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A paper published in the journal Neuropsychopharmacology presented evidence that ketamine treatments may help reduce depression during benzodiazepine withdrawal. The study evaluated 22 patients with severe unipolar or bipolar TRD (treatment resistant depression) undergoing discontinuation from long-term (>6 months) benzodiazepine use. The patients in the study received ketamine infusions over a period of four weeks. ARTICLE: Intravenous ketamine for benzodiazepine deprescription and withdrawal management in treatment-resistant depression: a preliminary report PUBLICATION: Neuropsychopharmacology AUTHORS: Nicolas Garel, Kyle T. Greenway, Lê-Anh L. Dinh-Williams, Julien Thibault-Levesque, Didier Jutras-Aswad, Gustavo Turecki, Soham Rej & Stephane Richard-Devantoy DATE: August 2, 2023 Situation Depression is a common symptom of withdrawal from BZDRs (benzodiazepines/Z-drugs). In addition, patients with depression are far more likely to be prescribed BZDRs than others. Approximately 30–50% of patients with depression are prescribed benzodiazepines and/or Z-drugs at some point during their illness. Although international depression guidelines generally recommend only short-term BZDR use, chronic use eventually arises in 10–15% of patients with depression – particularly those with treatment resistant depression (TRD). — Garel 2023 Since BZDR use is linked closely to depression for a number of reasons, and depression can have severe detrimental effects on a person's health, including suicide, finding an effective treatment for depression associated with discontinuation is a top priority. Study Findings The study evaluated 22 individuals, of which 91% "successfully discontinued all BZDRs [benzodiazepines/Z-drugs] by the end of the 4-week intervention." During follow-ups 3-24 months later, 64% remained off BZDRs. According to the article, "These preliminary results suggest that ketamine infusions for TRD may facilitate the deprescription of BZDRs, even in patients with active depressive symptoms and significant comorbidity." Only a minority (≤25%) of participants experienced clinically significant deterioration in depression, anxiety, sleep, or suicidality at any timepoint during the treatment process by PCC analysis. These results contrast with typical rates of BZDR withdrawal symptoms occurring in 40–100% of discontinuers, even with gradual tapering, most commonly in the days-weeks following the last quarter of the original dose. — Garel 2023 In closing, the authors summarized "we present the first quantitative and qualitative evidence that ketamine may facilitate discontinuation of chronic BZDRs," and they suggested that further research is warranted. Analysis New studies that provide hope for treatment of benzodiazepine withdrawal and/or BIND always grab our attention. We endlessly wish for the day when a treatment or protocol or medicine comes along a makes it all go away. Unfortunately, medicine, and life, are rarely that easy. This study does provide some hope, but it also has its limitations. The sample size was small, so a much larger study would be warranted. In addition, all of the patients had severe unipolar or bipolar TRD, so this is not a general sample and is limited to individuals with diagnosed TRD. The authors also stated other limiting factors such as "lack of a control group, varying length of follow-up, inability to examine the impact of sex on outcomes of interest, and, most importantly, the lack of standardized scales of BZDRs withdrawal." And then there is homeostasis. Homeostasis is a common topic in the benzo community. It is also a common theory of recovery — which at is core is about the "rebalancing" of the neurotransmitters glutamate (excitatory) and GABA (inhibitory), and how they are received by their respective receptors. The goal of this "rebalance" is to allow the body to return to normal functioning, without medication interfering with that process anymore. This definitely over simplifies the theory, and there are many other processes in the body affected by BZDR exposure, but for now I'm going to focus on the one that gets most of the attention. According to a 2020 study in Frontiers in Psychiatry, "Converging evidence suggests that ketamine elicits antidepressant effects via enhanced neuroplasticity precipitated by a surge of glutamate and modulation of GABA." Ketamine has also been found to directly affect cortical glutamate levels (Stone 2012). While it may be possible that a medication or treatment may assist in the "rebalance" we all seek, it is also possible that these treatments may hinder the natural healing process that is already taking place. I must admit that I am very skeptical about treating BIND with additional medication, but I also realize that for some individuals it is worth the risk. BIND can be distressing and debilitating for some people, and may also increase the risk of suicidality. In these cases, it is important for the patient to work closely with his/her doctor to determine the best course of action. I also want to state that I am not a medical professional and my analysis here is definitely that of a lay person. Still, sometimes common sense provides wisdom in these situations. When it comes to healing from benzodiazepine use, I will rely on the natural approach for now. We were told that benzos were completely safe time and time again by the medical establishment. That didn't turn out so well. Should it be a surprise, then, that we are now cautious of additional medication? I will remain open, and continue to analyze research on new treatments — and do so with a touch of caution and hope. Ketamine very well may help treat depression for individuals discontinuing benzodiazepines. But, as with many mediations, it may also hinder the healing process in the long-run, or even worse, cause its own added complications. We truly don't know. References Garel, N., Greenway, K.T., Dinh-Williams, LA.L. et al. Intravenous ketamine for benzodiazepine deprescription and withdrawal management in treatment-resistant depression: a preliminary report. Neuropsychopharmacol. (2023). https://doi.org/10.1038/s41386-023-01689-y. Ritvo AD, Foster DE, Huff C, Finlayson AJR, Silvernail B, et al. (2023) Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey. PLOS ONE 18(6): e0285584. https://doi.org/10.1371/journal.pone.0285584. Silberbauer LR, Spurny B, Handschuh P, Klöbl M, Bednarik P, Reiter B, Ritter V, Trost P, Konadu ME, Windpassinger M, Stimpfl T, Bogner W, Lanzenberger R, Spies M. Effect of Ketamine on Limbic GABA and Glutamate: A Human In Vivo Multivoxel Magnetic Resonance Spectroscopy Study. Front Psychiatry. 2020 Sep 8;11:549903. doi: 10.3389/fpsyt.2020.549903. PMID: 33101078; PMCID: PMC7507577. https://pubmed.ncbi.nlm.nih.gov/33101078/. Stone JM, Dietrich C, Edden R, Mehta MA, De Simoni S, Reed LJ, Krystal JH, Nutt D, Barker GJ. Ketamine effects on brain GABA and glutamate levels with 1H-MRS: relationship to ketamine-induced psychopathology. Mol Psychiatry. 2012 Jul;17(7):664-5. doi: 10.1038/mp.2011.171. Epub 2012 Jan 3. PMID: 22212598; PMCID: PMC3883303. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883303/. For Informational Purposes Only 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. This article was written by a living, breathing, human person. Please read our site disclaimer for more information.

February 6, 2023 – The second paper on the Benzodiazepine Survey of 2018-2019 was published today in Therapeutic Advances in Psychopharmacology titled: “Enduring neurological sequelae of benzodiazepine use: and Internet survey.” This is the second in a series of three papers our team has been working on for almost four years now. The first paper was published on April 25, 2022 and was titled “Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey.” Our third paper was recently completed and we are in the process of its submission. One of the key findings of this second paper is the differentiation between acute withdrawal symptoms such as seizures, hallucinations, and body trembling which typically last for days or weeks, and the protracted symptoms such as anxiety, insomnia, cognitive difficulties, low energy, and others which can often last for months, even years. According to the paper’s conclusion, “Evidence tentatively suggests that early and late symptoms occurring following benzodiazepine use may be attributable to different mechanisms,” and that the latter may be due to neurotoxicity and/or neuroplastic changes in the brain. These findings are groundbreaking and also led us to a third and final paper from the survey, which will address the life consequences of these drugs and formerly introduce the term benzodiazepine-induced neurological dysfunction, or BIND. As I mentioned when we announced the first paper, I was very grateful to be one of the authors on this amazing team which includes Dr. Christy Huff, Director of Benzodiazepine Information Coalition and Drs. A. J. Reid Finlayson and Peter R. Martin of Vanderbilt University Medical Center. Special thanks also go out to Christy Huff, M. D. (BIC), and Jane McCoubrie, Ph.D. who originated the survey, and equally so to Bernie Silvernail and the Alliance for Benzodiazepine Best Practices for sponsoring the work and leading the charge to get these papers completed and published. Online Article: https://journals.sagepub.com/doi/full/10.1177/20451253221082386 PDF Version: https://journals.sagepub.com/doi/epub/10.1177/20451253221145561

