I need people who have tried this or know very closely someone who has with eitheand both methadone (high dose +100mg/day) and/or fentanyl. I have been tapered by the clinic by 10mg/week from 130 to 90 now, since I started the bernese model 1month ago. My buprenorphine prescriber isn't experienced in methadone to Buprenorphine and is letting me run things(within reason and closely monitored), the methadone clinic told me they don't have much experience with the methadone compared to with fentanyl and aren't of any help with figuring out what to do, expect, etc. I had been moving slowly up from .2 mg bup (more put me in PW), over the course of 3.5 weeks and got up to 5 mg. At this time I tried speeding things up to get through the withdrawals I'm experiencing from not having my split dose anymore and a fast metabolism. Went through horrible PW again but even worse than the first time. Got scared and fed up with feeling so terrible for going on a month and decreased my dose of bup to 2 mg/ day. *am wondering if it is less PW coming from fentanyl instead of methadone?? How long do you have to wait in comparison to more easily make the switch? Got some fentanyl, enough to last me(speculating) up to 2 or 3 more days(started using it yesterday)and am thinking NOT to dose on methadone tomorrow and see how it goes, see what I'm left with of the fent for how much longer it will last me, and then go onto much higher dose of buprenorphine once I run out of the fentanyl which could happen as soon as tomorrow depending on how disciplined I use it and how bad if at all, the WD from not having methadone becomes. Might be able to score more fentanyl for use in about a week from now, but don't want to if I'm able to do the bernese without it. I'm lost and don't know what to do to get through this easier. I can't keep going without hardly any sleep due to withdrawal symptoms each night while getting up to 16 mg of buprenorphine and mostly terrified of PW hitting me again and not having anything strong enough to curb it. Please only solid advice, I know that no 2 people will experience it the same or react the same to any of it, I don't want to give up and in fact don't have that option as the only clinic is kicking me out with "no option to return." Thank everyone for reading this and all of your thoughts and consideration.

I currently contribute 15% towards by pre-taxed 401k. Employer contributes up to 6%.
I always max out my Roth IRA contributions every year.
At the end of every month, I have enough money available to comfortably withdraw 1k from my bank account into my brokerage account - which automatically buys 80/20 SP500 & international index funds.
My question: should I be re-tooling my investment strategy to increase my 410k contributions until I hit the max, and decrease my monthly brokerage account contributions? Or is 15% contribution towards 401k more than enough?

Hey everyone so I apologize in advance that this may be long I just wanted to explain my situation to see if anybody could help….
I have been doing streetfent for about 2 1/2 years. Prior to that I was addicted to heroin and shooting up for about three years moved to the East Coast and could only get this garbage streetfent. so I got down to around a gram to 2 g a day for the past couple weeks. So I finally started the Bernese method. I was hesitant to take the night dose/also scared to go into PWD’s so I kind of babied the Suboxone the first couple days. Taking .25 the first two or three days then .5 the next two days all in the am. Then I finally got my shit together and was confident enough that I wouldn’t go into PWD so I took .5 in the morning and .5 at night . Then I started decreasing my doc. While upping my dosage of sub. honestly had one day where I did more than I should have of my doc. So I got up to 6 mg of sub 3 in am and 3 at night.. I felt good enough to stop so I gave it a shot. Then withdrawals got pretty bad mid day so I caved and did my doc. yesterday I tried to stop doc again in the am I took 4mg. Come midday I had rls, the sweats and pretty bad stomach aches So I took another milligram and started to feel better. Then come the evening dose. I took another 4 mg which did not seem to do much I took another milligram and started to feel better. Then come the evening dose, I took another 4 mg and didn’t really feel like it did much. Still had horrible anxiety, RLS constant sweats, eyes watering, nose running, I ended up taking 1 mg about three times. my head felt like a balloon from all the subs I got about 24 hours from my last time using doc and the withdrawal symptoms were horrible. I couldn’t sleep had RLS, sweats, eyes watering, Unable to sit still . I took several showers because that usually helps the situation but nothing was touching the withdrawals, I was now at like probably 13mg of sub and no doc for 24 hrs.. after not being able to sleep all night, I ended up doing my DOC at about 7 AM so I could actually get some sleep.…
So there’s the story sorry that it took so long but I don’t know what to do. I don’t know if I should try to quit again today, I woke up feeling pretty good so I took 4 mg this morning and a gabapentin a couple hours after being up. Definitely uncomfortable but nothing like I was last night.. do you think I should keep upping the subs if I feel that shitty again today or did I botch the Bernese method by using to much doc? Or Should I just give up now try again in a few weeks? I just do not want to be that uncomfortable, I take care of my mother so I have to be able to function… thank you so much to anybody that took time to read this and respond I appreciate everybody in this community!

tl;dr: Did Sunosi make you feel more sleepy? If you stopped taking it for any reason, did you get bad headaches/body aches or any other side effects/symptoms?
I've been taking 70mg of Vyvanse and 20-40mg of Ritalin as needed for about 4-5 years now, and the combo works "okay". It's kind of manageable, but not great. I tried Wakix for two months in 2022 but it made me depressed, and as I have bipolar II with a history of chronic depression that's a no-go, so I stopped. About four months ago I started Sunosi and was up to 150mg - and it felt like it did nothing to help with the sleepiness/exhaustion, and even seemed to make me feel more sleepy? Like with just the Vyvanse/Ritalin combo I still get sleep attacks where I need to lie down, but I can't actually sleep - I have to just relax as if I'm going to nap for at least 30-45 minutes and then I'm (usually) good to go. But with Sunosi in the mix I would actually fall asleep when I napped during the day and I couldn't nap for anything less than 45 minutes, usually more than an hour, which is not dissimilar to how it was before I took any stimulants. I didn't notice any emotional or mental side effects, pretty much just the sleepiness.
I stopped taking the Sunosi about a week ago to see if it was really making a difference, and now I'm definitely having more headaches/migraines than usual (I have chronic migraines as it is), and my regular medication doesn't always make it stop, but I can't be sure if it's from stopping the med or if my migraines are just acting up. I also felt *really* nauseated yesterday morning and actually had to leave work, and my stomach has felt kind of messed up in general. I do feel a bit less sleepy and foggy during the day, but the headaches really suck, and I feel like my pain levels have been worse in general too.
If you've been on Sunosi did you notice any negative effects (other than agitation)? Did you ever feel more sleepy? And if you stopped it, did you have any "withdrawal" symptoms or negative effects? Everything I've seen says that Sunosi doesn't cause withdrawal issues, but I've had some weird side effects with other meds that supposedly weren't common, so I just don't know.
For context: I have narcolepsy w/o cataplexy, bipolar II disorder, ADHD, chronic migraines, and am being evaluated for Ehler's-Danlos Syndrome. I take 70mg Vyvanse, 20-40mg Ritalin, 300mg of Lamictal, 100mg Zoloft, 10mg Abilify, 5mg rizatriptan as needed and just started Emgality injections for migraines

I'm a third year social sciences major gunning for summa. As it stands, my GPA is 3.96, but is subject to decrease somewhat if I carry on this trajectory in a maths class I'm taking this quarter. I think getting an A- is possible, but I would probably need to ace the final and do well on most of my other assignments. I wanted to go p/f but just learned today that that option is not available for this class. This may be a stupid question, but is it worth withdrawing to avoid a B that may really hurt my chances at summa?

I've been smoking/vaping on and off since 2018. I was able to quit for about 6 months, but went back to it when I went through some stressful times. More recently, I was given an ultimatum to quit by my partner - and I've been trying. I have been closet vaping for the past 4-5 months, and while that decreased the amount of nicotine I consumed daily, it also gave me something to look forward to when I got the opportunity making the device far more valuable than it should be. Having said that though, the fact that I hid something from my partner was killing me and I was feeling extremely bad about it. Decided I have to kick this habit for once and for all. Read Allan Carr's Easy Way, some portions multiple times to really make it stick.
I'm on day 4 of my n'th quit attempt (cold turkey), and it seems like there's no light at the end of the tunnel. I have usually caved within the first 24 hours in my past attempts. While I feel proud of myself for getting this far, it doesn't feel like there's any win for me. It feels like I'll never be happy again, and there's nothing else that will ever make me feel the way nicotine did. I know it was the one creating the problem in the first place, but also quite an easy fix to make me feel so good. Since my partner didn't know that I was still vaping, I cannot discuss any of this with them, and I feel super alone in this journey of feeling like a non-smoker. Ever since I started my quitting journey I've been going to the gym everyday for an hour and putting everything I can into it. It feels good in the moment, but nothing as good as the hit of a vape when you wake up in the morning.
I know the Easy Way focuses on looking at yourself as a non-smoker, and I've been trying to do that but can't help but feel jealous of the people who were never addicted to nicotine in the first place. It seems like I had a cheat code to feeling happy (or at least tricking myself into feeling happy) and now I don't have that anymore. I just feel down and depressed throughout, and have constant brain fog that is impacting my ability to work. While I do not have much of the physical withdrawal symptoms, I cannot seem to win against the psyhcological withdrawal symptoms.

