Updated: Aug 2
Periodically, I post blogs based on articles written about anxiety and/ or anxiety medication (benzodiazepines / Z-drugs). My primary goal is to shine a light on new information about these topics and to better understand the problems that face us.
As part of this process, I have a Google alert set up for topics related to benzodiazepines, anxiety, and a few other topics. This is how I find many of the issues that I write about on this site. Last week, that algorithm alerted me to an article about a person named "D" who was addicted to "Xanax." As you might expect, I took notice.
ARTICLE: Brain chemistry: four stories of drug use and mental health in Aotearoa PUBLICATION: The Spinoff
AUTHOR: Naomii Seah DATE: May 25, 2023
In this article, the writer shares the stories of four individuals: James, D, Thomas, and Sam. Three of these stories focused on cannabis use, mostly recreational. But one, the one about "D," was about benzodiazepines. The names were changed to protect privacy, so perhaps the name "D" was invented by the author and there is no coincidence — I really don't know. But, that is not the reason for my commentary... so I'll move on.
Let's take a look at some quotes from the article.
Brain chemistry: four stories of drug use and mental health in Aotearoa
This first thing that grabbed my attention were the first two words of the article's title: "Brain Chemistry." The concept that mental health disorders are a result of a chemical imbalance in the brain is a controversial topic that, in my opinion, has lead to the overprescribing of psychiatric medication.
While it is true that brain chemistry affects our moods and mental stability, diagnosing every unique behavioral trait as a disorder — one which has a chemical fix in the form of psychiatric medication — has lead to an epidemic of overprescribing, dependence, and protracted symptoms similar to the opioid crisis.
In 2017, a national emergency was declared by the White House regarding the opioid crisis. Now, six years later, it appears that benzodiazepine overprescribing is following in its footsteps. “The real illness is that the model of care that we have is inadequate to meet the need...” said Dr. John Krystal in an article in Yale Medicine. “The symptom is benzodiazepine over-prescription.”
Please note, that while I use the term "overprescribing," I do not support a ban on psychiatric medication, nor do I believe they do not have their place in specific treatment protocols. I am not a psychiatrist or medical professional of any sort, and nothing I say in my blogs should ever be considered medical advice. But, I have worked with individuals dependent on benzodiazepines for almost ten years now, and I might have learned a few things along the way.
Prescription and Its Effects
“I was prescribed Xanax by my doctor. I f***ing loved it. It made all my anxieties go away… I wanted that feeling all the time.”
If benzodiazepines weren't effective in the short-term, we wouldn't have the problem that we have and I would not be writing this blog today. Unfortunately, they do work — at least for a little while. But eventually, with far too many individuals, dependence sets in and long-term complications plague that person's life. So, I'm not surprised by D's initial reaction to the drug.
The part of this excerpt that really got my attention, was that D's Xanax was prescribed by a doctor. This was not street use; and the patient did not acquire the medication recreationally, even though the rest of the article steered in that direction.
Which brings me to the fact that in the article, "dependence" was not mentioned once. The fact that D was prescribed Xanax by his/her doctor, should have been a red flag in my opinion — but it wasn't.
Benzos and Rehab
Even after D was sent to rehab, he didn’t believe he had an issue with drugs. It took a month until that realisation hit. “That’s how much denial I was in – I just thought what I was doing was normal,” he says. “To me, it wasn’t bad.”
Now, I realize that it is possible that "D" had a substance use disorder (SUD) in relation to his alprazolam (Xanax) use. Still, there was nothing in the article that lead me to believe that. I think there is a much more likely scenario. "D" took Xanax as prescribed by a doctor for years, and became "reliant on drug use." This sounds like dependence and tolerance to me.
I must admit, my heart goes out to D here. D was convinced by doctors and/or rehab counselors that it was addiction, and that it's necessary to "talk the talk" and "walk the walk" of someone dealing with substance use disorder (SUD).
This frightens me. Not because there is anything wrong with SUD treatment protocols, but because they just aren't appropriate, or effective, for most individuals dealing with benzodiazepine dependence, withdrawal, or BIND. These protocols are often far too rapid, use addiction-specific language and practices, and do not recognize the complications created by dependence.
An article by Nicole Lamberson, PA from the Benzodiazepine Information Coalition (BIC) lays out "Why Prescribed Benzo Patients Shouldn't Go to Detox or Rehab." In this article, Lamberson concludes that "...detox/rehab facilities are inappropriate and substandard for physically dependent benzodiazepine patients."
Unfortunately, rehab is rarely a productive solution for individuals dealing with benzodiazepine dependence. This is something I see consistently with the people I work with through the podcast. Most of these programs focus on 30 - 90 day treatment protocols, which are far too rapid for this class of drugs. Also, they commonly focus on behavioral modifications to deal with cravings and other SUD related issues which are not relevant, and can even be detrimental, to someone dealing with benzo withdrawal and/or BIND.
At the end of the article, the author shares that "D has now managed to stay away from his addiction for six years now," and D states that his mental health is now "the best it's ever been." I am so pleased that D is now doing well and that he is doing much better.
Perhaps rehab actually helped D. I can't say for sure. Or, perhaps, he healed from his dependence and his symptoms have now eased on their own. I don't really know. All I can say is that I have yet to work with an individual going through benzodiazepine withdrawal who shared with me that rehab was a good choice. Usually, it's the exact opposite.
I want to emphasize in the end here, that I am not against rehab facilities, or the protocols and languages used to treat people suffering with SUD. This is not my area of knowledge, so I would not assume to know how they should be run. But, I do know something about benzodiazepines, especially when taken as prescribed. For these individuals, in my experience, rehab has yet to shown itself to be a productive solution.
Chen, Jennifer. Are Benzodiazepines the New Opioids? Yale Medicine. December 11, 2019. Accessed August 2, 2023. https://www.yalemedicine.org/news/benzodiazepine-epidemic.
Lamberson, Nicole. Why Prescribed Benzo Patients Shouldn't Go To Detox Or Rehab. Benzodiazepine Information Coalition. April 20, 2018. Accessed August 2, 2023. https://www.benzoinfo.com/2018/04/20/why-prescribed-benzo-patients-shouldnt-go-to-detox-or-rehab/.
Seah, Naomii. Brain chemistry: four stories of drug use and mental health in Aotearoa. The Spinoff. July 25, 2023. Accessed July 26, 2023. https://thespinoff.co.nz/partner/25-07-2023/brain-chemistry-four-stories-of-drug-use-and-mental-health-in-aotearoa.
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