COMMENTARY Periodically, I post blogs based on articles written about anxiety and/ or anxiety medication (benzodiazepines / Z-drugs). My primary goal is to shine a light on new information about these topics and to better understand the problems that face us. As part of this process, I have a Google alert set up for topics related to benzodiazepines, anxiety, and a few other topics. This is how I find many of the issues that I write about on this site. Last week, that algorithm alerted me to an article about a person named "D" who was addicted to "Xanax." As you might expect, I took notice. ARTICLE: Brain chemistry: four stories of drug use and mental health in Aotearoa PUBLICATION: The Spinoff AUTHOR: Naomii Seah DATE: May 25, 2023 In this article, the writer shares the stories of four individuals: James, D, Thomas, and Sam. Three of these stories focused on cannabis use, mostly recreational. But one, the one about "D," was about benzodiazepines. The names were changed to protect privacy, so perhaps the name "D" was invented by the author and there is no coincidence — I really don't know. But, that is not the reason for my commentary... so I'll move on. Let's take a look at some quotes from the article. Brain Chemistry Brain chemistry: four stories of drug use and mental health in Aotearoa This first thing that grabbed my attention were the first two words of the article's title: "Brain Chemistry." The concept that mental health disorders are a result of a chemical imbalance in the brain is a controversial topic that, in my opinion, has lead to the overprescribing of psychiatric medication. While it is true that brain chemistry affects our moods and mental stability, diagnosing every unique behavioral trait as a disorder — one which has a chemical fix in the form of psychiatric medication — has lead to an epidemic of overprescribing, dependence, and protracted symptoms similar to the opioid crisis. In 2017, a national emergency was declared by the White House regarding the opioid crisis. Now, six years later, it appears that benzodiazepine overprescribing is following in its footsteps. “The real illness is that the model of care that we have is inadequate to meet the need...” said Dr. John Krystal in an article in Yale Medicine. “The symptom is benzodiazepine over-prescription.” Please note, that while I use the term "overprescribing," I do not support a ban on psychiatric medication, nor do I believe they do not have their place in specific treatment protocols. I am not a psychiatrist or medical professional of any sort, and nothing I say in my blogs should ever be considered medical advice. But, I have worked with individuals dependent on benzodiazepines for almost ten years now, and I might have learned a few things along the way. Prescription and Its Effects “I was prescribed Xanax by my doctor. I f***ing loved it. It made all my anxieties go away… I wanted that feeling all the time.” If benzodiazepines weren't effective in the short-term, we wouldn't have the problem that we have and I would not be writing this blog today. Unfortunately, they do work — at least for a little while. But eventually, with far too many individuals, dependence sets in and long-term complications plague that person's life. So, I'm not surprised by D's initial reaction to the drug. The part of this excerpt that really got my attention, was that D's Xanax was prescribed by a doctor. This was not street use; and the patient did not acquire the medication recreationally, even though the rest of the article steered in that direction. Which brings me to the fact that in the article, "dependence" was not mentioned once. The fact that D was prescribed Xanax by his/her doctor, should have been a red flag in my opinion — but it wasn't. Benzos and Rehab Even after D was sent to rehab, he didn’t believe he had an issue with drugs. It took a month until that realisation hit. “That’s how much denial I was in – I just thought what I was doing was normal,” he says. “To me, it wasn’t bad.” Now, I realize that it is possible that "D" had a substance use disorder (SUD) in relation to his alprazolam (Xanax) use. Still, there was nothing in the article that lead me to believe that. I think there is a much more likely scenario. "D" took Xanax as prescribed by a doctor for years, and became "reliant on drug use." This sounds like dependence and tolerance to me. I must admit, my heart goes out to D here. D was convinced by doctors and/or rehab counselors that it was addiction, and that it's necessary to "talk the talk" and "walk the walk" of someone dealing with substance use disorder (SUD). This frightens me. Not because there is anything wrong with SUD treatment protocols, but because they just aren't appropriate, or effective, for most individuals dealing with benzodiazepine dependence, withdrawal, or BIND. These protocols are often far too rapid, use addiction-specific language and practices, and do not recognize the complications created by dependence. An article by Nicole Lamberson, PA from the Benzodiazepine Information Coalition (BIC) lays out "Why Prescribed Benzo Patients Shouldn't Go to Detox or Rehab." In this article, Lamberson concludes that "...detox/rehab facilities are inappropriate and substandard for physically dependent benzodiazepine patients." Unfortunately, rehab is rarely a productive solution for individuals dealing with benzodiazepine dependence. This is something I see consistently with the people I work with through the podcast. Most of these programs focus on 30 - 90 day treatment protocols, which are far too rapid for this class of drugs. Also, they commonly focus on behavioral modifications to deal with cravings and other SUD related issues which are not relevant, and can even be detrimental, to someone dealing with benzo withdrawal and/or BIND. At the end of the article, the author shares that "D has now managed to stay away from his addiction for six years now," and D states that his mental health is now "the best it's ever been." I am so pleased that D is now doing well and that he is doing much better. Perhaps rehab actually helped D. I can't say for sure. Or, perhaps, he healed from his dependence and his symptoms have now eased on their own. I don't really know. All I can say is that I have yet to work with an individual going through benzodiazepine withdrawal who shared with me that rehab was a good choice. Usually, it's the exact opposite. I want to emphasize in the end here, that I am not against rehab facilities, or the protocols and languages used to treat people suffering with SUD. This is not my area of knowledge, so I would not assume to know how they should be run. But, I do know something about benzodiazepines, especially when taken as prescribed. For these individuals, in my experience, rehab has yet to shown itself to be a productive solution. References Chen, Jennifer. Are Benzodiazepines the New Opioids? Yale Medicine. December 11, 2019. Accessed August 2, 2023. https://www.yalemedicine.org/news/benzodiazepine-epidemic. Lamberson, Nicole. Why Prescribed Benzo Patients Shouldn't Go To Detox Or Rehab. Benzodiazepine Information Coalition. April 20, 2018. Accessed August 2, 2023. https://www.benzoinfo.com/2018/04/20/why-prescribed-benzo-patients-shouldnt-go-to-detox-or-rehab/. Seah, Naomii. Brain chemistry: four stories of drug use and mental health in Aotearoa. The Spinoff. July 25, 2023. Accessed July 26, 2023. https://thespinoff.co.nz/partner/25-07-2023/brain-chemistry-four-stories-of-drug-use-and-mental-health-in-aotearoa. For Informational Purposes Only 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. This article was written by a living, breathing, human person. Please read our site disclaimer for more information.

The Z-drugs: Ambien. Lunesta. Sonata. What are these? Are they benzos? Hypnotics? When did they hit the market? Can they cause dependence? Withdrawal? BIND? These questions and more will be discussed in our feature today. In today’s episode, we focus on nonbenzodiazepines, or Z-drugs. How are they like benzodiazepines, and how are they different? We also answer some questions about dosage, duration, and rebounding and we hear a story of struggle from Tulsa, Oklahoma. Video ID: BFP111 Listen on YouTube... The Benzo Free Podcast is also available on... Apple Podcasts / Audible / iHeart / PodBean / Spotify / Stitcher Chapters 00:00 INTRODUCTION 02:09 My Podcast Voice 05:33 Progress on Website 06:33 Peer Support Training Update 09:10 Struggles, Symptoms, and the Podcast 14:47 A reason why, or just coincidence? 18:16 MAILBAG 18:58 Does dosage or duration matter? 21:24 Rebound from medical procedures? 24:31 BENZO STORY 32:28 FEATURE: Z-drugs 34:38 What are Z-drugs? 36:00 When did Z-drugs hit the market? 36:36 Do Z-drugs act like BZDs on the body? 37:54 Z-drugs often partnered with BZDs 39:46 What are Z-drugs prescribed for? 40:07 The Quest for the Magic Pill 42:04 Are Z-drugs less likely to cause symptoms? 45:06 What are the Z-drug side effects? 47:02 Are Z-drug symptoms different? 48:20 How to taper from Z-drugs? 49:05 BZD and Z-drug Terminology 51:48 MOMENT OF PEACE Resources The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Easing Anxiety of the resource or any recommendations or advice provided therein. FEATURE: Z-drugs Ashton, C. Heather. Benzodiazepines: How They Work and How to Withdraw (aka The Ashton Manual). 2002. Accessed April 13, 2016. https://easinganxiety.com/ashton Brandt J, Leong C. Benzodiazepines and Z-Drugs: An Updated Review of Major Adverse Outcomes Reported on in Epidemiologic Research. Drugs R D. 2017 Dec;17(4):493-507. doi: 10.1007/s40268-017-0207-7. PMID: 28865038; PMCID: PMC5694420. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5694420/. Foster, D E. Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal. Erie, CO: Denim Mountain Press, 2018. https://easinganxiety.com/book Kay, Abigail L. et al. Drug Abuse, Dependency, and Withdrawal. Therapy in Sleep Medicine. 2012. https://doi.org/10.1016/C2009-0-40426-4. Schifano F, Chiappini S, Corkery JM, Guirguis A. An Insight into Z-Drug Abuse and Dependence: An Examination of Reports to the European Medicines Agency Database of Suspected Adverse Drug Reactions. Int J Neuropsychopharmacol. 2019 Apr 1;22(4):270-277. doi: 10.1093/ijnp/pyz007. PMID: 30722037; PMCID: PMC6441128. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441128/. U.S. Food & Drug Administration. Taking Z-drugs for Insomnia? Know the Risks. Last Updated April 30, 2019. Accessed November 30, 2022. https://www.fda.gov/consumers/consumer-updates/taking-z-drugs-insomnia-know-risks. Waller, Derek G., Anthony P. Sampson. Anxiety, obsessive-compulsive disorder and insomnia. Medical Pharmacology and Therapeutics. Fifth Edition. 2018. https://www.sciencedirect.com/science/article/pii/B9780702071676000208. Wikipedia. Nonbenzodiazepine. Accessed November 30, 2022. https://en.wikipedia.org/wiki/Nonbenzodiazepine. Z-Drug. ScienceDirect. 2022. Accessed November 30, 2022. https://www.sciencedirect.com/topics/neuroscience/z-drug. The Podcast The Benzo Free Podcast provides information, support, and community to those who struggle with the long-term effects of anxiety medications such as benzodiazepines (Xanax, Ativan, Klonopin, Valium) and Z-drugs (Ambien, Lunesta, Sonata). WEBSITE: https://www.easinganxiety.com MAILING LIST: https://www.easinganxiety.com/subscribe YOUTUBE: https://youtube.com/@easinganx DISCLAIMER All content provided by Easing Anxiety is for general informational purposes only and should never be considered medical advice. Any health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems, or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. CREDITS Music provided / licensed by Storyblocks Audio — https://www.storyblocks.com Benzo Free Theme — Title: “Walk in the Park” — Artist: Neil Cross PRODUCTION Easing Anxiety is produced by… Denim Mountain Press https://www.denimmountainpress.com ©2022 Denim Mountain Press – All Rights Reserved

