XANAX, ATIVAN, KLONOPIN, VALIUM, great info here

[windysan]

Hang in there man. It could be a lot worse. You could be dead from addiction. Keep that in mind. You are breathing and walking around. You're going to be fine.

[RUNVS]

Once again I made a positive in my recovery. I walk 2 miles today it took me 43 minutes with a heart rate of 148 when I was finish. This is the most I ever walk at one time in several years. Today is a very special day for me I am now alcohol free for 1 year now. I am also 9 months off Ativan. Last year I was very sick at this time. I was in the hospital for 4 days. Could not function at all.

I feel walking has help lift my spirits in 2 ways: (1) I am making a conscious decision in try to help my recovery instead of just laying there as I did for 8 months. (2) I actually feel physical and mentally better about 90 minutes after walking.

It feels as my brain is releasing natural endorphins when I walk, where I actually feel pleasure tingles in my brain. I feel about 15 to 20% better if I walk compared to days I don't walk. I would say now at 9 months off ativan I am about 50% recovered.

[woops]

Well done, Run - what a milestone? Your first year alcohol free!!!!!!!



Forgive the irony above?

And 9 months off the ativan...................... what can I say?



Will you marry me?


I so agree with you about exercise. I always, always feel better after a walk................ especially with the dog!! She is patient and listens to all my moans. She is so wise!! LOLOL
But - to be serious for a moment - if I am feeling really low, fed up, whatever - I know that getting on my coat and forcing myself to go for a brisk walk will make me feel oh so much better - never fails.
You know, Run - I think you underestimate yourself - you say you are about 50% recovered?
Nope - you are a thousand times better than you were this time last year - I just bet you are! Look in the mirror - bet you dont see any signs of that demoralised, pathetic wreck of a man (am I pushing my luck now?? ) of this time last year? You are thousands of times better........... and you will keep on getting better and better.................and there is just no limit?

Take great pleasure in your success............ it is amazing and it has been a hard fought battle? But just look at the fruits of your efforts now?

yeeeeeeeeeeeehhhhhhhhhaaaaaaaaaaaaaaaaaaaaaaaaaa.. ..........

Well done, sir

woops

[RUNVS]

Thank you so much!!!!! That was a terrific post you really made me feel good.

[Barto]

Originally Posted by RUNVS

Thank you so much!!!!! That was a terrific post you really made me feel good.

Yeah, but will you marry her? If she resembles that Avatar, it might be a good thing. :Wgla

Hey RUN. Where can I get more information about, or contact other people, recovering from benzos so that I can learn more about tinnitus recovery? I'd like to hear personal stories about recovery from this particular symptom. Are there any other forums that I can just have access to? Thanks.

[RUNVS]

http://benzobuddies.org/community/index.php

http://www.benzoisland.org/benzoforum/index.php

http://health.groups.yahoo.com/group/benzo/

[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]

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.

[RUNVS]

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

It may or may not. It depends on what your underlying problem was, and
what post-withdrawal measures you take to manage the condition, if
necessary. Sometimes, the underlying problem is simply "gone" by the
time you have detoxified yourself from a benzodiazepine. Many physical
and psychological conditions are a transitory response to a temporary
condition in your life, such as a traumatic event. Often, people take
habit forming drugs such as benzodiazepines to alleviate the symptoms
of these transitory conditions, and continue taking them long after the
condition would have gone away on its own.

Other conditions are less transitory, such as chronic, long term panic
disorder (PD). However, it is important to bear in mind that there are
other treatments for these conditions, both of a pharmacological and a
non-pharmacological nature. Anxiety and stress can be managed in a
variety of different ways that are not as harmful to your body as
benzodiazepines.

There is an ongoing debate in the medical profession as to whether there
is a narrow class of individuals with long-term, chronic panic disorder
(PD) who are justified in taking benzodiazepines for life. This F.A.Q is
for informative purposes only, and will not take a position on this
controversial issue.

