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Benzodiazepine Detoxification

David Hunter, MA.Ed, LPC

Medically reviewed by

David Hunter, MA.Ed, LPC

March 21, 2019

Benzodiazepine withdrawal is a difficult process that can become very uncomfortable. A medically-supported detox aids a person in withdrawing safely while reducing and alleviating the side effects of withdrawal.

During detox, a person will be slowly tapered from benzodiazepines, most commonly by the administration of a long-acting benzodiazepine drug. Any current concerns of anxiety may be addressed at this time, through the aid of other medications and counseling. A successful detox prepares the foundation for the next stages of addiction treatment.

Anxiety is rampant across our country, affecting countless Americans of all ages and walks of life each day. Due in part to this, benzodiazepines are among the most commonly prescribed class of drugs today. Used as per a medical directive, as prescribed, these medications hold great success and applications, however, when used incorrectly, misuse often turns to addiction. First, we will explain this class of drugs and the effects of withdrawal, so that you understand what effects you are addressing, and striving to avoid, during detox.

What Are Benzodiazepines?

Benzodiazepines, commonly referred to as “benzos,” are a class of prescription drugs exhibiting pronounced sedative and calming effects, due to the way they impact, and depress, the user’s central nervous system (CNS). Dependent on the specific medication, they create an anti-anxiety, anti-convulsant, muscle relaxant, or sedative-hypnotic effect. Benzos are most commonly prescribed for anxiety and insomnia, however, with these other effects, they are also used to treat seizures, accompany anesthesia, or as part of medication-assisted treatment for alcohol withdrawal.

Benzodiazepines are available in a tablet, capsule, or intravenous preparation, in either a short- or long-acting form. This duration of action affects the drug’s potential for abuse. For instance, as explained by the American Family Physician (AFP), dependence can emerge quicker when the drug of abuse is a higher-potency benzo with a short-acting effect, such as alprazolam (Xanax). Additionally, it is because of the intense sedative properties that these drugs have such a high potential for abuse and hold a Schedule IV designation within the Controlled Substance Act.

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Which Benzos Are Most Commonly Abused?

Benzos may be abused in two ways—a person may choose to misuse and abuse their personal prescription, or an individual may abuse a diverted, illicit benzo drug. The Drug Enforcement Administration (DEA) cautions us that the five most frequently prescribed benzodiazepine drugs are also those most commonly found in instances of illicit use. These include:

  • Alprazolam (Xanax)
  • Clonazepam (Klonopin)
  • Diazepam (Valium)
  • Lorazepam (Ativan)
  • Temazepam (Restoril)

Individuals may administer the drug orally or by crushing and snorting it. Additionally, the DEA asserts that those who abuse heroin and cocaine abuse benzos in higher proportions. This leads to another concern within benzodiazepine abuse—polysubstance abuse.

Benzodiazepine abuse is commonly, and dangerously, linked to the concurrent abuse of other drugs, to the extent that the AFP reports that “An estimated 80 percent of benzodiazepine abuse is part of polydrug abuse, most commonly with opioids.” This occurs as a person uses the benzodiazepine drug to either enhance the euphoric state of the primary drug or as a way to decrease an unpleasant side effect associated with it. In either instance, these practices increase numerous adverse health effects and dangers, including risk of death and co-occurring disorders. It is in the latter case, that detoxification may need to address, not one, but two substances.

What Are The Signs Of Benzodiazepine Withdrawal?

When an individual uses a drug for a prolonged period of time, their physiological functioning becomes dependent on it. When the drug is suddenly removed, the chemical and biological systems that are altered due to this react harshly, as they struggle to function without the drug, presenting as symptoms of withdrawal.

Withdrawal is dependent on the type of drug, a person’s dosage (frequency and dose of use), and length of abuse. According to the Center for Substance Abuse Research, “Withdrawal symptoms are most severe when a high dose of either a short-acting or intermediate-acting benzodiazepine is abruptly discontinued.” Due to the faster manner by which these drugs exit your system, discontinuation of short-acting benzos will result in a quicker onset of withdrawal.

