Heres some info on QUITTING DXM.
6.6 Is DXM Addictive?
From one viewpoint, of course, anything can be addictive -- television, chocolate, masturbation, self-mutilation, etc. So in that sense, yes, DXM can be addictive. Somewhat more relevant are the degree to which DXM is addictive, and how such addiction manifests itself. The quick answer is, DXM can be addictive if you use too much, too often.
The traditional distinction made with respect to addiction is between physical addiction and psychological addiction. As examples, alcohol is physically addictive, whereas marijuana is psychologically addictive. Unfortunately this distinction has its problems - not the least of which is that since the brain is a physical construct, any addiction is in some sense "physical."
As physical addiction is a somewhat nebulous concept at best, I prefer to use the concrete ideas of tolerance and serious withdrawal symptoms. Tolerance is a process by which the body and brain adjust to a drug so that the dosage must be increased to achieve the same effect (some drugs, such as nitrous oxide, exhibit reverse tolerance, becoming more potent the more often they are used). "Serious" withdrawal symptoms is somewhat less clear, unfortunately. Note that it is possible to become tolerant to a drug without being psychologically addicted; in fact, some people lose the desire to use a drug when tolerance takes away its more interesting effects.
There is considerable evidence based on personal reports that tolerance to DXM's more interesting dissociative effects builds quickly. This is a result of upregulation or sensitization of NMDA receptors, as well as possible changes in other receptors and systems indirectly affected by DXM. Cross-tolerance exists between DXM, PCP and ketamine, naturally. Some people seem to be immune to tolerance to dissociatives including DXM (lucky them).
Usually it takes several doses before tolerance is noticeable, although a few people have noted tolerance after just one dose. Larger doses will lead to quicker tolerance. Once tolerance has built, it takes at least three weeks before receptors will reregulate to normal levels. To avoid this problem, it is probably best to dose only once a week at most. Also, some people believe that receptors which are upregulated (or downregulated) for long periods of time may tend to stay that way. The practical upshot is you should take a month off every now and then (a good idea with any drug, incidentally).
Interestingly, the first plateau music euphoria effect also seems to disappear with repeated use of DXM. It's also one of the last effects to come back. This may be due to downregulation of dopamine receptors rather than upregulation of NMDA receptors. The practical upshot is, don't do DXM all the time. Again, some people are luckily immune to this tolerance effect.
For information on withdrawal and withdrawal symptoms, refer to the next section.
Psychological addiction to DXM has been noted a few times, and can theoretically lead to physical addiction. Generally, though, dissociatives aren't considered particularly habit-forming, since they tend to have such "heavy" effects. Low-dose DXM might be an exception due to its moderate to strong stimulant effect; in practicality, it's probably too hard to consistently hit the first plateau.
There are exceptions, some of them notable. One case report (132) involved a 23-year old male who maintained an incredible daily dose of 30mg/kg to 40mg/kg DXM (plus a six-pack of beer)! Needless to say, after maintaining this dose long enough, he had become addicted, although the authors consider it a "psychological" addiction, with withdrawal symptoms such as dysphoria, depression, and anxiety.
Most people who use DXM have noticed little or no addiction, and only mild tolerance (don't let that scare you; remember that coffee produces both tolerance and withdrawal symptoms). A few unfortunate people have developed problems with DXM. Prolonged, heavy use of DXM seems to induce dysphoria, anxiety, and/or depression in some people; as the dosage is increased, the problem gets worse. Unfortunately, at this point, there may be withdrawal problems (see the next section). If this happens to you, seek medical assistance.
6.7 Is DXM Withdrawal Dangerous?
Withdrawal from occasional DXM use is almost certainly not dangerous, and in fact any "symptoms" felt are probably just "jonesing" - the same sort of withdrawal "symptoms" felt with marijuana, television, sex, etc. At this point it's a matter of willpower more than anything else.
Once tolerance has built, withdrawal has the potential to cause more serious problems. Mild tolerance to DXM is probably no more dangerous than mild tolerance to alcohol (tolerance at the level of "being able to hold your liquor"). Withdrawal may produce boredom and mild anxiety, but rarely anything more troubling than that.
One person reported a curious withdrawal effect which has also been noted upon cessation of SSRI antidepressant therapy. Whenever moving his eyes, or upon any sudden change in sensory input, he experienced a sudden, momentary dizziness and altered consciousness. Ginkgo biloba, exercise, and sleep were reported to all help with this.
Beyond the mild tolerance level, things could get rapidly worse. There is evidence that significant NMDA upregulation can lead to (100) and many of the symptoms of opiate withdrawal may occur via a similar mechanism (109,133). The good news is, studies generally haven't found any significant evidence of brain damage from heroin withdrawal, so withdrawal from DXM probably wouldn't be much trouble. The bad news is, heroin withdrawal isn't particularly enjoyable.