Often, when people complete their benzodiazepine detoxification, they
find an emergence of an underlying psychological problem that was masked
by the benzodiazepine use for many years. People also often feel the
resurfacing of emotions that may have been suppressed for a long time.
Thus, there is sometimes a period of difficult adjustment even after the
withdrawal symptoms subside. However, people often find the end result
of this period of adjustment to be very rewarding.


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

Your first step is to educate yourself. That means reading this F.A.Q.
and seeking out many of the resources referred to herein. Your second
step is to see a doctor who understands the seriousness of benzodiazepine
dependency, and be as well armed with information as possible going into
that visit. Your third step is to approach your detoxification with a
clear plan in mind, to set goals for yourself, and to begin the
withdrawal process with confidence. Do not listen to horror stories
from others who have had unusually bad experiences in withdrawal.
Everyone's experience is different, and many people are able to withdraw
with very manageable symptoms.

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

No. There is nearly complete uniformity of opinion both in the medical
profession and in the benzodiazepine recovery community that cold turkey
is a dangerous and unacceptable method of detoxification. Cold turkey
withdrawal may cause seizures, and is also associated with a higher
probability of withdrawal psychosis. Seizures are almost non-existent
in those employing a taper method, with the limited exception of people
who have taken a benzodiazepine for a seizure disorder. Furthermore,
psychosis is rare in those who taper their benzodiazepine slowly.

There is a misconception that cold turkey withdrawal, though it may
cause more severe symptoms, will bring about a faster remission of
symptoms. This is the idea that a slow taper "prolongs the agony of
withdrawal". This notion is almost certainly false. In fact, there is
some anecdotal evidence that cold turkey withdrawal may lengthen the
course of the withdrawal syndrome, and may even cause Protracted
Withdrawal Syndrome (see below).

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

There are two very general rules, and one exception to the rule that is
discussed below. The first rule is, the slower the taper, the milder
the withdrawal symptoms. The second rule is, the smaller the cuts you
are able to make, the milder the withdrawal symptoms. These are
related, though separate, issues.

For example, you might decide to cut your dose by 1/4 mg. every month,
or in the alternative, cut your dose by 1/8 mg. every two weeks. Either
way, you are tapering at the same rate. In this author's opinion, the
second option is a far superior method of tapering. Any cut is a shock
to your brain and body. Cold turkey is the largest cut of all. It is a
spontaneous, total deprivation of your dependent substance. The shock
caused by cold turkey withdrawal is such that even after resumption of
your drug at the previous dose, it may take weeks or months to
"stabilize", and in some cases, you may never stabilize from a cold
turkey withdrawal until after you have completed your taper.

This logic further extends to the size of your cuts. The smaller the
cuts you make, the less the shock to your system, and the less
pronounced the withdrawal symptoms triggered by the cut. It is not
recommended that any individual cut represent more than 10% of your
total dose at a given time. Thus, it is preferable to make smaller and
smaller cuts as you go, though this can be very difficult as you
approach the end of your taper.

Always make the smallest cuts possible. That means taking the smallest
dose size available and splitting it into 4 pieces, which can be done
easily with or without a razor blade. For example, with Valium, you can
split the smallest (2 mg.) tablet into 4 .5 mg. pieces. With Klonopin,
you can split the smallest (.5 mg.) tablet into 4 pieces of .125 or
1/8th mg. If you are on a high dose and feel that you are able to taper
rapidly at first because you are above your tolerance point (see above),
space your cuts close together (no closer than 1 cut every 3 days), but
make the smallest cuts possible. If or when you begin to feel
withdrawal symptoms, you can start to space your cuts further apart (up
to about 4 weeks). Generally, the higher potency benzodiazepines such
as Xanax, Klonopin, and Ativan force you to make larger cuts (see
below), and therefore you must space your cuts at least 3 weeks apart
toward the end of your taper. Of course, even where you are able to make
very small cuts with lower potency benzodiazepines such as Valium, you can
make these small cuts relatively far apart if this is your most comfortable
method of detoxification.

