Using Benzodiazepines for Withdrawal Treatment


It can be difficult and uncomfortable to withdraw from drugs or alcohol, and sometimes it can even be dangerous or life-threatening.1 Medications can be used to help reduce or eliminate the medical consequences of withdrawal, ease the discomfort of withdrawal, and help to mitigate the increase in craving of people who are detoxing.1, 2

Benzodiazepines are a class of medications that may be prescribed to ease certain symptoms of withdrawal.1, 2, 3, 4

Substance Abuse Withdrawal Symptoms

When a person cuts back or eliminates using a substance of abuse, they will experience withdrawal symptoms that range from mildly uncomfortable to severe. There are several factors that influence the duration and severity of withdrawal symptoms: how long a person has been using, the drug(s) used, a person’s age as well as their physical and mental health.1  Some substances like alcohol can present dangerous and potentially fatal withdrawal symptoms.1

Common withdrawal symptoms that can be found across several different types of substances include:1, 3

  • Anxiety.
  • Depression.
  • Sleeping issues.
  • Stomach issues including cramping, nausea, and vomiting.
  • Changes in heart rate.
  • Seizures.

How Do Benzodiazepines Help Withdrawal Symptoms?

What are Benzodiazepines?

Benzodiazepines are a class of psychiatric medications used in the short-term treatment of anxiety, panic disorders, and insomnia. They can also be used to treat seizure disorders, including epilepsy.5

Benzodiazepines can be used to manage dangerous withdrawal symptoms from specific substances, such as seizures in severe alcohol withdrawal, and reduce the impact of symptoms during withdrawal from other substances.1, 2, 5

However, the use of benzodiazepines during detox should be monitored for any breakthrough symptoms or potential misuse. It can also be dangerous to use other substances while taking benzodiazepines, so prescribers should monitor patients for substance use as well.1

Alcohol Withdrawal

Alcohol can be one of the more dangerous substances to withdraw from, especially after heavy and/or prolonged use. The nausea and vomiting associated with alcohol detox can cause major abnormalities in electrolytes and dehydration.6 The symptoms of alcohol withdrawal can progress in severity and become life-threatening.6

Symptoms of moderate to severe alcohol withdrawal can include:1, 3, 5, 7

  • Agitation.
  • Anxiety.
  • Irritability.
  • Difficulty sleeping.
  • Loss of appetite.
  • Nausea and vomiting.
  • High blood pressure and body temperature.
  • Rapid heart rate.
  • Tremors.
  • Delusions, generally involving paranoia or feelings of being persecuted.
  • Hallucinations—seeing, hearing, or feeling things that aren’t there. Altered consciousness and disorientation to surroundings such as setting and time.
  • Seizures.

Benzodiazepines are safe and effective at managing alcohol withdrawal symptoms.1, 2, 3 These medications can reduce the severity of symptoms and lessen the risk of seizures, delusions, hallucinations, tremors, and changes in awareness and orientation.2, 3, 6

While benzodiazepines won’t make withdrawal symptoms completely disappear, they can make the detox process a little easier and considerably safer.1 Commonly used benzodiazepines used are generally long-acting, including chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax).1, 2, 3, 6

Opioid Withdrawal

opioid drugsOpioid withdrawal is generally not dangerous, although it can be extremely uncomfortable and medical complications can arise rapidly.1 Dehydration or imbalances in electrolytes can occur as a result of prolonged vomiting and diarrhea.1, 3 Symptoms of opioid withdrawal can include:1, 3, 7

  • Anxiety.
  • Depression.
  • Difficulty sleeping.
  • Increased heart rate, blood pressure, and temperature.
  • Muscle spasms.
  • Bone and muscle pain.
  • Stomach cramps, nausea, vomiting, and diarrhea.
  • Suicidal thoughts or behaviors.

While other medications are typically used to treat opioid withdrawal and manage intense cravings, benzodiazepines such as Valium can can be used to reduce uncomfortable withdrawal symptoms such as agitation, anxiety, body aches, cravings, and sleeplessness.2, 4

Use of benzodiazepines during opioid withdrawal must be done with caution, as it can worsen respiratory depression that might occur as a result of using buprenorphine or methadone. For this reason, they are often used only in a controlled environment, such as in an inpatient detoxification setting.8

Hallucinogen Withdrawal

Hallucinogens include LSD, phencyclidine (PCP), ketamine, gamma-hydroxybutyrate (GHB), and ecstasy (MDMA).1, 7 Many hallucinogens don’t have defined withdrawal syndromes, but there are common issues that can arise after hallucinogen use is stopped.1 Issues associated with stopping use of hallucinogens can include:1

  • Anxiety.
  • Flashbacks of hallucinations.
  • Ongoing symptoms of psychosis.

