4 months on benzo- Detox or Slow taper?

[[No...]]

 

Just a quick preface, I greatly appreciate from the bottom of my heart to anyone willing to give me any advice on my situation, as I am aware my post is a bit lengthy but I just didn’t want to leave out any important details when this is such an important and time-sensitive choice that I need to make.

So l had been on 2 mg of Ativan for 4 months. and I have been working with my psychiatrist to try to taper off slowly by switching to Valium 15 mgs + .5 Ativan equivalent. After about a week or 2, I am now switched on valium (15mgs) daily unless its a rough day, I take .5 of Ativan with my mid-day dose.

-for the record: I am male, 33 years old, have no financial/family support. The reasoning why I started this medication is because of an antibiotic toxicity that caused a diaphragmatic/breathing symptom that only benzos would somewhat alleviate, but not completely. I still suffer from this but I just don't want the hell of weaning off long term benzos down the road so Im trying to be proactive.

I am prone to pretty severe panic attacks that interfere with my work, and I fear they will get worse if I continue to taper and work simultaneously. Which is why I am even considering the detox clinic at all.. not to mention wanting to be done with being dependent on them asap.

Heavily considering the amount that I am on and how long I have been on it, what is your opinion on these options?

Option 1 is to continue the slow taper process as tedious as it is. With a scale (although it seems very complicated) or maybe not with a scale? I dont know.

 

Option 2 is to try a rapid taper and see how that plays out without any Dr supervision. although I predict that that might not be as manageable with me being prone to panic attacks and I am a sensitive individual.

 

Option 3 would be to go on a medical leave and go to a detox inpatient center and come off of it completely within a week or more with Dr. supervision and alternative meds. (FYI Would ultimately like to get on an SSRI to aid my underlying anxiety.) I have had multiple friends and family tell me that they think this might be the best option but they may not know what’s best.

+ (I would obviously need to takeoff work for the detox clinic, plus it would be a bit expensive and also there are apparent risks (PAWS and other problems) that come with coming off of it so quickly..but maybe not so much after only 4 months?) 
 

Option 4 would be to slow taper down to as low of a dose as I can manage while going about my regular life, and then go detox clinic at that point to make the process more smooth and less risky but I’d obviously prefer not to drag this out and keep my body on this medication for longer than it needs to be.

Considering all the factors, which option (or alternative option) do you think is best? | know that my body is physically dependent on it, but I'm getting mixed responses when I ask people. My psychiatrist is just leaving it up to me and what I feel is best so I need to make a decision. I decided to ask this community to see if I could gain any insight.

Thank you so much for any advice!

-Jeff

 

[[je...]]

Hi @[No...]

welcome to BenzoBuddies!

It sounds like you’ve weighed and considered your options. Before we discuss those options I would like to ask you a couple of questions. Have you ever used benzo’s before? Have you tried to make a cut or reduce your dose of Ativan or Valium and how did you react? What was the reason for crossing to Valium? 

[[No...]]

1 hour ago, [[j...] said:

Hi @[No...]

welcome to BenzoBuddies!

It sounds like you’ve weighed and considered your options. Before we discuss those options I would like to ask you a couple of questions. Have you ever used benzo’s before? Have you tried to make a cut or reduce your dose of Ativan or Valium and how did you react? What was the reason for crossing to Valium? 

Hi, thanks for answering,

So I have used them before but never on a daily basis. Before all this, I had used a single 1 mg tablet of ativan as needed for panic, (maybe 2-3 times a week, if that) before I had started taking multiple daily doses. 

I have not officially cut my dose yet. I am on the tail end of the adjustment period of the transition to Valium. I am ready to start cutting my dose but, as mentioned in my post, not sure how to go about that.

Im taking 5 mgs 3x a day. + the .5 of ativan with my mid-day dose. Today, Im trying to do without the .5 of ativan. Last time I tried, I had an anxiety attack at work but Im off work today and it seems to be going ok so far.

Crossing to Valium was my choice, and my psych agreed to try it. The reason being, I had been struggling with interdose withdrawal from the short-acting nature of Ativan. Also, I had done much research on the topic and the majority of people think that the “Ashton Method” or something similar is the gold standard for tapering. But maybe the drawn out process of the ashton manual is applicable to my circumstances? That’s my conundrum. 

