We Have Seen the Evidence Base, and it is Us

Janet Currie
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Anyone who has used benzodiazepines and sleeping pills knows how difficult it is to get off them (worse than heroin!) and how much time it takes to recover. Although there is a lot more helpful information on the web these days, a lot of it is based on anecdotal accounts, personal stories and theories rather than “real” evidence.

Many benzo addicts enter drug detox facilities to withdraw but these are expensive and most are geared to short term withdrawal (2-6 weeks). They may be appropriate for alcohol or street drugs but not for benzos/sleeping pills that require slow and consistent tapering that may take months.  Many psychiatrists and addictions specialists have limited experience with prescription drug withdrawal or how to design a taper.  They don’t believe that tapering should take much time and they undermine patients by telling them that withdrawal symptoms are not from the drugs but are because of a worsening of their “mental illness.”  Instead of being realistic about how tough withdrawal is and designing tapers that work, doctors recommend very fast tapers with large reductions.  This inevitably leads to intolerable symptoms which doctors respond to by adding more drugs. The patient then falls victim to the “prescription cascade.”

There is very limited research on withdrawal methods for benzodiazepines and sleeping pills or research that compares the effectiveness of different methods such as titration or valium substitution.  The pharmaceutical and psychiatric industries still deny the existence of prescription drug addiction or acknowledge the disabling but well documented effects of psychiatric drugs.  In the psychiatric world it is preferable to “blame patients” for their symptoms rather than the drugs or those who prescribe them.

Over the past twelve years I have observed or helped hundreds of people who are addicted to benzos and have designed successful tapers for many.  In most cases I suggest people use the method of slow valium substitution developed  by Dr. Heather Ashton,  a psychopharmacologist who has  dedicated her professional life to researching, writing and speaking about benzodiazepines. She is the only physician to write an extensive manual with sample tapering plans that can be used by doctors or ordinary people. This 56-page manual includes information on all the major effects of benzodiazepines at normal dose levels as well as in withdrawal and recovery.

Ashton developed her protocol based on her research as a  psychopharmacologist and from her work with benzo victims over the last 30+ years, including her work as director of a dedicated benzo withdrawal clinic in the UK for over twelve years. The results of a small sample of patients were written up in the in British Journal of Addiction

Ashton believes, based on her evidence,  that if a patient is motivated a slow personalized taper based on valium substitution can result in a better than 90% success rate for people of any age and that 70-80% of these people are likely to stay off. Other research suggests that more than half of the people who withdraw at psychiatric clinics (not using this method) will go back on benzos or other psychiatric drugs.

That being said, Ashton and I agree that more research on benzo tapering is required. Many people get off of benzos using their own or a variety of methods. Because of a lack of information I went to a standard detox in-patient facility to get off Ativan when I realized I was addicted and no other help was available.  The detox staff did not know what to do and I was brutally withdrawn in four days.  Although the experience and the months that followed were severely traumatizing,  I managed to  stay off and have completely recovered.  In my own work with benzo victims I have seen people succeed using a combination of methods such as daily titration (at the beginning) followed by a switch to valium or the reverse.  I know many people who just “did it themselves” in a messy kind of way, sometimes having to taper several times before finally succeeding.

The only “proof of effectiveness” that counts is whether an individual person finishes a taper and is able to stay off the drugs.   In my opinion, NO tapering method is painless or “easy.”   All involve time, planning, determination, patience and acceptance, but can be successful.

In future blogs I will look at the most important elements of a tapering plan, including such aspects as drug equivalencies, approach and timing. Most people go too slow or too fast even with a plan. We will also learn what people routinely experience in a taper – what recovery looks and feels like and the cyclical nature of recovery. We will also explore how to maintain courage and determination, and how to identify the things that provide comfort

We will consider what to avoid in a taper – what doesn’t work (including other drugs, seizure medication and scams), and what not to waste money on.

We will also consider a very important and neglected part of the recovery process: what happens after the taper is finished? What does pro-active recovery mean, and what does health mean in the future, when we are free of addiction?

6 COMMENTS

  1. I’ve found that my pharmacist is more knowlegable about tapering from psych drugs than any psychiatrist or other medical doctor I’ve dealt with. All of the doctors seem to know next to nothing about this very important process and most don’t want to talk about or deal with it. So, off to the pharmacist I went to find the information that I needed.

  2. I’ve come off long-term benzo use several of times cold turkey without a problem. Many people actually have. For years I was taking as much as 300-400mg of librium a day and then quit cold turkey without losing an hour of sleep or having a single issue.

    So saying things like (Worse then herion), could really be considered hyperbole, especially since a lot of people have had easy withdrawal from them.

    Of course I know there are exceptions. Whereas maybe 50 out of 100 people have significant problems withdrawing from benzos, and 10 out of 100 may have a withdraw syndrome worse than herion withdraw, the fact remains that 100 out of 100 people who withdraw from herion have that legendarily bad withdrawal experience.

    SSRI and neuroleptic withdrawals screwed me up much more. It took about 2 years of being off neuroleptics before I quit having terrible neurologic fits that gave me panic attacks by making my body feel indescribably weird in intense ways. I was lost in space most of the time, occasionally walking outside in my underwear, talking to myself in front of people without realizing it… smh

  3. The whole point behind the valium substitution taper is because valium is longer-acting and has a longer half-life than the benzos people most commonly get addicted to such as Xanax, halcion and ativan. For some reason short-acting benzos always put me in a psychotic rage, so klonopin was used first, then tranxene, then librium. Librium being even longer acting/longer half life than valium if I remember correctly. I’m only starting to wonder if that’s why I didn’t have any problems going off, but then again I went off cold turkey three times in 7 years and never had a problem. The dosage of librium that I was on turned heads everywhere I went besides my doctors office. A doctor at an after-hours clinic told me that it was a clinical overdose and that my doctor, who gave me 5 refills for every prescription, was a drug dealer. I still consider him the best doctor I’ve ever had. The only doctor that respect my intelligence and free will. He was a libertarian.

  4. “So saying things like (Worse then herion), could really be considered hyperbole, especially since a lot of people have had easy withdrawal from them.”

    I actually have thought a lot about the language and rhetoric that is developing around coming off of psychiatic drugs. I had a fairly wretched time of it, but not bad as some people have experienced.

    After I came off off of lorazepam, one thing I figured out about how my anxiety works is that negative anticipations tend to lay the foundation for self-reinforcing hideous times and over-focus on discomfort, difficulty, etc. This is not to deny the serious physical health risks involved in psych med withdrawal, or the effects of iatrogenic illness…but, is simply to acknowledge that – to some extent – the way we think about what we are going through, what we expect and fear, impacts what that process becomes for us.