Withdrawal & Detox from Benzodiazepine Addiction

Benzodiazepine Withdrawal Syndrome – An Overview

As touched upon above, abuse of benzodiazepines tends to lead to physical and psychological dependence, which in turn can result in a cluster of symptoms when the drug is withdrawn. This cluster of withdrawal symptoms are known as benzodiazepine withdrawal symptoms and can occur both when the drug is reduced and withdrawn.

It is important to be aware that while benzodiazepine withdrawal syndrome commonly occurs in those who have abused the drug, it can also occur in those who have taken it exactly as prescribed, particularly if it is taken for longer than the recommended two to four weeks.

Benzodiazepines Withdrawal Symptoms

It is never advisable to stop taking benzodiazepines suddenly as this can lead to serious withdrawal symptoms – some of which can even be life-threatening. The worst symptoms tend to occur in those who have been taking high doses of benzodiazepines for a long period of time. Common withdrawal symptoms associated with benzodiazepine reduction and withdrawal include:

Although benzodiazepines are often prescribed to treat anxiety disorders, when you stop taking this medication, you are likely to see an increase of the symptoms that it was initially taken to treat. This is known as rebound anxiety. Even those who did not take benzos to treat anxiety may become anxious and experience feelings of restlessness when the medication has been stopped.

How Long Do Benzo Withdrawal Symptoms Last?

As withdrawal from benzodiazepines is different for each person, it is not possible to say exactly how long the withdrawal symptoms will last. It is not even possible to tell which symptoms one will experience or how severe these will be until the detox has actually started.

However, what we can tell you is that certain types of benzodiazepines tend to be associated with more intense symptoms than others. If you have been taking a short-acting benzodiazepine, such as Xanax, Halcion, or Ativan, you are likely to notice the first symptoms beginning around six to eight hours after you stop taking them. Shorter-acting versions leave the system faster than longer-acting benzodiazepines, thus the early appearance of symptoms. The symptoms that are associated with short-acting benzos tend to be more severe than those caused by long-acting benzos like Klonopin, Valium, and Librium.

The type of benzo being abused, how long you were addicted, and the presence of underlying health problems can all affect the duration of withdrawal. For example, if you have a mild dependence on benzos, you might find that your symptoms pass within a week. Nevertheless, if your addiction is more severe, you are likely to be weaned off the drug over a period of months, which can obviously result in symptoms that last for longer.

When benzodiazepine tapering is used, a substitute drug might be prescribed. Benzodiazepine substitution tends to involve another benzodiazepine-type drug but one that is much less potent than the one being weaned. While the dose of one drug is reduced, the dose of the other is increased until you are taking just the less harmful drug.

Where a substitute benzodiazepine drug is not used, other medications can be prescribed to help ease the symptoms of withdrawal. These medications might help to relieve the symptoms of anxiety associated with withdrawal and many can also help curb cravings.

Psychological Withdrawal from Benzodiazepines

As benzodiazepines have such a profound effect on the brain, even altering the way it works, many psychological symptoms tend to occur when the drug is withdrawn. Due to the way the brain has adapted to the use of these drugs, you can reach a point where you feel as though you are unable to function without them. The longer you are abusing benzos, the worse the psychological withdrawal will be.

Nonetheless, as mentioned above, as you reduce your dose of benzodiazepines, you may begin to feel anxious and irritable, possibly experiencing panic attacks and a general feeling of fear in the process. Some individuals experience severe depression, causing them to have suicidal thoughts.

The psychological symptoms of withdrawal can be worse when rapid discontinuation of benzodiazepines occurs. Doing this means experiencing confusion as well as paranoid delusions that could cause you to become aggressive or violent.

However, when you continue to take benzodiazepines, and at higher doses, the body adapts quite quickly, resulting in physical dependence. When this happens, it can be incredibly difficult to quit, not least because of the physical symptoms that typically occur when you try to quit or cut back on your use.

Unpleasant physical withdrawal symptoms such as stiffness, headaches, nausea, and muscular pain are common when it comes to benzodiazepine dependence.

Substance Use Disorders and Detoxification

Substance use disorders are typically made up of two elements: a physical addiction and a psychological addiction, although not always. The type of substance that was being abused will determine whether a physical addiction occurs or not.

Where it does occur, a detox is almost always required to break the cycle of abuse. It should be noted here that the detox process occurs naturally. It is the body’s way of eliminating the toxins and chemicals that have built up over time. When you quit the substance that you are addicted to, your body will begin the healing process and will start getting rid of those toxins that do not belong. This is known as detoxification and it is this that results in the withdrawal symptoms.