The following information is developed and maintained by D E Foster, founder of Easing Anxiety and a member of the benzodiazepine research team that identified the term BIND. The contents of this page are for informational purposes only, and should never be considered medical advice. For the Concerned Patient Stopping benzodiazepines abruptly can be very dangerous. For those who wish to discontinue their medication, a slow taper under doctor supervision is the most commonly recommended method. See the "Caution: Taper Slowly" section at the bottom of this page for more info. Fear is common for individuals who believe they are dependent on benzodiazepines. Please note, thousands have tapered from long-term benzodiazepine use successfully and are living happy, healthy lives. Sites like Easing Anxiety, Benzodiazepine Information Coalition, and the Alliance for Benzodiazepine Best Practices are here to help should you have any concerns. A Few Words About Benzodiazepines Benzodiazepines are a class of medication commonly prescribed for anxiety, insomnia, and seizures. While they can be effective for treating some conditions in the short-term, long-term use may cause physical dependence, which may lead to withdrawal and/or a protracted condition we now call BIND. To learn more about these drugs, please visit our Basics of Benzos page. To learn more about BIND, please read on. BIND Terminology The standard terms used to define the long-lasting neurological complications associated with benzo use and/or discontinuation vary greatly depending on the source. Here are a few of the more common terms: Other Terms for BIND Benzo Dependence / Withdrawal Benzodiazepine Withdrawal Syndrome (BWS) Post-Acute Withdrawal Syndrome (PAWS) Protracted / Persistent / Prolonged Withdrawal Syndrome (PWS) Benzodiazepine Protracted Withdrawal (BPS) Benzodiazepine Injury Syndrome Benzo Brain Injury …and many others. Many of the above terms still exist within benzo literature, including this site. Symptoms that we now relate to BIND, have been considered part of withdrawal, dependence, and even addiction in the past. As we gain knowledge about this condition, terminology changes. Our goal is that BIND will become the permanent term used to define the neurological damage that has been caused by these drugs. BIND Definition BIND (benzodiazepine-induced neurological dysfunction) defines the lingering neurological effects of sustained benzodiazepine exposure. This term was proposed by a research team in 2022 and was formerly presented in a 2023 research article in the open access journal PLOS ONE titled, "Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey" (Ritvo 2023). BIND is now becoming widely adopted by organizations such as The Alliance for Benzodiazepine Best Practices, Benzodiazepine Information Coalition (BIC), the Benzodiazepine Action Work Group (BAWG), and here at Easing Anxiety (EA). Here is the formal definition of BIND: 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 Workgroup BIND Origin A team of 23 experts with mostly academic, clinical, and/or lived experience taking benzodiazepines formed the Benzodiazepine Nosology Workgroup. This Workgroup defined the rationale for the selection of BIND as the most appropriate terminology for the enduring effects of benzodiazepine exposure. The scientific paper listed above above explains this process and illustrates the need for consensus in nomenclature and convergence on BIND as the single descriptive term (Ritvo 2023). DISCLOSURE: D E Foster, founder of Easing Anxiety and the Benzo Free Podcast, is a member of the Benzodiazepine Nosology Workgroup and the Benzodiazepine Survey Research Team, and an author their published papers. Withdrawal vs. BIND In the past, withdrawal and terms associated with BIND have been somewhat interchangeable. This is no longer the case. Based on recent research, we now understand that these are two distinct effects of benzodiazepine use. Benzodiazepine withdrawal is specific to the removal of the drugs from the body, which typically lasts 7 to 28 days after discontinuation. Symptoms which are common and related to this process can include tremors, hallucinations, and seizures, which can be severe and even life-threatening. Thankfully, these symptoms are usually of short-duration. These are the symptoms that most physicians have been trained to look for when someone is discontinuing benzos. This is one of the key reasons why BIND has been so rarely recognized by the medical community. BIND symptoms are typically longer lasting. There are dozens of symptoms — some claim more than a hundred — that can be attributed to BIND. The most frequently reported of these based on the benzodiazepine survey (2018-2019) are severe anxiety, difficulty focusing and distraction, low energy, and insomnia (Huff 2023). Others like memory loss, sensitivity to light, sound and smell, digestion difficulties, pain, akathisia, trembling, tinnitus, uncontrollable emotions, muscle weakness, pulls, and strains, were also common. These are thought to be attributed to neuroadaptation to the drugs, and recovery from this can take months, even years in some people. The Truth About BIND Some people claim that BIND (formerly known as BWS, PAWS, or withdrawal) is not a real illness, that the patients are making it up or have succumbed to online hysteria and hypochondria. It’s an understandable argument considering the laundry list of seemingly unrelated symptoms which some patients may attribute to this illness. But BIND is real. and the evidence supports it repeatedly. Here are a few quotes regarding the legitimacy of protracted withdrawal (BIND): Physical dependence can occur when benzodiazepines are taken steadily for several days to weeks, even as prescribed. Stopping them abruptly or reducing the dosage too quickly can result in withdrawal reactions, including seizures, which can be life-threatening. — U.S. FDA Black Bow Warning on Benzodiazepines (FDA 2020) Withdrawal from benzos can be more dangerous than withdrawal from heroin. —Dr. Stuart Gitlow, Addiction Psychiatrist and President of the American Society of Addiction Medicine Facts: Benzodiazepine use can result in physical dependence at any dose with prolonged use. —New York City Department of Health and Mental Hygiene (New York City 2016) Benzodiazepines are potentially addictive drugs; physical and psychological dependence can develop within weeks of regular use…Dependence upon prescribed benzodiazepines is now recognized as a major clinical problem. —U.K. National Health Service / NHS Grampian (NHS 2006) I’ve met people who’ve been addicted to benzodiazepines for 20 or 30 years — wrecked their lives, wrecked their jobs, wrecked their families. It’s a silent addiction. We all know about illegal drugs, we all know about alcohol, we don’t know about this group. — Anne Milton, U.K. Public Health Minister Most governments and medical associations agree that benzo dependence is real, it can develop as quickly as two to four weeks, and the neurological effects can be debilitating, drawn out over a long period of time, and even fatal in extreme cases. The Science Behind BIND While somewhat effective treating some conditions, benzos can cause physical dependence when taken continuously for longer than 2-4 weeks. One of the processes that is thought to be affected by benzo use, is that of homeostasis. Homeostasis is the human body’s tendency toward physiological stability. When a new drug is introduced into the body, the body’s physiology changes according to the effects of the drug. Eventually, the body tends to re-balance itself — to find new stability. This process can often reduce the effects of the drug, which leads to the need for stronger doses. This is called tolerance. As one’s 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. The sensitivity of the glutamate receptors is also affected, but they become more susceptible to stimulation increasing the excitatory effect. The result is a decrease in calming influence and an increase in excitability. 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. Eventually, stability is reached again, and the withdrawal symptoms subside. The body returns to normal. The effects of benzo use are not limited to the central nervous system (CNS). There is evidence that the peripheral nervous system and mitochondria are also affected by these drugs. Dopamine, CRF concentrations, and even hyperventilation syndrome might also play a part. The long-lasting neurological effects are thought to be part of neuroadaptation and/or neurotoxicity, causing structural changes in the brain. After discontinuation, there also may exist what Ashton calls a learning deficit. While on benzos, the drug aided in the patient’s psychological and physiological response to stress. The patient didn’t have to develop — or learn — coping mechanisms to handle the anxiety. When the drug is removed, this learning deficit is exposed, and the patient has to create new synaptic pathways to manage the worries and complications of ordinary life. BIND Symptoms If someone had to use just one word to convey the general experience of symptoms during benzo discontinuation and BIND, it would have to be hypersensitivity. People in benzo withdrawal feel more — more pain, more agitation, more restlessness, more emotion, more aches, more spasms, more anxiety, more depression, more hopelessness. Benzodiazepine dependence has caused the central nervous system to become hypersensitive and over-reactive to everyday stimuli. Imagine drinking one cup of coffee but reacting like you drank five. Or even ten. A work party might induce mild anxiety in the average person. Imagine