There is a method of tapering that involves mixing the drug with either
water or a dry carrier like sugar to produce a "titration" which allows
for very minute reductions, such as 1% every other day. This method has
been employed with success by some people. In England, doctors have
created a liquid titration kit to assist users in withdrawing
comfortably. There is some promise that this method can substantially
diminish, if not eliminate, the withdrawal syndrome. Unfortunately,
these titration kits are not available in North America.

If you are unable to use a titration method, you may wish to consider
switching to Valium, assuming, of course, that you are not already using
that particular benzodiazepine. (See below) This method has been used
with success, particularly in England, for many years.

Dr. Heather Ashton has detailed taper schedules available that are based
on switching to Valium. (Also see below.)

There seems to be a limited exception to the slow taper rule where
people find that they have a "toxic" reaction to taking the
benzodiazepine (see "paradoxical symptoms" above). There is a tricky
distinction between toxic symptoms and withdrawal symptoms. The usual
way to tell the difference is to try increasing your dose. If the
symptoms reduce or stay the same, your symptoms are likely attributable
to withdrawal. If your symptoms increase, you may be experiencing
toxicity, and should probably consider a faster taper (6 to 8 weeks).
However, do not make a hasty decision to taper fast. Make certain that
you are experiencing toxicity first. Generally speaking, your symptoms
are far more likely to be related to withdrawal than toxicity.

One cause of toxicity may be the taking of more than one psychoactive
drug simultaneously. For example, taking a benzodiazepine with an
anti-depressant and a narcotic (pain killer).

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

Keep in mind that some people feel that switching to Valium is not for
everyone; and many have tapered their drug of dependency and have
recovered very well. However, if you are considering this alternative,
there are three reasons that are often cited for switching to Valium for
purposes of detoxification.

First, Valium has a far longer half-life than most other
benzodiazepines. (See above). This allows for a steady, smooth
reduction in dose over time. It also permits you to take your dose less
often. In some cases, you can take your entire daily dosage before
bedtime. This reduces problems of micro-managing your dose by taking
another pill every few hours. It also can aid in sleep, which can be a
large issue during withdrawal.

Second, Valium is low in potency relative to most other benzodiazepines
and comes in tablets of 2 mg., 5 mg. and 10 mg. As a practical matter,
you can make cuts as small as .5 mg. This is the equivalent of somewhere
between 1/20th and 1/40th mg. of Xanax or Klonopin. Given the importance
of making the smallest cuts possible, particularly as you approach the end
of your taper, this is a very large benefit.

Finally, Dr. Ashton and some others believe that the more modern, high
potency benzodiazepines such as Xanax, Klonopin, and Ativan tend to
produce more difficult withdrawal syndromes. So far the evidence of
this is anecdotal, meaning that it is based on clinical observation and
patient self-reports. There do not appear to be any studies that
conclusively correlate severity of withdrawal with type of
benzodiazepine.

If you do decide to switch to Valium, it is important that you have an
idea of what to expect. First of all, because each benzodiazepine has a
unique chemical composition, one benzodiazepine will not completely
cover the withdrawal syndrome of another. Medical literature
indicates that lower potency benzodiazepines cover fewer subclasses of
GABA-A receptors (see above) than the modern, high potency
benzodiazepines such as Xanax and Klonopin. This is why it is important
to observe the proper dose equivalencies. (See above.) These are
special equivalencies for purposes of switching to Valium, and are
sometimes called "loading doses" or "suppression doses." The consequence
of taking a loading dose is that although your withdrawal symptoms may be
suppressed very well, you might also experience the side effect of over
sedation. This is particularly so as Valium is a more potent sleep
agent than most high potency benzodiazepines even at the equivalent
therapeutic dose, and these equivalencies are probably well above the
therapeutic dose equivalencies. However, most benzodiazepine users
rapidly develop a tolerance to the sleep inducing (hypnotic) effects of
benzodiazepines, so that it is likely that this over-sedation will
recede within the first few weeks.

