Sep 28, 2021

Glossary of Terms

Updated: Jul 8, 2023

Benzo usage, withdrawal, and BIND can be very confusing experiences. Along with tapering schedules, substance boundaries, and a variety of known and unknown symptoms, there is also a collection of both medical and non-medical terms that are often unknown to the average person. We hope this glossary may help clarify this issue and perhaps start to create a sense of clarity in this confusing time.

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Acute Withdrawal

Acute withdrawal occurs in the immediate period following drug discontinuation. It is a function of the rate of elimination of the benzodiazepine and its active metabolites. Symptoms that are more frequent during this stage can be severe, and even life-threatening, and include hallucinations, whole body tremors, and seizures. Thankfully, they are also often rt-lived and rare with a slow taper. Acute withdrawal lasts for approximately 10 days, but longer-acting benzodiazepines with longer half-lives may require up to 28 days to clear the body.

Addiction

Addiction—or compulsive drug use despite harmful consequences—is characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and, sometimes (depending on the drug), tolerance and withdrawal. — [NIDA, “Is There a Difference?”]

Dependence and addiction can be totally unrelated. One can be dependent and addicted, dependent and not addicted, or addicted and not dependent. BIND is a result of dependence, and not addiction. The NIDA clarifies this further by stating:

…physical dependence in and of itself does not constitute addiction, but it often accompanies addiction. — [NIDA, “Is There a Difference?”]

Akathisia

Akathisia is a common symptom during BIND.

Simply put, akathisia is a disorder where the patient has a feeling of inner restlessness and the urgency to keep moving. It’s like being on high doses of caffeine all the time, even when you’re trying to sleep. You just want to get up and do something, like run a marathon or even climb the stairs. Anything to keep moving. Akathisia is a common side effect of earlier anti-psychotic drugs, and you guessed it, of benzos too.

Amnesiac

An amnesiac is a drug which provides loss of memory, typically recent memory, often used for medical procedures.

Amnesiac is also the term used for a person who experiences loss of memory.

Anti-Anxiety Medication

The term “anti-anxiety medication” typically refers to benzos and benzo-like drugs. This includes three specific classes of drugs including benzodiazepines, nonbenzodiazepines (z-drugs), and thienodiazepines.

Anticonvulsant

An anticonvulsant is a drug used to help reduce the frequency and/or severity of seizures, fits, or convulsions.

Anxiolytic

Anxiolytic is a term used to describe any medication that provides, or is designed to provide, relief from anxiety.

The Ashton Manual

The Ashton Manual is widely considered the de facto standard for withdrawal from benzodiazepines, z-drugs, and other minor tranquilizers. Officially titled “Benzodiazepines: How They Work and How to Withdraw,” it was written by Prof. C. Heather Ashton who spent 12 years working with benzo recovery patients in her clinic.

Learn more about Prof. Ashton and her manual here.

Benzodiazepine Withdrawal Syndrome (BWS)

Benzodiazepine withdrawal syndrome (BWS) was a term given the collection of symptoms that occur in some people when they try to withdraw from long-term benzodiazepine use. The term BIND has replaced BWS in most circumstances. These symptoms can last months and even years. For those of us who took benzos per a doctor’s prescription, BWS is an iatrogenic illness — an illness caused by medical treatment.

Benzo Belly

Digestive distress during BIND is so prevalent that it even has its own name: “benzo belly.”

Benzo belly is used to refer to the whole compilation of symptoms of the digestive tract that are the result of BIND. Some people have no problems at all with digestion during this time, while others have chronic discomfort and wind up on a very limited diet. Many of the symptoms are similar to those associated with irritable bowel syndrome, including nausea, vomiting, diarrhea, constipation, abdominal pain, flatulence, and heartburn.

One of the most visible signs of benzo belly is the belly itself. Distention and inflammation of the gut is common in patients suffering from benzo belly and can be quite noticeable, as I mentioned earlier.

