Free Course: Benzo Basics

Welcome to the Benzodiazepine Withdrawal Basics course!

In this comprehensive guide, we’ll delve into the essential aspects of benzodiazepines, offering you a clear understanding of:

  • The history and dangers of benzodiazepines
  • The medical community’s lack of benzo knowledge
  • The steps for their safe discontinuation
  • Insights into the recovery journey

Rooted in decades of anecdotal evidence from the benzo community and designed for clarity, this course ensures that whether you’re personally navigating the path away from benzos or assisting someone on their benzo-free journey, you’ll be well-equipped with knowledge and practical tools for a confident and informed approach.

You will receive text and video lessons you can follow at your own pace. 

If you need further information or assistance, please feel free to book a coaching session with me at 

benzowithdrawalhelp.com or join the Benzo Withdrawal Help Premium Support Group.

 

In The Beginning

Benzodiazepines quickly became one of the best-selling drugs on the market once they were introduced to the world. Why? Let’s take a look.

We have to go to Germany,  back before benzodiazepines were created. There, chemists developed a class of drugs called barbiturates. Seconal, Luminal, and Namutol were some of the first sedatives, also called tranquilizers. During the Great Depression of the 1930s, barbituates were sold over the counter and helped many Americans cope with the challenging economics of the time by reducing brain activity and depressing the central nervous system. In other words, they were calming.

Based on the manufacturer’s marketing materials, doctors and pharmacists assured the public that barbituates were safe. But they were not safe. Chemical dependency, fatal overdoses, and a horrific withdrawal syndrome (which could be fatal) were possible. Many were in harm’s way because, by 1944, one billion barbituates a year were being taken by U.S. citizens.

In 1951, the drugs changed from over-the-counter to prescription medication. With serious problems swirling around barbituates, drug companies searched for new tranquilizers that were safer. Leo Sternbach, a chemist at the Swiss drug company Hoffman-La Roche, created the first benzodiazepine, naming it Librium. 

Here is a quick story of how it came to be: In the 1950s, the popularity of the tranquilizer meprobamate (Miltown) prompted the leadership at Hoffman LaRoche laboratories to assign Sternbach the task of devising new anxiety-relieving medications. Given that many firms were making minor modifications to the meprobamate structure, Sternbach aimed to chart a novel course. He remembered that during his studies in Krakow in the 1930s, he had delved into azo dyes and their derivatives, a set of compounds rooted in the mid-19th century dye industry. (Yes, benzodiazepines started out in some ways as dyes!) The specific derivatives Sternbach had investigated—then termed 4,5-benzo-[hept-1,2,6-oxdiazines]—weren’t considered viable for commercial dye production, so research on them halted. However, reflecting upon this, Sternbach believed they could be the foundation for his current project. He went on to create around 40 variations of these molecules, yet most didn’t demonstrate the characteristics of tranquilizers in animal trials.

He almost gave up on his project as his superiors didn’t think it was viable. He was told to work on antibiotics. But one day, an assistant was about to throw away the 40th vial, which had not been tested. Sternbach decided to try again; this time, the compound produced results. 

It went to market in the 1960s. From there, other benzodiazepines followed. 

Benzodiazepines worked similarly to barbituates, both easing anxiety and creating a sense of calm. Just like barbituates, benzodiazepines were marketed as safe. True, they caused fewer overdose fatalities than barbituates, but in time, benzodiazepines were discovered to have the same dependence and withdrawal problems. Unpleasant side effects of the drugs were common, as well. That didn’t stop the marketing machinery of the manufacturers, however. Valium was marketed intensely by Arthur Sackler (of the opioid crisis), and soon, sales surpassed barbiturates.

Things aren’t as good as they seem.

Valium’s reputation as safe began to crumble in the wake of reports about dependence and grueling withdrawal syndromes. The Rolling Stones wrote the song, Mother’s Little Helper, a warning about the dangers of Valum. Just as they did when barbituates began to lose their reputation as safe, drug companies began scrambling to create better benzodiazepines. La Roche made Klonopin and marketed it in 1975. Wythe Pharmaceuticals created and marketed Ativan in 1977. Both drugs were touted as safer, faster-acting, and much smaller doses were needed. As part of the marketing campaign for these new benzodiazepines, the term “anxiolytic” was coined to distance them from the problems of the earlier benzodiazepines, the “tranquilizers.”

The word anxiolytic implied that the new benzodiazepines had a different operating mechanism, and the lower doses lulled people into believing they were safer, when in fact, Klonopin (and Xanax) is twenty times stronger than Valium, and Ativan is ten times stronger. The newer benzodiazepines are not only more potent but bind more tightly to GABA receptors as well as to sub-receptors. In short, they are extremely powerful. It didn’t take long until it became apparent that the new benzodiazepines were as dangerous as their old ones. 

A few years later, in 1979, Senator Ted Kenney led a senate hearing on the dangers of benzodiazepines. The manufacturers claimed that Valium, the tranquilizer, was dangerous, while the new drugs were “anxiolytics” and safe. The manufacturers won. The hearings failed. 

No matter how hard the manufacturers tried to make people believe the new benzodiazepines such as Klonopin, Ativan, and Xanax are safe, the evidence from users proved otherwise. All benzodiazepines are equally dangerous.

The rest of the world wakes up.

Other countries didn’t fall for the marketing of the new benzodiazepines. Many industrialized countries regulated the use of benzodiazepines. Lawsuits in the U.K. began to spring up. In the United Kingdom, the largest class-action lawsuit was filed. Fourteen thousand patients sued manufacturers of benzodiazepines for withholding and softening the drug’s potential for harm. Unfortunately, the plaintiffs ran out of money, and the suit was dropped.

But the case brought light to the benzo problem. Malcolm Lader, a psychopharmacologist, researched benzodiazepine brain changes. His research prompted him to become a benzodiazepine-harmed patient advocate. For reasons not divulged, the documentation around his research was sealed and designated as secret by the U.K. government. It was not to be unsealed until 2014. His research indicated brain changes from the ingestion of benzodiazepines.

The late Dr. Heather Ashton

Dr. Ashton is a hero in the benzo community. Her outstanding academic achievements include Chrystal Heather Ashton D.M., FRCP, graduated from Oxford and obtained a First Class Honours Degree (B.A.) in Physiology in 1951. She qualified in Medicine (BM, BCh, MA) in 1954 and gained a postgraduate Doctor of Medicine (DM) in 1956. She qualified as MRCP (Member of the Royal College of Physicians, London) in 1958 and was elected FRCP (Fellow of the Royal College of Physicians, London) in 1975. She also became National Health Service Consultant in Clinical Psychopharmacology in 1975 and National Health Service Consultant in Psychiatry in 1994.

Clearly, Dr. Ashton was a very learned physician with many honors. But it was her clinical work, running a benzodiazepine withdrawal clinic at the Royal Victoria Infirmary in Newcastle from 1982 to 1994, that is her most incredible legacy. She pioneered in helping people get benzo-free and sharing information about benzo withdrawal. 

America gets on board. Sort of. 

In 1990, while Dr. Ashton was still running her benzodiazepine withdrawal clinic, the American Psychiatric Association created a task force to investigate the dangers of benzodiazepines and the increasing number of prescriptions being written. It appeared that the APA was on board with the knowledge about benzodiazepines. But neither the task force nor Dr. Ashton’s work stopped the rising use of benzodiazepines in the 1990s. Literature about the dangers of benzodiazepines remained minimal as the number of people harmed grew.

Another drug gets promoted. 

The 1990s saw the promotion of “Z-drugs,” Zopiclone, eszopiclone, zaleplon, and zolpidem for insomnia. These drugs are highly effective in inducing sleep but are considered “baby benzos,” with similar dangers and potential for harm. Dependency and withdrawal symptoms can be similar to benzo withdrawal symptoms. 

The 2000s

Information about the dangers and harms of benzodiazepines began to surface more with more households using computers. The internet became the backbone of communication. But as we will see, it did not stem the growing tide of harm.

2002, The Ashton Manual

Dr. Ashton wrote a monograph, The Ashton Manual, a guide to getting off benzodiazepines. The manual was based on her experience working with patients trying to come off their benzodiazepine. The Ashton Manual continues to be the gold standard for benzodiazepine cessation and highlights the dangers and difficulties benzodiazepines present. Dr. Ashton estimated that one out of six prescribed benzodiazepine users will suffer extreme withdrawal symptoms. (The Ashton Manual can easily be found, for free, on the internet on various websites and on Amazon—https://benzo.org.uk/manual/ and here. 

2008

More than one in twenty American adults filled at least one benzodiazepine prescription.

2010

The Veterans Health Administration recommended that benzodiazepines not be used to treat PTSD.

2015

The British Medical Association published a major report highlighting the dangers of dependence and withdrawal posed by four classes of drugs, including benzodiazepines and Z-drugs.

2016

The benzodiazepine crisis finally began to gain notice from state and federal agencies in the United States. The NYC Department of Health and Hygiene and the state of Pennsylvania issued “prescribing guidelines” recommending against use longer than several weeks; that same year, the FDA issued a boxed warning against combining benzodiazepines with opiates.

2020

In 2020, after an FDA reporting program by the Benzodiazepine Information Coalition caught their attention, the FDA investigated and updated their benzodiazepine warnings to include the risks of abuse, addiction, physical dependence, and withdrawal reactions. Unfortunately, they did not announce their findings to physicians, research safe cessation, or offer any potential funding or help for protracted syndromes.

Present Day

Today, the number of prescriptions continues to rise, as does the size of the benzodiazepine-injured community. Nearly four decades after Senate hearings on the dangers of benzodiazepines, research into these drugs and physician knowledge remain woefully inadequate. The need for action grows more urgent with every passing day.

Fortunately, more people are helping sound the alarm and educating the public and the healthcare community. The Benzodiazepine Information Coalition continues to grow and shed light on the benzo problem. 

I created a certification course for healthcare workers so that they understand the dangers of benzodiazepines and can safely help their patients taper off and navigate recovery. 

Hopefully, in the not too distant future, benzodiazepines will not be prescribed as they are today.

 

Libirum (chlordiazepoxide) was the first benzodiazepine but isn’t prescribed very often. 

The most commonly prescribed benzodiazepines in the United States are:

 Valium (diazepam). It is a long-acting benzo with a half-life of 24-48 hours. It can remain in your system for ten days and can be found in urine tests up to 6 weeks after the last dose. Valium breaks down into three metabolites: nordiazepam, temazepam, and oxazepam.

