Benzodiazepines (known informally as benzos) are a family of prescription sedatives. Four of them – Ativan, Klonopin, Valium, and Xanax – are among the 100 most prescribed medications in the US. Used to treat everything from panic attacks to substance use disorders, these drugs can be a genuine help for people in crisis.
Unfortunately, these sedatives are among the most abused prescription drugs in the US. Detoxing from benzodiazepine abuse is difficult and complex. Without professional help, benzodiazepine detox and withdrawal can be dangerous.
The withdrawal symptoms from benzodiazepine abuse can be intensely unpleasant. Physical and psychological in nature, they can persist for years. Additionally, there’s a real risk of death from benzodiazepine withdrawal symptoms if done on one’s own. The risks are exceptionally dangerous if it’s done via a “cold turkey” approach.
Professional benzodiazepine detox centers are a great, necessary help when recovering from benzodiazepine abuse. Not only do patients benefit from 24/7 monitoring, but there are also ways to make sure the more dangerous withdrawal effects are avoided.
Aren’t Prescription Medicines Supposed To Be Safe?
Yes, particularly when they’re used according to a doctor’s instructions. When they’re not, however, people take huge risks.
It’s important to remember the phrase “drug addiction” doesn’t just describe using illicit substances. Drug abuse can be as simple as using a drug for longer than recommended, or a well-meaning person sharing their prescription tranquilizer with a nervous passenger before a flight.
- The following scenarios are all considered drug abuse:
- Using another person’s prescription medication
- Sharing a prescription medication with another person
- Using prescription drugs recreationally
- Using a prescription drug outside of a physician’s orders
- Taking too much of a prescription medicine
- Continuing to use a prescription medication when it’s not needed
Although dangerous in all cases, benzodiazepines are particularly risky to abuse. That has to do with the ways they work in the body.
Why Benzodiazepines Are Addictive
Cells in our nervous system contain receptors. These are areas which respond to certain drugs when we use them. Benzodiazepines act on receptors for a neurotransmitter called GABA, or gamma-amino butyric acid. GABA calms nerve impulses, which is why benzodiazepines work as sedatives.
GABA isn’t the only neurotransmitter benzodiazepines affect, however. They also cause the body to release a chemical called dopamine. Dopamine plays a role in the body’s reward system. When we engage in activities which benefit us, such as eating or reproduction, our nervous system drips out dopamine. This acts as a chemical reminder to continue doing those activities.
Benzodiazepines turn that drip into a torrent. For some, benzodiazepines create a powerful, euphoric rush. This rush is so powerful it compels some to take benzodiazepines over and over again. Regular use of benzodiazepines – even under a doctor’s orders – can make the drug lose its initial effectiveness. Users find themselves taking more and more of the drug to feel the same effects. This is what addiction professionals call “tolerance,” and the cycle of taking more drugs to experience the same effect drives addictive behaviors.
These behaviors appear in part to how benzodiazepines work with GABA. When benzodiazepines are used over longer periods of time, the brain compensates for them by reducing its GABA sensitivity in a process called downregulation. This protects the brain from damage and is its way of maintaining homeostasis, the balancing act the body engages in every day.
When benzodiazepine abuse stops, however, the brain is still less sensitive to GABA. That’s why benzodiazepines produce withdrawal symptoms including intense anxiety and seizures.
Some studies have shown benzodiazepine addiction can happen in as many as 44% of people who use the drugs.
What Is Benzodiazepine Withdrawal Like?
Unpleasant and complicated, unfortunately. Also, many of the same variables which affect withdrawal from other drugs affect benzodiazepine withdrawal as well. These variables include:
- Age
- Weight
- Length of time spent using (or abusing) benzodiazepines
Additionally, benzos don’t always stay active for the same period of time. Some benzos like Xanax tend to not last very long while others like Klonpin can last far longer. Long-lasting benzos may have milder withdrawal effects over a long period of time; shorter-acting benzos may cause intense withdrawal but for a far shorter period.
These variables all determine the severity and duration of benzodiazepine withdrawal. Plus, there’s no guarantee when withdrawal actually starts. Symptoms can start days after benzodiazepines were last used … or hours. In general, once the acute (active) phase of withdrawal starts, the symptoms will rapidly escalate and in general, last for about two weeks.
Benzodiazepine Withdrawal: Early Stages
The first symptoms most people face during benzodiazepine withdrawal are heavy sweating along with intense feelings of anxiety and nervousness. It’s also very common to have stomach issues during this time, too. After a couple of days, there’s a risk of seizures.
After 7 days or so, the symptoms peak – along with the risk of seizures, delirium and even psychosis, although the last two are more common in older patients. This critical period speaks to the danger of attempting benzodiazepine withdrawal on one’s own.
Symptoms include:
- Intense cravings
- Headache
- Sleep difficulties
- Restlessness
- Mood swings
- Memory and concentration problems
- Muscle cramps
- Constipation and diarrhea
- Auditory hallucinations
- Intense depression
- Strong feelings of anxiety, including panic attacks
- Shaking
- Seizures
- Psychosis
Benzodiazepine Withdrawal: Middle Stages
While many symptoms remain after 14 days or so, they are far less intense. Seizures are unlikely at this point; the same is true for hallucinations and shaking. However, the first month of withdrawal is still a risky period. Symptoms may include:
- Intense cravings
- Headache
- Sleep difficulties
- Memory and concentration problems
- Constipation and diarrhea
- Depression
- Anxiety with occasional panic attacks in some cases
- Mild shaking
Benzodiazepine Withdrawal: Late Stages
After a month free from benzodiazepine abuse, patients leave the active phase of recovery. Symptoms are still present but can persist for months depending on the individual’s case. Fortunately, these symptoms will continue to improve as time passes. Participating in rehab is also a great way to minimize their effects.
However, there is an additional complication.
What Post-Acute Withdrawal Syndrome (PAWS) Means For Benzodiazepine Withdrawal
PAWS, or post-acute withdrawal syndrome, isn’t widely understood. Although it can occur as part of withdrawal from all psychoactive substances, PAWS is unfortunately common after benzodiazepine abuse. Put simply, PAWS is a set of withdrawal symptoms which can persist for weeks or months after benzodiazepine use stops. They include:
- “Brain fog” and other cognitive difficulties such as memory and problem solving
- Irritability
- Mood disorders
- Obsessive-compulsive behavior
- Elevated responses to stress
- Apathy
- Drug cravings
- Relationship difficulties
Thought to be a result of physical changes in the brain due to substance abuse, PAWS symptoms can last for a long time, and can be potentially disruptive. Fortunately, participating in counseling, group therapy, and rehab programs can make these symptoms much more manageable.
Benzodiazepine Detox Is The Start
Complex, long-lasting, and particularly dangerous, benzodiazepine withdrawal should never be taken on one’s own. Like alcohol and opioids, the potentially lethal health complications require professional observation to succeed.
Professional detox done in a clinical environment doesn’t just give a recovering person a vital safety net. The withdrawal effects of benzodiazepine abuse, while bad, can be made far more bearable with help and observation. Patients can be made as comfortable as possible during this crucial period in recovery, ensuring that drug cravings, mood disorders, and other side effects don’t interfere with recovery.
Detox is only the start. Done right, it’s an excellent foundation to a lasting recovery. A detox program will work with the patient in determining the next path of their recovery.
