Recovering from benzodiazepine dependence

Perhaps this has been posted elsewhere, but I thought it might be of some use:

 

reconnexion10.pdf

 

Sorry, I don't see an option to add a PDF

Is this what you're looking for, liberty?

http://www.benzo.org.uk/amisc/reconnexion10.pdf

 

Also, I would like to ask if you have balance/dizziness issues at all. I've found that other people on either Klonopin or Ativan or both have had problems with dizziness.

Wow, from scanning this document, liberty, it has so much information!! I'm amazed, really, that this came out in 2010, I think it was.

 

The information is out there. Doctors' "lack of time" excuse cannot be valid. They're continually putting too many people in jeopardy by dispensing benzo drugs without paying heed to the dire consequences of doing so. 

Liberty, if I were you I'd post this over at the Benzo News thread. I think it's really valuable information. I haven't seen it before, and I'm betting that a lot of others haven't seen it either.

 

Although I just went very quickly over the document, it seems to be very sensitively done and by people who know what they're talking about.

 

Thanks so much for posting this!!

I'm just having a look at this document now. Thank you so much for sharing it!

wow excellent information...

 

I might even print it out and take to my dr too....

thanks so much valuable info....

Looks like a good resource. I only have two complaints.

 

1) It doesn't really highlight the fact that you can experience all of this stuff without ever having upped your dose or had cravings or anything like that. And when this isn't made clear it is easy for people to veer off on the wrong path when they are trying to understand what these drugs really do.

 

2) They touch on length of wd but on the subject of protracted wd they merely state "For a small percentage of long term benzodiazepine users, withdrawal symptoms may last for two to three years." and that just doesn't cut it when there are some folks out there who are still symptomatic far beyond that time frame.

I agree with you, FG, about the fact that so little was said about symptoms lasting for a very long time. At least they mentioned that w/d could last that long, though. Every other document I've read doesn't even touch on that subject and seems to just gloss over what the person suffering is going through as if it's no big deal to get off the drug. There are holes in every document that comes out about w/d. But this one seems the most comprehensive that I've looked at so far.

 

I still haven't read it fully yet, but I was really pleased to read that those in benzo w/d need to be dealt with in a very compassionate, understanding, and sensitive nature, for one thing. How often are we dealt with in that way with our families, friends, and doctors? Very, very slim to nil chance of that happening.

The problems of lorazepam and alprazolam are highlighted well.

 

Not a peep about clonazepam, though. It may be the most dangerous one.

Not common in Australia ?

I agree with you, FG, about the fact that so little was said about symptoms lasting for a very long time. At least they mentioned that w/d could last that long, though. Every other document I've read doesn't even touch on that subject and seems to just gloss over what the person suffering is going through as if it's no big deal to get off the drug. There are holes in every document that comes out about w/d. But this one seems the most comprehensive that I've looked at so far.

 

True. This is one of the most comprehensive documents I have read. It is professionally formatted and the fact that it has corporate "sponsors" adds to its credibility. And this illness definitely has a credibility issue.

 

I have just felt all along that everything I have seen or read misses the mark in some fundamental way. At least when looking at it from my perspective. And the two most common flaws are the lack of information about protracted withdrawal and the way it is often made to appear as if this is more of a psychological addiction issue than it is for most people.

 

For example:

 

Long-term benzodiazepine users who answer yes to one or more of the following questions may be benzodiazepine dependent.

 

1. Have you taken sleeping pills or tranquillisers each day or night for six months or longer? Most people taking benzodiazepine for longer than six months are taking them to prevent the onset of withdrawal symptoms rather than for any therapeutic effect. (Benzodiazepines are only effective for sleep for the first 3-7 nights, while there is not adequate research to suggest that the anxiety relieving properties of benzodiazepines are effective for more than 4-6 months.)

 

2. Have you ever increased your dose or felt that you needed to increase the dose to have the same effect as when you first took the benzodiazepines? Have you ever changed brands for the same reason? Increasing the dose and trying other brands of benzodiazepine in an attempt to achieve the same feeling as when the drugs were first taken is a good indication that the body has become tolerant to the drug and therefore the person taking the benzodiazepine needs an increase in dosage or a stronger drug to achieve the same effect.