1. Do the psychological withdrawal symptoms get any better? Is there a timeline for this?
   1. What have y'all done to not paint vaping as the only thing left on the planet that gives you pleasure, because that's what it feels like to me currently.
2. A non-smoker wouldn't have to worry about whether they will cave today or not, and if they should buy a vape etc. I understand that and I wish to be like that, however, a non-smoker doesn't also know how good the first couple of hits are going to make you feel.
   1. What are some activities that non-smokers engage in that make them feel like a "nicotine hit" does after a long day?

The final enactment of this legislation could potentially result in: - The suspension of candidate status - The withdrawal of visa-free movement privileges - The termination of the free-trade agreement - Consequently, the postponement of negotiation talks in 2024.
The likelihood of Georgia failing to accede to the EU by 2030 would be significantly increased if these measures were implemented. It is important to note that the suspension of candidate status does not equate to Georgia's exclusion from the EU, but it could lead to prolonged delays and decrease the probability of Georgia's swift accession.

27F, smoked for 10 years, from 2020 to 2023 the daily amount was approaching 2 packs a day, for the last 6 months it's been like 12-14 a day on average, or even 10 and less (moved to an apartment where i can't smoke inside but i can smoke on the balcony, which naturally decreased the frequency of smoke breaks).
quitting backstory: since the beginning of may 2024, i started getting violent headaches that were persistent and didn't go away with NSAIDs. went to a neurologist, was diagnosed with migraines, anti-migraine pills didn't work, a combo aspirine/paracetamol/caffeine drug that is very popular and cheap in my country did work for some reason. so, after a week of suffering, the episode stopped. and resumed 3 days later, i assumed smoking was the reason (the day headaches came back was when i resorted to smoking my usual amount of cigarettes, which is slightly above half a pack). so, i quit, currently on my 3rd day, i guess it works as an anti-migraine measure but at the same time quitting cold turkey turned out really goddamn detrimental to my life, and i need some advice.
the problem: well, first things first, i can't work for shit. i can't concentrate on anything, and all my willpower goes into the "don't smoke" task, so i can't really do anything else. i'm just sitting there with my teeth clenched. also, i'm getting really emotional, i spent the entire morning today crying my eyes out uncontrollably because i hate my job, i hate every second of my life, i hate myself, i hate this and that, and basically everything, and i just want it all to stop. my last 6 months, even if we're excluding the whole debilitating migraines issue, have already been quite stressful due to many things, and now on top of that i have even more stress, and i just can't take it anymore. even my boyfriend who encouraged me a lot to quit smoking due to migraines and is very proud of me finally doing that talked to me today (i called him because i was crying a lot, felt like absolute crap, and needed a distraction so i don't relapse) and suggested weaning off instead because of my current mental state.
what i'm already doing: i can't use stuff like nicotine gum bc i'm quitting nicotine specifically (since it causes vascular problems, which in its turn manifested as migraines) so i use nicotine-free disposable vapes that for some reason die very quickly, and these are a lot more expensive than cigarettes, which pisses me off a lot. however, if i didn't use these, i'd relapse on day 1. also, some other oral fixation treats i'm using: chewing gum (a lot of it, actually), fizzy drinks (coke zero turned out to be the best distraction btw, maybe because it also contains caffeine which is a stimulant too), unhealthy amounts of water, apples. i'm trying not to pacify myself with food because i'm terrified of gaining weight. still, these measures helped me get relatively easily through the first two days but right now i'm a complete mess. i know it's beneficial, and, well, i very much appreciate not having headaches but honestly, i feel so miserable right now. i feel punished for something i didn't do, it's like all the fun things are forbidden, even starting a morning with freshly brewed coffee because it's a trigger. i can't drink, i can't go out at all, the only thing i'm allowed to do is all work no play, and i can't even work because of withdrawals.
the question: if i keep living like that, i may end up losing my job and a lot of people from my surroundings due to me being an angry and miserable mess. i also don't want to be a nuisance to my boyfriend, i'm already a lot, first, this whole migraine shit that rendered me non-functional, now withdrawals. i want to be able to focus on tasks and i want to be fun to hang out with and spend at least a couple days not in tears, what can i do? should i actually wean off instead of cold turkeying myself into unemployment and social isolation?

Chapter 1: the event
It was the fall of my intern year as I bean my off service trauma rotation. This month was ubiquitously notorious for being the most labor intrusive and least productive rotaion of our emergency medicine program. Knowing this I entered with the intention of simply surviving the month.
Another intern and I let’s call them A for sake of ambiguity, we’re the first emergency medicine residents to roste on the trauma services that year. A shaky start would be an understatement. In the words of chance the raper “like my grama with the Parkinson’s playing operation.” Would better describe it. Medically we did well. We were very competent and completed our work daily, but communication and coordination was non existent. Our Cheifs had informed us that Tuesday was our day of and the Trauma cheif residents had minimum communication with us, or our Cheifs as it seams when A and I did not report on Tuesday they sternly made their dissatisfaction known.
I have struggled with insomnia sense the age of 10. Had 2 sleep studies by this point in my life and been prescribed nearly every sleeping aid on the market. The 80-94 hr work weeks of our trauma rotaion only worsened my insomnia. My lack of sleep likely contributed to a less than prime adaptive immune system and 2 days out of my trauma rotaion I contracted strep like symptoms with associated nausea, requiring me to call for a sick day the next day. No the first day that I felt too ill to work. I was not fully aware of the reporting process. I reported to my Chiefs, but I did not believe I could come to work tomorrow with amble time and notice, however I was somewhat delayed in letting their Cheifs know, because the surgical chiefs rotated every few days and I did not know who my was going to be the next day. The second day which I had to call out sick I was able to locate the cheif for the next day and reprot according to our university’s protocol, which requires that if a resident feels they are not fit for work they must not come in and the university must have staff coverage without any fear or implementation of punitive actions.
I had finally survived to the last week of my trauma rotaion and I could see the light at the end of the tunnel. What I could not see was the pile of stress, shitty diet, lack of mental well ness and sleep deprivation which I was pushing down to reach the light. By this time I had seen a psychiatrist regularly for sleep medication. I had mentioned to him that I had been experiencing more stressed lately and feel that I might be depressed. he reassured me that it was likely only due to my circumstances, given the difficulty of the trauma rotation and wish to reassess once the rotation was over. Looking back I had to fill the habit of drinking more than I usually do. My only on nights before I have days off became 1-2 beers every other night. All of this repressed unhealthy shit finally pushed bad on September 23rd. That night I was at work even later than usual, I stayed up later than usual and couldn’t seem to fall asleep. With the stress of only having minimal sleep and knowing I only had 2 more days of trauma left, I took an extra dose of my sleeping medication.
I opened my eyes to the fighting sight of sun beaming in my window and I instantly knew I was late. (Sense I hadn’t seen the sun in a month) . Due to my need for scrupulous sleep hygiene I have been sleeping with my phone of and away for me. I rushed to grab it and watched as the little Apple logo seamed to glow on the screen for an eternity. Then in conjunction with its fading I saw 3 missed calls from my director, a text from college A and 2 missed calls from the surgical director. Still, I was able to calm myself, knowing that resident A had been late to this rotation by a few hours 2 other days and nothing came of it. I called my director back and he asked me to report to his office where I was greeted by my director, my coordinator and another emergency medicine facility.
With the only explanation of: “we just want you to get better”, I was handed a letter, to my relief it did not entail my termination, but a declaration of administrative leave and a requirement to undergo an evaluation at a well known university in Florida.
Lake any other savvy millennial, I did my research. By research I mean numerous google searches and screeches thru the depts of redit. To my dismay I discovered that in order for a residency program to fire you, they must first initiate an administrative suspension. I would soon find out however, being terminated would have been a delightful outcome compared to what ensued.
I spend the next few weeks in the wallos of regret and depression. I indulged in higher qualities of alchohol then I ever have before. I all but ceased communing with peers, and abruptly stoped any physical activity I had once enjoyed. Frightened as I was I was ensured, it will be ok “we just want you to get better”
Chapter 2 The evaluation : guilty until proven innocent I did exactly as instructed and scheduled an evaluation, I supposed that this was either a mental evaluation to assess if I’m fit for work with plans of termination or it actually was an evaluation to better treat my insomnia. To this day I regret my ignorance, and wish I had researched the process more. The Hindi / sand-skrt idea of Hamsa 🪬 is that in order to do any good you must have full knowledge or else good intentions can result in harm. I truely believe my director had good intentions, however but him and I did not have full knowledge of the nature of this evaluation.
Looking back see how easily I could have avoided my troubles by asserting legal aid at this point or even by researching this evaluation process more in depth. If one searches impaired practitioner program which I now know this evaluator works for, the search entire will populate 5 or 6 layferms along side their home website and there is a valid reason for this.
If one every finds themself in this process I employ you to bring a DSM to your evaluation or at least be familiar with the most common use disorders in the DSM-5, because your evaluation will turn into a dance of questions where the evaluator attempts to trap you in a round about way to stating something that may qualify for one of the diagnosis. I have provided an image from the DSM-5 below outlining AUD, which the evaluator concluded that I had the most severe from:
Image
Example***** Here are 10 examples of how he fraudulently assessed me taken directly from his assessment note.

