Benzodiazepine

Benzo Addiction Treatment, Detox and Withdrawal Symptoms

Benzodiazepines, or benzos as they are sometimes called, are sedatives that are commonly prescribed by doctors for several purposes, including the following:

• The treatment of insomnia and sleep disorders
• The treatment of generalized anxiety disorder (GAD) and panic disorder
• Treating seizures, including status epilepticus
• Treating restless leg syndrome
• As part of a treatment plan for alcohol abuse

Benzos work by enhancing the sedative effects of a neurotransmitter called gamma-aminobutyric acid (GABA). This has the effect of decreasing the activity in the central nervous system responsible for the complaints listed above. Benzodiazepines are Schedule IV drugs, which means that although they are widely accepted prescribed medications, there is potential for their use to lead to abuse and addiction.

There are several types of benzodiazepine, classified by the duration of action:

• Short-acting benzodiazepines include Clorazepate (Tranxene) and Triazolam (Halcion)
• Medium-acting benzodiazepines include Alprazolam(Xanax) and Lorazepam (Ativan)
• Long-acting benzodiazepines include Diazepam (Valium) and Flurazepam

Short and medium-acting benzos are prescribed due to their relatively fast-acting sedating effects. They can quickly arrest frightening events like seizures and panic attacks, and some medical news channels have reported lower fatality rates among patients with congestive heart failure.

Unfortunately, taking benzodiazepines can create such a sense of calm and well-being that their use can easily lead to prescription drug abuse, as the body craves more and more in order to achieve the same calming effect.

The addictive effects of benzodiazepines are well known. For this reason, most doctors prescribe them for short-term use, after which patients are gradually weaned from the drug using a carefully planned schedule.

While all legitimate medical practitioners will help their patients manage their use of benzos, people who develop a physical dependence will often seek creative new ways to obtain more of the drug, without their doctors knowing. For example, they might steal a family member’s medication, or they might attempt to get multiple prescriptions by seeing more than one doctor.

Symptoms of Benzodiazepine Addiction

According to the Diagnostic & Statistical Manual of Mental Disorders, 5^th Edition (DSM-V), an individual can be diagnosed with a sedative use disorder based on the presence of several conditions. These include the following:

• The person is taking benzodiazepines at a higher dose, or for a longer time than originally intended
• Use of the drug adversely affects performance at work or school
• The person spends a lot of time obtaining and using the drug and experiences benzodiazepine withdrawal syndrome between uses

In addition, benzo drug abusers might experience some signs and symptoms of benzo addiction that include the following:

• A feeling of persistent weakness or tiredness
• Blurred vision, slurred speech, dizziness and confusion
• Reckless behaviour, such as driving or operating dangerous machinery after using benzodiazepine drugs
• Stealing money or belongings from family members in order to support the addiction
• Neglect of hygiene and personal care
• Poor memory and impaired judgment
• Inability to reduce intake of benzos in spite of wanting to
• Insomnia
• Frequent or persistent headaches
• Anxiety, paranoia and panic attacks
• People who suffer from chronic pain may find that this increases

In serious cases, the person may have difficulty breathing and fall into a coma. A fatal benzodiazepine overdose can occur when the drug is used in conjunction with alcohol.

What is Benzo’s Withdrawal Like?

While many people with benzo addictions attempt to stop using the drugs by themselves, this is not recommended. Benzodiazepine abusers who attempt unsupervised “cold turkey” withdrawal can experience medical issues, and they are at increased risk of relapsing. This can have serious impacts on the individual’s physical and mental health. Symptoms of abrupt discontinuation of benzos include crippling anxiety and withdrawal seizures requiring urgent medical treatment.

The only truly safe way to stop benzo abuse is through medically supervised detox. This will often involve a gradual reduction of the dosage to allow the body to become accustomed to the decrease of drugs in the bloodstream over time. In addition, doctors might prescribe some benzo detox medications to lower the intensity of withdrawal symptoms and reduce the risk of complications.

Some of the more commonly used medications used for benzodiazepine detox include:

• Clonazepam/Klonopin. Many benzo addictions involve short-acting drugs. By switching out the short-acting drug for the longer-acting Klonopin, withdrawal symptoms can be reduced.
• This is a barbiturate that is commonly prescribed for the treatment of seizures. It is sometimes used in benzo detox treatment to counter some of the withdrawal symptoms.
• Anti-anxiety medications. There are several medications that are used to treat anxiety without suppressing the central nervous system in the same way benzos do. These medications include Buspirone, Tofranil and Tegretol.

Medical detox is designed to serve two primary purposes: to keep the patient safe throughout the detox process, and to provide care and comfort when uncomfortable withdrawal symptoms occur. Many inpatient rehab facilities offer medical detox, but depending on the patient and his or her circumstances, detox can also be done at home under the supervision of a doctor and a support person, usually a family member.

It may be tempting to turn to alcohol during the uncomfortable detox process, but alcohol does not help with benzo withdrawal. On the contrary, it can worsen withdrawal symptoms and increase the risk of a relapse. Therefore, it is important to avoid alcohol while undergoing benzo detox.

