37. WHAT IS PROTRACTED WITHDRAWAL SYNDROME?
Protracted With Syndrome (PWS) is not a phenomenon with a single,
unitary definition. Many people who have no experience with
benzodiazepine dependency, which includes almost half of the medical
community, do not recognize any form of withdrawal syndrome as
persisting beyond about 30 days. Part of the problem is that the
average physician sees very few people with serious benzodiazepine
dependency, and when they do, the symptoms are often misinterpreted or
misdiagnosed. Another problem is that statistics actually show that,
indeed, about 70% of people with a benzodiazepine dependency are able to
complete withdrawal in less than a month. However, it is important to
understand that this statistic takes into account large numbers of
people who have used a benzodiazepine for only a few weeks or months.
For people who have used benzodiazepines for years, a 6 to 18 month
course of withdrawal is actually the norm. For doctors who have not
seen significant numbers of people in this circumstance, that scenario
is viewed as "protracted," because withdrawal syndromes rarely persist
more than 30 days for virtually every other class of drug.
What those few doctors and recovering victims who truly understand
benzodiazepine dependence know is that the 6 to 18 month scenario is
just a typical outcome for any serious dependency. In those circles,
PWS is roughly defined as significant, debilitating, and continuous (not
minor or occasionally occurring) symptoms persisting beyond about one
year after total cessation of the drug. One of the true ironies here is
that just as there is debate among the truly ignorant as to whether the
very common 6 to 18 month scenario exists, there is also a debate among
people in recovery and addiction medicine circles as to whether true PWS
(beyond about 18 months) is a real phenomenon. Most people in these circles
believe it is. However, some would attribute symptoms several years
out to a re-emergence of an underlying condition, to some other
undiagnosed medical or psychiatric condition, or to psychosomatic
complaints.
Dr. Ashton and others believe that PWS is a real phenomenon. What
causes it is at this point is unknown. However, there are two things to
keep in mind about PWS. First, even if you are in the category of
people with a serious dependency, the statistical likelihood of you
experiencing PWS is quite small, probably less than 1 in 10. If you are
two years out and have occasional, mild symptoms, that is not PWS. It
is typical. If you have significant, debilitating symptoms beyond a
year, that is PWS and it is atypical but not unheard of. However, the
second thing to keep in mind is that there is no evidence that
benzodiazepine withdrawal syndrome can ever be permanent. Even in the
rare cases that symptoms persist for years, they gradually diminish over
time until they are gone.
As you taper, do not concern yourself with whether or not you will
experience PWS. You probably will not. And even if you do, that is
something to manage if or when you get there.
38. SHOULD I USE A 12 STEP PROGRAM LIKE NARCOTICS ANONYMOUS TO HELP ME
RECOVER FROM MY BENZODIAZEPINE ADDICTION?
This is a personal choice, and opinions vary considerably in the
benzodiazepine recovery community. In fact, the issue has been debated
on the
benzo@egroups.com (see below) more than once. Some feel that
most people who have a benzodiazepine dependency are not drug abusers.
Rather, they are people who have taken a medication according to their
doctor's instructions for a specific medical and/or psychological
condition, have never exceeded the recommended dosage, have never
experienced a "high" or intoxication from the drug, and have never
experienced a specific craving for the drug. This is where the term
"accidental addict" is rooted. Often, people who fit this mold feel
that 12 step programs such as NA are not a proper fit for them, because
those programs are aimed at conditioning people to avoid abuse type
behaviors. People with a benzodiazepine dependency are often seeking
support and guidance on how to manage their withdrawal syndrome, not
training on how to avoid drug abuse.
Still others not only feel that these types of programs have helped
them, but feel that they would not be alive today without them. It is
important to note that a sizable percentage of benzodiazepine dependents
do exhibit patterns of abuse. The clearest sign is taking dosages far
in excess of what your doctor has prescribed, and/or having a history of
abusing other drugs in the past or simultaneously with your
benzodiazepine. 12 step programs may be a better fit for people in that
category.
One factor that many have found helpful in the withdrawal process is
spirituality, e.g. a connection with some form of Higher Power(s). Some
have found that 12 step programs help them understand the importance of
spirituality. Others have found their own spirituality without the
assistance of any such program.
39. WHO IS DR. HEATHER ASHTON?
Dr. C. Heather Ashton D.M. is a British psycho-pharmacologist (an expert on
psychiatric drugs) who ran a benzodiazepine detoxification clinic in Newcastle,
England between 1982 and 1994. During that time, she detoxified over 300
patients,
with a high rate of success. Her DM degree is a Doctorate in Medicine.
One of her papers is an observation of the outcome of her first 50 cases.
In that study, only three patients relapsed, and the others made it through
with varying long term outcomes - mostly positive. Dr. Ashton is undoubtedly
one
of the world's foremost authorities on benzodiazepine addiction and recovery.
Dr. Ashton always switches her patients to Valium (see above) unless, of course,
Valium is their drug of dependency. She also recommends a very slow taper.
She has written a manual for consumption by the general public. It is
available for purchase at
http://members.dencity.com/ashtonpapers/index.html. This manual is an
excellent resource for anyone beginning the process of detoxification.
Dr. Ashton is not the only expert on the subject, but she is one of the
more knowledgeable ones. She is far more knowledgeable than this
author.
39. WHAT IS
BENZO@EGROUPS.COM?
Benzo@egroups.com (aka
benzo@onelist.com) is a listserver (an e-mail
message board) that consists of people who are at various stages of
benzodiazepine dependency and recovery. Some have not even begun a
taper, others are tapering, others have completed their taper and are
still experiencing withdrawal. Still others are completely recovered
and post to the group to support those still in the recovery process.
