Withdrawal phenomena appear to be more severe following withdrawal from high doses or short-acting benzodiazepines. Dependence on alcohol or other sedatives may increase the risk of benzodiazepine dependence, but it has proved difficult to demonstrate unequivocally differences in the relative abuse potential of individual benzodiazepines. Certain benzodiazepine withdrawal factors play a role in the severity of withdrawal symptoms, such as dosage, duration of action of the BZD duration of treatment with the drug, and severity of psychiatric symptoms pre-treatment. Studies have shown that treatment for longer periods with high-dosage, short-acting BZD contribute to more severe withdrawal effects [61].
If you want to stop taking benzodiazepines after consistent long-term use, your doctor can help you gradually taper off your medication. Tapering can help take the edge off withdrawal symptoms like tremors and nausea, though it may not prevent withdrawal symptoms entirely. Some people, such as those with a history of complicated withdrawal, seizures, or severe mental illness, may be better suited for an inpatient setting. This can involve living at a detox facility or hospital for several weeks, where you can receive constant medical monitoring and psychological support.
1. Factors Influencing Withdrawal Symptoms
The ultimate concern is that such fetuses will later be susceptible to autism, learning difficulties, attention deficit disorder, and general hyperactivity [24]. The use and discontinuation of alprazolam within 2 weeks disrupt sleep onset and quality, increasing suicide risks [51]. Some patients are reluctant to consider ceasing their benzodiazepine and are at high risk of relapse or harm.
The mainstay of BZD withdrawal treatment at this time is a slow taper off the drug to prevent severe withdrawal symptoms; however, many patients cannot tolerate this taper without experiencing rebound anxiety and other symptoms. Current studies are aimed to decrease this rebound anxiety effect while also decreasing relapse into BZD use using different medications, counseling, BZD dosing strategies, or different tapering techniques. Patients with a lower risk of relapse are those taking a daily dose of 10 mg diazepam equivalent or less at the start of tapering, and those who have made a substantial dose reduction themselves before the start of tapering. The risk of falls leading to injuries in elderly BZD users is significantly increased in patients greater than 80 years old, while the increased risk is not significant in patients under 80 [22].
3. WITHDRAWAL MANAGEMENT FOR OPIOID DEPENDENCE
Acute withdrawal begins after the initial withdrawal symptoms, generally within a few days. Symptoms generally last 5–28 days, though some may last for several months. There are three possible phases for benzo withdrawals, each with an estimated timeline. A person should always withdraw from benzos under the guidance of a healthcare professional. They should never quit benzos suddenly without first consulting a professional and developing a plan with them.
This is because symptoms of withdrawal that are dangerous, such as seizures and the potential for coma, can arise without notice. It has been shown in a randomized, double-blind, placebo-controlled multisite trial12 to be effective as an adjunct to other forms of addiction treatment. In the first instance, attempt behavioural management strategies as shown in Table 2 (page 33). If this does not adequately calm the patient, it may be necessary to sedate him or her using diazepam. Provide 10-20ng of diazepam every 30 minutes until the patient is adequately sedated.
4. Complications of Benzodiazepine Abuse
The suppression of CaMKIIa by diazepam has a long-lasting effect leading to a limited neuronal response to changes in intracellular calcium and decreased response by GABA-A receptors [42]. In 2018, between 8.3% and 12.8% of BZD users in Switzerland have prescriptions from multiple physicians https://ecosoberhouse.com/article/is-it-safe-to-drink-alcohol-during-pregnancy/ which resulted in the inability to track the number of prescriptions a patient is given yearly [40]. In a survey of British general practitioners, many reported pressures in prescribing BZD to patients and a lack of adequate knowledge on alternative psychological treatment for insomnia [41].