[[je...]]

Thanks, this helps to better understand your situation. I have one more question please. I don't fully understand your crossover. 

2 hours ago, [[N...] said:

I have been working with my psychiatrist to try to taper off slowly by switching to Valium 15 mgs + .5 Ativan equivalent. After about a week or 2, I am now switched on valium (15mgs) daily unless its a rough day, I take .5 of Ativan with my mid-day dose.

Did you fully crossover to Valium? (I don't understand the 15mgs + 0.5 Ativan) According to the Ashton Manual 1mg Ativan equals 10mg Valium. With a starting dose of 2mg you should've been crossed to 20mg Valium. And how long did the crossover take - was it two weeks?

[[De...]]

I’m currently doing option 3 and on day 10. It was necessary in my situation because trying to self taper was impossible and putting me in harms way. I was also dual using both Ambien and Klonopin.

in patient detox was largely easy. They stabilized my dosage and even got me off Ambien. I am in a 30 day facility on a 21 day taper. So far the cuts have been ok. The one thing to consider, is the quality of the facility. If you can find the right place that insurance covers, you’ll have a care team to actively monitor and assist you during taper downs. It allows them to move faster but given my experience thus far, you may need a longer taper and longer stay. The thing you don’t want to do is do a detox and facility and then leave unstable. Otherwise you’ll just end up back in detox or reinstating/ updosing on your own. It’s kind of an all or nothing type thing and a big commitment. I wouldn’t do this option unless you’ve really tried to self taper slowly on your own.

im not suggestion a facility is right for you, but it was right for me. I will say the detox facility saved my life (quite literally). There’s also a huge amount of shitty ones so be careful if you ever go that route. 

[[De...]]

Also, just a quick follow up. Detoxing off benzos in 7 days would be very risky IMO even at the very best facility. I would be VERY wary of anyone claiming they can do that for someone struggling to come off. It takes as long as it takes. 

[[No...]]

On 27/02/2024 at 15:20, [[j...] said:

Thanks, this helps to better understand your situation. I have one more question please. I don't fully understand your crossover. 

Did you fully crossover to Valium? (I don't understand the 15mgs + 0.5 Ativan) According to the Ashton Manual 1mg Ativan equals 10mg Valium. With a starting dose of 2mg you should've been crossed to 20mg Valium. And how long did the crossover take - was it two weeks?

About a couple weeks yes. and yes Im assuming my psych will ultimately put me on 20 of valium and then start a taper. 

[[No...]]

Just to add, he doesn’t want me to stop the .5 of ativan with my mid-dose quite yet. So not sure what will be changed but I am hoping I will drop dosage soon

[[je...]]

Thank you @[No...]. I understand. It sounds like you're in the middle of your crossover. And it sounds like you're taking a slow approach which is better than a direct crossover. I needed to understand the process in order to give you the best advice.

The fact that you have already experienced interdose withdrawal suggests to me that you have developed dependency. Generally we do not recommend detox or rehab facilities. They are focussed on addiction not dependency. Benzo withdrawal can last for a considerable time. These facilities will give you adjunct meds to keep you comfortable while you are there, do a rapid taper which is pretty much the same as a cold turkey and when you leave you have to deal with the consequences of severe withdrawal at home. Most of our members who go to detox, eventually reinstate because symptoms are too severe. 

I know you have not been on the drug that long, but 4 months is enough to develop dependency and given the fact that you're already experiencing interdose withdrawal, I think your best option is to do a taper. If you have decided what you want to do, we can help you with that. Valium is practically easier to taper because it comes in smaller pill sizes. 

I hope this helps with your decision-making and please ask if you have any further questions. 

[[De...]]

Hey @[je...], that’s a good summary of what they’ve done so far with my residency, however I’d counter with the fact that most good residencies adjunct to an IOP or you can transition to PHP and stay onsite. In other words, the good facilities don’t just kick you out to deal with symptoms. I’d also note there’s a difference between detox and residency. A good treatment program will usually consist of detox, then residency (30/60/90 days), then IOP or continuum of care.

In his case, I agree that in his case tapering at home is probably best. Every case is different.

im currently on day 12 of in treatment facility and planning to jump K in 7 days. They cold turkeyed me on Ambien and 13 days sober now.

