XANAX, ATIVAN, KLONOPIN, VALIUM, great info here

[Live]

When I was first prescribed xanax I needed them. I needed them very much and they helped me survive and function.
It is the long term effect of being prescribed them for years that turned them into a very bad thing for me.
They no longer treated the condition they were prescribed for, developed a tolerance, have a short half life and take on a life of their own, taking them not to get high but just to stay out of withdrawal. And I am only beginning to learn how they have effected me and impaired me because it has taken me 3 weeks of a valium detox to even be able to concentrate to read. I have printed out the Ashton manual and will read it when I am able to.
Now, I have had my nose in a book since I was 4. Who would have ever guessed I would become so sick I couldn't read?! And if I can't concentrate and read, I have to be on medical leave.
Last week was rough...but that was due to multiple factors.
I don't miss the xanax a bit.
I can only thank Runvs over and over for putting the information out there.
I had no idea what was wrong with me, just that something was terribly wrong and I was supposedly being treated by a specialist for it all and wasn't supposed to be getting sicker and less functional.
You are kind of lucky emmer, none of my drs wanted to take me off of it.
I have been de-toxing for over a month now. I never would have dreamed that I wouldn't bounce back much sooner and that I would be out of work so long!

[RUNVS]

Day 331 off Ativan
Still struggling with post benzo recovery. I am dealing with muscle weakness and inner vibrations. Altough my mind is alot clearer now.

This sure does take a long time.

... Following an abrupt withdrawal, the symptoms will often last between six months and two years of gradually diminishing mixed psychological and somatic symptoms (Ashton). ...


I am still in the normal range of recovery

[RUNVS]

How is everyone?

[emmer]

Here in my town,most doctors know of the dangerous long term use of benzos.
I fired the doctor that put me on and kept me on klonopin far past the point of addiction......When I asked for help getting off the stuff he said no...you'll just come back blubbering for more. What A stupid thing to say!
The drug stopped working and like millions of others I was only taking it to ward off acute withdrawals. It served no other purpose.
Tolerance is built up quickly with benzos and they do nothing except cause
big problems with addiction.
The next doctor I went to was blown away at the amount I was on and couldn't see a purpose for remaining on them. I started withdrawing from them shortly afterwards. It took me 1 1/2 years to taper off them.
It was pure hell, especially the first 60 days or so.
I'm not going to pass judgement on anybody that's on benzos.....that being said - Be very careful..benzos are highly addictive and there will come a point where they will stop working (the only way around that, is to increase the amount taken daily)( But to what end ?). Also be warned, the withdrawal is something you don't want.


Peace be with you friends.

[Live]

Yeah, similar story. One Dr shook his head no when I asked if I would ever be able to get off xanax. Shrink wanted to put me in hospital and detox me using xanax.
I have to be really honest here.....Technically, I was addicted...but that is the chemical nature of the drug. I was just, after so much time, medicating the withdrawals.
My detox has gone almost too smoothly, and we are being very aggressive with it and at least half the time I don't even take my full dose of taper med (valium). Mostly around the boards, I am not "clean" if I am on taper meds. So I quit with the counting days thing. I can look up the day I made a commitment to myself and that is the one that counts with me.
So I am having some trouble reconciling my understanding of addiction with many of others here.
I know what I am addicted to and that is cigarettes.
My best gf and peer at work stopped this evening and had 2 bloody marys to unwind and laugh and then went home.
To much of SR, this means I am not clean.
To me, I drank a cup of coffee this morning...that jeopardizes my sobriety to me. Not those 2 bloody marys.
Are those short happy hours a problem to me, not now, but many would say it is destined to become one. However, I know my history. If it is causing a problem,...then I don't want problems.
My work is demanding, the workload went up exponentially today....we are drilling 6 new sites, means I will have to do 100 yr absolutely thorough abstract...and I am all ready so behind on my spreadsheets and mapping. I would hire someone to do my data entry, but because it requires specialized knowledge, I wouldn't trust any one else to do it. Hubby can help with mapping. So the news is : my project just gained alot of longevity, which all in our business wish for and is going to be 10 times the work. That's going to be tough. I come home just mentally brain dead everyday as it is. They would like me to work 6 days a week. It's physical too....ever seen one of those rooms in a courthouse with the walls lined with big heavy books, those are indexes to the next set of books lining the wall from ceiling to floor. I pull those and stand at a countertop and usually run 3 or 4 files at a time, to be more efficient so I don't have to wait on copies for one before I can proceed. I don't sit at a desk, I don't take my computer in,...it is handy but if I start setting up full office everyday in the conference room and breaking it down, that is three trips in and three trips out just to carry everything. And the whole time I am walking between all these different offices in the courthouse.

I talk more about my work here because I know that Levi can picture it.

Levi, this isn't my first job in the business and I LOVE the company I work for, but alot of things they do are definitely not standard and unconventional from the bigger dogs I worked for before. I do not understand some of the decisions regarding document. Geez, I have been trained since 89 to document. Before in the bigger company I was a document specialist. Bigger compnaies pay more too. I know you are dealing with that. But I am happier with my smaller, humanistic, good client to work for and the most excellent peers. And it's experience is better on my resume. I need to learn to think in terms of paid education! And still have all my contacts/allies to touch base with or ask a question.