Interestingly, one person who developed addiction and tolerance to DXM also compared the withdrawal symptoms to those of heroin (although DXM never produced any of the positive effects of opiates in this individual). These symptoms included watery eyes, stuffy nose, gooseflesh, muscle spasms, increased pain sensitivity, nausea, anxiety, and depression. Furthermore, the individual eventually began to develop some of these symptoms even while using DXM. This is definitely something to avoid.
If you happen to develop a significant degree of tolerance to DXM, it might be a good idea not to quit "cold turkey" (all at once). Build down slowly over a few weeks, and avoid all other drugs in the mean time. One person who had been using DXM twice daily reported no withdrawal symptoms after decreasing the dosage 10% per day, and stopping at 180mg. This should prevent any excitotoxic rebound.
On the other hand, given the research from Olney et al (see Section 6.3.1, it may be better to go ahead and quit cold turkey after all. Some research casts doubt upon upregulation of NMDA receptors with blockade, and if so, then there may be no danger to quitting DXM completely without tapering down. To be honest, there is evidence on both sides, and the best advice I can give you is not to get into this situation in the first place. If you do manage to develop a DXM addiction, I wish you the best of luck, and I think your best course of action would be to see a physician. Since most medical authorities are ignorant of DXM's psychoactive potential, it would probably be advisable to treat it as an addiction to any other dissociative (ketamine or PCP).
6.8 Kicking the DXM Habit: What to Do If You are Addicted
The first thing to understand about DXM addiction is that most people who find themselves addicted use DXM on a very regular basis -- weekly, or (more frequently) daily. This is very dangerous!. It is vital that you quit using DXM as quickly as possible if you are using it on a daily basis.
If you have access to mental health services I strongly suggest you seek them out. Many areas provide financial assistance for uninsured or low-income patients. DXM addiction can be treated like addiction to any other dissociative, i.e., PCP or ketamine. Unfortunately, many physicians and psychiatrists are not generally up-to-date on dissociative addiction, so you may need to look around.
The biggest problem with DXM addiction is rebound depression. Many casual DXM users have noticed a slight depression during the hangover phase. With regular use, however, the brain becomes tolerant to certain aspects of the DXM experience (probably a reregulation of serotonin receptors due to the DXM-induced serotonin release). To compensate for the depression (which can be severe) many people turn back to DXM. Unfortunately, dissociatives make poor antidepressants, since they have numerous side effects.
Incidentally, keep in mind that dissociative-induced depression is often severe enough to result in impaired mental functioning. Many cases of dissociative "brain damage" turn out not to be permanent after all, but only the consequences of major depression.
If you choose to kick the habit on your own, or if you have no other choice, you have two options: build-down and cold turkey. Build-down means that you slowly taper off DXM use in the hope that your brain will readjust as you do so, and thus avoid the potentially severe depression of sudden withdrawal. Cold turkey withdrawal (the term comes from the gooseflesh of heroin withdrawal) means stopping suddenly.
6.8.1 Preparing to Quit
The first and most important step in either case is wanting to quit. Not merely knowing you should, but actually wanting to. Take a good, hard look at your life. Talk to your friends about your problem -- I know it can be hard to do, but they probably already know it anyway. Examine your performance at work or school. And look at your own use patterns -- are you using DXM as a group activity, or are you using it alone? Take stock of your finances. All of these factors can help to contribute towards the desire to quit DXM.
Keep in mind that you may have to quit DXM permanently, and never use it again. By the time most people has become addicted to DXM, however, they tend to derive little or no pleasure from the experience anyway. So you must be prepared for the thought of never using DXM again, or at least waiting a year or two and before trying it again. Remember, though, there are other psychedelics out there, and many of the more interesting effects of DXM can be achieved through transcendental meditation, yoga, and other spiritual work.
In preparation for quitting any drug, get rid of anything and everything that acts as a "trigger" for DXM use. Let your friends who use DXM know you are trying to quit. You don't have to shun them completely, but you might be well-advised to avoid them while they are using or discussing DXM. Discard any supplies of DXM you have (if you are quitting cold- turkey). Don't go to the drugstore without someone else to watch over you. Don't go to places where you traditionally used DXM (this is hard if you used it at home). If you will be moving soon, you can use the move as an opportunity to leave behind all the sensory triggers that made you think about DXM.
6.8.2 Quitting "Cold Turkey"
The safest way to quit from a neurological standpoint is to quit cold turkey -- completely and suddenly. This is also the most difficult. The depression stage can last for several weeks, even months. Fortunately, it is treatable with drugs; SSRIs such as fluoxetine (Prozac) have been used with great success in treating PCP addiction, although there is some evidence that serotonin/dopamine reuptake inhibitors, or combining a SSRI with a dopamine reuptake inhibitor such as bupropion (Wellbutrin), may be preferrable. In drug-resistant cases, electroconvulsive therapy (ECT), or the newer (and safer) variant, left-prefrontal transcranial magnetic stimulation, have been used as well. In any event, it is important to see a psychiatrist who can assist you, give you a neurological evaluation, and prescribe any necessary drugs. DO NOT use DXM after you are placed on antidepressants of any kind.
