This is Dr. Stuart Kloda. I’m an addiction medicine physician in New York City. I have a solo private office located at Columbus Circle. Today I’m going to be talking about the outpatient detoxification, or medically supervised withdrawal, from the class of medications known as the benzodiazepines. These are drugs such as Xanax, Klonopin, Valium, and Ativan. They are frequently prescribed for anxiety and for patients with anxiety disorders. Xanax is one of the most addictive of the benzodiazepines. So for the purposes of this video, I’m going to be discussing the outpatient detox from Xanax in patients with anxiety disorders.

The withdrawal symptoms from a drug are the exact opposite of the effect of the drug. So if Xanax is prescribed for a patient with Generalized Anxiety Disorder, and the Xanax is taken away, the anxiety from that disorder is going to come out and rear its ugly head. However, in addition, with the detox, there’s going to be withdrawal symptoms from withdrawal anxiety. There can be withdrawal anxiety, of course, during the detox, however, there can be anxiety immediately after the detox, as well as for a longer period of time afterwards. This being acute, post-acute, and protracted withdrawal. Benzodiazepine detoxification can be extremely difficult for patients because the anxiety level can be so high. So it’s important to have a close therapeutic alliance between the patient and the physician. I accomplish this in my medical practice with weekly office visits, if not more, and by being available on my phone. I am available to my patients seven days a week on my cell phone, within reason of course.

The way to do a benzo detoxification is to take a long acting benzo such as Valium or Klonopin, and substitute it for the short acting benzo Xanax. So a dose of Valium or Klonopin is calculated that is roughly equivalent to the dose of Xanax being abused. The taper is started at that dose, and then the dose is gradually and slowly decreased over a long period of time. It is really important to taper down very slowly, otherwise the taper will be destroyed and the patient will not be able to complete it. Going too quickly will cause way too much anxiety to come out. Now I manage the withdrawal anxiety with a few things. I use a class of medications that work at the same receptor as the benzodiazepines, the GABA-A receptor. However, they don’t have the addictive properties and negative sequelae as using Xanax at high doses. So, as the taper dose decreases, I start adding the medications that I use to balance out the withdrawal anxiety.

I also make sure that the primary anxiety disorder is treated. So for things such as Panic Disorder, Social Anxiety Disorder, and Generalized Anxiety Disorder, the first line agents are the serotonin reuptake inhibitors such as Celexa, Zoloft, and Prozac, as well as the serotonin norepinephrine reuptake inhibitors such as Cymbalta and Effexor.

I have spoken about the psychological anxiety, however, there can also be a somatic anxiety as part of the withdrawal symptoms. The word somatic means body, so some patients will have palpitations, chest tightness, and even a feeling they want to crawl out of their skin. Beta blockers can be very effective for this. Beta blockers are a cardiac medication used to slow the heart rate down and control blood pressure. However, it also calms the nervous system down.

The other thing that I strongly encourage during benzo detox, and during any detoxification, are weekly acupuncture treatments. I have found acupuncture to be extremely effective, and a really great complement to the treatments that I just outlined. In addition, I highly encourage exercise, and I always encourage a lot of gym memberships.

The last thing I’m going to mention is the Ashton Method. The Ashton Method is a method of benzo detoxification from England that essentially is a long slow taper using Valium instead of Klonopin, which is more commonly used in the United States. I have had a number of people contact me and ask me if I use the Ashton Method. The answer is yes, I do use the Ashton Method. However, I’ve also had a number of people contact me and say that it is the only way to do a successful benzo detox. I have to say that for quite a while, I have been doing long slow tapers with Klonopin with a lot of success, in part because of the medications that I use. So while I do use the Ashton Method, I at the same time cannot discount my clinical experience and many happy patients.

If you would like more information, you can call and speak with me directly at (646) 713-6578. Thank you.