million dollar question??

hi can some one tell me why it takes 6 months to 2 years to recover from benzo an yet only 1 month to recover from alcohol an yet they both work on the same reseptors anyone please kate 7

Hi Katy, Im not sure where you heard that it only takes one month to recover from alcohol as there various factors to consider.

As far as the length of time for recovery. There is still so much that is not known about the GABA binding sites for both benzos and alcohol, but I have read that benzos bind to different GABA(a) receptor subunits than alcohol does. There is a good article here http://en.wikipedia.org/wiki/GABAA_receptor

Maybe someone else will reply who knows more about this, mandala 

That is actually the million dollar question I want answered.  What percentage of long term users, say those who took benzos everyday for a year or more have any withdrawal to speak of at all?

Let's make some wild assumptions here (that is what engineers do best :

1. There were about 100 million prescriptions for benzos written in 2011 in the US.

2. Of the 100 million, half were situational "good" prescriptions for benzos, half were for long term users, so 50 million

3. So 50 million scrips, means 4.2 million long term users received their monthly scrips.

4. There are 10,000 of us, 3500 joined in 2012 and maybe 2/3 or 2300 of those from the US. 

5. Let’s say in a given year, 5% of people decide to stop, or 200,000 people.

6. Of the people who have symptoms, say half of them end up on benzo buddies.

So of 200,000 people 4600 get nasty symptoms or about 2.3%

I have much more confidence in the 200,000 number than I do the 4600.  Let’s say I am wrong by a factor of 10, which would be the absolute worst case, that means that at most 23% of those that try to stop get nasty symptoms.

Realistically, it is between 2 and 23%, the midpoint being 13%.

I actually like this analysis, and am going to post on Withdrawal and Recovery (where people actually look to check it out.

Be well and good luck,

Ramcon1

Contrary to popular belief healing from benzos is hugely dependant on your body. No one says it will take you that long. It took me less than a month on very high doses. For everyone posting here with bad symptoms there are three more people that get over it quickly. Don't let posts here fool you into thinking it takes long for everyone as it doesn't.

True.  And remember the effects of chronic alcohol use/abuse that recovering alcoholics face:  memory loss, paethesia, poor balance, difficulty walking, disordered eye movements, not to mention gastrointestinal issues and the like.  (sound familiar?!)

It's all dependent on individual intake.

Let's make some wild assumptions here (that is what engineers do best :

 

1.   There were about 100 million prescriptions for benzos written in 2011 in the US.

2.   Of the 100 million, half were situational "good" prescriptions for benzos, half were for long term users, so 50 million

3.   So 50 million scrips, means 4.2 million long term users received their monthly scrips.

4.    There are 10,000 of us, 3500 joined in 2012 and maybe 2/3 or 2300 of those from the US. 

5.   Let’s say in a given year, 5% of people decide to stop, or 200,000 people.

6.   Of the people who have symptoms, say half of them end up on benzo buddies.

Well, I think number 5 and 6 are both wild guesses, could be off by a lot.

Also regarding number 6 of course there's a wide wide range of having symptoms.

I wonder if there is any way to know about number 2.  I mean how many scripts are one time or tiny number of pills. Seems that info would be known, but don't know if it is published at all. 

Number 1 - I take it you know this, and believe you, interesting number - from some public source?

I don't understand number 3.  Why 4.2 million long term users from 50 million scripts?  Um, each script is for a month??  Sorry I'm not following this more easily. BTW scripts can be for more than a months worth.

I'm not trying to be critical of the effort - I am impressed with your taking a swing at it, and think your methodology is reasonable.

Biggest thought: probably a LOT of people have difficulty and symptoms but not EXTREME difficulty and symptoms - and don't come here.  So much middle ground.

I wonder if there are any ER statistics on people going through withdrawals?

Item 1 came from googleing the top prescribed medicines, and adding up all the scrips for benzos.

Number 2 is a wild guess, and I do not think that number is even known.

3 is just 50 million/12.  Benzos are controlled substances and many states limit the prescription to a month, although some states are more liberal. The effect of being more liberal brings the total number of long term users down.

4 is a fact you can count.