The one thing I’d counter @[je...], is a physical dependence and “addiction”, are probably more closely related that we think. Just because you’re not an “addict”, your mind does still crave the drug’s effect. That’s one thing I’ve learned in my treatment. In my group classes for addiction, I’ve learned some powerful techniques to help battle interdose withdrawal, and also started developing a plan for staying sober and not relapsing once I’m discharged. Despite my doctor saying I’m not an “addict”, I disagree, because I took the drug every day and craved it’s impact on my mind, even though I never “abused” it.

Again, not saying go to detox/residence, but my experience thus far has gotten me further than I ever thought I could. 
 

 

 

[[je...]]

52 minutes ago, [[D...] said:

Hey @[je...], that’s a good summary of what they’ve done so far with my residency, however I’d counter with the fact that most good residencies adjunct to an IOP or you can transition to PHP and stay onsite. In other words, the good facilities don’t just kick you out to deal with symptoms. I’d also note there’s a difference between detox and residency. A good treatment program will usually consist of detox, then residency (30/60/90 days), then IOP or continuum of care.

In his case, I agree that in his case tapering at home is probably best. Every case is different.

im currently on day 12 of in treatment facility and planning to jump K in 7 days. They cold turkeyed me on Ambien and 13 days sober now.

The one thing I’d counter @[je...], is a physical dependence and “addiction”, are probably more closely related that we think. Just because you’re not an “addict”, your mind does still crave the drug’s effect. That’s one thing I’ve learned in my treatment. In my group classes for addiction, I’ve learned some powerful techniques to help battle interdose withdrawal, and also started developing a plan for staying sober and not relapsing once I’m discharged. Despite my doctor saying I’m not an “addict”, I disagree, because I took the drug every day and craved it’s impact on my mind, even though I never “abused” it.

Again, not saying go to detox/residence, but my experience thus far has gotten me further than I ever thought I could. 
 

I strongly disagree with you @[De...] about addiction and physical dependence. It’s exactly these myths, perpetuated by facilities, that have doctors treat us like drug addicts and then cut us off from prescriptions causing life threatening situations. My brain doesn’t crave the effect of the drug, it requires the drug to be able to function on a physical level. There is a big difference. I would also be really cautious of promoting CBT and group therapy as successful methods for acute withdrawal and post- recovery, when you are not yet off, out of the facility and been able to fully implement it yet. I really don’t want to come across as harsh and putting you down and I apologise if this is how I sound. I just have a serious problem with people labelling this addiction. If you want to describe yourself as an addict, that’s your choice, but please don’t try to label or convince the rest of us. You might want to read this post as well:

On 29/02/2024 at 23:59, [[L...] said:

I’m delighted I was able to clarify this for you @[kn...].

The words we use to describe what’s happened to us matter!  

Dependence is a normal physiological adaptation to repeated dosing of certain medications.  For example, physical dependence is also observed with antidepressants and beta-blockers … but we don’t mislabel people who take these medications as ‘addicts.’

Mislabeling and misdiagnoses of substance use disorders (addiction) can lead to a cascade of negative outcomes, including stigma, discontinuation of needed medications, and undue scrutiny of patients, physicians, and pharmacists.  Misdiagnosis can also result in inappropriate or harmful treatment of a patient (e.g. sending the ‘taken as prescribed’ benzodiazepine-dependent patient to a detox center or an inpatient psychiatric unit).  Even worse, mislabeling and misdiagnosis can threaten patients’ lives.  There have been multiple reports of sudden, involuntary cessation of benzodiazepine treatment leading to death as well as increased risks of suicidal thoughts and behavior.

To learn more:

Words Can Hurt Those on Benzodiazepines 
https://www.benzoinfo.com/2018/09/20/words-can-hurt-those-on-benzodiazepines/

Physical Dependence - Benzodiazepine Information Coalition
https://www.benzoinfo.com/physical-dependence/

 

[[De...]]

That’s a very fair point and I apologize for overstepping. I am very far from being out of this battle and should be more empathetic/considerate.

[[De...]]

I really am truly sorry and reread that post. It was very helpful for me to better understand this.

[[De...]]

