Why does benzo withdrawal last so long

Physical withdrawal from opioids, coke or alcohol is over in a few days or weeks, but the symptoms of addiction to benzos can last for months or years.

Why is that, why does it take the brain so long to recover from benzo addiction?

Well, that was difficult:

I have been on some benzo or another since 2001, two while in alcohol withdrawal.
Hypnotics, for those wondering.

I’m lucky in that the effects are limited to being unable to spell worth a damn.

I’m not sure id equate the “years” thing as being equal to the standard 5 day withdrawal from something like Oxycodone. There are symptoms like PAWS that can go on for supposedly months and months if not longer than that for opiate users, but actual physical normal withdrawal is usually over pretty quick.

That being said - your question is a good one - I know a lot more about opiates than benzos, but I do know - in general the withdrawal period for an opiate is somewhat highly correlated to the half life of the drug. Being that benzos (generally) have a higher half life than opiates - it wouldn’t surprise me that the half life of the drug is part of the reason.

It also wouldn’t surprise me that the same rule would apply to benzos - those with a shorter half life - are quicker to get off of. There are plenty of things that can be done to make your life easier withdrawaling from opiates, I’m not sure what the options are for benzos, but most doctors get very little training in addiction medicine - and it is only somewhat more recently being understood the extra problems at least SOME people seem to have getting off benzos.

Word on the street is it is not only longer, but harder too. Be careful what you read on the internet. Some people can stop with little or no problems. It depends on the person.

Yes, but this is also true of opiates and other addictive drugs after chronic use. Why do their changes happen so much more quickly? What is it about GABA[sub]A[/sub] receptors that take so long to up-regulate?

Unfortunately, I’m not sure anyone really knows. It’s taken quite a long time to get benzo withdrawal even recognized as a syndrome.

Actually, with drugs like benzos, the withdrawal is so bad that they recommend using a drugs with a longer half-life, so that the levels will naturally go down.

I’m also pretty sure there are opiates with half-lives that are as long or longer than most benzos. That apparently is not a sufficient explanation.

See Benzodiazepines: How They Work And How To Withdraw (a.k.a. “The Ashton Manual”). The author, a professor or neuroscience (retired), ran a benzo detox clinic for a dozen years.

Typical detox programs run a month or so. Benzo detox needs to run for six weeks, at a minimum. Benzo withdrawal times can be really long and nasty. It’s estimated that 10% to 15% of cases will result in “Protracted Withdrawal Syndrome”, where the withdrawal can last for as long as 18 months, or maybe even longer.

Nobody seems to know for sure why that happens. (At least as of 2002, when the Ashton Manual was published. Maybe there’s newer research available now.) One theory I heard was that benzos have an affinity for fatty compounds, and thus dissolve into the fatty tissue in your body – including into the myelin, the fatty coating on the nerve cells.

Thus, once the benzo is supposedly gone from your body, there is still a residue lingering, dissolved in your myelin. This, perhaps, can diffuse very gradually into the nerve, keeping the withdrawal effect going for arbitrarily long.

I’m not sure if that’s a theory supported by evidence, or just a speculative hypothesis, or just a wild-ass guess. I’m not entirely sure if it even makes sense. But that’s the story I got from one of my doctors. I don’t recall that the Ashton Manual mentions this theory, but it does discuss Protracted Withdrawal Syndrome.

The general rule is, the shorter the half-life on an addictive drug, the more addictive it is.

The commonly recommended protocol is to gradually reduce whatever benzo you are hooked on, while gradually replacing it with a different benzo with a longer half-life.

Valium has a very long half-life, and is thus supposedly the of the less addictive of the benzos. So if you are hooked on, say, clonazepam (Klonopin) or alprazolam (Xanax, one of the worst), a common strategy would be to gradually switch you over to Valium instead. Then, once you are fully hooked on the Valium and no longer using the nastier stuff, it is then supposedly easier to unhook you from the Valium, than it would have been to unhook you from whatever you were using before.

I guess I am fortunate re choice of hypnotics.

I burn CNS depressants faster than most medical types believe possible, so require a drug which hits at max effect, preferably very quickly. These also tend to have short half-lives.
Since I use them daily, I have not experienced withdrawal (so far, so good, as the man plummeting to his death is reported to have said).

I don’t remember how long I was on Lorazepam for Etoh witthdrawl, but did not have problems when I stopped.