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These days, it seems as if there is a pill for just about any condition. If you can’t focus, try Adderall; if you’re in pain, take a Vicodin; if you can’t sleep, try Zoloft; if you have sexual problems, there’s always Viagra; and if you are anxious, Xanax might be the fix. In 2018, more than 4.6 billion prescriptions were written for Americans, and that number is expected to reach 5 billion by the mid-2020s.
While these drugs have a time, a place, and can be extremely effective at dealing with these issues, all too often, the long-term ramifications of prescription medications go undiscussed or ignored. The dramatic rise in prescription numbers exemplifies our cultural problem of overmedicating and treating symptoms, instead of addressing the root causes underlying those problems. This cavalier attitude has alarmed an increasing percentage of doctors and medical professionals who see this as a mounting societal and cultural crisis.
What Are Benzos?
Benzodiazepines are prescriptions that are used to help users cope with social anxieties, phobias, panic attacks, muscle spasms, muscle tension, and insomnia. The most commonly prescribed benzos are Xanax (alprazolam), which is the most popular of all benzos, Klonopin (clonazepam), Valium (diazepam), Ativan (lorazepam), and Restoril (temazepam). These come in bar or pill form and typically will be prescribed in a 2mg or 4mg dose.
What differentiates these benzos from one another is their potency, half-life (extent of effects), and how quickly their effects take place. They can be split into two classes, shorter-acting, and longer-acting benzos.
Shorter-acting benzodiazepines include:
- Ativan – characterized by slow onset action with effects that last up to 20 hours
- Halcion – characterized by fast onset with effects that last anywhere from 3 to 8 hours
- Xanax – characterized by intermediate onset with effects that can last up to 20 hours
Longer-acting benzodiazepines include:
- Klonopin – characterized by an intermediate onset of action with effects that can last from 1 to 3 days
- Valium – characterized by a rapid onset of action, generally 30 to 60 minutes, and lasts anywhere from 1 to 3 days
Benzos and the Brain
In order to understand the benzo withdrawal timeline, it is first essential to know how they work in the brain. The brain uses neurotransmitters to send signals that either excite or inhibit impulses in other brain cells. This electrical signaling causes the body to react one way or another. GABA (Gamma Amino Butyric Acid) are inhibitory neurotransmitters which slow the brain’s transmission of messages between brain cells, creating a calming effect.
Benzos operate by enhancing the strength of GABA neurotransmitters and overwhelming other impulses. Once in the central nervous system (CNS), benzos work to sedate the brain, delivering anxiety relief and suppressing panic symptoms. The side effect to these calming measures is drowsiness and lethargy. Although, as mentioned, benzos are generally prescribed for panic disorders, social anxiety disorders, and insomnia, they have also historically been used as a muscle relaxant, surgery sedative, and general anesthesia.
Because benzos are so incredibly effective and provide such intense feelings of relaxation—which could be considered a high in itself—it is quite easy to become physically or psychologically addicted to them. This can occur even if a person is only taking their recommended dosage because the brain will inevitably adapt to an extended period of benzo use. When the brain grows accustomed to this medication and forms a physical dependence, three things happen:
- It requires stronger doses to experience the same sedative effects.
- It requires more frequent doses since the duration of the benzo’s efficacy ebbs.
- The brain grows ever more reliant upon benzos to remain at a neutral buoyancy.
This building of tolerance also goes hand in hand with physiological dependence. A benzo user will begin to feel as if they need the drug to feel normal or to go about their daily activities. Their natural ability to quell anxiety and handle stress will diminish as they become more reliant upon the drug to do the fighting on their behalf. Over time, if a person regularly uses a benzo and suddenly stops taking it, that person will likely exhibit benzo withdrawal symptoms as their brain begins to malfunction without its accustomed presence.
Signs of Benzo Withdrawal
According to the DSM-5, the American Psychiatric Association’s Diagnostic and Statical Manual of Mental Disorders, a person who undergoes at least two of these symptoms, within hours or days of last use, can be considered to be going through benzo withdrawal. Such post-acute symptoms include:
- Difficulty falling asleep
- Difficulty staying asleep
- Hallucinations, including hearing, feeling, or seeing things that are not real
- Muscle aches
- Muscle tension
- Numbness in extremities
- Panic Attacks
- Psychomotor agitation, inability to stand still
- Racing heartbeat
The Benzo Rebound Effect
Since most benzo users are prescribed the drug to help them handle phobias or anxieties, a person who stops using these meds will feel a rebound effect wherein these anxieties return stronger than before. This increased distress and unease is worsened since a person has become accustomed to using the drugs as a crutch to treat the symptoms instead of addressing the underlying issues.
This sudden onset of anxiety can be debilitating and may create extreme confusion and discomfort for regular benzo users. As a result, their psychological cravings are magnified. In most cases, the most extreme rebound effects will lessen after a few days, but echoes of these uncomfortable feelings will likely linger for months after as a person re-learns how to live their everyday life and deal with their stress without the aid of benzos.
Factors Which Alter the Benzo Withdrawal Timeline
The benzo withdrawal timeline is different for each benzo user because each person’s addiction and physiological makeup is unique. Generally speaking, this timeline and the strength of withdrawal symptoms can be altered by a host of factors such as:
- Co-occurring disorders – Benzos are commonly prescribed to treat existing issues such as anxiety or panic disorder. These issues often stem from underlying mental health issues that go untreated.