Is this off topic? To me, it is life, so that's all topic.

thanks to each and every one of you and thanks RUNVS for asking. I will forever be grateful to you and this thread.
I guess the teacher is there when the pupil is ready.

live

[emmer]

Yes I can certianly understand.
Accidental or not, unfortunately an addict is someone who is addicted to something (chemically) where, if the substance was taken away abruptly there would be withdrawal. esp-nasty.
I did the valium tapering thing at about 4mg of klonopin. I started @ 13mg per day. 13mg klonopin= 260mg valium. I found the valium withdrawal to be much easier than klonopin, Klonopin is like xanax potency wise.

[RUNVS]

Originally Posted by RUNVS

Benzodiazepine Recovery Tips

1. Recovery from being an accidental addict to benzodiazpines is serious
business. It takes time for the central nervous system to heal and for neurotransmitters to stop being sensitive. None of us had the faintest idea that this kind of situation lay in front of us. So we are dealing with shock at what has happened as well as the real physical and
mental/emotional symptoms of withdrawal.


2. Recovery is not linear, as it is with other illnesses or injuries. If we cut
our hands, we can actually see the cut heal and the pain diminish over time. In benzo withdrawal we can be well one day and very sick the next. This is normal and we have to look at our healing differently.


3. Recovery is an individual thing, and it is difficult to predict how quickly
symptoms will stop for good. People expect to be completely better after a certain period of time, and often get discouraged and depressed when they feel this time has passed and they are not completely better. Most patient support programs tell clients to anticipate 6 months to a year for recovery after a taper has ended. But some people feel better a few months after they stop taking benzos; for others it takes more than a year to feel completely better. Try not to be obsessed with how long it will take, because every day you stay off benzos, your body is healing at its own rate. If you do not follow this particular schedule, it does not mean there is something wrong or you are not healing. Even if you are feeling ill in some respects, other symptoms may disappear. Even people in difficult tapers see
improvements in symptoms very early on. So don't let these time-frames scare you. The way you feel at one month will not be how you will be feeling at three months or at six months.



4. It is very typical to have setbacks at different points of time (these times
can vary). These setbacks can be so intense that people feel their healing hasn't happened at all; they feel they have been taken right back to beginning. Setbacks, if they occur, are a normal part of recovery.



5. When people are in recovery, they have a lot of fears. One is that they will
never get better. Another is that their symptoms are really what they are like - perhaps what they have always been like. Both of these fears are stimulated by benzo withdrawal. In other words they are the thought components of benzo withdrawal, just as insomnia is a physical component.



6. There is no way around benzo withdrawal and recovery - you have to go through it. People try all sorts of measures to try to make the pain stop, but nothing can shortcut the process. Our body and brain have their own agenda for healing, and it will take place if you simply accept it.


7. When you are having a bad spell, healing is still going on. People typically
find that after a bad spell, symptoms improve and often go away forever. Try to remember this when times are hard.



8. There is no magic cure to recovery, but you can help yourself by comforting and reassuring yourself as much as possible. Read reassuring information, stay away from stress, ask your partner, family and others for reassurance, and go back to the things you did at the beginning if you are experiencing really tough symptoms.



9. When we start to feel better, it is very typical to try to do too much. We
are grateful to be alive and we have energy for the first time in weeks or months. But this can be a dangerous time. When we do to much and take on too much too early, it re-sensitizes the nervous system. It doesn't prevent healing in the long term, but it can make us feel discouraged. So try to pace yourself, even if you are feeling good.



10. You do need to respect your body during recovery, although you don't need to make drastic changes to your lifestyle. Exercise, in any form is critical - even if you can only walk around the house or to the end of the block. Eating well and avoiding all stimulants is crucial. Regular high-protein snacks can help with the shakes and the feelings of weakness we have during withdrawal and recovery.



11. Recovery is all about acceptance, but this does not mean passive acceptance. Set small goals for yourself that are achievable. Try to keep exercise happening. Work at your recovery even if that means accepting you are sick - for now. You wouldn't be hard on yourself if you were in a traffic accident and had injuries; you would work at rehab. --Try to take the same attitude and approach to benzodiazepine withdrawal.

Source
psychmedaware.org

[RUNVS]

A visual animation on how benzos work with gaba receptors

http://www.sciencemuseum.org.uk/exhi...-0-0-0-0-0.swf


sciencemuseum.org.uk

[woops]

Loved that presentation!
I would like to have seen it extended to include a visual representation of the cell cutting down its production of gaba in response the the "overload" by benzo ................. and ultimately the benzo being withdrawn and the lack of stimulation now as a result of reduction of production of gaba...............
Neat!
Thanks RUNVS

[RUNVS]

How is everyone?

[windysan]

doing okay here. it has been a rough month for me emotionally but otherwise i'm okay. how's my benzo buddy?

[Arura]

Its good to see this thread swing round.
I always get sooo much from it...!

Kool visuals Runvs, yer it would have been good to see more on just how they work, along with gaba.Intresting.

[RUNVS]

For me I still having alot of internal shaking but i guess thats part of the deal of recovery.