How a detox progresses will depend on the type of substance being abused. While some substances do not usually cause major withdrawals, others can result in symptoms that can be severe, or even life-threatening in some extreme cases. Where benzodiazepines are concerned, withdrawal symptoms need to be managed extremely carefully as there is a very real risk of serious complications.

Benzodiazepine Detox

As we alluded to in the above paragraphs, benzodiazepine tolerance develops quite quickly; as it does so, the need to use higher doses of the drug occurs. Doing this will usually lead to a physical dependence. And developing an addiction to benzodiazepines and then trying to quit means that you are more than likely to experience withdrawal symptoms.

Based on all the above, then, it is recommended that a detox from benzodiazepines takes place in a supervised facility as this will reduce the risk of complications. In such a facility, your detox will be effectively managed, and it may even be possible for the worst of the withdrawal symptoms to be headed off. During detox, you might possibly be prescribed a longer-acting benzodiazepine such as Klonopin. This will allow you to be weaned off the drug you are taking without suffering the worst symptoms.

Withdrawal Timeline and Length of Detoxification

Detox is not the same for everyone as there is a range of factors that can influence it including your own physical and mental health, your age, and the severity of your addiction. The following timeline will give you a rough idea of what to expect from a benzodiazepine detox:

• 6-8 Hours After Quitting – It can take several hours before the first signs of withdrawal appear. This is because it can take a while before your body realises that the usual dose of medication is not forthcoming. The onset of withdrawal symptoms occurs earlier if you were taking short-acting benzodiazepines than it does for longer-acting ones.
• 1-4 Days After Quitting – It is likely that you will experience symptoms such as nervousness, anxiety, and panic attacks as the detox progresses. You might also experience hallucinations and depression and may then believe that this is a return of the symptoms that the benzodiazepines were prescribed to treat. Nevertheless, these are natural symptoms that are associated with benzodiazepine withdrawal and can occur in those who never had them in the first place. The symptoms associated with short-acting benzodiazepines can be quite intense; without medical supervision, there is the possibility of them becoming fatal. It is at this point that those who were abusing longer-acting benzos may start to notice the first signs of withdrawal.
• 10-14 Days After Quitting – Symptoms of benzodiazepine withdrawal can continue for around ten to fourteen days, although some do linger for longer than this. You will typically have good days mixed with bad ones as you progress.
• More than 2 Weeks After Quitting – Although most of the symptoms associated with withdrawal will reach their peak after about three to four weeks before subsiding, some can continue for many months. Indeed, some people will still notice the effects more than a year after they have quit. The severity of symptoms lessens as time goes by though, and most affected individuals will notice that all symptoms eventually disappear.

Benzodiazepine Detox Protocol

The protocol for benzodiazepine detox involves preparing to withdraw from the drug and implementing effective strategies for dealing with the symptoms that may occur during the process. It is best, and highly recommended, to detox in a clinic under the supervision of staff with experience in dealing with such detox procedures.

A plan will be put in place to ensure your comfort and safety throughout. Your doctors will discuss the procedure with you and will determine if it is appropriate for you to be provided with a substitute medication to help you withdraw from benzos or whether you will instead be provided with medication that aims to provide relief from any symptoms you may experience.

During the detox, effective strategies will be put in place to help you relax. You may experience anxiety and panic attacks, but staff can help to relieve these symptoms and might be able to provide advice and suggestions for improving your sleep if this is something that you are struggling with. The benzodiazepine detox protocol is all about helping you to break free from the hold that your medication has over you in the safest and most comfortable way possible.

In a dedicated detox clinic, medical staff will be on hand to take care of your needs and to make the process more comfortable. This support can be vital in helping you to break free from benzodiazepine abuse for good.

Benzo Detox Medications

During a medical detox, you will obviously be supported throughout the process of quitting your medication. This will typically involve a gradual reduction of your medication or, in some cases, a substitute drug being provided to reduce the dose of your current medication.

We mentioned that when trying to break free from a short-acting benzo that your doctor may prescribe a longer-acting alternative to help keep the worst withdrawal symptoms from occurring during detox. Well, some examples of longer-acting benzos that might be used as substitutes are:

• Klonopin – often prescribed to treat anxiety, short-term insomnia, and mental symptoms associated with substance withdrawal.
• Librium – typically prescribed for the treatment of anxiety disorders and treatment of withdrawal symptoms in acute alcoholism.
• Valium – used for the treatment of seizures, anxiety, muscle spasms, and withdrawal symptoms associated with alcohol withdrawal.