Benzo@egroups.com is a tremendous source of both support and information
regarding all aspects of benzodiazepine dependency. You can sign up for
the listserver by going to
www.egroups.com. There are other listservers
on a variety of different topics at the egroups site, including
benzofree@egroups.com. This group is for people who have completely
discontinued their benzodiazepine. It is a forum for celebrating
freedom from dependency and tends to be oriented towards the 12 step
philosophy more so than
benzo@egroups.com. There is, however,
considerable cross-membership between the groups.
40. ARE THERE ANY OTHER RESOURCES THAT WOULD BE HELPFUL TO ME IN
UNDERSTANDING BENZODIAZEPINE DEPENDENCY AND WITHDRAWAL?
Yes. There are lots.
Get the Ashton manual with detailed detoxification protocols here:
http://members.dencity.com/ashtonpapers/index.html.
Here is perhaps the single best website regarding benzodiazepine
dependency and withdrawal:
http://homepage.ntlworld.com/raymond.nimmo/or http://www.benzo.org.uk This is growing very fast and should be consulted
frequently for updated information on this issue.
Here again is the extremely comprehensive list of possible withdrawal
symptoms mentioned above: members.dencity.com/BenzoBusters/index.html.
Here is an excellent site that contains references to hundreds of
articles and books on benzodiazepines:
www.benzodiazepines.net.
Here is a good site that addresses the issue of managing and recovering
from panic disorder without the use of benzodiazepines. It contains
many helpful links and references.
http://home1.gte.net/panicdoc/
The "Benzodiazepine Angst Webring" contains these sites and many other
helpful ones. You can start here:
http://www.slipperysquid.simplenet.com/benzo.html or at any of the
individual sites.
Here are some other websites of interest:
Detoxification: Principles and Protocols
http://www.asam.org/publ/detoxification.htm
(This is the website for the American Society of Addiction Medicine.
There is some valuable information here, but you have to separate the
wheat from the chaff. For example, there is a benzodiazepine
equivalency chart here that is extremely inaccurate.)
KLONOPIN: Little Known Facts
http://neuro-www.mgh.harvard.edu/for...MKLONOPIN.Lit\
tleKn
Bristol and District Tranquilliser Project
http://www.epost.co.uk/charities/bdtranq.html
HYPNOTICS, SEDATIVES AND ANXIOLYTICS
http://www.mssm.edu/pharmacology/Pha...-57/56-57.html
ICFDA Klonopin
http://www.drugawareness.org/klonopin.html
Roche's latest Klonopin Monograph:
http://www.rocheusa.com/products/klonopin/pi.html
(This is the pharmaceutical company's own information. There is
detailed pharmacological information here. However, bear in mind that
Roche and other companies who manufacture benzodiazepines offer slanted
views on the severity of withdrawal for long time users, for obvious
reasons.)
The Merck Manual - Home Edition, Sec. 7, Ch. 92, Drug Dependence and
Addiction:
http://www.merck.com/pubs/mmanual_home/sec7/92.htm
(Again, you need to separate the wheat from the chaff here. For
example, the Merck Manual, a mainstream publication, takes the position
that barbiturate withdrawal is more severe than benzodiazepine
withdrawal. This is almost certainly false. Although the symptom
profile is very similar, barbiturate withdrawal typically passes in no
more than 30 days after discontinuance, and usually less time than
that.)
Management of Withdrawal Symptoms and Relapse in Drug and Alcohol
Dependence:
http://www.aafp.org/afp/980700ap/miller.html
American Family Physician: Addiction - Part I Benzodiazepines:
http://www.aafp.org/afp/20000401/2121.html
Classification of Tremor and Update on Treatment - American Academy of
Family Physicians:
http://www.aafp.org/afp/990315ap/1565.html
Two particularly excellent books on benzodiazepine dependence and recovery:
The Accidental Addict by Porritt and Russell. This one is essentially
out of print, but can be ordered here:
http://members.dencity.com/BenzoBusters/index.html. Copies are running
out, so get it while you can. It is excellent.
Freeing Yourself From Tranquillizers, by Shirley Trickett. This one is
in general circulation and can be ordered from
www.amazon.com or on
special order through any reputable book store. The title of this book
in the UK is "Coming off Tranquillizers, Sleeping Pills &
Anti-depressants." It is an odd title, because the book has very little
to do with coming off of anti-depressants. It is basically a book about
benzodiazepine dependency and withdrawal.
Council for Involuntary Tranquilizer Addiction: C I T A
Cavendish House, Brighton Road, Waterloo, Liverpool L22, ENGLAND 5NG
Tel: 0151 474 9626, FAX 0151 284 8324, Helpline: 0151 949 0102
It is rumored that there will be other books on the subject published soon.
The above list of references, along with the entire archived history of
posts at
benzo@egroups.com, also serves as the bibliography for this
F.A.Q. It is this body of information that this author has used as a
basis for the facts and opinions stated herein.
The reader is encouraged to do his or her own research, as there are
undoubtedly more resources both on the Internet and in print which are
relevant to this topic. Any reader who uncovers such information is
encouraged to bring it to
benzo@egroups.com.
****Rescue Remedy is a product name. This FAQ neither promotes nor
discourages the use of any specific product.
End of F.A.Q. version 1.1.
This F.A.Q. is expressly placed into the public domain, and may be
freely disseminated by any who come into its possession. The identity
of its authors is irrelevant. It is a product of the effort of a few
among a community known as
benzo@egroups.com (aka,
benzo@onelist.com.)
It is also a product of the spirit of that entire community. It is both
a gift from its authors to that community, and a gift from that
community to anyone in the world whose life has been touched by
benzodiazepine dependency.