Benzo Treatment Program
At Sprout Health California, we provide highly individualized treatment programs that take into consideration the needs as well as co-occurring mental health issues of the client.
Anxiety is a normal occurrence in everyday life. Frankly, there is not one person that has never been anxious, even in the slightest degree, at least once in his life. Babies cry because they are hungry, in pain, or even just require the comforting arms of their respective mothers. This is anxiety in its simplest form. Thankfully, as babies grow into children and then into adolescents before finally becoming adults, they learn a lot of things. And when it comes to anxiety, they are able to develop coping mechanisms that allow them to still function as optimally as possible. Unfortunately, some individuals have developed or learned to react to anxiety in a maladaptive way. For these individuals, they really need help.
One of the classes of drugs that are often indicated for individuals with moderate to severe anxiety problems is benzodiazepines. These drugs are also called minor tranquilizers because they produce sedation and a calming effect. They are primarily indicated in anxiety states or whatever condition where the individual can manifest extreme anxiety. It is for this reason that benzodiazepines are also called anxiolytics or anti-anxiety drugs. Aside from their use in anxiety, benzodiazepines are also effective in controlling seizures or convulsions, in the management of alcohol withdrawal symptoms, in the management of insomnia, and in inducing or producing muscle relaxation. It is in the latter action that benzodiazepines are given as a pre-anesthetic agent. It can also be used to produce amnesia for certain uncomfortable procedures.
Benzodiazepines are generally categorized according to their plasma half-life. This is the amount or length of time needed by the body to clear or eliminate half of the benzodiazepine dose. As such, they categorized as follows:
Long-acting benzodiazepines can last up to 250 hours and can include desalkylflurazepam, desmethyldiazepam, flurazepam, diazepam, prazepam, chlordiazepoxide, and clorazepate.
It should be noted that majority of the benzodiazepine addiction cases involve intermediate-acting compounds. In fact 3 of the most commonly abused benzodiazepines belong to this class: alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin).
Benzodiazepines exert their effects on the body by enhancing the efficiency of GABA. This neurotransmitter decreases the excitability of individual neurons. This leads to the benzo’s calming effect. Unfortunately, it also dampens all other physiologic processes in the brain. When there is too much benzodiazepines in the body, it leads to the development of benzodiazepine overdose or toxicity which can include slurring of speech, hypotension, drowsiness, nystagmus, respiratory depression, coma, and cardiopulmonary arrest.
The addictive nature of benzodiazepines is closely related to their ability to produce calmness and pleasure. This gets registered in the brain’s reward center where such sensations are interpreted as being beneficial. This leads to the realization that, in order to keep on feeling these sensations, the substance must be kept at a substantially constant level. Unfortunately, doing so increases tolerance simply because the body has already grown accustomed to the amount of drugs in the system. It now requires substantially greater doses of benzodiazepines to experience the same sensations. If this is not achieved, the individual goes into withdrawal. This occurs because he has already developed psychological and physical dependence to the benzodiazepine. Removing the benzodiazepine now will result in withdrawal symptoms.
Discontinuing benzodiazepines should always be done in a gradual manner. This is in order to avoid the much-dreaded withdrawal symptoms. These can include insomnia, tremors, fearfulness, muscle spasms, agitation, and fearfulness. Unfortunately, there are individuals who may develop more severe withdrawal symptoms that can include depersonalization, psychosis, suicidal ideation, hypersensitivity to stimuli, derealization, seizures, depression, and even delirium. What is quite troubling about benzodiazepine addiction is the risk of worsening any psychiatric symptoms particularly suicide ideation and depression.
Treating benzodiazepine addiction starts with detoxification. However, what is very important to understand is that benzodiazepines often have cumulative effects. This means that it is highly possible that withdrawal symptoms can occur even several weeks after the removal or discontinuation of the benzodiazepine. Additionally, if benzodiazepines were abruptly removed, there is a tendency for rebound symptoms. This means that the individual will experience the same clinical manifestations that were supposed to be managed by benzodiazepines, only this time they are more severe. And since benzodiazepines are indicated for anxiety, a rebound phenomenon will be more severe anxiety as well as panic attacks.
Currently, there exists a benzodiazepine receptor antagonist which acts to reverse the effects of benzodiazepines. However, flumazenil is rarely recommended because of the high risk of seizures and re-sedation. Supportive management therefore, remains the cornerstone of benzodiazepine detoxification in addition to the gradual removal of the drug from the system.
Since the problem which benzodiazepines aim to solve is anxiety, cognitive behavioral therapeutic interventions can help the individual find more effective coping mechanisms which he can use to manage his anxieties. This includes assisting the individual to examine what causes his anxieties and try to reflect on past methods that may have worked through Solution-Focused Brief Therapy. Experiential therapies as well as mind-body therapeutic modalities can help the individual learn how to relax and calm his nerves without resorting to anti-anxiety drugs.