5 is an educated guess.  The main reason people stop is reaching tolerance.  I have read tolerance any where from 1 year to 20, so I just took the worst case, 1 in 20, or 5%

6 is the main flaw, an why I said lets assume I am off by a factor or 10, so any where from 1/2 to 1/20 end up here.

And for the record, I welcome criticism.  Even in withdrawal, you cannot offend me.  This was an attempt to figure out something not readily available to us, and if anyone's criticism can make it better, please reply.

ramcon1

My two cents: alcohol does for sure "work on GABA receptors," but it doesn't target them. In the case of alcohol it's an ancillary effect, and the amount of GABAergic action is undoubtedly pretty small when compared to the high-precision targeting of benzos. On top of that there's the question of whether or not they even effect the same GABA receptors, e.g., extrasynaptic GABA_a versus GABA_cR or GABA_bR or postsynaptic receptors or.... you get the idea.

Check into the literature and you'll see that like zero medical professionals know the answer to those questions. (Start here, a paper from 2011 that takes tentative guesses at what benzos do: http://www.addictionscience.unige.ch/LabPublications-1/TrendsNeurosciKT2011.pdf). They were rushed to market so fast the only thing people can say for sure is, "Well.... GABA receptors, some of them anyway..... are involved. Somehow."

On that note, I'd like to see a side-by-side comparison of alcohol and benzo GABAergic density. Something with an abstract that reads "We conclude that the GABA-specific binding activity of 1mg of alprazolam is equivalent to 600L of ethanol." Or something.

That is actually the million dollar question I want answered.  What percentage of long term users, say those who took benzos everyday for a year or more have any withdrawal to speak of at all?

 

Let's make some wild assumptions here (that is what engineers do best :

 

1. There were about 100 million prescriptions for benzos written in 2011 in the US.

2. Of the 100 million, half were situational "good" prescriptions for benzos, half were for long term users, so 50 million

3. So 50 million scrips, means 4.2 million long term users received their monthly scrips.

4. There are 10,000 of us, 3500 joined in 2012 and maybe 2/3 or 2300 of those from the US. 

5. Let’s say in a given year, 5% of people decide to stop, or 200,000 people.

6. Of the people who have symptoms, say half of them end up on benzo buddies.

 

So of 200,000 people 4600 get nasty symptoms or about 2.3%

 

I have much more confidence in the 200,000 number than I do the 4600.  Let’s say I am wrong by a factor of 10, which would be the absolute worst case, that means that at most 23% of those that try to stop get nasty symptoms.

 

Realistically, it is between 2 and 23%, the midpoint being 13%.

 

I actually like this analysis, and am going to post on Withdrawal and Recovery (where people actually look to check it out.

 

Be well and good luck,

 

Ramcon1

I agree with Brother, and would like to add a few more variables just to cloud the water some more. <--- that is, add to the discussion

1. Per-year bases of withdrawal symptoms are misleading in this case, because benzos have only been on the market for a few decades and a lot of people take - and have been taking - them for tens of years. If every prescription was written with the same timeline then you'd get nice distribution with n number of prescriptions within the time parameters and x number of people who get sick when they stop. But it's hard to track things like that when two people who decide to stop taking benzos in a given month may have started taking them years apart from each other.

2. Benzo withdrawal is easily one of the most misdiagnosed conditions I've ever come across. Hell, I had it going on for 18 months before I figured out what it was, and was told the entire time that it was a bacterial infection and that I shouldn't stop taking my Klonopin. Some of the fellow benzo-strugglers I've met here in Salt Lake City report similar stories - they either stop taking them one day or they hit tolerance, doctors are clueless about what's wrong with them, and they go home with a diagnosis of anxiety/depression and a bottle of Zoloft. This will skew the stats pretty good.

3. I hesitate to mention this one, but: I spent a lot of time as a fledgling medical researcher investigating Lyme disease and while doing so I stumbled across some pretty startling data, which is that in many cases - or anyway many, many more than you would think - the symptoms are so non-specific and so horrible that people just... you know, throw in the towel. This is an enormous thorn in the side for Lyme researchers and I can't imagine it's any less of an issue with benzos. (Read some of Ashton's long-term studies; she makes reference to this issue a few times.)

