Benzodiazepine Dependence and Tapering Fort Lauderdale, FL

It is important to clarify that benzodiazepine dependence is not the same as benzodiazepine addiction. In fact, most people who take benzos long-term are dependent, meaning that they will get physically sick if they try to quit too quickly. However, most people who take benzos are not addicted. Primary benzodiazepine addiction is rare.

Benzodiazepines are not a medication most people misuse on their own. The risk that matters for someone taking a prescribed benzodiazepine is combining it with alcohol or with other medications that slow the central nervous system, which can suppress breathing and is genuinely dangerous. That is a different problem from physical dependence. Dependence is what develops in most people who take a benzodiazepine for months or years, and it is the reason the dose has to be reduced gradually rather than stopped.

What is the Ashton Manual?

You may have heard of the Ashton Method, based on the famous Ashton Manual, written by the British psychopharmacologist Professor C. Heather Ashton. This groundbreaking work details various strategies for tapering off of different benzodiazepines. Professor Ashton also makes a strong argument for using Valium (diazepam) as the benzo of choice for the tapering process.

Is the Ashton Method for everyone?

In some cases, tapering at home over a period of months is not a good idea. There are people who are heavily addicted to benzodiazepines, using dosages far above what is considered therapeutic or safe. And, there are people who are abusing other dangerous drugs at the same time who are at high risk of overdose.

What is hyperbolic tapering?

The Ashton Manual describes reductions in fixed amounts: for example, cutting the same number of milligrams every couple of weeks. Hyperbolic tapering takes a different approach. Each reduction is a percentage of the current dose rather than a fixed amount, so the cuts get smaller in absolute terms as the dose comes down.

The reason has to do with how these medications work in the brain. The relationship between the dose and the effect on receptors is not a straight line. At higher doses, a small reduction changes relatively little. At lower doses, the same reduction can be a much bigger change. This is why many people find the last part of a taper harder than the beginning, and why the final stretch usually needs to go slowest.

In practice this generally means reducing by about 5 to 10 percent of the current dose at a time, with two to four weeks between reductions. This approach is consistent with the Maudsley Deprescribing Guidelines, which set out hyperbolic tapering schedules for benzodiazepines and antidepressants.

How long does a benzodiazepine taper take?

There is no single answer, but a benzodiazepine taper is almost always longer than people expect, and longer than any inpatient program allows.

Dr. Leeds does not taper anyone off a benzodiazepine in less than six months. In many cases a year or more is needed. A taper that is going well is one where you are able to keep working, sleeping, and functioning throughout, not one that finishes quickly. Programs that offer to get you off a benzodiazepine in a few weeks are reducing the dose far faster than most physically dependent patients can tolerate.

The schedule is not set in advance and then left alone. If a reduction is harder than expected, the next one is delayed or made smaller. Some people hold at the same dose for several weeks before continuing. That is normal, and it is not a setback.

Is benzodiazepine addiction the same as benzodiazepine dependence?

The majority of people who consider themselves to have a benzo addiction are actually benzo dependent. Benzodiazepines cause dependence and have a serious withdrawal syndrome. Many people have difficulty quitting benzos because they get physically sick, but they do not use them in an obsessive, compulsive, addictive manner.

Physical dependence shows itself when the dose is reduced too quickly. Common symptoms include increased anxiety, difficulty sleeping, heightened sensitivity to light and sound, muscle tension and pain, tremor, and digestive upset. These are withdrawal symptoms, not a return of the original condition, and they are the reason a taper needs to be gradual.

Can I taper off benzodiazepines without going to rehab?

Most of the facilities that come up when you search for benzodiazepine help are inpatient detox centers or residential rehab programs. These are built for addiction treatment. They are usually 28 days or shorter, and they often reduce the dose much faster than someone who is physically dependent can comfortably tolerate.

Outpatient tapering works differently. You stay at home. You keep going to work. You reduce your dose gradually over months rather than weeks, at a pace you can handle, and the schedule is adjusted if a reduction turns out to be too much.

If you are physically dependent on a benzodiazepine that was prescribed to you, and you are not misusing it or combining it with other substances, you usually do not need a residential program. What you need is a doctor who will supervise a slow taper and adjust it as you go.

What is benzo belly bloating?

Benzodiazepine withdrawal can be intense. Most people are concerned about seizures, which they should be, because seizures can be dangerous. However, there are other symptoms that are very uncomfortable that occur when a person stops benzos cold turkey.

Benzo belly is a common symptom, characterized by gastrointestinal upset. It can include bloating, constipation, pain, and other GI symptoms. Benzo withdrawal stomach pain can be managed by tapering properly and with additional treatment if needed.

What are some common benzodiazepines?

There are many benzos. It is a large class of drugs that mostly work the same, other than how fast they start working and how fast they wear off. Klonopin (clonazepam) and Ativan (lorazepam) are commonly prescribed by psychiatrists for anxiety. There are also many other benzos commonly prescribed by family doctors and other primary care prescribers.

Temazepam for sleep.

Also known as Restoril, temazepam is a popular sleeping pill. Doctors prescribe it often to patients who have trouble sleeping. Lorazepam, known by the brand name, Ativan, is also used for helping patients get to sleep as well as reducing anxiety. If you take these drugs for sleep, you may have difficulty sleeping after you stop the drug. Rebound withdrawal symptoms are a serious problem with benzodiazepines.