If you do not have access to psychiatric medicine, you still have other options. Try to vary your daily routine to expose yourself to new and interesting stimuli. As corny as it seems, taking long walks in the woods and, especially, getting a lot of sunlight, has helped many people (and there may be some evidence that DXM-induced depression may be in part due to a disruption of the circadian rhythm, similar to Seasonal Affective Disorder). Keep a regular, rigid schedule of getting up and going to bed at the same time. Some people have had success using melatonin to help them stay on schedule but there is some evidence that melatonin may worsen depression in susceptible individuals. And the most important thing you can do is to get regular physical exercise! Not only does it help with depression, it also helps to get your body and brain back in top working order.
6.8.3 Build-Down
Build-down is a controversial method for dealing with addiction. Many people with whom I've spoken have used build-down successfully, but many others tried it and failed. At the very least you can try it first and then, if that doesn't work, try cold-turkey withdrawal (which may be easier after you have cut down DXM use).
There are two conflicting issues here. On the one hand, maintaining a regular, even dose of any drug can prevent the "rush" that so many people find contributes to the addictiveness of the drug. On the other hand, regular use of DXM can become dangerous to the brain. Weighing these issues, and on the basis of those who have used build-down successfully, I believe that a regular low dose of DXM may be appropriate for build-down. Fortunately, even a lower dose of DXM seems to help fight off dissociative depression.
I do not claim to be a physician and I can only relay to you what others have told me. Before attempting build-down you must consult a medical authority, and at the very least have your serum bromide level checked (or check anion gap, which amounts to the same thing) to see if you are already in danger or bromide poisoning. Assuming you check out OK, and your physician is willing to let you try build-down, here is what I have been told from successful build-down attempts. THIS IS NOT INTENDED AS MEDICAL ADVICE, ONLY ANECDOTAL EVIDENCE FROM FORMER DXM USERS.
First off, get someone else to help you -- a friend, spouse, whatever. You want to make sure they will keep you on the rigorous schedule and not let you go back to using large amounts of DXM.
The key to this method, according to those who have used it successfully, is to place yourself on a regular, low dose of DXM -- just enough to keep the depression from becoming severe. First off, wait at least three days from your last DXM dose before starting the build-down; this should allow your body to clear out any DXM and metabolites. Also, make sure you are not on any drug which can alter DXM metabolism -- including antidepressants.
The build-down dose is taken three times per day at rigid six hour intervals, and an individual dose should not be enough to get you high. One person successfully used 30mg 3/day; most however have used 60mg 3/day. It would probably be better to start at 30mg 3/day and then move up, if that isn't working, after two or thee days.
After establishing the maintenance dose, build-down users continued this dose for one to two weeks, before halving the dose. Again, after another one to two weeks, the dose was halved again; finally, when the total daily dose was less than 45mg, they went to twice a day for one week, then once a day for one week, and then quit completely.
All of the people who built down experienced mild depression, although most found it manageable, and some told me that the ideas suggested above in Section 6.8.2 (exercise, walks in the woods, sunlight, regular sleep habits, etc.) helped to make them feel better.
Again, remember, I'm only conveying anecdotal information here; you absolutely must work with a physician or counselor who can give you the professional help you need. For all I know, these people who told me their successes could be unique in some way (or for that matter they could be lying to me).
6.8.4 After Quitting: When Can I Use DXM Again?
Possibly never. Like any other severe addiction, there is always the risk of a relapse. If you choose to throw caution to the wind, that's your choice and you do it with the understanding of the risks involved. The only suggestion I can give you is to limit DXM use to one particular environment, and make sure it's an environment you do not encounter when not using DXM. Basically, by making it into an isolated ritual, you lessen the chances of normal sensory cues leading you back into addiction. One former DXM addict managed to use DXM again without becoming addicted after two years of being drug-free; he did so by only using it with a select group of people, in one particular place, and then one of his friends was responsible for giving him his dose in a particular cup (thus avoiding the sensory cue of the cough syrup bottle).
Still, it's better to find other ways of feeling good. Yoga and meditation are probably the two best means of achieving altered states of consciousness that are similar to DXM (unfortunately, unlike DXM, they require hard work and patience). If you live somewhere where serotonergic psychedelics (mushrooms, LSD, 2CB, etc) are legal, you may find that these can give you the psychedelic consciousness without the addictiveness (or danger of neurological damage) that come with DXM.
Best of luck, and remember, above all, seek professional help. I am not a physician, only a researcher, and I cannot and will not claim to give advice for your particular case. There are too many other factors which I do not know, and cannot understand, as I have limited medical knowledge in areas other than neuroscience.
Now if your asking from a personal stand point, i must say. I used DEX for many years trying to escape verious situations that i never wanted to accept. If thats the case and your using a drug to deal with shit. You have to stop and deal with whatever it is you need to deal with yourself not with drugs. If thats not the case and your just addicted to DEX from using all the time thats different. You first have to accept that you want to quit. Thats easy to say, but doing it for good is another thing. Really and truly i had to get burnt out on dex to quit doing it so much. There comes a point when it wont do the same for you anymore and that really sux....Good luck.
