I have my own ‘formula’ for success when it comes to benzodiazepine detoxification. It is not the only way, but it is the way that has worked for me, and for the patients that I have treated, since starting private practice. Most of the patients that come to me for this treatment have anxiety disorders. They have become physically dependent on prescription benzodiazepines that are being taken as prescribed. They are not using the medication in an addictive manner.
I do long slow tapers with Valium that are based on the Ashton Method. When a potential patient calls, I explain to him or her that I have never seen patients successfully complete their tapers with me in the following situations:
1. Patients refusing to treat their primary anxiety disorder with an antidepressant or with Buspar. The primary anxiety disorder is being unmasked as the taper progresses. If this is not treated, the anxiety becomes overwhelming. After all, this is the reason that the patient started taking benzodiazepines in the first place. Standard first line therapy for anxiety disorders are antidepressants such as Prozac, Zoloft, Cymbalta, and Effexor. Buspar is a different type of medication that was developed specifically to treat anxiety. While Buspar does not work for a lot of patients, it is extremely effective for some.
2. Patients that drink alcohol. Benzodiazepines work on the same receptor as alcohol (GABA and glutamate). Benzodiazepines are basically freeze dried alcohol, and alcohol is basically liquid Valium. Drinking alcohol causes rebound anxiety when the effect wears off. It disrupts a GABA/glutamate system that is already very dysregulated from benzodiazepine dependence. Some patients really want to taper, but are unable to abstain from alcohol. In this case, after a discussion of the risks and benefits of the medication, Antabuse is given as an observed dose in the office. When someone drinks alcohol while on Antabuse, they develop a horrible reaction. The reaction includes symptoms of nausea, vomiting, palpitations, flushing, and headache. Antabuse almost guarantees a benzodiazepine detox that is not disrupted by alcohol.
3. Refusing to engage in CBT (Cognitive Behavioral Therapy). CBT is a therapy of choice for anxiety disorders. It teaches coping skills. CBT is based on ten cognitive distortions. These are ten dysfunctional ways of thinking that can cause anxiety and depression. The symptoms of benzo withdrawal can be overwhelming. CBT is needed to help patients cope with this. Medication alone is not enough.
4. Personality disorders. So far, I have never seen a patient with a personality disorder complete a benzo detox with me. For example, one of the hallmarks of borderline personality disorder is pervasive emotional dysregulation. Patients with this disorder have a biologically based emotional vulnerability. Emotional vulnerability includes extreme reactions over “small” things. These reactions are also long lasting, and it takes time to quiet their emotions down. Patients like this are unable to tolerate the roller coaster of withdrawal symptoms.
5. Refusing to take medications to treat withdrawal symptoms. I use medications as sparingly, and in as low doses, as possible. However, if withdrawal symptoms are so intense and/or persistent, they need to be treated. The patient and I are unable to continue tapering if withdrawal symptoms are active. Patients are ready to taper, and lower their Valium dose, only when they are in a place of stability and control with their anxiety.
So in order to be successful in a benzo detox, these factors need to be carefully considered.