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Benzodiazepine Withdrawal

Once hailed as a safe drug alternative in the 1960s, benzodiazepines are mainly used to treat anxiety, but they also are associated with many health risks. This class of medications, which are called “benzos” for short, includes Ativan, Xanax, Klonopin, Librium, and others.

Long-term use of benzodiazepines is likely to lead to withdrawal symptoms that can take months to overcome.  

While these drugs have been commonly prescribed to treat anxiety, stress, depression, and sleep disorders, they are not prescribed for long-term use because of the risk of developing an addiction. 

Regular, long-term abuse of benzodiazepines can result in serious side effects including confusion, slurred speech, seizures or convulsions, severe drowsiness or coma, shakiness, slow heartbeat, difficulty breathing, and severe weakness.

People who are addicted to benzodiazepines are also at-risk for developing dementia, an illness affecting the brain that causes gradual memory loss and problems with language and motor skills.

Even more severe are the dangers of benzodiazepine addiction or overdose that contribute to emergency and hospital room admissions. 

Depending on the type of drug and its frequency, benzodiazepines differ in terms of what they are most commonly prescribed for and how long they continue to impact the brain. 

How Benzodiazepines Affect the Brain

Benzodiazepines work to reduce the activity of nerves in the brain and spinal cord by enhancing the effects of neurotransmitters in the brain. 

In short, it slows down the body’s central nervous system. When combined with other medications, benzodiazepines can slow the brain’s functions creating surges of dopamine.

Benzodiazepines affect the brain’s ability to function, which prompts dopamine-producing neurons to release more dopamine than needed. This tricks the brain into creating greater dopamine surges and further addiction or drug abuse.   

What You Can Expect from Benzodiazepine Withdrawal 

Research shows that benzodiazepine withdrawal brings on adverse effects, including cognitive complications that have affected visuospatial ability, a processing function, and verbal learning.

Withdrawal symptoms from benzodiazepine drugs include:

  • Increased anxiety, including panic attacks
  • Sweating
  • Irritability
  • Insomnia
  • Nausea
  • Headaches
  • Muscle aches

Months of continuous use can severely impair one’s cognitive abilities to the point that benzodiazepine users will continue to experience confusion and impaired reasoning abilities.

Rebound Anxiety

Rebound anxiety is defined as the worsening of symptoms upon discontinuation of treatment as compared to baseline symptoms. Those who take intermediate-acting benzodiazepines can experience anxiety after abruptly stopping use of the drugs. 

The symptoms are intensified symptoms of a pre-existing psychological disorder, which can include anxiety, panic attacks, and insomnia. The symptoms should go away in a week, but they could be prevalent in something known as Post-Acute Withdrawal Syndrome (PAWS), which we will discuss below.

Benzodiazepine Withdrawal Timeline

Although there is little documented research on how long benzodiazepine withdrawal lasts, various factors, which often vary by the individual, can affect this timeline. These factors include:

  • How long a person uses benzodiazepines
  • Dosage amount
  • Other drugs or alcohol used during the same time as benzos are used
  • Type of drug used/abused
  • How benzodiazepines were taken 
  • Current medical or health issues or conditions

If anything, time is needed to get off the drug fully. However, an individual also needs professional treatment and help to successfully move through all three stages from detox to outpatient care. 

First stage: The first symptoms start appearing within six-12 hours of discontinuing the drug. These symptoms can last anywhere from one to four days. 

Acute stage: The second stage, also known as the acute stage, usually lasts anywhere from 10 to 14 days. Short-term symptoms of acute withdrawal peak at Week 2 and include insomnia, palpitations, sweating, headache, weight loss, tinnitus, anxiety and panic attacks, nausea and dry retching, flu-like symptoms, muscle aches and pains, abnormal body sensations as well as perceptual changes and hallucinations. 

After the Week 2 mark, these symptoms will slowly begin to ease up. Symptoms can last up to several months or even years if they are not addressed professionally. Symptoms can wax and wane in severity from day to day or week to week. 

Post-Acute Withdrawal Syndrome (PAWS)

Post-Acute Withdrawal Syndrome (PAWS) can be just as severe as the acute withdrawal stage. While someone who has achieved prolonged sobriety and navigated through the dangerous withdrawals, they can still deal with PAWS, which can last for weeks, months, and even up to a year after cessation. 

PAWS is similar to anxiety and mood disorders, and it includes mood swings, insomnia, and increased levels of anxiety without any stimulus.

PAWS typically occurs after a withdrawal period from benzos, alcohol, or opioids. An estimated 75 percent of alcohol or benzo users will experience the condition. 

The cause of the disorder is subjective and is being heavily studied, but scientists believe the physical changes to the brain that occur as a result of substance abuse is responsible for increased tolerance to the substance, which is a reason for recurring symptoms.