Ativan (lorazepam) is a short-acting benzo. The half-life is about 12 hours, and its major metabolite, lorazepam glucuronide, is about 18 hours. It can be detected in urine for up to 6 days after you stop taking it.

Xanax (alprazolam) is a very short-acting benzo and is known for causing interdose withdrawal symptoms (withdrawal symptoms that arise between doses.) It has a half-life of about 11 hours, but its effects are only felt for a few hours. It can be detected in the urine for up to four days after cessation of the medication. Xanax does not break down into any active metabolites.

Klonopin (clonazepam) is a moderately long-acting. Its half-life is 30-50 hours. It can be detected in the urine for up to 30 days after the last dose. Klonopin does not break down into any active metabolites.

If your medication ends in ‘pam,’ it may be a benzodiazepine. Always good to check.

Each benzodiazepine can produce the same effects: sedation, sleep, calm, muscle relaxation, etc. Each benzo can cause the same withdrawal symptoms; however, each one is known for having a corner market on specific withdrawal symptoms. 

Valium is known for depression.
Ativan is known for insomnia.
Xanax is known for pain.
Klonopin is known for psychological issues.

 

To understand how a benzodiazepine works, we must first understand what they are designed to do.

What are their therapeutic actions?

Benzodiazepines are designed to inhibit excitatory responses. They calm anxiety, induce sleep, relax muscles, treat fits, seizures, and convulsions, and impair short-term memory.  These actions are referred to as: anxiolytic, hypnotic, myorelaxant, anticonvulsant, and amnestic.  

Each benzodiazepine has these effects, some more skewed to a particular action than others. 

Benzodiazepines are extraordinarily effective and have very low toxicity, especially compared to barbiturates. They can be life-saving medications in some instances.

It is unfortunate, then, that such an effective drug has an incredibly dark side to it, rendering it dangerous to use for more than a few days. The manufacturer’s insert recommends no more than two to four weeks of continued use, which is often too long for many users. Some people taking a benzodiazepine as prescribed become damaged in a few days. 

 

It’s all about GABA

Gamma-aminobutyric acid (GABA) is the calming neurotransmitter controlling the majority of inhibitory signaling in the central nervous system. GABA reduces neuronal excitability and regulates muscle tone. You can think of GABA as the brakes for your central nervous system. 

GABA works by binding to a GABA-A receptor on the outside of a neuron, which triggers the neuron to open a channel, allowing chloride ions to move through the neuron. These chloride ions make the neurons less able to respond to excitatory neurotransmitters such as serotonin, dopamine, norepinephrine, and acetylcholine. 

Benzodiazepines have their own receptor on the GABA-A receptor. When a benzodiazepine fits into its receptor, it enhances the effect of GABA and allows more chloride ions to move through the neuron, making it far less excitable. The benzos inhibit the excitatory action.

The problem is that the brain doesn’t like to be forced to do what it is not designed to do, and it wants homeostasis (balance) of excitatory and inhibitory action, so to counterbalance the inhibiting action of the benzodiazepine, GABA receptors begin to shut down, a process called “down-regulation.” Down-regulation is at the heart of benzo withdrawal symptoms.

 

Benzodiazepine withdrawal is a series of physical, emotional, and behavioral changes experienced when a person tries to reduce their dose or ceases taking a benzodiazepine. Withdrawal symptoms can also occur while on a steady prescribed dose (tolerance withdrawal), in-between doses (inter-dose withdrawal), tapering, or after cessation of the drug. Symptoms occur whether one becomes chemically dependent on the medication or is truly addicted. Week three will cover dependence vs. addiction.

Causes of Benzodiazepine Withdrawal:

  • Benzodiazepines work on GABA  (inhibitory neurotransmitter) receptors, causing downregulation of the receptors and functional changes. Without a full-functioning inhibitory system, the mind and body will be chaotic and hyper-aroused.
  • Physical dependency on the medication leads to withdrawal symptoms when one reaches tolerance, reduces the medication, or stops it.
  • Tolerance withdrawal and interdose withdrawal can occur without reducing the dose.

Prevalence of Withdrawal Symptoms:

  • An estimated 50-80% of long-term users experience withdrawal symptoms.
  • A smaller percentage experience severe withdrawal symptoms.
  • Many people fail to attribute their symptoms to benzodiazepine use and remain undiagnosed.  Many people go to doctor after doctor, not knowing why they are experiencing such odd and frightening symptoms, never to be told that they are in benzo withdrawal or BIND. They may be misdiagnosed and mistreated with medications. 

Severity and Duration of Withdrawal Symptoms:

  • Severity varies, with some individuals experiencing mild symptoms while others face severe complications.
  • Duration can range from days to months or even years.
  • Slow tapering is recommended to minimize the risk of withdrawal symptoms and promote recovery. (The Ashton Manual recommends reducing no more than 10% of the current dose every few weeks.)

Factors Influencing Withdrawal Symptoms:

  • The largest factor predicting symptom duration is the method of discontinuation (slow tapering or rapid cessation). The dose and duration on the medication do not play as significant a role as one might think. Some can take a small amount for a short time and become badly damaged. 
  • No other known predictors for severity exist. Genetics may play a role. We do not know what DNA anomaly allows the drug to harm some but not all.
  • Reducing the dose by less than 5-10% monthly can minimize withdrawal symptoms and promote safe discontinuation. Many doctors suggest a 25% reduction, possibly weekly, which is fine for opioids but too fast for benzodiazepines. 

Experiences of Benzodiazepine Withdrawal:

  • Individuals may experience “windows” (symptom-free periods) and “waves” (periods of mild or severe symptoms).
  • Symptoms can change over time, with varying levels of severity and clusters of symptoms.
  • Some people may become disabled during withdrawal, unable to work or function normally for extended periods.

Recovery Process:

  • Improvement often occurs gradually, as people taper or in the months and years following cessation.  Windows and waves are the common recovery pattern. 
  • The majority of individuals recover completely, experiencing good mental and physical health.
  • Some people may continue to have cognitive changes or a reduced tolerance to stress after long-term benzodiazepine use for some time.

Withdrawal Symptoms:

Physiological dependence on benzodiazepines is accompanied by a withdrawal syndrome characterized by a cluster of any of the symptoms listed at the end of the lesson. For more, read the blog post, Understanding Benzodiazepines and Their Withdrawal  Symptoms.

Some people have a few symptoms; some have many. Some have mild symptoms, and some have intense, even life-threatening ones. Fatal seizures have occurred, usually after a cold turkey off high doses.

 Ways to cope with benzo withdrawal symptoms:

Acceptance is a powerful tool for cultivati peace, resilience, and well-being. By accepting what we cannot change, we free ourselves from unnecessary stress and worry. Practicing acceptance involves acknowledging the reality of the present moment, letting go of resistance, and embracing what is.

We can also practice acceptance by cultivating gratitude, focusing on what we can control, and developing a growth mindset. Acceptance takes practice, but the benefits are profound, including improved relationships, greater emotional stability, and increased self-awareness. When we accept ourselves and our circumstances, we can approach life with greater ease and contentment.  Mindfulness goes hand-in-hand with acceptance. Being mindful means to have awareness of the present moment without judgment. Curiosity helps. Becoming a neutral observer helps reduce suffering in benzo withdrawal. 

Practicing patience can help you reduce stress, improve relationships, and achieve your goals with less frustration. To practice patience, it’s important to focus on the present moment, take deep breaths, and maintain a positive mindset. You can also try techniques like meditation, mindfulness, or visualization to help you cultivate patience. Remember, developing patience is a process, and it takes time and practice, but the benefits are worth the effort.

Distraction can be a useful coping tool for navigating benzo withdrawal/BIND. By focusing on something other than symptoms and negative emotions, you improve your overall well-being.

Some ways to practice distraction may include engaging in hobbies or leisure activities, spending time with loved ones, practicing mindfulness or meditation, listening to music, reading a good book, learning something new, or, my favorite, gardening. (Every year I grow a demonstration garden to teach people in withdrawal how to plant flowers and vegetables as a way to cope and recover from benzo withdrawal/BIND.)

These activities can help shift your focus away from your symptoms and turn down the volume, so to speak, of your suffering.

It’s important to note that distraction should not be used as a substitute for proper medical care.

 

The recovery time from the damage caused by benzodiazepines is estimated to be six to eighteen months on average. If symptoms persist after eighteen months, the benzo community considers the individual to be experiencing protracted withdrawal. Many people go well beyond eighteen months to recover. Some take close to a decade. 

The FDA has acknowledged that symptoms can last for weeks to years in a Drug Safety Communication from 2020. However, the FDA uses the word protracted withdrawal to indicate symptoms that last beyond four to six weeks after cessation.  (Read a post about the confusing benzo withdrawal/BIND terminology.)  

It is believed that up to 15 percent of patients who take benzodiazepines for longer than the recommended 2-4 weeks may experience protracted withdrawals 18+ months out. Still, there is no conclusive data to support this. Abruptly stopping or rapidly tapering benzodiazepines increases the risk of protracted symptoms. It is unclear whether genetics play a role in the likelihood of becoming protracted.

Healthcare professionals are often unaware of benzodiazepines and the recovery process, including protracted withdrawal syndrome. Patients who report their symptoms are frequently misdiagnosed with their pre-existing psychiatric conditions or a new psychiatric illness. Doctors may claim that the benzodiazepine has been out of the patient’s body for too long to be causing their symptoms. Many medical practitioners do not recognize protracted withdrawal as a legitimate diagnosis and may prescribe additional medications, which can cause further harm. To minimize the risk of protracted symptoms, it is recommended to slowly taper off benzodiazepines.

People can feel recovered for quite some time and then have what is called in the benzo community a setback. Setbacks can happen months or even years after one has been benzo free and feeling healed or mostly healed. setbacks often occur because one is under emotional or physical stress or has taken a supplement or drug (antibiotics are known to cause setbacks in some people). The trigger for a setback occurring is often unknown. Some seem to happen “out of the blue.” 

Setbacks can last weeks, months, or longer but do not usually last as long as the original recovery. Setbacks are often diagnosed as a new psychological issue or are dismissed as “all in the patient’s head.” 

I had two setbacks, one at three years and another at six years. Both times I was misdiagnosed and mistreated by the medical community. At some point, our nervous system heals, and we can take medication, endure stress, and take supplements without the risk of a setback. However, it is hard to determine when one is fully healed. People feel better and assume they can engage fully in life once again, only to fall back into BIND symptoms. The rule of thumb in the benzo community is to wait at least six months after you think you are fully healed before engaging in things that could possibly cause a setback.

