Basics of BIND
Updated: Apr 2
What is BIND? What is withdrawal? Are they the same? What’s the science behind it? What are the symptoms? Let’s take a look.
Preface (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.
Now that we’ve covered that, back to the Basics of BIND.
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, our podcast, and D’s book (Benzo Free). 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 (benzodiazepine-induced neurological dysfunction) defines the lingering neurological effects of sustained benzodiazepine exposure. This term was proposed by a research team in 2022, and 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
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. A scientific paper intended for publication in a major medical journal has been written to explain this process and illustrate the need for consensus in nomenclature and convergence on BIND as the single descriptive term (Alliance, 2022).
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 Team, and an author on several of 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 and 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 a recent survey are severe anxiety, difficulty focusing and distraction, low energy, and insomnia. 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.
There are two different types of difficulty that long-term benzodiazepine users are likely to face. The first difficulty is associated with the reversible neuroadaptive changes in response to benzodiazepine use and the withdrawal symptoms which occur as the benzodiazepine leaves the body; this is the withdrawal syndrome. The second difficulty is due to 1) benzodiazepine neurotoxicity (i.e., the negative alterations in either the structure or function of nerve cells) and 2) some neuroadaptive changes can last long after withdrawal is complete; this is BIND. — Alliance, 2022
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 BIND:
Thousands of people could not possibly invent the bizarre symptoms caused by the therapeutic use of benzodiazepines and reactions to their withdrawal. Many users have to cope, not only with a frightening range of symptoms, but also with the disbelief and hostility of their doctors and families…This is a drug-induced disease, not drug abuse. — Shirley Trickett, Journal of the Royal College of General Practitioners
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
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
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 neuroplasticity 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.
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 shooting through and your muscles are spasming as if you just drank a six-pack of Red Bull.
Sounds fun, right? And sensitivity is just the tip of the iceberg. Add 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 several months, even years.
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 months or even years. 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.
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.
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.
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.
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.
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.