Can one take benzos/BDZ drugs everyday and still function?

In My Humble Opinion
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And by function I mean work a job, exercise, etc… My psychiatrist has given me x10 tablets of 500mcg alprazolam (Xanax) and x10 tablets of 10mg zolpidem (Ambien). He says I should only take them sparingly and they last for a month

I sort of like how they feel but he says because of that, the risk of addiction is too high and he can’t give me any more.

I’ve heard thought that these are ‘slippery slope’ drugs and very addictive, even more so than opiates (though less euphoria, people build up tolerance very quickly and withdrawals are said to be worse than opioids).

I haven’t experienced benzo withdrawal but alcohol withdrawal when I went on a binge for a month then suddenly stopped. Experienced my first panic attack and that was horrendous. I know both alcohol and benzos act on GABA receptors so if benzo withdrawal is anything like alcohol withdrawal, I’d want to avoid taking them as much as possible and only when needed.

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Paging @Qadgop_the_Mercotan, Paging Dr. Qadgop

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Some folks can be maintained on daily doses of benzos and function (for a variable definition of the word ‘function’), but the benefits of doing so should clearly outweigh the risks. I’d NOT recommend non-emergent benzo use by anyone who had been so physically dependent on alcohol in the past that they went through withdrawal upon cessation of drinking; likelihood of cross-addiction is too damn high.

Problems also arise for the person on benzo maintenance if suddenly their supply is cut off. Withdrawal from benzos tends to be prolonged and miserable.

The amounts the OP is being issued would tend to minimize the risk of physical dependency and subsequent withdrawal. But for many people, those initial low doses that avoid the risk of those issues tend to lose effectiveness over time, and higher doses are required to achieve the same effect. Also, people with the susceptibility for addictive disease often start supplementing their benzos with alcohol or other substances.

So I’m not really enthused about prescribing such meds chronically to manage anxiety and/or sleeplessness, or most other conditions either.

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Personal anecdote, since this is IMHO.

I hate benzos. I was prescribed Xanax for anxiety, and my initial dose was three times a day at – let me find the bottle – 0.25 mg. I took some Xanax about 20 years ago, as well, when I had actual panic attacks and I just stopped taking it, because it just wrecked me. I tried it again, for two days, though not at 3x a day, and I just said, no, absolutely not. I called my PCP and said, this is not the right solution for me.

It does relax me and relax me pretty quickly. Like within 5 minutes of taking the pill. I would use it if I were having an all-out panic attack, but as maintenance medicine, it just doesn’t sit well with me. I repeat, this is a personal anecdote, I am not a doctor, I am reporting my experience with it.

But everyone is different. Qadgop has weighed in with his actual medical opinion. I’m chiming in with my personal experience.

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I’m on a half mg of Xanax at night to help me sleep. I effectively can’t get to sleep without taking it now (does that make me addicted?), but it has no ill effects when I’m awake. I’ve been on it for more years than I can remember; at least 5 now, probably more like 10. The last 4 years of my life at a good-paying job have been by far the most successful for me since I graduated from high school, which was just over 20 years ago now.

But there’s no way I could function if I had to be “high” on Xanax during the day. The stuff makes me just want to go to sleep.

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I’ve been taking 2mg Alprazolam ER (extended release) for the past 3 years, with very occasional use of .5mg instant-release to take the edge off the odd aggravating situation. I’ve not only functioned but been thriving, busy as hell with various work gigs and (up until COVID) a band, and I’m in good shape, regularly hiking, biking, fishing, and working on home improvement and gardening projects. Have had zero problems with anything. When I got a CDL (commercial driver’s license) earlier this year, I needed a waiver from my psychiatrist for those benzos though. I had my required physical exam when I applied for the license, and the doctor performing the exam told me to get a waiver certifying that they wouldn’t impair my driving ability - I called up my shrink’s office and they faxed them a signed waiver in about 15 minutes. Done.

There’s your sample size of one, anyway.

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This Benzodiazepine Ex-Users Manual is a MUST read.

https://www.benzo.org.uk/manual/

Prof. C. Heather Ashton (Ret.) operated a benzo detox clinic for a dozen years.

