Although a painful eye problem made sleeping difficult, the solution seemed innocent enough. Christy took the medication – Xanax – as her doctor directed. But the initial relief at night was soon followed by anxiety and tremors in the daytime. With Xanax, Christy seemed fine. Without it, she would go into withdrawal.
After just three weeks, Christy’s body was dependent on Xanax. Her condition left Christy both shocked and sick; especially considering her doctor never gave fair warning about the potential for addiction.
Xanax is a benzodiazepine, a class of drugs sometimes called “benzos” for short. Benzodiazepines are sedatives used primarily to treat anxiety, phobias, panic attacks, seizures, and insomnia. Other popular benzodiazepines include Valium, Ativan, and Klonopin.
Complications from benzos, such as dependency and addiction, are fueling a hidden epidemic in the United States that is overshadowed by the opioid crisis. In fact, primary care doctors and psychiatrists are authorizing twice as any benzodiazepine prescriptions than they did 15 years earlier. And overdose deaths related to benzodiazepines have quadrupled. What’s more, most of these deaths involve an opioid.
Benzodiazepines calm the brain. By attaching to GABA (gamma-Aminobutyric acid) receptors – or neurotransmitters – benzodiazepines suppress the messages that are sent to the brain and nervous system. That means benzodiazepines can trigger emotional reactions, memory lapses, irrational thinking, uncontrolled consciousness, muscle tone deficiencies, and coordination problems. When the brain becomes conditioned to expect benzodiazepines, feelings of anxiety are heightened.
Benzodiazepines begin to sedate, relax muscles, and lower anxiety levels almost immediately. Of the 2,000 some benzodiazepines, only about 15 are currently FDA-approved in the United States. These drugs are usually classified based on the duration of their sedative effects.
- Ultra-short acting – Midazolam (Versed), triazolam (Halcion)
- Short-acting – Alprazolam (Xanax), lorazepam (Ativan)
- Long-acting – Chlordiazepoxide (Librium), diazepam (Valium)
Because of the relaxing effects of benzodiazepines are experienced rather quickly, many doctors will prescribe them for short-term, intermittent or “as needed” use. The problem is that many patients do not adhere to the dosages as sensibly as they should. And doctors who are prone to accommodate patient requests for renewed prescriptions only compound the dilemma.
Aside from anxiety, cardiovascular and gastrointestinal conditions, doctors regularly prescribe benzodiazepines for muscle spasticity, convulsive disorders, pre-surgical sedation, involuntary movements, and detoxification from alcohol and other substances.
If a doctor prescribes benzodiazepines daily, they shouldn’t be taken for longer than two to four weeks.
Long-term use should be regulated to two or three times a week. Some say up to 15 percent of this type of prescribed use will develop into addiction. And a large portion of these individuals will develop physiological dependence or reach the point at which they are hooked.
Benzodiazepine withdrawal can be even more dangerous than a departure from opioids. The severity of withdrawal depends on the type of drug consumed. When stopped abruptly after consistent use, for example, the withdrawal for Xanax is harsher than Librium and Valium.
The therapeutic benefits — reducing anxiety, inducing sleep and quelling panic symptoms — of benzodiazepines are difficult to dispute. However, extreme caution must be used when prescribing benzodiazepines to patients, especially those with a history of substance abuse including alcohol. Abusers are apt to combine benzodiazepines with other drugs, particularly opioids, to increase euphoric feelings.
When patients fail to follow the advice of a doctor or medical professional, the potential for complications including physical dependence and addiction will mount. The misuse of benzodiazepines can have serious consequences. But stopping this exploitation can be challenging without a thorough understanding of the potential for withdrawal and the processes required to ensure a safe recovery.
What are the Benzodiazepine Withdrawal Symptoms?
Benzodiazepine withdrawal can be very dangerous. Symptoms usually emerge in a series of physical, emotional and behavioral changes after prolonged and disorderly use. About 50 to 80 percent of those who have taken benzodiazepines for six months or longer will experience some symptoms of withdrawal when the dosage is either reduced or completely stopped.
