What is BIND, and why does it have such a long name?
BIND stands for benzodiazepine-induced neurological dysfunction. It is the name for the collection of nervous system symptoms that can appear during a benzodiazepine taper, and that can continue for months or longer after the last dose. Benzodiazepines, or benzos, are medications such as Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), and Valium (diazepam).
If you read the name one word at a time, it explains itself. Benzodiazepine-induced means that the drug caused the problem. Neurological dysfunction means that the nervous system is not working the way it should, which is very different from saying that it is destroyed.
The name is fairly new, and you may not hear it in your doctor’s office yet. So, why do I use it on this show, when there are older words that everyone already knows? What is wrong with calling it withdrawal, or calling it addiction?
Why do I not simply call it withdrawal?
Withdrawal is a good word for what happens in the days after a drug dose drops. Most people picture something like a caffeine headache, unpleasant and short. While that picture fits many drugs, it does not fit what many benzodiazepine patients live through.
BIND can begin while a person is still taking the same dose every day, which is known as tolerance withdrawal. And, it can continue long after the drug has left the body, which is known as protracted withdrawal. How can it be withdrawal when nothing has been withdrawn yet, or when the drug has been gone for months?
Professor C. Heather Ashton described these long-lasting symptoms in the Ashton Manual many years ago. In 2020, the US Food and Drug Administration (FDA) updated the boxed warning and labeling on all benzodiazepines, recognizing that physical dependence can develop at prescribed doses and that withdrawal symptoms can persist for a long time. A word that suggests a rough week does not cover that.
BIND is not addiction.
Unfortunately, when a person gets sick while trying to come off of Xanax or Klonopin, the people around them often reach for the word addiction. Family members do it, emergency room doctors do it, and the detox and rehab industry has built a business on it. It is the wrong word.
Physical dependence is not addiction. In fact, most people who become dependent on a benzodiazepine never misused it. They took the pill a doctor prescribed, at the dose printed on the bottle, and their nervous system adapted to it, the way any nervous system would.
I want to be careful here, because addiction is a medical condition too. It is not a character defect, and people who have it deserve respect and real medical treatment. My point is only that these are two different conditions, and treating one as if it were the other is how people get hurt.
How can this happen to someone who took the medication exactly as prescribed?
Your brain has a calming system that runs on a chemical messenger called gamma-aminobutyric acid, or GABA. Benzodiazepines make GABA receptors respond more strongly, which is why the first pills felt like relief. Over months and years, the brain is believed to compensate by making those receptors fewer and less sensitive.
An analogy that might help is to imagine wearing earplugs every day for years. The world gets quiet, so you turn up the television, the stereo, and the phone ringer until everything sounds normal again. Then, one morning, someone pulls the earplugs out.
Nothing in the house is broken. Yet, every sound is painfully loud, and in this house the volume knobs only turn down slowly, on their own schedule. While this is not a perfect analogy, it explains why light, sound, touch, and even your own heartbeat can feel turned up too high.
Notice that nothing in the story requires misuse. It only requires a prescription, refills, and time. The way out is to take the earplugs out a little at a time, and to give the knobs time to turn.
What kinds of symptoms do people describe?
The list is long, and that is part of the reason people are not believed. People describe adrenaline surges, severe insomnia, panic that wakes them from sleep, and the terrifying inner restlessness known as akathisia. They describe burning skin, internal vibrations, muscle twitching, ringing in the ears, and painful sensitivity to light and sound.
They also describe brain fog, a racing heart on standing, a detached and unreal feeling known as depersonalization, and the bloating and stomach pain that the community calls benzo belly. How could one medication cause trouble in the gut, the heart, the skin, the ears, and the mood? Because the GABA system reaches into all of them.
Patients have told me that the worst part was not any symptom on the list. It was hearing, from one doctor after another, that it was just their anxiety coming back. Often, the visit ended with a new prescription, and then there were two drugs to come off of instead of one. In fairness, most of those doctors were never taught any of this.
Is my nervous system permanently damaged?
This is the fear underneath every other question, so it should be said out loud. Is BIND permanent? In most cases, it is not, although after many months of symptoms coming and going, it can certainly feel that way.
These are regulatory systems, like the knobs in the earplug house, and they can readjust. I cannot tell you how long that will take for you, and I would be suspicious of anyone who gives you a date. There is often nothing we can do to hurry the process, but there is a great deal we can do to avoid making it worse.
Healing tends to come in what the community calls windows and waves. A window is a stretch of feeling better, and a wave is a return of symptoms. With time, the windows tend to get longer and the waves shorter. A wave is not a failure.
Why does the name matter so much?
A name decides what happens next. If the chart says addiction, the plan is often a fast detox, group meetings, and a discharge date. If the chart says anxiety, the plan is often more medication. If the chart says benzodiazepine-induced neurological dysfunction, the plan can finally match the problem.
Fortunately, that plan exists. It is a slow, medically supervised taper, with the patient setting the pace. The Ashton Manual describes a crossover taper to diazepam, a longer-acting benzodiazepine, followed by gradual reductions, and the Maudsley Deprescribing Guidelines describe hyperbolic tapering, where each reduction gets smaller as the dose gets lower.
I believe the Ashton approach is excellent, and I have a lot to say about it on this show. Still, it is not the only safe method. What matters is that the taper is gradual, that it responds to symptoms, and that the doctor must slow down when the patient says it is too fast.
What is never safe is stopping abruptly. Quitting a benzodiazepine cold turkey, or rushing a taper to fit a rehab’s calendar, can cause seizures and can make BIND more severe. Insurance may cover a stay of a few weeks. Unfortunately, GABA receptors do not read insurance policies.
Call 911 or go to an emergency department if you or someone near you:
- has a seizure
- becomes confused, or sees or hears things that are not there
- has thoughts of self-harm or suicide
You can also call or text 988, the Suicide and Crisis Lifeline, at any hour. For everything else, work with your prescriber. Please do not change your dose because of an article or a podcast, including mine.
Where can you hear more about BIND on the show?
Two conversations on the podcast go deeper than I can in one article. Barbara Connolly, PhD, joined me to talk about safe benzodiazepine tapering and the Benzo Warrior community, and Nicole Lamberson talked about surviving protracted withdrawal over the long term. They speak from their own experience, in their own words.
If you recognized yourself in this article, you now have a name for what is happening. You are not weak, and you are not imagining it. Your nervous system adapted to a medication, and with time and a careful taper, it can adapt back.
What else do listeners ask about BIND?
Is BIND the same as protracted withdrawal?
The two overlap. Protracted withdrawal describes symptoms that continue long after the medication is stopped. BIND is the wider name, because it also covers symptoms that appear during a taper, or while a person is still taking a steady dose.
Can sleep medications such as Ambien cause the same problem?
They can. Ambien (zolpidem) and Lunesta (eszopiclone), known as z-drugs, act on the same receptors as benzodiazepines, and coming off of them can produce a very similar set of symptoms. The same slow, supervised tapering principles apply.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.