Having said all of that

I do think your derived statistic is pretty solid for the specific question "approximately how many people prescribed benzodiazepines end up on Benzo Buddies if we assume 5% of patients try to stop in a year?" The mean you arrived at is 13% and I would probably give it a confidence interval of like 10-15%. Maybe technically accurate, maybe not, but it's at least believable and for the record that is a REALLY high number. If 13% of people doing literally anything else ended up in dire straits that thing would be scheduled for a federal ban in record time.

Thank you Brother and Huraqan for your insightful contribution to the discussion.

I agree with the 80/20 rule for sure.  As I said, I have a lot more confidence in the 200,000 number than the 4600, that is why a gave the variable of a factor of 10.

The only thing with which I disagree is that 13% would cause an outrage.  13% of 200,000 is 26,000 people.  In an nation of 350 million, 26,000 would not even get noticed, and I think that is why we are not.

I mentioned in a previous post that I hope the doctor doing a benzo survey gets participants from other sources than benzo buddies, as if she can get a better sampling, we will have a better answer to this question.

Huraqan, I also like your analysis of the original question about alcohol.  My personal opinion is that alcohol is WAAAAY less toxic than benzos.  Chronic abuse will ruin people, but even regular casual use will not in most people.  I think that some percentage of people are very sensitive to everything, a higher percentage of them are here on BB, and so while (again in my opinion) it exacerbates symptoms in some, it probably does not impede the healing of most.

Thank you again.

Ramcon1

I am not a fan of conspiracy theories, or that drug companies use money to cover up evidence.  It might be true, but I am inclined to think that it is just too complicated a problem, and so far easier to ignore.  Nor do I think that percentage alone is enough to get a topic noticed.  Take poverty.  Some estimates have poverty in the US at about 50 million or 14%.  Even if that is off by a factor of 2, you would think that if 7% of a population suffered from something, the rest would do all they could to fix it.  Again, I think the problem is just too complex, and so gets ignored.

I am a fan of the squeaky wheel get the oil.  Problems that do get addressed are the ones who have advocates for a solution that scream the loudest (although it does help to have a convincing argument, and piles of cash

I am going to do my best to get us noticed.  I managed to get myself booked on a web-based radio show that discusses topics about which doctors know little.  Please see the thread entitled "a radio show about us," and tell everyone you know, especially doctors, to tune in.

We have a very convincing argument, and I have a very loud voice

I am not going to live and die by 13%, but I am pretty confident it is higher than 2, and 5% of 200,000 is still 10,000 people.  Every year.  I am willing to fight for 10,000 people.

Be well and good luck,

Ramcon1

Benzos alter receptors, invert them and flat just turn them OFF. Alcohol does not have that much power.

Alcohol is natural and benzo's are synthetic's made in a lab. That's another problem, we have no natural defense against them.

hi can some one tell me why it takes 6 months to 2 years to recover from benzo an yet only 1 month to recover from alcohol an yet they both work on the same reseptors anyone please kate 7

Hi Kate7,

Although benzodiazepines and alcohol both affect GABA receptors, benzodiazepines have effects which can be very slow to reverse, especially after protracted use. There are no hard and fast rules about this. Some people can, apparently, take high doses of benzodiazepines for many years and quit quite rapidly with few ill effects. At the other end of the spectrum, some people can become dependent after just a few weeks of regular use, and require a gradual withdrawal. I would suggest that these are both outlier situations. Of course you will see a higher incidence here, BB membership being a self-selecting group of (on the whole) tougher cases (those that experience few or no problems are unlikely to seek us out and join our support group).

Anyway, the evidence suggests that the effects of benzodiazepines upon GABA receptors can be very slow to reverse for many people, but far from all. There is some cross-tolerance between benzodiazepines and alcohol, but they do not operate totally analogously upon GABA receptors, of course.

Unless personal past experience informs you otherwise, you will probably recover (or mostly recover) within a few months of quitting, even if after protracted use. It is just that our membership is made up of a disproportionate number of tougher cases - this can skew the appearance of what members might expect in their recovery.

