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Detoxification Guide for Benzodiazepines.

Written By Jeff Mahre BA MFA MLIS - January 12th, 2017

Benzodiazepines (or “benzo’s” for short) are a commonly prescribed medication for anxiety and/or panic disorder. They fall under the group of drugs known as sedative hypnotics. However, benzodiazepines have a strong habit-forming potential and patients should always be warned about this before using them. Our guide allows you to make informed decisions regarding the use of these drugs. As with other addictive substances, we recommend that benzodiazepine detox is done in a professional medical facility. Contact someone who can help you today.

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benzo abuse facts

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There is limited evidence available regarding benzodiazepine misuse in the United States. A cross-sectional analysis by Maust, Lin and Blow (2019) found that:

  • 6% of adults reported past-year benzodiazepine use
  • 2% of overall use was attributed to misuse
  • Older adults (50-64 years) had the highest prescribed use
  • Younger adults (18-25 years) had the highest misuse

Benzodiazepines provide sedative effects by increasing the levels of GABA, an inhibitory neurotransmitter in the brain. GABA produces a calming effect on the brain, thus decreasing anxiety. They can cause drowsiness and in-coordination. When used with alcohol, driving becomes dangerous as both benzodiazepines and alcohol suppress the central nervous system. Sleep may be induced and, in even higher doses, respiratory depression and death can occur. Higher doses also impair memory and cognitive functions (Longo & Johnson, 2000).

The most commonly prescribed benzodiazepines tend to be the following (Kroll, Nieva, Barsky & Linder, 2016):

  • Valium (diazepam)
  • Xanax (alprazolam)
  • Klonopin (clonazepam)
  • Ativan (lorazepam)

While these prescription drugs can certainly provide profound relief to someone in the throes of ongoing panic attacks, the long-term effects of these prescription drugs often negates any good that they may provide.  As stated, they are incredibly addictive substances and, particularly in patients with co-existing substance abuse, are easy to become dependent on.

Continue reading if you or a loved one are battling an addiction to benzodiazepines.

symptoms of benzo withdrawal

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There are three different classes of benzodiazepine drugs: long-acting, intermediate-acting and short-acting. According to Longo & Johnson (2000), short-acting drugs such as midazolam (Versed) and triazolam (Halcion) causes a withdrawal syndrome earlier which is possibly more severe than the long-acting agents such as diazepam (Valium) or clonazepam (Klonopin). Alprazolam (Xanax) and lorazepam (Ativan) are intermediate-acting agents and fall in-between the short and long-acting drugs. The shorter the onset of action of the benzodiazepine, the higher the potential of abuse. Valium, although a long-acting agent, has also been regarded to be highly addictive.

As a person withdraws, their neurochemistry suffers a decrease in GABA. This causes the user to experience acute withdrawal symptoms. If the symptoms continue for a prolonged period, it is known as a withdrawal syndrome. The symptoms of withdrawal include Longo & Johnson (2000):

  • Anxiety
  • Restlessness
  • Panic
  • Irritability
  • Insomnia
  • Nausea and vomiting
  • Muscle aches
  • Headaches
  • Psychosis
  • Seizures
  • Sweating
  • Tremors

If a long-term or high dose benzodiazepine is abruptly discontinued, a person may experience seizures, confusion or psychosis. That is why every person on a long-term or high dose regimen of any benzodiazepine should be slowly weaned (Liebrenz, Gehring, Buadze & Caflisch, 2015).

benzo withdrawal timeline

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Before embarking on a benzodiazepine detox, it is wise to have a treatment plan in place and to ideally be admitted to a rehabilitation centre beforehand. Importantly, detoxification from benzodiazepines is a particularly lengthy process.

A withdrawal from chronic benzodiazepine usage usually progresses through the following stages (Pétursson, 1994):

Stage 1: Onset Period

During this phase, the withdrawal symptoms begin. This occurs sooner in short-acting benzodiazepines. It can begin as quickly as 6-8 hours after the last use, or up to 7 days thereafter. At the onset of symptoms, the user will likely experience anxiety and insomnia.

Stage 2: Rebound Period

The rebound period begins anywhere from 1 to 4 days after the last use, depending on the type of benzodiazepines the user was taking. During this stage, the symptoms of “rebound” anxiety and insomnia continue to increase.

Stage 3: Peak Period

In a full-blown withdrawal syndrome, this usually occurs within 10 to 14 days after the last dose of benzodiazepines. This is the most painful and “physical” stage on the timeline and often includes nausea, vomiting, severe anxiety, and insomnia. Psychosis may occur in certain users. During this peak period, it is best to be monitored and treated by professionals in order to prevent relapse. Detoxification centres have the expertise to slowly wean certain users who are accustomed to high-dose, long-term use of benzodiazepines. The weaning process prevents complications such as seizures and successfully allows the person in recovery to avoid imminent relapse (Liebrenz, Gehring, Buadze & Caflisch, 2015).

Stage 4: Final Period

In this stage, symptoms dissipate. However, benzodiazepine withdrawal lasts longer than withdrawal from other drugs. Some may experience symptoms for months thereafter.

symptoms of benzo detox

Abuse facts  |  Withdrawal symptoms  |  Withdrawal timeline  |  Back to top

The benzodiazepine withdrawal syndrome is particularly lengthy and gruelling. It is best treated with a professional recovery treatment plan. Long-term recovery can be difficult to achieve without professional help and relapse is common.

Begin your path to recovery today with the help of substance abuse professionals and find the right treatment centre for you.

 

References

Kroll, D. S., Nieva, H. R., Barsky, A. J., & Linder, J. A. (2016). Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care. Journal of General Internal Medicine31(9), 1027-34.

Liebrenz, M., Gehring, M. T., Buadze, A., & Caflisch, C. (2015). High-dose benzodiazepine dependence: a qualitative study of patients’ perception on cessation and withdrawal. BMC psychiatry, 15;116. doi:10.1186/s12888-015-0493-y

Longo, L.P., & Johnson, B. (2000). Addiction: Part I. Benzodiazepines—Side Effects Abuse Risk and Alternatives. American Academy of Family Physicians, 61: 2121-8.

Maust, D.T., Lin, L.A., & Blow, F.C. (2019). Benzodiazepine Use and Misuse Among Adults in the United States. Psychiatr Serv 1;70(2):97-106. doi: 10.1176/appi.ps.201800321.

Pétursson, H. (1994). The benzodiazepine withdrawal syndrome. Addiction, 89: 1455-1459.

MEDICALLY VERIFIED ON 3/5/2019

Chief Editor

Dr. Ashley Murray

About

Dr Ashley Murray obtained her MBBCh Cum Laude in 2016. She currently practises in the public domain in South Africa. She has an interest in medical writing and has a keen interest in evidence-based medicine.

Author

Contributor

Jeff Mahre BA MFA MLIS

About

Jeff holds an MFA in Creative Writing from the University of California-Irvine, and has eleven years of experience teaching Composition on the college level.