What really is tolerance? How does it differ from withdrawal? From BIND? When does one start and the other finish? Today, we clear up some confusion around benzo terminology and timing. We also examine the recent uptick of fatigue and pain. Join us.

CHAPTERS

0:00:00 Getting Everything Ready

0:00:42 Welcome / Catching Up

0:03:14 The Uneven Community (uneven.life)

0:08:02 ASAM Benzo Guidelines

0:10:36 Learning from Working with You

0:11:22 Benzo Community as a Model for Others

0:13:18 Our Team at Uneven

0:14:42 Terminology in the Benzo Community

0:17:00 Why BIND is the Proper Term

0:21:56 Benzo Belly vs. GABA Belly

0:24:40 Are These Symptoms Tolerance?

0:28:23 Too Focused on Terminology?

0:30:19 Looking for Answers / Obsession

0:34:20 The Rationality of Acceptance

0:36:19 There's No One Way to Do This

0:38:35 Fatigue, Aches, Pain, and COVID

0:43:15 Symptoms May Not Be Just Benzos

0:45:50 Wrapping Things Up

REFERENCES

ASAM Benzo Guidelines

— https://www.asam.org/quality-care/clinical-guidelines/benzodiazepine-tapering

Basics of BIND

— https://www.easinganxiety.com/post/basics-of-bind

Long COVID: Lasting effects of COVID-19 (Mayo Clinic)

— https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351

Podcast Episode on the ASAM Guidelines (#142)

— https://www.easinganxiety.com/post/new-asam-benzo-guideline-pros-cons-top-10-takeaways-benzo-free-142

Understanding Drug Tolerance (Healthline)

— https://www.healthline.com/health/drug-tolerance

RECODING INFO

— RECORDED: Friday, April 18, 2025

— LOCATION: Colorado

PODCAST SITELINKS

— PODCAST WEBSITE: https://www.easinganxiety.com/benzofree

— EASING ANXIETY: https://www.easinganxiety.com

— YOUTUBE: https://youtube.com/@easinganx

— X (TWITTER): https://twitter.com/@easinganx

PODCAST SUMMARY

This podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax.

PODCAST DISCLAIMER

The Benzo Free podcast is for general information purposes only and should never be considered medical, psychological, or any other form of health advice. Health-related information provided is not a substitute for professional advice and should not be used to diagnose or treat health problems or to prescribe any medical devices, psychological treatments, or other remedies. Never disregard medical advice or delay in seeking it.

Please visit our website for our complete disclaimer at https://easinganxiety.com/disclaimer.

SUICIDE PREVENTION

If you, or anyone you know, is having suicidal thoughts, please seek help immediately. Resources can be found on our website at: https://www.easinganxiety.com/resources#suicide.

PODCAST MUSIC

All music provided / licensed through Storyblocks (https://www.storyblocks.com)

Benzo Free Theme Music

— TITLE: Walk in the Park

— ARTIST: Neil Cross

PODCAST PRODUCTION

The Benzo Free Podcast is part of the Easing Anxiety network (https://easinganxiety.com) and is a production of Denim Mountain Press (https://denimmountainpress.com).

The new ASAM Benzo Guideline is finally here! Join panel member, D E Foster, as he takes us on an unfiltered tour of "The Joint Clinical Practice Guideline on Benzodiazepine Tapering," sharing his thoughts and experiences along the way.