 

Valium, the brand name for  Diazepam, is a long-acting benzodiazepine prescribed for various conditions, including anxiety, insomnia, muscle spasms, and panic disorders. In this post, I’ll discuss the challenges of Valium withdrawal,  strategies for success, and unique aspects of withdrawal/BIND (Benzodiazepine-induced neurological disorder). BIND is what we call the symptoms after we have withdrawn from the drug, i.e., it is no longer in our system. BIND symptoms can last for weeks, months, and for some, years. Symptoms are caused by neuroadaptation (brain changes) to the drug.

The Challenge of Tapering Valium

In the 1980s, Dr. Heather Ashton ran benzo withdrawal clinics in the UK. Dr. Ashton crossed her benzo patients over to Diazepam to taper. (In the Ashton Manual, it is suggested that everyone cross over.). This recommendation might give the false assumption that tapering off Diazepam will be easier than other benzos. Diazepam’s long action and small doses might make it mechanically easier to taper from, but the benefits end there. A crossover does not necessarily mean fewer or easier symptoms. There are challenges to tapering off Diazepam.

Histamine Issues

Valium inhibits the body’s ability to produce Diamine Oxidase (DAO), an enzyme crucial for breaking down histamine. High levels of histamine in the body can lead to symptoms of histamine intolerance, such as flushing, headaches, itching, and digestive issues, among others. No other benzodiazepine appears to affect the DAO. Many feel that they have developed histamine issues during their taper and beyond, and is should be noted that not all were on Valium. Histamine-like issues are fairly common in benzo withdrawal, but Valium is the worst offender.

Sedation/Depression/Anhedonia

All benzodiazepines can cause the same withdrawal/BIND symptoms. However, some have a “corner market” on specific symptoms. Valium has the unique property of being more sedating than other benzos. The reason behind this sedating effect lies in its metabolism. Upon ingestion, Valium is metabolized into three active metabolites: Desmethyldiazepam, Temazepam, and Oxazepam. (These are benzodiazepines.) These metabolites contribute to the long half-life of Valium, extending its effects for much longer periods than other drugs in its class. They are thought to contribute to the deep depression that a Valium taper can cause.  Many people experience anhedonia (the lack of ability to experience pleasure) while tapering off Valium. All benzos can cause these symptoms; however, they are usually far more pronounced when one is tapering off Valium.

Tapering Options: Water Titration, Weighing, and Compounding 

There are several methods for tapering off Valium, and two popular options are water tapering and using a scale. Water tapering involves crushing a tablet and adding it to a known volume of water and gradually reducing the amount of liquid consumed daily  Benzodiazepines are not water soluble, so this method is less accurate than using a scale, but it requires little math and is easy for most to do  One can reduce the amount daily, known as a daily micro taper (DMT), or reduce it every few weeks, which is known as the cut-and-hold method.

Using a scale involves weighing the tablets and reducing the dose by removing small portions of the tablet based on weight. One can use a sharp knife or an emery board to file down the pill. This method is reasonably accurate, but it requires a high-precision scale. A lot of math is needed if doing a daily micro taper. To avoid complex math, one can do a cut-and-hold taper.

Both methods have pros and cons, depending on personal preference. There are videos on YouTube with detailed instructions on the various tapering methods. The best tapering method for you is the one you are most comfortable implementing.

Another tapering option is to ask your doctor to write a script for reduced doses and get them compounded by a pharmacy. This is the most accurate way to taper; however, many doctors don’t like to write scripts for compounding, and it can be expensive as some insurance companies won’t cover them.

The least effective method for tapering off any benzodiazepine is “eyeballing” your dose and using a pill cutter or knife. It is almost impossible to taper accurately by simply looking at the pill’s size and guessing how much you take.

The general rule of thumb for tapering off a benzo is to reduce no more than ten percent of your current dose in two to four weeks.

Liquid Valium

I’ve heard many complaints about liquid Valium. People changing their Valium or Diazepam pills for liquid often report feeling much worse, even though the dose remained the same. I’m not aware of what causes this issue; however, it has been reported so frequently that it is worth mentioning.

Tips for Coping with Valium Withdrawal/BIND

Dealing with Valium withdrawal/BIND can be challenging, but there are several strategies to help cope with the process:

  • Consult with a benzo-wise healthcare professional if you can find one.
  • Educate yourself about benzo withdrawal/BIND, so you are your best advocate. Most healthcare professionals are not educated about benzos. You must be.
  • Develop a support system: Having friends, family, or support groups who understand your situation and can provide support is helpful.
  • Practice stress reduction techniques: Engaging in techniques such as mindfulness, meditation, deep breathing exercises, and progressive muscle relaxation can be helpful.
  • Embrace the four cornerstones of well-being:  Eat right (whole-food, plant-based diet), move enough, stress less, and love well.
  • Be patient and kind to yourself: Recovery from Valium withdrawal/BIND can be a lengthy process, and it is essential to be patient with yourself and acknowledge your progress.
  • Join a positive, solution-focused group for education, encouragement, and support.
  • Work with a benzo-wise therapist or coach.
  • Hot or cold packs can help with the pain.
  • Gentle exercise helps to metabolize stress hormones.
  • Avoid baths with Epson Salts as the magnesium may rev up symptoms.
    Should You Cross Over to Valium?
    There are pros and cons to crossing over to Valium. Crossing over has been a Godsend to some of my clients and a disaster for others. There is no way to know who will do well and who won’t. As with many things in the benzo world, we have to test and learn.
    Pros:

    • Diazepam is long-acting.
    • Diazepam comes in small doses, making cutting and tapering easier.
  • Cons:
    • Some people will feel withdrawal symptoms more intensely during the crossover or afterward.
    • Not everyone can make the switch to Diazepam.
    • Diazepam is more sedating. It is metabolized into three benzodiazpines: menordiazepam, temazepam, and oxazepam.
    • Depression can be more of a problem when tapering from Diazepam.
    • Diazepam blocks the body’s ability to make DAO so that histamine issues may arise.
    • Some doctors villainize Diazepam, thinking it is the only “addictive” benzo, and won’t prescribe it.

Ativan, a commonly prescribed benzodiazepine (especially for insomnia), can be challenging. It is essential to approach this journey with knowledge and a well-structured tapering and symptom-coping plan. In this blog post, we will explore various aspects of Ativan withdrawal/BIND (benzodiazepine-induced neurological dysfunction), including a slow taper schedule, the potential use of Valium, coping skills, and essential takeaways for a successful withdrawal experience. (We use the term withdrawal to denote symptoms that may occur while someone is on the medication or unit the drug has left the body. After that time, any remaining symptoms are referred to as BIND.)

Slow Taper Schedule

The late Dr. Healther Ashton ran a  benzodiazepine withdrawal clinic in the 1980s. She discovered that tapering slowly, no more than 10% every two to four weeks, was the best practice for coming off a benzodiazepine. Unfortunately, many doctors are unfamiliar with her work and recommend a taper designed for opioids, which is too fast. Using Dr. Ashton’s manual as a guideline is more appropriate. Slow and steady wins the race. For example, those on 1 mg of Ativan would take about 10 to 12 months to complete. It is not advisable to stop the medication abruptly as it can cause life-threatening symptoms such as seizures. A tapering plan should be personalized and based on an individual’s specific circumstances and needs, and sometimes, one may need to hold a dose if they feel they are becoming too symptomatic.

Multi-Dose Throughout the Day

To maintain stability during withdrawal, some individuals find it helpful to divide their total daily dose of Ativan into multiple smaller doses. This approach helps to ensure a consistent level of the medication in the system, reducing the likelihood of experiencing interdose withdrawal symptoms. Ativan’s half-life is reported to be approximately ten hours; however, many people feel interdose withdrawal symptoms before that time.

Possible Crossover to Valium

Dr. Ashton moved her patients over to Valium, which comes in small doses and is long-acting. Her manual recommends this. However, we now know that not everyone can make a successful crossover to Valium and that it comes with some risks. Valium is quite sedating as it breaks down into three metabolites that are benzodiazepines (nordiazepam, temazepam, and oxazepam), and can cause severe depression. Valium also blocks the body’s ability to create DAO, which is needed to break down histamine. While some individuals may find it easier to taper from Valium vs. Ativan, many find the crossover or the depression and histamine issues aren’t worth it. Only you can decide if you want to make the switch to Valium. If you do choose to crossover, do so in steps. Remove a portion of your Ativan and replace it with Valium. Ativan is about ten times stronger than Valium, so do the math to find the proper dose.

Kindling

Kindling is a phenomenon that occurs with ethanol, barbituates, and benzodiazepines. It happens when one has stopped and resumed the substance or raised then lowered the amount, which causes an increase in symptoms. Being kindled does not automatically mean one will have a protracted withdrawal (more than eighteen months of recovery) or be precluded from healing. However, it is advisable to taper slowly so that your symptoms are more manageable, avoiding the urge to up the dose and risk being kindled. If you need to hold your dose for a few days or weeks to see if your symptoms will stabilize, that is a better choice than up-dosing. Once off the medication, it is best to stay off unless your symptoms are unbearable. If you must reinstate, do so within thirty days of cessation.

Tapering Methods

There are a few ways one can slowly reduce their dose. The three main methods are:

  1. Water: Dissolve the tablet in a measured amount of water (some use milk) and gradually reduce the amount consumed over time.
  2. Scale: Using a precise digital scale to weigh the appropriate dosage for each taper.
  3. Compounding: Having a compounding pharmacy create custom-dosed capsules to help ensure accurate and consistent dosing during tapering.

These methods are shown on YoutTube and are easy to follow if you need instructions. It is not recommended to “eyeball” the pill and cut it with a knife or pill cutter.

Micro Tapering Versus Cut And Hold

One can do a micro taper or cut and hold to taper. A micro taper can be done with both water and a scale. You reduce the amount by a small fraction every day or every other day so that you’ve reduced ten percent in two to four weeks. This method requires good math skills if you are using a scale. Doing a micro taper with water is very easy; you simply remove and discard a little bit more water every day. A cut-and-hold taper is one where you cut and hold that dose for two to four weeks. A micro taper (also called a Daily Micro Taper, or DMT) has the advantage of doing away with anticipatory anxiety over the next cut as one reduces tiny amounts daily. A micro taper may be easier on the brain/nervous system as it doesn’t “shock” with a larger reduction one has to stabilize from. Both methods are effective, and the one that is best for you is the one you are most comfortable using.

