One hundred and twenty-seven million prescriptions. That is how many prescriptions have been filled in the U.S. for the wildly popular drug class, benzodiazepine—commonly referred to as “benzos”—according to the Drug Enforcement Administration. Benzos are a class of Schedule IV controlled substances that include fifteen approved medications, including such brands as Xanax, Valium, Ativan, Klonopin, and Librium, to name a few. These drugs produce a calming effect by attaching to the brain’s GABA-A receptors, and are generally prescribed for patients with anxiety disorder or insomnia.

Benzos also happen to be widely abused, as they are extremely addicting. Tolerance to the drug’s effects builds rapidly, leading the individual to begin taking higher and/or more frequent doses to gain the same effect as originally experienced. This quickly advances into drug dependency, where withdrawal symptoms commence if the individual decides to discontinue use.

Benzo withdrawal is extremely dangerous, and potentially fatal, if not undergone under medical supervision. Doctors who specialize in benzo withdrawal are trained to manage the detox and withdrawal process carefully in order to avoid dangerous health events. By no means should anyone attempt to detox from benzos without the supervision of doctors who specialize in benzo withdrawal.

About Benzodiazepines

Benzos are a popular drug classification that provides immediate sedating effects for individuals struggling with a variety of conditions such as anxiety, panic disorder, restless leg syndrome, epileptic seizures, and insomnia. The mildly tranquilizing effects of benzos are helpful for relaxing patients prior to a medical procedure or surgery. These medications are not intended for long-term use due to their propensity for becoming addictive.

Benzos are also used recreationally, usually via illicit routes of obtaining the drug. Some people purposely use both benzos and alcohol, a dangerous combination, for an enhanced sedative effect. Opioid addicts often take benzos with the opioid, another dangerous poly-substance habit. The drug is available in tablet, capsule, suppository or liquid form, with some individuals crushing and snorting the benzodiazepines recreationally.

Benzos reduce respiratory rate, heart rate, and blood pressure, so when these drugs are taken with another depressant, such as alcohol, the result can be fatal. In fact, 30% of overdose deaths involve this combination, according to the National Institute on Drug Abuse, with an estimated 9,000 people overdosing on benzos in 2015.

Individuals may use benzos in an attempt to reduce the effects of stimulants, such as cocaine or Adderall. The sedative properties of the benzo can offset the stimulant effects, allowing the individual to “come down”and be able to sleep. 

Benzodiazepines play a legitimate role in alcohol detoxification. Individuals entering alcohol detox will usually be prescribed a benzo to assist in preventing seizures, while also mitigating anxiety and insomnia. 

Benzos are available in short-acting formulas, such as Restoril, Halcion, and Dalmane, and longer acting formulas, including Xanax, Valium, Paxipam, Librium, Ativan, Doral, and Klonopin. On average, the drug remains in the blood stream for 2-3 days.

BENZO DEPENDENCE

Becoming physically dependent on the effects of a benzodiazepine can happen quickly. For instance, taking 4mg of Xanax a day for three months can likely result in drug dependency. As the body becomes accustomed to the drug, tolerance increases and it takes larger doses to achieve the initial effects. With continued use, the brain structures will become modified resulting in chemical dependence.

Some of the warning signs indicating an emerging benzodiazepine addiction or dependence include:

• Taking increasingly higher doses more frequently
• Psychological addiction, as in believing he or she cannot function without the benzo
• Doctor shopping or buying the pills online once prescription has expired
• Thoughts begin to revolve around the drug, looking forward to taking the benzo
• Attempts to stop taking the benzo fail
• Sleep disturbances
• Mood swings
• Weakness and fatigue
• Memory problems
• Withdrawal symptoms emerge if benzo is withheld

When attempting to stop taking the benzodiazepine, the body immediately goes into withdrawal ode, with can cause highly uncomfortable symptoms to emerge. This is the most obvious sign that the body has become dependent on the drug. The longer the drug use continues, the more difficult it is to withdraw from.

BENZO OVERDOSE SYMPTOMSDETOXING FROM 

People who abuse benzodiazepines recreationally high may combine the drug with other benzos, opioids, or alcohol, creating a potentially lethal result. Using benzos with another depressant puts too much strain on the central nervous system, which can cause respiratory distress and even death.

Age is another risk factor for possible overdose. Drugs and alcohol are not metabolized at the same rate as in younger years, which can cause the drug to build up in the system. For this reason, doctors now prescribe lower quantities and dosages of these sedatives to patients who are over age 65.

Overdose can also occur after a period of abstinence from the drug. When returning to using benzodiazepines the body cannot tolerate the prior levels, resulting in overdose.

Additionally, if the benzo is crushed and snorted or chewed, it can hit the system faster.  

Symptoms of overdose include:

• Lightheadedness
• Confusion
• Extreme drowsiness
• Difficulty breathing
• Loss of balance
• Unresponsive
• Fainting 
• Coma

An overdose is a medical emergency that requires immediate intervention. Depending on the level of the overdose emergency, detoxification from the benzodiazepine can be completed within a hospital setting, if the gastric lavage and  IV infusions are required.

Medical Benzo Detox Process

When someone has developed a significant benzodiazepine use disorder it is recommended that they obtain detoxification with the support of Doctors who Specialize in Benzo Withdrawal and support of a medical detox program. To abruptly stop taking the drug after a lengthy history of use can cause serious, even fatal, health events such as seizures or psychosis. A medical detox program will have a tapering schedule to safely wean the individual off the drug over a two-week period.