Alprazolam (Xanax) and why it can be harder to taper

Known as Xanax, alprazolam is found often in the systems of drug abusers who have overdosed. Because of the fast onset and short half-life, alprazolam is thought to cause dependence and addiction more often than other benzodiazepines. For this reason, psychiatrists often prefer Klonopin, or clonazepam, as an alternative because of the long half-life. Both anti-anxiety, sedative-hypnotic drugs are effective for treating anxiety disorders. Yet, doctors can explore other options first, such as cognitive-behavioral therapy or other medications with less abuse potential. The same short half-life makes alprazolam harder to taper directly, which is why a crossover taper is usually preferred: moving to diazepam (Valium) and reducing from there, or to clonazepam (Klonopin) when diazepam is not a good fit.

Valium is used for sleep, anxiety and as a muscle relaxer.

Valium, or diazepam, has many uses. It is probably the benzodiazepine with the most FDA approved indications. Doctors prescribe it as a muscle relaxer for patients who have pain and related muscle spasms. It is also used for sleep and anxiety due to its sedative effects.

Librium and alcohol and drug detox.

While other benzos can be used, Librium, or chlordiazepoxide, is a sedative that is often used in detox programs. When patients are detoxing from alcohol or drugs, chlordiazepoxide can calm their anxiety and reduce the risk of seizure. While rarely abused, chlordiazepoxide is a habit forming drug, so it must be used carefully in the treatment of addiction.

Serax for elderly patients.

Also known as oxazepam, Serax is a benzodiazepine that is considered to be safer for the elderly. Yet, doctors must be careful in prescribing any of the benzos to elderly patients who are at higher risk for serious fall injuries. Oxazepam is also used to treat alcohol-related disorders and alcohol withdrawal.

Other benzodiazepines that are less frequently used.

There is quazepam, or Dural, often prescribed for sleep. Another of the benzos used for sleep is flurazepam, or Dalmane or Dalmadorm. It is longer-acting with a very long half-life. Etizolam is a related drug that is known to work on the GABA-A receptor. Tranxene, or clorazepate, is used to prevent seizures and is also used to treat alcohol withdrawal. Estazolam, or Prosom, is used for sleep. Loprazolam, or triazulenone, is an infrequently prescribed benzodiazepine used short term for sleep and other uses. As you can see, there are a long list of benzos. Doctors often stick to the more mainstream and better known benzodiazepines. Mental health specialists are more likely to prescribe the less-used forms of these drugs for sleep, panic disorder and the treatment of drug and alcohol abuse.

Long-term use of benzodiazepine prescriptions drugs.

It is not unusual for a doctor to prescribe benzodiazepines, such as alprazolam, diazepam or lorazepam to a patient for many years for pain disorder. If there are no adverse effects and the patient functions better in their daily activities, these long-acting and short-acting benzodiazepines can be used safely long-term. However, if the patient decides to stop taking benzodiazepines at some point, they have to work carefully with their doctor to reduce benzodiazepine use. These drugs should be tapered gradually over time. If benzodiazepine use is stopped to abruptly, there is a serious risk of rebound anxiety and even dangerous seizures.

Addiction and benzodiazepine overdose.

People do become addicted to drugs such as Xanax and Valium. While alprazolam and diazepam are probably most associated with abuse, clonazepam, lorazepam and many other benzos can be abused as well. Doctors must exercise care in prescribing benzodiazepines and be aware of signs of overuse and abuse. The treatment of benzodiazepine addiction should be handled by an addiction specialist with experience in detoxing patients off of benzos in a safe setting.

Can I do a benzodiazepine taper by telemedicine in Florida?

Dr. Leeds is licensed in Florida and sees patients both at his Fort Lauderdale office and by telemedicine throughout the state.

A first appointment usually involves going over your current prescription, how long you have been taking it, what dose you are on now, and any previous attempts to reduce it. From there, you and Dr. Leeds agree on a starting schedule and a pace to begin with.

Ongoing appointments are used to check how each reduction went and to adjust the schedule before the next one.

What if my current doctor will not help me taper?

It is common to find that the doctor who prescribed a benzodiazepine is unwilling or unable to supervise coming off it. Some prescribers are not comfortable managing a taper that runs for a year. Some will only offer to stop the medication over a few weeks. Some have retired, moved, or stopped prescribing controlled medications altogether.

Dr. Leeds accepts patients in this situation. If you are physically dependent on a benzodiazepine that was prescribed to you, and your current prescriber will not supervise a gradual reduction, he can take over that part of your care and manage the taper at a pace you are able to tolerate.

You do not need to have stopped taking the medication before your first appointment, and you do not need to have a taper plan already worked out. Coming off a benzodiazepine safely starts from wherever you are now.

Outpatient benzodiazepine tapering with Dr. Leeds in Fort Lauderdale and by telemedicine in Florida

Dr. Leeds’ concierge program is private, discreet, caring, compassionate, and customized to your needs. Tapering programs are tailored to your specific situation. The program is continually updated to make coming off benzodiazepines as comfortable as possible. Please call today or use the contact page on this website for more information.