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Benzodiazepines—or benzos, for short—are a tranquilizing class of doctor-prescribed medications that, in addition to being widely administered to treat anxiety and insomnia in the U.S., can lead to abuse, addiction, and dependency. Some of the more familiar household names falling within this category include Ativan (lorazepam), Klonopin (clonazepam), Xanax (alprazolam) and Valium (diazepam). What makes these drugs “benzos”—and thus subject to abuse and addiction—is the distinctive way in which they affect the brain: they bind to the GABA neurotransmitter receptor, in effect calming the brain down and relaxing the body.
This article will educate readers on everything they need to know about detox from benzos, based on firsthand interviews with clinical and medical experts in the field, including the nature of abuse, addiction, and dependency; how medically managed detox can help patients; and withdrawal symptoms and a timeline for recovery.
Benzo Abuse, Addiction and Dependency: Why Detox
Detox, the medically managed supervision of drug withdrawal, can benefit people suffering from benzo abuse, addiction or dependency. (And each of these is its own distinct clinical phenomenon, according to an article in the Journal of the American Board of Family Medicine which explains the differences.)
Many people entering treatment for benzos are abusing the drug(s) alongside others, such as heroin, which may signify their primary addiction. For example, 80 percent of benzo abuse occurs within the context of “polydrug abuse,” according to a report by University of Wisconsin researchers published in American Family Physician. By that, they mean that benzos are rarely abused on their own but instead are a cohort to other drugs of abuse, the most common being (in cases of benzo abuse) opiates like heroin and prescription painkillers. High-dose benzo abuse is also reported as common among those who use methadone.
Still, others may be struggling with a benzo dependency (meaning physical tolerance and withdrawal, without other symptoms of abuse or addiction) for which detox can also be helpful. For example, a patient taking a therapeutic regular dose of the short-acting drug Ativan can develop a physical tolerance for the drug that requires them to take higher doses in order to achieve the same effect. When discontinued, the drug can cause a withdrawal “so severe that it becomes debilitating and their symptoms can be confusing to the treating physician,” in the words of the JABFM article cited earlier.
In such cases, a medically supervised detox can help patients safely and successfully taper off the drug so as to avoid the drug’s reportedly dangerous long-term side effects—a recent finding suggested benzos significantly raise one’s chances of developing Alzheimer’s, for instance—and with a view to finding safer medical and non-pharmacological alternatives for treating their symptoms.
Research in recent years has shown, moreover, that those prescribed benzos for medical purposes exhibit high rates of dependency. Such studies are summed up in the following conclusion: “We now know that benzodiazepines can cause a drug dependency even in what are considered therapeutic doses, and even in a short course of treatment.” (The same finding helps to explain how a full-blown benzo addiction, involving a chronic and progressive pattern of compulsive use despite negative consequences, can often begin with a doctor’s prescription for a bona fide medical condition.)
Benzo Withdrawal Symptoms
Withdrawal from benzos can involve a host of physical and psychological symptoms that benefit from the clinical and medical management of professionals in addiction treatment.
Psychological symptoms can often include:
- Anxiety, panic attacks and/or phobias
- Depression and/or obsessive negative thoughts, sometimes suicidal ideation
- Feelings of disassociation (or a sense of being detached from one’s surroundings)
- Rapid mood changes (including sudden outbursts)
- Cognitive impairment
- Nightmares and hallucinations
Physical symptoms can often include and are not limited to the following:
- Heightened sensory sensitivity
- Joint and muscle pain
- Blurred vision
- Itchy skin
- Numbness in extremities
- Sensations of “pins and needles”
- Gastrointestinal discomfort
- Muscle twitching
- Heart palpitations
The recovery timeline for benzos can vary on the basis of patients’ individual medical profiles, their substance abuse history, and severity of the addiction, and their provider’s treatment approach. Patients at Beach House Center for Recovery can typically expect to spend six to eight days in detox from benzodiazepines, depending on their specific needs.
During this time, patients receive a full clinical and medical work-up that looks at their medical and psychiatric history and nutritional status, as well as their emotional and spiritual needs, as part of a holistic approach to help patients move toward wellness. Within 24 to 48 hours of a detailed nursing assessment on Day 1 of detox, and then at least once daily thereafter during detox, patients will meet individually with a staff psychiatrist or medical doctor, in addition to being monitored 24/7 by a medical team.
Patients also take part daily in clinical groups overseen by a detox therapist, with the goal of:
- Emotionally and psychologically stabilizing and acclimating as they taper off the drug(s)
- Learning more about the basics of addiction and the spiritual foundation for recovery, via the 12-Step model, for example
- Addressing distorted thinking and other dysfunctional aspects of addiction, by replacing them with healthier behavioral tools
- Developing practical tools (deep breathing, meditation, etc.) for coping with the anxiety that frequently accompanies benzo withdrawal
- Developing specific goals for their time in rehab following detox
Following a larger general trend in substance abuse treatment, many people detoxing from benzos also have a co-occurring mental disorder. Common CODs among the benzo treatment population are generalized anxiety and panic disorder, depression, and insomnia. In many cases, benzo abuse and/or dependency began as the result of a primary care physician’s prescription for alleviating the symptoms of one of these CODs. For these patients, therapy in combination with non-narcotic medications and patient education is “a proven strategy for success,” according to Brandi Angeletti, Beach House Center for Recovery’s Directory of Nursing.
Medications that alleviate benzo withdrawal symptoms help patients move safely and comfortably through detox. In instances of benzo and opiate abuse, buprenorphine (Suboxone) may be prescribed. Alternatively, in instances of benzo and alcohol abuse, a substitute benzodiazepine, such as Librium, which has a longer half-life and can be less addictive than other faster-metabolized benzos, such as Ativan and Xanax, may be warranted as a short-term intervention. Other medications can also provide comfort and address symptoms of withdrawal, including muscle relaxants, anxiety medication, and sleep aids. Vitamins are also prescribed to replenish the body.
The above clinical and medical protocol for benzo detox has ensured that a great majority of benzo-dependent patients at Beach House Center for Recovery are able to successfully complete detox and transition to intensive residential treatment services that address the recovery goals identified during detox.