Because it is important to manage this problem of over sedation and to
avoid cross-over withdrawal symptoms, it is a very good practice to use
a gradual dose substitution method rather than simply discontinue your
drug of dependency and begin taking Valium at the full equivalency dose.
Depending on the size of your dose, the period of dose substitution may
be anywhere from 3 weeks to about 3 months.

During this period of dose substitution, sometimes cuts to your total
dose are made, and other times, slight increases are made. If you
experience extreme over-sedation and no withdrawal symptoms, that is a
sign that the equivalency dose is too high for you, and you may wish
make a small cut in your total dose as you cross-over. If, on the other
hand, you begin to experience heightened withdrawal symptoms during
cross-over, you may wish to make a small increase in your dose during
cross-over. Because the proper equivalencies vary from person to
person, the cross-over process can be a matter of trial and error.
However, it is important to understand that the end result of switching
to Valium should be that you are relatively stable after the switch is
complete, meaning that you are experiencing either no withdrawal or very
mild withdrawal symptoms.

Dr. Ashton has circulated detailed protocols based upon switching to
Valium and explaining the method in detail. (See above and below.)

Librium is another long acting benzodiazepine that is sometimes (but
rarely) used as a substitute. This author has insufficient information
regarding the effectiveness of Librium substitution to provide a
meaningful comment at this time. It is not necessary to switch from
Librium to Valium. Librium should be tapered directly, although there
is a problem in that it comes only in 5 mg. capsules in North America.
Ideally, for Librium detoxification, the capsule should be opened and
the contents halved to make 2.5 mg. cuts. Of course, if it possible
to make even smaller cuts, that is most preferable.

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

Some doctors, particularly in the United States, use a detoxification
method of switching the patient to phenobarbitol, then tapering the
phenobarbitol, usually over a period of 2 to 6 weeks. Phenobarbitol is
a long acting barbiturate (another class of sedatives). It acts upon
many of the same GABA-A receptors as benzodiazepines, but binds to the
receptors at a different location. Phenobarbitol is very cross-tolerant
with the benzodiazepine class, and if taken in a proper "loading dose"
(see above) will probably suppress withdrawal symptoms fairly well.
Phenobarbitol detoxification is "medically safe," in that Phenobarbitol
is a potent anti-seizure agent so that you will likely not have any risk
of seizures with this method.

Phenobarbitol also has a very long half-life, similar to that of Valium,
and can be broken down into very small cuts. The equivalency is 3 mg.
of Phenobarbitol to 1 mg. of Valium.

Reported results from Phenobarbitol substitution are mixed but
inconclusive due to the small number of people at benzo@egroups.com who
have experienced this method. Doctors using this method generally
observe the practice of using a heavy "loading dose," but they usually
do not employ a gradual dose substitution method. More importantly,
when this method is used, the detoxification is usually done very
rapidly (e.g. 4-6 weeks). The problem with Phenobarbitol detoxification
may not be so much the use of Phenobarbitol itself as the rapidity of the
taper that is usually employed. Where information is discovered related
to the effectiveness of Phenobarbitol using a slow taper method, this F.A.Q.
will be revised to reflect that information.

[RUNVS]

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

Only in a relatively small percentage of cases do people have successful
experiences detoxing from benzodiazepines on an in-patient basis. The
problems with detoxification centers are multi-fold. First and
foremost, detox facilities are geared towards treating drug abuse
behaviors, not providing support for withdrawal. The facilities often
do not understand the necessity of tapering your benzodiazepine slowly.
Often, they will require you to taper over a 3-6 week period. Some will
even take you off your benzodiazepine over a one week period with a
Valium or phenobarbitol substitute. These facilities usually will not
keep you in-patient for more than about 6 weeks. The result is that you
may end up being detoxed in an overly rapid fashion, while receiving
classes on drug abuse but no specific support for managing withdrawal.
The experience after leaving the facility can often be very rough, as you
may be left in a state of fairly intense withdrawal that can persist for
a long while. In short, people with benzodiazepine dependencies often
feel worse after they leave these facilities than before then entered.

