In 1994, I spent some time researching benzo use and recovery in the U.S.A and Great Britain. In America I glimpsed a medical culture profoundly enamoured of pharmaceutical products.
At the annual national conference of the American Society of Addiction Medicine I sat amongst hundreds of psychiatrists in a glossy hotel in Manhattan, overlooking Times Square. I listened as eminent medicos characterised the “ English view” on benzo prescribing (i.e. cautious, short-term use only) as quaint, a little eccentric.
During a break in proceedings, the important Dr. M, having discovered I was Australian, approached to ask my advice regarding his upcoming trip Down Under. He began by politely asking about my work. I told him I was working as a social researcher and support worker with those in recovery from prolonged, medical use of benzodiazepines.
Dr. M.’s face registered the most peculiar expression of non-comprehension, as though the words I’d spoken - the concept of recovering from prescribed use - didn’t compute. He struggled unsuccessfully for a moment to find a suitable response until, obviously stymied, he reverted awkwardly to his default program; “Now, about the Australian outback...”
At the time of that New York conference, Xanax (alprazolam), a benzo derivative which appears to produce a particularly nasty illness and vicious withdrawal syndrome in many long-term users, had recently taken off like wild-fire in the USA. (Part of why the sales of these things are so impressive is because many people, once on them, simply can’t get off them!) Xanax was recommended as a fine ongoing treatment for panic-disorder and agoraphobia, and as a perfect companion medicine for the other new wonder-drug of the day, the anti-depressant Prozac.
Anything wrong with that?
Well, Xanax was being touted as an ongoing treatment despite the very real and mounting evidence across the globe (acknowledged by Australian and British government recommendations) that long-term use of benzos was generally ill-advised.
And this drug was being pushed as an ideal treatment for agoraphobia despite the fact that benzoes were being implicated as a possible cause of agoraphobia in case after case seen by health workers in Britain, Australia and elsewhere (ex-benzo users have frequently described the crippling agoraphobia which descended during their use of benzoes, and gradually dissolved when they finally came off the pills).
And it was also recommended that America use Xanax as its treatment of choice for panic disorder, regardless of the persuasive evidence hither and yon indicating that panic attacks and anxiety can be a side-effect of benzo use! (My own panic attacks came monthly, eventually weekly and finally bi-weekly during my years of benzo use and like others, I have never had a panic attack since withdrawing from those drugs 20 years ago.)
And, finally, Xanax was being promoted as an adjunctive medication for Prozac patients; a great marketing move since Prozac was selling well, but a questionable public health initiative since health workers and regulatory bodies in other parts of the globe, as well as certain benzo manufacturers, were specifically warning against prescribing benzoes to those who were depressed because these drugs were thought to cause or exacerbate that condition in a significant number of patients.
As I made my way around the States, revelling in the rich and majestic culture of that land, I nevertheless found it difficult to countenance the ongoing, misguided, enthusiasm for these sometimes useful but often dangerous medications.
Frequently I found myself remembering a comment made by down-to-earth nurse Pam Armstrong who founded the Council for Involuntary Tranquilliser Addiction in Liverpool, England.
Pam had spoken at a conference I attended in England, prior to the American leg of my research trip. She had just returned from a visit to the U.S.A. Expressing amazement at the attitudes she encountered there, she had declared; “ When it comes to the benzoes, the Americans are in deep denial.”
As had happened in other parts of the world, grass roots support groups sprang up in the United States in order to assist men, women and children who had been caught in the benzo trap. Among their number, Caroline Kearney Hirshfeld co-ordinated Benzodiazepines Anonymous in Los Angeles, Sandra Jacobs founded Tranquilliser Users Recovery Network in Northern California and Jim Parker toiled away in Tempe, Arizona through the Do It Now foundation.
But unlike Australia and Britain where the combination of word of mouth, patient activism, media coverage and community education by organisations such as Tranx (now known as 'Reconnexion') had eventually come to influence mainstream medical practice, in the U.S., to my knowledge, the penny never really dropped.
To this day, American benzo patients make contact with English and sometimes Australian benzo-recovery groups, seeking help. Of course the internet has become a valuable benzo recovery resource, enabling folk in the U.S.A. to communicate with each other and with services in other parts of the world. But presumably there are great numbers of people dutifully taking their medication and struggling daily with a mysterious illness the cause of which is unknown to them.
The American medical profession, arguably under the influence of habit and the powerful pharmaceutical corporations, had stuck to their benzodiazepine guns. They held on to their Xanax, their Valium, their Mogadon and Normison, and with the help of eager drug companies, continued to find new uses for them.
And so it seems to me, bit by bit, the unstinting, ongoing enthusiasm for these drugs in the U.S.A. has bled back around the globe. As a result of this and other factors, positive changes, hard won in Australia during the 1980’s and 90’s, have been whittled back.
So what if the Australian Government’s National Health and Medical Research Council (NHMRC) had recommended to all doctors in 1989 and again in 1991 that benzoes be best avoided, or, if they must be prescribed, to generally limit use to 'less than two to four weeks.
You see, the NHMRC guidelines were recommendations, not regulations, so it has been the folly of many medical professionals to decide to ignore the guidelines and take their lead from elsewhere. Perhaps they listen more closely to persuasive drug company advertising; perhaps they attend to pro-benzo articles in prestigious journals (often penned by doctors or scientists who have financial ties to pharmaceutical companies); perhaps, because medical professionals are just as impressionable and fashion conscious as any other group on the planet, the sexy appeal of supposedly innovative American ideas turns their heads.
Or perhaps, as I suspect, many simply continue to miss the point. For a good ten years from 1985 to 1995 there was regular Australian media coverage of the phenomenon of ‘benzo dependence’. Over time it had a powerful impact but I believe the word ‘dependence’ has always muddied the waters.
In common use, particularly in popular psychology, the word ‘dependence’ often implies a deficiency, a need, or a problem of some kind in the dependent person. The subtle implication therefore in the term ‘drug dependence’ is that the source of the problem lies with the patient not the pill. I know from my many conversations with medicos over the years, and from the experiences related to me by ex-benzo users, that many doctors have been misled by that term.
And in 2006, further distracted by the American perspective, some doctors continue to think that it is only problematic people, those who have an ‘addictive personality’, who ‘get into trouble’ with benzoes. See 'Benzo Illness not Benzo Addiction or Benzo Dependence'.