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How Long Does Ativan Withdrawal Take?

Overview – What are the signs of abuse, effects, and withdrawal timeline for Ativan?

ABUSE:

  • Ativan has a higher potency than many other benzodiazepines, meaning that low doses of the drug produce very strong effects.

WITHDRAWAL SYMPTOMS:

  • Inability to Eat
  • Mood Swings
  • Increased Blood Pressure

WITHDRAWAL TIMELINE:

  • Early symptoms: 24 hours
  • Acute withdrawal: 5 Days
  • Protracted withdrawal: 10-14 Days

Ativan (lorazepam) is a member of a class of drugs that are known as benzodiazepines. According to the textbook Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, benzodiazepines are a rather large class of drugs that are primarily used to treat anxiety disorders, to reduce seizures, as sleep aids, and as muscle relaxants. In some instances, they are also used as presurgical drugs to relax individuals prior to receiving formal anesthesia.

All of the drugs classified as benzodiazepines are potential drugs of abuse and have been classified as Schedule IV controlled substances by the DEA. This classification means that all of these drugs have a moderate potential for abuse, the development of physical dependence (a syndrome that consists of both tolerance and withdrawal symptoms), and can only be legally obtained via a prescription from a physician.

Ativan, like other benzodiazepines, primarily acts in the central nervous system by increasing the actions of the major inhibitory neurotransmitter in the brain, gamma-aminobutyric acid (which is often just abbreviated as GABA). When the actions of GABA are increased, this results in a corresponding decrease in the action of other brain and body processes and a reduction in the actions produced by other neurotransmitters. Thus, benzodiazepines are often referred to as central nervous system depressants, because they reduce or depress the actions that occur in the central nervous system. They do not necessarily make people become depressed but instead slow down the mental and physical actions of the brain and body. The actions produced by Ativan and other benzodiazepines result in their ability to treat anxiety, quell seizure activity, and induce sedation and relaxation in individuals. However, the actions of Ativan also produce a significant feeling of euphoria and wellbeing, and a reduction in inhibitions. They also interact with other drugs to increase or dampen their effects. These factors result in Ativan and other benzodiazepines being significant target as drugs of abuse and addiction.

Ativan Abuse

riveroaks-drug-cycle

There are several factors that contribute to Ativan having a particularly high potential for the development of abuse and addiction:

  • Ativan has a higher potency than many other benzodiazepines, meaning that low doses of the drug produce very strong effects.
  • Ativan also has a relatively short half-life, meaning that the drug does not remain in the system very long.
  • The two qualities of high potency and short half-life make Ativan particularly prone for abuse, even for a benzodiazepine, because individuals will achieve peak effects quickly and the effects will wear off rather quickly. Therefore, individuals abusing the drug will want to take more and more of the drug to try and achieve the effects that wear off rather quickly.
  • In addition, these aspects of the drug lead to the development of tolerance to Ativan occurring rather quickly. Tolerance is a physiological phenomenon that occurs when someone takes the drug on a regular basis over time. The individual develops tolerance when they need to take more of the drug to get the same effect that they initially got at lower doses.
  • Thus, individuals abusing Ativan will develop tolerance very quickly and may be taking higher amounts of the drug in order to get the same experience of euphoria that they once achieved at lower doses. Some individuals who develop tolerance can eventually take amounts that could be toxic to people who normally would not use the drug.
  • In addition, benzodiazepines like Ativan are also well-known for their tendency to produce withdrawal effects when they are suddenly stopped or the dosage that the person has been taking is suddenly reduced.
  • A person taking high levels of Ativan who suddenly begins experiencing withdrawal symptoms will be prompted to take more Ativan to counter the symptoms.
  • Because of its short half-life, withdrawal from Ativan can occur rather quickly. This means that individuals with severe Ativan use disorders may find that they begin to experience withdrawal effects a short time after they stop taking the drug.

Consequently, Ativan abuse becomes a vicious cycle of an individual needing to take more Ativan to avoid the negative effects that are associated with taking more and more Ativan. Many individuals will potentially take very high amounts of Ativan that are associated with severe potential health issues.

These factors make Ativan abuse a particularly difficult situation to overcome. Individuals become trapped in the cycle of using the drug to avoid withdrawal symptoms and physically needing more of the drug as a result of abusing it. In addition, benzodiazepines are often abused with other drugs, such as alcohol, narcotic pain medications, and even stimulant drugs like cocaine. This type of polydrug abuse complicates the entire situation and has potential dangerous and even fatal consequences.

Withdrawal Symptoms and Timeline

Withdrawal Symptoms and Timeline for ativanEmpirical research investigating withdrawal from benzodiazepines like Ativan indicates that the process is one that occurs in stages, and that withdrawal from a serious Ativan use disorder can be potentially fatal due to the development of seizures.