Benzodiazepines

Benzodiazepines are a class of psychoactive prescription drugs developed in the 1960s. Also called “anti-anxiety medications” or “minor tranquilizers,” benzos were developed to combat a variety of issues including panic attacks, anxiety, insomnia, muscle spasms, and seizures.

Benzos

The term “benzos” was originally derived from the word “benzodiazepine.” While it is still used as a slang term for benzodiazepines, and it can be used to also refer to other anti-anxiety drugs, such as nonbenzodiazepines (Z-drugs).

BIND (Benzodiazepine-Induced Neurological Dysfunction)

BIND defines the lingering neurological effects of sustained benzodiazepine exposure. Previously, this condition went by disparate terms such as Benzodiazepine Withdrawal Syndrome (BWS), Post-Acute Withdrawal Syndrome (PAWS), Protracted Withdrawal, Benzo Brain Injury, and many others. A new term (BIND) was proposed by the Benzodiazepine Nosology Group in 2022, and is now widely accepted within the benzo and medical communities.

Formal Definition: Benzodiazepine-induced neurological dysfunction (BIND) is a constellation of functionally limiting neurologic symptoms (both physical and psychological) that are the consequence of neuroadaptation and/or neurotoxicity to benzodiazepine exposure. These symptoms may begin while taking or tapering benzodiazepines, and can persist for weeks, months, or even years after discontinuation. (Benzodiazepine Nosology Group) (Alliance, 2022)

BZAI

BZAI is an acronym which stands for Benzodiazepine-Affected Individuals. A BZAI is any person who has taken benzodiazepines and is, or has, adverse symptoms and/or life effects from their its use. This includes anyone dealing with benzodiazepine withdrawal or BIND.

BZD

BZD is an acronym for benzodiazepine(s) commonly used in medical literature and studies.

BZRA

BZRA is an acronym which stands for Benzodiazepine Receptor Agonist; BZRAs include benzodiazepines and nonbenzodiazepines (Z-drugs).

Cold Turkey (CT)

Cold-turkey, or CT, refers to the sudden cessation of taking benzos after long-term use. Some patients have stopped taking their benzos abruptly, either independently or under doctors orders.

CAUTION: Most medical experts recommend a slow taper to withdraw. Stopping cold turkey, especially without medical supervision, can be very dangerous. It can even be fatal in extreme cases.

Abrupt cessation of benzodiazepines may be very dangerous. — Prof. C. Heather Ashton, The Ashton Manual

Dependence

Benzos can cause a person to become physically dependent on the drug. Here is a definition:

[Physical dependence is when] the body adapts to the drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal). — [NIDA, “Is There a Difference?”]

There is a difference between addiction and dependence. One can be dependent and addicted, dependent and not addicted, or addicted and not dependent. The NIDA clarifies this further by stating:

…physical dependence in and of itself does not constitute addiction, but it often accompanies addiction.” — [NIDA, “Is There a Difference?”]

Depersonalization (DP)

Depersonalization is a common symptom during BIND and is defined by the feeling of detachment from oneself as if someone is viewing themselves from outside of their body. This symptom is often experienced in conjunction with derealization.

Derealization (DR)

Derealization is a common symptom during BIND and is defined by the feeling of being disconnected from one’s surroundings, almost like living in a dream state. This symptom is often experienced in conjunction with depersonalization.

Direct Taper

If a person decides to discontinue taking benzos, it is recommend that he or she do so via a slow tapering process. There are three main methods for tapering: direct taper, substitution taper, or titration taper.

The first and most straightforward method of tapering is a direct taper. This means that the person reduces the dosage of the benzodiazepine they’re currently on and they don’t substitute another benzo, like diazepam. This is the most popular method. They will still need a doctor to prescribe differing doses and perhaps a pill cutter to split pills. This method works best for benzos that are less potent or have a longer half-life. [Ashton, “The Ashton Manual”]

Dopamine

Similar to GABA and glutamate, dopamine is a neurotransmitter. The effect that dopamine has on the receiving neurons depends on its source, destination, type, and role. Dopamine is responsible for some emotions, desires, and motivation including the initiation of muscle movement.