Ativan’s Association with Insomnia

Benzodiazepines work on GABA receptors which are the body’s calming mechanism. The drug causes some of the receptors to stop working, a process called downregulation. The body loses some of its ability to relax, including the ability to fall asleep or to remain asleep. All benzodiazepines can cause insomnia; however, Ativan is known for its propensity for insomnia. Several strategies can be beneficial in managing insomnia during withdrawal. Establishing a consistent sleep schedule, creating a calming bedtime routine, and engaging in relaxation techniques, such as deep breathing or meditation, can promote better sleep hygiene. Acceptance of sleepless nights can also be helpful. Supplements and medications that work on GABA should be avoided. Only you can decide if you want to risk taking another psych med that can cause sedation. Antidepressants, antipsychotics, and some mood stabilizers have been offered as sleep inducers, but they come with risks and possible withdrawal syndromes.

Symptoms of Withdrawal/BIND

Withdrawal from Ativan can lead to various symptoms, including intense mental anguish. Common symptoms of withdrawal may include:

  • Anxiety
  • Insomnia
  • Agitation
  • Depression
  • DP/DR
  • Panic attacks
  • Tremors
  • Dizziness
  • Headaches
  • Nausea
  • Memory problems
  • Muscle pain and stiffness
  • Intrusive thoughts/memories
  • Burning skin
  • Weakness

For a list of reported benzodiazepine withdrawal/BIND symptoms, go here.

Coping with Ativan Withdrawal Symptoms

There are no medications or treatments that cure Ativan withdrawal. Many medications offered to people with Ativan withdrawal symptoms can slow down the recovery or present with their own withdrawal syndrome down the road. While Ativan withdrawal can be challenging, there are several strategies to help cope with symptoms.

  1. Establish a support network: Reach out to friends, family members, or support groups to discuss your experiences and seek encouragement during withdrawal.
  2. Maintain a healthy lifestyle: Eat right (WFPB), move enough, stress less, and love well.
  3. Practice relaxation techniques: Deep breathing, meditation, and progressive muscle relaxation can help manage anxiety and stress during withdrawal.
  4. Stay engaged in activities: If you can, participate in hobbies, social events, and other activities that help you to distract.
  5. Be patient: Ativan withdrawal can be lengthy, and it is essential to remember that healing takes time. Be patient with yourself and focus on small, achievable goals to maintain motivation and a sense of progress.
  6. Distract when possible: Distraction takes our focus off our symptoms and helps the nervous system settle down.
  7. Learn something new.” Learning grows new neuronal connections and gives us a feel-good dose of dopamine.
  8. Garden: Tending to a flower or veggie garden is good for the nervous system and has proven benefits for relieving depression.
  9. Get professional help: Work with a benzo-wise coach or healthcare professional to learn how to cope with symptoms.
  10. Join a support group: Become a member of a positive, solution-focused benzo withdrawal support group.
  11. Practice acceptance: Acceptance rewires the brain and nervous system for the better.

Klonopin, or clonazepam, is a medication commonly prescribed for anxiety, panic disorders, and seizures. In the benzo community, is considered “the granddaddy” of all benzodiazepines. It is twenty times more potent than Valium, and it binds more tightly to GABA receptors and works on sub-receptors. This blog post will discuss Klonopin withdrawal, its potential difficulties, and suggestions for coping with withdrawal/BIND (benzodiazepine-induced neurological dysfunction) symptoms. I was on clonazepam for 18 years. I know a thing or two about withdrawing and healing from the BIND symptoms it can cause.

The Strength of Klonopin

As noted, Klonopin is twenty times stronger than Valium, making it a potent medication with a high potential for withdrawal/BIND symptoms. This difference in strength can create challenges when tapering off the medication, as even a tiny crumb of the pill packs a wallop. It’s hard to taper in small amounts with such a high-potency pill.

Tapering Amounts

The late Dr. Healther Ashton ran a  benzodiazepine withdrawal clinic in the 1980s. She discovered that tapering slowly, no more than 10% every two to four weeks was the best practice for coming off a benzo. Unfortunately, many doctors are unfamiliar with her work and recommend a taper designed for opioids, which is too fast. Using Dr. Ashton’s manual as a guideline is more appropriate. Slow and steady wins the race. For example, those on 1 mg of Klonopin would take about 10 to 12 months to complete. It is not advisable to stop the medication abruptly as it can cause life-threatening symptoms such as seizures.

Tapering Methods

There are a few ways one can slowly reduce their dose. The three main methods are:

  1. Water: Dissolve the tablet in a measured amount of water (some use milk) and gradually reduce the amount consumed over time.
  2. Scale: Using a precise digital scale to weigh out the appropriate dosage for each taper.
  3. Compounding: Having a compounding pharmacy create custom-dosed capsules to help ensure accurate and consistent dosing during the tapering process.

These methods are shown on YoutTube and are easy to follow if you need instructions. It is not recommended to “eyeball” the pill and cut it with a knife or pill cutter.

Micro Tapering Versus Cut And Hold

One can choose to do a micro taper or cut and hold to taper. A micro taper can be done with both water and a scale. You reduce the amount by a small fraction every day or every other day so that in two to four weeks, you’ve reduced ten percent. This method requires good math skills if you are using a scale. Doing a micro taper with water is very easy; you simply removed a little bit more water every day and discard it. A cut-and-hold taper is one where you cut and hold that dose for two to four weeks. A micro taper (also called a Daily Micro Taper, or DMT) has the advantage that it does away with anticipatory anxiety over the next cut as one is reducing tiny amounts daily. A micro taper may be easier on the brain/nervous system as it doesn’t “shock” with a larger reduction one has to stabilize from. Both methods are effective, and the one that is best for you is the one you are most comfortable using.

Crossing Over to Valium

Dr. Ashton moved her patients over to Valium as it comes in small doses and is long-acting. Her manual recommends this. However, we now know that not everyone can make a successful crossover to Valium and that it comes with some risks. Valium is quite sedating as it breaks down into three metabolites that are benzodiazepines (nordiazepam, temazepam, and oxazepam), and can cause severe depression. Valium also blocks the body’s ability to create DAO, which is needed to break down histamine. While some individuals may find it easier to taper from Valium vs. Klonopin, many find the crossover or the depression and histamine issues aren’t worth it. Klonopin binds more tightly to the GABA receptor and works on sub-receptors, making the transition to Valium difficult for some. (I tried crossing over in hopes it would help my severe withdrawal symptoms. It made my symptoms worse, and so I remained on clonazepam.)

Kindling

Kindling is a phenomenon that occurs with ethanol, barbituates, and benzodiazepines. It occurs when one has stopped and resumed the substance or raised then lowered the amount, which causes an increase in symptoms. Being kindled does not automatically mean that one will have a protracted withdrawal (more than eighteen months of recovery) or be precluded from healing. However, it is advisable to taper slowly so that your symptoms are more manageable, avoiding the urge to up the dose and risk being kindled. If you need to hold your dose for a few days or weeks to see if your symptoms will stabilize, that is a better choice than up-dosing. Once off the medication, it is best to stay off unless your symptoms are truly unbearable. If you must reinstate, do so within thirty days of cessation.

Unique Metabolic Pathway

Klonopin is the only benzodiazepine that is metabolized through the NAT2 pathway and acetylation. This unique metabolic pathway means that individuals with certain genetic variations may experience a more intense withdrawal process due to their body’s inability to break down and eliminate the drug effectively.

Cornering the Market

Every benzo can cause all of the known withdrawal/BIND symptoms (over 300 have been listed in the benzo community.) However, some of the benzos “corner the market” on certain symptoms. Valium is known for depression, and Ativan is known for insomnia. Xanax is known for pain, and Klonopin is known for intense mental symptoms. This doesn’t mean that you will have intense mental symptoms; however, it is best to educate yourself so you know how to best navigate your recovery

Symptoms of Withdrawal/BIND

Withdrawal from Klonopin, or benzodiazepine-induced neurological dysfunction (BIND), can lead to a range of symptoms, including intense mental anguish. Common symptoms of withdrawal may include:

  • Anxiety
  • Insomnia
  • Agitation
  • Depression
  • DP/DR
  • Panic attacks
  • Tremors
  • Dizziness
  • Headaches
  • Nausea
  • Memory problems
  • Muscle pain and stiffness
  • Intrusive thoughts/memories
  • Burning skin
  • Weakness

For a list of reported benzodiazepine withdrawal/BIND symptoms, go here.

Coping with Klonopin Withdrawal Symptoms

There are no medications or treatments that cure Klonopin withdrawal. Many medications offered to people with Klonopin withdrawal symptoms can slow down the recovery or present with their own withdrawal syndrome down the road. While Klonopin withdrawal can be challenging, there are several strategies to help cope with symptoms.

  1. Establish a support network: Reach out to friends, family members, or support groups to discuss your experiences and seek encouragement during the withdrawal process.
  2. Maintain a healthy lifestyle: Eat right (WFPB), move enough, stress less, and love well.
  3. Practice relaxation techniques: Deep breathing, meditation, and progressive muscle relaxation can help manage anxiety and stress during withdrawal.
  4. Stay engaged in activities: If you are able, participate in hobbies, social events, and other activities that help you to distract.
  5. Be patient: Klonopin withdrawal can be a lengthy process, and it is essential to remember that healing takes time. Be patient with yourself and focus on small, achievable goals to maintain motivation and a sense of progress.
  6. Distract when possible: Distraction takes our focus off our symptoms and helps the nervous system settle down.
  7. Learn something new.”The process of learning grows new neuronal connections and gives us a feel-good dose of dopamine.
  8. Garden: Tending to a flower or veggie garden is good for the nervous system and has proven benefits for relieving depression.
  9. Get professional help: Work with a benzo-wise coach or healthcare professional to learn how to cope with symptoms.
  10. Join a support group: Become a member of a positive, solution-focused benzo withdrawal support group.
  11. Practice acceptance: Acceptance rewires the brain and nervous system for the better.

Xanax, also known as alprazolam, is a short-acting benzodiazepine prescribed for various conditions, including anxiety and panic disorders. It is the fast action of Xanax that makes it challenging to taper, along with its high potency. A  .5 tablet is the equivalent of ten mg of Diazepam. In this post, I’ll discuss those challenges, strategies for success, and unique aspects of Xanax withdrawal/BIND (Benzodiazepine-induced neurological disorder). BIND is what we call the symptoms after we have withdrawn from the drug, i.e., it is no longer in our system. BIND symptoms can last for weeks, months, and for some, years. Symptoms are caused by neuroadaptation (brain changes) to the drug.

