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The Dangers of Quitting Benzos Cold Turkey

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Benzodiazepines are commonly prescribed medications that depress certain central nervous system (CNS) activity and are used to manage a range of conditions, including panic disorder, anxiety, seizure, muscle spasm, and acute alcohol withdrawal.1 They are classified as Schedule IV controlled substances, and though they may have a lower risk of abuse and addiction than Schedule I and II drugs, such as heroin, cocaine, or methamphetamine, they still have significant abuse potential.1 People may misuse or abuse benzodiazepines in order to experience a euphoric high or to heighten relaxation.1,2 According to a 2011 survey, more than 20 million Americans older than the age of 12 reported misusing benzodiazepines at some point.1 Benzodiazepines can be abused by diverting legal prescriptions to be taken orally, crushed and snorted, dissolving in liquid and injected, or combined with other drugs, such as opioids or alcohol. Cocaine users often abuse benzodiazepines to mitigate the unwanted side effects of cocaine abuse, such as agitation and irritability.1,2

Misuse of benzodiazepines can lead to physical dependence over time, leading to withdrawal symptoms upon stopping use. However, the mere presence of physical dependence does not necessarily mean that you have a substance use disorder.1,3 While physical dependence is one indicator of a potential substance use disorder, there are several other criteria involved in the diagnosis of an addiction.4 Additionally, some amount of withdrawal may arise even when these medications are used as prescribed and under the supervision of a medical professional.3

Addiction, on the other hand, is a chronic and complex condition involving the reward, motivation, and memory centers of the brain. It is often characterized not only by significant physiological dependence, but by the compulsive use of a substance regardless of negative consequences directly arising from such use. Among these negative consequences are an undeniable decline in overall health and additional risks to health, such as those posed by acute withdrawal. When someone is addicted to benzodiazepines and attempts to quit cold turkey, withdrawal symptoms can be very severe and even life-threatening.

Signs of Benzo Addiction

An addiction to benzodiazepines falls under the category of sedative, hypnotic, or anxiolytic use disorder.4 Signs and symptoms of a benzodiazepine addiction include:4

  • Continuing use causing difficulty or inability to function at work, school, or home.
  • Continuing use even after knowing that it has caused or worsened a physical or mental health issue.
  • Developing tolerance, which results in less drug effect with the same dosage, or the need for a larger dosage to achieve the results.
  • Experiencing strong cravings or urges for benzodiazepines.
  • Foregoing important recreational, work-related, or social activities due to benzodiazepine use.
  • Having withdrawal symptoms when use is stopped or slowed.
  • Experiencing many failed attempts to cut back or stop use of benzodiazepines.
  • Using benzos in physically hazardous situations, such as when driving or operating machinery.
  • Spending a lot of time obtaining or using benzos, as well as recovering from the effects of use.
  • Taking benzodiazepines for longer periods of time or in larger amounts than originally intended.
  • Using despite knowing that benzodiazepines have caused or worsened relationship issues.

If you or someone you know exhibits 2 or more of the above symptoms within a 1-year period, it is likely that a benzodiazepine addiction has developed.4 As part of benzodiazepine addiction, should physical dependence have significantly developed, quitting cold turkey can be unpleasant or even life-threatening. Attempting to detox without medical assistance could be dangerous and is not recommended.7

Why You Shouldn’t Quit On Your Own

If you or someone you know is addicted to benzodiazepines and looking to get clean, seek the help of your doctor or other treatment professional—it can be dangerous or even life-threatening to suddenly quit on your own.7 Benzodiazepine withdrawal symptoms can include:3,4Benzodiazepine withdrawal can involve various symptoms including insomnia, tremors, and seizures.

  • Anxiety.
  • Insomnia.
  • Nausea or vomiting.
  • Hallucinations, which can include seeing, feeling, or hearing things that are not there.
  • Perceptual disturbances.
  • Increased autonomic activity, such as sweating, rapid heartbeat, increased breathing rate, and high blood pressure.
  • Sensory hypersensitivity.
  • Restlessness.
  • Tremors.
  • Grand mal seizures, which can be fatal.

Seizures may occur in as many as 20 to 30% of people withdrawing cold turkey from sedatives, such as benzodiazepines.4 In order to prevent benzodiazepine withdrawal deaths, a detox facility that is medically supervised around the clock is strongly recommended.7 This type of facility is equipped to provide the necessary support and monitoring to address any withdrawal-related complications and prevent death.7

What Does Detox Entail?