Benzodiazepines can be useful when managing withdrawal from hallucinogens.1, 2 Ativan or Valium may be prescribed to manage symptoms of anxiety, depression, and sleeplessness.1, 2

Stimulant Withdrawal

Withdrawal from stimulants generally isn’t as severe as withdrawal from other substances, but it can be associated with critical mental health symptoms.1 There can also be seizures or complications involving the heart, which can be especially dangerous. Stimulant withdrawal is accompanied by an increased risk of a heart attack and irregular heartbeat.1 Stimulant use frequently occurs together with the abuse of other substances.1 Symptoms of stimulant withdrawal can include:1, 3, 7

  • Stimulants.
  • Depression that can be severe.
  • Eating more than usual.
  • Feeling exhausted.
  • Feeling paranoid.
  • Irritability.
  • Sleeping too much or too little.
  • Slowed heart rate.
  • Strong cravings for drugs.
  • Suicidal thoughts or behaviors.

No medications are FDA-approved specifically for detoxification from stimulants.

However, medications may be prescribed to ease symptoms as they arise.3 For example, benzodiazepines can help to manage anxiety and sleep difficulties commonly experienced when detoxing from stimulants.1,5

Stimulants are often used in a pattern of heavy use over hours or days—known as a run—followed by a crash when there are no more drugs or the user succumbs to exhaustion.7 This can lead to symptoms such as paranoia, delusions, and repetitive and compulsive behavior.3 This syndrome is treated with benzodiazepines such as Librium.3

Medically Supervised Withdrawal Treatment

Benzodiazepines can be an effective class of medications when used as directed, but they can be very dangerous if prescribing instructions aren’t followed. Attending an inpatient detox facility during detox with benzodiazepines is frequently suggested for several reasons.3

If severe symptoms such as seizures, hallucinations, depression, psychosis, or suicidal ideation are present, inpatient detox provides medical supervision around the clock for the person’s safety.3

If a person is expected to experience severe withdrawal symptoms, or has in the past, there is an increased likelihood of experiencing severe symptoms again.7

Attending an inpatient detox facility allows benzodiazepines to be provided in a controlled environment where there is no access to other substances that can have dangerous or lethal interactions.

Benzodiazepines are a medication, but they also have a potential to be misused.9 People who have substance use disorders, a family history of addiction, or mental health disorders are more likely to struggle with abusing benzodiazepines.9

Benzodiazepines may be misused in conjunction with other substances to increase the feeling of a high, counteract the effects of another drug, promote sleep, or self-medicate withdrawal symptoms.9

Fast-acting benzodiazepines are more likely to be misused; these include Valium (diazepam), Xanax (alprazolam), Ativan (lorazepam), and Klonopin (clonazepam).9 Attending an inpatient detox program allows staff to monitor all doses and ensure that the medication is taken safely and not misused.

Withdrawal Help at Sunrise House

Sunrise House Treatment Center is equipped to help patients detox from a number of substances, including alcohol and opioids. The facility’s medical detox practices allow patients to detox safely and comfortably. To learn more about the facility’s practices, and what other treatment options are available, call our Admissions Navigators at 973-862-4820.

If you are interested in detox services, you can find out if your insurance will help pay for some of the cost below.

 

Sources

  1. Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series 45, DHHS Publication No. (SMA) 06-4131. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  2. Diaper, A.M., Law, F.D., & Melichar, J.K. (2013). Pharmacological strategies for detoxification. British Journal of Clinical Pharmacology, 77(2), 302-314.
  3. Kosten, T.R., & O’Connor, P.G. (2003). Management of drug and alcohol withdrawal. The New England Journal of Medicine, 348(18), 1786-1795.
  4. Miller, N.S. (2004). Treatment of dependence on opiate medications. Virtual Mentor, 6(1), 22-26.
  5. Drug Enforcement Administration. (2019). Benzodiazepines.
  6. Hoffman, R.S., & Weinhouse, G.L. (2020). Management of moderate and severe alcohol withdrawal syndromes. UpToDate.
  7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th). Arlington, VA: American Psychiatric Publishing.
  8. National Institute on Drug Abuse. (2018). Benzodiazepines and opioids.
  9. Schmitz, A. (2016). Benzodiazepine use, misuse, and abuse: A review. The Mental Health Clinician, 6(3), 120-126.

 



About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More


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