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January 19, 2019

Ativan Detox Guide

Ativan (lorazepam) is a popular, brand-name benzodiazepine from a class of drugs primarily used to treat anxiety disorders. The fast-acting medication—which is available as a pill or intravenous injection—is also used to treat irritable bowel syndrome (IBS), insomnia, epilepsy, seizures, chemo-induced nausea and vomiting, as well as to help manage alcohol withdrawal.

Ativan’s chemical composition includes a potent combination of sedatives and tranquilizers that produce a calming effect on the brain and numerous physiological functions. Ativan is designated a Schedule IV substance by the Drug Enforcement Administration (DEA), but exhibits a high potential for addiction and abuse. For this reason, it is rarely prescribed for longer than two to four weeks.

Although unethical healthcare practices occasionally result in Ativan being prescribed beyond what is medically necessary, continuing to take the medication for longer than a month dramatically increases the likelihood of developing physical dependence. According to the Centers for Disease Control and Prevention (CDC), in 2011, approximately 28 million Ativan prescriptions were filled. The inordinate volume of prescriptions, combined with the tripling rate of drug treatment center admissions between 1998 and 2008, is a major cause for concern.    

ATIVAN WITHDRAWAL SYMPTOMS

Ativan’s suppressant effect on the central nervous system (CNS) is highly addictive, especially to those suffering from anxiety. When used inappropriately—and sometimes even when used exactly as prescribed—Ativan begins to create physical and psychological dependence. Once someone becomes Ativan-dependent, they inevitably experience withdrawal symptoms whenever it is taken in lower doses, there is a lapse in between uses, or the medication is stopped completely. Unsuspecting users may even find themselves initially doing quite well on the medication, only to be increasingly consumed by a desire for higher doses of the medication in shorter intervals of time.  In such cases, the compulsion to use becomes pathological.

An abundance of empirical research indicates that short-term Ativan users are less likely to experience severe withdrawal symptoms when compared to cases of long-term, immoderate use. For users who have taken the drug for a period of six months or longer (4 months by some estimates), withdrawal symptoms will be of higher intensity and more difficult to safely navigate.  A genetic proclivity toward addiction, known family history of substance abuse, and prior personal history of substance abuse are also relevant factors in determining the likelihood and severity of withdrawal symptoms. 

Ativan features a relatively short half-life of 10-12 hours, and mild withdrawal symptoms may begin within 24 hours of discontinuing use.  Ativan dependence produces a broad spectrum of neurological, cardiovascular, gastrointestinal, and psychological symptoms including:

  • Headache
  • Tremors
  • Perspiration
  • Disorientation
  • Difficulty concentrating
  • Agitation
  • Nausea
  • Vomiting
  • Weight loss
  • Anxiety
  • Mood swings
  • Panic attacks
  • Seizures
  • Hallucinations
  • Hypertension
  • Heart palpitations
  • Dizziness
  • Depression
  • Suicidal ideation

ATIVAN WITHDRAWAL TIMELINE

Ativan withdrawal is typically broken down into three separate stages— acute withdrawal, protracted withdrawal, and post-acute withdrawal syndrome (PAWS). The following provides a detailed summary:

  • Acute withdrawal – although mild withdrawal symptoms may begin within 24 hours, the average onset is between three to four days following cessation. In the majority of users, acute withdrawal is characterized by heightened anxiety, which in turn produces an accelerated heart rate, increased blood pressure, and insomnia. This surge of anxiety is frequently known as rebound anxiety, or a rebound effect in general. Acute withdrawal usually lasts between five days and one month, during which time symptoms peak within two weeks before gradually diminishing.
  • Protracted withdrawal – the protracted withdrawal phase typically lasts between 10 and 14 days, although it can extend for much longer depending upon the intensity and duration of use. During this phase, users may experience milder anxiety and depression-related symptoms, in addition to increased cravings, as their body acclimates to the absence of the drug. In some users, headache and flu-like symptoms emerge, and temptations to use are a constant battle.
  • Post-acute withdrawal syndrome (PAWS) – PAWS describes the extended anxiety and depression-related symptoms that may linger for months, or even years, beyond the acute and protracted withdrawal phases. In many users, PAWS may include decreased motivation, apathy, erratic mood swings, or other forms of psychological instability. In certain users, these symptoms are difficult to detect although still clinically relevant.

INPATIENT TREATMENT FOR ATIVAN

Addiction to Ativan requires quality clinical care in a medically managed environment in order to ensure optimal treatment outcomes and minimize the risk of relapse. Following successful initial detox, many clients choose to enroll in treatment at a designated residential facility. This treatment method—known as inpatient treatment—provides a number of advantages, including 24/7 client monitoring, a high staff-to-client ratio, and a team of highly experienced clinicians and licensed medical professionals. Inpatient treatment programs offer a safe, supportive environment in which recovery remains a top priority, and environmental risks and triggers are strategically minimized, usually for a period of between 30 and 90 days. Certain inpatient treatment programs also offer an impressive list of ancillary benefits and services that includes:

