Aside from the severity of symptoms tending to fluctuate, people report a wide range of experiences. A particularly severe or troublesome cluster of symptoms may predominate for a time, and then change to another cluster. Many people become disbaled during this time, unable to maintain work or other functioning, sometimes for years. Benzodiazepines are a class of drugs such as Xanax and valium that have a medium potential for abuse and misuse. When taken for muscle spasms, anxiety and panic disorder, these medications can be very useful.

4. Complications of Benzodiazepine Abuse

More severe reactions or withdrawals may also be more likely when taking strong drugs either for long periods or alongside other types of medications. The main cause of the symptoms of benzo withdrawal is the sudden reduction of dopamine in the brain. Acute withdrawal begins after the initial withdrawal symptoms, generally within a few days. Symptoms generally last 5–28 days, though some may last for several months. During the early stages of withdrawal, the person may notice the symptoms of the condition that the drug was treating start to return, or rebound.

2. Side Effects of Benzodiazepine Use

Patients who repeatedly relapse following withdrawal management are likely to benefit from methadone maintenance treatment or other opioid substitution treatment. Another study that tested a different standardized education protocol showed more promising results [73]. The experimental group in this study was counseled on the first visit for 15–20 min on the effects, dangers, and alternatives to chronic BZD use and dependence [73]. The subjects were interviewed with surgery-based consultations for approximately 10 min [12]. This study found that patients undergoing this structured intervention were 5-fold more likely to successfully discontinue BZD than those who just tapered off the drug [73]. Interestingly, a lower prevalence of withdrawal symptoms was noted in the experimental group without any change in pharmacologic treatment from control group [73].

Difficult tapers

Agarwal and Landon 2019 stated that the prescription of BZD in outpatient settings significantly increased from 2003 to 2015 [27]. Several studies have examined the relationship between BZD use and mortality. In a systematic review of research, Charlson et al. could not find conclusive evidence supporting increased risk of mortality in BZD users [43]. In their analysis of six retrospective studies, half of them showed no significant relationship between BZD use and mortality. One of the studies showed an increase in mortality with increased dosage and frequency of use which could be attributed to increased toxicity, another showed a positive correlation among older adults [43].

Management of benzodiazepine misuse and dependence

People who are not dependent on drugs will not experience withdrawal and hence do not need WM. Refer to the patient’s assessment to determine if he or she is dependent and requires WM. Withdrawal symptoms may begin after as little as 3–6 weeks of use, even when a person uses the drugs as the doctor directed. In the first week of tapering off, your doctor may reduce your dose as much as 30% to get you to a safe amount. After that first leap, the steps become smaller, usually 5% to 10% of the original dose.

Provide 10-20ng of diazepam every 30 minutes until the patient is adequately sedated. The patient should be observed during sedation and no more diazepam given if signs of respiratory depression are observed. Symptomatic treatment can be used in cases where residual withdrawal https://ecosoberhouse.com/ symptoms persist (Table 3). This dose of diazepam (up to a maximum of 40mg) is then given to the patient daily in three divided doses. Even if the patient’s equivalent diazepam dose exceeds 40mg, do not give greater than 40mg diazepam daily during this stabilisation phase.

During the first week, you can also expect physical symptoms like headaches and hand tremors. The researchers used a unique lab model called “Guwiyang Wurra-TSPO knockout,” a healthy mouse lacking a protein present in the mitochondrion, the cell’s energy-providing organelle (5). Anti-anxiety drugs like diazepam bind to TSPO on the surface of microglial cell organelles. Microglial cells are the benzodiazepine withdrawal brain’s first immune responders and are implicated in dementia, long COVID, chronic fatigue and other cognitive impairments. A study analyzing over 1000 cases of oxycodone-related drug abuse deaths showed that BZDs are among the most abused drugs by individuals using multiple drugs of abuse. The study showed that in oxycodone users, combination use with diazepam was the most prevalent [44].

• When you are physically dependent on a drug, it means your body can’t operate normally without it.
• If you stop taking them “cold turkey,” or all at once, you may experience severe, even life threatening, withdrawal symptoms.
• Though therapy generally can’t address withdrawal symptoms specifically, it can help improve some symptoms, like anxiety and insomnia.
• Withdrawal symptoms vary according to the drug of dependence and severity of dependence, but often include nausea, vomiting, diarrhoea, anxiety and insomnia.
• These withdrawal symptoms can be attributed to tolerance or interdose withdrawal.
• This same mechanism is also thought to be the cause behind alprazolam’s strong rebound hyperadrenergic effects with cessation [54,55].

Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Data sources include Micromedex (updated 6 May 2024), Cerner Multum™ (updated 6 May 2024), ASHP (updated 10 Apr 2024) and others. Emily Guarnotta holds a doctorate degree in Clinical Psychology from the California School of Professional Psychology.

Long-Term Treatment for Benzodiazepine Withdrawal