Benzo Withdrawal symptoms commence between 10-24 hours after the last drug dosing. This will vary depending on whether the individual is dependent on a short-acting benzo, such as Xanax, or a longer acting one like Valium. Withdrawal symptoms usually proceed in three stages, including early withdrawal, acute withdrawal, and protracted withdrawal, although only approximately 10% of individuals experience the protracted withdrawal stage. The symptoms peak around day ten before beginning to subside.

BENZO WITHDRAWAL SYMPTOMS

Detox involves the process through which the body eliminates the residual effects of the benzodiazepine and eventually stabilizes. While the individual is cycling through the detox process, they will experience withdrawal symptoms. The severity of the benzo withdrawal symptoms will depend on the length of history of benzo dependency, the amount of the drug consumed, the specific type of benzodiazepine involved, whether there is a poly-drug addiction, and if there is a co-occurring mental health disorder present.

According to Dr. Michael Greenberg, M.D., M.P.H., patients with more entrenched, long-term benzo dependency face more health risks. Greenberg states, “The more severely affected patient may require more complex therapy, including the use of barbiturates as substitute agents for benzodiazepines. Other drugs such as valproate also have been proposed as potentially useful adjuncts in treating benzodiazepine withdrawal. Even in a severely effected patient, immediate benzodiazepine replacement is advocated pending the administration of barbiturates.”

Withdrawal progresses through two distinct phases, the early withdrawal phase and the acute withdrawal phase, before symptoms begin to subside. The tapering schedule will allow the body to incrementally become accustomed to less and less of the drug. This will help in mitigating the severity of the withdrawal symptoms. Medical detox providers will help ease the symptoms further by offering various interventions throughout the detox and withdrawal process.

Withdrawal symptoms when detoxing from benzodiazepines include:

Early withdrawal stage:

• ANXIETY
• INSOMNIA

Acute withdrawal stage:

• NAUSEA AND VOMITING
• MUSCLE SPASMS
• DIARRHEA
• BLURRED VISION
• TROUBLE CONCENTRATING
• TWITCHING
• FOGGY THINKING
• MOOD SWINGS
• PANIC
• ANXIETY
• INSOMNIA
• HALLUCINATIONS
• SEIZURES
• SUICIDAL THOUGHTS AND ACTIONS

Protracted withdrawal stage:

• TINGLING IN ARMS AND LEGS
• MUSCLE TWITCHES
• COGNITIVE PROBLEMS
• DEPRESSION
• INSOMNIA
• MOOD SWINGS
• PROLONGED ANXIETY

The severity of the benzo withdrawal symptoms will depend on the length of history of benzo dependency, the amount of the drug consumed, and whether there is a co-occurring mental health disorder present.

Following the medical detox, the individual will need to participate in a formal treatment program to change the addictive behaviors that have become part of the brain’s reward system.  This treatment is necessary to learn how to manage stress and anxiety without resorting to benzos, and to establish long-term recovery. 

Treatment for a Benzo Addiction

After the successful completion of a medical detox, the next phase of recovery from benzo dependency is treatment. Addiction treatment encompasses assorted therapies that provide a comprehensive approach to reshaping thoughts and behaviors and equipping the individual with sound coping skills and recovery tools. This multi-pronged treatment program will include:

• Individual psychotherapy, also called talk therapy. These sessions help the therapist understand what underlying issues might be causing anxiety, and then assist the client in making some life changes. Learning how to better manage stress triggers is an important element of psychotherapy. This can be achieved through the use of cognitive behavior therapy, which is a short-term therapy model that guides individuals to identify disordered thoughts that keep them hostage to relying on benzos. These thought patterns can be reshaped through positive affirmations and more proactive responses to triggers.
• Small group therapy sessions. Group therapy helps the group hash out their struggles with addiction, to share stories, and to become accountable to the group in the shared goal of remaining drug free. During rehab, these peer-based formats are an important source of additional support.
• Relapse prevention strategizing. Classes that provide information about how addiction develops, and how sobriety can be sustained, are an important source of psychosocial support for learning how to manage daily life in recovery. New skills are taught, offering useful coping tools to further aid the recovery process.
• Adjunctive therapies, such as recreational therapy, yoga, meditation, acupuncture, massage, and art therapy, are essential in teaching individuals how to better regulate stress and anxiety in recovery. Managing stress is critical in benzodiazepine recovery. 
• Recovery groups. 12-step meetings provide a meaningful roadmap of benchmarks that incrementally help the client rebuild their lives. The meetings are a good source of social support as well.

RECOVERY SUCCESS

Completing an outpatient or residential addiction treatment program provides the individual with essential recovery tools and techniques that will assist him or her in managing life after rehab. There are several actionable steps that can help the individual further solidify recovery, including:

• Continuing outpatient therapy. By continuing to engage in therapy the individual will have a source of ongoing guidance, especially in the first year of recovery
• Recovery community. Finding a community that is a good fit, whether it is a 12-step group or an alternative format, provides social support in recovery.
• Holistic activities. Incorporating activities that help the individual manage stress can become handy tools to help reinforce recovery and avoid relapse. 
• Exercise and diet. Establishing a healthy routine will help support recovery. This includes getting regular exercise, making dietary changes, and improving sleep quality.

Solutions 4 Recovery Provides Doctors Who Specialize in Benzo Withdrawal

Solutions 4 Recovery is a full-spectrum addiction treatment program serving South Orange County, California. The highly trained detox team at Solutions 4 Recovery includes doctors who specialize in benzo withdrawal and management, safely guiding the client through the process and into their highly effective, customized treatment program. For more information about benzo detox and withdrawal and treatment, please contact Solutions 4 Recovery today at (888) 417-1874