CHAPTERS

0:00:00 Welcome

0:02:31 My Involvement / Disclaimer

0:04:00 The Uneven Life (uneven.life)

0:06:52 ASAM Guideline (unscripted review)

0:08:51 Introduction to the ASAM Guideline

0:14:13 Patients with Lived Experience Panel (PWLE)

0:17:42 Physical Dependence vs. SUD

0:19:13 Do Not Discontinue Abruptly / No Cold Turkey

0:20:02 Public Comments on Guideline

0:20:52 Key Takeaways

0:22:01 1) Ongoing Assessment of the Risks

0:22:45 Benzos & Pregnancy

0:23:16 Discontinuation Decision in Older Adults

0:26:29 2) Shared-Decision Making Strategies

0:27:41 3) Do Not Discontinue Abruptly

0:28:54 Physical Dependence Can Start in Weeks

0:29:32 4) Inpatient Care / Rehab

0:32:26 5) Taper Rate

0:34:07 6) Tailor Tapering Strategies to the Patient

0:34:16 6a) Substitution Concerns / clonazepam

0:37:03 6b) Slow or Pause Taper Based on Symptoms

0:38:20 6d) Some May Not Fully Taper

0:39:14 7) Recommending Therapy Support (CBT)

0:41:07 8) Provide Treatment for Other Conditions

0:41:41 9) Provide Harm Reduction Strategies

0:42:41 10) It May Take Months to Years

0:45:59 We Need Your Questions & Comments

0:46:29 More on Physical Dependence vs. SUD

0:48:11 Increased Risk of Self-Harm

0:48:58 Reporting of Benzo Harms

0:49:32 What About Z-Drugs?

0:50:49 No One Size Fits All Approach

0:52:05 Reviewed All Public Comments

0:52:55 Benefits of Support

0:53:41 Maudsley Deprescribing Guideline

0:54:22 Peer Support Specialists

0:55:02 Protracted Withdrawal / Benzo Survey

0:57:23 Benzodiazepine Induced Neurological Dysfunction (BIND)

0:58:37 Adjunctive Medication (SSRIs, SNRIs, etc.)

1:03:40 More Coverage of the Guideline to Come

1:04:26 My Summation / "A Huge Step Forward"

1:09:43 In Closing

REFERENCES

ASAM Benzodiazepine Tapering Guidelines

— https://www.asam.org/quality-care/clinical-guidelines/benzodiazepine-tapering

— Free Downloadable PDF

BLOG POST: ASAM Benzo Guideline Publication

— https://www.easinganxiety.com/post/new-asam-guideline-for-benzodiazepine-tapering-just-released

The Uneven Life (an online community)

— https://uneven.life

— Join us now for a 14-day free trial.

RECODING INFO

— RECORDED: Sunday, March 9, 2025

— LOCATION: Colorado

PODCAST SITELINKS

— PODCAST WEBSITE: https://www.easinganxiety.com/benzofree

— EASING ANXIETY: https://www.easinganxiety.com

— YOUTUBE: https://youtube.com/@easinganx

— X (TWITTER): https://twitter.com/@easinganx

PODCAST SUMMARY

This podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax.

PODCAST DISCLAIMER

The Benzo Free podcast is for general information purposes only and should never be considered medical, psychological, or any other form of health advice. Health-related information provided is not a substitute for professional advice and should not be used to diagnose or treat health problems or to prescribe any medical devices, psychological treatments, or other remedies. Never disregard medical advice or delay in seeking it.

Please visit our website for our complete disclaimer at https://easinganxiety.com/disclaimer.

SUICIDE PREVENTION

If you, or anyone you know, is having suicidal thoughts, please seek help immediately. Resources can be found on our website at: https://www.easinganxiety.com/resources#suicide.

PODCAST MUSIC

All music provided / licensed through Storyblocks (https://www.storyblocks.com)

Benzo Free Theme Music

— TITLE: Walk in the Park

— ARTIST: Neil Cross

PODCAST PRODUCTION

The Benzo Free Podcast is part of the Easing Anxiety network (https://easinganxiety.com) and is a production of Denim Mountain Press (https://denimmountainpress.com).

Alexis Ritvo MD, MPH is a board-certified psychiatrist at the University of Colorado School Medicine, co-founder of the Benzodiazepine Action Work Group, and lead author on the research study that introduced BIND. Join us for this illuminating conversation.