1. Evaluator: Have you ever stoped drinking in the last year.

Me: yes I stoped every week day, I was only drinking on the weekends, until two weeks ago.
-Evaluator uses stoping and starting every week to qualify for 2 or more unsuccessful attempts to stop in the last year “There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.”

1. Evaluator Have you ever had withdrawal symptoms

Me no
Evaluator Well Have you ever had a hangover? You know that’s a from of acute withdrawal
Me: yes in college, I had a few but that was years ago and I’m pretty sure the pathophysiology is different.
Evaluator uses this to count for withdrawal symptoms even tho is was more than a year ago

1. Evaluator: Have you even taken your sleeping medication on a day or night which you drank? Me: Yes, I took my prescriptions are prescribed but I never drank close to bed

Evaluator: qualified this as dangerous behavior with alcohol (where the DSM gives examples such as unprotected sex and drunk driving). The sleeping medication I was on is not a benzodiazepine therefore it is not deadly with alcohol. I personally have seen many patients in the ED who have taken their entire bottle of the medication and drank copious amounts, we just monitor them over night and rehydrate them

1. Evaluator Has anyone told you you drink to much or been worried about you Me: No I drink much less than my friends

Evaluator what about your girlfriend? Me: well she actually doesn’t drink at all she doesn’t like it. She often buys me beer for The Weeknd’s tho. One time we went to a movie and she got a little irritated because I waited for beer then complained about them not having any craft beer. So she said, “you couldn’t have just said no” and drank something else. However, she apologized after and said it’s worth waiting if it’s my only day off.
Evaluator said this qualifies for continued drinking despite causing significant relation consequences, ie divorce.

1. Evaluator : you have sleep issues I hear, and your chart says you’ve had depression in the past, don’t you know that alcohol can effect your sleep and mood Me: yes that’s why I never drink within 3 hours of sleep.

Evaluator but you knew this and still drank
Evaluator: qualifies for drinking despite unwanted physical or psychological effects (this should be recurring to effects the alcohol is causing, I have had insomnia sense the age of 10 long before I took my first sip)
7 evaluator you were late for work and told my you had a drink the day before
Me: Yes but I was late because I didn’t sleep and took double my sleeping meds, I will never do that again
Qualifies for 2 significant work or school issues in the past year ( a therapist and other psychologist ensured me that being late on or a few days doesn’t count they typically are getting fired or failing) ( moreover, this would assume I was late do to drinking it’s self and also assume if happened more than once)

1. • Alcohol is often taken in larger amounts or over a longer period than was intended

He never once asked anything related to this question yet said I qualified in his final report 9. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. The evaluators logic here was sense I was late for work and I had 2 beers the day before I must be taking long to recover from it (this is assuming I missed due to alcohol)

1. Tolerance drinking more to require the same effect: this he checked as true in his final note however it was never even discussed in our evaluation. I did mention to him that I’ve been drinking more than I had earlier in the year frequency wise, but they said nothing to do with quantity or needing more.
   
2. Wanting to drink so bad you can not think of anything else: this is the only qualification of SAUD my evaluator said I did not have.
   

Moreover, without legal help I was not aware that I could obtain a second evaluation or even oppose going to get evaluated at all, but that wouldn’t have mattered seeing I still thought this was for my health and wellbeing as seen when I was asked why do you think you are here to today, to which I replayed “so that I can be evaluated to see what is needed to get back to work”.
To maks the ordeal more infuriating the evaluator continues to ingratiate himself and lie through the process telling you, “it will be fine as long as you are 100% honest”, “anything you say in here is between you and me” or “you slipped up once with your meds, I know your residnecy program they will probably just want a few more out patient tests”
Two weeks later I received a phone call right before I left for an out of state vacation to visit my nice for her birthday. During the call I was informed that I would be required to complete a partial hospitalization program (PHP) lasting “6-10 weeks” which would coast from 15-50 grand not including doctor visits or housing which is billed separately. I suppressed this inconvenience, enjoyed my vocation and reported when I returned, knowing that I must complete this soon so I may return to work with due to the fact that my payed time off would soon be diminished. At this time I had not yet heard of the organization PRN.
Chapter 3 Guilty till proven innocent: The diagnosis
Shell shocked I arrived to a in patient psychiatric unit and was rapidly cleared to progress to treatment without detoxification. During my 90 day of forced rehabilitation I met a few other individuals who were unjustly and fraudulently forced into treatment. I began to look up to one of these such members of the men’s community, who I will refer to as patient X for ambiguity sake.
Unlike me patient X did have alcohol use disorder. He spent many clinic days drinking to avoid alcoholic withdraws. The curious component of his story is that he admitted his depravity, saught help and through his own journey became sober. The bodies at be, namely his local physician, Health monitoring program, rejected his personal path to sobriety and forced him to undergo 90 days of in patient treatment before he could practice medicine again. When he checked in to rehab he had been sober for over a year.
Ask for Stories of people from online
As for me I spend many sleepless nights pondering how consuming a legal substance in a moderate amount could throw me into significant legal financial issues. My labs my toxicology, my story and my collateral from colleagues from colleagues all indicated light to moderate alcohol use but my evaluators word stood as the word of God.
More frightening was the director of this rehabs acknowledgment of this. The director who happens to also coincidentally be the evaluator, stated to me as well as to staff on multiple occasions: “ I suggest inpatient treatment for everyone who is reported”. “This is safer for me not to miss anyone who could harm patients, and I figure there must be a reason someone reported them.”
I am still elucidating the reason why I was determined guilty and proven innocent, however I can say from my 90 day stent that the majority of the patients at this rehab needed to be there. This program is saving lives of both providers and patients, however it is destroying the lives of those wrongfully accused.
Chapter 4 your lisense rehab or jail : Upon arivil I was sent to a detox hospital underwent a medical examination and was “one of the lucky ones” who required no detoxification and could report directly to PHP. Like everyone else, I spent 90 days in a PHP, being as 6-10 weeks is simply a lie they tell patients to decrease the change of resisting the treatment. When discussing the topic one therapist sated “if we told patients 90 days they would never come.” She then attempted to justify the treatment by outlining the story of a patient she had called who “didn’t make it to treatment” and killed themselves”. It is my belief that it is not the lack of PHP which impelled such professionals to take their life, but them realizing that they now will be obliged to undergo 90 days of PHP, 5 years of PRN monitoring with a loss of autonomy and hundreds of thousands of dollars taken from them that induced their hopelessness. For even if these professionals were truly mentally unstable in their addictions, in every case it was only following a phone call where they were informed they must undergo treatment that they took their life’s. By this time I still haven’t the slightest clue what PRN was.
Despite the security these programs provide for many my 6 main issues with them can be summarized in : 1. Kick backs: evaluators are directors of treatment clinics 2. The reported are guilty till proven innocent 3. The price, the overflow of money these places drag in from both patients and state universities is appalling, they charge separately for every visit and test 4. Although they make the claim that they are individualized, they are anything but. Every patient gets the same stay and treatment from the doctor drunk on the job and the one who was late to a shift 5. They force voluntary treatment. remember that friendly evaluator who promised he had your best interest at heart, so you opened up and told him everything about your substance use/ developmental / family history, well if you don’t stay for 90 days he will be “normally obliged” to tip the board of medical off to you.

1. The programs have overstepped their intended jurisdiction. -these programs work well if they function how they were intended at their inception. Cite original purpose. Originally these programs were designed to protect physicians and civilians from impaired practitioners; being healthcare workers who were impaired at work. Over the years, these organizations have extended their authority to encompass individuals with substance use disorders When not at work and also those who are in training to become healthcare professionals. Take for example myself compared to a physician who is impaired at work. A doctor who arrived for duty under the influence would surely benifit from the extensive testing, therapy and accountability enforced via these programs. In accordance the 20,000$ per year cost is appropriate when only making up roughly 7% of their yearly salary vs nearly half of a residents. In my case with my loss of income from employment, coast of treatment and monitoring, this year I will be required to pay 20,000$ to work. Yes, I will be losing money to work. Even if did indeed have a substance use disorder this level of monitoring wouldn’t not be considered appropriate.

