A Guide to Benzodiazepine Addiction Treatment & Rehab

Benzodiazepines are a type of sedative drugs, used to treat anxiety, seizures, muscle spasms and insomnia. Both chronic & recreational use, within weeks can build up a tolerance to the intended effects and may lead to dependence or addiction.

Benzodiazepine dependence or addiction makes it difficult to stop taking benzodiazepines, due to the difficult withdrawal symptoms that can develop as a result of long term use. Furthermore, addiction is a psychological phenomena that develops irrespective of benzodiazepine use and requires therapy to address the underlining causes. If you are taking benzodiazepines daily, outside of their prescribed intent or purchased illegally, and you are unable to stop taking them despite negative consequences to your health, work and family commitments, you may have developed benzodiazepine addiction.

The good news is that treatment options are available, both as an inpatient within a treatment centre as well as outpatient services, together we will explore the options available for treating benzodiazepine addiction.

Understanding Benzodiazepine Addiction

The Drug Abuse Warning Network, which monitors prescription and illicit drug use, found that two of the most frequently reported prescription medications in drug abuse-related cases are opioid-based pain relievers and benzodiazepines.

All addictive drugs increase your dopamine (pleasure chemical) levels in the reward centre of your brain. Unlike a natural reward (eg chocolate) which becomes predictive so your reward system is inhibited, addictive drugs like benzodiazepines always cause an increase in dopamine levels in your brain no matter how many times they are taken, it’s the tolerance level that increases, causing a need to take more than prescribed to achieve the same feelings.

Although addiction is less frequent than dependence, it often occurs in conjunction with the abuse of another substance, they enhance the euphoric effects of opioids (incl methadone), they help alleviate withdrawal and abstinence syndromes (such as between heroin ‘fixes’), help to temper the high from cocaine and augment alcohol effects.

This type of abuse is known as poly-drug abuse and takes a multi pronged treatment plan to guide you through withdrawal, rehabilitation and recovery. If you are taking benzodiazepines and abusing other substances including alcohol, private residential treatment may be the best option for you.

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Why Benzodiazepine Drug Addiction Treatment is Important

Benzodiazepine abuse and addiction are more common than you may think, there could be negative impact to the following areas of your life if left untreated:

  • Personal and social relationship costs – emotionally, financially and mentally
  • Employment – affects your ability to work safely and effectively especially if you are tasked with operating heavy machinery or driving company vehicles
  • Physical health – impaired motor coordination, dizziness, vertigo, slurred speech, blurry vision, mood swings
  • Mental health – euphoria, as well as hostile or erratic behaviour, suicidal ideation, lethargy, memory impairment, depression.

Benzodiazepines are eliminated slowly from the body, so accumulation in fatty tissues can result from repeated use over a prolonged period. Thus, some symptoms of overmedication (impaired thinking, disorientation, confusion, slurred speech) can appear over time. While you are taking benzodiazepines you may feel like you are handling the stresses of your life more effectively, in reality you are reacting less dramatically as the medication reduces your awareness of life.

Working with a treatment team will assist you with handling your physical and mental reactions to the tolerance, dependence, and withdrawal effects associated with long-term use.

Clinical experience has shown that most long-term benzodiazepine and opiate users actually feel better after coming off their medication and have reported an improvement in their mood and general wellbeing and a significant reduction in anxiety. (https://www.candi.nhs.uk/services/Benzodiazepine-and-Opiate-Withdrawal-Service).

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What Does Benzodiazepine Addiction Treatment Involve?

Your treatment for benzodiazepine addiction within a residential rehab environment is multifaceted:

  • Medical care to assist with the withdrawal symptoms during detox (incl poly-drug use)
  • Psychological care to help you with any underlying mental and psychiatric disorders (Dual-Diagnosis)
  • After care and family support to help you rebuild family relationships, remain supported throughout your recovery.

Effective treatment addresses all your needs rather than just treating your addiction.