  • Access to state-of-the-art technology
  • A variety of evidence-based therapies
  • On-site recreational and social amenities
  • Aftercare planning and alumni networking
  • Holistic treatment modalities including yoga, nutrition, etc.
  • Close proximity to major attractions

Medication-Assisted Treatment (MAT)

Ativan addiction is best treated with a combination of ongoing psychotherapy and pharmacological interventions— a protocol known as MAT. The staple of Ativan addiction treatment is based on a variety of Food and Drug Administration (FDA)-approved medications combined with the following evidence-based therapies:

  • Cognitive behavioral therapy (CBT)
  • Trauma-focused therapy
  • Dialectical behavioral therapy (DBT)
  • Motivational interviewing (MI)
  • Narrative therapy
  • Family therapy
  • Creative and expressive therapy

Medications may include Ativan or other benzodiazepines (during initial detox), antidepressants, anticonvulsants, and a wide range of other primary or supplemental medications. In certain clients, medications are explored on a trial basis depending upon symptoms, and switched based upon the findings of a thorough follow-up evaluation.  Although clearly established Ativan treatment protocols are generally followed, administering physicians demonstrate flexibility when attending to individual client needs.    

Dual Diagnosis Treatment

Ativan addiction is frequently the result of co-occurring mental health disorders such as anxiety, depression, or post-traumatic stress (PTSD). Similarly, painful physical ailments or medical conditions can serve as precipitating or aggravating factors. As a result, supplemental medications may be included in the treatment protocol.

OUTPATIENT TREATMENT FOR ATIVAN

Outpatient treatment is a popular option that is particularly suited to those with demanding personal and/or professional schedules. Unlike inpatient treatment, which occurs in a residential setting, outpatient treatment is available only on a non-residential basis. Outpatient treatment is based upon a convenient routine of pre-scheduled individual and group therapy sessions. In most outpatient facilities, group sessions are conducted in the mornings or evenings three to five times per week to ensure maximum flexibility, and clients enjoy a more casual, low-key treatment environment. Although flexible and affordable, outpatient treatment is generally not recommended for moderate to severe Ativan addiction.   

CAN ATIVAN DETOX BE DONE AT HOME?

Self-administered, at-home Ativan detox is never recommended under any circumstance. Not only does at-home detox dramatically increase the risk of precipitated withdrawal—the dangerous acceleration and intensification of withdrawal symptoms—it may lead to unanticipated complications and virtually guarantees poor recovery outcomes. In some cases, it may even result in a heart attack, coma, or death. 

TAPERED VS COLD TURKEY

During initial detox, clients are frequently put on what is known as a tapering schedule—a treatment method in which Ativan is administered in diminishing doses over a predetermined period of time. As part of the tapering schedule, some physicians may substitute Ativan for a longer-acting benzodiazepine to help ensure a smoother transition and prevent the occurrence of debilitating withdrawal symptoms. Like at-home treatment, quitting Ativan cold turkey and without proper adjustment is never recommended.   

CONSIDERATIONS/ HOW TO DECIDE WHAT IS RIGHT FOR YOU

For most clients, treatment decisions are based upon the following factors: facility location, facility reputation, affordability, and insurance coverage / benefits. The decision to enroll in treatment can be overwhelming— especially for those with no previous substance abuse treatment experience. In order to help expedite the process, many facilities have experienced admissions staff available to help answer questions and alleviate concerns. New clients may be surprised to discover that, despite their initial concerns, questions related to insurance coverage and benefits are answered quickly and efficiently.  And, even in the unlikely scenario that coverage is denied, alternative financing options will be discussed.

RECOVERY SUCCESS AND AFTERCARE SERVICES FOR ATIVAN

Long-term recovery success requires commitment well beyond initial detox and inpatient or outpatient treatment. An empirically proven relapse prevention plan should include the following elements:

  • AA or NA (12-step) involvement
  • Sponsorship
  • Life and jobs skills coaching (if applicable)
  • Community involvement
  • Sober peer support
  • Healthy dietary and lifestyle decisions
  • Abstinence from social and environmental triggers
  • One-on-one and /or individual therapy

WHO NEEDS ATIVAN DETOX?

Despite its milder drug classification by the DEA, Ativan is a highly addictive medication that produces major physical and psychological changes when chronically abused. Anyone, at any time, can find themselves addicted to Ativan and in need of professional help. Like other mind-altering drugs, Ativan addiction requires early intervention and quality clinical care in order to ensure optimal treatment outcomes.

If you or someone you love is addicted to Ativan, call a substance abuse professional today. Taking that first step is always the hardest, but the long-term results are well worth the effort. 

For more about Ativan addiction and recovery, check out these related articles:

Sources:

  1. The Journal of Physiology. What makes Lorazepam different from other Benzodiazepines? Dec, 2005.
  2. The Journal of Clinical Psychiatry. The effects of benzodiazepines on cognition. September, 2006.
  3. Journal of Addictions Nursing. Ativan (Lorazepam). May, 2012.
  4. Anesthesiology. Lorazepam Is an Independent Risk Factor for Transitioning to Delirium in Intensive Care Unit Patients. Jan, 2006.

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