What is the conection between tolerance and physical dependence in benzodiazepines ?

[ikop]

i made a thread about 2 hours ago - and it was delteted or i just didnt post it corectly.
I will try to make it it short this time.
i started to use benzodiazepines allmost 3 years ago - after i got Ptsd. I did it to get reliefe from the ptsd symptoms. at first i was given diffrente kind of meds , mostly "anti d" and drugs that migh reduce adrenalin like deralin (pronanolol , and clonodine). this things dis not worked for me. from the beginnig i was diagnosed with somthing they call sub ptsd . it means that i do not fulfill the full critirias for PTSD. BUT only some of the symtpms. so they gave me clonazepam o.5 mg twice a day . wich offcourse after 2 weeks was not enought to get a relief from the ptsd. i was sufering from terrrble hypoervigalnce, anxiety, body jerks, musclue fasculations ,startle responses , problems with sounds . memory probems and insomnia. If you are fammilar with the benzodiazapines wizthdrwal symptoms , it is very close to what i felt . but the bensoz helpped.
i was very depirate and lost my job, friends , became isolated , so i started to take higher doses than the doctors gave me - i wanted to fill normal , to eliminate athe anxiety , not to reduce it. so started with taking the 2 mg pills of clonazpeamtablets... evantualy the doctors refused to upgrade my dosage and i started to buy from the street. At this point i did not had any routine. i was buying 60- 90 pills of 2 mg and finishig it in couPle oF days- like i said i was naive and i didnt wanted to fill the ptsd anxiety. (i was going to psychologists, trying cbt, relaxiton , biofeedback emdr, eft, neurofedback - lost most all my mony, mental and phsical health was bad i was 25 than... it was 2 years ago - so i got back to my mothers place . basicly buying clonazepam - finishinig it in 2-4 days and than waitng for about 9-11 days until i got mony to buy more pills.
After 2 years of this routine" mu tolernce becameso huge UNTIL the point that i need to take about 20 mg of clonazepam to get relief from the anxiety. (I know you migh not belive , but it it the true , have now resono to lie here)

Now i want to stop it. and to try to be clean for abouT a year and to see if my ptsd got better or not, becsuse i fell like shit but i dont know if i tis ptsd or the benzo abuse.
How can i know if i have only hight tolerance with moderate pysical dependence (becaue i did not use it on a dayli bsasis ) or i have only hight tolerAnce without high phiscal dependence . becasue i know it is not the same. there are people who took only 1 mg pf xanax of clonazpem (dayli)for 2-3 years and got severe withdrawls symptoms..... i am taking 20 mg but with breaks.... i want to stop. but i do not know how to do it in my case.
i have 2 options to taper from lets say 5 or 6 mg but start to take it dayli , or to stop taking it 'cold turkey in hope that i have high tolernce with moderate pyshical dependce and i will not Have the severe phiscal withsrwals.
The doctors i went to , do not know or even understand ,what is going and theY suume that if i have hight tolernce it means = high dependnce , but i know it is not working like that. So they say taper slowly, but i migh get meself in more serious problemS if i will start to take it dayli .

I hope you understand my question .
if somonoe have a real knowldge about this kind of situations , i will apritiate any usuful advises.


i hope you understant what i mean
soryy if i did grammar or spelling mistkes , english only my 3 language

 

[Swimmingdancer]

So a lot of past assumptions have been built on the idea that tolerance and dependence are directly correlated, that you can't have dependence without tolerance and vice versa, but in reality it is definitely not that simple. Some people can take a benzo in the same dose for a long time and not notice a real perceptible tolerance yet they still have withdrawal symptoms when they stop, and some people can have a noticeably high tolerance without current physical dependence/withdrawals. It is complex and poorly understood and there are likely a number of mechanisms at play. Some level of tolerance may be retained even with long-term abstinence from the drug (and if you do start using it again after having a tolerance a decent chunk of your original tolerance can return in a matter of days, very different from someone taking the drug for the first time).

As to how you can know if you only have a high tolerance with moderate or mild physical dependence without seeing what happens if you go longer without taking it, that is a very tough question. Everyone is so different.

How often do you currently take clonazepam? That is very important. It's possible to be dependent on it even if you don't take it every day because it can last for such a long time. Do you notice any withdrawal symptoms on the days that you don't take it? And why are doing a taper by taking it daily or stopping cold turkey your only options? Couldn't you do a taper but stick to not taking it every day?

 

[Foreigner]

^ Is the dependence/tolerance correlation just as varied with other drugs? Are there drugs where tolerance and dependence are more of a linear curve?

 

[Mass08]

No there is not because your body becomes dependent on a substance in defense of the foreign drugs presence. This can happen on extremely low doses as long as they are used for an extended period of time.

 

[Swimmingdancer]

^ Is the dependence/tolerance correlation just as varied with other drugs? Are there drugs where tolerance and dependence are more of a linear curve?

It's complicated with other drugs as well. There are so many factors contributing to tolerance and to dependence/withdrawal including allostasis, which itself is very complex. There is pharmacokinetic tolerance which occurs because of a decreased quantity of the drug reaching the sites it affects; pharmacodynamic tolerance, where the brain/body's response to the drug is decreased by cellular mechanisms, like a downregulation of receptor numbers and/or decreased sensitivity of receptors; conditioned tolerance, where environmental and psychological factors affect tolerance (for example, tolerance can be lowered by simply being in a new environment). Conditioning plays a big role in withdrawal as well. There is a whole bunch more science-y stuff I could mention (I can give you some links to check out if you're interested). And we still don't really understand that much about tolerance or dependence in the big scheme of things.

And all of these things are affected by the individual's unique brain and body, their history with the drug (if they have had tolerance or dependence before), why they are using it, their expectations, and on on. I don't think there is any psychoactive drug where it is as simple as tolerance=dependence.