The Challenge of Tapering Xanax

Tapering Xanax can be difficult due to its short-acting nature, which means that it has a rapid onset of action and a relatively short duration of effect. As a result, withdrawal symptoms can emerge between doses, a phenomenon called interdose withdrawal. You may not experience interdose withdrawal symptoms initially, but they may arise as your brain adapts to the drug’s action, causing the GABA receptors to downregulate.

To combat interdose withdrawals, some people dose four times a day to keep a more steady state of the drug available in their system. This can be cumbersome and prone to mistakes as doses may be forgotten or taken at the wrong times. (The brain likes consistency when dosing.)

Transitioning to Diazepam

One strategy for managing Xanax withdrawal is transitioning to a longer-acting benzodiazepine, such as Diazepam (Valium). Diazepam has a slower onset of action and a longer half-life, which can make tapering off benzodiazepines more manageable. One doesn’t need to dose Diazepam frequently throughout the day. However, it is crucial to note that Xanax is approximately 20 times stronger than Diazepam, so the dose needs to be adjusted accordingly.

The Ashton Manual, a well-regarded guide for tapering off benzodiazepines, provides detailed information on transitioning from Xanax to Diazepam. According to the manual, the crossover should be done stepwise, gradually substituting a portion of the Xanax dose with an equivalent amount of Diazepam.

Pros and Cons of a Cross Over

There are pros and cons to crossing over to Diazepam. Crossing over has been a Godsend to some of my clients and a disaster for others. There is no way to know who will do well and who won’t. As with many things in the benzo world, we have to test and learn.

Pros:

  • Diazepam is long-acting.
  • Diazepam comes in small doses, making cutting and tapering easier.

Cons:

  • Some people will feel withdrawal symptoms more intensely during the crossover or afterward.
  • Not everyone can make the switch to Diazepam.
  • Diazepam is more sedating. It is metabolized into three benzodiazpines: menordiazepam, temazepam, and oxazepam.
  • Depression can be more of a problem when tapering from Diazepam.
  • Diazepam blocks the body’s ability to make DAO so that histamine issues may arise.
  • Some doctors villainize Diazepam, thinking it is the only “addictive” benzo, and won’t prescribe it.

 

Xanax Withdrawal and Pain Symptoms

All benzodiazepines can cause the same withdrawal/BIND symptoms. However, some have a “corner market” on specific symptoms. Xanax has the corner market on muscle, joint, nerve, and bone pain. These symptoms can be challenging to manage but are generally temporary and subside as the body recovers from the withdrawal process  (When a new client reports pain as a predominant symptom, and I ask if they are taking Xanax, the answer is most often “Yes!”)

Tapering Options: Water Titration, Weighing, and Compounding 

There are several methods for tapering off Xanax, and two popular options are water tapering and using a scale. Water tapering involves crushing a tablet and adding it to a known volume of water and gradually reducing the amount of liquid consumed daily  Benzodiazepines are not water soluble, so this method is less accurate than using a scale, but it requires little math and is easy for most to do  One can reduce the amount daily, known as a daily micro taper (DMT), or reduce it every few weeks, which is known as the cut-and-hold method.

Using a scale involves weighing the tablets and reducing the dose by removing small portions of the tablet based on weight. One can use a sharp knife or an emery board to file down the pill. This method is reasonably accurate, but it requires a high-precision scale. If doing a daily micro taper, a great deal of math is needed. To avoid complex math, one can do a cut-and-hold taper.

Both methods have pros and cons, depending on personal preference. There are videos on YouTube with detailed instructions on the various tapering methods. The best tapering method for you is the one you are most comfortable implementing.

Another tapering option is to ask your doctor to write a script for reduced doses and get them compounded by a pharmacy. This is the most accurate way to taper; however, many doctors don’t like to write scripts for compounding, and it can be expensive as some insurance companies won’t cover them.

The least effective method for tapering off any benzodiazepine is “eyeballing” your dose and using a pill cutter or knife. Xanax is so incredibly powerful that small crumbs of the pill pack a punch. It is almost impossible to taper accurately by simply looking at the pill’s size and guessing how much you take.

Tips for Coping with Xanax Withdrawal and BIND

Dealing with Xanax withdrawal and BIND can be challenging, but there are several strategies to help cope with the process:

  • Consult with a benzo-wise healthcare professional if you can find one.
  • Educate yourself about benzo withdrawal/BIND, so you are your best advocate. Most healthcare professionals are not educated about benzos. You must be.
  • Develop a support system: Having friends, family, or support groups who understand your situation and can provide support is helpful.
  • Practice stress reduction techniques: Engaging in techniques such as mindfulness, meditation, deep breathing exercises, and progressive muscle relaxation can be helpful.
  • Embrace the four cornerstones of well-being:  Eat right (whole-food, plant-based diet), move enough, stress less, and love well.
  • Be patient and kind to yourself: Recovery from Xanax withdrawal and BIND can be a lengthy process, and it is essential to be patient with yourself and acknowledge your progress.
  • Join a positive, solution-focused group for education, encouragement, and support.
  • Work with a benzo-wise therapist or coach.
  • Hot or cold packs can help with the pain commonly associated with Xanax withdrawal/BIND.
  • If an OTC pain relief medication is needed, Tylenol is better tolerated in the benzo community than Advil.
  • Avoid baths with Epson Salts as the magnesium may rev up symptoms.


An interesting Xanax study can be found here.

There is no hard data proving how many people experience benzodiazepine withdrawal/BIND.  There are quite a few estimates proposed by various doctors and researchers. While we may never know the exact percentage of people who will be harmed by a benzodiazepine and experience withdrawal/BIND symptoms, we do know that benzodiazepine withdrawal/BIND is real, and people suffer.

The late Dr. Heather Ashton estimates that 50% of individuals can stop benzodiazepines without experiencing withdrawal symptoms, even after chronic usage for a year. 

Dr. Malcolm Lader suggests that 20-30% of benzodiazepine users have difficulty stopping, with a third of them experiencing distressing symptoms.

Reconnexion, an Australian nonprofit organization, claims that 50-80% of individuals who have used benzodiazepines continuously for six months or longer will experience withdrawal symptoms.

In a study comparing short half-life and long half-life benzodiazepines, 90% of patients experienced withdrawal reactions, which were generally mild to moderate.

The American Psychiatric Association’s Benzodiazepine Task Force on Benzodiazepine Dependence, Toxicity, and Abuse estimates that 40-80% of patients experience withdrawal.

The Royal College of Psychiatry and the Royal College of General Practitioners states that about 4 in 10 individuals who take benzodiazepines daily for over six weeks will become dependent. 

A 2014 study by Hood et al. found that anyone who has taken benzodiazepines for at least six months and then attempts to stop quickly will experience withdrawal reactions, with 40% experiencing moderate or severe reactions.

It doesn’t matter what the exact percentage is. Even one person suffering is one too many. The suffering is real and it touches not just the person who took the benzo, but their family, friends, and their work connections. Benzodiazepines cast negative ripples out into the world. 

 

Benzo withdrawal is unlike any other illness. It affects every level of existence; our bodies, minds, and our spirits. As hard as it is going through benzo withdrawal, what makes it even harder is that friends and family often don’t understand our illness. Here is what we wish they knew:

  1. We suffer from an iatrogenic illness, meaning it is doctor induced. We trusted our doctor and took our medication as prescribed. That medication caused a chemical injury to our brain and central nervous system (downregulated GABA receptors). We are angry (hurt, saddened shocked) that our doctors prescribed a harmful medication. We need time to come to terms with our feelings about the recovery we must go through to reclaim our health.
  2. Most doctors are uneducated about the damage caused, and therefore their advice on how to treat or cope with the damage while we heal can sometimes be dangerous. We don’t have medical support, and frankly, it is demoralizing to talk with medical personnel who tell us that “The drugs can’t do that.” or, “It’s all in your head.” or worse, “You’ve got a disorder and need more drugs.”  Please don’t tell us to seek medical help from a doctor who isn’t benzo-wise, or to shame us for not following an uneducated doctor’s advice that we know is harmful.
  3. Life may change a great deal while we are recovering. We may be unable to work or to take care of our family for quite some time. Please understand that we are not lazy. We are benzo sick. We may need you to help us do the paperwork of paying bills, taxes, etc. We may need help with grocery shopping, food preparation, or taking a shower. We may not be able to drive, walk around the block, or do much physical activity.
  4. Healing from benzo withdrawal is not linear. We have windows and waves. When we feel better, we are in a window. When we have an increase or a return of symptoms, we are in a wave. Window and waves can come on suddenly. Thus it is hard to make plans because we don’t know how we will feel from one moment to the next. Please understand when we have to suddenly cancel plans.
  5. We don’t have normal thoughts or feelings in benzo withdrawal. We are often consumed by fear and a doom and gloom view of the world/life. We may also suddenly experience euphoria one moment, only to plummet into despair the next. This is due to the damaged receptors in our brains. We can’t logically think our way out of these states. They are biological, not psychological. We must wait for our brains to recover, which means we need you to be patient with us. Don’t abandon us on our journey back to health. And, it can be a very long journey. Please go the distance with us.
  6. We may not look sick, but we feel sick. On top of not having normal thoughts or feelings, we may suffer from pain, burning skin, crushing fatigue, weakness, dizziness, tingling, and other physical symptoms. We may need someone to help us cook, clean, grocery shop, run errands, take care of our children, etc.
  7. Giving unasked for advice is damaging. It puts people on the defensive. The best thing you can do for us is to simply be present. Don’t tell us what you think we should think, feel, or do. Just listen. Deeply.  If you want to be helpful, say this: “What do you need and how can I help?” Those words empower us to find our truth and our solutions.
  8. Know that we want to be well and back to normal far more than you want that for us. We are doing our best as we face a recovery that can take quite a long time. It would be wonderful if you could educate yourself some about what we are going through, but as long as you treat us with care and compassion, that is all that matters. We need you now more than ever, and we are grateful for your love and support, even if we can’t show it or express it at the moment. When our emotions return to normal, we will be more able to communicate our deep thanks to you. Until then, please don’t be offended by our inability to connect with you.
  9. People experiencing benzo withdrawal can be exceptionally needy. We aren’t in control of our thoughts or feelings, and our bodies are experiencing strange, frightening things. We are frightened that we may never heal. We may ask over and over and over again, “Will I get well?” The answer to this question is “Yes.” Please remind us as many times as we may ask. If we become too draining with our neediness, please take care of yourself and take a break. We understand you may need to recharge your batteries.
  10. Suicide is a very real danger in benzo withdrawal. Please take us seriously if we say we don’t feel that we can go on. Have a plan of action in place with us so we both know what to do should thoughts of suicide occur.
  11. We may experience “benzo rage,” a frightening state of anger that feels overwhelming. We’ve momentarily lost control. Protect yourself, of course, should we direct our rage at you. Know that we aren’t ourselves and the rage is not who we are, nor is it really about you. It’s about damage to our brain that is slowly healing.
  12. People in withdrawal often develop food sensitivities. We have to avoid some things that we used to be able to eat. We aren’t being picky, stubborn, demanding, or seeking attention. We are avoiding certain foods to avoid an increase in benzo withdrawal symptoms. We also may have an increase in symptoms if we take certain supplements or vitamins, prescription or over-the-counter drugs.
  13. It can take years to be fully recovered from the damage caused by taking a benzodiazepine. In that time, we may have times of feeling mostly normal, only to experience a setback. We can have a flare of symptoms that once again make normal life difficult. At some point windows, waves, and setbacks will stop occurring, but until then, we have to be careful to take very good care of ourselves and limit our stress levels, eat healthily, rest, etc.
  14. We want you to know that we miss you. We miss ourselves. We miss the life we used to have. We miss the joy, the fun, the love, and the laughter. It will return, but until then, we live in an altered reality that is foreign and frightening. Please love us. Please walk with us all the way to recovery, holding our hands and our hearts. We will love you all the more when we are well, and life will once again be wonderful. Thank you for being there for us.

