Benzo Detox: Details to Know before Proceeding
Benzodiazepine dependence has attracted increased attention in recent years, as a result of which scientific works have appeared, which raise the issue of the possibility of abuse and dependence in the long-term use of benzodiazepines.
The importance of psychological mechanisms in the genesis and control of withdrawal syndrome (including benzodiazepines) was emphasized by the authors of the cognitive theory. Such patients show catastrophic thinking and believe that reducing the dose of the drug can lead to a personality catastrophe. Anxiety, in turn, increases the severity of the existing symptoms.
The benzo detox experts suggested five mechanisms explaining the development of some withdrawal syndrome in some patients:
- Patients irrationally believe in the potency of drugs, and therefore, expect more severe withdrawal symptoms;
- Any bodily symptoms during the reduction of the drug is a measure (wine) for the abolition of the drug;
- The withdrawal of the drug causes fear, and this fear contributes to the appearance of somatic symptoms of anxiety, which are associated with withdrawal symptoms; while patients are not able to distinguish symptoms of anxiety from withdrawal symptoms; this fact may be a primary defect in the development of prolonged withdrawal syndrome;
- Benzodiazepines are presented to the patient as the only possible way to control vegetative arousal, while other strategies for coping with stress are absent;
- Patients are distinguished by a special personality structure, more focused than normal, on bodily symptoms.
It is also necessary to distinguish “benzodiazepine dependence” and “the difficulty of canceling an effective drug”. Conceptual differences in the availability of specific criteria for benzodiazepine dependence, as well as difficulties in differential diagnosis of withdrawal syndrome, “rebound” syndromes (recoil syndrome or “rebound” phenomenon) and exacerbation of anxiety symptoms lead to a wide range of data on prevalence of addiction to benzodiazepines – from 0.5% to 7%. The fact that patients who developed a dependence on benzodiazepines usually have problems before taking drugs, drew the attention that withdrawal syndrome is more often observed in patients with passive-dependent personality traits.
When prescribing benzodiazepines for treatment (and withdrawal), the following tactics should be followed:
- Carefully select patients, taking into account the clinical-psychopathological state, age, personality characteristics, propensity to dependences ;
- If possible, maintain low or medium dosages of the drug or use a variety of “fluctuating” doses, and also conduct fractional short courses of therapy;
- The drug should be withdrawn within 1 to 2 months with the obligatory simultaneous addition of other therapeutic strategies: placebo, psychotherapy, etc.
- Given the cross-tolerance characteristic of benzodiazepines, it is possible to replace one drug with another using the equivalent dose method (e.g., short-lived for long-lived benzodiazepine);
- It is important to adhere to a reasonable rate of dose reduction: approximately 25% per quarter of the withdrawal period (for example, if the withdrawal period is 4 weeks, then the dose reduction should be carried out at a rate of 25% per week)