Awareness of the deadly opioid epidemic in the United States has increased a great deal, especially since the deadly drugs have claimed thousands of lives in recent years. But there’s another class of drugs that has earned a place on the dangerous medications list to watch out for, and they’re called benzodiazepines.
Benzodiazepines, or “benzos” for short, are medications that are prescribed for anxiety disorders, panic disorders, sleep disorders, insomnia, seizures, and severe alcohol withdrawal. They depress the central nervous system and attach to the brain’s gamma-aminobutyric-acid (GABA) receptors, making users feel calm or relaxed.
More than 2,000-plus benzos have been produced, but only 15 have been approved by the U.S. Food and Drug Administration (FDA). Ativan (generic name lorazepam), Valium (generic name diazepam), and Xanax (alprazolam) are among the most popular ones that are misused and abused.
Other commonly prescribed benzodiazepines include:
People who are prescribed benzodiazepines range in age, from teenagers to older people. Data from one study showed that benzodiazepine prescriptions seemed to increase with age.
The known risks are believed to be higher for senior adults. “In older people, research has shown that benzodiazepines can impair cognition, mobility, and driving skills, and they increase the risk of falls,” says a news release from the National Institutes of Health.
These highly addictive drugs are ripe for misuse and abuse.
According to the 2015 National Survey on Drug Use and Health (NSDUH), more than five million people age 12 and older in the U.S. had misused benzos in the past year. And, the number of prescriptions for benzodiazepines has increased considerably in the nation, according to an April 2016 study, as well as fatal benzo-related overdoses.
Overdose deaths involving benzodiazepines increased more than seven-fold between 1999 and 2015, according to one report.
The addictive nature of benzos makes it easy for one to develop a dependence on them, so they typically are advised for short-term use. Their misuse and abuse have hooked both recreational users and those who have legitimate prescriptions, and their effects can be deadly. Benzo abuse can mean:
Many people become physically and psychologically dependent on benzos, which makes it difficult for them to stop using. It is highly possible to develop a dependence on benzos without realizing it. People who have a substance use disorder are at a higher risk of developing benzodiazepine dependence or addiction and should tell their doctor before they start taking these medications.
Some will attempt to end their dependence on their own after long-term benzo use, a move that is highly discouraged.
Quitting an addictive drug after chronic, frequent, or long-term is dangerous. This is known as going cold turkey, and while the practice is glamorized in movies and the media, it can lead to relapse, overdose, and death.
It is not recommended. Instead of doing it on their own, benzo users are encouraged to seek professional addiction help at a reputable treatment center.
You will know if you are in benzo withdrawal if you notice any changes in how you think, feel or behave after you’ve reduced or entirely stopped using the drugs. These changes signal that benzodiazepine withdrawal is either beginning or are underway. This period is characterized by uncomfortable or painful symptoms. Among those symptoms are:
Physiological dependence on benzos is followed by a period of withdrawal. This is characterized by sleep, increased tension, anxiety, panic attacks, hand tremors, an inability to concentrate, and a host of perceptual changes.
There are several scenarios where individuals consuming high doses of benzo drugs develop serious problems such as seizures and psychotic reactions. In some cases, these can turn deadly and must always be monitored by medical professionals.
One of the most common withdrawal symptoms from a typical dosage of benzodiazepine treatment can result in what is known as “rebound” symptoms. This is a return of the ailments the medications were designed to treat. It can occur within one to four days after discontinuation, depending on the half-life of the drug. The two most common rebound symptoms include:
Abrupt cessation of benzodiazepine treatment in those with anxiety disorders were found to induce a state of rebound anxiety, which is in addition to the physical symptoms of withdrawal.
It is common for those struggling with an anxiety disorder to have a return to their baseline symptoms, but much more severe than before they were being treated. It’s common for a rebound reaction to trigger a relapse. Between 10 to 35 percent of people stopping benzos will experience rebound anxiety that can lead to panic attacks. A slow tapering will lead to fewer withdrawal symptoms.