Here are the four key components of treatment:

1. Medical Assessment

A comprehensive history will be taken as it’s important for the physician to understand the reasons you were prescribed benzodiazepines originally.
This will be done in a non-judgemental, non-confrontational way.
Some of the questions asked will be as follows:

  • Medical indication for benzodiazepines
  • Full list of all medication, routes of administration and how long prescribed
  • What other medication with addictive potential is prescribed to the patient including opiates and gabapentin/pregabalin
  • What the patient perceives as positive and negative attributes of prescribed benzodiazepines
  • Current alcohol and illicit drug use
  • Current physical health
  • Current psychological health
  • Current tobacco consumption
  • Previous history of drug and alcohol dependence and treatment
  • Physical health history and any interventions
  • History of psychiatric illness
  • Social functioning and employment status
  • Family and carer support
  • Appropriate physical examination

From this a tailored treatment programme will be created for you.

2. Detox

Detoxification is used to rid your body of benzodiazepine to ensure you are physically steady and ready to start therapy, the withdrawal management options you have during detox are dependent on the dosage and length of time you have been using benzodiazepine: Inpatient detox is recommended for long term high dosage withdrawal whilst outpatient care is for shorter term low dosage withdrawal. (https://pubmed.ncbi.nlm.nih.gov/1675694/)

During the detox phase of your treatment, the dosage of benzodiazepine will be adjusted and tapered off over a course of weeks or even months. This helps minimise withdrawal symptoms and gives your body time to acclimatise to a life without benzodiazepine.

3. Rehabilitative Therapy

A detoxification program for physical dependence does not necessarily address the triggers that led you to becoming addicted such as, social factors, psychological addiction, or behavioural issues that intermingle with your addiction.

Rehabilitative Therapy uses different therapeutic approaches that will help you address the underlying and psychiatric reasons leading to your addiction:

Cognitive Behavioral Therapy (CBT) – the tenet of CBT is that all humans’ core beliefs can be summed up in three categories: self, others, future.
CBT gives you the tools to:

  • Challenge and change cognitive distortions (thoughts, beliefs & attitudes) that led you to addiction
  • Use information processing skills to adapt the behaviours that have kept you in a cycle of medication misuse
  • Improve emotional regulation
  • Solving current problems with coping strategies.

Rational Emotive Behaviour Therapy (REBT) -REBT claims that humans have both innate rational (meaning self-helping, socially helping, and constructive) and irrational (meaning self-defeating, socially defeating, and unhelpful) tendencies and leanings
REBT therapy aims to help you with emotional and behavioral problem resolution to help you lead a happier and more fulfilling life by:

  • Identifying irrational and self-defeating beliefs (self-blame, self-pity, clinical anger, hurt, guilt, shame, depression and anxiety)
  • Identifying behavioral problems (procrastination, compulsiveness, avoidance, addiction and withdrawal by the means of their irrational and self-defeating thinking).

Together with a therapist you will be guided towards replacing the self-defeating tendencies with more rational and self-helping ones in order to gain a more constructive, rational way of thinking, emoting and behaving.

Acceptance & Commitment Therapy (ACT) – ACT is about achieving psychological flexibility
ACT views the core of many problems to be due to the concepts represented in the acronym, FEAR

  • Fusion with your thoughts
  • Evaluation of experience
  • Avoidance of your experience
  • Reason-giving for your behaviour.

Where the healthy alternative is ACT

  • Accept your thoughts and emotions
  • Choose a valued direction
  • Take action.

ACT is compatible with the 12 step program, both approaches enforce acceptance of your addiction and a broad life reorientation as opposed to just elimination of the substance use.

Dialectical Behaviour Therapy (DBT) – DBT is about developing a therapeutic alliance between you and your therapist through unconditional acceptance within a climate of loving-kindness.

DBT aims to help:

  • Increase your emotional and cognitive regulation
  • Learn about the triggers that lead to your reactive state
  • Develop coping skills to apply to help avoid undesired reactions.

You may want to consider becoming involved in a wider addiction treatment program in conjunction with your preferred treatment plan.
Options include

  • Individual & group motivational therapy
  • Relapse prevention therapy
  • Mutual aid (12 Step Programs)
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    Aftercare & Support

    When the drug is no longer being ingested it becomes harder for you to believe that the symptoms are still coming from the drug withdrawal, this is often the stage when most support is required as well as the increasing recognition that drug misuse affects the entire family, as such most rehabs offer private aftercare and family support free of charge for a year.