Although the above medications can help when used as a substitute for shorter-acting benzodiazepines, they are not always used as part of a medical detox. There are, however, other medications that are commonly prescribed to provide relief from the symptoms of benzodiazepine withdrawal; these include:

• Flumazenil – while primarily used to reverse a benzodiazepine overdose, flumazenil is also used during detox to help reduce the symptoms associated with withdrawal. This is because it can block the effects of the benzos by attaching to the same receptors in the brain.
• Buspirone – Buspirone is a non-addictive drug that can relieve the symptoms of anxiety associated with substance abuse withdrawal.

Gradual Dose Reduction for Benzodiazepine Withdrawal

Dose reduction for benzodiazepine withdrawal should be tailored to your own specific needs and circumstances. The rate at which your medication is withdrawn will be a matter for your doctor to decide after an assessment of your mental and physical health. A range of factors will be considered such as specific vulnerabilities, the severity of addiction, lifestyle, and personality. In most cases, a gradual reduction is a preferable solution to abrupt cessation.

How quickly your medication is withdrawn though will depend on your needs and the specific provider. If you are detoxing in a medical clinic, for instance, the rate of reduction may be faster than if you were to be withdrawing from your medication at home over a much longer period.

• Motivational Interviewing – This technique is often used to help remind patients of their own self-worth and can be beneficial during withdrawal from benzodiazepines as the brain is readjusting to life without the substance it has grown accustomed to. Low self-esteem is a common problem during addiction and withdrawal, and motivational interviewing can help to tackle this.
• Cognitive Behavioural Therapy – CBT in benzodiazepine withdrawal helps in the identification of thoughts and behaviours that could be making your withdrawal symptoms worse. During CBT, you will learn how to deal with your emotions and will develop healthy ways of handling stress.
• Group Therapy – Group therapy sessions are used so that you can learn from others who are either going through a similar situation or have already managed to withdraw from benzodiazepines.

Pharmacological Interventions for Benzodiazepine Withdrawal

As benzodiazepine withdrawal can be a complicated process, it may be necessary for a pharmacological intervention to ensure your comfort and safety. If your care team believe that medication will be useful to help make you more comfortable during the detox process and to relieve any pain that you are experiencing, they will speak with your doctor for advice.

In the event of an emergency situation, such as in the case of extreme withdrawal symptoms, it may be necessary for you to be sedated to ensure your safety.

You might also benefit from a pharmacological intervention if the symptoms of withdrawal such as anxiety and depression are having a negative impact on your progress. In this case, medication such as antidepressants or beta-blockers may be an effective solution.

• It has been estimated that around half-a-million people in Britain have a dependence on prescribed benzodiazepines.
• Up to one million individuals are currently taking prescribed benzodiazepines long term, with surveys showing that there are more than 180 long-term users of the drug per general practice.
• Dependence on benzodiazepines in the UK has now been classed as a major clinical problem.
• 30-40% of long-term benzodiazepine users will experience withdrawal symptoms when they try to quit.
• 90% of those attending drug treatment services reported using illegal benzodiazepines in the previous 3 months.
• In the 2007 Office for National Statistics General Household Survey, 0.5% of the population admitted to having used tranquilisers in the previous year.
• Dose reduction for the treatment of benzodiazepine withdrawal is recommended at a 5-10% reduction every 1-2 weeks. When reduced at this rate, detox can last from around 6 weeks to several months.
• In around 40-60% of people, anxiety is reduced when benzodiazepines are stopped, suggesting that anxiety can actually be caused by the use of this medication.

Benzodiazepine Addiction Treatment and Rehab

After benzodiazepines have been successfully withdrawn, the rehabilitation process can begin. Treatment at this stage involves a series of psychotherapeutic counselling and 12-step-therapy to help get to the root of the problem.

Often, there are deep-rooted issues that have led to the addictive behaviour and these will need to be addressed if you are to move on to a substance-free life. You will need to learn how to change your addictive behaviour patterns and challenge the negative thoughts that drive your behaviour.

You are likely to have both individual and group counselling sessions and there may also be the option for your family to get involved in your recovery programme. Family therapy can be a vital part of recovery as it not only helps all family members to deal with any issues that have arisen as a consequence of your illness, but it can also tackle any underlying family issues that may have led to your addiction in the first place.

Frequently Asked Questions