 

3. Have you ever tried to cut down or stop your benzodiazepine use? Some people aren’t able to cut down or stop their benzodiazepine use even though they’ve made numerous attempts. This is usually due to the discomfort of withdrawal symptoms. However, it might be related to the initial reason the person was prescribed the drug. Careful questioning may be necessary to understand what the person is actually experiencing. This can sometimes be difficult as increased anxiety and insomnia are the most common withdrawal

symptoms. identifying benzodiazepine dependency.

 

4. If you have missed a dose of your benzodiazepine, have you felt ill or highly anxious? People missing a dose and feeling agitated, sweaty, sick or unable to sleep will often see this as a reason to quickly start taking their dose again because they ‘need’ the tablets. Usually, however, it is an indication of benzodiazepine withdrawal.

 

5. Are the effects of the benzodiazepines interfering with your life in some way? Are you, for example, missing work regularly, having family or relationship problems, experiencing difficulty in coping or remembering things? People who have taken benzodiazepines for a long-term period may not have made the connection between the deterioration of their abilities and relationships with the long-term use

of drugs.

 

6. In addition to your benzodiazepines, are you drinking alcohol or using other drugs? ‘Topping up’ with alcohol to achieve the same sedative effect is indicative of tolerance. Increasing the amount of alcohol may occur quite subtly and the person may not realise the

extent to which they have increased their drinking over time. Often, antidepressants or other psychotropic drugs are prescribed in an attempt to alleviate some of the anxiety or depression that has actually been caused by the long-term use of benzodiazepines.

 

7. Do you make sure that you never miss a dose of benzodiazepines? Being careful to always take their dose of benzodiazepines on time could mean that psychological or physical dependence is present. The symptoms of anxiety or sleep difficulties that the person is hoping to control may well be benzodiazepine withdrawal symptoms rather than the original problem.

 

8. Do you feel that you need your benzodiazepines to help you get through the day? Needing to take a benzodiazepine just to feel normal is an indication of the development of physical tolerance as the brain adapts to the presence of the drug.

 

9. Do you ever take any additional pills to help you cope with a stressful situation? Relying on benzodiazepines for extra stress or anxiety is indicative of an increasing psychological dependence on using the benzodiazepines as the main coping strategy.

 

10.Do you carry your benzodiazepines with you just in case? A strong indication of dependency is when a person takes great care to make sure that they always have a supply of tablets and never run out of scripts. Some people always ensure they have some benzodiazepines on hand in their wallet or purse as security – just in case they should feel anxious.

 

4, 5 and 6 apply to me to an extent but the rest of it I can't relate to and to me it gives the reader the impression that this is a psychological thing that can be "controlled" if the user is strong enough to resist the urges to take a pill. I'm sure these things apply to others here in varying degrees and maybe the reason why it seems to me this information misses the mark has as much to do with the fact that most people are inclined to interpret it the wrong way as anything but either way, we have to be careful how this information is presented if we want this to be taken seriously and if we want proper treatments to be administered.

 

My point is that if we want any of this to change the rest of the world needs to understand that this can happen to anyone, it can come pretty much out of the blue and it isn't usually a result of misuse of pills or a psychological issue in the user.

I agree with what you say, FG. What has to be underlined is that w/d symptoms can happen to anyone. What has to be emphasized, also, is that the physical tolerance or w/d a person is experiencing has nothing to do with the person's initial reason for taking the benzo drug. It's too easy for doctors and caregivers to quickly conclude that the person is just experiencing psychological anxiety and that the person therefore "needs" the drug in order to function psychologically. That couldn't be further from the truth. It's simply the PHYSICAL symptoms of w/d that have caused the person to become anxious and to have insomnia, be very fearful, etc. #9 is troublesome - "Do you ever take any additional pills to help you cope with a stressful situation? Relying on benzodiazepines for extra stress or anxiety is indicative of an increasing psychological dependence on using the benzodiazepines as the main coping strategy." I used to take extra pills, thinking that my psychological anxiety was out of control. What I didn't realize was that my body was in active physical w/d after having been in tolerance for so many months. I didn't have "an increasing psychological dependence." I had an increasing physical dependence.