Edit: typo.

That is actually the million dollar question I want answered.  What percentage of long term users, say those who took benzos everyday for a year or more have any withdrawal to speak of at all?

 

Let's make some wild assumptions here (that is what engineers do best :

 

1. There were about 100 million prescriptions for benzos written in 2011 in the US.

Hi ramcom,

Is that 100 million prescriptions an assumption too? For argument sake, I'll go with it - I have no idea of the prescription rate in the US.

2. Of the 100 million, half were situational "good" prescriptions for benzos, half were for long term users, so 50 million

Again, is this an assumption, or do you have some figures suggesting that half the prescriptions were for situational or temporary problems? Again, I'll go with what you suggested.

However, I think few will have a single prescription. I think many will have two, three or more prescriptions - this will skew your numbers. Then, there are those who take benzoduiazepines 'as needed'. Clearly, some of these will take benzodiazepines every day, but many will not. Irregular use is unlikely to lead to dependency.

3. So 50 million scrips, means 4.2 million long term users received their monthly scrips.

I think the number will be less than this, but clearly, it will still be a lot.

4. There are 10,000 of us, 3500 joined in 2012 and maybe 2/3 or 2300 of those from the US.

That seems a reasonable estimate.

5. Let’s say in a given year, 5% of people decide to stop, or 200,000 people.

I'm really not sure about that. Since you would expect dependency to increase with (extended) use, I think those taking benzodiazepine for, say, 10 years or more (and huge numbers do this - doctors often advising patients that they can be take benzodiazepins for life without ill-effect), I would suggest that long-term users are under-represented at BB. If long-term users are indeed under-represented here, might this indicate that fewer than 5% decide to quit each year? My feeling is that many long-term users either feel they will not be able to cope if they quit, or they do not attribute their problems with benzodiazeine use, or they don't feel particularly adversely affected by their use of benzodiazpines. Of course, it is next to impossible to make sensible guesses about these numbers - it would require properly conducted research.

My personal experience was that I did not appreciate what was occurring to me was due to benzodiazepine side effects. I took clonazepam as an anticonvulsant - it stopped working; this is why I quit. I was too fogged by its use to appreciate all the other problems (side effects) until after I quit. Oh, I fully realised I was suffering withdrawal symptoms, but I had no idea of just how numbed I was by benzodiazopine use. I wasn't motivated to quit because of side effects - I had just become very tolerant of the anticonvulsant effects. I wonder how many others never realise?

6. Of the people who have symptoms, say half of them end up on benzo buddies.

This is the bit with which I most disagree. The vast majority of people who make use of forums never join. I'm sure you've often ended up at all kinds of forums when looking up something on the Net; how many of them did you join? I know I've joined only a tiny fraction of the forums from where I've gathered useful information. I'm sure I'm quite typical in this regard. My guess is that no more than a few percent of visitors will join BB.

Since moving servers some months ago, I no longer have detailed stats. However, I think we were receiving about 50,000 unique visitors per month. Some will have arrived here by mistake, but about 350 of them do join each month. This actually equates pretty well with the 1% rule:

http://en.wikipedia.org/wiki/1%25_rule_%28Internet_culture%29

So of 200,000 people 4600 get nasty symptoms or about 2.3%

I think there is enough evidence to suggest that the figure (for long term users) is considerably higher than 2.3%. However, your point is well taken (that many people can quit, even after protracted use, with few ill-effects). But, of course, irrespective of the figures for the general population, the numbers will be much greater here for our self-selecting group. After all, someone experiencing few problems with benzodiazepines are unlikely to seek us out, let alone join.

I have much more confidence in the 200,000 number than I do the 4600.  Let’s say I am wrong by a factor of 10, which would be the absolute worst case, that means that at most 23% of those that try to stop get nasty symptoms.

Well, it will be spectrum of 'nastiness' too. There are many factors which affect an individual's ability to manage benzodiazepine withdrawal, not just the actual depth of the dependency. Personality traits, real word support, other life stresses, etc., will all affect the ability of an individual to cope with benzodiazepine withdrawal. What I mean is, who is to say that just the toughest cases require or would benefit from online support?

