Withdrawal Treatment and Support
Bristol and District Tranquilliser Project.
Beat the Benzos Conference, November 2000.
I'm going to say something in a bit of detail about counselLing in withdrawal, I realize I'm going
to repeart some of the things already said by Melanie and Pam, so bear with me.
Considering how to counsel those who are addicted to benzodiazepines I've always been very much
guided by my own experiences of addiction and withdrawal and how I was helped through them.
My experience of taking Lorazepam for just over a year in the mid 1980's was of living in a twilight
world of pain and exclusion, out of touch with myself and the world around me. Gradual withdrawal
brought terror, sickness and regular panic attacks.
Eventual cold turkey withdrawal, brought a major epileptic fit and over two months in Swiss Psychiatric
hospitals, which believe me were absolutely as clueless as our own about how to treat me. I then came
back to England, as I saw it, to die, or to end up incarcerated, crazy for the rest of my life.
Instead I spent 18 months at home, feeling suicidal, unable to look after myself, to sustain
any relationships or friendships, unable even to read or watch television. Every night of those
18 months I prayed not to wake up the next morning. I never in all that time expected to live a normal
life again. I felt totally, irretrievably mad.
What did help to sustain me through that terrifying period was the support and advice of a
tranquilliser withdrawal group in Bristol. Only with them did I feel safe and able speak openly
about what I was going through. At least temporarily, when I was with them I was given to believe that
I might one day escape from the agony and live some kind of a normal life again.
So My first principle of counselling is to bear in mind just how difficult it is for clients to
take on board the message that it is possible to get off these drugs and get well. In most cases
their lives will have been blighted, their relationships will have been wrecked, they may have
lost houses, and jobs and they will have lost all sense of enjoyment, happiness or fulfillment.
They will have been given the impression by all those around them that they are strange, different,
suffering from a kind of mental illness, from which they are not expected to recover. The medical
services will almost certainly have long since written them off as hopeless cases. Almost certainly no
one will have told them that the root of their problem lies squarely in the 'helpfu'l drugs that they
have been taking religiously all that time.
My second principle in counselling, therefore is that it needs to be more directed and
interventionist than with most other forms of counseling. There is just so much ground to be made up,
and there is so much ignorance on the part of the person you are trying to help. It will probably
take several sessions before they are able to trust you and what you are saying and realize that
you are not just another of those well-meaning professionals who secretly label them and send them
away with another worthless solution.
The element of personal identification here is so important, that is why self help groups can be such
a help. Clients can hear and observe others who have exactly the same symptoms as they have suffered
from for years, the same messed up life, the same emptiness and despair. They can come to realize
that the private hell hole they have been living in all these years is no different from the place
all these other people have been living in too. This dawning realization can be huge step away from
hopelessness towards solidarity and commitment.
My Third Principle of counseling is the providing of articles by people like Heather Ashton and
some individual case histories. They will also need to have their eyes opened about just why they
took those strange decisions while on the drugs, or why they hate Christmas, or cannot bear to have
their family around them. They need to understand that above all, what has happened to them is
not their own fault.
This is my forth principle, reassurance. People will have suffered under the false assumption that
they are inherently sick, weak, misguided and even that in some strange way, they have brought all
their torment down on themselves and that they are responsible for it. The daily task here for
the counsellor is to try to absolve them of guilt and to awaken healthier assertive feelings and a
determination to start to put things right.
This is the fifth principle, hope. These people will have lived without hope for so long that they
can scarcely recognize what it is. It will be hard to ignite this flame and even harder to keep it
alight in the weeks and months ahead. The client will lose sight of it constantly as I did myself.
They will continually come back to the idea that they are different, damaged and that they will
be the only one not to recover. So the counsellor must constantly remind the client of
the prize at stake to be drug free and well and make it seem attainable.
So much work may need to be done even before the clients make their first cut. There is no point in
people starting to cut down if they have no understanding of what the drugs have done to them, or what
will lie ahead through the long process of withdrawal.