Clinical experience suggests that benzodiazepine detoxification works
best where the patient controls his or her own taper schedule in
conjunction with the advise of a physician knowledgeable about
benzodiazepine dependency. Detoxification centers, even where they
might permit a relatively slow taper, will usually take the control
of the process away from the patient and force the patient into a
rigid protocol.

However, detox centers should be considered in two circumstances.
First, if you have a problem abusing benzodiazepines either alone or in
combination with other drugs, an in-patient setting is often appropriate
to enforce the discipline of tapering the drug, and to educate you on
how to avoid drug abuse. (But see the discussion on 12 step programs
below.) If you feel that you lack the necessary self-discipline to
taper yourself slowly and gradually and have no spouse or other
caretaker who will manage your taper for you, you may wish to consider a
facility.

Second, in the rare circumstance where your withdrawal syndrome is so
severe that you are unable to take care of yourself and you have no
live-in spouse or other caretaker, you may wish to consider the
in-patient option.

Before choosing a detox facility, you should call at least five
different facilities and make, at a minimum, the following inquiries:

a. Will they permit you to taper your benzodiazepine slowly?

b. Do they have staff who have direct experience with patients in
benzodiazepine withdrawal?

c. Do they have an in-house psychiatrist and/or psychologist to provide
support?

If the answer to these questions is yes, yes, and yes, the chances are
that you have found the best possible detox facility. However, it is
still inadvisable to detox yourself on an in-patient basis unless you
are in either of the two circumstances discussed above.

19. WHAT IS THE LENGTH OF THE WITHDRAWAL PROCESS?

It varies tremendously. For people with mild dependencies, the
withdrawal process typically encompasses 1-4 weeks of symptoms. This
generally applies to most, but not all, people who have used a benzodiazepine
for less than six months. It also applies to a percentage of people
who have used a benzodiazepine for more than one year. For people with severe
dependencies, 6 to 18 months total recovery time, including the taper
process, is typical. Generally, one may expect 6 months to a year of
diminishing symptoms after a taper is complete.

There is also an uncommon phenomenon called Protracted Withdrawal
Syndrome (see below).

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?

This is strictly a matter of opinion. In the opinion of this author,
anyone detoxing from benzodiazepines who has a history of abuse should
avoid the temptation to temporarily increase the dose at all costs,
unless it is to avoid seizures or psychosis. If one has poor
self-discipline, giving in on a single occasion to increase the dose in
order to better cope with some stressful event may lead to a pattern of
"giving in" which will ultimately lead to total relapse. If confronted
with a stressful event, my advice is avoid the stressful event if
possible. If not, make sure a supportive individual is there with you
and tough it out.

If, however, you are among the majority who have no history of abuse and
have never abused your benzodiazepine, it is probably not harmful to do
this on rare occasions, e.g. if you must attend a wedding or funeral or
are forced to attend a function in a crowded public place where you have
some fear of crowds and/or public places. If you have demonstrated
self-discipline in your taper, you can probably get away with increasing
your dose for one day on rare occasions, e.g. a few times during your
taper.

As clarification, it is always acceptable to "go sideways," (stay at
the same dose as opposed to cutting) for a while in order to stabilize
where your symptoms are particularly severe. This is different than the
issue of increasing your dose to cope with stressful events.

Finally, if you feel that you must increase your dose a little to
stabilize yourself because you have tapered too quickly, do so.
However, the better solution is to avoid tapering too quickly in the
first place. (See above.)

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

Going through withdrawal while managing the demands of everyday life is
a difficult balancing act. It cannot be emphasized strongly enough the
extent to which stress can worsen your withdrawal symptoms. That means
stress related to jobs, relationships, or anything else. The key is
that you need to understand going into your withdrawal process is that
you will have to make adjustments in your life, including your level of
activity and the types of activities in which you engage. The amount of
adjustment will depend on the severity of your withdrawal on the one hand,
and the stress level brought on by the activities on the other. Some people
can work through withdrawal; others cannot. Some people quit their jobs,
some take leaves of absence, some work through it with considerable
difficulty, and still others work through it with mild difficulty. While
in withdrawal, the best advice is to reduce your stress by the maximum
amount that is feasible given the demands of your life. What that means
will vary tremendously from one case to the next.