Dispite all of the miscomings of this System My time spend in PHP was indeed helpful, as I believe it would be for anyone. Time for exercise, a reprieve from work and weekly counseling. A sample structure of my day to day schedule is provided below for insight:
Structure The general structure of these rehabitation centers is as follows: 1. One week of orientation phase, where you are not allowed in electronics or contact with the outside world world. Therefore, if you’re going, bring some things you would like to read or study. 2. In phase 2, you can use your phone however you cannot leave campus. You must stay in the dorm on campus. These shitty 1 room run down apartments with two other roommates will cost you about $1000 a week, they are required for at least four weeks and they are billed separately, no insurance will help you out here. 3. In phase 3 you can commute to campus if you beg your therapist and live very close. Whether you’re on campus or living off-campus, you are allowed to leave up to four hours per day. If you commute, you’ll be required to take a sober link decide you must Breath, alcohol test into every 6 hours. Like everything else in this program you must pay for this separately, a few hundred dollars a week. You advanced to other phases by completing assignments, however, assignments are limited by required built-in time, intrusive, scheduling, and reviewing. Therefore, if you do everything as rapidly as possible phase 1 will take one week phase 2 will take three weeks.
Every day schedule:
7:30: wake up, report to the front desk to inform them that you haven’t ran away yet and take and prescribed medications. They keep all your medications and require that you report to take them; for me this was antidepressants in an attempt to dispel the depression I contracted from being forced into treatment and whatever off label medication they were attempting to treat my ADHD with, since control medications were forbidden.
8 am: community group assessments This consisted of other patients presenting their assignments amongst the large group, on the weekends this was often an hour later and 12 study regularly took the place of assignment presentation.
10 am: process group. This was a two hour group therapy session with 6 to 12 other professionals in a therapist and training or occasionally a licensed mental health therapist.
1 pm: recreation This was generally about an hour of some sober themed craft or activity. Once a week this time slot was used for yoga.
2 pm: this was another time slot used for patients to present assignments as well as for individual therapy sessions. Each patient had one individual therapy session lasting 30 minutes per week.
3pm: This was time allotted to work on assignments or go to the gym on your sex specific scheduled gym day.
5pm: this time was used for guest speakers or another 12 step study group.
6 pm : this was generally an off-campus 12 step group
10 pm: report to the front desk and let them know you still haven’t ran away and take and Medication which are prescribed to take at night, then return to your cot bed in your room with 1-2 other roommates.
I found the community to be one of the most beneficial aspects of the PHP program. I was in a cohort of chill ass professionals of the same occupation who were always there to help each other.
Assignments The curriculum of the PHP consisted of assignment based on every step of the 12th step program. Generally, a patient would be required to complete an assignment on their own, review it with other patients, then faculty and finally present the assignment in front of the whole treatment group. You’re only given one assignment at a time and there are multiple steps to each which all requires scheduling this ensures that no matter how determined a patient is a full 90 days of treatment is required to complete all the assignments.
AA structure -the obsolete nature of AA has been verified in numbers studies, but I will refrain from divulging here and lend that endeavor to Dr. Lance Dodes very thorough discussion on the subject,in “the sober truth “
In all sincerity, if I truely did have a severe use disorder this experience could have been life saving. I only wish I could have used my 50 grand for someone who has spent their life time In addictive without reprieve. My first conversation when I was given my phone back was how I wish my father could be able to attend this PHP.
Chapter 5 reporting and PRN Self reporting What they ask you What you should tell them
There’s a third-party agency called professional resource network. Every state has their own. This agency works as a liaison between you and whatever credentialing service your occupation requires. Essentially they ensure your monitoring after treatment. Stake governments and licensing boards trust them, mainly because they monitor with the highest level of intrusiveness. This alleviates much work for state governments and licensing boards because once an individual is being monitored by a professional resource network, then they are deemed appropriate for duty and no further investigation/litigation needs to occur, as long as the monitored individual completely complies.
Because I was never impaired at work I was never reported to this agency. The general workflow of things someone would report you to professional resource network, then the resource network would contact you, and then you would be required to report for an evaluation at a treatment center, which would inevitably result in a suggestion I’ve treatment at that given treatment center. In my case I was sent to the treatment center without PRN being involved. Thus, two weeks into treatment. I was notified by my therapist that I needed to call PRN and self report. I attempted to resistance given that I did not have a problem and was not individually seeking help. I asked what happened if I didn’t self report. I was told that in order to stay in the treatment program I had to report to PRN. This meant either I report to PRN or I get kicked out of the treatment program and lose my job.
When you report to PRN they will ask you why you are in treatment. They will then list off every substance imaginable, asking you if you have ever tried the substance and when your last use was. Ultimately, they will obtain your discharge information from your treatment center, so it is in your best interest to report only what was found in your biochemical testing. If it wasn’t in your hair, I would argue that you don’t have a use disorder regarding that substance and it’s not relevant. I don’t believe it’s important for them to know that you smoked weed when you were 12.
Chapter 6 The contract:
Before being discharged from a treatment facility, a professional resource network will have you sign a contract. A little known fact which I was oblivious to is that contracts can be negotiated. Though this isn’t it possible, it is highly improbable that you can negotiate your contract since PRN has a power to delay your clearance to return to work.
Contractor almost never personalized, and I have not heard of a contract which is not a five-year agreement. You will sign releases of information so that PRN has access to all of your information which was gathered at the treatment facility. You must have a therapist, psychiatrist, primary care, doctor, and a addiction, medicine psychiatrist. You assign releases of information for all of them. You will be required To commit to: 1. three mutual aid meetings a week which you must log. I log smart recovery meetings. 2. Weekly therapy sessions with an approved mental health therapist from their list 3. Monthly doctors appointments with an addiction medicine psychiatrist 4. Yearly appointments with a primary care physician 5. Monthly appointments with a psychiatrist 6. Daily check-ins on a random drug testing app ( you will agree to weekly urine tests, a peth test 4 times a year, a hair test twice a year and a little caveat that says anything else they deem, clinically reasonable) 7. Quarterly update reports which you are required to obtain from a workplace monitor, therapist, addiction, medicine, psychiatrist, primary care physician and any other doctor you are seeing. 8. You must upload all of your prescriptions into a mobile application every single time you get them refilled and are not allowed to take them until they are approved. 9. Attendance of a PRN group via zoom. This is a local group you are assigned along with other monitored practitioners. There is a fee of roughly 130$ a month to attend this required group. For me all of these requirements coast around 20,000 a year. If you ever have a positive test even if it is the result of contamination from rubbing alcohol or unintentional ingestion of alcohol/ allergy medication your contract will rest to 5 years from the time of positive test. Once your five year contract is completed, you must ask to be released from monitoring. At that point they will search for any reason to keep you under monitoring. This could be dilute urines, daily check ins or a week where you did not attend mutual aid meetings. Every certification and license which you apply for will likely ask you if you were under a monitoring program/ have been treated for substance use. You must give an explanation and check yes. As far as licensing programs are concerned, if you were under the monitoring of PRN, you are safe, however they group practitioners who have had behavioral issues with practitioners who were diverting drugs from work. Therefore, keep in mind that you will be labeled as a sever addict.
7 Back to work and only work. During treatment your only goal is to return to work, however when you return your experience will be drastically distinct from what you remember. For me, I was now working in isolation. Missing six months of my training meant that no other Resident was on the same rotation as me. My coworkers at all formed friend groups. When I returned I was greeted with much concern for my well being. No one would speak to be about my absence, however everyone knew there is only one reason a resident would leave for 6 months then return. My Accdeemic meetings were consisting of attending telling me “I have a target on my back now” and “ I have to preform even better than others” in the light of my time missed. If this wasn’t alienating enough, the majority of Resident events, sponsored by recruiters and my university revolved around alcohol to which I had to give some excuse to why I can not partake with others. I’m fortunate that I do not have an addiction, because these stressful conditions along with the daunting amount of dead and requirements imposed by PRN are enough to make any addict relapse. While I was at treatment, I was in the dative with Samyr stories a physicians whose addictions got the best of them. Physicians who did not make it to treatment, often taking their own life. These stories were presented as a warning. Your addictions will kill you without our treatment was the message. When, in reality I did not hear one story in which the addiction killed physician. Every physician who didn’t make it to treatment took their life after being told they must report to a treatment facility. Perhaps they knew what this entailed and it was not their addiction or getting caught which caused them to end their lives, but the unmanageable and often unreasonable burden that treatment would put on their lives.
9 How to escape So your fucked your in PRN and should be or you should and now your recovered and want to terminated your contract.