I am glad im 1 year off BENZOS!!!

Hope next month is better for you .

[RUNVS]

Hows the benzo recovery going out there?

[windysan]

No dope for me. 3.5 years and not counting.

[Live]

Bump...for some I have referred here.

And....this benzo thing is hell. I wanted it to be over by now....but I guess I was warned.

[woops]

Yep - the benzo withdrawal is really tough. Takes a long long time. Better never to use - no matter what the circumstances - there are always other alternatives?
woops

[RUNVS]

[woops]

Hey RUNVS - there is someone who could do with your advice - "hydrocodone addiction" is the thread............... someone coming off opiates and valium at the same time and suffering...............
Always good to hear from you!

[woops]

RUNVS?

Chloe06 is the name.....................

[RUNVS]

ok

[Live]

lots of bad words. that is all and well okay I have alot of them to say! My primary shrink denies the xanax to vailium equivalancy and really chewed me out for trying to dump them when I have a severe anxiety disorder. I negotiated down, telling her about memory problems etc. BITCH. Insists I need them, stay hooked and then takes 5 days to call in meds! I hate this ****!
I am hostage to licensed drug dealers!
Kick my butt for flushing over 100 of them!
I want off. If for no other reason than the damned withdrawals!
I am so tired of being jerked around. That more than anything. It is scary enough being diagnosed as mentally ill in one and more ways. And knowing, damned it all, that those assessments are true!
jkesljgfok;sahgfk;ashgk';hjgkfl'oaj'

[RUNVS]

http://www.benzo.org.uk/bzequiv.htm

These equivalents do not agree with those used by some authors. They are firmly based on clinical experience during switch-over to diazepam at start of withdrawal programs but may vary between individuals.

WHAT ARE THE DOSE EQUIVALENCIES AMONGST VARIOUS BENZODIAZEPINES?

There are no clearly definitive equivalencies for various benzodiazepines. This author has personally seen at least a dozen different benzodiazepine equivalency charts and no two are alike. The table below has been chosen because it reflects the clinical experience of Professor Ashton in having helped over 300 people to withdraw from benzodiazepines by use of a Valium substitution method (see below).

Alprazolam 0.5
Bromazepam 6
Chlordiazepoxide 25
Clonazepam 0.5
Clorazepate 15
Diazepam 10
Estazolam 1-2
Flunitrazepam 1
Flurazepam 15
Halazepam 20
Ketazolam 15-30
Lorazepam 1
Lormetazepam 1-2
Nitrazepam 10
Oxazepam 20
Prazepam 10-20
Quazepam 20
Temazepam 20
Triazolam 0.5

Thus, 1mg of alprazolam (Xanax) or clonazepam (Klonopin) is the equivalent of 20mg of Valium; 1mg of lorazepam (Ativan) is the equivalent of 10mg of Valium.

These dose equivalencies are important for a number of reasons, the most significant of which is the issue of switching to a different benzodiazepine such as Valium prior to tapering (see below). These figures are taken from Professor Ashton's Manual and several other sources. See for example the Benzo Equivalence Table on this site.

You may find a doctor who will want to switch you from Xanax to Valium at a 1mg to 10mg equivalency. This is a recipe for a very difficult cross-over. Whatever the precise therapeutic dose equivalencies, the above equivalencies should be observed in switching from one benzodiazepine to another for purposes of withdrawal

There is no obvious reason why about 10% of the people have problems with
diazepam tapering, but it is sometimes due to one or more of the following:

1) Incorrect equivalent dose – the values quoted by Ashton, et. al.
are those found to be effective in benzodiazepine withdrawal
and should in principle compensate for any difference in
binding of the benzodiazepines to either the same or different
benzodiazepine receptors. There values are not necessarily the
same as therapeutically effective doses, but sometimes are.
2) Poorly planned or too short a period for the exchange from
another benzodiazepine to diazepam. Mild daytime sedation at
the end of a 2-3 weeks exchange suggests the equivalent dose is
correct.

3) Failure to maximize accumulation of diazepam used and its
metabolites – it takes about four weeks to achieve 90% accumulation,
i.e. four weeks after exchange.

4) Tapering too fast. Each person should find the rate suitable to
themselves. A good starting guide is 2 ½ % of the initial dose/week.
The rate for the last 1/3 of the taper should be reduced to ½ of that for
the first 2/3.


Professor C Heather Ashton DM, FRCP, 2002.


--------------------------------------------------------------------------------


Valium (Diazepam) vs. Klonopin (Clonazepam) in Benzodiazepine Withdrawal
by Dr. Reg Peart Victims of Tranquilizers

[RUNVS]

Originally Posted by RUNVS

TABLE OF CONTENTS:

1. WHAT IS A BENZODIAZEPINE?

2. HOW DO BENZODIAZEPINES AFFECT YOUR BODY?

3. HOW QUICKLY CAN I BECOME ADDICTED TO A BENZODIAZEPINE?

4. WHAT ARE THE DOSE EQUIVALENCIES AMONG VARIOUS BENZODIAZEPINES?

5. WHAT IS A "HALF-LIFE", AND HOW IS THE CONCEPT IMPORTANT TO
BENZODIAZEPINE DEPENDENCE?

6. WHAT DOES "TOLERANCE" MEAN?

7. IF MY DOCTOR HAS PRESCRIBED A BENZODIAZEPINE AND INSTRUCTED ME TO
TAKE IT FOR A MEDICAL AND/OR PSYCHOLOGICAL REASON, IS THERE ANY
REASON I SHOULD DISREGARD MY DOCTOR'S ADVICE AND DISCONTINUE THE
BENZODIAZEPINE?

