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Benzodiazepine Detox and Withdrawal

Benzodiazepine withdrawal symptoms can be severe, therefore detoxification should be medically supervised with gradual tapering of the drug at specific intervals.1 Stopping cold turkey can result in life-threatening seizures, tremors and muscle cramps.2 Benzos are frequently abused with other drugs, making detox and withdrawal more complex. For example, 81 percent of Xanax-related emergency room visits in 2011 involved nonmedical use in combination with one to three other drugs.3

As mentioned above, the preferred approach for benzo detox involves decreased doses of the drug. This generally involves several types of interventions such as gradual reduction with a long or short half-life benzo, switching to non-benzo anxiolytics or prescribing adjunctive medications including antidepressants or anticonvulsants.4 While the risk for withdrawal symptoms decreases with professionally supervised detox, all symptoms may not be eliminated s. Many studies have found that gradual withdrawal over at least 10 weeks is effective in achieving long-term abstinence.5,6

Withdrawal Symptoms

  • Sleep disturbances
  • Irritability
  • Increased tension and anxiety
  • Panic attacks
  • Hand tremor
  • Sweating
  • Concentration difficulties
  • Confusion and cognitive issues
  • Memory problems
  • Dry retching and nausea
  • Weight loss
  • Palpitations
  • Headache
  • Muscular pain and stiffness
  • Perceptual changes
  • Hallucinations
  • Seizures
  • Psychosis
  • Suicide

For people with high-dose benzodiazepine dependence (doses equivalent to more than 40 mg diazepam per day), reduction approaches are often ineffective. Emerging scientific evidence indicates a medical intervention approach (used successfully to treat opioid dependence) may have potential for those with high-dose benzo addiction. A study on patients enrolled in a methadone maintenance treatment program with comorbid benzo dependence compared the efficacy of clonazepam detoxification versus clonazepam maintenance treatment. Researchers found that 78.8 percent of patients in the maintenance group refrained from abusing additional benzos after stabilization and the rate remained constant for more than one year.4

A more recent Swiss study was conducted with 41 participants, ages 25 to 61. Participants had long-term,high-dose benzodiazepine dependence and/or otherwise problematic use including mixing substances, dose escalation, recreational use or obtaining drugs illegally. This was the first study to use qualitative methodology to explore high-dose benzo-dependent patients’ attitudes towards a maintenance treatment approach. The majority of participants favored discontinuation treatment, despite failure, due to ambivalent attitudes towards maintenance therapy. Several participants perceived the slow-onset, long-acting benzos as stabilizing and preventing criminal activity. In conclusion, the researchers encouraged benzo users to consider treatment alternatives when discontinuation strategies fail.4

  1. Commonly Abused Drugs Charts. National Institute on Drug Abuse website. https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts Updated April 2016. Accessed October 3, 2016.
  2. Benzodiazepines: Uses, Side Effects and Risks. Medical New Today website. http://www.medicalnewstoday.com/articles/262809.php Updated April 13, 2016. Accessed October 3, 2016.
  3. Bush DM. Emergency Department Visits Involving Nonmedical Use of the Anti-Anxiety Medication Alprazolam. The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013-2014 May 22.
  4. Liebrenz M, Schneider M, Buadze A, Gehring M-T, Dube A, Caflisch C. Attitudes towards a maintenance (-agonist) treatment approach in high-dose benzodiazepine-dependent patients: a qualitative study. Harm Reduct J. 2016;13:1. doi:10.1186/s12954-015-0090-x.
  5. Petursson, H. (1994). The benzodiazepine withdrawal syndrome. Addiction, 89: 1455-1459. doi:10.1111/j.1360-0443.1994.tb03743.x.
  6. Brett J, Murnion B. Management of benzodiazepine misuse and dependence. Aust Prescr. 2015;38(5):152-155. doi:10.18773/austprescr.2015.055.
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