Similar to rebound anxiety, rebound insomnia is defined as difficulty initiating or maintaining sleep that is worsened by the abrupt discontinuation of sleeping pills. Insomnia can return worse than it has been, which leads to individuals experiencing a complete loss of sleep that lasts hours or days. Insomnia can worsen compared to pre-treatment levels.
How long it takes one to withdraw from benzos will be different depending on the person. Several factors should be considered when determining a timeline. Among them are:
The following is a general overview of what happens when a person goes through benzodiazepine withdrawal. Experiences will vary by the person, so consult with a doctor to get the clearest understanding of what’s going on in your situation.
Benzodiazepine withdrawal typically happens in two phases. The first is the acute phase, which can last a week to three months (90 days). The second is the post-acute withdrawal syndrome phase, known as PAWS, and it can last much longer, for weeks and even years.
During the acute phase, users who took shorter-acting benzos, such as Ativan, Halcion, and Xanax, may experience their first signs of benzo withdrawal within six to eight hours. People who are in withdrawal from longer-acting benzos, which include Valium, Klonopin, and Librium, usually start to notice symptoms 24 to 48 hours after their last dose.
Anxiety, appetite loss, nausea, and sleeping trouble happens during this period.
Insomnia, anxiety, and nausea peak. Mental, emotional, and physical discomfort may be experienced. Recovering benzo users are at risk of having a seizure now. Medical supervision is needed.
The symptoms will continue. Some patients might feel better before experiencing rebound anxiety and insomnia, which occur in inconsistent periods. This is because the benzo used may have a long half-life, which means it takes longer to leave the body.
Recovering benzo users begin to see acute symptoms fading. Post-acute withdrawal symptoms (PAWS), such as drug cravings, depression, and irritability, are unpredictable and may appear at any time. Treatment should be continued to help former users navigate this rough and uncertain period.
If you are experiencing PAWS symptoms, keep in mind that you do not have to manage these on your own. Professional treatment is recommended to manage this period. Getting enough rest, practicing habits that promote health and wellness, and supportive network of people are effective ways to manage PAWS. Consult with your physician to come up with the best plan for you.
The decision to seek professional medical detox for benzodiazepine withdrawal is up to each person going through withdrawal. However, the benefits of completing one are clear.
A medically monitored detox ensures that all traces of drugs, alcohol, and other toxins are safely removed from the body to bring about physical and psychological stability. It also helps prevent the complications that commonly happen during withdrawal. If any medical emergencies arise, health care professionals can address them right away.
Detox is just the first step in a process designed to link users with the therapies and treatments needed to prevent benzo use and relapse.
If someone has resorted to frequently abusing benzos, it will take a change in behavior and support to stay true to sobriety. Post-detox therapy and counseling can help recovering users achieve those results.
During this time, recovering benzo users may undergo a controlled tapering schedule that gradually lowers the dosage of the drug they were using until the substance is completely removed from the body.
It is up to the health professionals who review the client’s needs, but medications may be used during the tapering process, including Phenobarbital, a barbiturate, which is given to prevent seizures. Longer-acting benzodiazepines also may be given in place of shorter-acting ones to help ease discomfort.
Medical detox can last anywhere from three to seven days or longer, depending on how severe the situation is. Mild situations may be managed outside of a rehab center, but even in that case, a physician’s assessment should be sought to determine what at-home treatment and medications are needed for a recovery taking place at home.
During a health examination, the medical staff performs a physical exam that will check for things such as a rapid heart rate, shaky hands, dehydration, fever, abnormal eye movements, and abnormal heart rhythms and other things.
The primary objective in treatment is to abstain from benzos, but another target in treatment is to learn the tools necessary to sustain that achievement. One such phenomenon that can threaten and challenge someone’s sobriety is post-acute withdrawal syndrome (PAWS), which is lingering effects of withdrawal long past the typical window. The impairment can persist for weeks, months, and in some more severe cases years, after abstaining from a substance of abuse.
