STRUGGLING with DEPRESSION, ANXIETY, or BIPOLARITY? LEARNING can really HELP. Start with ARTICLES above or Topics below. Ty! Bill

Benzodiazepines: The Need-to-Know Series (“Addicted?!”)

Xanax Addiction

“No doubt about it, those little yellow pills made life a whole lot easier. But gulping one down as soon as I got out of bed got me to thinkin’…”

We began our benzodiazepine need-to-know series yesterday. Must-read foundational learning in Part 1, so click here and you’re on it.

My initial plan was to chat discontinuation and withdrawal today. But I decided it made more sense to drop in a piece on dependence first. Good idea?

Let’s get after it…

Benzo Dependence

Benzodiazepine (benzo) dependence is deceptive and dangerous business. Research has found that some 40% of those qualifying for a diagnosis of benzo dependence have no clue they have a problem. On the other side of the coin, 11% found not be dependent believe they are.

Benzo dependence can be physical, psychological, or both. A physical dependence is grounded in tolerance and the presentation of withdrawal symptoms upon a decrease in dosage or cessation. Physical dependence typically stems from long-term prescribed use. Abuse is rarely involved.

A psychological dependence is about craving. But the craving doesn’t present in an effort to relieve withdrawal symptoms. No, it’s about experiencing the pleasures of the drug. Abuse is likely a factor.

Tolerance

In coming to understand benzo tolerance, it’s important to keep in mind their assorted actions – anticonvulsant, muscle-relaxant, anxiolytic (anti-anxiety), and sleep-inducing.

Tolerance to the anticonvulsant and muscle-relaxing effects of benzos occurs within a few weeks of onset of use. Tolerance develops rapidly to the sleep-inducing effects of benzos; however, it takes several months to develop tolerance to the anxiolytic effects.

Interestingly enough, there’s great debate as to whether or not benzos retain their anxiolytic properties after four months. In fact, there’s evidence suggesting long-term use of benzos may actually worsen anxiety. And that may lead to dosage escalation.

Of course, there are some in the research world who believe benzos are effective in neutralizing anxiety over the long-haul. But then others say the action is strictly a matter of preventing rebound anxiety withdrawal effects.

“Could I be the next benzo addict?”

Could be. There are risk factors regarding who may become benzo dependent…

  • Use beyond four weeks
  • Use of high doses
  • Use of benzos with higher potency (e.g.: alprazolam (Xanax)) or shorter action (e.g.: triazolam (Halcion))
  • A leaning toward a substance dependent personality
  • Past or present substance abuse or dependence disorders
  • Concomitant use of antidepressants

“What are the signs and symptoms of benzo dependence?”

The most obvious signs and symptoms of trouble are…

Feeling unable to cope without the drug, unsuccessful attempts to cut down or discontinue use, tolerance, and withdrawal symptoms when decreasing dosage or upon cessation.

One may also experience anxiety, depressed mood, depersonalization, derealization, sleep disturbance, hypersensitivity to touch and pain, tremor, shakiness, muscular aches, pains, twitches, and headache.

Suicidal and self-injurious ideation and behavior have been reported – especially in adolescents.

Let’s take a look at The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) criteria for benzo dependence. At least three of the following are present, and have been for at least one month. If less than a month, they appeared repeatedly during a 12-month period…

  • Behavioral, cognitive, and physiological phenomena that are associated with the repeated use and that typically include a strong desire to take the drug.
  • Difficulty controlling use.
  • Continued use despite harmful consequences.
  • Preference given to drug use rather than to other activities and obligations.
  • Increased tolerance to effects of the drug and sometimes a physical withdrawal state.

One final note. Long-term benzo use and dependence are serious problems for the elderly. Failure to address either can lead to dangerous medical complications.

Tomorrow: Discontinuation, Withdrawal, and Opinion!

Okay, tomorrow – for sure – we’ll handle benzo discontinuation and withdrawal. But don’t you think it made sense to do the dependence piece first?

I’ll also give you my professional and personal opinion regarding benzo use.

So that will do it for today. Look forward to chatting with you on the morrow…

image credit Emma Holister art-margin.com

  • S_penny

    Ok, one more quick note from the peanut gallery, just an FYI I have MS and can have anxiety if my symptoms present themselves while I am out in public. I get dizzy, and that dizziness of course makes me anxious, and a little scared (can I get to my car?  am I with my young son? If I’m dizzy and I am with my young son should I drive??)  Guess what my neurologist prescribed…Xanax.