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

Maybe. Most doctors who prescribe anti-depressants for benzodiazepine
withdrawal, or for any other purpose, will prescribe one of the modern
class of SSRIs (Selective Serotonin Reuptake Inhibitors) that includes
Prozac, Paxil, Zoloft, Celexa, and Serzone. Or they sometimes prescribe
one of two even more recently developed drugs: Effexor and Wellbutrin.
Doctors often prescribe these particular drugs because, in addition to
their anti-depressant properties, they are recognized as anxiolytics
(anti-anxiety agents). Ironically, all of these drugs are known to
heighten anxiety and agitation, though this side effect often diminishes
after the first few weeks of use. Even the SSRI's such as Paxil and
Zoloft which are thought to have a primary sedative effect often cause
heightened anxiety when you are in withdrawal. This heightened anxiety
may be one reason that people in benzodiazepine withdrawal often
discontinue the use of these drugs after a short period of time.

Among those who have taken anti-depressants for long periods of time
during withdrawal, the experiences are mixed. Some seem to benefit,
others do not. Still others feel that their symptoms are worsened.
Generally, due to the potential for creating complications of your other
withdrawal symptoms, anti-depressants should only be taken where you are
suicidally depressed. That does not mean that you are simply pondering
or even obsessing about suicide. It means that you feel that, barring
some kind of pharmacological intervention, you *will* do something
self-destructive. Otherwise, anti-depressants should generally be
avoided during withdrawal.

Another issue is that most anti-depressants are documented to be addictive
to varying degrees and, in fact, there is some evidence that the withdrawal
syndrome can be very pronounced and similar to benzodiazepine withdrawal
(though not nearly as protracted) in some cases of long term use.

There are a few scattered reports of people who have benefited from the
use of an earlier class of anti-depressants known as "tricyclics." One
of these is Doxepin, which has a primary sedative effect as opposed to
the stimulant effect of the SSRIs. Tricyclics also have their own set
of complications and side effects. Consult your physician and check the
written warnings for tricyclics to make sure that you do not have any of
a number of medical conditions that may be complicated by the use of
tricyclics. As with SSRI's, some are known to cause primarily sedation,
where others are known to have stimulant properties.

The best advice with anti-depressants or any other prescribed adjunct
drug is to proceed with caution. If you decide to take an
anti-depressant, you may want to start at a very low dose to see how
well you tolerate the drug before increasing to the dose recommended by
your physician.


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

Yes. There are several. And your doctor may suggest one or more.
Again, the best advice is to proceed with caution and carefully research
any new drug you are considering. A few are mentioned below.

Tegretol (carbomazepine): an anti-seizure drug. Some studies have shown
this drug to be effective in reducing certain physical withdrawal
symptoms. Others have shown it to be ineffective. Testimonials
regarding the use of Tegretol are mixed.

Neurontin: primarily a pain medication, neurontin has been implicated as
alleviating certain physical withdrawal symptoms. Testimonials are
mixed and too few for reliable generalization.

Beta blockers (e.g. Inderal): beta blockers help with heart palpitations,
hypertension, as well as shakes/tremors. Some beta blockers cross the
blood/brain barrier, and may be mildly addictive, though the official
medical literature states that they are non-addictive. However, that
same literature also recommends that they not be discontinued abruptly.
Do not take a beta blocker unless you are seriously troubled by any of
the above-mentioned symptoms. Even then, you should either take them at
the lowest dose possible, or take them situationally (as the symptom
emerges). Beta blockers do not directly reduce anxiety, but they can
alleviate some of the physical symptoms associated with panic attacks,
which may indirectly help to reduce the associated anxiety level.

