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Benzodiazepine Withdrawal: What to Expect

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Benzodiazepines, or “benzos,” are medications that are typically prescribed to an individual for a variety of reasons.  Benzos provide a relaxing and euphoric effect for some, which has led to many individuals struggling with overuse and obtaining the medication without a prescription and developing a prescription pill addiction. Benzos can have a variety of reasons to use, including assisting in managing anxiety, panic attacks, muscle spasms, alcohol withdrawal, insomnia, just to name a few. Most providers will explain that although these benzos will be effective, they should be paired with physical therapy and or individual therapy to target the underlying reasons for the disorders or symptoms listed previously to get the best results possible. However, many individuals feel that these benzos are the answer to their problems, and some individuals are more likely to take these medications for longer than they were originally prescribed. These medications can be safe if they are used prescribed, but they can become habit-forming and addictive in long term use, sometimes forming benzodiazepine addiction. Some popular names of benzos are Valium (diazepam), Ativan (lorazepam), Klonopin (clonazepam), or Xanax (alprazolam). Like any other substance, with time the body will build a tolerance, therefore the effectiveness of the original prescription may not be as efficient as it once was. The tolerance can drive an individual to take more than prescribed doses, which ultimately can lead that individual to be at a major risk for a fatal overdose from drug abuse. When attempting to detox from these benzos, it is safest if done in a rehabilitation center or a medical detox setting. This will allow medical professionals to monitor vital signs as well as any post-acute withdrawal symptoms (PAWS) that the individual may be experiencing. Serious benzodiazepine withdrawal symptoms include psychosis, seizures, and or delirium tremens. Delirium tremens is a rapid onset of confusion. These can last anywhere from a few hours to a few days depending on the individual. The symptoms that the individual was being treated for originally could return at a greater severity. Individuals may also experience intense levels of anxiety, insomnia, and pain from the detox. Common withdrawal symptoms also include anxiety, panic, irritability, insomnia, sweating, headaches, muscle pain, muscle weakness, poor concentration, nausea, heart palpitations, agitation, elevated blood pressure, etc. As mentioned previously, these are the common severe withdrawal symptoms that would be monitored by medical professionals to assist in maintaining through the detox process. The medical professionals would be monitoring the individuals to make sure if there is a medical concern, that the individual is cared for and that they would be available to troubleshoot, as well as relay to the provider the situation, and then execute any orders that need to be carried out. Symptoms of the detox can begin as early as 24 hours after the last use and can last up to months and even years. The importance of seeing the provider at the beginning of detox as well as during or after the detox process, to adjust comfort medications, assist in making sure that the individual is detoxing safely. Everyone has a different detox, based on medical history, use of benzos, and the number of times someone has detoxed. It has been seen that individuals who have detoxed and maintained sobriety for as long as a week and relapse, tend to have a more intense or increased detox than previously. Mainly due to the body working to maintain sobriety, and understanding the feelings of sobriety. Re-entering those substances can cause for more detox related benzo withdrawal symptoms to appear when attempting to detox again, that was not present in the previous detox. Seeing a provider can allow the individual to get a better understanding of what is occurring during this detox period as well as what is to be expected. There is also an opportunity to check in with the provider after the detox period for longer-term medications to assist with comfort, work to decrease anxiety and insomnia, as well as medication that can decrease overall cravings. The provider may also be able to provide and suggest herbal or holistic supplements for the individual to use more long term than the medications prescribed. These supplements are a safe and complimentary addition to the rehabilitation program that the individual is currently in. Often, individuals who are detoxing from benzos experience a majority of these symptoms of withdrawal listed throughout the detox process, however, they may experience more than one at a time. Any individual who is detoxing from benzos is likely to experience the PAWs of chronic anxiety, depression, and sleep difficulties. However, during the detox, your provider should also prescribe comfort medications to ease the detox symptoms. Medications that are typically prescribed during detox that are considered comfort medications are a low dose Valium taper (5-7 days), clonidine and or propranolol for blood pressure, anxiety, sweating, and racing heart, as well as trazodone for sleep. During the detox process, the individual should begin to participate in group and individual therapy. Ultimately the individual is addicted to benzos for underlying reasons, and once the individual