Rehab 4 Addiction

Benzodiazepines are a form of medication. They have a sedative effect, which means that they delay the working of the mind and body.

Benzodiazepines are typically prescribed for conditions such as anxiety and insomnia. They help with anxiety by calming you down; they help with insomnia by making you more tired and more able to get to sleep.

Benzodiazepines and addiction

Although benzodiazepines are effective at treating anxiety and insomnia, they also carry a risk of dependence, much like opioids such as morphine.

Due to their addictive nature, benzodiazepines should not be prescribed for long periods. Ideally, benzodiazepines (or ‘benzos’ as they are sometimes known) should only be prescribed for between two to four weeks. Any longer risks creating a dependence which can be difficult to get rid of.

One of the problems with using benzodiazepines for longer periods is that you can start to develop a tolerance. This is when you need more and more benzodiazepines to achieve the same effect.

Usually, tolerance is a warning sign that you may be starting to become dependent.

Benzodiazepine use becomes problematic when the user starts taking more than the dose recommended by their doctor. This can rapidly lead to a benzodiazepine addiction.

In order to get rid of a benzodiazepine addiction, a detox will be required, generally using a careful taper method so as to minimise withdrawal symptoms.

Benzodiazepine withdrawal symptoms

Benzodiazepine withdrawal occurs when someone who has developed a physical dependence on benzodiazepine stops taking this medication.

Withdrawal from benzodiazepine brings about a set of symptoms known as withdrawal symptoms. Acute withdrawal symptoms for benzodiazepine detox are:

Protracted withdrawal symptoms, which occur after the initial acute phase of benzodiazepine withdrawal, include:

  • Depression
  • Diminished appetite
  • Irritability
  • Milder forms of anxiety
  • Insomnia
  • Mood swings
  • Lack of concentration
  • Restlessness

How long does benzodiazepine withdrawal take?

There is a range of factors that can affect the length of time it takes for someone to withdraw from benzodiazepines.

According to one NHS leaflet, ‘attempting to withdraw patient from benzodiazepines should be a gradual process and may take from 3 months up to a year or longer’. [1]

However, if you only have a mild dependence on benzodiazepines, you may choose to quit outright, rather than tapering. If you do so, you will experience withdrawal symptoms fairly quickly. Short-acting benzos such as Xanax (alprazolam) will start to cause withdrawal symptoms only six to eight hours after the last use.

Longer-acting benzos such as Valium (diazepam) will take a few days to produce withdrawal symptoms.

What else do I need to know about benzodiazepine withdrawal?

Withdrawal symptoms can affect anyone with a mild physical dependence on benzodiazepines. This means that even someone who has been taking benzodiazepines as medication but does not consider themselves ‘addicted’, could experience these symptoms when they stop taking benzodiazepines.

Withdrawal symptoms are worst in those who go from taking large amounts of benzodiazepines to taking none at all in a short space of time. It can be dangerous to your health to ‘go cold turkey’ on benzodiazepines if you have a severe addiction. It is much safer to taper down under the supervision of a doctor.

Benzodiazepines are a form of anxiety medication, and so-called ‘rebound anxiety’ is one of the withdrawal symptoms which is most common among people who have stopped taking this medication. Rebound anxiety is where people suddenly begin to feel anxious after they stop taking benzodiazepines.

It can affect people who have had anxiety in the past, as well as people who have never experienced anxiety. It occurs because benzodiazepines have a sedative effect, which helps to calm people down.

When this sedative effect is removed, people find that they are more stressed, and need to find other ways to calm themselves down that do not involve medication.

Are some benzodiazepines more likely to produce withdrawal symptoms than others?

Diazepam (brand name: Valium) has a longer half-life than other benzodiazepines, which means that it carries a lower risk of withdrawal symptoms when you stop taking it.

This is because it is longer-acting. With short-acting benzodiazepines, such as sleeping pills, your body does not have much time to get used to being without the medication. [2]

Complicating factors can impact the way someone withdraws from benzodiazepine. For instance, if someone has been using benzodiazepines for a long time, it may be advisable for them to switch to diazepam rather than attempting to withdraw directly from another benzodiazepine, such as temazepam or nitrazepam.

How to deal with benzodiazepine withdrawal symptoms

Benzodiazepine withdrawal symptoms can be quite unpleasant, so if possible, it is best to try and avoid them altogether.