PAWS symptoms commonly occur after a period of withdrawal from benzos, alcohol, or opioids, and it is estimated that 75 percent of benzo users will experience it to some varying degree. Scientists believe this occurs due to the physical changes that are sustained over time of drug abuse to the brain.
The symptoms are going to fluctuate in severity based on how long someone was using drugs.
The most common symptoms of PAWS include:
Those at an increased risk of PAWS are more likely to relapse. While detox is a crucial step in the continuum of care, it will not address the underlying issues that pushes someone into using drugs, and will not cater to the needs of someone that is experiencing PAWS. For that reason, the next step after detox must be formal treatment.
Medical detox is the first in a series of steps to benzo abuse recovery. After this process takes place, entering a licensed alcohol or drug treatment center is the next step. Such a place promotes ending problematic drug use or drug addiction by beginning to understand and address the underlying reasons for their dependence.
Addiction is a chronic, relapsing brain disease, according to the National Institute on Drug Abuse. The government agency also saysaddiction is treatable. Research shows that at least 90 days or more are needed to treat substance addiction.
Before a treatment center is chosen, the needs and preferences of the person in recovery must be reviewed. Addiction treatment won’t be the same for everyone, so this is an important step.
After it is determined what kind of arrangement is beneficial, recovering benzo users can choose from:
Residential programs, also known as inpatient programs, provide clients with a safe, supportive, and supervised environment that allows benzo users to focus on their addiction with minimal distractions. Clients may stay on site for anywhere from 30 days to three months or longer, depending on their needs and severity of their situation. Clients are typically supervised around the clock to ensure they get the care they need on all levels. Research supports that the longer someone stays in treatment (at least 90 days), the better their chances are of achieving long-term recovery.
Intensive outpatient programs (IOPs) provide strong support for recovering benzo users without requiring them to stay overnight or at a rehab facility for extended periods. IOPs are viewed as an affordable option for people who are recovering from substance addiction. The length of an IOP depends on the individual, but the program can run at least up to three months. Clients can receive intensive therapies for a set number of hours each week.
Partial hospitalization programs (PHPs) provide services that are similar to those of inpatient or outpatient programs. In a partial hospitalization program, individuals in active addiction must meet set criteria so they can successfully complete the program. PHPs can be used for people who need a place to live as they step down from a higher level of care, and transition back into society. Partial hospitalization can serve as a substitute for inpatient care or be a form of intensive outpatient treatment.
Outpatient programs offer the most flexibility. Inpatient and residential programs typically require you to complete a 30-day or longer stay at the treatment facility. During your time in any of these programs, you will have various therapies and counseling opportunities to help you put your life back together after addiction.
Outpatient programs usually include holistic therapy, behavior therapy, trauma therapy, and others. There’s also individual, group, and family counseling, 12-step programs such as Alcoholics Anonymous, life skills management, relapse prevention training, and more.
If you or someone you know has tried everything to end a dependence on benzos but can’t seem to do it, Pathway to Hope can help you find the peace you’re seeking. Call us at (866) 361-0809 or contact us online today for a free assessment consultation so we can help you find the right treatment program for you or someone you know. We also can walk you through the process to discuss your insurance needs and what treatment programs you are interested in. Don’t delay. If you need addiction treatment, now’s a good time to get it.
Pétursson, H. (1994, November). The benzodiazepine withdrawal syndrome. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/7841856
Anxieties.com. (n.d.). Retrieved from https://www.anxieties.com/157/benzodiazepines-bzs#.XQOZhlxKiUm
Gillin, J. C., Spinweber, C. L., & Johnson, L. C. (1989, June). Rebound insomnia: A critical review. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/2567741
Post-Acute Withdrawal Syndrome (PAWS). (n.d.). Retrieved from https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS
What are the ASAM Levels of Care? (2018, July 20). Retrieved from https://www.asamcontinuum.org/knowledgebase/what-are-the-asam-levels-of-care/