 

I think that it has to be emphasized that the person is undergoing physical symptoms of tolerance FIRST, not psychological symptoms first. #10 - well, I certainly used to do that with Ativan when I didn't have a clue what was going on. I thought I was just a more anxious person and didn't realize that I was physically in tolerance.

 

I might not be making myself clear. But I do think that any info on benzos needs to stress the physical manifestations of tolerance or w/d first rather than the psychological. There is no "psychological craving" for the drug, although the physical need for the drug can easily create, in people's minds who don't understand the nature of being physically dependent on a drug, the feeling that there must be a psychological need.

 

Does this make sense or is it as clear as mud?

 

Anyway, although there are holes in the information given, there are good points in it too. 

 

 

That makes perfect sense Terry. I have often said that in order to have a productive conversation about benzo wd with anyone, both parties MUST understand that the root of this issue is physiological in nature, not psychological. If a person (doctor, family member, anyone) believes that withdrawal stems from a psychological issue there really isn't a point on moving forward with the conversation until they understand the true cause.

 

In my opinion the bulk of the benzo issue stems from this very basic misunderstanding. What if you went to the doctor with a broken arm or a nasty infection and they tried to treat it as if it were a psychological condition? How would that work? This is every bit as physical of a condition, its just that there is no blood test or xray that can allow them to see the damage that was done to our bodies. And the fact that it caused mental symptoms and mimics preexiting conditions means that all but the most astute doctors are pretty much clueless about this.

FG, another thing I was thinking about is blood pressure pills. I've never once had a doctor, or anyone for that matter, tell me that I'm "psychologically craving" the drug. Yet I'm as dependent on blood pressure pills as I was on benzo drugs. When the bp drugs wear off, my body senses that and reacts. I could be in rebound in very little time at all. They're yet more pills that at some point I'll need to taper slowly off of. And I have to admit that there have been many, many times during w/d that I've been glad I'm on blood pressure pills because my bp has been way too high. So because I'm physically dependent on bp pills, taking them gives me a psychological feeling of relaxation, and that equates to lower bp. But as I said, who would ever dare tell me that I'm "psychologically craving" a bp pill? No one. It's too easy to point the finger at people taking benzos since the pills are prescribed for anxiety. Well, my bp pills are prescribed for anxiety, also, because when I get really anxious, my bp automatically goes up.

Oh dear me  blood pressure  pills compared to benzo dependance....

 

I think benzos affect the brain often,

 

and the blood pressure pills affect parts of the body that restrict the blood flow to the brain in many instances..

 

quite different modes of action.

 

Although benzo drugs and blood pressure drugs are completely different from each other, in one respect they're very similar: When there isn't enough of either of these drugs in someone's body, they both produce the physical w/d symptoms, although benzo w/d can last for who knows how long. To right off the bat just label us, who have taken benzos in the past, as psychologically craving the drug makes no sense to me. I have read about people getting a high from benzo drugs. I've never gotten a high, so I have no knowledge about that. And of course there are people who have overdosed who have been found to have ingested benzos, so I'm sure that's where people get the idea that benzo users must be psychologically craving the drug. I just think it's unfair to be labeled automatically as someone who psychologically craves the drug first and foremost instead of realizing that the person is physically in w/d first and foremost.

 

I've probably painted myself into a corner...oh, well, what else is new.

 

 

 

Just weighing in here....One of the articles I posted in the News section looked at a number of drugs that have a withdrawal syndrome. It was written by a pharmacist/pharmacy professor, and it said in no uncertain terms that the withdrawal/discontinuation syndrome is part of the effects of the drug. Many drugs have withdrawal effects, and benzos and opioids were just two of the many he listed. These are physiological effects that result from removing the drug from a person who has become accustomed to taking it on a regular basis. And yes, these experiences can be scary and stressful for anyone.

 

Here's a link to the abstract in PubMed:

 

http://www.ncbi.nlm.nih.gov/pubmed/21849624

 

 

Thanks for that, Lapis!