Common symptoms of PAWS include:

  • Extreme difficulty in completing cognitive tasks, such as learning, problem-solving, or memory recall
  • Irritability
  • Anxiety
  • Panic attacks
  • Depression

More severe symptoms include:

  • Obsessive-compulsive disorder (OCD) type behavior
  • Inability to maintain social relationships
  • Craving the substance, despite weeks or months of sobriety
  • Apathetic
  • Pessimistic behavior 
  • Insomnia or a disturbed sleep pattern
  • Sensitivity to stress

PAWS is thought to be the result of physiologic changes that occur directly because of substance abuse. When someone is abusing drugs, the brain makes adaptations to accommodate changes in the neurotransmitters. 

The changes can cause excitability when the neurotransmitters change during abstinence. Infants born to mothers who have abused substances are also at risk of developing PAWS.

What Are Treatment Steps for Benzodiazepine Withdrawal?

Going through the detox process of benzodiazepine withdrawal can be extremely challenging, especially if a user has been taking the drug long-term. A cold turkey withdrawal from benzodiazepine is not recommended as symptoms can be uncomfortable enough for the patient to relapse. Additionally, there is a real risk of seizure and even death due to sudden cessation from benzodiazepines. 

Seeking treatment beginning with detox at a rehabilitation facility with medical intervention can help alleviate physical symptoms associated with withdrawal, including vomiting, insomnia, flu-like symptoms, and hallucinations. 

Doing the full continuum of treatment with professional help is imperative. One cannot attempt to “get clean” alone for the process itself is complicated and painfully unpleasant and can result in seizures.

Unsupervised withdrawal can be fatal, which is why one must begin a medically supervised tapering off of the drug while given another benzodiazepine such as Valium or Librium. This new benzodiazepine has a stabilizing effect depending on how one’s body metabolizes benzodiazepines.

Working through a benzo withdrawal can take years involving post-acute withdrawal (PAWS) symptoms, which is why it treatment options like those offered at Arete Recovery can help stabilize the body while undergoing the necessary full continuum of treatment. 

Arete Recovery manages the process of drug recovery in patients addicted to benzodiazepines   in the following way:

Detox is the first stage in recovery, where users gradually decrease their dosage. This process can take a few weeks to a few years, depending on the severity of withdrawal symptoms. 

During this phase, an initial assessment will be conducted, which includes evaluating ongoing health issues or pre-existing conditions, a psychiatric evaluation as well as an assessment of one’s living environment. Anti-anxiety and anticonvulsant medication is usually prescribed to manage the onset of symptoms. 

Following the successful completion of detox, the patient will continue with the next stage of treatment that leads him/her to either an inpatient or outpatient treatment program. This includes treatment from intensive inpatient treatment to residential treatment where the focus is on instilling confidence and comfort in the patient.  

An addiction rehabilitation program, which includes either an outpatient or inpatient residential program, is determined by a treatment specialist. This determination is made after the factors involved in the severity of one’s addiction are reviewed. 

People with severe addiction who have a long history of substance abuse or those addicted to multiple drugs will most likely benefit from a residential treatment center with 24-hour supervision, which is different from an outpatient setting that includes therapy sessions but without the 24-hour supportive environment of inpatient treatment by therapists, nurses, and physicians. 

These professionals provide mental health treatment and routine care designed to help the abuser toward resisting relapse and the causes of their benzodiazepine addiction.  

Group therapy treatment and/or individual therapy treatment options to help the addict get to the root cause behind his/her addiction. 

Some treatment centers favor group therapy over individual therapy, which is commonly referred to as cognitive behavior therapy (CBT). CBT helps recovering users identify thinking patterns that ultimately help create new neurological pathways to the brain that result in new ways of thinking. 

Group therapy has been known to create a sense of unity around community and sharing stories in this way a user doesn’t feel at the mercy of his/her addiction.

Sources

Post-Acute Withdrawal Syndrome (PAWS). (n.d.). Retrieved from https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS

Benzodiazepine withdrawal management. (n.d.). Retrieved from https://www.sahealth.sa.gov.au/wps/wcm/connect/public content/sa health internet/clinical resources/clinical topics/substance misuse and dependence/substance withdrawal management/benzodiazepine withdrawal management

Herman, J. B., Brotman, A. W., & Rosenbaum, J. F. (1987, October). Rebound anxiety in panic disorder patients treated with shorter-acting benzodiazepines. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/2889722

Brain Damage from Benzodiazepines: The Troubling Facts, Risks, and History of Minor Tranquilizers. (n.d.). Retrieved from https://www.psychologytoday.com/us/blog/side-effects/201011/brain-damage-benzodiazepines-the-troubling-facts-risks-and-history-minor

Benzodiazepine Abuse. (n.d.). Retrieved from https://www.webmd.com/mental-health/addiction/benzodiazepine-abuse#1

Benzodiazepines. (n.d.). Retrieved from https://www.dea.gov/factsheets/benzodiazepines

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