if that same event felt like you were speaking in front of a thousand people. Naked. Imagine being dog tired but inside your body energy is on a rampage and your muscles are spasming as if you just drank a six-pack of Red Bull. Not fun, right? And sensitivity is just the tip of the iceberg. Some individuals also experience depersonalization, memory and cognitive dysfunction, muscle tightness and spasms, heart palpitations, phantom nerve sensations, and chronic gastrointestinal distress, just to name a few. And even though most evidence points to these symptoms being temporary, recovery can be drawn out over a long time. That being said, please remember that these examples are the extremes. About half of all long-term benzo users will not experience a difficult withdrawal at all. And for the other half, the withdrawal experience can be significantly improved with proper planning and mindset. To see a more complete list of possible symptoms, visit our BIND Symptoms page. Methods of Tapering Tapering is the process of reducing one’s dosage of a benzo over a period of time, usually several months. Abrupt cessation of benzos can be dangerous and often leads to a more difficult experience. A slow taper under doctor supervision is recommended by most experts. There are three primary options for tapering from benzos: Direct Taper – The first and most straightforward method of tapering is a direct taper. This means that the patient reduces the dosage of the benzodiazepine they are currently on and they don’t substitute another benzo. Substitution Taper – This method of tapering 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. Titration Taper – Titration means mixing benzos with milk or water to create a liquid form of the drug, allowing the user to better control her dosage. This allows for very small and accurate doses. The Ashton Manual covers tapering methodology in more detail. No one should reduce their dosage of benzos or any other prescription medication unless under the direct supervision of a licensed physician. Caution: Taper Slowly For those who chose to stop taking their benzos, we understand the urgent desire to become free from this medication. But the most important thing to remember is that quitting cold turkey will most likely make it worse. It can even be fatal in extreme cases. If one decides to stop taking benzos, a slow taper under doctor supervision is the recommended course of action. Abrupt cessation of benzodiazepines may be very dangerous. — Prof. C. Heather Ashton, The Ashton Manual For those who have already stopped taking benzos cold turkey (CT), don’t panic. Thousands of people have CT’d and recovered fully — many under doctor’s orders. While all evidence points to a better outcome for those who taper slowly, it also points to success even for those who stop more rapidly. For more information about discontinuing (tapering) from benzodiazepines, please check out the Deprescribing Guidelines from the Benzodiazepine Action Work Group. BIND in Scientific Literature Our research article formally introducing the term BIND was published on June 29, 2023 in the open access journal PLOS ONE, titled "Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey." This story has been picked up by Psychology Today, the New York Post, and WebMD among others. BIND Research Roundtable Video Join the Benzodiazepine Survey Research Team for a lively roundtable discussion about their research, the findings from the survey, and their latest paper which formally introduces the term benzodiazepine-induced neurological dysfunction, or BIND. This video was recorded on June 9th, 2023 and is available on the Easing Anxiety YouTube Channel, among many other videos and podcast episodes. VIDEO POST: https://www.easinganxiety.com/post/the-bind-roundtable-benzodiazepine-survey-research-team Benzodiazepine Effects on the Brain and Body This 8-minute animated video was created by the Benzodiazepine Action Work Group for the "Recovering from Benzodiazepines for Peer Support" training course. It demonstrates the effects that benzodiazepines have on the nervous system, the role glutamate, GABA, and GABA receptors play, how homeostasis affects healing, and why this process may take months or years. References The Alliance for Benzodiazepine Best Practices. “Benzodiazepine-induced neurological dysfunction (BIND).” May 2022. https://benzoreform.org/bind. 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/. Ashton, C. Heather. “Protracted Withdrawal from Benzodiazepines: The Post-Withdrawal Syndrome.” Psychiatric Annals 25(3)(1995):174-179. Accessed April 14, 2018. doi:10.3928/0048-5713-19950301-11. Bleyer, Jennifer, “Popping Xanax Is More Harmful Than You Think,” Self, February 20, 2014, accessed January 30, 2017, https://www.self.com/story/xanax-more-harmful-than-you-think. Finlayson AJR, Macoubrie J, Huff C, Foster DE, Martin PR. Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey. Therapeutic Advances in Psychopharmacology. 2022;12. https://journals.sagepub.com/doi/full/10.1177/20451253221082386. 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. Huff C, Finlayson AJR, Foster DE, Martin PR. Enduring neurological sequelae of benzodiazepine use: an Internet survey. Therapeutic Advances in Psychopharmacology. 2023;13. https://journals.sagepub.com/doi/10.1177/20451253221145561. New York City Department of Health and Mental Hygiene (NYC DOHMH). City Health Information: Judicious Prescribing of Benzodiazepines 35(2)(2016). https://docs.wixstatic.com/ugd/990dad_167113513c9445f8bc77a77370ce649f.pdf. Ritvo AD, Foster DE, Huff C, Finlayson AJR, Silvernail B, et al. (2023) Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey. PLOS ONE 18(6): e0285584. https://doi.org/10.1371/journal.pone.0285584. Trickett, Shirley. Withdrawal from Benzodiazepines. Journal of the Royal College of General Practitioners 33(254)(September 1983):608. Accessed April 17, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1973010/. U.K. National Health Service (NHS). “Guidance for Prescribing and Withdrawal of Benzodiazepines & Hypnotics in General Practice.” NHS Grampian. October 2006. Reviewed October 2008. https://www.benzo.org.uk/amisc/bzgrampian.pdf. U.S. Food & Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. September 23, 2020. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class. For Informational 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. Please read our site disclaimer for more information.

In the benzo community, some observations have almost become clichés. These include "every one is different," "it's dependence not addiction," or even "we do heal, in time." Then there are the ones about certain doctors and pharmaceutical companies — but I think it's better not to repeat those here. That being said, there are also a few other observations I have seen which are a bit more complex, and perhaps not as frequently discussed around the water cooler, or whatever the virtual version of that is today. I've noticed one observation stand out over the past couple of years; one which appears to be relatively consistent with many individuals I've worked with. While many of us — yours truly included — talk about "acceptance" in our blogs and videos and support groups, rarely do we discuss the source of that concept. "Acceptance" is actually the fifth and final stage of a process that many individuals experience when something traumatic has happened in their life. But, what about the other four stages? These too are quite common in benzo withdrawal and BIND, and I think it is wise to take a few minutes here to understand them better. The Five Stages of Grief were originally introduced in the book, "On Death & Dying" by Elisabeth Kübler-Ross, MD, published over 50 years ago. She lists the five stages as Denial, Anger, Bargaining, Depression, and Acceptance. This book was not only a massive best-seller, but it became a standard text book in classrooms across the nation. It even inspired entire courses which adopted the book's name. How do I know this? Well, I actually took a class titled "On Death and Dying," based on Kübler-Ross' work, back in high school. Yes, in case you were wondering, we had books back then. Benzos and the 5 Stages What does a book on death and dying have to do with benzodiazepines? Great question. I'm glad I asked it. A terminal illness, or the death of a loved one, are two of the most significant events in a person's life, and often the most traumatic. But, death is not the only cause of this type of trauma. Other life events like disaster, loss of career, and non-terminal illnesses can also trigger a similar reaction. And that is where BIND comes in. Today, I want to take a look at the fives stages as Dr. Kübler-Ross originally defined them, and discuss how they present themselves for those of us who have experienced benzodiazepine dependence, withdrawal, and BIND. And as we step through them, it is important to keep in mind that this is not necessarily a linear process. Some individuals start with anger, some with depression, some even skip stages altogether or double-back more than once. While the road map presented here may be the more common progression, it is definitely not the only one. Let's move on to the first one... 1) Denial Among the over 200 patients interviewed for her book, Dr. Kübler-Ross noted that "most reacted to the awareness of a terminal illness at first with the statement, 'No, not me, it cannot be true.'" As human beings, we have a natural predisposition of avoiding difficult news. It's a protection mechanism. Denial, at least partial denial, is used by almost all patients, not only during the first stages of illness or following confrontation, but also later on from time to time. — Elisabeth Kübler-Ross, "On Death and Dying" Does any of this sound familiar? Most individuals I have worked with in the benzo community resisted the thought that they might be dependent on a long-term medication. It's not a comfortable position to be in. When I learned that the clonazepam (Klonopin) my doctors prescribed me for over12 years may have seriously altered my body and mind, I freaked out. I had an all out panic attack, didn't sleep for days, and thought that my world had collapsed around me. I wanted nothing more than to get this drug out of me immediately. Thankfully, I did not quit cold turkey, but instead educated myself and