People get into trouble with benzodiazepine tranquillisers and sleeping pills in different ways.
Some, obedient medical patients,
dutifully take a small prescribed daily dose of one benzo or another, or perhaps
they take their small dose only three or four times a week, because they or
their doctor believe it is helpful.
After taking the drug in this fashion for a period of weeks, months or years (it varies from person to person) patients may find themselves becoming depleted and fatigued. Although the regular dose of benzoes still seems to be effective in the short term, producing a feeling of sedation shortly after being swallowed, the patient’s overall daily levels of anxiety or insomnia haven’t really improved much regardless of other therapeutic interventions and lifestyle changes. In fact the overall levels of anxiety and insomnia may be worsening.
These patients may develop agoraphobia, panic attacks, a dreamlike feeling of unreality or ‘depersonalisation’ and a generally fearful outlook. Solution? More benzoes.
Depression might kick in, as well as digestive and bowel problems, visual disturbances, painful muscle spasms, strange aches and pains and a various other peculiar, physical and sensory symptoms. Patients may be sent for repeated diagnostic testing which ultimately finds no cause for this unusual ill-health. They and their doctors may come to think of these patients as hypochondriacs. Solution? More benzoes.
Because benzoes are prescribed to treat anxiety, panic and agoraphobia it doesn’t occur to these people (or their doctors) that the medicine may be insidiously producing, maintaining or worsening these anxiety related symptoms, let alone causing the other mysterious health disorders which have popped up during the period of prolonged benzo use.
But that is exactly what benzodiazepines do for a fair number of patients if the pills are used regularly over a prolonged period; they maintain or aggravate the very ailments they are prescribed to treat, as well as producing a wide range of debilitating and seemingly unrelated physical problems.
Another small group of benzo patients have a dramatic, negative reaction to these drugs from the very beginning. This is sometimes referred to as a ‘paradoxical reaction’. After the first dose, or the first few doses, these patients may become hyperactive, agitated, aggressive, may experience insomnia or other undesirable reactions to the medication.
However not all benzo users are conventional, medical patients: some use benzoes simply to escape from their feelings, responsibilities and circumstances for a time, or for pleasure seeking purposes, to ‘get out of it’, perhaps combining the benzoes with alcohol.
If this kind of benzo use becomes habitual it too can lead to the distressing benzo-produced symptoms described above. In such circumstances it might seem reasonable to take more benzoes in an attempt to quieten the increasing physical and mental chaos. This works for a time but eventually the body can no longer cope: the calming power of the pills fades but not their damaging effects: the user winds up in a mess.
The illness caused by benzodiazepines (‘benzo illness’) can be brought on by any kind of regular use, medical or recreational, no matter how tiny or large the dose. It doesn’t happen to everyone but it is not at all rare. Symptoms vary in nature and intensity from person to person; for some the drug-produced illness is not particularly severe however for others it becomes a profoundly debilitating and long-winded health problem.
Benzo illness can be further complicated by a withdrawal syndrome which hits many long term users when they attempt to reduce the dose or come off the pills.
(N.B. It is dangerous to withdrawal from benzoes abruptly; it must be done very gradually with appropriate guidance.)
It is true that some people use benzoes regularly for months or years with no obvious adverse effects and no significant withdrawal symptoms when they stop the medication.
However other long-term medical patients, or recreational users, whether or not they have significant symptoms of benzo illness whilst on the medication, find themselves enduring a withdrawal syndrome when they attempt to reduce or cease taking the drug.
The withdrawal syndrome is very common and may include the symptoms of benzo illness described above, as well as a host of others. The syndrome varies greatly in intensity; some people have little trouble, others have a tougher time - benzo withdrawal can often be very painful and distressing. In a minority of cases the withdrawal syndrome becomes a protracted illness.
As a very short-term treatment, in a crisis situation, benzodiazepines may have a role to play, and in certain very unusual cases, long-term treatment with benzodiazepines may be judged the best available option. However we have learnt over time that, generally speaking, long-term treatment too often leads to trouble. In some sensitive individuals it appears that even a relatively short period of use can produce illness and a nasty withdrawal.
As well as the possibility of illness and withdrawal, these drugs are capable of subtly altering personality and behaviour with continued use, thereby interfering profoundly with patients’ sense of self, their ambitions, their relationships with others and with their environment.
Unfortunately benzodiazepine tranquillisers and sleeping pills are still frequently prescribed as a long term treatment even though we have known for some time that it is often unwise to do so.
As long ago as 1989 the Australian Government’s National Health and Medical Research Council issued guidelines to doctors recommending that henceforth, in routine general practice, as a treatment for anxiety and insomnia, benzodiazepines be prescribed only as a last resort and for periods of no longer than a few weeks. (The guidelines noted that there was a possibility that some patients may be adversely affected by just one week of consistent use.) The British Office of Classification of Medicines had issued similar guidelines some years earlier.
As I’ve said, not all long-term benzo patients run into serious trouble but many do.
That’s the trouble with benzoes.