8. WHAT IS BENZODIAZEPINE WITHDRAWAL SYNDROME?

9. WHAT ARE THE SYMPTOMS OF BENZODIAZEPINE WITHDRAWAL?

10. I AM EXPERIENCING ONE OR MORE OF THE SYMPTOMS LISTED ABOVE, BUT I
HAVE NOT BEGUN TAPERING MY BENZODIAZEPINE. IS IT POSSIBLE THAT THE
SYMPTOMS ARE NOT RELATED TO BENZODIAZEPINE USE, OR COULD I ALREADY
HAVE STARTED WITHDRAWAL WITHOUT EVEN TAPERING?

11. WHAT FACTORS DETERMINE HOW SEVERE MY WITHDRAWAL WILL BE?

12. IF I DISCONTINUE MY BENZODIAZEPINE, WON'T THE UNDERLYING CONDITION
THAT MY DOCTOR PRESCRIBED THE BENZODIAZEPINE FOR RETURN?

13. I HAVE DECIDED TO DISCONTINUE THE USE OF MY BENZODIAZEPINE. WHAT
ARE THE FIRST STEPS I SHOULD TAKE?

14. IS COLD TURKEY (ABRUPT, TOTAL DISCONTINUANCE OF THE DRUG) AN
ACCEPTABLE METHOD FOR DETOXING FROM A BENZODIAZEPINE?

15. OK, IF I AM GOING TO TAPER MY BENZODIAZEPINE, HOW SHOULD I STRUCTURE
THE TAPER?

16. SHOULD I SWITCH TO ANOTHER BENZODIAZEPINE SUCH AS VALIUM BEFORE
TAPERING?

17. MY DOCTOR HAS ASKED ME TO SWITCH TO A DRUG CALLED "PHENOBARBITOL"
FOR DETOXIFICATION? IS THIS A GOOD IDEA?

18. SHOULD I CONSIDER GOING INTO AN IN-PATIENT DRUG REHABILITATION
FACILITY OR DETOX CENTER TO GET OFF MY BENZODIAZEPINE?

19. WHAT IS THE LENGTH OF THE WITHDRAWAL PROCESS?

20. IS IT OK FOR ME TO SOMETIMES "CHEAT" DURING MY TAPER AND TAKE A
LITTLE MORE OF MY BENZODIAZEPINE IF I HAVE TO GO THROUGH A STRESSFUL
EVENT?

21. WILL I NEED TO QUIT WORK OR GIVE UP OTHER IMPORTANT ASPECTS OF MY
LIFE DURING BENZODIAZEPINE WITHDRAWAL?

22. MY DOCTOR HAS PRESCRIBED AN ANTI-DEPRESSANT TO TAKE DURING MY
WITHDRAWAL. IS THAT A GOOD THING TO DO?

23. ARE THERE ANY OTHER DRUGS BESIDES ANTI-DEPRESSANTS TO CONSIDER USING
DURING BENZODIAZEPINE WITHDRAWAL?

24. ARE THERE ANY PARTICULAR DRUGS A DOCTOR MIGHT PRESCRIBE THAT
DEFINITELY DO NOT HELP WITHDRAWAL?

25. WHAT ABOUT HERBS AND OTHER HOMEOPATHIC REMEDIES - DO ANY OF THOSE
HELP THE WITHDRAWAL SYMPTOMS?

26. WHAT ABOUT USING CAFFEINE DURING WITHDRAWAL?

27. WHAT ABOUT EATING SUGAR DURING WITHDRAWAL?

28. WHAT ABOUT CONSUMING ALCOHOL DURING WITHDRAWAL?

29. WHAT FOODS SHOULD I EAT (OR AVOID) DURING WITHDRAWAL?

30. I SMOKE CIGARETTES, SOULD I QUIT DURING WITHDRAWAL?

31. SHOULD I EXERCISE DURING BENZODIAZEPINE WITHDRAWAL?

32. I HAVE TERRIBLE INSOMNIA DURING MY WITHDRAWAL. SHOULD I TAKE
SOMETHING TO HELP ME SLEEP?

33. WHAT CAN I TAKE FOR PAIN MANAGEMENT DURING WITHDRAWAL?

34. ARE THERE ANY PARTICULAR DRUGS THAT ARE KNOWN TO COMPLICATE
WITHDRAWAL?

35. I AM WELL INTO MY TAPER, AND MY SYMPTOMS ARE EITHER NO BETTER OR ARE
WORSE. WHEN CAN I EXPECT MY SYMPTOMS TO GET BETTER?