 

 

But as I said, who would ever dare tell me that I'm "psychologically craving" a bp pill? No one. It's too easy to point the finger at people taking benzos since the pills are prescribed for anxiety. Well, my bp pills are prescribed for anxiety, also, because when I get really anxious, my bp automatically goes up.

 

Yes, it is sad that we have to deal with this extra layer of ignorance and doubt because of the nature of these drugs and (for some of us) the conditions that led us to taking them in the first place. It convolutes the entire issue. Strip away the misconceptions that these drugs are highly psychologically addictive and that the cause of these issues is preexisting anxiety and the damage these drugs cause would be obvious. Unfortunately that isn't how it works though.

 

The fact that people who are put on these drugs for things other than anxiety and such experience the same set of physical and mental symptoms should blow a pretty big hole in the idea that this all stems from psychological issues but doctors and the general public seem to like to gloss over that fact. And even if they acknowledge that the symptoms may not stem from a preexisting issue they simply fall back on the addiction thing to try to point the finger at the victim. In most people's reality it isn't possible for a doctor to make you super sick for months or years on end with a commonly prescribed drug that has been in use for decades, so it must be the fault of the patient.

Thanks for that, Lapis!

 

Here's the link to the full article, if you're interested:

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200000/

 

It's a good article and it speaks to the issue that you're discussing here.

Thanks so much for this, Lapis!!

 

Unfortunately, a lot of doctors (most?) don't seem to "get it" when it comes to discontinuation syndrome. I could have died from stopping NSAIDs suddenly. I'd been taking Aleve for years, tapered off too quickly at one point, and later on took a number of Advil pills for a continuing foot problem (exacerbated by the Aleve). All hell broke loose, and 4 days later I was taken to the ER by ambulance. Another time I was told by a doctor to just quit taking the calcium channel blocker I was on (Diltiazem, 160 mg.), and to take a couple more Labetalol pills instead as a substitute. All hell broke loose again, and it ended up taking me 4 months to get off the Diltiazem.

 

This is a huge medical issue that has been overlooked for far too long.

 

Thanks again!!

I agree, FG. Strip away the preexisting condition and the misconception that these drugs are psychologically addictive, and the bottom line is that when the benzo drug wears off, physical changes take place very quickly in the body that can cause a person extreme emotional discomfort. And it's very difficult for outsiders and doctors themselves to believe that a drug, so commonly prescribed, could cause a patient such physical distress. In that case, then, the conclusion is the continuing false belief that the distress must be stemming from the prior condition of anxiety rising up again.

Thanks so much for this, Lapis!!

 

Unfortunately, a lot of doctors (most?) don't seem to "get it" when it comes to discontinuation syndrome. I could have died from stopping NSAIDs suddenly. I'd been taking Aleve for years, tapered off too quickly at one point, and later on took a number of Advil pills for a continuing foot problem (exacerbated by the Aleve). All hell broke loose, and 4 days later I was taken to the ER by ambulance. Another time I was told by a doctor to just quit taking the calcium channel blocker I was on (Diltiazem, 160 mg.), and to take a couple more Labetalol pills instead as a substitute. All hell broke loose again, and it ended up taking me 4 months to get off the Diltiazem.

 

This is a huge medical issue that has been overlooked for far too long.

 

Thanks again!!

 

You're welcome!

Thanks so much for this, Lapis!!

I could have died from stopping NSAIDs suddenly. .

 

 

Even NSAIDs? Geez, I don't think there is any drug that is safe .

I took them too long, benzogirl, and I'm one of the really sensitive ones when it comes to drugs. On askapatient.com, others have reported a lot of problems with NSAIDs. The older population is especially susceptible to terrible problems with drugs in general.

Loved the article Lapis. Thank you for sharing.  Very educational.  I had know idea that stopping aspirin abruptly could kill you. Most doctors have no idea about the drugs they prescribe other than what they have been told by a pharma rep.  I think it should be the responsibility of Big Pharma to make sure doctors are educated properly as to dangers taking a drug and stopping a drug.  Since that is not going to happen, then I guess we're on our own.  My doctor told me I could just stop taking tamazepam without any problem. Guess how that turned out.

 

Anyway, very interesting article.  Hope the FDA takes the research to heart and starts to require studies on what happens upon stopping a drug as well.