found the support I needed. But, the panic attack was not my only reaction. Most of all, I wanted a way out. I wanted for this not have happened. I wanted to wake from this nightmare. But, that wasn't possible. It wasn't a nightmare. I wasn't sleeping. This was real. We sometimes avoid knowing things, as a way of coping. Denying it happened is a protection mechanism. It's a way for our minds to say, "wait a minute, this is more than I can handle at this time." Rather than face what could be life-altering news all at once, we can block our understanding temporarily, and ease into it. But eventually, it does sink in, and then we quite often... get mad. 2) Anger I think we all know this one. When it comes to benzodiazepine dependence, anger is very common. We're mad at God. We're mad at ourselves. And most often, we're mad at the doctors who prescribed the drugs and the pharmaceutical companies who made them. The experiences that so many have faced in doctor's offices border on horrendous at times. Individuals ignored, distrusted, and even forced to quit their drugs cold turkey. All while the pharmaceutical companies — who made billions from these same drugs — ignore the patients' stories and pretend their medications are perfectly safe. The search for a "benzo-wise" doctor is a common one. In fact, the most common request I receive through the Benzo Free Podcast is, "how do I find a doctor who can help me?" I provide these individuals some references, such as BIC's Cooperative Doctors List — but in all honesty, we don't have a very good solution. Still, I wouldn't have to answer this question so often if more doctors were educated on proper prescribing and deprescribing protocols for benzodiazepines. Unfortunately, that is not the case. When the first stage of denial cannot be maintained any longer, it is replaced by feelings of anger, rage, envy, and resentment. The next logical question becomes: "Why me?" — Elisabeth Kübler-Ross, "On Death and Dying" Anger is a normal and expected emotion during this time. It is also a difficult stage to move past. So many of us in the benzo community are still trapped in this stage. We get mired in the frustration and the blame and the rage and find it difficult to leave those emotions behind. We might even tell ourselves that "we are justified in our anger," so why would we want to let it go. There is one key reason why letting go of the anger is important. Because, it is not a friend to healing. As long as we hang on to the blame and the hate, healing can't move in. There's just not enough room. At some point, most of us realize that we need to move on. But, even if we move past the anger, we still may not be ready yet to accept what has happened. And, we might be looking for another way out. 3) Bargaining If denial and anger don't work, it's time to make a deal. It's time to bargain. It's time to ask God, or someone else with enough power, to take this away from us. It's time to beg for this not to be. At least, that's what our minds tell us. ...maybe we can succeed in entering into some sort of an agreement which may postpone the inevitable happening... — Elisabeth Kübler-Ross, "On Death and Dying" In BIND, bargaining takes a variety of forms. Here are just a few examples: "Please God, Doctor, or whatever powerful entity you wish to bargain with, I'll do anything if..." "...I'm not dependent on this drug." "...my taper goes smoothly." "...these symptoms would just stop." "...I could have one good night's sleep." "...I could just think straight for one minute." Or, perhaps the most common... "...this was all over tomorrow." For so many of us, this is a desperate time. We'll do anything to stop the anxiety, the akathisia, the tremors, the burning, the muscle pain, the tinnitus, or whatever your most severe symptoms are — we'll do anything to stop them. And thus, we are willing to make a deal. Sometimes this is just a request, "please do this for me." Sometimes it includes a bargaining chip, "I'll donate to charity," or "I'll spend more time with my family," or "I'll eat right, exercise, and take better care of myself." It doesn't matter the bargain, it's about us being at the end of our rope and willing to do anything to make this go away. But, it's usually a futile ask. And then, we hit the next stage... 4) Depression Depression is perhaps the one stage that makes the most sense, considering what we are going through. For those of us dealing with severe withdrawal or BIND, our lives have changed for the worse. There's no skirting around that fact. Life is going to be harder for a while. Perhaps a long while. And this can be a very depressing fact. When the [patient] can no longer deny his illness, when he is forced to undergo more surgery or hospitalization, when he begins to have more symptoms or becomes weaker and thinner, he cannot smile it off anymore. — Elisabeth Kübler-Ross, "On Death and Dying" In the three research papers we published from the Benzodiazepine Survey of 2018-2019, we reported not only on the common symptoms of withdrawal and BIND, but also on the adverse life effects. These include the negative effects on relationships, loss of job, loss of house, loss of a business, violent thoughts, and perhaps one of the most common, financial struggles. In Kübler-Ross' book, she spoke about the financial strain that terminal illness can place on a family, and this is equally as relevant to BIND. Financial burdens "have forced many patients to sell the only possessions they had; they were unable to keep a house which they built for their old age, unable to send a child through college, and unable perhaps to make many dreams come true." When you combine the symptoms common in BIND, sometimes severe, the duration that these symptoms may last, sometimes years, and the strain this can place on the individuals and the people around them, sometimes unseen and often unsupported, it is no surprise that depression is a common result. And this rarely effects only the individual, but instead the entire family unit and/or support team. During this time, suicidality is also a serious concern. Suicidal ideation and threats of suicide should never be taken lightly, especially when benzodiazepine dependence is involved. If you, or someone you know, is experiencing thoughts of suicide, please get professional help immediately. We have a list of suicide prevention resources on our website for your reference. 5) Acceptance Finally, we get to the somewhat mystical stage, of acceptance. Acceptance is spoken of quite regularly in the benzo community; and in my opinion, for good reason. If a patient has had enough time and has been given some help in working through the previously described stages, he will reach a stage during which he is neither depressed nor angry about his "fate." Dr. Kübler-Ross defines acceptance as a stage of accepting the inevitable fate, which, considering the target audience of her book, is often death. Benzos are different. Benzodiazepine dependence and BIND is not a death sentence — although for some of us it seems like that. It's a hardship. A severe hardship, for some, but a hardship none-the-less. And all hardships can be overcome. And "acceptance" is where this takes place. I have spoken about acceptance on my site and podcast many, many times. In my book, "Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal," I wrote a whole chapter on "Managing the Fear of Benzo Withdrawal." I also dedicated episodes 3, 4, & 5 of the Benzo Free Podcast to the same topic. In both of these, I share the five areas where we can improve to help manage our fear. These include responsibility, positivity, mental and physical activity, kindness, and finally, acceptance. Acceptance was a cornerstone of healing from benzos over four years ago when I published my book, and it still is today. Finding acceptance is about moving past the anger, the frustration, even the depression, and accepting that this happened to you. It's no longer about avoiding it, it's no longer about bargaining your way out of it, it's not even about blaming others for it — it's about accepting it. This has happened to you. There is nothing you can do to change that. Now you must decide how you are going to handle it. Finding acceptance for me was about healing: That's all that benzo withdrawal really is; it's your body healing. And healing is a good thing. In fact, it's an amazing thing. Our bodies heal even from some of the most horrendous injuries. It's an incredible piece of biochemical engineering. And the best thing I could do was let it do its job. — D E Foster, Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal. Summary Why did I write this article? Well, the primary reason was so that we can recognize the stages some of us may go through during benzo withdrawal and BIND. When we can recognize these stages, we can have a better understanding of them, and ultimately, learn how do deal with their effects in a healthy manner. BIND is a mental game. Sure, many of us experience a series of physical symptoms ranging from mild nuisances to debilitating effects, but the area where we can make the most positive change, is in our mind. It's all about "mindset." Learning about what happened to us, finding acceptance for what happened to us, and ultimately, rising above and making the most out of what happened to us; that's where we can make the most gains. Well, that should wrap things up. I hope this helped. And thank you again, for allowing me to be part of your healing journey. References Kübler-Ross, Elisabeth. "On Death & Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, & Their Own Families." New York: Scribner 1969. 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. Foster, D E. "Managing the Fear of Benzo Withdrawal (Part 3 of 3)." The Benzo Free Podcast. February 20, 2019. https://www.easinganxiety.com/post/managing-the-fear-of-benzo-withdrawal-part-3-bfp005. Ritvo AD, Foster DE, Huff C, Finlayson AJR, Silvernail B, et al. (2023) Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey. PLOS ONE 18(6): e0285584. https://doi.org/10.1371/journal.pone.0285584. Disclaimer This post is for informational purposes only, and should never be considered medical or professional advice of any kind. Please visit our disclaimer page for more info. This article was written by a living, breathing, human person. No A.I. was utilized in its creation.