1. You ask to be released early done at 1/2 time ( good luck)
2. You have “good reason” (no one has ever been let out of contract because of this reason, the verbiage is far too vague)
3. You serve all your time and they let you out(maybe, as discussed earlier, they would do everything they can to keep you in your contract as long as your practicing)
4. You can’t practice medicine anymore

10 Layer up butter cup : I cannot emphasize the extent to which legal help is required in this process. You much seek it and seek it early. Lawyers can provide many avenues to you early in the process. Once you have committed to treatment, gone for evaluation or are in a PRN contract , this is very little that you or legal help can do. Spend a few thousand dollars when you are accused and save the 20-30,000 later.
After you have been evaluated if you disagree as I did, then this is the process you must undergo. 1. Hire a occupation, defense, lawyer 2. Prove you don’t have an addiction, this is done by having an alternative evaluator with similar credentials state that either you don’t have an addiction or that PRN’s level of monitoring is not medically appropriate ( this will need to be a multi day neuropsychological evaluation, which will cost about $5000). 3. Your lawyer must draft in writing that the medical level of monitoring is not required such as another medical professional and send this to PRN 4. PRN will tattle on you to the board of medicine. 5. The board of medicine will conduct an investigation. 6. At the end or when they believe they have enough reasonable evidence to the board of medicine will suspend your license or claim, you must comply with the PRN contract to practice. 7. At this time your lawyer will defend you in the state court against the board. This is costly but much less than the coast of a 5 year PRN contract 8. If you win you will likely suggest an alternative level of care such as gonna get therapy every week. If you lose, than you wasted a fuck ton of money and are still bound by your PRN contract.
Overall this entire process has coast me Over all coast:
My finances for this year only including PRN and rent are as follows:
120-200$ every week for testing 480-800/ month
65 every week for therapy 195/month
125 every month for PRN group
About 50-69 every month for 2 doctor apts
So at least 745$/month at the lowest
Treatment at the recovery center coast 20,000 for me out of pocket and
I wasn’t payed for 6 months with no FMLA because I am a first year. At the 1 year mark I will have made 26,000 this year after taxes And payed About 29,000 on PRN alone
Rent is 1,000 so that’s 12,000 a year
Just in rent and PRN alone I will be at 26,000- 41,600 -15,600.
I will be in debt by at least 18,000 at the 1 year mark
Coast of treatment center 20,000 (with insurance) For each year of PRN roughly 20,000 Add that to 6 months of attending salary which was delayed due to my treatment time: at least 150,000 Layer coasts along with other evaluations 25,000 Missing 6 months of residency pay 30,000 Coast of 1 year in monitoring: 245,000 Coast of 5 years 325,000
If my case progress to a trail I will require an extra 20,000 in court coasts
Chapter 11 My secondary eval: Dr sushi After I arrived at my treatment center I challenge my evaluation multiple times. Each and every time I was discharged and often accused of alternate mental health/ substance abuse issues to discourage my advances. I was never given the opportunity to undergo alternative assessment, however PRN guidelines state that you can obtain a second option within 7 days of your first. This is a mute point, however, because you will not receive the results of your evaluation until over a week after it is conducted and the second evaluation must be conducted by another PRN hired evaluator of their choosing. During my stay in rehab I contacted PRN multiple times to attempt another evaluation/ legal help. They warned against both stating they were a “waste of money” and “pointless”.
After completing my treatment with the guidance of many addiction, experienced physicians, mental health counselors and psychiatrists recommendations I sought in a secondary evaluation. I chose a highly qualified professional with over 30 years of experience to conduct an extensive neuo psycho social evaluation of me. One that I was sure would be more extensive than the evaluation I received at treatment and more importantly an unbiased evaluation.
The results from my evaluation not only showed that I did not have a substance abuse problem warranting PRN level monitoring, but also that PRN was falling to allow adequate treatment of other conditions such as my ADHD. My evaluation showed my ADHD was not only untreated by PRNs attempt at using non controlled medication, but also in the top 3% most severe presentations of ADHD. My evaluator went on to explain my results by questioning why my treatment center even mandated I undergo neuro cognitive evaluation. The only neurodiverse findings were my IQ, my dyslexia and my ADHD. However, a neuo cognitive examination can be billed separately by treatment centers, therefore they always recommend one.
Chapter 12 Amongst its greed, intrusive nature and faulty accusations, professional recourse network function highly proficiently at the task they were designed to; protective physicians and patients from physicians who are impaired at work. In this domain they save lives, offer second changes and protect the public. When they act beyond their intended jurisdiction by imposing unnecessary monetary demands on practitionersin training, accuse practitioners without proof or act on behavior exemplified outside of a work setting they unjustly and inappropriately attack the week and innocent.
Proposed reform: As a trainee my universities malpractice insurance covers me for mistakes made at work. If a learner mistakenly harms a patient, then the university stands on their behalf. If the learner does something wrong under a teachers direct guidance, then the teacher is at fault. This makes sense logically as well as pragmatically. The state entrusts large amounts of money to hospital systems and universities to train resident physicians. A portion of this money is allocated to malpractice insurance. This should extend to accused impairment.
Suppose a training university was required to cover rehabilitation and monitoring of a resident of whom they claim is impaired. Alternatively they have the option of firing the trainee. This would reduce the number of innocent trainees being accused of impairment, make the process of rehabilitation more fair and provide a better use for tax payer derived dollars, which hospital systems are given to train residents. The truly impaired could still seek help, less false accusations would be made and with the employers having the ability to fire at the moment of impairment, there would be less chance of impairment at work.

This is, arguably, the most common question we hear in the hospice setting. It is an OK question to ask. We, in hospice, understand why you are asking! It is not that you want this death to be happening. You do want, if possible, to understand the timeline of the journey.
The answer should never be "well, only (your creator) knows". This is a medical question and has finite medical answers.
It helps many to know that MOST people are not afraid of death. Most people are afraid to suffer. The thought of hoping/praying/wishing for death to come is to acknowledge that we desire to end the potential for suffering.

And, as always, add info to the comments, correct any grammar or syntax issues, and add anything that may be valuable. The goal for these posts are to be an easy to read quick FAQ for the families we serve in the hospice community.

Pre-Transitional phase of death (months out)

They know that they are dying. They may start inserting benign comments about the dying process. "You know I won't be here forever..." or "when I am gone...". ENCOURAGE these discussions.
*you may, or may not, have learned that your loved one is terminal at this point.
Making ready, may want to review legal paperwork and talk about distribution of belongings.
Talking less, emotionally withdrawing, less interactive
Often mistaken for depression. It is not depression. This is a normal phase of transitioning.
Nostalgic, talking about the past, remembering stories. Often accompanied by wakeful dreaming and VIVID sleep time dreams. This is called a life review. It is a VERY good idea to record these stories or write them down.

Transitional Phase of Death (months to weeks) This phase will have disease specific benchmarks. This list is a general set of signs.

Sleeping more (16-22 hours a day)
Eating less and/or weight loss despite intake (called cachexia)
Changes in vital signs, breathing pattern, skin changes, mottling of the skin
Decreasing alertness as time moves forward
Often starts declining medications, meals, other daily "normal routine" steps & items

Pre-Active Phase of Dying AKA Late transitional (weeks to days)

Intake is limited to bites and sips
Dysphasia progressing or progressive (loss of ability to swallow, won't use a straw).
Sleeping most of the day
Loss of bladder and bowel continence
Sarcopenia, weakness of the muscles, wasting. May be bed to chair dependent.
*In this phase the addition of PT or OT may actually exacerbate the weakness.

Active Phase of dying (days to hours. Usually 3-14 days depending on varying circumstances)

Marked by cessation, completely, of food and water. Not a bite nor sips
semi comatose to comatose state with very little response
Orally breathing
changes in breathing, periods of apnea
Mottling of the legs, arms, skin (can come and go), skin feels hot/cold
Terminal fever (use the Tylenol rectal suppositories if you have them)
Changes in urine output

Moments of death

Breathing changes: slower breaths, shallow breaths, longer periods of apnea. As the brain quiets they may have Biot's breathing (fast breaths with pauses), Cheyne–Stokes (irregular periods of breath with apnea between), and atonal breathing (looks like a fish out of water).
Absence of breathing can last for MINUTES, then resume. This is normal.
Often last breaths are deep, atonal, and can have vocalizations. This is not suffering...this is the nervous system making changes for the final acts of death.