starts to put in the work on themselves to figure out those reasons, they can also assist in maintaining sobriety even after recovery. Groups sessions related to psycho-education, mindfulness, and meditation, as well as social skills, building techniques can be beneficial for the individual to develop a better understanding of why they were addicted to benzos, as well as beginning to develop essential coping strategies to assist with anxiety, depression, or a combination of both. During treatment, there are different levels of care and different goals for each level of care. For example, an individual who is detoxing from benzos will be closely monitored during their detox. Medical professionals will work to take vitals and determine a pattern of the vitals based on the detox, as well as provide the comfort medications that will ease the detox. A very crucial part of the detox process is eating, drinking, and getting rest. The body is working hard to get all the benzos out of its system, and really work to get to a sober state. This requires time and patience. The ability to rest will assist with the detox process, as many individuals take the benzos for sleep, therefore sleeping can allow one to feel better. The other important aspect of detox is eating and drinking fluids. Getting enough nutrients can help your body recover. Many times, individuals skip meals, or they are not eating the appropriate amount of nutrients and not drinking enough fluids, then body aches, headaches, nausea, etc. could occur. Ultimately during the detox phase of treatment, it would be imperative to have the medical staff providing support and monitoring, as well as encouraging to increase fluids and eating as tolerated. Once the detox phase is completed, and the individual is no longer on a medication taper, the individual should be encouraged to start reforming a daily routine during the residential level of care. Increasing the participation in group therapy sessions and developing social skills can be helpful, as well as begin a healthy work out regimen. Individual therapy with a master’s level clinician will allow the individual to really understand the underlying reasons for their benzodiazepine dependence and addiction, whether it be anxiety, depression, trauma, etc. During these sessions, the individual will learn ways to explore their feelings, emotions, and thoughts, all while developing and implementing coping strategies into their routine. Continuing to eat healthy meals and get fluids is also essential for the individual after the detox phase, allowing the body to heal and refuel is essential to developing a new routine. Another aspect that can be beneficial during this crucial time frame is developing a mindfulness approach. Ultimately before a benzodiazepine detox, the individual was likely consistently on the go or looking for ways to avoid their feelings, thoughts, emotions. However being able to sit in their emotions or even silence, and utilizing mindfulness techniques such as deep breathing, increasing awareness to physical sensations, and different grounding exercises can allow the individual to slow down, and work on what they might be experiencing to allow themselves to feel, as well as implement those coping strategies that they have been working on in therapy. The next few weeks after detox are all about developing routines, implementing and learning new skills, and preparing themselves for the social interactions in the community as well as with family and loved ones. During the residential level of care, the individual will be working on preparing for triggers, cravings, and different relationships in the community. Often, when the individual is putting in a lot of individual time and work on themselves, it also requires changes within the relationships that they surround themselves with. This can be difficult for some individuals, as their loved ones may not feel or seem to think that they need to put in the work as well. Also, many times, individuals are using these benzos in familiar places such as home, work or school and as a result, they may be triggered by these places to use again once they are sober. There may be friends or family members who are continuing to use around the individual, which can add some additional pressure or cravings to the individual. Ultimately the individual would benefit from the coping strategies, mindfulness techniques, and the individual work in therapy come into play and can effectively assist the individual to refrain from using. Ultimately, individual therapy and intensive outpatient therapy are beneficial tools for the individual. This allows them to continue to work on themselves, and still have the accountability to maintain sober, but also still supports the individual through the things life may throw at them. At APEX Recovery, we understand the struggles associated with benzodiazepine withdrawal, and our staff can help ease the discomfort at all levels of care.  Our trained staff and medical doctors will monitor any distress from physical withdrawal symptoms, while our clinicians will help you feel connected to others while beginning to support you in addressing your emotional and psychological symptoms and mental health.  While the detoxification and benzodiazepine withdrawal treatment process is unique to each individual, one thing is certain: at APEX Recovery you will be provided with the support necessary to begin your journey to recovery.

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