Benzodiazepine Dependence | A Hard Habit to Kick

When most people hear the words “drug abuse” they think of opioids like oxycodone, hydrocodone, fentanyl or heroin. Other contenders include stimulants like cocaine and methamphetamine (“meth”), alcohol, ecstasy (MDMA) or LSD. Benzodiazepines (benzos for short) are rarely considered a problem because they are prescribed in such huge quantities. At last count, roughly 10 million Americans filled nearly 50 million prescriptions for drugs like alprazolam, clonazepam, lorazepam and diazepam. Many people do not realize there is something called benzodiazepine dependence and it can be hard to overcome!

“BIND” A New Name for Benzodiazepine-Induced Neurological Dysfunction

An article published in PLOS ONE (June 29, 2023) was titled:

“Long-term consequences of benzodiapepine-induced neurological dysfunction: A survey”

The idea that popular anti-anxiety agents and/or sleeping pills could lead to long-lasting “neurological dysfunction” will likely come as a shock to most health professionals. The authors of this research report have used the abbreviation BIND to describe this condition. Surprisingly, symptoms of BIND appear to persist for months or years, even after benzo discontinuation.

What Are Symptoms of BIND?

The authors of this study surveyed 1,207 benzodiazepine users. There were 136 people still taking benzos. Another 294 were tapering off such drugs. The largest number, 763, had fully discontinued taking benzodiazepines.

The results of the survey were worrisome:

“Of all respondents, 88.1% reported having anxiety, nervousness, or fear; 86.9% sleep disturbances; 86.2% low energy levels; and 85.3% difficulty focusing or distractedness. Some respondents reported these symptoms occurring following complete cessation of benzodiazepines and for long-term durations of months or years. In fact, 76.6% of all affirmative answers on symptom questions reported symptom durations to be months or ‘one year or longer.’”

Other symptoms that persisted for one year or longer included:

• “Memory loss
• Nervous, anxiety
• Sensitivity to sights and sounds
• Digestive issues
• Muscle weakness
• Body aches and pains”

We found this observation especially disconcerting:

“Over 90% of respondents attributed one or more general adverse life consequences to benzodiazepine use. These included adverse effect on work life, fun and recreation, ability to take care of home and other, ability to drive or walk, social interactions or friendships, and relationships with spouse or family.”

How Do Health Professionals Respond to BIND?

Many years ago, during our live nationally syndicated radio show, we received a call from a listener who complained about severe withdrawal symptoms associated with stopping alprazolam (Xanax). She said that her physician did not believe her extreme discomfort was due to discontinuing alprazolam.

Instead, he suggested that her symptoms were related to the original anxiety condition returning. The doctor believed that she was suffering from a “Xanax deficiency syndrome” and that she would need to take this benzodiazepine for the rest of her life.

The authors of the latest research offer a different explanation:

“A significant subpopulation of respondents with BIND reported multiple and severe symptoms, many of which were not the symptoms for which the benzodiazepines were originally prescribed.”

They go on to conclude:

“This analysis presents survey evidence that enduring symptoms along with adverse life consequences emerged de novo [anew] with benzodiazepine use. Although protracted symptoms following discontinuation of benzodiazepine use have been reported previously, it has generally been tacitly assumed that these symptoms were withdrawal phenomena that would resolve with time. This study reveals something entirely different: that new, and often persistent, symptoms induced by the use of benzodiazepines may emerge while using, tapering, or after discontinuing these medications. In fact, a subset of respondents who had completely discontinued benzodiazepines, including those who had ceased taking benzodiazepines for a year or more, continued to experience enduring life consequences.”

Benzos and Dementia?

There is growing recognition that benzodiazepines should generally not be prescribed to older people.

Despite this, a study in the Journal of General Internal Medicine (Dec. 2018) notes that:

“Benzodiazepines (BZD) impair cognition and are associated with motor vehicle accidents, misuse and abuse, as well as falls and fractures among older adults. After opioids, BZDs are the second-most common medication class linked with pharmaceutical overdose deaths, the rate of which grew 13.6% per year from 1996 to 2013.”

The issue of cognition is not trivial. We have written about the association between benzos and dementia:

Will Benzos Increase the risk of Dementia?

No one should EVER stop a benzodiazepine suddenly without very careful medical supervision! Here is why.

Benzodiazepine Dependence:

The idea that people could develop benzodiazepine dependence came as quite a shock to many health professions. There was resistance to such a concept. Patients who stopped taking alprazolam or diazepam and complained of anxiety or insomnia were likely told that their original symptoms had returned. Many were advised to just keep taking the benzos and stop worrying.

We now know that people who take benzodiazepines regularly for several months are likely to experience withdrawal symptoms if they stop suddenly.