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

Yes. Buspar, a commonly prescribed anti-anxiety agent, is virtually
certain to be totally ineffective in alleviating withdrawal symptoms.
This conclusion is supported by studies. Furthermore, this
author has never heard a single testimonial from anyone who claims to
have benefited from this particular drug in withdrawal.

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

Maybe. Everyone's experience is different. Acupuncture, massage
therapy and chiropractic have been commented on, but there is little
conclusive data as to their effectiveness in relieving withdrawal
symptoms. As for herbal remedies, all of the following have been
mentioned as helpful to one person or another: valerian, kava kava,
st. john's wort, 5htp, SAMe, melatonin, GABA, chamomile, and Rescue
Remedy****.

With very few exceptions, the majority of these have been found to be
helpful in only a few cases, and several people have felt that their
withdrawal symptoms were heightened by taking one or more of
these substances. Of the entire group mentioned, only two have been
singled out by a fairly large number of people as especially helpful:
chamomile tea and Rescue Remedy****. Keep in mind that even those
herbal substances which you find helpful may only work where your
symptoms are relatively mild. For example, chamomile tea might
relieve mild agitation, but is very unlikely to bring you out of a full
blown panic attack. However, there are breathing and relaxation methods
that can help to alleviate panic attacks.

Kava is noted as creating more adverse reactions than some of these
other substances, and is probably the least recommended of the group
for experimentation. However, all herbal drugs have been noted by one
person or another as producing unpleasant side effects or as simply being
ineffective. Herbal drugs are generally not regulated and there are
occasional reports of these substances containing toxins, though these
occurrences are becoming particularly rare in industrialized countries
in recent years due to heightened media scrutiny of homeopathic drugs.

It is also important to understand that herbal medicines are drugs.
These plants contain organic, bioactive substances that cross the blood
brain barrier and act upon your brain just as synthetic drugs do. In fact,
many pharmaceuticals are synthesized versions of bioactive substances
naturally occurring in plants and animals. The only difference is, you get
a much higher purity of the substance in synthetic form than you would
in organic form.

Because herbs are drugs, they can also have toxic and deleterious
effects. Fortunately, most herbal medicines are low enough in potency
that they are well tolerated and non-addictive.

However, it is important to start at a low dose and pay close attention to
your body's reaction to the use of an herbal medicine just as it is with a
synthetic one. Generally speaking, you will have a strong sense of how well
you are tolerating a particular substance shortly after you beginning taking
it, often after the very first dose.

This FAQ does not recommend, negatively or positively, the use of herbal
remedies for anxiety disorders such as GAD or PD. This FAQ is about
benzodiazepine dependency and withdrawal, not about alternative treatments
for anxiety disorders. The only opinion intimated herein is that some
people may experience some relief from certain herbal remedies during the
withdrawal process. Many, if not most, others, experience no relief at all.

In general, herbal medicines are safer to experiment with during
withdrawal than are synthetic ones. Therefore, you may wish to consider
these possibilities before trying another potentially addictive
synthetic drug. However, keep in mind that even if you experience some
form of relief from an herbal remedy, there are no panaceas for
benzodiazepine withdrawal syndrome, and only time will ultimately
produce total recovery.

26. WHAT ABOUT USING CAFFEINE DURING WITHDRAWAL?

You should *totally* abstain from the use of caffeine during
benzodiazepine withdrawal. It is a stimulant and is known to worsen
withdrawal symptoms. If you use caffeine to ward off migraine
headaches, try to find another remedy that does not contain caffeine.
You should refrain from the use of all other stimulants as well. For
example, do not use "non drowsy decongestants" that contain the drug
"pseudophedrine." That is a stimulant that will likely cause heightened
agitation, which is the last thing you need during withdrawal.




27. WHAT ABOUT EATING SUGAR DURING WITHDRAWAL?

There is considerable anecdotal evidence in the form of testimonials
from people in withdrawal that sugar can exacerbate withdrawal symptoms.
Shirley Trickett, in her book Freeing Yourself From Tranquilizers,
indicates that benzodiazepine withdrawal causes hypoglycemia. This is
one theory as to why sugar may cause problems during withdrawal.
Another is that sugar may stimulate the production of adrenaline. In
much the same way that it may cause hyperactivity in children, it can
cause heightened agitation during withdrawal.