Dopamine is a neurotransmitter that helps control the brain’s reward and pleasure centers. — Psychology Today

Dopamine is also a big player in addiction. All abused drugs including heroin, cocaine, alcohol, and benzos increase dopamine in one way or another. [NIDA, “Well-Known Mechanism”]

Drug Enforcement Administration (DEA)

The DEA is the governing body and law enforcement agency for prescription and non-prescription drugs in the United States.

Emotional Blunting

Emotional blunting, also known as emotional anesthesia, is quite simply the inability to feel pleasure or pain. It’s like having no emotions. Benzos are tranquilizers, and they sedate emotional responses sometimes providing a general feeling of being emotionally numb.

Former long-term benzodiazepine users often bitterly regret their lack of emotional responses to family members — children and spouses or partners — during the period when they were taking the drug. — Prof. C. Heather Ashton, The Ashton Manual

Formication

A common symptom during benzo withdrawal, formication is a specific type of paresthesia. It is usually identified by the feeling of something crawling on the skin, like a spider or bug.

GABA

Gamma-aminobutyric acid, or GABA, is a neurotransmitter. This natural brain chemical transmits messages from one neuron to another. Unlike glutamate, which carries an excitatory message, GABA’s message is inhibitory. Thus, when received, GABA signals the central nervous system to calm down.

Benzos enhance the actions of GABA. Meaning, benzos increase the inhibitory effect of GABA on the neurons, therefore calming the brain and central nervous system.[Ashton, The Ashton Manual.] While this initial effect provides therapeutic benefits to the patient, eventually the body balances itself out in an effort to reach homeostasis.

As the body adapts to a benzodiazepine, it down-regulates the gamma-Aminobutyric acid (GABA) receptors, decreasing their sensitivity. So, GABA has less of an effect. And since GABA is an inhibitory neurotransmitter, the calming effect of GABA is less effective.

When a person discontinues taking benzodiazepines, all the physiological changes are exposed, which results in a rebound effect. The effect is generally the opposite of the initial effects of the drug. The homeostasis process kicks in again, but as before, this process takes time. Sometimes weeks, months, or even years. This is known as benzodiazepine withdrawal syndrome (BWS).

Eventually, stability is reached again, and the withdrawal symptoms subside. The body returns to normal.

Glutamate

Glutamate is the most abundant neurotransmitter in the entire nervous system. It stimulates the neurons making them fire and helps brain development including learning and memory.

Too much glutamate has been linked to Alzheimer’s disease, stroke, Parkinson’s disease, multiple sclerosis, and other diseases. Low levels of glutamate are often found in people with depression, schizophrenia, and autism. High concentrations of glutamate in the body can be toxic to nerve cells. If this happens over a prolonged period, it can cause damage, which is known as excitotoxicity.

When it comes to brain communication, there are two opposing systems: glutamate and GABA. Glutamate stimulates, and GABA inhibits. Together they regulate the level of excitability in the brain.

Think of glutamate as the gas pedal: it excites things into action. GABA, on the other hand, puts on the brakes. — Leigh, Jennifer, “Five (5) Facts About Benzodiazepine Withdrawal”

Half-Life

Benzos differ substantially based on how long the drugs take to become metabolized and eliminated from the body. This amount of time is measured by half-life, which is the amount of time it takes for half of the initial dose to be left in the blood. Some drugs like triazolam (Halcion) have a half-life of only 2–5 hours, while others like diazepam (Valium) can take anywhere from 20–100 hours to reduce to half of the initial dose.

The speed of elimination often comes into question when people ask about long-term symptoms. Can the drugs stay in the system longer even if they’re no longer found in the bloodstream, such as in brain tissue? This question is still to be determined.

Hypnotic

Hypnotic drugs are any medication that improves, or are designed to improve, the length or quality of sleep.

Interdose Withdrawal

Experiencing withdrawal symptoms between doses of a benzo is called interdose withdrawal. This most commonly occurs in people who are on benzos with a shorter half-life, such as midazolam, oxazepam, and temazepam. It can also occur in people who take benzos periodically, such as before a stressful event like flying or public speaking. Once a person takes his/her next dose, the symptoms usually ease.