3:02am. Thursday morning. I'm awake. Actually, it's now 4:23am as I write this, but I woke a little over an hour ago to a thunderstorm. Chances of returning to sleep... maybe 10%. This has happened a lot lately. Not the thunderstorms, but waking early. I have a feeling some of you can relate. When this happens to me, I usually stay in bed, open up my iPad, and watch some YouTube videos or sitcom reruns on PlutoTV. I try not to start a movie or TV series since it takes too much of my attention, preventing me from returning to my slumber. Still, I'm usually up for a few hours regardless. I may get drowsy and fade in and out while watching, but not enough to fully fall asleep. And then, it's time to get up. Yes, yes, I know the horrors of screens in bed. In fact, I've written blog posts about them. "Good sleep hygiene," is what we usually call it. And yes, I do believe in it. It's just that sometimes I get out of practice, develop bad habits, and have to be reminded of what got me here. This morning, I decided to take a different route and be productive. Some may say that getting up and working is the wrong direction, in that it wakes us up even more. And, I get that. For me, though, I know the odds of returning to sleep are very low — so I might as well make the most of it. The truth is, I've been struggling with insomnia lately. In fact, I've been in a wave lately. Yes, yours truly at almost nine years off benzos, is still having waves. Please remember, this is me, not you, and my journey will not be yours. (see My Personal Symptom Disclaimer at the end). Insomnia, the Mental Game I haven't talked about this topic for far too long. Insomnia is a BIND symptom that has significantly improved for me over the years, even though I still have short bouts now and again. I have a tendency to let my own struggles and symptoms lead me to the topics for these posts. Maybe that's a bit selfish of me, but I don't know, sometimes I think it's more real and even natural when I can write about a topic as it's happening. The rain just picked up outside, and the thunder is a low rumble in the distance. Middle-of-the-night thunderstorms are not the norm here on the front range of Colorado. Back home in Kansas City, it was a different story. And I think I miss them. Not necessarily waking up in the middle of the night, but there is some comfort to a good rain storm. And, normally, it's great for sleep. For most of us, insomnia is a mental game. At least, that is the case for me. Once I wake up, to use the restroom, from a nightmare, or because of a loud noise, I'm usually up. Getting back to sleep is rare. Ah, the insidious demon of an anxious mind. If I wake in the middle of the night, can manage to stumble to the bathroom and pee, and return to bed without waking myself too much, I might be able to get back to sleep. But, that is a big if. If during that time my mind finds just one tiny, little thought, or worry, or fear to latch on to — it's over. Ruminations, looping thoughts, a cascade of "what ifs" and "why did she say thats" and "I'm so far behinds" and of course the classic, "why am I still struggling with this," flood our psyches and demand that we pay attention. Our minds are our worst enemies sometimes, and we long to find a way out. That's why I started opening my tablet to watch shows in the first place. It would take my mind off my own, well, mind. Sometimes, it would pull me away just enough to let me get back to sleep. But, most of the time, it's not very effective. Screens rarely are. I don't have the answer for insomnia here. I know a lot of tools and techniques, many of which can be effective, but this is not one of those posts. It's more the "stream of consciousness" type. It's 4:54am now, and even though I can write this, I don't think I'm up to research right now. Instead, this is just one of those posts where I say "hi," I'm here, I still struggle too, and I get it." That's it. More often than not, that's all I do. And, according to many of you, it seems to help. DVDs, Movies, and Pleasure Let's change the subject a bit. Why? Well, since this is one of those "stream of consciousness" posts, and this is where my consciousness is taking me, I guess I'll go along for the ride. Don't worry, at the end of this section I'll desperately attempt to tie it back to the original topic, and probably fail, as I often do. It's still dark outside, my brain is working at about 35% capacity, and this is all I have in me. What can you do? Anyway, what I was going to say is that as I'm writing this, I'm also ripping DVD's onto my PLEX server. Like I said, I'm changing the subject here. So, sue me. I like movies. Some of you may recall that I used to be a screenwriter and taught screenwriting at college in a former life. While I'm still partial to the older movies, there are some recent ones that have impressed me too. I have about a thousand movies and TV shows on a server in my basement which is accessible throughout my house via a software app called PLEX. Following so far? Good. Now, before I get too far, for those who think I'm pirating videos, don't worry. As a former screenwriter, I've lost revenue along the way from video piracy. So, I can't say I'm a fan of that. No, instead I keep all of the DVDs that I rip onto my server in boxes in the basement. By having them on a server too, I don't have to manually pull out the DVD each time to watch it. Instead, I just pull up a movie as if it was on Netflix or Hulu. Yes, I can't be bothered to stand up, pull a DVD from a box, and put it in the player. Another sacrifice to the convenience Gods. So, why am I telling you this? Let me see. I know I can relate it to something psychological, philosophical, or something else that ends with "-ological." Oh, I think I have one. Here it goes. I enjoy finding movies, ripping movies, updating my database about the movies, seeing the new movies on the app on my TV, and reselling the movies I didn't rip or donating them to the VA or other charities. I enjoy that, because I like movies. I realize it may not be the most healthy obsession, but it's also not the most destructive either. It just makes me happy. And, that's my point. I can't sleep right now. So, I could lay there in the dark obsessing about my latest ache or pain or twitch. I could watch some YouTube video or movie on my PLEX app. I could even turn on the light and read a book — which I do on occasion, but not as often as I'd like. Or, I could get up, throw on a robe, and go to my office and do this — rip movies and write to you. Both of these are productive and pleasurable. Not a bad use of my time, I'd say. Hang on... I need to change out a movie. Give me a sec... Okay, I'm back. Now, I will admit that getting up isn't always the best idea. For those who may fall back to sleep, laying there might be the better choice. Plus, even if you are not sleeping, you are still getting rest. Perhaps adding a soothing soundscape might help, or a meditation recording, or the sound of a podcaster's voice (yes, I know some of you fall asleep to my voice). If that is the case, give it a go. But, if you know that for you this is not going to work, then perhaps change things up a bit. Who knows? My point is this. I'm making good of a bad situation. I will eventually sleep. It will catch up to me. Perhaps this afternoon I will find time for a short nap. Perhaps I will wait until tonight and will sleep through the night. Perhaps I'll even have short nights for a while. But, eventually, I'll get back to my normal pattern. Sleep will return. It always does. In the meantime, though, I really have two choices. I can obsess about it, get angry about it, blame anybody from here to there about it, and ruin a brand new day from the ground up. Or, I can make the most of it. I just wrote a 30-something paragraph blog post for my site, ripped six DVDs, and feel pretty damn good. I made the best of a bad situation, and I'd say that's a good start to the day. My Personal Symptom Disclaimer Now, the disclaimer. Yes, I still have symptoms. Sometimes strong symptoms. In this recent wave I'm dealing with cognitive issues, dysphagia, throat tightening, tinnitus, muscle aches and pains, gastric distress, insomnia, and others. Is this all caused solely by benzos and BIND? No. It's not. Does this mean you will have symptoms at nine years out? No. That is highly unlikely. I am definitely in a small minority. Every one of us has more than one factor at play here. None of us can truly say, "it's absolutely the benzos, and only the benzos." There are too many factors. I updosed during my taper, have moderate to severe ADHD, took a fluoroquinolone antibiotic which can cause neuropathy all by itself, have had three bouts of COVID including long COVID, recently lost my father, mother, and dog all in the same year, been under constant stress, let many of my tools which helped me recover lapse, and on and on and on. I have plenty of comorbidities, as they say in the medical profession. So, I can't say it is definitely one thing or another. In fact, the reason that I am doing well now is in part, due to my BIND. It taught me how to enjoy the little things, how to see the good in each day, and how to make the most of life and live it to the fullest — even for those of us who have certain limitations. In addition, I have come a long, long way. I am significantly improved from the early days of my withdrawal. And, that includes my insomnia. I typically get 6-7 hours of sleep a night now, and that is wonderful. I never was a long sleeper, so it's rare for me to get an eight-hour night. Only in the past week or so has the insomnia returned. And, I'm not really worried about it. I know that it will pass and I will get back to restful nights again soon. I am pleased more than you know, that sharing my story has helped thousands of people who are struggling with benzo withdrawal and BIND. But, please, don't use my experiences as a litmus test of what to expect for yourself. We all are different. Very different in this journey. I happen to be in the minority of individuals who still struggle this far out. Will this be you? Most likely, not. In fact, the odds are definitely against it. Also, times have changed. We know more and have significantly better support systems now than when I started my taper over 10 years ago. The truth is, with education about what to expect, a team to support you, and a positive mindset, anyone can taper from benzodiazepines successfully. I truly believe that. I often wonder why I still struggle with symptoms from BIND to this day. And, it comforts me to think that maybe there is a reason for it. Maybe, just maybe, it's because I'm supposed to. Because, by being reminded of what it is truly like dealing with BIND's symptoms, I can relate better to you. And you know what, I'm okay with that. It's amazing what we can tolerate in life when we believe it is for a purpose. I have a purpose, and that's a wonderful thing. I Am Happy Please take care of yourself, and don't use me as an example of what it will be like for you. I am happy. Honest. I am happy. Who cares if I have a few sleepless nights. They will pass. They always do. So what if I still have some symptoms now and then. They're not nearly as severe as they were in the early stages of my withdrawal. This experience has made me stronger. My symptoms don't own me. They're just there, I deal with them, and I get back to my life. I'm actually excited right now. I've had a ball writing this blog post. Insomnia can be so incredibly lonely and isolating. But, as with all my posts and podcast recordings, when I speak to you I don't feel so alone. It may seem corny to say that, but that doesn't make it any less true. I love talking with you, and that hasn't changed. And, I am grateful for that. I am grateful for you. It's 5:33am. The thunder is still rolling outside in the distance. I'd go for a walk, but I might get drenched. I could go back to bed, but I know I would just lay there in the dark — sleepless. And that isn't very productive. I'll try and find time for a short nap this afternoon. I guess I'll just keep working. I'm in a zone now, and I might as well make the most of it. We do what we have to do. But, what's more important, is that it's a brand new day. And, I get to decide if it's a good day, or a bad day. I chose the former. Now, try and get back to sleep, With love, D :)

Our research paper on BIND is still getting attention from academia and the media almost three weeks after its publication. In the last week alone, the study was picked up by the U.S. Sun, Forbes, and Vanderbilt University, among others. The paper, "Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey," published in the open-access journal PLOS ONE, was the third paper on the Benzodiazepine Survey of 2018/2019, and it formally introduced the term benzodiazepine-induced neurological dysfunction (BIND) into medical literature. Research team members include Alexis Ritvo, MD, MPH (University of Colorado, Anschutz Medical Campus), Christy Huff, MD (Benzodiazepine Information Coalition), A. J. Reid Finlayson, MD, MMHC & Peter R. Martin, MD, MSc (Vanderbilt University Medical Center), Bernard Silvernail (The Alliance for Benzodiazepine Best Practices) and D E Foster (Easing Anxiety, author of this article). Highlights from Recent Articles Of particular note this past week, is the article from Vanderbilt University Medical Center titled "Study highlights consequences of chronic benzodiazepine use." This article highlighted two distinguished members of the research team who call Vanderbilt University Medical Center home: Dr. Peter Martin, Professor of Psychiatry and Behavioral Sciences and senior author of the study, and Dr. Reid Finlayson, Professor of Clinical Psychiatry and Behavioral Sciences. Benzodiazepines are toxic to brain functioning, especially to the anxiety mechanisms in the brain — Dr. Peter Martin, Vanderbilt University Medical Center In this article by VUMC Reporter Danny Bonvissuto, Drs. Martin and Finlayson shared some insight into the effects of benzodiazepines on the brain and body. This study identified that more than 50% of the respondents to the survey had suicidal thoughts or had attempted suicide. The author also cautioned that, "because benzodiazepines change the biochemistry of the brain, they require a slow tapering process to avoid elevated blood pressure, anxiety and seizures." [Benzodiazepine] is an anesthetic agent generally assumed to be helpful for anxiety symptoms. There are a few studies that, unfortunately, show worse outcomes for anxiety symptoms, particularly if the benzodiazepine use exceeds several weeks. — Dr. Reid Finlayson, Vanderbilt University Medical Center Another team member and co-originator of the study, Christy Huff, MD, was interviewed for the Sun article in which she shared that, "[benzodiazepines] can take months to years to fully resolve." The Sun article also highlighted the correlation between benzodiazepine use and physical aggression, sexual disinhibition, impulsive decision-making, and acts of physical violence. According to a 2018 report from Cambridge University Press, "benzodiazepines act by reducing 5HT (serotonin) neurotransmission, which may, in turn, lead to aggressive behavior." The continuing coverage of this research is raising awareness and improving opportunities for education. We welcome the feedback and inquiries it has generated. References Bonvissuto, Danny. Study highlights consequences of chronic benzodiazepine use. VUMC Reporter, Vanderbilt University Medical Center. July 19, 2023. https://news.vumc.org/2023/07/19/study-highlights-consequences-of-chronic-benzodiazepine-use/. Ghlionn, John Mac. BENZO ABUSE Xanax and other anxiety medications linked to horror side effects including ‘aggression and acts of violence’. The U.S. Sun. July 15, 2023. https://www.the-sun.com/health/8567743/xanax-anxiety-medications-linked-aggression-violence-seizures/. Paton, C. (2002). Benzodiazepines and disinhibition: A review. Psychiatric Bulletin,26(12), 460-462. doi:10.1192/pb.26.12.460. https://www.cambridge.org/core/journals/psychiatric-bulletin/article/benzodiazepines-and-disinhibition-a-review. Ritvo AD, Foster DE, Huff C, Finlayson AJR, Silvernail B, Martin P. (2023) Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey. PLOS ONE 18(6): e0285584. https://doi.org/10.1371/journal.pone.0285584. Varanasi, Anuradha. Benzodiazepine Use Might Result In Long-Term Neurological Dysfunction. Forbes. July 11, 2023. https://www.forbes.com/sites/anuradhavaranasi/2023/07/11/benzodiazepine-use-might-result-in-long-term-neurological-dysfunction.