    Here is the thing, I have a prescription for 3 a day for 30 days with unlimited refills.  Did my doctor even question me on my personality?  Am I an addictive personality (YES) Is it safer for me to be dizzy pop a xanax and then drive my son?  Hmmm

    I guess my question / comment is why are the doctors that prescribe these medications not liable for the consequences? Does that doctor even know I have filled that 90 pill prescription 6 months in a row? Shouldn’t he at least ask me how much/often am I taking these pill?  I would love to hear your prospective on this. 

    • Ah, we’re all in the peanut gallery of life. Man, what a great comment – and point. Where do I start?

      First of all, absolutely – feelings of dizziness/unsteadiness on your feet can generate buckets of anxiety. We rely so much upon spatial orientation – and when things get a little dicey in terms of where we are in space, off go the alarms.

      How surprising that a physician would cavalierly ink out a scrip for Xanax ;) You didn’t mention the dosage, but I’m thinking 1mg (doesn’t much matter). I’m curious if she/he put as needed (PRN) on the scrip. Yes, it’s amazing – but routine – that you weren’t at least quickly assessed: personality, dependence potential, history, etc. But the fact of the matter is, she/he could have done so – you could have lied – and the scrip would likely have been written anyway.

      I’ll tell ya’, Penny. Should something happen in the midst of a dizzy/Xanax/son episode you’re physician may well be held liable. I mean, I’m not a lawyer – but I’m guessing malpractice $$$ has been awarded for less.

      With regard to “Does that doctor even know…” I suspect your refill history lurks about in your medical record. But, hello! Wouldn’t you want to access that information – have completed your patient care due diligence – before inking another?

      In my opinion, this is just one more example of how anything even seemingly emotional/mental in nature gets backseat care.

      Great comment!!! Thanks…

    • Ah, we’re all in the peanut gallery of life. Man, what a great comment – and point. Where do I start?

      First of all, absolutely – feelings of dizziness/unsteadiness on your feet can generate buckets of anxiety. We rely so much upon spatial orientation – and when things get a little dicey in terms of where we are in space, off go the alarms.

      How surprising that a physician would cavalierly ink out a scrip for Xanax ;) You didn’t mention the dosage, but I’m thinking 1mg (doesn’t much matter). I’m curious if she/he put as needed (PRN) on the scrip. Yes, it’s amazing – but routine – that you weren’t at least quickly assessed: personality, dependence potential, history, etc. But the fact of the matter is, she/he could have done so – you could have lied – and the scrip would likely have been written anyway.

      I’ll tell ya’, Penny. Should something happen in the midst of a dizzy/Xanax/son episode you’re physician may well be held liable. I mean, I’m not a lawyer – but I’m guessing malpractice $$$ has been awarded for less.

      With regard to “Does that doctor even know…” I suspect your refill history lurks about in your medical record. But, hello! Wouldn’t you want to access that information – have completed your patient care due diligence – before inking another?

      In my opinion, this is just one more example of how anything even seemingly emotional/mental in nature gets backseat care.

      Great comment!!! Thanks…

  • Marty

    Hi, thanks for your article…interesting (but scary) reading. I’ve been trying to taper off Valium for the last two years. So far I’m up to about my seventh unsuccessful attempt – withdrawl symptoms mean I always end up reinstating. I was only on 4mg, so I would have thought it should have been relatively easy to get off – clearly I was wrong. Even scarier, I’ve heard that repeated withdrawls are associated with worse outcomes and symptoms. I’ve tried a slow taper, a rapid taper – nothing seems to work. Any advice would be greatly appreciated – I’m at a bit of a loss right now.
    I also read somewhere about a benzo antagonist (flumenzil?) recently being used to help with withdrawl. Do you have any info on this?
    Many thanks,
    Marty.

    • Hey, Marty! Sure appreciate your Chipur visit and participation. Glad you stopped-by.

      Yeah, how ’bout it?! Benzos are dicey business, and I wonder if prescribers really take the time to disclose just how dicey when they whip-out the prescription pad.

      Just real sorry you’re having a rough go. Regarding flumazenil (Anexate) – injected, by the way – though its primary uses don’t include treating benzo withdrawal, it’s been used successfully for high-dose benzo dependence in Italy, for example. But that “high-dose” means up to 70 times higher than the typical dosage. Wow! Guess who are common patients. Yep, physicians. Man, I’m not thinking it’s readily available for withdrawal treatment – anywhere – just now.

      Regarding advice, I, as well as clients, have found benzobuddies.org very helpful. Also benzo.org.uk.

      That’s about it, Marty, other than to offer you my best in your recovery…
      Bill