Realistically, it is between 2 and 23%, the midpoint being 13%.

 

I actually like this analysis, and am going to post on Withdrawal and Recovery (where people actually look to check it out.

 

Be well and good luck,

 

Ramcon1

I might quibble with some of your assumptions, and I make my own  assumptions or raise questions without necessarily providing answers, but the point that not everyone has a terrible time quitting is undoubtedly true. What I tell members is that if that have no reason to know differently (through past personal experience), they should not expect a very tough withdrawal, even after protracted use. So long as they follow a sensible taper plan, testing the water with any proposed taper rate (do not just assume that they can taper off by following a few quick cuts), they'll probably finish their taper quite comfortably*. If they cut by about 10% of their dose, wait a week or so, and experience no or few problems, they might increase the size of their next cut or increase the frequency of the cuts. Some will find they can taper off very comfortably within a month or two. Others might take six months or more; or much less likely, a year or more. It would be foolhardy to quit in gung-ho after protracted use; but neither should people be unduly pessimistic, drawing out a taper plan for longer than required. Members should determine their own taper rates, based upon how they react to cuts.

*If a member joins because they have heard how hard benzodiazepine withdrawal can be, but they have never personally attempted withdrawal, they should not expect the worst. They should be reasonably assured that their withdrawal likely will be pretty uneventful (so long as they follow a sensible plan).

ramcon1, I would like to suggest a further refinement to your analysis.

 

Management consultants use a rule of thumb that 80% of all group interactions involve only 20% of group members. In terms of the BB forum, this suggests that frequent posters are from the 20% minority, not the 80% majority of all forum members. Anyone who reads the mail can easily see that the postings are dominated by a relative handful of frequent posters.

The 80%/20% rule (an observation really) crops in quite a lot of situations. Though, I think the 1% rule I mentioned in my last post would seem more applicable for our forum. Of course, we cannot know the precise figure. I expect the 80%/20% rule would fit quite well if applied to the posts from members: 20% of the members producing 80% of the output (posts).

This means that the posts do not represent the general population of all posters. It is not hard to for me to be convinced that the "typical" story we see on the forum is not typical at all. There are at least three reasons:

1. 80% of the posts are made by 20% of the members.

Yes, but as I stated in my last comment, your numbers relate to content generation. Ramcon's post related to the numbers of people joining and what this might suggest about the number of people suffering problems in the general population.

2. Those suffering the most are most likely to be motivated to post. (And conversely, those suffering less are less motivated to post.)

Absolutely. And this can give a very distorted picture of what members might or should expect of benzodiazepine withdrawal

3. Membership to the BB forum is by self selection. Therefore it is does not meet any conceivable test for randomness. This means membership is NOT typical of the general population at large. In fact, someone who stops cold turkey with little problem is not likely to ever join the BB forum in the first place, so looking for his story here is a fool's errand.

Again, I totally agree. This matter has been discussed before. Try here:

http://www.benzobuddies.org/forum/index.php?topic=48083.0

(I think the main posts covering this matter were in the first half of that thread.)

In summary, I believe you may have overweighted the importance of the BB forum in determining what percentage of the general population has protracted symptoms. Certainly, anyone who has protracted symptoms will gain much from consulting the BB forum because it it attracts the worst case segment of the population. However, the forum probably does more harm than good when it comes to informing the general population about Benzodiazepine withdrawal.

I agree that ramcon has overweighted the importance of BB in arriving at his numbers, but I appreciate his effort.

As for causing more harm than good for the general population: there is always this risk when people extrapolate from the specific (our self-selecting group) to the general (all those taking or withdrawing from benzodiazeopines). However, as you clearly understand, those who suffer few or no problems, are unlikely to visit us - we will not influence them in what they might expect. Still, it remains a concern for those do visit and join. Clearly, we cannot disallow member from reporting their problems. All we can do is try to offer some balance and correct assumptions based on personal experience.

Please don't misunderstand! I believe the stories I see on the forum. But I do not believe they are typical or in any way representative of the general population of users. I know that statement will inflame many, but I believe it would be borne out by any critical analysis of any randomized sample of users. The only problem is that nobody will spend the money to do such a study, so we are left to our own devices.

