Benzodiazepine Addiction & Recovery

Benzodiazepine Addiction & Recovery

Benzodiazepines (“benzos”) are psychoactive drugs that are widely prescribed for anxiety, insomnia, and seizures. Some of the most common benzodiazepines include Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), Ativan (lorazepam), Rohypnol (flunitrazepam), Dalmane (flurazepam), and Librium (chlordiazepoxide).

Benzodiazepines work by enhancing the effect of a neurochemical called gamma aminobutyric acid (GABA). This enhanced GABA activity results in sedative, sleep-inducing, muscle relaxing, anti-anxiety, and anticonvulsant effects, similar to the effects of alcohol.

But benzodiazepines are NOT a long-term solution.

Benzodiazepines can be helpful if taken for a short time, for a few days or weeks. But though they are effective, patients pay a heavy price. Long-term use can cause poor memory and cognition, decreased alertness and concentration, lack of coordination, emotional blunting, increased anxiety, depression, physical dependence, and, upon cessation of use, a withdrawal syndrome. Evidence further suggests that benzodiazepines become ineffective after a few weeks or months of regular use, because patients become tolerant of the drug.

It’s extremely easy to get hooked on benzodiazepines and can be very difficult to withdraw.

Dependence can happen inadvertently, even if patients are just following your doctor’s orders and never abuse their prescriptions. In fact, all of the patients I have seen for benzodiazepine addiction were started on the drug by their doctors. Many physicians try to prescribe benzodiazepines for only a few days because it can be very difficult to get people off these drugs – it has often been described as more difficult than getting addicts off heroine.

Withdrawal generally leads to improved physical and mental health.

Many patients don’t even realize that they’ve been suffering from benzodiazepines’ side effects until after they’ve come off their drugs. They feel as though a veil has been lifted from their eyes – their minds are clearer, colors are brighter, their moods are lifted, and their energy and vitality have returned.

Gradual, long-term benzodiazapine withdrawal is the best solution.

People who have had bad experiences in attempting to withdraw from benzodiazepines have usually been withdrawn too quickly. Restoring normal brain and GABA receptor function is a slow process that takes a lot of energy, enzymatic activity, and protein synthesis. It can take place over weeks or months and occurs at different rates in different parts of the brain, which explains why individual withdrawal symptoms and durations can vary widely. Each person’s experience of withdrawal also depends on factors such as the dosage and type of benzodiazepine taken, the duration of the individual’s use, the reason it was prescribed, the patient’s personality and lifestyle, stress factors, and the rate of withdrawal.

If withdrawal is not done properly, patients can have very unpleasant symptoms for months. Suddenly stopping benzodiazepines can cause severe withdrawal symptoms. There is a high risk of seizure, strokes, heart attacks, convulsions, or hallucinations if patients stop benzodiazepines suddenly, especially if they have been taking them for a prolonged period of time. Stopping abruptly can also bring on symptoms such as disturbed sleep, gastrointestinal upset, loss of appetite, anxiety, weakness, sweating, trembling, mood swings, and a numbing of the senses.

Remember, benzodiazepines enhance GABA activity in the brain, and the brain and body adapt to their presence. When the benzodiazepines are stopped, the brain is left in a state of GABA-underactivity and is hyperexcitable. The withdrawal symptoms, therefore, are basically the opposite of the original benzodiazepine side effects: insomnia instead of sedation, anxiety instead of tranquility, and muscle tension instead of relaxation. Ironically, these are the very symptoms patients are trying to mitigate with these drugs!

There is a high success rate for patients using a gradual and individualized tapering schedule.

Professor Heather Ashton, a world authority on benzodiazepine withdrawal, started a Benzodiazepine Withdrawal Clinic in 1982 and has since come up with general principles of withdrawal that have been continually confirmed by hundreds of benzodiazepine users. Professor Ashton has written the “Ashton Manual”, also referred to as the “Benzo Wise” protocol, which I follow in my treatment of benzodiazepine-addicted patients. Professor Ashton has seen a success rate of over 90%, and her patients – even those who had taken benzodiazepines over 20 years – have felt better both physically and mentally.

Basically, the Benzo Wise withdrawal protocol involves a gradual reduction (or “tapering”) of benzodiazepine dosages, usually over a period of about nine months. (Though the protocol is oriented toward a nine-month schedule, this varies by patient and is highly dependent upon the original benzodiazepine type and dosage.)

The goal is to achieve a slow and steady decline in the blood and tissue concentrations of benzodiazepines so the brain can readjust to its normal state. Patients are first switched to a long-acting, slowly metabolized benzodiazepine such as diazepam (Valium), so that this slow decline can be achieved. (With short-acting drugs, tablets must be taken several times per day, and people may experience “mini-withdrawals” as the benzodiazepine concentration in their blood fluctuates.) Once switched over, patients follow a dosage tapering schedule that is designed around their own symptoms. With this process, many patients find that they experience few withdrawal symptoms and are able to comfortably learn to cope without the drugs.

Over the past two years, I’ve successfully treated about 100 patients who have come to me specifically for the Benzo Wise treatment. These patients either know they are addicted and want to stop, have started feeling severe anxiety and distress while on the drugs, or have attempted to stop on their own but experienced catastrophic symptoms of withdrawal. But because they really wanted to come off benzodiazepines, and they took the time to slowly and smoothly complete the withdrawal, they did.

Successful withdrawal also requires patience, confidence, and a strong support system.

The number one factor in successful treatment is a personal support network to help you through the withdrawal process. Support could come from family, friends, a doctor, a therapist, or other people who have experienced the process and understand about benzodiazepine withdrawal. There are many websites, online forums, and self-help groups where users and ex-users can network and share their experiences and thought processes. (Please see the LINKS tab of this website for links to some of these sites.)

And you must be patient and confident. With the right schedule and the right support, you can do it; you can stop your dependence on benzodiazepines.

There is absolutely no need to hurry withdrawal. Many people take over a year to do it. Healing is a slow process – your body and brain need time to readjust and regain control of the functions that have been affected by the benzodiazepines. Withdrawal symptoms gradually get better, and some people get little or no symptoms at all. Slow withdrawal will allow you to continue with your normal life and create alternative strategies for living without benzodiazepines. With you in control, a slow and steady withdrawal is nearly always successful.