Benzodiazepine Withdrawal Syndrome

Any form of prescription drug abuse is highly individualized. No two people will experience addiction in the same way. Similarly, no two people will experience withdrawal in the same way. The duration and intensity of the withdrawal symptoms depend on many factors, including:

• The drug. Not all benzos are created equal. These medications are prescribed for different purposes, depending on the potency of their ingredients and how fast-acting they are. In addition, benzos have something called a half-life that determines how long they remain in the bloodstream after ingestion. The drugs with a shorter half-life, which generally work more quickly, tend to produce withdrawal effects sooner.
• The method of ingestion. Most benzodiazepine abusers take benzos in tablet form. However, some people inject or inhale them in powder form. This method of ingestion causes the drugs to reach the bloodstream much more quickly, and it can produce a faster and more intense onset of withdrawal.
• How much of the drug has been used? The formula is simple: the more benzos consumed, the more severe the withdrawal symptoms are likely to be. One of the reasons benzos are typically prescribed for short-term use is that patients are far more likely to develop a physical dependence after more than three months of use. A stronger dependency resulting from long-term use of benzodiazepines leads to more uncomfortable symptoms.
• Drug interactions. It is very common for benzo addictions to coexist with alcohol abuse. The effect on withdrawal depends on whether the person is withdrawing from benzo alone, or whether they are simultaneously dealing with alcohol withdrawal. Other drugs that are being used would also have an impact.
• Dual diagnoses. The presence of coexisting physical or mental health problems, whether these problems existed before the addiction or developed as a result of it, can affect how an individual experiences withdrawal.

Early Withdrawal Symptoms

The first withdrawal symptoms start appearing hours or days after the last use of the drug, depending on the above-mentioned factors. The primary symptom is a resurgence of the problems for which the drug was originally prescribed, such as generalized anxiety disorder, panic disorder, muscle spasms or insomnia. The early withdrawal phase, which is often mitigated by a gradual tapering of the dosage during medical detox, can last for several days.

Acute Withdrawal Symptoms

Generally regarded as the most challenging phase of withdrawal, acute benzo withdrawal starts several days after the last use of the drug. A wide range of symptoms can occur during this phase, many of which can pose an increased risk to the individual’s sense of physical and mental well-being. These symptoms include the following:

• Anxiety, agitation or panic attacks
• Involuntary twitches or muscle spasms
• Digestive problems such as nausea, vomiting, diarrhea and abdominal cramping
• Unpredictable mood swings and uncharacteristic aggression
• Blurred vision
• Seizures, dizziness and headaches
• Confusion, impaired concentration and short-term memory loss
• Insomnia and sleep disorders
• Decreased appetite resulting in weight loss
• Drug cravings
• Suicidal thoughts that can lead to attempted suicide or self-harm

Acute withdrawal can last anywhere from two weeks to several months, depending on the individual circumstances. Medical detox plays a crucial role during this phase, as doctors work to keep the patient safe and reduce the effects of some of the withdrawal symptoms.

Protracted Withdrawal

A small percentage of recovering benzo drug abusers will go on to have protracted withdrawal that can last for several months or even, in some circumstances, over a year. There is no definitive timeline for these symptoms; they can appear seemingly at random weeks or months after the acute withdrawal symptoms have subsided. The symptoms depend on the individual, and may include the following:

• Depression, prolonged anxiety and unmanageable mood swings
• Chronic insomnia
• Muscle twitches, and tingling in the arms and legs
• The trouble with cognitive functioning

Protracted withdrawal symptoms are typically managed through the provision of group and individual counselling, and where appropriate, specialized treatment for any concurrent mental health conditions.

Benzo Addiction Treatment

Although these are commonly abused drugs, an addiction to benzodiazepine drugs is unique to the individual. It is therefore important for any benzo treatment plan to be customized for the person it is intended for. The treatment depends on a number of factors, such as the person’s home and work circumstances, the severity of the addiction, and whether or not other substances are being used as well. Some individuals can successfully be treated on an outpatient basis, while others would benefit from an inpatient addiction rehab program. The detox procedure varies as well, from a schedule of tapering doses for some people to hospitalization for others.

In many cases, a benzo addiction coexists with mental health concerns such as depression, anxiety or panic disorder. Indeed, it is frequently these very conditions for which the person has been prescribed benzo. Therefore, any treatment plan for the addiction should also include treatment for the underlying condition.

Methods used for benzo addiction treatment may include group or individual counselling, family therapy, art or music therapy, nutrition counselling, medication, and more. Many treatment plans use a combination of methodologies.

Inpatient vs Outpatient Treatment

People with severe benzo addictions, particularly those with an increased risk of relapse and limited support from friends and family members, can benefit from an inpatient addiction rehab and treatment program. These last anywhere from three weeks to three months, during which time the patient lives at the facility and is provided with meals and other essentials. Most inpatient rehab programs include medically supervised detox, an intense daily regimen of group and individual counselling, life skills training, team-building activities and family therapy. Individuals are under 24-hour supervision, and they have access to immediate care in the event of a physical or mental health emergency.

Not all people with a benzo abuse problem need inpatient rehab. There are outpatient treatment programs available, which allow the person to live at home and undergo treatment without major disruptions to work, school or other daily activities. Outpatient treatment has a higher chance of success for those who have the support of loved ones. Most programs are weekly group and individual therapy sessions, and regular checkups with a doctor or psychiatrist to monitor the use of medication and discuss progress.

Some factors that should be considered when making the decision between inpatient or outpatient treatment for a benzo addiction include the following:

• Inpatient treatment costs more because it includes meals and accommodation. It is not covered by any provincial health plan, but some insurance plans may provide coverage.
• Outpatient care allows the person the freedom to attend work or school, as well as unlimited access to loved ones.
• People at inpatient rehab facilities do not have access to benzo drugs, nor to the outside influences that may fuel their addictions.
• People in outpatient programs have the opportunity to generalize the coping skills and techniques learned during therapy to the “real world”.
• An inpatient program can significantly reduce the risk of a relapse if it is paired with an aftercare support program that gives the person access to professional help when things become difficult in the outside world.

Life After Rehab

Anyone considering treatment for benzo addiction should also consider whether an aftercare plan is needed. In many cases, the condition for which the benzo drug was originally prescribed will still exist after the addiction treatment has been completed. To avoid a relapse, the individual and his or her treatment team will need to find an alternative means of treating the underlying condition.