What to Expect During Benzodiazepine Detox

In some instances, benzodiazepine detox can include life-threatening withdrawal symptoms. Medical detox is always recommended.

Physicians will generally employ a gradual tapering schedule to reduce the likelihood and severity of withdrawal symptoms.

 

Benzodiazepine Use

Benzodiazepines are a large class of drugs that attach to the receptors that are specialized for GABA (gamma-aminobutyric acid) in the central nervous system (CNS) and scattered in other areas throughout the body. 

By attaching to the GABA receptors, benzodiazepines mimic the functioning of GABA, the major inhibitory neurotransmitter in the CNS.

In this manner, they produce relaxation, anxiety control, seizure control, and sedation. They can even be used to treat withdrawal from alcohol and other drugs.

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Tolerance and Withdrawal

Over time, tolerance develops, as the system makes adjustments to counteract the effect of benzodiazepines. Eventually, these adjustments result in neurotransmitters and other substances that exert effects in opposition to benzodiazepines being produced in more substantial amounts. This includes increases in excitatory neurotransmitters and hormones that produce excitation.

When benzodiazepines are active in the system, this increase in other neurotransmitters may result in a state of balance. When benzodiazepines are metabolized and leave the system, the person stops taking them; there is a state of imbalance. The person experiences withdrawal, which means they have developed a physical dependence on benzodiazepines.

Benzodiazepine Withdrawal

Benzodiazepine withdrawal syndrome is a term that describes a broad series of symptoms that occur when a person has developed a physical dependence on benzodiazepines and experiences withdrawal symptoms when they discontinue use of the drugs.

 

During Benzodiazepine Detox

The withdrawal symptoms can be quite variable. They can include a wide range of physically and mentally debilitating effects.

Some of these effects can be potentially dangerous, including the development of seizures, hallucinations, labored breathing, and even the potential for cardiac arrest.

Because of these potentially dangerous symptoms, individuals who are attempting to discontinue abuse of benzodiazepines or even those who want to stop long-term medicinal use should only do so under the supervision of a physician.

Differential Withdrawal Effects

Benzodiazepines are metabolized differently, depending on the type. There are differential withdrawal effects for short-acting benzodiazepines and long-acting benzodiazepines.

SHORT-ACTING BENZODIAZEPINES

Short-acting benzodiazepines like Xanax (alprazolam) and Ativan (lorazepam) will often produce withdrawal syndromes 24 hours after discontinuation. They peak within one to five days and last anywhere from seven to 21 days.

LONG-ACTING BENZODIAZEPINES

Long-acting benzodiazepines like Valium (diazepam) and Librium (chlordiazepoxide) produce withdrawal symptoms within several days of discontinuation (up to five days). They peak in intensity within one to nine days, and the withdrawal syndrome can last 10 to 28 days.

Although formal withdrawal symptoms from benzodiazepines typically last less than a month, some individuals may still experience residual symptoms — such as anxiety, increased sensitivity to perceived stress, problems with motivation, and/or issues with insomnia — for months or even years.

Benzodiazepine Detox. What to expect?

Before the detox process begins, there should be a thorough psychiatric evaluation to determine any issues that need to be addressed during the recovery process. A medical detox program uses a tapered withdrawal from benzodiazepines to minimize the potentially dangerous symptoms that can occur during the withdrawal process.

Rapid detox from benzodiazepines or short-term detox programs for benzodiazepine withdrawal should be avoided. Instead, a longer taper is suggested to help the system slowly return to levels of functioning that are as close to normal as possible. Rapid detox programs can be potentially dangerous and even life-threatening.

Outpatient vs. Inpatient Detox

For most individuals who abuse benzodiazepines, outpatient detox is not recommended. People with substance use disorders as a result of benzodiazepine abuse have already demonstrated an inability to control their use of benzodiazepines. To expect them to complete an outpatient tapering program successfully or to be able to taper their dosage on their own is unrealistic.

The safest way to engage in a withdrawal management program from benzodiazepines is on an inpatient basis.

Polysubstance Abuse

Benzodiazepines are most often not the primary drug of abuse. They are commonly abused in conjunction with other drugs like opioids, alcohol, sedatives, and even stimulant drugs. Individuals with polysubstance abuse issues may have very complicated withdrawal syndromes that need special intervention.

People with substance use disorders often have other co-occurring psychological disorders that also need to be treated along with the substance abuse problem. These issues can be addressed more effectively in an environment that provides constant supervision, monitoring, and professional care.

Inpatient Medical Detox

During inpatient medical detox, the person has access to immediate care if they need it. Most often, the tapering process consists of using a long-acting benzodiazepine like Librium or Valium, starting with the dose that controls any withdrawal symptoms and then slowly tapering down the dose over time.

The tapering process is adjusted to suit the needs of the individual, but often, a particular percentage of the dose will be cut down every day or every other day to slowly wean the person off the benzodiazepine. Other medications may be used to address any symptoms that are not completely controlled by the tapering process or other issues that were identified in the assessment.

In some cases, benzodiazepines may not be used during the tapering process. The barbiturate phenobarbital or some anticonvulsant medications may be used in place of benzodiazepines.

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Is Detox and Rehab the same?

Although many people view the medical detox process as “rehab,” it is not a rehabilitation program. The medical detox process prepares the person to engage in recovery by limiting the potential for relapse.

Once the person has completed a medical detox program and discontinued use of benzodiazepines, they should continue to engage in a treatment program that includes:

  • Continued medical assisted treatments as recommended by a psychiatrist or addiction medicine physician
  • Individual or group substance use disorder therapy
  • Participation in peer support groups like 12-step groups
  • Treatment for any co-occurring psychological disorders that were identified in the initial assessment
  • Vocational rehabilitation services, case management services, educational services, and other services

People need to remain in treatment and maintain abstinence for a minimum of five years before they can consider their risk of relapse to be significantly reduced. The risk of relapse never totally disappears in those in recovery from substance use disorders, but after five years of continued treatment and abstinence, it is significantly lowered.

Speak to an addiction treatment specialist at Serenity at Summit to learn more about addiction and how it can be treated. Call 844-326-4514 or contact us online to learn more about your addiction therapy options.