Some benzos are more addictive than others. Apparently it depends on their half-life. Valium (longer half-life): Less addictive. Xanax (very short half-life): Quite addictive. Klonopin (mid-range, I think): Also quite addictive, maybe not as bad as Xanax.

Ashton says that a useful detox protocol should be at least six weeks (compare with four weeks for opioids). But approx. 15% of ex-users will have “Protracted Withdrawal Syndrome” that could last arbitrarily long, even longer than a year. Nobody quite fully understands why this happens.

If you do get into that situation, Good Fucking Luck finding a doctor who knows anything about it, let alone anything about how to treat it or at least manage the unpleasant symptoms.

Ask me how I know about that. Or simply wait for my next post, where I’ll tell some of my story.

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That last sentence sums it up: take as little as possible, and only when needed.

You can also halve the dose if you wish, if that works for you.

Personally, I’m not as worried about the alprazolam as I am about the Ambien. I just can’t believe Ambien got, let alone stayed, on the market.

(Pharmacist here; licensed but not practicing.)

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I got “hooked” on Klonopin, even at a very low dosage. The doc prescribed 1 mg four times a day as needed. I started taking one half tablet once a day. It helped me stay calm and helped sleep.

It wasn’t long before I needed 1/2 mg twice a day and occasionally three times a day. I think I went up to 1 mg twice a day. (I don’t remember clearly because this was 15 years ago.)

I began getting “withdrawal” symptoms in between doses, especially in the hours before the afternoon dose. The symptom was jitteriness and, eventually, craving that next dose. It didn’t help me sleep any longer.

I knew it was addictive, so when this started happening, I quit. I wasn’t under a doctor’s supervision at the time, but after-the-fact, a doctor told me that at the low doses I was using, he would have suggested just quitting cold-turkey too.

I had nasty withdrawal symptoms for 18 months after that. (Severe insomnia, sensations of electric jolts through my brain every 30 seconds non-stop, massive and prolonged gut-wrenching anxiety attacks.)

I was substantially non-functional, primarily due to the sleep deprivation. I estimated that I was getting maybe 2 hours sleep a night and not very high-quality sleep either.

I think before it was over, I ended up consulting something like six different doctors, including several shrinks. None of them seemed to know much about benzo withdrawal beyond some basic “textbook” stuff. They definitely didn’t know anything about prolonged withdrawal syndrome. They all had different suggestions and different prescriptions to alleviate the symptoms, none of which helped very much.

One doc gave 400 mg trazodone to help sleep. (That’s a HUGE dose, I think.) It worked well for two nights and then no more after that. Another doc gave hydroxyzine pills (an antihistimine) with similar results. Another doc gave me clonidine (an alpha blocker, I think). The next doc told me to quit clonidine, saying (and I quote exactly): “Clonidine makes people feel shitty.” (He was right, too.) Yet another doc, a shrink, had me take mirtazipine (an antidepressant, but sometimes described as an antipsychotic). That got me sleeping all right, but I quit after several weeks because of side effects.

One ER doc suggested that should try yoga.

One recurring theme was that docs didn’t know about long-term withdrawal syndromes, and so assumed I was malingering.

It took me about 16-18 months for the withdrawal symptoms to mostly subside, during which time I was barely able to function. For the last 8 of those months, I went to live in a board-and-care home. And even after all of that, I still didn’t feel quite right for another year.

Benzos are drugs from hell.

ETA: Because I was jittery and shaky, one doctor screened me for Parkinson’s Disease, and two other doctors ordered brain MRI’s to check for Multiple Sclerosis.

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I guess I was lucky. My doctor prescribed Klonopin for periodic limb movement disorder (spasms in my legs at night). I took one tab at night for several years. Then I went to a sleep clinic, and the doctor was appalled that I was on Klonopin. He said it was highly addictive. He Rx’d ropinerole, and I quit taking Klonopin with no withdrawal. Addiction sounds like pure hell to me, so I’m grateful I didn’t get hooked.

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I personally say to stick with the guidelines, based on my horrific experience that has had lasting effects to this day. Use it for the four weeks, and try to taper off, SLOWLY. If you need anxiety meds, try to get on something longer lasting that may take time to take effect, like the SSRIs and such, and only use the benzos short term to bridge the gap.

Save long-term benzos for the situation where nothing else will work.