For the blog entry about this topic, please read this.

Recognizing the potential dangers of over-rapid tapering or inaccurate conversion to longer-lasting benzodiazepines is essential to avoid causing severe withdrawal symptoms and complications for patients.

The general rule of thumb is to reduce no more than 10% of the current dose every two to four weeks. It takes approximately one year to do a slow taper from 1 mg of Klonopin or Xanax, 2 mg of Ativan, or 20 mg of Valium.

If crossing over to Valium or another longer-acting benzodiazepine, it is best to reduce the current benzo in small amounts and replace it with the longer-acting benzodiazepine equivalent. Not everyone can handle a crossover, and no one should be forced to change their benzodiazepine. 

Additionally, be aware that add-on medications that interfere with GABA may further exacerbate withdrawal symptoms.

Many people taking a benzodiazepine do a DMT, a Daily Micro Taper, either with liquid or by using a scale. A DMT is considered to be easier on the nervous system. The goal is to reduce tiny increments daily.

A DMT with water (or milk) uses the formula as follows: Determine how many days it takes to taper. Fill a beaker or measure out a milliliter of liquid for every day. Crush the pill into a fine powder and put it into the liquid. Rinse off any instruments used for crushing with the measured liquid (do not introduce any more liquid). Swirl the particles in the liquid. Remove one ml of liquid and discard. Drink the rest (divide into doses for the day if need be).  Do the same the next day, except remove two ml of liquid. The amount of liquid used and the pill dose never change, only the amount of liquid removed and discarded. 

Others do a cut-and-hold taper; they cut their dose and stay at that dose (hold) for a few days to weeks. Most use a scale for this method, although some do a liquid titration. 

A few people get their benzo compounded by a pharmacist per their doctor’s prescription. Compounding is the most accurate; however, some doctors won’t give a prescription for compounding, and the cost deters some benzo users. 

It is also important to familiarize oneself with established tapering protocols, such as the Ashton Manual, which provides guidance on tapering rates, equivalence tables, and diazepam crossover schedules.

Furthermore, be aware that the British National Formulary guidelines advise against using medications such as gabapentin, Lyrica, clonidine, Buspar, and antidepressants for benzodiazepine cessation. Many other drugs are contraindicated by anecdotal evidence in the benzo community. 

There are many videos on YouTube about the tapering methods of benzodiazepines, which can be very helpful.

Some people who have stopped a benzodiazepine with no withdrawal symptoms will go on to have withdrawal symptoms if they return to taking the medication. Some can get on and off the medication numerous times before they become symptomatic. Some can lower the dose, raise the dose, then lower it again, and have an increase in symptoms. This phenomenon is known as kindling.

Kindling refers to a neurological condition that occurs with repeated withdrawals from three known substances: alcohol, barbiturates, and benzodiazepines. 

Each cessation increased the likelihood of increased withdrawal symptoms. Some feel that the more one is “kindled,” the more risk they have for severe withdrawal symptoms such as seizures.

The mechanisms of kindling are currently unknown. There are several hypotheses:

  •  A “priming effect”—caused by repeated exposure to the substance itself—to the repeated experience of withdrawal
  • The glutamate system is believed to play an important role in this kindling phenomenon, with a subtype of glutamate receptors being altered by repeated withdrawals from benzodiazepines.

More research is needed.

It should be noted that kindling can occur not just with cessation and reinstatement of a benzodiazepine but also by upping and lowering the dose, especially when this is done frequently. 

Also, some people seem to have been kindled by taking the drug every few days, or PRN. 

It is important for a prescriber to know the medication history of a patient, including alcohol use to avoid kindling.

Anyone who has experienced tolerance and/or benzodiazepine withdrawal symptoms should avoid taking a benzodiazepine in the future unless it is a one-time exposure for a surgical procedure, for example.

Even taking a benzodiazepine again for a short period of time can cause severe symptoms or paradoxical reactions.

If someone has become kindled, it is best to taper off the medication slowly.

Some believe that being kindled means that their recovery will be more problematic and of a longer duration. Not true. Being kindled does not automatically equate to a longer healing timeframe, nor does it mean that their symptoms will be intense for a long time.

Physical dependence and addiction are not the same things. For benzodiazepines, physical dependence results from persistent changes in GABA receptor conformation due to repeated prescribed dosing.  Addiction, on the other hand, involves destructive behaviors driven by cravings, compulsive drug use, and the inability to control drug intake despite harm to oneself or others. A person can be physically dependent without being addicted.

The majority of residential rehab and detox centers in the United States use a 12-step model focused on addiction, which is inappropriate for patients who have become physically dependent on benzodiazepines through prescribed use. This model does not address the physiological changes that occur in benzodiazepine dependence, which can only be resolved through a slow taper.

Patients often become physically dependent on benzodiazepines unknowingly and without informed consent. When tolerance develops or other reasons for discontinuation arise, they may experience intolerable withdrawal symptoms. Prescribers sometimes misinterpret these symptoms as addiction, referring patients to rehab or detox facilities instead of providing appropriate treatment.

In detox centers, benzodiazepine-prescribed users are placed alongside people suffering from Substance Use Disorder and forced to engage in Twelve-Step meetings or classes, which can be very distressing. The solution is not to place patients in inappropriate systems but to provide medical education and develop specialized facilities and resources for benzodiazepine withdrawal.

Unlike benzodiazepine-dependent patients, those prescribed antidepressants are not typically sent to rehab or detox centers despite the potential for physical dependence and withdrawal. Benzodiazepines, being a Schedule IV controlled substance, may explain this discrepancy. However, not all controlled substances indicate abuse, and patients should not be automatically deemed addicts based on their prescribed medication.

Prescribers must be knowledgeable about the differences between physical dependence and addiction and not equate evidence of tolerance and withdrawal symptoms with addiction. When this distinction is misunderstood, patients may be inappropriately sent to detox or rehab centers, resulting in dangerous and prolonged suffering.

Detox and rehab facilities face numerous challenges when addressing benzodiazepine withdrawal, including limited accessibility, affordability, insufficient resources, and poor patient outcomes.

Limited Accessibility and Affordability

  • Annual industry revenues for addiction treatment centers reached $35 billion in 2013.
  • Costs range from $15,000 to low six-figures for a 30-day stay at a private facility.
  • Government agencies and psychiatric wards offer more affordable detox programs but with limited durations.

Insufficient Resources and Time

  • Detox programs typically last between 7-90 days. Benzo patients are taken off way too quickly, oftentimes causing severe withdrawal symptoms.
  • Benzodiazepine withdrawal can take 12-18 months or more, making short-term programs ineffective for many patients.
  • A lack of resources dedicated to deprescribing contributes to the problem.

Poor & Dangerous Outcomes

  • Some facilities refuse to offer benzodiazepine detox due to risks such as protracted withdrawal, psychosis, seizures, and death.
  • Those who accept benzodiazepine-dependent patients often use rapid tapers or cold-turkey withdrawal, resulting in increased risks and poor outcomes.
  • Rapid withdrawal can lead to a delayed withdrawal syndrome, leaving patients without support during severe symptoms.
  • Patients may be so overwhelmed by the withdrawal symptoms that they go home and reinstate, feeling worse than they did before they entered the detox center.

The Unpredictability of Withdrawal

  • Withdrawal experiences vary, with some individuals experiencing minimal to no symptoms.
  • It is unwise to stop benzodiazepines suddenly, as there is no way to predict which patients will experience severe or protracted withdrawal.
  • Medical providers and patients should avoid playing “Russian roulette” with benzodiazepine cessation.

Tapering as the Most Successful Method

  • Gradual, patient-controlled taper plans, such as The Ashton Manual, have reported a 90% success rate in benzodiazepine withdrawal.

Benzodiazepines and Legal Action: Class Action Lawsuits and Medical Malpractice in the United Kingdom and the United States

In the 1980s and 1990s, benzodiazepines became the focus of the largest class-action lawsuit against drug manufacturers in the United Kingdom’s history. The case involved thousands of patients and law firms and millions of pounds in legal aid and company expenses. The plaintiffs argued that the manufacturers were aware of the drug’s potential to cause physical dependence but withheld this information from medical professionals. The suit ultimately did not result in a settlement or verdict, and changes in British law following the trial made future class-action lawsuits more difficult.

In the United States, there have been no class-action lawsuits related to benzodiazepines. The 2011 Supreme Court decision protects generic manufacturers from being sued for failure to warn, leaving patients in a difficult position regarding legal recourse for harm.

Medical malpractice lawsuits have seen some success for individual patients or their families who have been harmed by benzodiazepines. Legal action has been an important avenue for addressing the benzodiazepine crisis, but finding a knowledgeable attorney and navigating restrictions can be challenging. 

In 2023, a six-figure lawsuit was won against a doctor working at a large HMO in the US. It has set the stage for future lawsuits. More will be coming.

A way to protect yourself from possible legal action is to learn about benzodiazepine withdrawal/BIND and put into practice the best practices currently known, which are what this course is all about.