I have been taking clozapine for 7 years. Doctor has been decreasing the dose gradually due to ocd and racing thoughts that was disturbing my daily life. The dosage decease was actually fine and I feel way better in terms of the active I am feeling , less drowsy more alert and active and i didnt slept too much and I stop salivating alot and wetting my bed(urinating), I was not slow in movements like before but my ocd thoughts were not improving so he decided to make the clozapine to 0. It's been 2 days since the withdrawal and I lost my appetite, I don't eat much I'm normally a girl that eats a lot so I was surprised. I feel like vomit and having panic attacks and palpitations & feel like i am going to faint.I am going to toilet more than usual. And most importantly my delusional thoughts are coming back. When I am walking for a walk, I am scared that someone is going to stab or kidnap me or kill me. I get scared to go out. But still I don't want to retake clozapine. it's a nightmare, I never dare to take it again. ocd thoughts are worse than delusional thoughts & so are the sode effects, since clozapine caused the ocd thoughts, I got to learn to live with it instead of adding medications. I feel like my feelings are rolled in a box and it's going to explode, the frustration like when girls get pms. Are these the withdrawal symptoms?if so how long will it last? I am feeling uncomfortable.

A-to-Z Reasons For Not Smoking

Smoking damages almost every organ of the body, not just lungs. People are not aware of the extent of damage smoking causes. Following are 26 easy-to-remember reasons why smoking is so dangerous.

• A — Aging
  • Smoking speeds up one’s aging. Causes wrinkles prematurely.
• B — Bad keystone habit
  • Smokers are more likely to pick up other bad habits, like alcohol, hard drugs etc. They meet other smokers and might pick up their bad habits too.
• C — Cancer
  • Not just lung cancer. It can cause mouth cancer, throat cancer, and many other cancers.
• D — Diabetes Type 2
  • Smoking increases chances of getting Diabetes Type 2. Symptoms may include increased thirst, frequent urination, hunger, fatigue, blurred vision, poor wound healing.
• E — Erectile Dysfunction (ED)
  • Increases ED in males and infertility in both males and females.
• F — Fatigue
  • Smokers easily feel fatigued after a physical activity. They feel less energetic.
• G — Guilt
  • Smoking breeds guilt and shame. “What am I doing to my body? I have no control or what?”
• H — Heart diseases
  • Smoking can permanently damage your heart and blood vessels, leading to cardiovascular disease. Smoking can also cause coronary heart disease, which is the narrowing of blood vessels that carry blood to the heart.
• I — Immunity
  • Smoking reduces one’s immunity, making one more prone to falling ill to bacteria and viruses and other diseases easily.
• J — Jaw and TMJ problems
  • Smoking can lead to dental problems, including gum disease and tooth loss, which can contribute to jaw pain and temporomandibular joint (TMJ) disorders.
• K — Kidney diseases
  • Leads to poor blood flow to the kidneys and causes kidney damage over time. Can also cause kidney cancer.
• L — Lungs problems
  • Diseases like Chronic obstructive pulmonary disease (COPD) and Emphysema. Above all, lung cancer.
• M — Memory and Cognitive Decline
  • Smoking can negatively impact memory and cognitive function. Smoking can lead to a decline in memory, cognitive flexibility, and global cognition. Smoking can also negatively impact attention, processing speed, and executive functions.
• N — Nicotine Addiction
  • Nicotine causes cravings and dependency. It reaches the brain within seconds, creating neurochemical hooks that lead to a strong addiction.
• O — Odour
  • Breath, clothes, car, house stink
• P — Passive/SecondHand smoking
  • A smoker is more likely to be with other smokers and thus inhale more secondhand smoke. As if first hand smoke wasn’t enough.
• Q — Quality of life deterioration
  • Smoking affects overall quality of life, leading to decreased physical health, mental well-being, and social interactions. Smokers often experience a lower quality of life compared to non-smokers.
• R — Restlessness
  • Smoking can cause restlessness and anxiety. Nicotine withdrawal symptoms include irritability and difficulty concentrating, leading to an overall sense of unease.
• S — Stroke
  • Smoking is a major risk factor for stroke, increasing the risk by three to four times. Smoking causes blood to thicken and clot in veins and arteries, which can block blood flow to the brain.
• T — Taste and smell
  • One’s sense of taste and smell deteriorates.
• U — Ulcers
  • Smoking can be a risk factor for peptic ulcer disease, which can cause stomach ulcers
• V — Vitamin absorption reduces
  • Smoking impairs the absorption of essential vitamins and nutrients, such as vitamin C and E, leading to deficiencies and associated health problems.
• W — Weakening of bones and muscles
  • Smoking contributes to osteoporosis and muscle degeneration. It reduces bone density and interferes with the body's ability to repair muscle tissue.
• X — eXtra effects
  • Smoking can cause negative cause-and-effects chain reactions in life. For example, somebody sees you smoking somewhere -> makes them see you in a bad light -> in turn causes them withholding a benefit in future. It’s like bad karma.
• Y — Yellowness and Discoloration
  • Smoking causes discoloration, leading to yellowing of teeth, nails, and skin. It also causes lips to darken and become discolored over time due to reduced blood flow and exposure to harmful chemicals.
• Z — Zzzz
  • Smoking affects Sleep quality.

Hey friends. I'm (39F) currently in the process of tapering off Effexor after being on it since summer 2020. Since I was at 225 mg for almost 4 years, I knew tapering was going to be a beast. But the side effect of nightmares/vivid dreams has become unmanageable, so I finally decided it's time to free myself from the nightly trauma.
My first few jumps were really no problem---first from 225 to 187.5, then 187.5 to 150, and so on and so forth until last month, when at my monthly psych appointment, I was steadily at 75 mg.
My doctor warned me that the jump from 37.5 to 0 is "anecdotally" the worst of it. So I was pretty surprised by how terrible the jump from 75 to 37.5 has been for me. It's been over 3 weeks now, and I'm still experiencing withdrawal symptoms. I'm hoping to steady out at 37.5 before I start the final jump. I have a psych appt next Monday, so I'll definitely mention all of this to him, too. I'm legit scared of the final drop.
But my main concern/notice has been weight gain and bloating in the past 3 weeks since dropping to 37.5. I have noticed an increase in my appetite, so I can see why that would add to SOME weight gain. (And by "increase in appetite," I mean I'm hungry for breakfast when I wake up now, whereas before when I was on the meds, I could go 'til 5 PM without food. So it's less that I have an increase in appetite and more like the side effect of decreased appetite is no longer in effect and now I'm a normal person with a normal appetite.) But it's been 8 pounds in 3 weeks. I looked it up online and you can put on 1-2 lbs per week if you're doing a "healthy" approach to weight gain, so 8 pounds in that amount of time must be some water retention, right? I've been feeling very bloated and gassy so this makes sense. Like constant bubble gut. I feel like I'm full of air.
Has anyone else experienced this? Is this water weight that will wear off eventually, or is this actual weight gain I need to actively combat during this process?

so i’ve been on olanzapine for 9 months and my doctor has recently ceased my prescription. the past 5 days have been hell from not sleeping a wink & moderately severe withdrawal symptoms to calling my doc and him shutting me up by prescribing olanz again & giving me no further info on what to do. i want to taper off them asap but can’t get an appointment with my doc for a couple weeks & struggling to find information on how to taper off. i know i’m supposed to decrease by 2.5mg but not sure if it’s supposed to be per week or per couple weeks? i don’t want to go to quickly and have more mental symptoms so any info is appreciated. (currently taking 10mg each night)