I’m really trying to understand my own relationship with this drug and should not be considered and authority on any of it, especially given I’m not even done with my taper. 

[[je...]]

Thanks @[De...]. None of us are experts or an authority in this space. I am very sensitive to this topic because of the stigma associated with it. It has caused a lot of trauma in our house as my kids cannot reach out to their friends for support when they are struggling with my withdrawal issues. Not a single person in our lives (other than one friend) knows about my situation because I fear for my children getting bullied. I have had a very long discussion with my children about it and warned them not to tell anyone about my withdrawal as parents can be extremely judgmental and not understand that I'm not a drug addict. If parents think I'm a drug addict my kids could lose friendships, get bullied, ostracised and teased at school. My daughter was bullied at school because I had Long Covid. If people don't even understand that, how on earth will they understand dependence? It's really important for me that society understands the difference between dependence and addiction because it has a huge impact not only on how we are being perceived but also our loved ones. 

@[No...] apologies for going off-topic on your thread.

[[De...]]

I’m so so sorry to have triggered you. I am also very scared as I go through my taper and I feel like a real ass for trying to spout knowledge on something I genuinely know nothing about. Maybe my post can be educational on how not to be an ignorant idiot 😂

 

[[De...]]

I’d also add one more thing. In treatment is very very hard. I miss my kids tremendously and every taper down feels like I’m being attacked, even though it’s what I came here to do. I use this forum as a major support for me so I feel terrible to have detracted or distracted from the main goal of getting us all free from this horrible drug. 

[[No...]]

On 03/03/2024 at 17:48, [[j...] said:

Thank you @[No...]. I understand. It sounds like you're in the middle of your crossover. And it sounds like you're taking a slow approach which is better than a direct crossover. I needed to understand the process in order to give you the best advice.

The fact that you have already experienced interdose withdrawal suggests to me that you have developed dependency. Generally we do not recommend detox or rehab facilities. They are focussed on addiction not dependency. Benzo withdrawal can last for a considerable time. These facilities will give you adjunct meds to keep you comfortable while you are there, do a rapid taper which is pretty much the same as a cold turkey and when you leave you have to deal with the consequences of severe withdrawal at home. Most of our members who go to detox, eventually reinstate because symptoms are too severe. 

I know you have not been on the drug that long, but 4 months is enough to develop dependency and given the fact that you're already experiencing interdose withdrawal, I think your best option is to do a taper. If you have decided what you want to do, we can help you with that. Valium is practically easier to taper because it comes in smaller pill sizes. 

I hope this helps with your decision-making and please ask if you have any further questions. 

 

Thanks, based on ur advice and others, I have decided that the risks are just too high and it wouldn’t make sense for me to go to an inpatient detox clinic.

The cross-over to valium is going somewhat smoothly. I haven’t dropped my dose yet though.. and am frankly terrified after researching the testimonies and severity of benzo withdrawal and of what’s to come. 

I also have to work to survive and make ends meet financially. I am prone to severe panic attacks that interfere with my work, and I fear they will get worse if I continue to taper and work simultaneously. Im just very uncertain on how I am going to be able to handle this and am trying not to panic and keep calm.

In your opinion, how should I go about a valium taper? 

considering my specific situation, how rapid should I try to taper. And how? 

To be honest, the less tedious the better..considering I don’t have much time and work six days a week, Id like to try other simpler avenues rather than to weigh out each dose on a complicated scale or do water tapers ect. if possible.

Hopefully I can just use a pill cutter and drop my dose without any substantial risks of withdrawal. I feel like valium’s long half life would eliminate the need for micro-tapering or such precise dosing?

Anyhow, Im praying it will not be as hellish as I am anticipating and I can still keep living my life semi-normally during this process.

 

[[je...]]

I think you should be okay just halving pills for a considerable amount of time. You are at a fairly high dose so it should be easy to just work with the pills itself. You could start off by reducing 1mg every two weeks for a couple of cuts. This will be around 5-6% reductions if you make around 5 cuts. I suggest you trial this and see how it goes and we reassess after cut 2-3. It’s very important to see how you react to each cut. 
 

I’m sure you’ll be fine. The fact that the crossover is going well is very promising. If you take it slowly you are giving yourself the best chance to succeed.