36. I HAVE COMPLETED MY TAPER, AND HAVE FELT MUCH BETTER FOR A WHILE,
BUT NOW I FEEL WORSE AGAIN. WHY?

37. WHAT IS PROTRACTED WITHDRAWAL SYNDROME?

38. SHOULD I USE A 12 STEP PROGRAM LIKE NARCOTICS ANONYMOUS TO HELP ME
RECOVER FROM MY BENZODIAZEPINE ADDICTION?

39. WHO IS DR. HEATHER ASHTON?

40. WHAT IS BENZO@EGROUPS.COM?

41. ARE THERE ANY OTHER RESOURCES THAT WOULD BE HELPFUL TO ME IN
UNDERSTANDING BENZODIAZEPINE DEPENDENCY AND WITHDRAWAL?


1. WHAT IS A BENZODIAZEPINE?

Benzodiazepines are a large class of commonly prescribed tranquilizers,
otherwise referred to as central nervous system (CNS) depressants.
They include alprazolam (Xanax), bromazepam (Lexotan), chlordiazepoxide
(Librium/Nova-Pam), clonazepam (Klonopin/Rivotril), clorazepate
(Tranxene), diazepam (Valium/D-Pam/Pro-Pam), estazolam, flunitrazepam
(Rohypnol), flurazepam (Dalmane), halazepam, ketazolam, loprazolam
(Dormonoct), lorazepam (Ativan), nitrazepam (Mogadon, Insoma, Nitrados),
oxazepam (Serax, Serapax, Seranid, Benzotran), trazepam, tuazepam,
temazepam (Euhypnos, Normison, Sompam), triazolam (Halcion, Hypam,
Tricam). There may be others as well.

All benzodiazepines have five primary effects. They are:

A. Hypnotic (tending to make you sleepy);

B. Anxiolytic (tending to reduce anxiety/produce relaxation);

C. Anti-seizure (tending to reduce the probability of having seizures
and convulsions);

D. Muscle relaxant (tending to reduce muscle tension and associated
pain);

E. Amnesic (tending to disrupt both long and short term memory).

There may be secondary effects as well. Different benzodiazepines
exhibit these primary effects to varying degrees. For example, diazepam
(Valium) is a relatively powerful hypnotic (sleep inducer), whereas the
more modern benzodiazepines such as alprazolam (Xanax), lorazepam (Ativan),
and clonazepam (Klonopin), are less powerful hypnotics, but are very
powerful anxiolytics. Do not assume that because one benzodiazepine
makes you sleepier than another that this benzodiazepine is more potent
than those which do not produce sleepiness to the same degree. Often,
the reverse is true.

Benzodiazepines have been referred to as being part of a larger class of
drugs known as "minor tranquilizers". As applied to benzodiazepines,
this is almost certainly a misnomer, and the label has fallen into
relative disuse in the past ten years. However, you may encounter this
term from time to time.

Benzodiazepines are most commonly prescribed for anxiety conditions,
especially panic disorder (PD) and generalized anxiety disorder (GAD).
They are also sometimes prescribed for seizure disorders. Klonopin, for
example, is often prescribed for epilepsy. Benzodiazepines are also
prescribed for insomnia and other sleep problems, such as restless leg
syndrome (RLS). Benzodiazepines are also occasionally prescribed as
muscle relaxants.

By far the most common benzodiazepines prescribed today are Valium,
Xanax, Ativan and Klonopin. Probably over 95% of the over 450 members
of benzo@egroups.com (see below) are using or have used one or more of
those four drugs. Valium is particularly common in the British Isles.
Valium has become less common in the United States over the past 15
years, while Xanax and Klonopin have experienced increased popularity in
the United States over this time. In certain Latin American countries,
it appears that the drug Lexotan (bromazepam) is very popular.

All benzodiazepines can cause physical dependency, otherwise commonly
known as addiction.

2. HOW DO BENZODIAZEPINES AFFECT YOUR BODY?

Benzodiazepines are general central nervous system (CNS) depressants.
They are all very similar chemically. Specifically, they all bind
directly to and act upon your GABA-A receptor sites in your brain.
There are also recognized subclasses of GABA-A receptors that different
benzodiazepines act upon to varying degrees. Those sites respond to the
neurotransmitter GABA (gamma-aminobutyric acid). The effect of
benzodiazepines in binding to and acting upon your GABA-A receptor sites
is to potentiate (heighten) the effect of GABA. GABA suppresses the action
of wide variety of other neurotransmitters and neural activity including,
for example, the action of norepinephrine (noradrenaline). The mechanism
of action of GABA is to send negatively charged chloride ions into your
brain cells, making those cells resistant to the effects of neurotransmitters
such as seratonin and norepinephrine that cause excitation.
GABA will perform this function with or without stimulation from a
benzodiazepine, but where a benzodiazepine binds to a GABA receptor site,
the action is heightened. This mechanism of action is what produces the
primary effects of this class of drugs. (See above.)

.

[RUNVS]

Originally Posted by RUNVS

Contrary to a popular misconception (which was reinforced by some erroneous
language in the prior version of this FAQ), benzodiazepines do not actually
increase the organic synthesis of GABA. As stated, they heighten the action
of existing GABA. Actually, benzodiazepines can, over time, decrease the
synthesis of GABA in certain areas of your brain. This is one of numerous
theories attempting to explain the occurrence of "paradoxical" symptoms
(See below).