Whatever the reason, there is substantial anecdotal evidence that
consuming sweets, particularly in large quantities, can greatly
complicate withdrawal.

28. WHAT ABOUT CONSUMING ALCOHOL DURING WITHDRAWAL?

Alcohol consumption, even in relatively small amounts, is not advised
during benzodiazepine withdrawal. Many people report that alcohol, a
sedative that should cause a reduction in anxiety, actually heightens
withdrawal symptoms, particularly those of derealization and
depersonalization.

Even if you find that alcohol has a calming effect on withdrawal
symptoms, regular alcohol use creates a toxicity that will almost
certainly prolong your recovery process. And even if you are able to
successfully withdraw from benzodiazepines while consuming alcohol on a
regular basis, which is unlikely, you will have probably substituted one
addiction for another.

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

First of all, you should probably drink lots of liquid, perhaps double
your ordinary intake. Some people feel that this may hasten the
recovery process. The evidence of this is inconclusive. However,
drinking large quantities of liquids helps to flush toxins from your
system and is a generally good for digestion. Even if it provides no
specific relief in withdrawal, it is generally a healthy practice.

As for food, there are various theories about what should and should not
be consumed. Some people develop fixations about their diets during
withdrawal, associating a new withdrawal symptom with whatever food they
consumed most recently, and concluding that this food is something to be
avoided during withdrawal.

Shirley Trickett (see above), in her book Freeing Yourself From
Tranquilizers, recommends a hypoglycemic diet. This consists of eating
three small meals per day, and having at least 2-3 snacks spaced out
between the meals. The regimen consists of roughly equal parts complex
carbohydrates, protein, and fat, with very little or no sugar intake.

Whatever diet you decide is appropriate, the most important
consideration during withdrawal is that it is a healthy diet. While the
evidence regarding the effect of one particular food versus another is
not conclusive, there is strong evidence that a healthy diet makes for
an easier withdrawal. Another way of looking at it is in the converse:
when you eat junk, your body rebels and causes you to experience
discomfort. While this is true even when you are not in withdrawal, it
is true more so in withdrawal because your body is already in a state of
trauma. That trauma is virtually certain to be compounded by an
unhealthy diet.

There are a wide variety of opinions about proper diet and nutrition
during withdrawal, and to discuss all of them is outside the scope of
this F.A.Q. If you are interested in eliciting opinions on this
subject, inquire to benzo@egroups.com wherein you will find no shortage
of ideas on the subject.

30. I SMOKE CIGARETTES. SHOULD I QUIT DURING WITHDRAWAL?

Nicotine, the primary drug contained in tobacco, is an addictive sedative
drug like benzodiazepines, although it is vastly different in its chemical
structure and mechanism of action. Unlike benzodiazepines, the primary
symptom of Nicotine withdrawal is a craving for the drug. However, other
symptoms, especially agitation and insomnia, have been noted as Nicotine
withdrawal symptoms. Therefore, it is inadvisable to withdraw from Nicotine
while you are in the process of benzodiazepine detoxification. If you plan
to quit smoking (which is always a good idea for health reasons), it is
preferable that you accomplish this before you begin benzodiazepine
detoxification. Failing that, you should wait until you have fully recovered
from benzodiazepine withdrawal before discontinuing cigarettes.

The only exception to this guideline is where you are carrying a child. In
that circumstance, it is critical that you quit smoking immediately.
Benzodiazepine detoxification should also be accomplished during pregnancy,
as there is clear medical evidence that a child born of a benzodiazepine
dependent parent may experience symptoms consistent with benzodiazepine
withdrawal. Where you are dependent on a benzodiazepine and carrying a
child, a more rapid taper schedule that is generally desirable may be
advisable. Detoxification during pregnancy, as in all other situations,