With the rapid development of residential energy storage in Europe, it has emerged as a key player in the realm of energy transformation. On one hand, the imperative of transitioning to renewable energy sources is undeniable. On the other hand, certain regions grapple with weak grid infrastructure, intensifying the demand for localized residential storage solutions. As the industry matures, accompanied by declining raw material costs, the prices of residential storage systems are starting to decline. Simultaneously, the burgeoning demand for Energy Storage Systems (ESS) suggests ample room for further market penetration.
Moreover, residential energy storage products primarily cater to consumers (To C), necessitating a competitive edge in product quality, brand recognition, and distribution channels to ensure sustained profitability.
In 2022, the energy storage industry witnessed a meteoric rise, evolving from its nascent stages. By 2023, however, demand tapered off amidst shifting policies and inventory dynamics. Now, in 2024, the trajectory of the residential energy storage sector is poised to be influenced by a multitude of factors, including sustained policy support, product innovation, channel optimization, dwindling inventory levels, and declining interest rates. The forthcoming discussion will delve into the anticipated future of the industry, drawing insights from the experiences of international energy storage enterprises.
SolarEdge:
SolarEdge dominates the European market, offering cost-effective products that pose a challenge for our enterprises to match. Renowned as a top player in solar and storage inverters across Europe and the United States, SolarEdge boasts a market share that reigns supreme in both regions.
Established in Delaware in 2006, SolarEdge experienced rapid growth through strategic collaborations, notably with Tesla SolarCity from 2013 to 2015, culminating in its NASDAQ listing in 2015. The 2017 mandate by the United States NEC requiring solar PV systems to integrate Module Level Power Electronics (MLPE) with rapid shutdown functionality played to SolarEdge's strengths, enabling the company to swiftly expand its market share.
According to data from Wood Mackenzie, SolarEdge secured the 7th position in global inverter shipments in 2022, firmly establishing its dominance in European and American markets.
SolarEdge's product portfolio encompasses a diverse range of offerings, including solar and storage inverters, energy storage systems, uninterruptible power supplies, electric vehicle charging stations, and integrated solar and energy storage solutions. These solutions cater to various sectors, spanning from residential and commercial to utility-scale ground-mounted power installations.
In 2023, SolarEdge introduced the SolarEdge One software, marking a significant expansion into the realm of virtual power plants. Through sophisticated algorithms, this software facilitates new energy power trading, empowering customers with advanced solar and energy storage solutions. By bridging the gap between software and hardware, SolarEdge continues to bolster its product ecosystem, solidifying its position as a leading provider of comprehensive new energy solutions.
With a strong focus on customer collaboration, technological mastery, and leveraging the benefits of U.S. trade policies, SolarEdge has consistently excelled.
The first phase, starting in 2013, saw SolarEdge achieve rapid revenue growth through strategic partnerships, notably with Tesla SolarCity. During this period, the company experienced a remarkable compound annual growth rate of 83.7% from 2013 to 2016.
In 2017, the introduction of stringent safety regulations by the U.S. NEC mandated the use of Module Level Power Electronics (MLPE) with rapid shutdown capabilities in PV systems, rendering traditional string inverters obsolete for residential energy storage solutions. SolarEdge, with its mastery of the requisite technology, swiftly capitalized on this shift, rapidly expanding its market share and witnessing substantial revenue growth in 2018 and 2019.
The third phase unfolded in 2018 with the imposition of 10% tariffs on Chinese PV inverters under U.S. trade policies. SolarEdge benefited from these trade barriers. Subsequently, in May 2019, tariffs were increased to 25%, prompting Huawei's withdrawal from the U.S. inverter market. Despite the overall growth of the new energy industry, SolarEdge experienced a revenue decline in 2023, attributed to the industry-wide destocking process.
Reports indicate that market demand in Europe and the U.S. was disrupted by high interest rates and policy uncertainties. In 2023, SolarEdge's revenue from its inverter, optimizer, and backup battery businesses reached $1.37 billion, $900 million, and $380 million respectively. This represented a 20.8% increase, a 20.5% decline, and an 11.8% decrease from the previous year. Furthermore, sales figures stood at 1.013 million sets, 17.4 million sets, and 744 MWh, marking declines of 0.8%, 26.6%, and 2.2% respectively compared to the previous year. The unit prices were recorded at USD 1,356 per set, USD 52 per set, and USD 0.51 per kWh respectively.
The substantial decline in optimizer sales can be attributed to the superiority of micro-inverter solutions over optimizer and string solutions in meeting the stringent MLPE requirements set forth by the NEC for rapid shutdown functionality.
In 2023, the company's photovoltaic business revenue in the European and U.S. markets amounted to $1.81 billion and $760 million, respectively. This represented a 15.8% increase in Europe but a significant 35.9% decline in the U.S. compared to the previous year. While the beginning of 2023 saw some relief in the industrial chain situation, the European market initially experienced rapid growth despite a slowdown. However, the latter half of the year was marred by high interest rates and policy uncertainties in countries such as the Netherlands, Belgium, and Italy, resulting in a substantial contraction in market demand. Although the company's revenue from the European market maintained modest growth, the growth rate declined by 55% compared to the previous month. Similar trends were observed in the U.S. market, exacerbated by the transition of California's NEM 2.0 policy to 3.0, which created a vacuum in the demand for distributed PV storage.
In 2023, the European and American market demand was significantly affected by uncertain policies, with expectations for gradual recovery in 2024. Throughout the year, power optimizer shipments fluctuated, reaching 6.4 million, 5.5 million, 3.3 million, and 2.2 million sets from Q1 to Q4 respectively. Inverter shipments followed a similar pattern, with 330000, 335000, 274000 and 74000 units shipped during the same period. Energy storage battery pack shipments also varied, with 221 MWh, 269 MWh, 121 MWh, and 133 MWh recorded from Q1 to Q4 respectively. However, in the latter half of 2023, impacted by lower demand and high inventory, SolarEdge's shipments experienced a sharp decline compared to the previous month.
Looking ahead to 2024, several developments are anticipated in the following regions:

1. Germany: Expectations are that certain tariff caps will be lifted in 2024, resulting in higher electricity prices in the country. Consequently, the return on investment (ROI) for photovoltaic (PV) installations is projected to increase, fueling continued growth in residential PV installations.
2. Austria: It is anticipated that the value-added tax (VAT) on PV power generation, introduced at the beginning of 2024, will be repealed.
3. Netherlands: The uncertainty stemming from the 2023 election and the changing net metering policy led to a sharp decline in PV installations in Q4. Recent decisions by the Dutch Senate indicate a potential sustainability of net metering, prompting optimistic market responses in the future.

Enphase:
Anticipated shifts in demand are on the horizon as the second quarter of 2024 draws to a close.
Enphase stands as the undisputed global leader in microinverters, spearheading advancements in solar, energy storage, and charging solutions. Founded in 2006 in Delaware, Enphase revolutionized the market by introducing the world's first microinverter, the M175. In 2011, Enphase embarked on a global expansion strategy, penetrating the MLPE market in Europe, Australia, and other regions, culminating in its listing on the NASDAQ in 2012.
Leveraging its pioneering status in the MLPE sector, Enphase has continually enhanced its microinverter products, elevating power output from 175W in the first generation to 550W in the eighth generation. The latest iteration of inverters boasts additional features such as split-phase grid connection and off-grid capability. As a result, Enphase commands a market share exceeding 70%, firmly establishing itself as the industry leader.
Building on its expertise in microinverter technology, Enphase embarked on a series of strategic mergers and acquisitions, consolidating businesses in energy storage, electric vehicle charging infrastructure, and cloud services to develop comprehensive solar and storage solutions for households.
In 2016, Enphase introduced its inaugural residential storage product, marking its entry into the energy storage sector. By the close of 2020, the company unveiled the IQ Battery residential storage system, expanding its product portfolio to encompass residential energy storage solutions. Enphase IQ Batteries operate on low-voltage DC power, mitigating the risks associated with high-voltage DC power and enhancing system safety and efficiency.
In 2021, Enphase ventured into the electric vehicle charging infrastructure market with the acquisition of ClipperCreek. The following year, the acquisition of GreenCom positioned Enphase as a leading provider of home solar, energy storage, and charging system solutions, bolstering its offering with Internet of Things (IoT) solutions.
Thanks to favorable policies, expanded channels, and enhanced product competitiveness, Enphase has experienced rapid revenue growth since 2019.
On one hand, Enphase has reaped the benefits of supportive policies such as the NEC 2017 mandate requiring residential PV systems to integrate Module Level Power Electronics (MLPE), driving demand for the company's microinverters. Additionally, the 301 tariff prompted Huawei's exit from the U.S. inverter market in 2019. Furthermore, the IRC's gradual reduction of the Investment Tax Credit (ITC) subsidy from 2019 onward stimulated PV market growth. The introduction of the IRA in 2022, alongside the extension of the Advanced Manufacturing Production Tax Credit (AMPTC) and Advanced Energy Project Investment Tax Credit (AEPITC) subsidies, has had a significant impact. These subsidies, extended to 2032 and 2030 respectively, have bolstered Enphase's microinverter production.
In terms of channel expansion, Enphase's acquisition of SunPower's subsidiary in 2018 solidified its position as the exclusive supplier. Moreover, strategic partnerships with Sunrun, LG, Panasonic, Solaria, and GRID Alternatives have further expanded its reach and market presence.
Regarding product development, Enphase has concentrated on promoting its IQ 7 and IQ 8 series microinverters since 2019. With conversion efficiencies of up to 97.5%, these inverters cater to a broader range of solar panel installations. Additionally, the higher power range of Enphase's inverters ensures compatibility with solar panels in various regions, while the company's commitment to efficient after-sales service has reduced average waiting times to less than one minute.
By the latter half of 2023, Enphase faced increased pressure in both the US and European markets due to weakened demand for energy storage and high inventory levels.
In the US market, the transition to NEM 3.0 and elevated interest rates dampened investor confidence in residential solar storage investments. As per the company's investor communications, revenue from the US market dropped by 16% and 35% in the third and fourth quarters of 2023 respectively, compared to the previous quarters. Notably, the California market experienced a sharper decline, with Enphase's microinverter sales falling by 25% and 27% in Q3 and Q4 respectively, while non-California markets remained relatively stable.
In Europe, the anticipated demand recovery in the latter half of 2023 fell short of expectations, exacerbating distributor inventory backlogs. Enphase's top three European markets—Netherlands, France, and Germany—faced distinct challenges. The Netherlands saw hesitancy among users awaiting the removal of the net metering program, while seasonality impacted the French market, and the German market grappled with feed-in tariff reductions. Consequently, market demand and shipments related to residential PV in major European countries all experienced declines.
According to Enphase's investor communication disclosures, microinverter shipments in 2023 were as follows: 4.8 million units in Q1, 5.2 million units in Q2, 3.9 million units in Q3, and 1.6 million units in Q4. Additionally, battery shipments totaled 102.0 MWh, 82.3 MWh, 86.0 MWh, and 80.7 MWh from Q1 to Q4 in 2023 respectively. However, in the latter half of 2023, microinverter shipments experienced a sharp decline due to weak demand and inventory accumulation. Enphase estimates that channel inventory will normalize by the end of Q2 in 2024, with shipments expected to increase again in Q3. Conversely, battery sales, buoyed by NEM 3.0, continue to rise.
Currently, the European market shows signs of recovery, while the California market is anticipated to gradually improve. The Dutch parliament recently confirmed that net metering policy will remain unchanged in the short term, and electricity costs have increased in France and Germany. Consequently, it is expected that the company's business will reach its nadir in the first quarter of 2024. In the United States, non-California markets are poised for swift recovery after interest rate fluctuations. However, the California market's recovery may take several quarters due to the transition from NEM 2.0 to NEM 3.0. Nevertheless, given the high electricity costs, the integration of solar and energy storage offers a higher return on investment under NEM 3.0, leading to a gradual recovery in market demand.