A reader of our syndicated newspaper column recently wrote:

Q. Can you give me some information on how to taper off a benzodiazepine?

My doctor prescribed diazepam (Valium) more than six years ago. I am now trying to get off it, but it is pure hell. The physician doesn’t seem to have specific recommendations. Before we start taking such a medication, doctors should warn us how very difficult it is to stop using it.

The FDA has a sanitized name for this:

“discontinuation syndrome.”

Here is what the FDA has to say about benzodiazepine dependence with regard to alprazolam (Xanax):

“Dependence and Withdrawal Reactions, Including Seizures

“Certain adverse clinical events, some life-threatening, are a direct consequence of physical dependence to XANAX. These include a spectrum of withdrawal symptoms; the most important is seizure.

“In a controlled clinical trial in which 63 patients were randomized to XANAX and where withdrawal symptoms were specifically sought, the following were identified as symptoms of withdrawal: heightened sensory perception, impaired concentration, dysosmia [smell disturbance], clouded sensorium, paresthesias, muscle cramps, muscle twitch, diarrhea, blurred vision, appetite decrease, and weight loss. Other symptoms, such as anxiety and insomnia, were frequently seen during discontinuation, but it could not be determined if they were due to return of illness, rebound, or withdrawal.”

What to do About Benzodiazepine Dependence?

We answered the reader of our newspaper column this way:

A. Neither the FDA nor the drug manufacturers of benzodiazepines like diazepam provide much useful guidance on discontinuation.

The official prescribing information for Valium states:

“Abrupt discontinuation or rapid dosage reduction of VALIUM after continued use may precipitate acute withdrawal reactions, which can be life-threatening. To reduce the risk of withdrawal reactions, use a gradual taper to discontinue VALIUM or reduce the dosage.”

Drug companies have not been encouraged to study this phenomenon. As a result, there are no clear guidelines for stopping benzos. People may be advised to taper off the medicine gradually, but that could be interpreted as a few days, a few weeks or a few months.

Here is the official prescribing information for alprazolam (Xanax):

“Risk of Dose Reduction

“Withdrawal reactions may occur when dosage reduction occurs for any reason. This includes purposeful tapering, but also inadvertent reduction of dose (eg, the patient forgets, the patient is admitted to a hospital). Therefore, the dosage of XANAX should be reduced or discontinued gradually.”

Dealing with Benzodiazepine Dependence:

What is it like to experience benzo withdrawal?

Here are some stories from readers of this column:

“I am a retired RN who worked 20 of her 47 years in mental health. My observations of people on benzodiazapines are: long term administration of benzos resulted in addiction to substances within two weeks. The longer the time they were given, the more difficult to withdraw.

“During withdrawal, patients suffered complete cognitive disintegration, neurological tics and delusions, and were screaming and crying for hours on end. This can go on for months if it doesn’t kill the person.

“I think it is inhumane to discontinue benzos for a patient who has been taking them for long time without a long-term tapered withdrawal plan. I was aware of the dangers of benzodiazepines in the 1970s. Why has this knowledge not been transmitted to new nursing and medical students?”

Another reader offered this:

“I wish doctors would be better advised about how to help patients get off psych drugs. I’m in the heat of alprazolam withdrawal right now. It’s been six months, and there isn’t a doctor out there that acknowledges it. It’s so maddening and totally frustrating.”

Because older people are particularly vulnerable to confusion or falls from benzos, they need special assistance in weaning off such drugs. We wish the FDA would provide better guidance to prescribers when it comes to a tapering plan.

In the meantime, you may find this article helpful:

“What are the Most Dangerous Drugs for Older People”

The Ashton Manual for Benzodiazepine Dependence:

For more specific advice, we encourage patients to have their health care professional consult the “Ashton Manual.” This online guide was developed by Dr. Heather Ashton, a psychopharmacologist and physician who developed a detailed protocol to help patients discontinue benzos.

If you would like to learn more about benzodiazepines, anti-anxiety agents and antidepressants, along with a discussion of the Ashton Manual, why not take a few minutes to listen to our interview with Dr. Joanna Moncrieff? She is the second guest on this show: Challenging Dogma About Alzheimer Disease and Depression.

You may also find this podcast quite valuable:

Show 1315: Are We Medicating Normal Emotions?
A psychiatrist and a patient each describes her perspective on the dangers of medicating normal emotions with psychotropic drugs.

Reader Comments?

Share your own experience with benzos in the comment section below. We recognize that many older people rely on drugs like alprazolam or clonazepam to get to sleep at night. They may not recognize they have a benzodiazepine dependence problem.

In no case should anyone ever attempt to stop a benzo suddenly or on her own. If the benzo needs to be discontinued, it should be done VERY gradually over several weeks or months with medical supervision. Some people may need to take much longer to wean off a benzo. And some people may need to stay on a benzodiazepine indefinitely because of a medical condition or because they cannot tolerate stopping the drug.