Jump

Jump is a term commonly used to define the moment someone takes their last dose of benzos, usually at the end of their taper. Someone’s “jump day” may be very important to them since it identifies the day they are finally benzo-free, even though their symptoms may linger on for months, or even years.

Kindling

Kindling is still somewhat of a mystery. Some people have gone back on benzos for some reason or another once they have become benzo-free. When they decide to withdraw again, it’s often harder than it was the first time. This is expected to be due to a process known as “kindling,” even though the mechanisms and other specifics are still open to speculation.

Myorelaxant

Myorelaxant is a term used to describe medication that relaxes the skeletal muscles.

Nonbenzodiazepine (Z-drug)

Nonbenzodiazepines, or z-drugs, are often prescribed as an alternative to benzodiazepines. The nickname “z-drugs” came from the name of drugs themselves; zolpidem, zopiclone, and zaleplon.

Nonbenzodiazepines were released in the late 1980s as an alternative to benzodiazepines. They have entirely different chemical structures to benzodiazepines, and yet they have almost identical effects, and side effects. This includes tolerance and the potential for BIND, which is why they are included here and treated them the same as benzos.

Some of the brand names of z-drugs are quite well known, such as Lunesta, Sonata, and Ambien.

Paresthesia

A common symptom of BIND, paresthesia refers to the experience of strange sensations on or near the surface of the skin with no apparent physical cause. Common complaints include burning, tingling, pins and needles, numbness, or even electrical impulses.

Potency

Potency refers to the strength of the specific drug. The original benzodiazepines, like Librium and Valium, differ significantly from the current drugs, such as Xanax, Ativan, and Klonopin, based on potency. This variance can severely affect withdrawal.

Protracted Withdrawal (Syndrome)

Protracted Withdrawal goes by many names, depending on whom you ask. It’s known as protracted withdrawal syndrome (PWS), post-withdrawal, post-withdrawal syndrome, prolonged withdrawal syndrome, and persistent withdrawal syndrome. The current term that we use, is BIND. Only 10-15% of long-term benzo users will experience protracted withdrawal. Most will be symptom free well before this time.

Rescue Pill

A rescue pill is a benzo pill to use in extreme cases during withdrawal or BIND when one’s symptoms and/or anxiety are more than they can handle. While it may provide a sense of security for the patient, it can also lead to updosing, if used. And, this can create more complications during the withdrawal process.

Respiratory Depression

Respiratory depression, also known as hypoventilation, is when breathing is too low or slow to provide adequate gas exchange, which increases the amount of carbon dioxide in the blood. It’s the opposite of hyperventilation, in which you breathe too fast and get too much oxygen in the blood.

As humans, we need a balance of oxygen and carbon dioxide, and when we get out of balance, bad things can happen. When benzos are combined with street drugs, such as cocaine, heroin, or others, this respiratory depression can become fatal.

Substitution Taper

If a person decides to discontinue taking benzos, it is recommend that he or she do so via a slow tapering process. There are three main methods for tapering: direct taper, substitution taper, or titration taper.

A substitution taper includes switching, over time, from the patient’s current benzo to another benzo that is better for tapering. The choice for substitution is usually diazepam (Valium). Diazepam has a long half-life and is less potent, making it a good substitute for a slow tapering schedule. Diazepam substitution will take more planning and coordination with one’s doctor and may extend their tapering time to include switching between benzos, but it has been a very effective method for people who take more potent benzos. [Ashton, “The Ashton Manual”]

Taper

Most experts agree that quitting benzos suddenly (cold turkey) is ill-advised, dangerous, and can be fatal in extreme cases. A slow reduction in dosage, or taper, is normally recommended and can last months or even years. Tapering can incorporate substitution, titration, or just a direct reduction in dosage depending on the needs of the patient. Please see The Ashton Manual for more information on tapering.

Any reduction in dosage should only be done under the direct supervision of a licensed physician.