Part 2 of this discussion was released on our sister podcast, "uneven." Listen to it here:

https://uneven.podbean.com/e/a-psychiatrists-perspective-w-dr-alexis-ritvo-part-2-of-2-uneven-70/

CHAPTERS

0:00:00 Introduction

0:03:26 Dr. Ritvo's Bio

0:06:30 Tell Us a Bit About Your Family

0:08:13 What Interested You in Psychiatry

0:10:07 What Brought You to the Alliance?

0:12:37 Exploring Benzodiazepine Prescribing Practices

0:13:19 The Benzodiazepine Action Work Group (BAWG)

0:14:53 Benzodiazepine Legislation in Colorado

0:18:03 Documentation on Benzo Prescribing / Deprescribing

0:19:19 BAWG's Peer Support Training

0:19:53 What's New at the Alliance?

0:22:35 What About Benzo Research?

0:22:58 Research on Benzodiazepine Use

0:24:07 The Science and Timing of BIND

0:29:59 Other Benzo Effects?

0:32:03 Benzos & Akathisia

0:35:55 Determining Which Medication to Taper First

0:38:34 What About Taper Plans?

0:40:41 Can We Become Too Obsessive About Our Taper?

0:43:56 Wrap Up

ALEXIS RITVO, MD, MPH

Alexis Ritvo MD, MPH is a board-certified addiction psychiatrist. She is the Program Director for the Addiction Psychiatry Fellowship at the University of Colorado (CU) School of Medicine where she is an Assistant Professor of Psychiatry. She earned her Medical Degree and a Master’s in Public Health in Health Policy from Emory University in 2012. She completed her general psychiatry residency and addiction psychiatry fellowship at CU before joining faculty in 2017. Since then, she has been a supervising attending of general psychiatry residents in the CU Medicine Outpatient Psychiatry clinic where she directs a co-occurring disorder subspeciality clinic. Her growing interest in the safe prescribing and deprescribing of prescription benzodiazepines led her to co-found the Benzodiazepine Action Work Group with the Colorado Consortium for Prescription Drug Abuse in late 2020. In 2022, she became medical director for the national non-profit the Alliance for Benzodiazepines Best Practices. She is the current chair of the Education Committee for the American Association of Addiction Psychiatry. She has a passion for psychotherapy, teaching trainees, improving health systems, and advocacy.

RECODING INFO

— RECORDED: Monday, January 13, 2025

— LOCATION: Colorado

PODCAST SITELINKS

— PODCAST WEBSITE: https://www.easinganxiety.com/benzofree

— EASING ANXIETY: https://www.easinganxiety.com

— YOUTUBE: https://youtube.com/@easinganx

— X (TWITTER): https://twitter.com/@easinganx

PODCAST SUMMARY

This podcast is dedicated to those who struggle with side effects, dependence, and withdrawal from benzos, a group of drugs from the benzodiazepine and nonbenzodiazepine classes, better known as anti-anxiety drugs, sleeping pills, sedatives, and minor tranquilizers. Their common brand names include Ambien, Ativan, Klonopin, Lunesta, Valium, and Xanax.

PODCAST DISCLAIMER

The Benzo Free podcast is for general information purposes only and should never be considered medical, psychological, or any other form of health advice. Health-related information provided is not a substitute for professional advice and should not be used to diagnose or treat health problems or to prescribe any medical devices, psychological treatments, or other remedies. Never disregard medical advice or delay in seeking it.

Please visit our website for our complete disclaimer at https://easinganxiety.com/disclaimer.

SUICIDE PREVENTION

If you, or anyone you know, is having suicidal thoughts, please seek help immediately. Resources can be found on our website at: https://www.easinganxiety.com/resources#suicide.

PODCAST MUSIC

All music provided / licensed through Storyblocks (https://www.storyblocks.com)

Benzo Free Theme Music

— TITLE: Walk in the Park

— ARTIST: Neil Cross

PODCAST PRODUCTION

The Benzo Free Podcast is part of the Easing Anxiety network (https://easinganxiety.com) and is a production of Denim Mountain Press (https://denimmountainpress.com).