The most prominent feature of withdrawal is anxiety. In its
acute form it is after all one of the reasons why a benzodiazepine is
prescribed in the first place. Anxiety produces the most profound results.
People report apparently quite unreasonable fears. They are afraid to go
shopping, entertain a friend, or even just leave the house. Their lives become
very limited. Fear becomes all pervading.
Fear
Fear of People and Events. These
fears are very real to the sufferer and must be taken seriously. If someone is
frightened to leave the house, it is because they see the house as safe and the
outdoors as a threat. All sorts of
normal events become threats, for example:
- an
unexpected visit from a friend
- a
sudden change of shopping trip
- just
going into a shop
- almost
any form of surprise however well meant
- a
misinterpreted facial expression.
Fear of the Present. Accompanying fears of others is fear of oneself. People suffer from feelings of hopelessness,
and their moods are flat. The fear of impending doom is much more intense than any normal
equivalent, and although often overwhelming, it cannot readily be associated
with any specific worry or trigger. Moods also swing from optimism to pessimism
very quickly in the manner of a bipolar disorder.
Fear of the Future. Sufferers
have serious doubts about the future, so they say:
- I’ll
never get better
- no-one
else is suffering as much as me
- it’s
getting worse
- will
it really happen
- what
happens if the rest of my life is like this?
- I’m
going to die
The intensity and pain of withdrawal means that sufferers
are certain to be somewhat pessimistic about the outcome, so the carer needs to
be reassuring. But how? Withdrawal is unpredictable so a good day may be followed
by a bad day, a better day or a similar one, in any combination. There is very
little in the way of a reliable pattern. What is worse it is nigh on impossible
to put an end date to withdrawal, so the inevitable “but how long is it going
to take?” is pretty well unanswerable.
What the Carer Can Do
The carer then has a number of options, which are covered in
more detail in the sections which follow, such as:
- talk
through the problem
- distract
the sufferer from the problem
- use
other people’s positive experiences and successes
- remind
the sufferer that the problem is the direct result of withdrawal
- call
on outside support
- encourage exercise
- help the sufferer to do things
My wife had poor short-term memory and so tended to forget
the cause of her distress. I used to question the thought itself, reminding my
wife by getting her to repeat the simple mantra “it’s not me, it’s the
illness”. Sufferers are very
wrapped up in themselves and the actual cause of the withdrawal gets lost in
their minds. Reminding them that it is, or was, the drug which is at fault
helps to alleviate any feelings of guilt they may have. These doubts are just
thoughts and need to be put into a proper perspective.
At this point the carer’s support will be at its most
stretched, and constant reassurance most needed. Sometimes persuading sufferers
that the mood problems they face are also faced by many other people and they
will eventually disappear will help, but many sufferers will find it difficult
to believe when they are distressed, and so all that the carer can do is hold
on and wait until things improve. Moreover sufferers seem to feel guilty as if
the illness were their fault. At the risk of seeming trivial I use some simple
mantras such as:
- “it’s
one day nearer the end”
- “you
will recover – it’s the natural outcome of the illness”
- “it’s
not your fault – it’s the illness”
These and smiling seem to help.