But withdrawal symptoms, such as poor physical and mental health, can surface even when dosage has not been disrupted. This is especially true for those patients who have been taking benzodiazepines for long periods.
On the other hand, not everyone who stops or reduces intake will experience withdrawal. The potential for withdrawal is dependent on the individual. Some will experience discomfort for a few weeks. Other patients will have months of trouble. Regardless of the length of time, benzodiazepine withdrawal is far from pleasant.
Depending on the type of benzodiazepine, symptoms will manifest in anxiety, perceptual distortions, and major episodes including:
- Anxiety, panic attacks, hyperventilation, tremors
- Sleep disturbance, muscle spasms, anorexia, weight loss
- Visual disturbance, sweating
- Altered mood
- Hypersensitivity to very loud noises
- Abnormal body sensations the body
- Generalized seizures
- Delirium or psychotic disorders
These symptoms are unlikely in the case of intermittent usage. More severe symptoms are usually associated with abrupt stoppage of short-acting agents, such as alprazolam, and high dosages.
What are the Stages of the Benzodiazepine Withdrawal Timeline?
The withdrawal timeline depends on both the patient and the drug taken. A patient’s health and the degree to which the individual is tapered off the benzo are additional factors to be considered. But just like there is no conclusive evidence to draw from about how a drug will work on particular patients, nothing is written in stone about how individuals will react to withdrawal from benzodiazepines.
The most common withdrawal is between one to four days. A short-acting drug like Xanax will usually have shorter timeframes for withdrawal. Xanax, for example, typically has a withdrawal lasting around seven days.
For long-acting benzodiazepines like Valium, Klonopin, and Librium, withdrawal may begin within one or two days of the last use, peak at 10 to 14 days and extend up to 90 days.
Treatment for Benzodiazepine Withdrawal
Most people have been prescribed benzodiazepines because they need to treat mental health ailments. For this reason, a decision to stop taking medication is usually not an option for many to consider. However, a commitment to stop abusing a benzodiazepine is a choice that can and should be made.
The good news is that there are medications to treat benzodiazepine withdrawal and relieve the physical and emotional suffering that often provoke many individuals to relapse. One method is to gradually reduce the dosage over weeks or months. Another measure is for a doctor to prescribe another benzodiazepine with a longer half-life, such as chlordiazepoxide or Klonopin. Other drugs that a doctor may use to manage withdrawal symptoms include:
- Anticonvulsants including carbamazepine and valproate
- Sedating antidepressants, such as trazodone
- Antihypertensive medications, such as clonidine or propranolol
Any of these medications, although helpful, may not eliminate discomfort from withdrawal. Unfortunately, symptoms from withdrawal are often part of the recovery process. That’s why the most advantageous treatment typically requires detoxification and therapeutic analysis of the reasons behind the addiction.
Why Should I Detox?
The start of any sustained recovery from the abuse of benzodiazepines begins with a decision to take control back of your life. This first step can be as difficult a choice as you allow it to be. If you are serious about your commitment, detox at a residential treatment facility is a good idea. Here, highly trained medical professionals can gradually remove you from your dependence on benzodiazepines, monitor your progress, and provide the therapeutic support you will need to gain a safe and sustained recovery.
What is the Next Treatment Step?
You know better than anyone about the escalating threat and dangers of benzodiazepines. But you most likely are just not quite sure how you have reached such a state of despair. That’s why, after detoxification, educating yourself about the issues that made you turn to benzodiazepines in the first place is highly recommended.
This stage or recovery may continue at an inpatient facility or on an outpatient basis. Here, you will take part in a customized treatment program featuring behavioral therapies including one-on-one counseling, educational lectures and workshops, and peer support groups that will help you cope with triggers, prevent relapse, and give you a picture of what life can be like sober.