In a very simplified way, this video explains how benzodiazepines affect the nervous system and body. This video was created by the Benzodiazepine Action Work Group (BAWG) at the Colorado Consortium for Prescription Drug Abuse as part of the Recovering from Benzodiazepines Peer Support Training Course. To learn more about this course, please visit https://benzopeertraining.org. For more information about the Benzodiazepine Action Work Group, visit: https://benzoaction.org Video ID: BAWGTraining001 Watch the Video Chapters 00:00 Introduction 00:27 The Key Players 02:13 Binding of Benzos 02:43 Balance and the Brain 03:03 Tolerance, Dependence, & Withdrawal 03:40 The Car Analogy 04:56 Withdrawal Symptoms 05:33 Why Do Symptoms Persist? 06:22 Take Home Messages 06:56 Support is Essential 07:15 Closing Resources The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Benzo Free of the resource or any recommendations or advice provided therein. FOR MORE INFORMATION ON THE TRAINING COURSE — Recovering from Benzodiazepines for Peer Specialists — https://benzopeertraining.org FOR BENZO SUPPORT, PLEASE VISIT THESE PARTNER ORGANIZATIONS — Easing Anxiety (EA) — https://easinganxiety.com — Benzodiazepine Information Coalition (BIC) — https://benzoinfo.com — The Alliance for Benzodiazepine Best Practices — https://benzoreform.org — Benzo Warrior — https://benzowarrior.com Video Credits This video was produced by, and is property of, the Benzodiazepine Action Work Group at the Colorado Consortium for Prescription Drug Abuse Prevention. VIDEO PRODUCTION SERVICES — JBCM Media Production — https://gojbcm.com PARTNER ORGANIZATIONS — Easing Anxiety (EA) — https://easinganxiety.com — Benzodiazepine Information Coalition (BIC) — https://benzoinfo.com — The Alliance for Benzodiazepine Best Practices — https://benzoreform.org — Benzo Warrior — https://benzowarrior.com — The Schreiber Research Group (TSRG) — https://tsrg.org PRODUCTION TEAM — Produced by: The Benzodiazepine Action Work Group — Project Lead / Writing: Nicole Lamberson, PA — Animation / Video Production: Jay Billups (JBCM Media Production) — Narration: D E Foster — Consortium / Program Management: Shayna Micucci This video is for general educational purposes only. It does not constitute professional medical advice, encouragement, or recommendation that any individual reduce or withdraw from benzodiazepines and/or other psychiatric medication(s). Copyright: ©2023 Colorado Consortium for Prescription Drug Abuse Prevention (https://corxconsortium.org) Disclaimer All content provided on this YouTube channel is for general informational purposes only and should never be considered medical or health advice. The author of the content provided on this channel is not engaged in rendering medical, health, psychological, or any other kind of personal or professional services. Health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. https://easinganxiety.com

NOTICE: This article contains content which may be difficult for some BZAIs. See end of article for info. An article titled, "Cognitive Consequences of Benzodiazepine Use: Is It Worth Losing Our Mind Over?," was recently published in Pharmacy Times. This article was written by researchers affiliated with the Alliance for Benzodiazepine Best Practices and it highlighted the link between long-term benzodiazepine use and cognitive dysfunction. This article's primary focus was a meta-analysis of 13 studies. These studies focused on a variety of cognitive effects that appear to be associated with long-term benzodiazepine use. Here are some highlights from the article: Based on a meta-analysis of 13 studies, the average duration of benzodiazepine use was 9.9 years. Since the FDA recommends short-term use only, this is a significant disconnect. (Stewart 2005) One study concluded that long-term exposure to benzodiazepines "increases the risk of dementia by as much as 78%" (Islam 2016), yet other studies have presented conflicting evidence. "Previous long-term benzodiazepine users experience some degree of improvement in cognitive abilities [after cessation]" (Barker 2005), although "it is not known whether or when cognitive function will return to baseline levels." (Zetsen 2022) Benzodiazepines have been shown to cause impairment to motor coordination, psychomotor speed, verbal reasoning and learning, executive function, sensory processing, episodic memory, concentration, IQ, processing speed, visuospatial and visuomotor abilities, and they can result in delayed response time and an altered perception of self, environment, and relationships. (Neal 2023) Certain populations are at higher risk, "including those taking higher doses, elderly patients, and those using benzodiazepines concomitantly with drugs, alcohol, or anticholinergic psychotropic medications." (Stewart 2005) Much of these findings are consistent with our research recently published in PLOS ONE, which introduces the terminology for benzodiazepine-induced neurological dysfunction, or BIND. Link to complete article: https://www.pharmacytimes.com/view/cognitive-consequences-of-benzodiazepine-use-is-it-worth-losing-our-mind-over- References Barker MJ, Greenwood KM, Jackson M, Crowe SF. An evaluation of persisting cognitive effects after withdrawal from long-term benzodiazepine use. J Int Neuropsychol Soc. 2005 May;11(3):281-9. doi: 10.1017/S1355617705050332. PMID: 15892904. https://pubmed.ncbi.nlm.nih.gov/15892904/. Islam MM, Iqbal U, Walther B, Atique S, Dubey NK, Nguyen PA, Poly TN, Masud JH, Li YJ, Shabbir SA. Benzodiazepine Use and Risk of Dementia in the Elderly Population: A Systematic Review and Meta-Analysis. Neuroepidemiology. 2016;47(3-4):181-191. doi: 10.1159/000454881. Epub 2016 Dec 24. PMID: 28013304. https://pubmed.ncbi.nlm.nih.gov/28013304/. Neal D and Bressi J. "Cognitive Consequences of Benzodiazepine Use: Is it Worth Losing Our Mind Over?" Pharmacy Times. July 6, 2023. Accessed July 7, 2023. https://www.pharmacytimes.com/view/cognitive-consequences-of-benzodiazepine-use-is-it-worth-losing-our-mind-over-. Stewart SA. The effects of benzodiazepines on cognition. J Clin Psychiatry. 2005;66 Suppl 2:9-13. PMID: 15762814. https://www.psychiatrist.com/wp-content/uploads/2021/02/24595_effects-benzodiazepines-cognition.pdf. Zetsen SPG, Schellekens AFA, Paling EP, Kan CC, Kessels RPC. Cognitive Functioning in Long-Term Benzodiazepine Users. Eur Addict Res. 2022;28(5):377-381. doi: 10.1159/000525988. Epub 2022 Aug 30. PMID: 36041417. https://pubmed.ncbi.nlm.nih.gov/36041417/. BZAI Caution This article contains information regarding the long-term effects of benzodiazepines, including cognitive and memory impairment. This information may be distressing to certain benzodiazepine-affected individuals (BZAIs) during acute phases of withdrawal and BIND. It may be wise to avoid exposure during this time.

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. We need your help We all make mistakes. And that definitely holds true for this website. Easing Anxiety is only as good as the time and effort put into it. We welcome any updates, corrections, or additions via our online feedback form. If you have references, please include them too. Thanks. A 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. B 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). C 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 D 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. E 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 F 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. G 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” H 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. I 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. J 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. K 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. M Myorelaxant Myorelaxant is a term used to describe medication that relaxes the skeletal muscles. N 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. P 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. R 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. S 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”] T 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. Please read our site disclaimer for more information.