- Family history – Genetics play a huge role in any potential user. If you have a history of drug use in your parents or grandparents, you will have a natural proclivity towards drug addiction.
- Frequency of benzo use – Similar to length and dosage, the frequency a person takes benzos will alter the strength of withdrawal symptoms. The more frequent the dose, the more reliant the body is upon the benzos.
- Gender – Men and women are biologically different. Their bodies respond differently to substances, and they tend to have varied patterns of drug use. Because of this and their biological variances, men and women will naturally experience slight differences in withdrawal symptoms.
- Height and Weight – A person’s size often alters how effective the drug will be. A larger person will need more benzos to receive the same effects; such a person might then experience stronger withdrawal effects as a result.
- Length of benzo use – The longer a person has been using benzos, the more reliant they become upon the drug and the more difficult it will be to function normally without it.
- Medical history – If a benzo user has had previous physical health issues, their body could have a harder time-fighting withdrawal symptoms. A fit person will typically have an easier time during withdrawal than someone whose body is not functioning optimally.
- Mode of benzo intake – A person can alter the speed of onset and potency of the drug depending upon how they take it. A person who snorts a benzo will feel stronger effects of withdrawal and have those symptoms hit quicker than a person who simply takes the pill orally as prescribed.
- Poly-drug abuse – A person who has had past drug or alcohol abuse issues, or used benzos in conjunction with drugs or alcohol will have a more difficult withdrawal period. This is especially true if drugs and alcohol are used in combination with benzos since the user could be dealing with additional symptoms of withdrawal from these other substances.
- Strength of dose – the larger the typical dose, the stronger the withdrawal symptoms exhibited, and the greater the shock to the system. A person who takes a much stronger dose demonstrates that their body has grown accustomed to the drug’s effect in the brain.
- Type of benzo – Whether you are using a short-acting or long-acting benzo will alter the withdrawal symptoms as well as the timeline of these symptoms.
Benzo Withdrawal Timeline
Typically, the benzo withdrawal timeline consists of four phases. Before we dive into these phases, however, we must first mention that the type of benzo will affect the length and onset of this timeline.
Short-Acting and Long-Acting Benzos
As discussed previously, short-acting and long-acting benzos have different half-lives, which alter how quickly the drugs hit and how long they remain effective. Differences include:
- Short-acting benzos – Initial withdrawal signs begin within hours of last use since they stay in the system for a shorter period of time. The strength of symptoms is also much stronger in comparison.
- Longer-acting benzos – Initial withdrawal signs take longer to appear since these drug effects can last days. As a result, mental and physical withdrawal symptoms take longer to materialize and are milder.
The 4 Phases of the Benzo Withdrawal Timeline
The four phases of benzo withdrawal will depend upon the type of benzo and the various factors we mentioned above. Generally speaking, though, a benzo user can expect detoxification to look like the following:
Phase 1 of Benzo Withdrawals: 6 – 8 hours
- Short-acting benzo users – The initial feelings of withdrawal will begin within hours of last use. A benzo user will feel heightened anxiety and discomfort. Sleep issues are common as the user undergoes heightened cravings.
- Long-acting benzo users – This is far too soon to begin feeling any type of withdrawal symptom.
Phase 2 of Benzo Withdrawals: 24 to 48 hours
- Short-acting benzo users – Rebound anxiety and other withdrawal symptoms firmly set in. This stage of withdrawal is the most uncomfortable and dangerous part of the benzo detox process. Users at this point are also most likely to relapse if they are attempting this detox own, which is why we suggest they perform detox under medical supervision.
- Long-acting benzo users – the first signs of withdrawal may crop up, although it could take another day or two until symptoms fully manifest.
Phase 3 of Benzo Withdrawals: 72 to 96 hours
- Short-acting benzo users – Withdrawal symptoms may continue but should begin to subside in strength. The body begins to return to normal, and a person can start treating the underlying issues of their addiction.
- Long-acting benzo users – Withdrawal symptoms will be in full effect, but will not be as severe as those seen in short-term users.
Phase 4 of Benzo Withdrawals: 10 to 14 days
- Short-acting benzo users – Symptoms of withdrawal should have entirely abated. Cravings may continue, but the body is no longer physically dependent on the drug.
- Long-acting benzo users – Symptoms of withdrawal should begin to subside.
Protracted Acute Withdrawal Syndrome
A select few people, who were extremely dependent on benzos, will experience protracted acute withdrawal syndrome (PAWS). Although uncommon, people who suffer from PAWS may experience intense withdrawal symptoms intermittently over the months following the initial detox. To prevent PAWS, most doctors suggest a benzo taper as opposed to a complete cessation of benzo use.
Benzo addiction is an issue that hundreds of thousands of people struggle with. If you count yourself among this group, remember that you are not alone. The benzo withdrawal timeline is not easy, but it can be managed, especially with medical supervision and assistance. If you have a physical dependence on benzos, our Florida drug rehab center can help. Call us today to get on the road to recovery.
Safe and Effective Use of Benzodiazepines in Clinical Practice – https://www.integration.samhsa.gov/about-us//Benzodiazepines_Presentation.pdf
Combining benzodiazepines with other substances raises risks – https://www.samhsa.gov/newsroom/press-announcements/201412180300
Withdrawal from long-term benzodiazepine use – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1934057/