If you feel you may act on suicidal thoughts or impulses, please seek appropriate help! This course is not designed to be suicide preventative. It is an informational course only. Please take good care of yourself. 

Taking a benzodiazepine as prescribed can cause depression and suicidal ideation in people without a history of depression or worsen pre-existing depression. Similarly, tapering or cessation of benzodiazepines can also cause depression, suicidal ideation, and suicide attempts.

Unfortunately, adverse reactions and benzodiazepine withdrawal symptoms are often misdiagnosed and mistreated, leading to catastrophic outcomes. Suicide ideation (SI) is a common benzodiazepine and benzodiazepine withdrawal symptom. People experiencing these symptoms report feeling tortured beyond endurance, which can make suicide seem like the only way to end the horrific symptoms. I have been in the benzo community since 2010, and I know of over 100 suicides, some of them my clients. It is heartbreaking to know that someone lost their life because of a medication they took as prescribed. 

Taking or withdrawing from benzodiazepines can also cause emotional anesthesia, anhedonia, and altered emotional states, resulting in patients regretting living in a state of altered emotions, unable to fully enjoy their lives, families, etc. Furthermore, in the “benzo community,” there have been numerous suicides by people having paradoxical reactions, inter-dose withdrawal, tolerance withdrawal, or benzodiazepine withdrawal-induced neurotoxicity (BWD/BIND) symptoms, especially akathisia. The mental and physical pain and anguish can be too much to bear, and holding on every day becomes a monumental task.

Many patients having adverse reactions or benzodiazepine withdrawal symptoms report that disbelief, arrogance, and dismissal from their family, friends, and healthcare workers make their suicide ideation worse, as they feel hopeless and abandoned. This may be one of the reasons why people suffering from benzodiazepine damage do not seek help, knowing that there is no cure and that they may be hospitalized against their will and forced to take psychiatric or other medications that can make their symptoms worse or slow their healing. The gaslighting from the medical community can be especially difficult. A common comment from doctors is: “Benzos can’t do that.” “The drug is out of your system.” “It’s your underlying anxiety.” To have our symptoms/suffering dismissed is extremely frustrating. People in the benzo community frequently report feeling gaslighted by their doctors or therapists. 

A note to healthcare workers:

Healthcare workers need to learn the potential risks and severe consequences of benzodiazepine use. It is essential that they recognize the symptoms of benzodiazepine withdrawal and the correct tapering protocol to avoid catastrophic outcomes.

Remember that SI is a common benzo withdrawal symptom. Many people talk about wanting to end their lives when, in fact, they want the suffering to stop. It may be a challenge to discern despair or hopelessness vs. a true plan for ending their life. Putting people into psychiatric hospitals for SI may or may not be a good thing. Many are treated with medications that are counterproductive, misdiagnosed, and made to feel as if they are an addict or are truly “crazy.” Use caution when working with someone who is exhibiting SI. Compassion and deep listening can go a long way.

To cultivate a state of health and well-being, it is essential to focus on four key areas of life. These cornerstones—eat right, moving enough, stress less, and love well—provide a foundation for physical, mental, and emotional health. In this lesson, we will explore each cornerstone in detail and discuss how they contribute to our well-being. Additionally, we will touch upon the Polyvagal Theory as a framework for understanding stress and its impact on our well-being. These cornerstones can help stack the cards in your favor to heal as quickly as possible.

  1. Eat Right (WFPB): The cornerstone of “Eat Right” emphasizes the importance of nourishing our bodies with a whole-food, plant-based diet. A Whole-Food, Plant-Based (WFPB) approach focuses on consuming predominantly unprocessed plant-based foods, such as fruits, vegetables, whole grains, legumes, nuts, and seeds. This dietary pattern provides essential nutrients, fiber, and antioxidants, supporting optimal physical health and reducing the risk of chronic diseases. Good resources for further study are nutritionfacts.org and forksoverknives.com.  The movies The Game Changers and Forks Over Knives are educational. The book Fiber Fueled by Dr. Will Bulsiewics explains the merits of a WFPB diet on the gut microbiome. Science has shown that we are only as healthy as our gut, so it is best to feed it what it needs. All animal proteins are inflammatory. We are healthier when we avoid them. And yes, one can get enough protein (we only need 10% of our daily caloric intake to be protein) from a WFPB diet. The SAD diet (standard American diet) is high in sugar, sodium, cholesterol, and fats (and calories!) and is lacking in fiber, which is what nourishes the gut microbiome. 
  2. Move Enough: “Move Enough” highlights the significance of regular physical activity for maintaining physical fitness, vitality, and overall well-being. Engaging in activities that get your body moving, such as walking, jogging, dancing, swimming, or yoga, helps improve cardiovascular health, strength, flexibility, and mood. Finding activities that you enjoy and incorporating movement into your daily routine is key. Exercise metabolizes stress hormones.  
  3. Stress Less: Stress Less is about managing stress levels to promote emotional well-being. Polyvagal Theory, developed by Dr. Stephen Porges, provides insights into how our autonomic nervous system responds to stress and how it influences our overall state of well-being. According to the theory, our state (the physiological and emotional state of our nervous system) drives our story (our thoughts, emotions, and behaviors). By understanding this connection, we can implement strategies to regulate our nervous system and reduce stress. Our default state is called the connect state. It is a parasympathetic ventral vagal response. When we are in the connect state, we have an outward focus. We can engage with others and the world around us in life and love-affirming ways. We have more connection to the prefrontal cortex, the center for executive functioning. We will have positive thoughts and feelings in the connect state. By engaging in activities that reduce stress and avoiding stressful events or environments is helpful. 
  4. Love Well: “Love Well” encompasses various qualities and practices that contribute to our emotional and social well-being. It involves being kind, caring, and compassionate towards ourselves and others. Practicing forgiveness, gratitude, patience, acceptance, grace, and empathy fosters positive relationships and enhances our overall sense of connection and fulfillment. Cultivating curiosity, awe, wonder, and vulnerability and engaging in acts of service to others also contribute to our emotional well-being. Learning to listen effectively (don’t interrupt, steal the conversation, multitask, lose focus, make the speaker defensive, give unasked advice, etc.) goes a long way to being love in the world. Loving well is an outward focus, taking the spotlight off our egos and opening our hearts and minds to life around us. Loving well encourages the ventral vagal response (connect state), helping us to be healthier and happier. 

It’s important to know that “State Drives Story”.  The concept of “State Drives Story” within the context of the third cornerstone refers to the idea that our physiological state influences our thoughts, emotions, and behaviors. When our autonomic nervous system is in a calm and regulated state, we are more likely to experience positive thoughts, and emotions, think rationally and logically, and engage in prosocial behaviors. Conversely, when we are in a stressed, dysregulated state, feeling a threat of some kind we are in the protect state. Our thoughts, and emotions will be negative.  The protect state is sympathetic fight or flight and a parasympathetic dorsal vagal freeze reaction. By focusing on regulating our state through practices like deep breathing, meditation, mindfulness, and self-care, we can positively influence our nervous system and change our story, and enhance our well-being. Practicing the fourth cornerstone, love well, helps us shift out of the protect state and into the default connect state where we want to be, where deep healing happens.

The four cornerstones of well-being—Eat Right (WFPB), Move Enough, Stress Less (incorporating the Polyvagal Theory), and Love Well—provide a comprehensive approach to promoting physical, mental, and emotional health. By nourishing our bodies with wholesome foods, engaging in regular physical activity, managing stress through state regulation, and fostering love, compassion, and positive relationships, we can create a solid foundation for overall well-being. Remember, each cornerstone is interconnected, and finding a balance that suits your unique needs is key to cultivating a fulfilling and healthy lifestyle.

The four cornerstones of well-being help stack the cards in a benzo sufferer’s favor to heal as quickly as possible and to go on beyond withdrawal much healthier and happier. Even old emotional wounds and past traumas can be overcome with the practice of the four cornerstones. 

 Go Plant-Based in 30 Days

Please download the PDF below and read about the impact of animal protein. 

Impact of Animal Protein.pdf

Recovering from benzodiazepine withdrawal or Benzodiazepine-Induced Neurological Dysfunction (BIND) requires a comprehensive approach that prioritizes the well-being of both the mind and body. 

This lesson will outline recommended strategies to support recovery during this challenging process. These strategies include introducing a slow taper, avoiding gabaergic supplements or medications, minimizing the use of adjunct medications if possible, listening to your body (don’t taper too fast or too slow and be aware of overdoing activity or stress), joining positive solution-oriented support groups, educating yourself about benzo withdrawal/BIND, embracing the four cornerstones of well-being, practicing patience, acceptance, and gratitude and finding ways to distract. Mindfulness practices are also helpful. 

