly can become “addicted” to benzodiazapines such as Klonopin. It is easy to develop tolerance to it, to require higher and higher doses for a given effect, and to become psychologically dependent on it. Taking the Klonopin becomes just another version of drinking alcohol. For this reason, most physicians do not prescribe Klonopin or other benzodiazepines to people with a history of alcohol abuse, and it is best for such people to stay away from these agents.
On the other hand, some people with a history of alcoholism really do also have an anxiety disorder, and deserve to have their anxiety disorder treated. I have every now and then seen such people (they are rare) who, once they are clean and sober, can be prescribed some low-doses of a benzodiazepine and take it in a responsible manner, usually in addition to receiving an antidepressant medication that targets the anxiety and mood symptoms also. But this should only be done after careful and judicious consideration, under the supervision of a physician with experience in treating recovering alcoholics.