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Just got off the phone with a guy I have known for about 15 years, never could get more than about 1 year sober. This time he had about 6 months, and started drinking again. It's complicated, as he also suffers from a bad case of PTSD. Anyway he got himself to the hospital and through a detox. He called because his so called sponsor asked him "Why did you drink", and this pissed my friend off.

There is no shame in relapse, And why is a nonsense question.
"There is no human power."

@corlin PTSD. Sorry for your friend. That sucks his sponsor didn't help him.

@corlin My thoughts:

- While relapse does not necessarily imply a personal failing (addiction is a beast that even the strongest among us often fail to tame), I can't help but wonder if the disincentive shame provides might (at least in certain cases) be helpful in reducing the odds of relapse.

- I don't believe "why" is necessarily a nonsense question there; from what I've seen, relapses (or the paths toward relapse) are often precipitated by a specific psychological stressor or trigger.

@corlin Further thoughts:

- It seems likely to me that for someone w/ an addiction intertwined w/ PTSD, when other treatment modalities are ineffective & relapses into substance abuse keep occurring, substitution/maintenance therapy may be more effective than continued pursuit of abstinence. In my experience, replacing a destructive addiction w/ a less destructive one often works & makes a huge difference. If I were trying to replace alcohol, I might look at gabapentin, pregabalin, or ketamine.

@corlin Why would I look at gabapentin, pregabalin, or ketamine if attempting to treat alcoholism via substitution?

Gabapentin and pregabalin are GABAergics; they can relieve some of the withdrawal symptoms of alcohol &, like alcohol, reduce anxiety. Best for those who drink due to anxiety or mild dependence.

Ketamine, on the other hand, is a NMDA antagonist; like alcohol it impairs memory & numbs pain; however, it also has antidepressant effects. Best for those who drink to forget / be numb.

@corlin As for why one might even want to replace alcohol with gabapentin, pregabalin, or ketamine in a case of alcoholism...

They aren't nearly as damaging to the human body as alcohol; they're more difficult to overdose on due to their greater therapeutic indices, & they're less likely to cause life-threatening complications w/ extended use. They should also be less apt to cause violent behaviour.

Long-term ketamine use may wreck one's bladder, but it won't cause Wernicke-Korsakoff syndrome.

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