Medical detox occurs in a facility that is staffed with medical professionals to treat withdrawal, manage symptoms, and identify and treat any complications to reduce mortality from benzodiazepine withdrawal.7 Benzodiazepine detox is managed by slowly tapering the dosage of the currently abused benzodiazepine over a period of weeks or months or by switching to a longer-acting benzodiazepine, such as Librium (chlordiazepoxide), and then slowly tapering off of that.3,7

Detox programs may vary somewhat in terms of setting and intensity. However, regardless of the precise detox setting, there are 3 vital aspects that should be present in any detox program. These aspects include:7

  • Assessment: This involves the intake process, where a medical history and physical will be performed (including psychiatric evaluation and substance use history). A toxicology screening or drug testing may be conducted to determine the exact substances used. This allows clinicians to determine the specific needs of each patient and to develop an individualized detox plan. The rules of the facility are usually explained and confidentiality and consent for others to participate in treatment are reviewed in this phase of treatment.
  • Stabilization: This encompasses assisting you through the withdrawal process. Medications are tapered to ensure your safety, and staff will give you a clear picture of what to expect, which can vary between facilities, and also let you know about what is expected of you during the withdrawal process. Outside support such as family, friends, and employers are also enlisted, as long as you provide consent to have them participate in your treatment.
  • Fostering a transition into substance abuse treatment: This relates to the discharge plan, where follow-up treatment is mapped out for continued success in recovery. Detox doesn’t address the underlying issues related to addiction; it merely cleanses the body of drugs. Further treatment can increase the likelihood of long-term sobriety and provides skills to prevent future relapse.

Benzo Detox Options

Detox can be accomplished in various types of settings, depending on your unique needs and situation. These include:7

  • Hospital: If you are actively in withdrawal, have previously experienced a severe or complicated withdrawal process, or have experienced a medical emergency due to overdose, a hospital may be the best setting to detox. Doctors and nurses are available around the clock to monitor and treat any complications of withdrawal from benzodiazepines. Counselors are on site daily to provide therapeutic care and supportive services to you throughout the withdrawal process. Hospitals have the benefit of having medical equipment readily accessible to manage any severe symptoms of withdrawal, such as hallucinations, seizures, or delirium. This setting is especially helpful if you have co-occurring medical or mental health conditions, or are addicted to more than just benzos.
  • Inpatient: This generally takes place in a facility that is staffed 24 hours a day, where you will stay for the duration of withdrawal. The main focus of this type of setting is to provide medical detox services and to taper the medications down slowly until you are drug-free. Doctors are on call at all hours, and nursing staff is always available to monitor patients and assess detox progress. Counselors are also available to assist with the beginning stages of addiction treatment and to help develop an aftercare plan for ongoing treatment.
  • Outpatient: This type of treatment occurs in an outpatient facility, where you will attend treatment for several hours a week and receive periodic monitoring by a medical doctor, nursing staff, and counseling staff. The doctor may provide medication to assist you through the detox process and counselors will provide psychological support throughout. The amount of time spent at the facility weekly will be determined by several factors, including the length and severity of addiction, and if there are any other mental health needs that should be addressed. This type of setting is best for you if you have a less severe addiction, significant social support, and mild or no mental health issues that need to be addressed.
  • Doctor’s office: This is the least restrictive type of detox services, where the doctor will provide information on how detox is accomplished, create a gradual tapering schedule to prevent withdrawal symptoms and possible complications, offer referrals for additional treatment for addiction, medical, or psychiatric issues, and regularly meet with you to monitor your progress in detoxing. This setting may be right for you if you’ve been taking benzos under the supervision of a doctor and have developed some amount of physical dependence. The limited amount of supervision afforded by this detox scenario may be less appropriate for those dealing with relatively severe dependence to have developed from significant benzodiazepine misuse.

When choosing a type of detox method, keep in mind that 24-hour monitoring and support is strongly recommended for benzodiazepine detox due to safety concerns.7 If you are thinking about outpatient or doctor’s office detox services, the first step to take is to see a medical doctor to determine if these options are right for you. The doctor will assess you and identify your risk of experiencing more severe withdrawal, the severity of your use and/or addiction, and help you choose the right detox type for you.

Sources

  1. Drug Enforcement Administration. (2013). Benzodiazepines.
  2. Drug Enforcement Administration. (2015). Drugs of Abuse. 9, 36–37, 59.
  3. Longo, L.P. & Johnson, B. (2000). Addiction: Part I. Benzodiazepines—Side Effects, Abuse Risk and Alternatives. American Family Physician, 61(7), 2121-2128.
  4. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th). Arlington, VA: American Psychiatric Publishing.
  5. Center for Substance Abuse Research. (2013). Benzodiazepines.
  6. American Society of Addiction Medicine. (2017). Definition of Addiction.
  7. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15–4131, Rockville, MD. 4–7, 11–20, 74–76.
  8. Kim, S., Ting, A., Puisis, M., Rodrigues, S., Benzon, R., Mennella, C., & Davis, F. (2007). Deaths in the Cook County Jail: 10 Year Report, 1995–2004. Journal of Urban Health, 84(1), 70–84.
  9. National Institute on Drug Abuse. (2012).  Principles of Drug Addiction Treatment: A Research-Based Guide (3rd Edition).

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