I've posted a lot lately, but it's all been about BIND and the research paper we just published. I wanted to take today to just touch base and say hi. And perhaps ramble on a bit on a non-sequitur, as I often do. I started working on this anxiety article yesterday morning, and then walked away from it for a while. This is also common for me. Sometimes I never return to the topic, and it stays in my draft folder until I delete it. And sometimes I return to it a bit later, with new focus and energy, and create a post out of it. This time, thankfully, it was the latter. During the time I stepped away, a dear friend called me for some counsel. She was struggling with some fear of an upcoming event, and we connected over the similarity of our struggles. After that conversation, I knew the topic might be useful to others and that I needed to finish it. So, here it is. Laying the Groundwork of Fear A cornerstone of Easing Anxiety and the Benzo Free Podcast has been honesty — from day one. And that often includes sharing much of myself — even my flaws, my failures, and my embarrassments. By doing this, we have connected, and that connection is the heart and soul of what we do here. Since January, I've been dealing with some health difficulties which I shared on occasion with you. In an effort to keep this short — a quest who's goal continues to elude me — I am not going to repeat them in detail here. Suffice it to say, I've had about 15 doctor visits, tests, and procedures since the first of the year. And that brings me to June 23. A couple of weeks ago, I had what I like to call a triple-header procedure — a colonoscopy, endoscopy, and esophageal dilation. The endoscopy was diagnostic for my dysphagia (difficulty swallowing), the esophageal dilation was an attempt to help with that condition, and the colonoscopy was preventive. The good news is that everything turned out pretty good. A few polyps removed, some acid reflux which we knew going in, and some pain for about a week from the dilation. But, all in all, things were better than I had expected. But, that's far from the whole story. That's the "after." What about the "before?" What were things like leading up to the procedure? Fueling the Fear Seven years ago, I visited the gastroenterologist about my stomach distress. I was a year or two off clonazepam (Klonopin), which I had taken for 12 years prior, and I was having some strong benzo belly symptoms. The doctor scheduled me for an endoscopy, and since I had recently turned 50, a colonoscopy too. I didn't like the idea, but I thought it was needed. Well, it didn't take long for me to twist an upcoming medical test into a Greek tragedy. My anxiety was already through-the-roof from the benzo withdrawal and BIND, and adding this upcoming event was the lighter fluid, gasoline, TNT, and nuclear warhead it needed to send me over the edge. In the month leading up to the procedure, I obsessed about every little thing that could go wrong. Trust me, I left no stone unturned. The "what if's" were endless. Here are some examples: What if they find something? Throat Cancer? Colon Cancer? What if they make my throat worse? What if it tears? What if I have a reaction to the anesthesia, and never wake up? What if they want to give me a benzodiazepine? Do I say yes? No? What if they want to give me fentanyl? What would be my reaction to that? What if I screw up the prep? Eat something? Drink something? Forget any part of it? What if I can't go through with it, and have to cancel at the last minute? Another factor, was that I have a tendency to wake up during surgery and medical procedures — something common with gingers, of which I am one. The last time I had an endoscopy, I woke in the middle of the procedure with a large tube down my throat, gagging. It's a memory that has stuck with me, and one I would prefer not to repeat — as you might imagine. And on top of all of this, is the shame — why am I so embarrassingly weak and full of fear? Ah, there's the rub. The eternal threat of the anxious mind. Why am I so weak, when others — millions in this case — do this every year? Why am I lying awake night after night, sleepless, obsessing about something that is as common as having a physical? Why am I so broken? So screwed up? Such a useless and utter loser? It's harsh, I know, and mostly unrealistic —but these are some of the thoughts we have. I had some anxiety before I started taking benzos, but never anything like this. This was extreme. Four days before the procedure, I cancelled it. I couldn't do it. The anxiety was so severe, and my symptoms so elevated, I almost couldn't function. Once I cancelled it, I felt immediate relief. I found a new gastroenterologist, explained my complications, and he was okay postponing it a while. I knew I still needed the procedure at some point, but for now it would have to wait. I never thought it would be seven years, though. While I felt much better immediately after cancelling the procedure, there was another side effect of this whole experience. A very significant side effect. One that I hadn't anticipated. Creating a Fear Event The whole experience of the fear, worry, and eventual cancellation of the procedure created what I like to call a "traumatic anxiety event." The ruminations were so intense, lasting for weeks, that it left its legacy in my psyche. While not formally PTSD, some of the reactions I experienced were quite similar. This dark cloud hung over me for seven years, affecting my reaction to any topic that was even remotely related. A general visit to the doctor, a neighbor diagnosed with cancer, the latest Cologuard commercial — you name it. Even a diet ad for laxatives could set me off. It didn't take much. Anything that would remind me that I I still needed this procedure would send me into an anxiety spiral. I had built the event up to be this mental maniac of misery, who's sole purpose was to scare the hell out of me — and it was quite effective. And I wondered, if I can't handle this, what would I be like if I was actually diagnosed with cancer, or some terminal illness? The irony of the situation is that the anxiety I experienced those seven years was far worse than if I had just had the procedure the first time. At the time, I just couldn't go through with it. My anxiety levels just off of Klonopin after 12 years of use were too severe. But, if only I could have pushed through back then, my life would have been less fearful. And then there's the embarrassment of the whole thing. I'm even feeling pangs of shame as I write this. I'm a 57-year-old man afraid of a very common medical test and procedure. It's ridiculous. I have to admit, I am not proud of being this way. In fact, I've had second thoughts of posting this article right up until I hit "publish." Still, I know that by sharing my experiences, even my most embarrassing experiences, that others' fear may be lessened. And I'm okay with that. Being a Person in Fear I have neurological damage. It's a fact. Long-term prescribed use of a benzodiazepine has reduced the effectiveness of my GABA-A receptors. I can get revved up easily, but I can't calm down like I used to — I just don't have the brakes. And that makes me more susceptible to anxiety from daily stressors and events. This is not a matter of will for me, or for many like me. Whether the cause is genetic, traumatic, environmental, iatrogenic, or something else, some of us just feel more anxiety than others. We're "wired" differently, and it's harder for us to let go of the fearful thoughts. Even though there are tools and techniques we can practice that can help us manage our reactions to these events — and I'll mention a few of these below — they don't eliminate the problem. They just help us ease it a bit. Get it? "...ease it a bit?" "Easing Anxiety?" Yes, that is where the name came from, in case you were wondering. While we rarely can do anything to eliminate the anxiety completely, we can ease it, and that alone can make a huge difference. Easing the Fear So, how did I get through it in the end? Well, I used some visualization and focus techniques. Here are a few that worked for me: LESSEN THE SEVERITY — The first one that helped me was learning to lessen the severity of the upcoming event in my mind. If I was reminded of my upcoming procedure by some external stimuli, and my thoughts started to go there, I'd try and lessen its effect. I'd tell myself that millions of people have this procedure every year, without complications, and that it will be fine. And then I'd immediately go back to what I was doing before, attempting to put it behind me. And sometimes it worked. ANTICIPATE THE SUCCESS — Another technique I used was to anticipate the success after the procedure was over. I would think about how amazing it would be to have this procedure done. After seven years of worry, what would it feel like to have it behind me? It must be amazing. And that positivity would help me get through. BUILD ON SUCCESS — And once we have those successes, we can build on them. In October 2022, I had foot surgery. This event was also fearful for me, although not to the degree of the endoscopy / colonoscopy. Still, that foot surgery, that success, was a building block. Having overcome my fear back in October, gave me a foundation of courage and confidence which helped to push through on this one. Help Others with Their Fear Another technique that I found useful, was to be less selfish. The truth is, anxious people are often selfish. I'm not saying this to put any of us down, it's just that managing our anxiety and trying to control the world around us is a 24/7/365 kind of job. It's overwhelming. Our fear demands that we focus all of our attention on avoiding being triggered. The penalties if we don't, can be quite severe. Purposefully thinking of others can pull us out of our own mind and its misery, at least for a little while. Here's an example. Leading up to my procedure, I'd envision a child. I'd be in a bed at the hospital waiting for them to wheel me in, and next to me was a 5-year boy waiting on the same procedure. The boy is frightened, and I need to be strong for him. I'd imagine what I'd say to him, how I'd soothe his fears. Soon, I actually felt stronger myself, and my fears lessened. I'd also realize how ridiculous some of my fears, and even my behaviors, might have been in context. I'm not a parent, but I'm sure that this is something parents have to do every day. Sometimes we have to be strong for others, and that action can help take our minds off our own problems. This process was perhaps the most successful for me of the ones I've mentioned here. When I'd focus on helping another, my worries seemed small. In case you're wondering, the boy I envisioned was me, as a child. I had my first endoscopy at six-months-old, and my first pre-ulcer at five. Living with Fear Whether you struggle with chronic anxiety, panic attacks, or perhaps your nervous system was damaged by medication, there are techniques that can help. I've only listed a few here, but there are hundreds more. Changing the way we think, even in the slightest degree, is a good first step. By using the above techniques, the week before my procedure was relatively manageable. I'm not proud of my fear leading up to it, but I'm also not ashamed by it. This is me. I have anxiety, and I have to deal with it. And perhaps, by sharing my fears here, others may get on that plane, speak at that seminar, ask the girl for dinner, or even have that medical procedure that's been plaguing them for so long. Perhaps. Take care and be at peace, D :)