3. HOW QUICKLY CAN I BECOME ADDICTED TO A BENZODIAZEPINE?

The time it takes to form a physical dependency on a given
benzodiazepine varies widely. The following variables may play a role:
the size of your dose, the regularity with which you consume your dose,
and most importantly, your personal body chemistry. People have been
known to form dependencies in as little as 14 days of regular use at
therapeutic dose levels. Your probability of forming some degree of
dependency is significant, probably at least 50%, by the time you have
been using them daily for 6 months. After a year of continuous use, it
is highly likely that you have formed a dependency. It is unclear
whether certain benzodiazepines are associated with a more rapid onset
of dependency than others.

4. WHAT ARE THE DOSE EQUIVALENCIES AMONG VARIOUS BENZODIAZEPINES?

There are no clearly definitive equivalencies for various benzodiazepines.
This author has personally seen at least a dozen different benzodiazepine
equivalency charts and no two are alike. The table below has been chosen
because it reflects the clinical experience of Dr. Ashton in having detoxed
over 300 people from benzodiazepines by use of a Valium substitution
method (See below).

Alprazolam 0.5
Bromazepam 6
Chlordiazepoxide 25
Clonazepam 0.5
Clorazepate 15
Diazepam 10
Estazolam 1
Flurazepam 15
Halazepam 20
Ketazolam 15
Lorazepam 1
Nitrazepam 10
Oxazepam 30
Prazepam 20
Quazepam 20
Temazepam 20
Triazolam 0.5

Thus, 1 mg. of alprazolam (Xanax) or clonazepam (Klonopin) is the
equivalent of 20 mg. of Valium; 1 mg. of lorazepam (Ativan) is the
equivalent of 10 mg. of Valium.

These dose equivalencies are important for a number of reasons, the most
significant of which is the issue of switching to a different
benzodiazepine such as Valium prior to tapering (see below). These
figures are taken from Dr. Ashton's (see below) papers and several other
sources. A similar (though not identical) equivalency table can be found at
http://uhs.bsd.uchicago.edu/~bhsiung/tips/bzd.html.

There is some disagreement in the medical profession about these
equivalencies. You may find a doctor who will want to switch you from
Xanax to Valium at a 1 mg. to 10 mg. equivalency. This is a recipe for
a very difficult cross-over withdrawal. Whatever the precise
therapeutic dose equivalencies, the above equivalencies should be
observed in switching from one benzodiazepine to another for purposes of
detoxification. (See below.)

5. WHAT IS A "HALF-LIFE", AND HOW IS THE CONCEPT IMPORTANT TO
BENZODIAZEPINE DEPENDENCE?

Half-life is a numerical expression of how long it takes for a drug to
leave your body. Technically, the "half-life," expressed as a range, is
the time it takes for half of the amount consumed to be eliminated from
your body, and so on. There is some controversy as to how long
benzodiazepines may actually remain in your body after you have
discontinued them entirely. Benzodiazepines are fat soluble and can
persist in fatty tissues. However, benzodiazepines no longer show up in
blood screenings beyond 30 days after discontinuance. This either means
they are totally eliminated by that time, or that they persist in
amounts too small to have any long term effect.

The importance of half-life is that a longer half-life generally makes
for an easier withdrawal because your blood levels remain relatively
constant, as opposed to the up and down roller coaster that you
experience with short half life benzodiazepines. Furthermore, longer
half-life benzodiazepines require less dose micro-management. For
example, Valium can be taken once every 12 hours, or in some cases,
once every 24 hours. Xanax, however, must be taken once every 4-6 hours
to maintain constant blood levels. This is a practical impossibility
for some people.

The following is a list of benzodiazepines with their corresponding
half-lives, expressed as a range in hours:

Alprazolam 9 - 20
Bromazepam 8 - 30
Chlordiazepoxide 24 - 100
Clonazepam 19 - 60
Clorazepate 1.3 - 120
Diazepam 30 - 200
Estazolam 8 - 24
Flurazepam 40 - 250
Halazepam 30 - 96
Ketazolam 30 - 200
Lorazepam 8 - 24
Nitrazepam 15 - 48
Oxazepam 3 - 25
Prazepam 30 - 100
Quazepam 39 - 120
Temazepam 3 - 25
Triazolam 1.5 - 5

There is a misconception that longer half-life benzodiazepines prolong
the withdrawal recovery process by remaining in your bodily tissues for
longer. However, there is no evidence that longer half-life
benzodiazepines are any greater risk for Protracted Benzodiazepine
Withdrawal Syndrome (see below) than shorter half-life benzodiazepines.
This method of using a longer half-life equivalent is well understood in
addiction medicine circles, and is employed with other classes of drugs
as well. For example, people who are experiencing withdrawal symptoms
from an anti-depressant such as Paxil are often given Prozac as a
substitute for purposes of detoxification, because Prozac has a longer
half-life. Perhaps a more typical example is the use of the drug Methadone
in heroin detoxification which is employed in part because of its relatively
long half-life.

