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Croydon, UK, November 2000

Withdrawal Treatment and Support

Ian Singleton

Bristol and District Tranquilliser Project

I'm going to say something in a bit of detail about counselling in withdrawal. I realise I'm going to repeat 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 1980s 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 fulfilment.

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 'helpful' 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 counselling. 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 realise 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 realise 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 realisation can be a huge step away from hopelessness towards solidarity and commitment.

My third principle of counselling 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 fourth 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 recognise 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. So you 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 it.

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 a bad cut to other times when the ultimate goal seems quite attainable. So the counsellor needs to be flexible, tailoring "[Cut off *** here]

Ian Singleton,
November 2000

Reproduced with kind permission of the author.

[Note: This speech was transcribed from a recording. Breaks etc in the recording are indicated by ***.]

Biographical Note

Ian Singleton Bristol & District Tranquilliser Project

Mr Singleton was educated at XIV School and Clifton College in Bristol (1962-65), and at the Queen's College, Oxford University (1966-70), where he read modern languages. He then taught German and French for two years at an international school in St Gallen, Switzerland (1970-72). Following this he worked for 13 years in central government administration (1972-85), first at the Forestry Commission then at the Department of Trade and Industry in Whitehall.

Because of stress at work he was then prescribed lorazepam 5mg, which he took for around 18 months. Unable to withdraw slowly he came off lorazepam and temazepam cold-turkey in March 1986 in Switzerland and suffered a major epileptic fit. He was then put in a psychiatric hospital for 2 months and returned to England in a state of total despair. He was unable to work and lost his job with the Department of Trade and Industry.

Fortunately he then made contact with the user-led tranquilliser withdrawal group in Bristol, which gave him vital advice and support through an appalling time. Since then he has been chiefly involved in helping to build up the Bristol & District Tranquilliser Project, which achieved 3 year funding from Joint Finance in 1995, and mainstream funding from Avon Health Authority in 1998.

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