  1. Slow Taper: A slow and gradual tapering schedule is recommended to minimize the intensity of withdrawal symptoms and provide the body with ample time to adjust to reduced benzodiazepine doses. Tapering should be conducted under the guidance of a knowledgeable healthcare professional who specializes in benzodiazepine withdrawal. Read the Ashton Manual. (A crossover to Valium is not needed unless one is taking a very short-acting benzo like Xanax.) Sidebar: many people cannot find a benzo-wise prescriber and design a taper for themselves, using their prescriber only as the source for their medication.
  2. Avoid Gabaergic Supplements or Medications: During benzodiazepine withdrawal/BIND, it is advisable to avoid supplements or medications that act on the GABA receptors, as they may interfere with the body’s natural healing process and potentially prolong withdrawal symptoms.  Many medications can rev up symptoms.
  3. Minimize the Use of Adjunct Medications: If possible, it is recommended to minimize the use of adjunct medications during benzodiazepine withdrawal/BIND. While these medications may be prescribed in certain cases, it is important to be aware of the potential risks associated with their use, as discussed in the previous lesson. A benzo-wise healthcare professional (or benzo coach) can provide guidance on the appropriateness and potential risks of adjunct medications.
  4. Listen to Your Body: During the recovery process, it is essential to listen to your body’s signals and respond accordingly. Rest when needed, engage in activities that promote relaxation and stress reduction, and prioritize self-care. Pushing through symptoms or following a rigid calendar may hinder the healing process and increase stress levels.
  5. Join Positive Solution-Oriented Support Groups: Seek support groups that focus on positive solutions and provide a supportive and understanding environment. Connecting with others who have gone through or are going through similar experiences can provide valuable insights, encouragement, and practical advice. However, it is crucial to avoid negative, symptom-focused groups that may perpetuate anxiety or fear.
  6. Educate Yourself: Educating yourself about benzodiazepine withdrawal/BIND can empower you with knowledge about the process, potential challenges, and strategies for managing symptoms. Reliable resources, books, and reputable websites can offer valuable information to support your recovery journey.
  7. Work with Benzo-Wise Medical Professionals: Collaborating with healthcare professionals who have expertise in benzodiazepine withdrawal/BIND is highly recommended. These professionals understand the complexities of the condition and can provide tailored support and guidance throughout the recovery process.
  8. Embrace the Four Cornerstones of Well-Being: To promote overall well-being during recovery, embrace the four cornerstones: a) Eat Right: Adopt a whole-food, plant-based (WFPB) diet that focuses on nutrient-dense foods to nourish your body and support healing. b) Move Enough: Engage in regular physical activity that suits your capabilities and preferences, promoting circulation, stress reduction, and overall well-being. Don’t over do it! c) Stress Less: Practice stress reduction techniques such as meditation, deep breathing exercises, mindfulness, or engaging in activities that bring you joy and relaxation. Learn how your nervous system works, i.e. the connect vs the protect state. d) Love Well: Cultivate healthy relationships, seek support from loved ones, and prioritize self-love. Loving well doesn’t mean to feel love, as many can’t access positive emotions during benzo withdrawal, but rather it means to BE love: kind, caring, compassionate, forgiving, generous, curious, patient, accepting, being of service to others, extending grace, practicing gratitude, embracing humility, awe and wonder. These ways of being in the world are an outward focus, encouraging the nervous system to move out of the protect state and into the connect state, which is where we are healthier and happier. 
  1. Be Patient: Recovering from benzodiazepine withdrawal/BIND takes time and patience. Healing is a gradual process, and progress may not always be linear. Embrace the ups and downs, and remember that each person’s journey is unique. Allow yourself the time and space needed to heal fully. Windows and waves are the norm. Symptoms can come and go. 
  2. Practice Acceptance and Gratitude: Acceptance of the current situation and the challenges it presents can help reduce resistance and promote a more peaceful mindset. Cultivate gratitude for the small victories, progress made, and the support and resources available to you. Gratitude can shift your focus to the positive aspects of your recovery journey.
  3. Become an observer: Observe your thoughts and feelings. Don’t believe the negative ones as “state is driving story.” If you have intrusive or looping thoughts, know that they are NOT a reflection of your character but rather a reflection of your nervous system being in a hyper-aroused state without the necessary working of the GABA receptors to calm it. 
  4. Other Ideas: a) Engage in stress-reducing activities such as yoga, meditation, mindfulness, or deep breathing exercises. b) Explore alternative therapies like acupuncture or massage if appropriate and with guidance from a healthcare professional. (Be careful as both have been known to rev up symptoms in some, but are very effective in reducing symptoms in others. c) Prioritize sleep hygiene and establish a regular sleep schedule to support restful and restorative sleep. Insomnia is very common, but sleep hygiene can help. d) Engage in creative outlets, hobbies, or activities that bring you a sense of purpose and fulfillment. e) Consider journaling to express your thoughts and emotions, track your progress, and reflect on your experiences. f) Connect with nature and spend time outdoors to promote relaxation and rejuvenation.

Timeline for recovery.

The healing timeline for benzodiazepine withdrawal is a complex and highly individualized process. Contrary to a linear progression, where one might expect consistent improvement over time, benzodiazepine withdrawal often follows a “windows and waves” pattern. “Windows” refer to periods where symptoms lessen, and you may feel closer to your old self, experiencing moments of clarity and well-being. “Waves,” on the other hand, are phases where symptoms resurface or intensify, which can be disheartening for those in the midst of withdrawal. This cyclical nature can make it challenging to predict when you’ll feel better, as the windows and waves can be erratic and unpredictable.

What adds to the complexity is that each individual’s experience can vary widely. So many factors influence the withdrawal process. This makes it virtually impossible to set a standardized timeline for recovery. Some people may recover within a few months, while others might take years to return to their baseline health. 

Understanding the unpredictability and non-linearity of benzodiazepine withdrawal is crucial for both those going through it and their support networks. Expecting a straightforward path to recovery may lead to frustration and added stress, which are counterproductive to the healing process. Patience, support, and evidence-based interventions are key elements in navigating this challenging journey. Since everyone is different, it’s essential to consult healthcare professionals for a tailored treatment plan that addresses your unique needs.

Conclusion: Recovering from benzodiazepine withdrawal/BIND requires a holistic approach that considers both physical and emotional well-being. By implementing strategies such as a slow taper, avoiding gabaergic supplements or medications, minimizing the use of adjunct medications, listening to your body, joining positive support groups, educating yourself, working with knowledgeable professionals, embracing the four cornerstones of well-being, practicing patience, acceptance, and gratitude, you can optimize your recovery journey and support your overall well-being. Remember, each person’s journey is unique, so it is essential to personalize these strategies based on your specific needs and consult with healthcare professionals who specialize in benzodiazepine withdrawal/BIND for personalized guidance and support.

Many people go to an emergency room because they don’t understand what is happening (they don’t know they are in benzo withdrawal) and are frightened that they may be having a true medical emergency. You can help yourself avoid needless trips to the ER by educating yourself about benzo withdrawal symptoms and how to cope best. Of course, it is always prudent for someone to seek help if they feel in danger. 

Visits to the ER often result in embarrassment or frustration as most ER doctors and nurses are not educated about benzo withdrawal and make erroneous diagnoses. Benzo withdrawal sufferers are frequently told there is nothing wrong with them or they have anxiety. Sometimes, a benzo will be offered to calm the person down. Other outcomes for an ER visit are to be treated (and shamed) as an addict and told that the visit is drug seeking. Or, one may be told they must go to a psychiatric hospital or detox center. Rarely is someone educated and comforted by a trip to the ER for benzo withdrawal/BIND symptoms.

Psych hospitals can be dangerous for someone in benzo withdrawal/BIND. As most medical personnel are ignorant about benzo withdrawal/BIND, medications that can hinder healing, cause a flare in symptoms (a wave), or have a withdrawal syndrome are given. Benzo sufferers are often told that they have severe mental illness and will never be able to function in society again without a cocktail of psych meds. When a sufferer speaks up to try to educate about benzo withdrawal, they are dismissed and may be labeled noncompliant. Medical records of benzo withdrawal sufferers are often a trail of incorrect labels and diagnostic codes. 

There are no treatments for benzo withdrawal, so there is little psych hospitals can do other than to help keep someone who is suicidal from acting on their impulse. Insisting that a patient/client go inpatient may not be the best for them. Please consider all options carefully. 

Outpatient programs are sometimes recommended for people suffering in benzo withdrawal/BIND. These programs are usually to teach how to cope with anxiety or depression. Although they are good programs, they may not be beneficial for someone in benzo withdrawal/BIND as their anxiety is from downregulated GABA receptors. It is good to learn new life skills, but one cannot expect an outpatient program to relieve someone’s benzo withdrawal/BIND symptoms. It may be tempting to tell someone who is not progressing with the program that it is their fault; they aren’t working hard enough, etc., but it’s not their fault. It is the chemical brain injury from the benzo that is keeping them anxious.

It is frustrating to know that there is no way out of benzo withdrawal/BIND other than through. Hospitals can’t take away our suffering. There is no cure other than time.

There are so many little details about benzo withdrawal/BIND that are difficult to include in any one lesson category. I’ve included some of them here for you.

  • Tylenol is usually better tolerated than Advil in the benzo community.
  • Magnesium, B12, vitamin D, and fish oil usually cause an increase in symptoms. (No one should use fish oil as it contains heavy metals, is often rancid, and there is a correlation to prostate cancer in men. Algae supplements are better.)
  • If one has been taking magnesium and wants to stop, tapering off of it may be better than abruptly stopping. 
  • Progesterone can be very difficult to stop taking. Withdrawal symptoms can mimic benzo withdrawal symptoms for some. Unless it is necessary, hormone replacement therapy should be avoided in benzo withdrawal.
  • Botox injections can rev up symptoms. 
  • Dental work, including novocaine with epinephrine in it, can rev up symptoms. Asking for a local without epi is usually best. 
  • No alcohol or caffeine during withdrawal/BIND, and wait until many months have gone by since one felt normal to start using again. 
  • Life review is a symptom that is especially cruel. One ruminates over every negative thing they have said or done, feeling guilt and shame. Remembering the bad things people did to you can also occur, causing anger, rage, and resentment.
  • Making big life changes during benzo withdrawal/BIND is not a good idea.
  • No baths with Epsom salt as it contains magnesium and it can be revving. 
  • CBD and medical marijuana are controversial in that they help some but can severely increase symptoms in others.
  • All antibiotics can cause intense waves or setbacks.  Floroquinolones must be avoided if someone is taking a benzodiazepine, as it can cause a cold-turkey reaction.
  • Weight loss can be extreme during benzo withdrawal.
  • Detox diets, teas, saunas, etc., are usually not helpful and often make symptoms worse. 
  • IV therapies have not been shown to be helpful and are very expensive. 
  • Flumazenil has not been shown to be helpful or to “reset” the GABA receptors. It can cost tens of thousands of dollars. 
  • Heat often makes symptoms worse.
  • “Benzo Belly” is a constellation of symptoms that doctors have not pinpointed the cause. Stomachs can swell and protrude, appearing as if one is very pregnant. Pain, cramping, the sensation of heat, and other uncomfortable symptoms can occur. 
  • Getting disability payments when one is unable to work due to benzo withdrawal/BIND is often very difficult. Many are denied. Finding a benzo-wise doctor to write a note and be an advocate can help.
  • Propanolol is sometimes given for controlling benzo withdrawal/BIND symptoms, especially akathisia or high blood pressure. It should be tapered when one is ready to stop taking it. Don’t stop it abruptly. Only prescribe it if is necessary, as it can be problematic. 
  • Tinnitus is a very common benzo withdrawal symptom, as are insomnia, fear, anxiety, paranoia, intrusive thoughts, and pain. 
  • Some people become dependent on a benzodiazepine in a matter of days. Tolerance withdrawal symptoms begin. 
  • The duration of recovery is not dose-dependent, or the length of time using the medication.  Some people have taken three years to recover from 1 week of benzo use, for example. 
  • Many people in benzo withdrawal become exercise intolerant.
  • Avoiding a benzo pre-surgery may be a good idea if possible. Profopol seems to be better tolerated than other anesthetics.

There are more resources than ever to learn about benzodiazepine withdrawal/BIND and receive support.