People who cut down on the drugs without this understanding will almost certainly fail. It is hard
enough to come off, even when in possession of all the facts and with maximum support. They may well
have tried to come off before without proper understanding and support so they will have yet another
sense of failure to overcome.
The reasons for this previous failure - most likely too quick a reduction, will need to be gone into and
explained. S oyu may need to actually restrain the client from starting to cut until you are satisfied
that their thinking is clear. The first cut is of course crucial and clients are always nervous about
making it. It is helpful to go through possible withdrawal symptoms with the client before they make
the cut, when they might expect a reaction, how long it might last, when they might expect to get over
In this way the process can be demystified and the client can begin to exercise a measure of control
over their situation. This is really the key to the whole withdrawal process, helping the client to
regain control of their own life. Once the client has made that ****[ it is difficult to] predict what
effect each cut will have.
Some cuts have a devastating effect, others leave the client feeling little different
and this is when cutting the same amount of benzodiazepine at the same interval can veer
from times of near despair in bad cut to other times when the ultimate goal seems quite
attainable. So the counsellor needs to be flexible, tailoring "[Cut off ***here]
With kind permission form the author
Ian Singleton, November 2000.
Beat the Benzos Conference
November 2nd, 2000
"My husband has been on benzodiazepines for 18 years now, he started on lorazepam and he certainly was not
the first person not to know it had any effects at all. I didn't even know what tablets he was on.
For 13 years he became increasingly violent, uncaring , no interest and ignoring his friends.
Eventually I was fearing for my life, so it was me, it was the family, probably it's happened to a
lot of people here as well.
After 12 years I said "there's a problem" - the doctor didn't say there was a problem, the patient didn't say
there was a problem. It's often the relatives who are the closest and they, the people who accept all this
strange behaviour blame themselves. They blame what the patient says and they are the first people, I think, to
discover there is a problem.
There is such a time lapse from the time that people take these pills intil the time that the problem is discovered.
My husband is here today. He is upstairs in his hotel room - he cannot come down as he's in such a state. He
said to me, "tell them that I'm withdrawing now, I'm on 5 tablets a week, but I feel I'm in danger of
I a normal everyday situation [such as] driving a car, nobody stops him driving a car, he's a big man,and very
forceful - he could easily injure someone. If somebody upsets him in any way, just a normal member of the public,
or if someone 'cuts him up'when he's driving. If someone does something that he interprets as an expression
of anger or agression he will react.
He says someone should him - he says "I'm going to kill someone in the end and and it's the only time
anyone will listen to me.
I'm sure that this is such a problem - somebody here mentioned crime - we should be investigating some of the causes.
I hope that rings a bell somewhere..."
Audience Comment (2).
Beat the Benzos Conference
November 1st - 2nd,2000
"I don't think the doctors do understand what informed consent is if something like the Bristol
children's heart scandal is anything to go by. Here parents gave their, what they thought was informed
consent, only to find out that actually, parts of their children had been disposed of in quite a digusting way.
I think we've got to rethink the whole idea of informed consent.
I want to say that during this whole conference I have had a sense of a slight swing towards the patients
being expected to take responsibility for what they were being prescribed. We were talking about having
the patient information leaflets put into the packs of drugs. Now I think that's fine, that's an aide
memoire for the patients. We can all have a look at it and see what's going on, but I think that the first level of
responsibility is with the doctors. They are the people who have the power to prescribe - they should take
responsibility for that prescription. I just don't think it's good enough.
We heard the last speaker this morning, and there was a sense of the GP somehow being coerced by
the paients to give them something. Now this is absolute nonsense. There is a very little word - no,
now if the doctors can't use that word, they should be trained to use it. You cannot have a GP
turn round and say "well I'm sorry Mrs so & so put pressure on me"- that is absolute, if you'll
pardon the phrase, bullshit."