If you have a very mild benzodiazepine dependence, you may want to stop using benzodiazepine without tapering, i.e. go cold turkey. In this case, you may still get some withdrawal symptoms, but they are unlikely to be severe.

You will probably experience some anxiety, for which your doctor may be able to prescribe some medication that is not benzodiazepine. You may also experience some cravings; again, there are medications that your doctor can prescribe to ease these cravings.

Baclofen is one drug that has been used in this context. You can read more about Baclofen and its usage for benzodiazepine withdrawal here.

For those with a more severe benzodiazepine addiction, tapering is likely to be your best option. A slow, gradual taper can keep withdrawal symptoms to a minimum. You can read more about specific guidelines for tapering down from temazepam, zopiclone and diazepam here.

Things to consider before going through benzodiazepine withdrawal

Benzodiazepine withdrawal can be a difficult process and should not be attempted if a patient is in very poor physical or mental health.

Doctors need to take into account how they are going to manage symptoms of anxiety or depression in a patient during this time, and whether the patient has any previous history of substance addiction.

Things to consider during benzodiazepine withdrawal

It is important that the person going through withdrawal stays in contact with their doctor and lets them know exactly what their symptoms are. This will help the doctor to adjust their withdrawal schedule.

The patient should have regular consultations with their doctor so that the doctor can provide support and advice, as well as spotting any problems before they become more severe.

Unfortunately, many people try and fail to quit benzodiazepines. The withdrawal process is long and can be difficult, especially if the person trying to quit suffers from anxiety and/or insomnia.

However, in the event of a lapse, doctors should remind their patients that they can always try again, and one lapse is not the same as a full relapse.

Things to consider after benzodiazepine withdrawal

Once you have successfully weaned off benzodiazepines, you need to put measures in place to try to stop yourself from relapsing. Therapy is one of the best ways to do this. You can access therapy in benzodiazepine rehab.

During therapy, you will speak to a therapist about why you started to use benzodiazepines, and why you became addicted. They will help you to find more productive solutions to the problems which led to your addiction.

For instance, if you suffer from anxiety, they will discuss ways to manage that anxiety without resorting to benzodiazepines.

Rapid benzodiazepine withdrawal timeline

Rapid benzodiazepine withdrawal is not typically recommended, especially for those with more severe benzo addictions. This is because it can lead to intense withdrawal symptoms.

However, if you do wish to go through a rapid detox, you should have an idea of the withdrawal timeline:

  • Stage one. For a short-acting benzodiazepine such as Xanax (alprazolam), withdrawal symptoms will start to kick in around 6-8 hours after your last dose. The delay will be slightly longer with longer-acting benzos such as Valium (diazepam). Initial withdrawal symptoms include anxiety, perspiration and a rapid heart rate
  • Stage two. In the next three to four days, those using short-acting benzos will experience more withdrawal symptoms, including panic attacks, depression and sometimes hallucinations. Those who were using longer-acting benzodiazepines will also start to notice some withdrawal symptoms around this point. Since anxiety and panic are common withdrawal symptoms for benzodiazepines, and are also one of the main things that benzodiazepines are used to treat, many people get the mistaken impression that their anxiety is playing up, when in fact this anxiety is simply a withdrawal symptom. Many people also feel the urge to use benzodiazepines to treat this anxiety; this is one advantage to detoxing in rehab, where you have no access to benzos, and therefore cannot relapse
  • Stage three. Benzodiazepine withdrawal symptoms should start to subside around 10-14 days after your last dose. During this stage, you are likely to have some depression and anxiety, but with fewer physical withdrawal symptoms such as sweating and palpitations. You may also have some insomnia
  • Stage four. After the first two weeks have passed, the acute stage of withdrawal should be over, and most withdrawal symptoms will have calmed down. You will still get some bouts of anxiety, depression and sleeplessness but these will come and go periodically rather than being there constantly. For some, protracted withdrawal symptoms last for months, for others, they can last for up to a year. The duration of withdrawal depends on lots of factors, including the severity of your benzodiazepine addiction, your age, weight, sex and so on

Medications used in benzodiazepine detox

One of the most common ways to detox from benzodiazepine is to taper down using longer-acting benzo; this helps to keep withdrawal symptoms at a minimum. We’ve listed some of the most commonly-used long-acting benzos below:

  • Valium (diazepam). Valium is a long-acting benzodiazepine used to treat anxiety, seizures, and alcohol withdrawal, as well as to help people wean themselves off short-acting benzos. Valium relaxes the mind and nerves. It is generally taken in liquid form via the mouth. One thing to bear in mind when using Valium: grapefruits and grapefruit juice should not be consumed when taking this medication as they can cause added symptoms.
  • Klonopin (clonazepam). The main use of this benzodiazepine is to control seizures. It also has applications in the treatment of panic attacks.
  • Librium (chlordiazepoxide). Mainly used for treating withdrawal symptoms among people suffering from alcoholism, Librium can also be used to help people taper off a benzodiazepine dependence. Librium is often taken in capsule form.

A word of warning when taking any of the above diazepines: make sure you get the exact dose recommended by your doctor or physician.

When tapering, you should follow an exact plan with dosages for each day/month. Deviating from this plan significantly greatly increases your chance of either relapsing or suffering from withdrawal symptoms.

Other drugs used in benzodiazepine detox include Buspirone, which is used to soothe anxiety caused by benzo detox; and Flumazenil, which blocks benzo withdrawal symptoms and is also used to help people recover from a benzo overdose.

Benzodiazepine rehab

If you want to make a lasting recovery from benzodiazepine addiction, rehab is a very good option.

Rehab helps you to deal with the root causes of your addiction, through the medium of therapy. In rehab, you can access a range of different therapies for your benzo addiction.

These include:

  • Individual therapy. Individual therapy is a key part of any recovery because it allows you time alone with the therapist. This one-to-one time is invaluable because it gives the therapist an opportunity to really delve into your personal situation and discuss what made you resort to benzodiazepines. This will be very beneficial for you as it will help you to understand and come to terms with your own problems
  • Group therapy. Group therapy is as useful as individual therapy, but in a different way. Whereas individual therapy is great for helping people in recovery understand their own addictions, group therapy provides a valuable sense of community and solidarity among people with substance use disorders (SUDs). For people with benzodiazepine addictions, some of whom may suffer from anxiety, the experience of going through therapy in a group can be both daunting and cathartic. Group therapy reminds people that they are not alone in their fight against addiction
  • Motivational Interviewing. Motivational Interviewing is a form of therapy based on short interventions that ascertain people’s core drives and motivations, and use these motivations to help encourage people towards further treatment. At the beginning of treatment, when someone may not be completely ready for a stay in inpatient rehab, a course of Motivational Interviewing can be very helpful. Given the duration of benzodiazepine withdrawal, which can last for months, and the possibility of severe withdrawal symptoms, many people with benzo addictions are likely to feel nervous at the prospect of going through detox. Motivational Interviewing may be exactly what they need to prepare themselves mentally for a detox
  • Cognitive Behavioural Therapy. One of the most popular forms of therapy, cognitive behavioural therapy focuses on thought patterns which lead to substance use. It teaches you how to spot these thought patterns and observe them ‘from outside’, therefore preventing them from spiralling into negative behaviours such as relapse. CBT has an enormous wealth of evidence to back it up, and has been one of the most successful and widespread forms of therapy over the last decade [3]
  • Contingency Management. Contingency Management is a reward/incentive system to help people stay on course when detoxing. Typical CM programmes work by providing prizes or raffle tickets to those who can produce drug-free urine samples. In benzodiazepine treatment, this might work best for people going through a rapid detox

Final thoughts

Detoxing from benzodiazepines can be a time-consuming, difficult process. It requires medical supervision, and needs to be done carefully in order to avoid severe withdrawal symptoms.

For anyone wishing to detox from benzos, we would recommend that you seek professional help before doing so. Trying to detox from benzodiazepines alone could put your health at risk.

Despite the difficulty that comes with benzodiazepine detox, we would encourage anyone with a benzo habit to detox as soon as possible. Getting sober can turn your life around.

References

[1] https://mm.wirral.nhs.uk/document_uploads/Controlled%20Drugs/BenzoWithdrawalGuidance.pdf

[2] https://www.mind.org.uk/information-support/drugs-and-treatments/sleeping-pills-and-minor-tranquillisers/comparing-benzodiazepines/

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897895/