    There has also been a growth in carer organisations, most notably Adfam and Families Anonymous

    The Adfam website (https://adfam.org.uk/help-for-families/useful-organisations) is very useful and has a list of different organisations that you can contact for support for your family through treatment.

    Families Anonymous (http://famanon.org.uk/) is a self-help service based on the 12-steps plan and is aimed at helping families affected by drug use and behavioural problems.

    Inpatient VS Outpatient Services

    Once your medical assessment is complete and the treatment plan decided on, in some cases, you can choose to receive your treatment as either an outpatient or as an inpatient at a residential treatment centre.

    Why should you choose to receive treatment as an inpatient?

    • You require concurrent detox treatment for more than one substance & require a high level of expertise
    • You are just starting out on your benzodiazepine abuse journey and could benefit significantly from a residential rehab during and after detox
    • You have other physical and mental health problems and need a high level of medical, nursing support
    • The environment you reside in is not conducive to your recovery
    • Being able to fully focus on your recovery without your normal life stressors
    • Less risk of coming into contact with or use benzodiazepines outside of your treatment plan
    • Shorter programs due to the full time intensive treatment.

    Considerations before choosing to be treated in an Outpatient capacity:

    Pros:

    • You can recover at home
    • You can continue working during treatment
    • You can control your schedule
    • It is usually cheaper (or provided by the NHS & charity groups for free)
    • No need for childcare

    Cons:

    • More temptation to relapse
    • You don’t get a break from the stressors that initiated your need for benzodiazepines
    • You may have little to no support between the predefined treatment schedule you have
    • Treatment may be less effective in the case of severe use disorder.

    If you are considering self-detox, you should at a minimum maintain contact with a drug service or your local GP.

    Choosing a Treatment Centre

    Sourcing a treatment centre best suited to your individual needs takes some consideration:

    Location

    • Are you wanting to be treated closer to where you live?
    • Does the facility include support systems and after care?

    Treatment

    • Does the centre have trained and certified professionals suitable for your treatment?
    • Credible programs should offer a wide selection of evidence based therapy options to find the right mix for you. The more options, the better your chance at success.
    • Does the centre offer a treatment program that you like?
    • Different treatment centres utilise different therapeutic models
    • 12 Step Model -A spiritual abstinence based programme pioneered by the Alcoholics anonymous (AA) where the belief is that addiction is a disease. The programme focuses on your motivation to change your addictive behaviours within the treatment and recovery process

    Medical

    • Does the treatment centre offer medical assistance to aid your recovery?
    • In the case of benzodiazepine abuse treatment, a tapering approach may be necessary. Can the centre provide medication to assist with your withdrawal?

    All residential treatment centres in the UK are regulated by the Care Quality Commission (CQC), the independent regulator of health and social care in England. All centres are individually rated to ensure that they meet the fundamental standards of quality and safety for your care and treatment.

    We can assist you with finding the right treatment centre for your treatment.

    Secondary Addiction Treatment

    Once your initial treatment (generally a 28 day inpatient programme) has been completed, the need for ongoing support for you and your family is available to facilitate your journey back to living your life free of benzodiazepine.

    This is where a Secondary Addiction Care Service can assist you with:

    • Reintegration back into your daily life
    • Relapse prevention
    • Re-establishing a support network within your community and family
    • Continuation of therapy
    • Rebuilding your daily life skills.

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    Paying for Residential Treatment

    Treatment costs will depend on the length of stay and the type of rehab. Typically, a deposit is paid in advance followed by a final payment. The treatment centre will detail the payment options when booking treatment.

    Some private insurance providers do accept addiction treatment, but this will depend on your policy.

    What to bring to the Treatment Centre

    You are permitted to bring:

    • Clothing that is comfortable, appropriate and modest – no pictures of any drug-related items or phrases or sexually suggestive words/graphics
    • Comfortable shoes
    • Toiletries
    • Books, journal and appropriate magazines
    • Pictures of your family
    • Medications in original bottles with prescription instructions from the doctor.

    Talk to the treatment centre if your circumstances have changed:

    • Your substance use disorder involves more than benzodiazepine
    • Your support structure has broken down
    • Your benzodiazepine use has changed.