I really don't know what a randomised sample would show. However, at the end of the day, BB serves those who feel they need us or would benefit from a online support group. Obvously, a support group such as ours is not for everyone.

I believe the problem to be vary large, and suspect that many people are too badly affected to even realise what's happening to them, but I am speaking from my own personal and biased experience. I think the problem is certainly large enough to warrant proper studies and the truth will come out some time.

There is very little study data available, and many forum members don't appreciate the difference between an anecdote and a scientific study anyway. I have seen a poster state he absolutely believes that 100% of users will experience protracted withdrawal. Besides being silly on the face of it, that belief is obviously a projection of his own experience by an emotionally stressed poster.

Such postings are unfortunate, but totally understandable. I try to reason with such posters when I happen upon them, explain about self-selecting groups, etc. I would encourage other members to do likewise.

Hello Colin,

Thank you for the insightful analysis.  Just a couple of comments.

The 100 million number is googlable, top prescriptions of 2011, then add up the benzos. The 10,000 number is countable on BB.

The rest are assumptions or educated guesses.    I acknowledge that the assumption that half end up on BB is the weakest, and that it why I put in the factor of 10 which would make the number 5%, and the 13% would represent 10%.

Again, I was trying to get an estimate, and this technique is "engineering 101," get the facts you can (100 million, 10,000) make assumptions as reasonably as you can, and put in factors that help damper the effects of the assumptions.

When all is said and done, I still like the conclusion:

10-20K/year end up suffering, 350 of whom end up here.

Also, I agree with your comments about many people not having any symptoms to speak of, and they would be reflected in the other 100-200K.

Ramcon1

Ashton herself says that only about 10-15% of people will have a long difficult withdrawal. Seems to be highly individual.

eastcoast

As a minimum, drug sheets should warn of the addiction potential, and possibily of serious withdrawal symptoms.

Problem is, how do you get across the seriousness of this on paper? Also, I don't know how many people suffer from wd 2 years or longer, but we all know that it can happen. Would anyone take these drugs if they were told that there was a chance that they would be incapacitated with debilitating wd symptoms for years after discontinuation?

If we paid more attention to the possible drug side effects listed on the info sheets than we did our doctors, none of us would take anything. Even if the drug sheet lists suicide as a possible side effect, none of us think that applies to us. We listen to our doctor (who don't seem to take the time to underscore the possible negatives) and swallow the pills. If we become a statistic, oh well.

Psychiatrists are another matter. Their stock in trade is psychoactive drugs, and those drugs are what gives psychiatrists their power. Their solution to drug dependence is to prescribe a second and a third and a fourth drug.

I second this, with the following addendum: more and more psychiatric drugs are being prescribed by general practitioners (in fact I've *never* been prescribed a drug by a psychiatrist - I went from anti-depressant to anti-depressant while trying to figure out that I had benzo withdrawal and all of those scripts were written by PAs or GPs). If psychiatrists know - or care - little about the side effects of psychoactive drugs, general physicians know even less.

Physicians do not hand out Vicodin and Oxtcontin like candy, so it is certainly possible to control dangerous drugs. Physicians need to be better educated about psychoactive drugs, starting in med school.

 

Psychiatrists are another matter. Their stock in trade is psychoactive drugs, and those drugs are what gives psychiatrists their power. Their solution to drug dependence is to prescribe a second and a third and a fourth drug.

I agree. This is an issue of education and control. If doctors knew what these drugs could do and therefore prescribed them properly (only to people who "need" them, and only for very short term use in most cases) most of us wouldn't be here. The fact that these drugs mess with brain chemistry means they shouldn't be taken lightly. Most people would agree that if you were to take ecstasy or GHB or LSD every day for years you would be asking for trouble, but prescription drugs aren't subject to the same scrutiny.

1.  I fully agree physicians need to be better educated.  We all need to do our best to do just that, educate our doctors.

2.  Eastcoast, I had no idea that Ashton published the 10-15% number.  That gives our little exercise a little more credibility.

"I am willing to fight for 10,000 people."

Thanks Ram.