Thienodiazepines

Thienodiazepines, like z-drugs, also have a very similar effect as benzodiazepines. They interact with the same receptor sites as benzos and as a result, have similar side effects.

Bentazepam, brotizolam, clotiazepam, and etizolam are some of the common thienodiazepines. Some of their brand names include Clozan, Rize, Etilaam, and Pasaden.

Titration Taper

If a person decides to discontinue taking benzos, it is recommend that he or she do so via a slow tapering process. There are three main methods for tapering: direct taper, substitution taper, or titration taper.

Titration means mixing benzos with milk or water to create a liquid form of the drug, allowing the user to better control his or her dosage. This allows for very small and accurate doses. It also allows the patient to stay on one medication while tapering at a slow, controlled rate. [Ashton, “The Ashton Manual”]

Tolerance

When a person is in tolerance it means that their body responds less and less to the effects of the drug requiring more and more to get the same benefit. This can be tied with an increase in side effects and even symptoms like those experienced during BIND. This is called “relative withdrawal.” Your body thinks it’s withdrawing since it needs more and it’s not getting more.

When drugs such as heroin are used repeatedly over time, tolerance may develop. Tolerance occurs when the person no longer responds to the drug in the way that person initially responded. — [NIDA, “Definition of Tolerance.”]

Tolerance Withdrawal

After taking benzos for several weeks, a patient’s body will start to adapt, and the drug can stop being as effective. Their body has reached stasis and has adjusted to the drug’s effects. Therefore, their body craves more of the drug to provide the same benefits, which causes them to increase their dose.

If their body doesn’t get more of the drug, then it can go into tolerance withdrawal, meaning that their body has reached tolerance of the medication and craves more. BIND symptoms can also be present during tolerance. Many of the symptoms during this phase can be similar to those experienced during and after actual withdrawal of the drug.

X Y Z

Waves & Windows

Waves & Windows are terms used during BIND referring to the cyclical nature of symptoms.

A wave is when you experience intense symptoms during BIND for a period of time. This can be days, weeks, or even months. Windows are the opposite. A window is when you feel good and most, or all, your symptoms have subsided. You start to feel normal again.

Most people with BIND go through waves and windows at some point in their recovery. It may feel much like a roller coaster. Symptoms get better, then they get worse, then they get better, etc. There are even times when some symptoms get worse while other symptoms get better.

Z-drugs

See “nonbenzodiazepines.”

References

This list of references for the Glossary of Terms is not comprehensive and represents some of the more frequently referenced materials.

Ashton, C. Heather. Benzodiazepines: How They Work and How to Withdraw (aka The Ashton Manual). 2002. Accessed April 13, 2016. http://www.benzo.org.uk/manual/.
Foster, D E. Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal. Erie, Colorado: Denim Mountain Press, 2018. https://easinganxiety.com/book.
Leigh, Jennifer, “Five (5) Facts About Benzodiazepine Withdrawal (You Need to Know),” Additionblog.org, August 16, 2015, accessed March 6, 2017, http://prescription-drug.addictionblog.org/five-5-facts-about-benzodiazepine-withdrawal-you-need-to-know.
National Institute on Drug Abuse (NIDA). “Is There a Difference Between Physical Dependence and Addiction?” Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). Updated January 2018. Accessed April 8, 2018. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/there-difference-between-physical-dependence.
National Institute on Drug Abuse (NIDA). “Well-Known Mechanism Underlies Benzodiazepines’ Addictive Properties.” NIDA Notes, April 19, 2012. Accessed August 10, 2017. https://www.drugabuse.gov/news-events/nida-notes/2012/04/well-known-mechanism-underlies-benzodiazepines-addictive-properties.
“What is Dopamine?,” Psychology Today, accessed August 10, 2017, https://www.psychologytoday.com/us/basics/dopamine.
Wikipedia (varied).

For Information Purposes Only – Not Medical Advice

All information presented on Easing Anxiety is for informational purposes only, and should never be considered medical or health advice. Withdrawal, tapering, or any change in dosage of benzodiazepines or any other prescription drugs should only be done under the direct supervision of a licensed physician.

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