6. WHAT DOES "TOLERANCE" MEAN?

Tolerance is the process by which the receptors in your brain become
habituated to the action of a drug. When tolerance is reached, more of
the drug is required to achieve the same effect. With benzodiazepines,
and probably with many other classes of drugs as well, tolerance is
virtually always associated with some degree of physical dependence. If
you find that you are experiencing tolerance, this is a clear warning
sign that you may have formed a dependency.

7. IF MY DOCTOR HAS PRESCRIBED A BENZODIAZEPINE AND INSTRUCTED ME TO
TAKE IT FOR A MEDICAL AND/OR PSYCHOLOGICAL REASON, IS THERE ANY
REASON I SHOULD DISREGARD MY DOCTOR'S ADVISE AND DISCONTINUE THE
BENZODIAZEPINE?

Yes, there may be. Unfortunately, there are many well-intended
physicians who simply do not understand the seriousness of long-term
benzodiazepine use.

Regular benzodiazepine use almost always causes some degree of
deterioration in cognitive functioning, which progresses with continued
use.

Long term benzodiazepine use also causes lethargy, decreased energy
levels that result in impairment in work productivity and disinclination
towards exercise.

Furthermore, benzodiazepines, and all other classes of sedatives,
frequently cause and/or worsen depression. This is why people are often
given anti-depressants after being given a benzodiazepine for anxiety.
Anti-depressants, though therapeutically effective for many people, have
their own complications and potential for dependency. (See below)

Benzodiazepines can also cause what is sometimes referred to as a "flat
affect" or "emotional blunting," in which the user's ability to
experience powerful emotions is impaired. Long-term benzodiazepine
users often describe their experience as "sleepwalking through life."

Benzodiazepine use can also cause what is called "paradoxical" symptoms
in a minority of users. Paradoxical symptoms are contrary to the
intended therapeutic purpose, including outbursts of rage, increased
anxiety, and sleeplessness. Paradoxical symptoms can be caused by the
drug's interaction with the psychological makeup of the user, or may be
a biological reaction to use of the drug that people sometimes refer to
as "toxicity." Paradoxical symptoms are sometimes mistaken for
withdrawal, and vice versa.

The above effects occur to varying degrees, depending on the individual.
Some individuals may not experience certain of the effects at all.
However, one effect is common to virtually all users: a
physical dependency will eventually form. Benzodiazepine dependency is
particularly serious as the withdrawal syndrome (see below) can be
extremely difficult and protracted. Furthermore, the development of
tolerance often makes long term use non-feasible, and detoxification
becomes a necessary eventuality.

Benzodiazepines are often misprescribed for conditions to which they
are not appropriate, such as depression. Furthermore, they are often
prescribed for anxiety conditions for which the individual could be
treated effectively with a less addictive drug or with other therapeutic
techniques.

There are, however, legitimate therapeutic benefits for benzodiazepines,
particularly if they are used in the short term (no more than 2 weeks of
continuous use), or for situational anxiety/panic (for example, one dose
of Xanax per month as the need arises.) Furthermore, many users of
benzodiazepines, including some who have used them regularly for more than
a year, are able to discontinue them with little difficulty.

Nothing in this F.A.Q. is to be construed as advising any individual to
ignore the advice of his or her physician. Decisions regarding the use
or discontinuance of any benzodiazepine should be made in consultation
with a physician. However, in this area you must also undertake
considerable self-education in addition to listening carefully to your
doctor's advice. Fortunately, there are many available resources to
accomplish that (see below). Where a doctor does not appear to be up to
date with current medical literature regarding benzodiazepine dependency
and the withdrawal syndrome, seeking a second and third medical opinion
can be a desirable option.

8. WHAT IS BENZODIAZEPINE WITHDRAWAL SYNDROME?

Benzodiazepine withdrawal syndrome is believed to be caused by a dampening
of the action of GABA as neuroadaptivity causes GABA to become dependent
on stimulation from the benzodiazepine to initiate its primary action.
In other words, when you have become dependent upon a benzodiazepine,
your GABA is unable to perform its natural action without the presence of
the benzodiazepine. This results in a wide variety of over-activity in
different areas of your brain, causing a vast and diffuse array of symptoms.
These symptoms are believed to be various manifestations of neurological
over-excitation as the cells in your brain become especially sensitive to
the action of excitatory neurotransmitters. The most extreme manifestation
of this over-excitation a seizure event.

Benzodiazepine withdrawal syndrome is noted both for its relative severity
and, in some cases, its lengthy duration, as compared to withdrawal from
other classes of drugs.

Withdrawal either occurs through the development of tolerance without an
attendant increase in dose, or through a decrease in dosage below your
"tolerance point". Your tolerance point is the dose point below which
the functioning of your receptors becomes impaired due to a deficiency
in stimulation from the drug. Your tolerance point may be lower than
your actual dosage, such that you can sometimes cut your dose by some
amount without experiencing withdrawal symptoms. However, this does not
mean that you will not experience withdrawal symptoms by cutting the
dose further.