Benzodiazepine withdrawal symptoms may include:

  • anxiety
  • irritability
  • tension and panic attacks
  • trouble concentrating
  • increased heart rate
  • increased blood pressure
  • heart palpitations
  • headache
  • nausea and dry heaving
  • sweating
  • trembling or weakness
  • insomnia
  • increased sensory stimulation
  • changes to perception
  • seizure
  • psychotic incidences
  • delirium tremens

If left untreated, benzodiazepine withdrawal may be fatal.

What Is Medically-Supervised Benzodiazepine Detoxification?

A medically-supervised detoxification (medical detox) supports an individual as their body and mind work towards flushing out the harmful toxins that have accumulated within their system from chronic drug abuse. Medical detox works towards preventing, and significantly alleviating symptoms of withdrawal. In the case of benzodiazepines, detox works towards preventing seizures, delirium tremens, or any other changes to a person’s critical organ or life support systems that could cause them harm.

A person’s vital signs and physical and mental states will be continuously monitored and addressed during detox. Withdrawal can become psychologically draining. Because of this, the facility’s staff will be standing by to offer companionship or counseling, as needed. Medication-supported therapies or treatment (MAT) are typically initiated, which entail various medications utilized alongside of behavioral support, such as counseling.

As withdrawal occurs with abrupt cessation of use, we strongly urge you never quit in this way. Instead, within detox, the facility’s staff will gradually taper you off of benzodiazepines so that your body and brain have time to adjust to the chemical changes. To do this, they will most likely use a long-acting benzodiazepine drug. Those that are used in this way have a more limited potential for abuse, and remain in your system longer, so that you can be safely weaned from the drug of abuse. The AFP suggests that certain antidepressant medications or Zolpidem (Ambien) may be used to address insomnia.

Benzos have been tied to many cases of polysubstance abuse. Should this be the case, prior to the detoxification process, an individual will be thoroughly evaluated, so that the proper treatment protocol can be designed and implemented. Depending on the drug, this may require various other forms of MAT.

How Long Does Detox Take?

The American Family Physician has set forth guidelines pertaining to the timeline of benzodiazepine withdrawal. The duration of the taper is dependent on the type of drug and its duration of effect, specifically, they suggest for:

  • Short-acting forms: A seven to ten day taper
  • Long-acting forms: A ten to 14 day taper

They do, however, note that in instances of prolonged abuse, such as that which occurs over the period of several years, a more extended taper of eight to 12 weeks, or even longer, may be necessary.

What If I Still Have Anxiety?

A paradox of benzodiazepine withdrawal is that rebound anxiety is often one of the most dominant side effects, occurring heavily in various stages until treatment is initiated. Secondly, one concern that is unique to prescription drug abuse, is recognizing and treating a valid need that may have been at the heart of abuse. For instance, an individual with a benzodiazepine addiction may yet suffer from severe anxiety. In fact, this anxiety may be why their drug abuse begin in the first place, as they attempted to self-medicate their symptoms. While these behaviors may have accelerated to addiction, at the core of the situation, the person may still need anxiety treatment in other forms.

The American Family Physician comments on this, suggesting that care providers first seek to determine which subtype of anxiety disorders a client has, before preceding in administering a medication. The AFP suggests that “antidepressants, anticonvulsants, buspirone (Buspar), certain antihypertensive agents and newer neuroleptics” may be utilized in this manner, however, they do warn that these medication’s onset of action are slower than benzodiazepine drugs. To counter this, treatment may need to be concurrently supported by therapy until the medication’s effects are felt.

Benzodiazepine Addiction Treatment Programs

Within a good treatment plan or program, a medically-supported detox is only the first step, one which becomes foundational for those which follow. During detox, you will be supported physically, mentally, and emotionally as you cleanse and find balance to prepare you for moving forward into the next step of treatment. Once you have successfully completed detox, you will be ready to begin working on enhancing your sobriety and establishing recovery goals.

If you struggle with benzodiazepine addiction and would like to find treatment, contact us today.

American Family Physician - Management of Withdrawal Syndromes and Relapse Prevention in Drug and Alcohol Dependence

Center for Substance Abuse Research - Benzodiazepines

Drug Enforcement Agency - Drug Fact Sheet: Benzodiazepines

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