Had been taking 300mg for ~year and a half, two 150mg tabs every morning. Tapered off completely over the span of a month. I was not planning on such a quick taper but it just happened, I felt better with each decrease and no symptoms so just kept going.
Have been completely off it for 12 days now. The second day I felt a little woozy, idk how else to describe it other than feeling like I was high (but I haven’t smoked weed in 10 months) but that only lasted a day or two.
12 days and no withdrawal symptoms. I’m not manic or depressed. My mood, energy, motivation is increased. I used to have regular, somewhat intense mood swings throughout the day and no longer experience that. No suicidal ideation like I used to have. I have noticed more social anxiety but I attribute a lot of this to being in a lot of new situations (just moved to student apartments, my dad is getting married, being more social than I used to be, etc)
For a few days I took a tab and a half, then just one tab for a couple weeks, then half a tab for a couple weeks til I went to none.
Is it normal to have essentially no withdrawals? Zero irritiability, anger, mood swings, in fact my mood swings have IMPROVED. I don’t think I was ever supposed to be on this medicine and it made me previously somebody I wasn’t

So about a month ago I started playing DDDA on PC, decided I wanted to finish the first before I started the second.. I'm not sure if I can post about mods here but I'll give it a try
At some point I got tired of the weight limitations and downloaded this mod which supposedly makes the carry limit to something like 10k.
I noticed that over time for some reason the limit starts to actually decrease (not really sure why) and I just can't carry anymore stuff; buying/enhancing/withdrawing from bank/giving items from pawns to me etc.. Idk how to fix this.
I'm still new to modding this game and new to the game in general and I'd really appreciate help on this.

Biden's approval rating is at 38 percent and that is pretty consistent across a number of polls. He had decent approval numbers before the Afghanistan withdraw, but his numbers have never really recovered from the messy way it unfolded in the media. All president approval rating decline over time. None since Truman been re-elected with a sub-40 percent approval rating. The public don’t know or don’t seem to give a fuck or shit about any of his accomplishments either:

Unfortunately for Biden, less than a quarter of Americans have “heard a lot” about his signature legislative achievements: “Congress passing a law that will enable Medicare to negotiate lower prescription drug prices” (23%); “Congress passing infrastructure investments in 2021” (20%); “Congress passing climate and clean-energy investments in 2022” (18%); and “Congress passing a gun safety law in 2022” (14%).

In contrast, far more Americans have heard a lot about Biden “physically stumbling at public events” (47%); making “verbal gaffes” (41%) and “falling asleep at public events” (33%). It’s not particularly surprising, then, that just under a quarter of Americans (24%) think Biden has accomplished “a lot” as president A recent NYT/Sienna poll showed Trump winning 20% of the black vote and coming within 1 point of Biden with voters below 30. I would argue the NYT polls are too optimistic for Biden's chances, because Trump tends to outperform his polls given his ability to attract low propensity Republican voters and pollsters' inability to capture these people. This was one of the top pollsters in the country. The fact that Trump is approaching 50 percent in these polls instead of a 43-41 split with undecideds demands that Democrats change course with their nominating contest immediately.
Before you say that sounds preposterous, you need to think of these responses in the context of a more nuanced expression of frustration and dissatisfaction. Black voters and young voters aren't saying they will vote for Trump. They are saying they will stay their asses home on election day if Joe Biden is the nominee.And I think there is every reason to take their threat seriously:

Trump’s claim that many black voters stayed home, though, is correct. On Sunday, the New York Times published research from a group of political scientists and data analysts that breaks out how voters who supported President Barack Obama in 2012 behaved in 2016. Most of them, unsurprisingly, voted for Hillary Clinton. Nine percent voted for Trump. Seven percent didn’t vote. Those percentages aren’t distributed evenly by race. According to the analysis, 12 percent of white voters who had backed Obama in 2012 voted for Trump four years later. Eleven percent of black Obama 2012 voters stayed home.

In 2016 Hillary Clinton performed much worse than Obama '12 in the key battleground states because so many base voters preferred to stay home than vote for her:

2016 was an election cycle in which Trump’s margin of victory was one of the narrowest in U.S. history. It came down to about 78,000 votes in three states, including Michigan, Pennsylvania and Wisconsin. It’s hard not to wonder, then, how the decrease in turnout among black voters might have affected the outcome. In Michigan, where 14 percent of residents are black, Trump won by 10,704 votes of 4.8 million cast. In Pennsylvania, he won by 44,000 of 6.2 million cast — with blacks making up more than a tenth of the population. Clinton wins those states, and the 2016 race is essentially a tie.

In other words, "Not this woman!" the base said. And today Biden’s numbers are very similar to where her’s were. In fact, he's polling worse than she was in August 2016. Young voters and black voters are pissed that he hasn't delivered on things like reforming the court, voting rights, student loans etc. The shit with Israel where we have promised the Israeli government unconditional support and military aid while they level Palestine isn't helping him. A majority of Americans now disapprove of his handling of the conflict.
The White House has said that polling a year out doesn’t mean anything. But 55 percent of the voting public having a negative perception of you is a lot to turn around in less than a year when they have 3-4 years of previous knowledge of you as president informing their opinion.
They have also pointed to the success of measures like abortion and marijuana legalization in the recent off year elections as a good sign, mistakenly. These elections indicate that voters like abortion and weed. They do not like Joe Biden. Unless he changes his name to Abortion and Weed, there's no reason to think the success of these referendums (deep-red Trump country Ohio legalized abortion for pete's sake) carries over to Biden himself when he's on the ballot.
His numbers are about as bad as they can get for a sitting president:

Only one-third of U.S. adults say they approve of President Biden’s job performance — a record low for his presidency and for any president in the last 15 years. In an ABC News/Ipsos poll, conducted Jan. 4-8, only 33 percent of those surveyed said they approved of Biden, a drop from the previous poll in September 2023, when 37 percent approved of his performance. Biden’s disapproval rating is 58 percent, up from 56 percent in September.

The party is taking an unwarranted gamble nominating someone whose approval rating is in the 30s and the base has lost trust in. It's totally unwise to run somebody that the base and 55 percent of voters have a negative perception of. These numbers matter particularly when you're talking about how razor thin the vote margins in some of these swing states were in 2020. When he loses next year Reddit will be sitting here posting about how "stupid" "entitled" "low information" the voters are when they sent a message loud and clear in polling a year before the election that he was not their first choice.
We have seen this before. Both parties run historically unpopular candidates, and Republicans eak out a win because Dems stayed home. It is not an inevitable outcome. There is still time to course correct and dump Biden, but Dems need to act quickly and find a younger nominee.
Why aren't they doing it??