Generally, a drug's withdrawal syndrome is the mirror opposite of its
primary effects. Thus, for benzodiazepines, you can expect
sleeplessness (the mirror of its hypnotic effect), anxiety (the mirror
of its anxiolytic effect), muscle tension/pain (the mirror of its muscle
relaxant effect), and seizures in rare cases (the mirror of its
anti-seizure effect). The only exception is that benzodiazepine
withdrawal syndrome does not "mirror" the amnesic effect. To the
contrary, the withdrawal syndrome often results in increased impairment
of memory and cognitive functioning. However, in all cases, after
detoxification is complete and withdrawal is in total remission,
cognitive functioning will gradually return to the level that it was at
before you began using the drug.

For a more complete list of symptoms, see below.

9. WHAT ARE THE SYMPTOMS OF BENZODIAZEPINE WITHDRAWAL?

The following is a list of symptoms reported by enough individuals that
they are statistically likely to be legitimate withdrawal symptoms.
Keep in mind that there are a wide variety of other symptoms that have
been reported that may be legitimate withdrawal symptoms as well, but
have not been reported by enough individuals to be statistically
significant. The determination of statistical significance is not based
on hard data, but on the observations of this author in reading through
thousands of posts from people in withdrawal, as well as several books
and articles on the subject.

This list is broken down into psychological and physical symptoms. The
double asterisk indicates symptoms that occur to some degree or another,
at one time or another, in virtually every person experiencing
benzodiazepine withdrawal. Single asterisk are symptoms that are
common, and occur in most people. Others are symptoms that are common
enough to be verifiable withdrawal symptoms, but probably occur in a
minority of cases.

Psychological symptoms: anxiety** (including panic attacks),
depression**, insomnia*, derealization/depersonalization* (feelings of
unreality/detachment from self), abnormal sensitivity sensory stimuli*
(such as loud noise or bright light), obsessive negative thoughts*,
(particularly of a violent and/or sexual nature) rapid mood changes*
(including especially outbursts of anger or rage), phobias* (especially
agoraphobia and fear of insanity), dysphoria* (loss of capacity to enjoy
life; possibility a combination of depression, anxiety, and
derealization/depersonalization), impairment of cognitive functioning*,
suicidal thoughts*, nightmares, hallucinations, psychosis, pill cravings.
Note that it is far more common to fear psychosis than it is to actually
experience it.

Physical Symptoms: muscle tension/pain**, joint pain*, tinnitus*,
headaches*, shaking/tremors*, blurred vision* (and other complications
related to the eyes), itchy skin* (including sensations of insects
crawling on skin), gastrointestinal discomfort*, electric shock
sensations*, paresthesia* (numbness and pins and needles, especially in
extremities), fatigue*, weakness in the extremities (particularly the
legs)*, feelings of inner vibrations* (especially in the torso),
sweating, fluctuations in body temperature, difficulty in swallowing,
loss of appetite, "flu like" symptoms, fasciculations (muscle
twitching), metallic taste in mouth, nausea, extreme thirst (including
dry mouth and increased frequency of urination), sexual dysfunction (or
occasional increase in libido), heart palpitations, dizziness, vertigo,
breathlessness.

Here is a site with a far more comprehensive list of possible symptoms:
members.dencity.com/BenzoBusters/index.html. Here, I have cited only
the ones most commonly reported.

10. I AM EXPERIENCING ONE OR MORE OF THE SYMPTOMS LISTED ABOVE, BUT I
HAVE NOT BEGUN TAPERING MY BENZODIAZEPINE. IS IT POSSIBLE THAT THE
SYMPTOMS ARE NOT RELATED TO BENZODIAZEPINE USE, OR COULD I ALREADY
HAVE STARTED WITHDRAWAL WITHOUT EVEN TAPERING?

You are probably experiencing tolerance withdrawal. When you reach
tolerance, your brain needs more of the drug to stimulate the active of
GABA, and you begin to experience withdrawal symptoms. Some people find
that no matter how much they increase their dose, they are unable to obtain
complete relief. This may be caused by a fast, upward tolerance spiral,
or by toxicity (see above). Detoxification is necessary where this
occurs.

Some people mistakenly form a belief that the drug has "quit working" to
alleviate their anxiety disorder when in fact they are experiencing
anxiety brought on by tolerance withdrawal. Unfortunately, physicians
will sometimes reinforce this misperception and advise you to increase
your dose as a result.

11. WHAT FACTORS DETERMINE HOW SEVERE MY WITHDRAWAL WILL BE?

It is impossible to predict how severe your particular withdrawal will
be, or which of the 30 or so common symptoms you are likely to
experience. However, predictors of severity include duration of use,
dosage, type of benzodiazepine, age, your personal body chemistry, and
your method of detoxification. It is unclear which, if any, of these
factors relate to the duration of your withdrawal syndrome as opposed to
the severity. The data regarding factors correlating to duration is
less conclusive than the data correlating to severity.

There is some evidence that the more modern, high potency
benzodiazepines, especially Xanax, Klonopin, and Ativan may be
associated with more severe withdrawal syndromes. However, this
evidence remains anecdotal.

Keep in mind that there is wide variation from the above
generalizations. For example, one person may take a low dose of a
benzodiazepine for a short period of time, and have a very severe
withdrawal phase. Another individual may take a high dose of the same
drug for much longer, and experience very manageable withdrawal
symptoms. Furthermore, an individual Valium user may have a harder time
than an individual Xanax user. These variables are only very general
predictors.

.