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A therapist or other mental health professional can offer support with navigating these effects and helping improve your overall quality of life during the withdrawal period. In addition, over half of the survey respondents said benzodiazepines’ side effects or withdrawal symptoms caused them to consider suicide. Read on to learn more about benzodiazepine withdrawal, including the signs, how long it lasts, and how to get support with tapering off safely. During your taper, you may still experience some of the symptoms of withdrawal. Cognitive behavioral therapy (CBT) is a common approach to treating benzodiazepine addiction. CBT assumes that there is a relationship between a person’s thoughts, feelings, and behaviors.

Give 20mg diazepam by mouth every 1-2 hours until symptoms are controlled and AWS score is less than 5. Monitor the patient regularly during this time for excessive sedation. Stimulants are drugs such as methamphetamine, amphetamine and cocaine. Although these drugs vary in their effects, they have similar withdrawal syndromes. Patients should be monitored regularly (3-4 times daily) for symptoms and complications. The Short Opioid Withdrawal Scale (SOWS, p.37) is a useful tool for monitoring withdrawal.

4. WITHDRAWAL MANAGEMENT FOR BENZODIAZEPINE DEPENDENCE

Alprazolam, the generic name for Xanax, was the 13th most prescribed medication in the country in 2012, according to a survey done by IMS Health. According to the American Psychiatric Association (APA), withdrawal symptoms from short-acting benzodiazepines peak on the second day and improve by the fourth or fifth. While medications may be beneficial and even necessary during withdrawal from benzos, understand that addiction treatment does not solely entail the use of medication or stopping when the withdrawal period is completed.

Benzodiazepines are a powerful class of medication used to treat anxiety, insomnia, and panic disorder. Examples of benzodiazepines include alprazolam (Xanax) and diazepam (Valium). The best way to quit benzodiazepines is to avoid withdrawal by asking your doctor to taper down your dose. Tapering means taking progressively smaller doses over the course of a few weeks or months. The primary difference between these drugs is the length of time they stay active in the body.

Early or immediate withdrawal

After withdrawal is completed, the patient should be engaged in psychosocial interventions such as described in Section 5. Provide symptomatic treatment (see Table 3) and supportive care as required. Symptoms begin within 24 hours of last use of stimulants and last for 3-5 days. Patients should be allowed to sleep or rest in bed if they wish, or to do moderate activities such as walking. Offer patients opportunities to engage in meditation or other calming practices.

Patients with cognitive impairments as a result of alcohol dependence should be provided with ongoing vitamin B1 (thiamine) supplements. This dose of diazepam (up to a maximum of 40mg) is then given to the patient daily in three divided doses. Even if the patient's equivalent diazepam dose exceeds 40mg, do not give greater than 40mg diazepam daily during this stabilisation phase. Patients should drink at least 2-3 litres of water per day during withdrawal to replace fluids lost through perspiration and diarrhoea. Anyone experiencing troubling symptoms from withdrawal, such as suicidal thoughts or tendencies, should seek immediate medical care. These symptoms may be troubling or affect a person’s quality of life.

Alcohol Withdrawal Scale8

According to the British National Formulary, it is better to withdraw too slowly rather than too quickly from benzodiazepines.[67] The rate of dosage reduction is best carried out so as to minimize the symptoms' intensity and severity. Anecdotally, a slow rate of reduction may reduce the risk of developing a severe protracted syndrome. Medications may be used in treatment for benzo withdrawal to taper users off of the drugs, treat withdrawal symptoms, and reduce discomfort. The signs and symptoms of benzodiazepine withdrawal are similar to those for withdrawal of other sedative/hypnotics (barbiturates, ethchylorvynol [Placidyl], glutethimide and meprobamate [Equanil]) (Table 1). The management of withdrawal for sedative/hypnotics (barbiturates) is similar to that for benzodiazepines (Table 3). A loading dose of a long-acting benzodiazepine such as diazepam or chlordiazepoxide may be given initially, and the dosage may then be tapered.

• Management of alcohol withdrawal is based on the patient's history and current clinical status.
• A taper over eight to 12 weeks or longer may be indicated in patients who have been taking benzodiazepines for several years (Table 5).
• Several types of benzodiazepines are sold under popular brand names like Valium, Xanax, and Klonopin.
• Experiencing rebound symptoms means the symptoms you had before taking benzodiazepines come back even stronger than before.
• Severe withdrawal symptoms tend to occur in chronic users and can also present with seizures and rhabdomyolysis.
• Rather, withdrawal management is an important first step before a patient commences psychosocial treatment.

During withdrawal some patients may become disruptive and difficult to manage. The patient may be scared of being in the closed setting, or may not understand why they are in the closed setting. In the first instance, use behaviour management strategies to address difficult behaviour (Table 2). Do not try to engage the patient in counselling or other psychological therapy at this stage.

Methadone

The number of people addicted to opioids, sedatives, and stimulants is not known. Though benzodiazepine withdrawal is a medical emergency due to the onset of withdrawal seizures, benzodiazepine intoxication is relatively benign. Withdrawal from cocaine and amphetamine results in sedation and a state resembling adrenergic blockade, death is rare. Presentation may vary based on the frequency, duration, and quantity that was typically used. The body aims to maintain homeostasis, and when a chemical that was once overused is removed, counter-regulatory mechanisms may produce unopposed effects, and withdrawal symptoms may ensue. This activity outlines the evaluation and management of patients presenting with withdrawal syndromes and highlights the role of the interprofessional team in managing the patients with these conditions.