Carrying the fight to stop tranquilliser addiction

Pam Armstrong is a nurse and midwife with a degree in psychology and sociology. During her nursing studies she was amazed by the problems benzodiazepines caused and, as a result, founded The Council For Involuntary Tranquilliser Addiction (CITA) with Peter Ritson, who had grappled with his own tranquilliser addiction  

Since early January, 1987, the Council for Involuntary Tranquilliser Addiction (CITA) has endeavoured to produce a greater understanding of the problem of benzodiazepine addiction and its effects on an individual’s personality and the families in close contact with the addict.

So it is disheartening, in certain respects, that in 1992 there is still little awareness in society of just what prolonged use of these drugs does to the human persona.

Basically, long-term use of benzodiazepines causes disintegration of the personality, largely because of an increase in anxiety and a simultaneous suppression of the ability to cope with it. The anxiety becomes totally destructive and disabling. This seems to happen because of the effect of benzodiazepines in blocking receptors in the brain which would otherwise have perceived stress factors. As a diminished amount of stress is perceived, so the person feels more able to cope initially, and the addiction is born psychologically.

However, the stress-coping chemicals in the body have a ‘use it or lose it’ influence on their production. As less stress is perceived, so less coping chemicals are produced, and the ability to cope with stress is diminished. Behaviourally, as well as chemically, the human being gradually ceases to be able to handle stress inducers. Like an army that does not train for battle, the human body loses its ability to react to psychological stress.

There are certain parallels to be drawn between the use of antibiotics and benzodiazepines - indeed, the over-prescribing of antibiotics decreases the effectiveness of a person’s immune system which, similarly, is unable to cope with infection, and leads to the growth of super-resistant ‘bugs’. So, the continual use of benzodiazepines leads to the inadequate production of coping chemicals and to anxiety that becomes enormous and out of hand.

Counselling, in any true sense, requires rational thought processes by the participant and, quite clearly, for those addicted to benzodiazepines, counselling must be very directive and, more than anything, should take the role of information-giving and support. There is enormous need for the person to know what steps to take to withdraw from the drugs. In most cases, the sufferer has tried before without guidance and has been petrified by the effect it has had. Reassurance is an initial part of the help which should be offered - reassurance that it is possible to withdraw and reassurance that help will be there.

During benzodiazepine withdrawal is the worst possible time to make important decisions about one’s life and these should be avoided, if at all possible. Many benzodiazepine sufferers have told me that the decisions they have made, or would have made, when they were taking benzodiazepines would have been utterly different from those they would have made when clear of the drugs. However, we do realise that withdrawal does not occur-in a vacuum and, for some, decisions’ may have to be made at this inappropriate time, in which case support should always be offered.

Understanding drug action eases withdrawal

Providing an understanding of the drugs is an initial part of our work; if a client understands the way a drug works, he/she will find it a lot easier to cope with withdrawal. Such understanding may also help to convince a client that he/she is not in the grip of severe illness.

When discussing any subject with such a client, it is vital to realise that long-term benzodiazepine use blocks the memory and impairs concentration. When one realises that benzodiazepines, given as pre-medication, are prescribed largely to induce this effect, it becomes easier to understand why long-term use severely damages memory. For many. this is one of the saddest effects, -being. as we are, the product of our memories. Precious memories, such as those of early childhood, may be irretrievably lost.

Fear of ‘impending doom’

Fear is the overriding problem faced by a benzodiazepine-addicted individual and, without exception, all will tell you that unexplainable fear rules their lives. It is obviously helpful to explain that the continual sense of fear results from uncontrolled adrenalin reflex action thrown out of synchronisation by crude chemical interference, which is not countered by brain endorphins because they have also been suppressed by the drugs. This fear may be misinterpreted as a sign of ‘impending doom’, as may the physical symptoms, such as butterfly stomachs, bowel disturbances, headaches, palpitations and so on, all of which are due to the chronic sense of fear.

Other physical symptoms may also occur, such as muscle aches and pains and eye problems that are associated with the muscle-relaxant qualities of benzodiazepines. These symptoms will ease as the drugs disappear from the body. Similarly, chemically irritated nerve endings and joints will also become pain-free in due course.

However, it must be remembered that benzodiazepines are fat-soluble drugs, which take an indeterminate length of time to leave the fat cells, unlike many other drugs that are water-soluble. Many have suffered because they were told by doctors that, having stopped taking benzodiazepines for some time, any symptoms being experienced could not possibly be caused by withdrawal. But, in fact, it seems that each time benzodiazepines are released from the fat cells, further withdrawal symptoms may be experienced.

The period after stopping the drugs can be very difficult because the emotional state is very raw and fragile and the nervous system is like an electrical circuit with no insulation. It is at this point that many people feel very unable to cope and their resolve may reach its lowest level, since they no longer feel that they can blame drugs for the way they feel. Symptoms can often be very severe and, since many doctors do not appreciate the fat-soluble, slow-release nature of benzodiazepines. sufferers have recommenced taking them, believing they have something else wrong and, thus, sadly, the good work of withdrawal is undone.

CITA’s services

Realising the difficulties of benzodiazepine withdrawal, The Council for Involuntary Tranquilliser Addiction offers various help services to sufferers.

The Council For Involuntary Tranquilliser Addiction has set up 30 clinics on Merseyside during the past year.

These are all situated in GP surgeries, with clients being seen individually on a weekly basis. Doctors usually encourage their patients to attend at least once in order to become aware of the benefits from withdrawal from the drugs. Some surgeries require us to teach anxiety management to patients who might have previously been prescribed benzodiazepines.

At the present time, the Family Health Service Associations on Merseyside stipulate that each clinic should include six people. CITA hopes, however, that this regulation of numbers may gradually disappear. Clinics are evaluated by measuring take-up of invitations and by numbers who reduce dose or who withdraw totally.

This has proved a helpful way of assisting patients and supporting doctors and there is no reason why this Merseyside model could not be replicated in all parts of the UK. We have already travelled to various parts of the country to spread the word and provide tints for setting up similar clinics.

Please contact CITA, at Cavendish louse, Brighton Road, Waterloo, Liverpool L22 5NG, for such advice.