It is generally accepted that Ativan withdrawal occurs in two stages:

  • Acute withdrawal: Due to the drug’s relatively short half-life, there can be withdrawal symptoms within 24 hours of discontinuation. The average onset of withdrawal symptoms is longer and occurs typically between 3-4 days following discontinuation of Ativan. Acute withdrawal from Ativan often consists of a rush of anxiety, increased heart rate, increased blood pressure, and difficulty sleeping. The rush of anxiety is often referred to as a rebound effect. A rebound effect occurs when symptoms that the medication was initially designed to reduce (in this case anxiety) return once the person discontinues the medication. A number of other symptoms may be present during acute withdrawal.
    • Neurological symptoms, such as headache, shakiness or tremors in the hands, confusion, mental dullness, and profuse sweating may be present. There is also a potential to develop seizures. The development of seizures during acute withdrawal can be potentially fatal, and any sign of seizure activity requires immediate medical attention.
    • Cardiovascular symptoms, such as increased heart rate or increased blood pressure, may occur.
    • Gastrointestinal issues, such as nausea, vomiting, stomach cramps, an inability to eat, and weight loss, may be present.
    • Psychological symptoms, including cravings for Ativan, mood swings, depression, and anxiety, may occur.

The acute phase of withdrawal will typically last between 5 days and 4 weeks. Symptoms will typically peak within 2 weeks and then begin to decrease in intensity.

  • Protracted withdrawal: This phase may last 10-14 days, although for individuals using very high amounts of Ativan, it can conceivably be longer. The symptoms are significantly reduced in both their intensity and number but can still consist of issues with anxiety and depression, cravings for the drug, upset stomach, headache, and flulike symptoms.

In some cases, individuals experience a return of severe anxiety following protracted withdrawal. When there is a significant return of anxiety following protracted withdrawal, some researchers label this is as third phase of the withdrawal process from Ativan and other benzodiazepines. In addition, a subset of individuals may continue to experience issues with decreased motivation, apathy, mood swings, and other psychological issues for months or years after they have stopped taking Ativan (sometimes, this is referred to as post-acute withdrawal syndrome).

Treatment for an Ativan Use Disorder

The major issue with trying to discontinue Ativan or any other benzodiazepine once a person has developed a substance use disorder to this class of drugs is the inevitable experience of the withdrawal syndrome. Because one of the quickest ways to stop the withdrawal symptoms is to take more Ativan, it becomes extremely difficult for many individuals to negotiate the early stages of recovery from an Ativan use disorder. The negative withdrawal symptoms and increased cravings for Ativan result in individuals relapsing rather quickly. The chances of success in recovery from an Ativan use disorder are greatly increase by utilizing a formal treatment approach that includes a medically assisted detox program.

The major components of a successful recovery program from an Ativan use disorder will typically include the following:

  • A formal detox component that is supervised by a psychiatrist or addiction medicine physician should be part of the program. This component can be either an inpatient or outpatient program but will require that the individual receive medical supervision to assist with withdrawal process. One strategy involves a physician-supervised tapering program that slowly tapers down the dosage of Ativan or uses another benzodiazepine to slowly wean the person off benzos. This allows for the individual system to adjust to decreasing amounts of Ativan in their system and reduces the intensity of the withdrawal process. Other medically assisted treatments may be required throughout the entire recovery process to address other situations, such as psychological problems or medical conditions, that need treatment.
  • The formalized treatment program will need to include some form of counseling or therapy designed to discover and address the issues that led to the substance use disorder, assist the client in developing new ways to cope with these issues, and continue to address other issues that may be present. Therapy can be delivered in an individual, group, or combined individual and group format. For individuals with domestic issues, family therapy is also an option.
  • There should be an option to participate in support groups, such as 12-Step meetings or other peer support groups. Support group attendance offers the potential for extended care once the more acute phases of treatment and therapy have been completed. Because therapy is typically not an ongoing situation but is time-limited, individuals need some type of long-term involvement in order to address situations that could trigger relapse over the longer term. Support groups are good sources for long term aftercare and treatment.
  • Any other supports or services that the individual needs, such as occupational therapy, vocational counseling, etc., should be included in the treatment package.

One Final Note

aftercare note Even though the development of physical dependency on Ativan is inevitable for individuals who develop Ativan use disorders, simply negotiating the withdrawal process and going through a medical detox program is not sufficient to ensure recovery. Professional organizations, such as the American Society of Addiction Medicine, formally recognize that getting through the withdrawal phase is only the first step in the addiction recovery process. Individuals who simply go through detox and do not then invest their time in a formal recovery program are at a very high risk for relapse following detox. A substance use disorder has many components and only one of these components is the actual substance use or abuse. In order for recovery to have a chance of being successful and sustained, individuals need to address the underlying reasons for their substance use disorder and continue to maintain some type of long-term involvement in recovery.