BIND and Benzo PAWS: A Comprehensive Overview

Anyone who has taken benzos may experience BIND/PAWS, though it’s more often reported among people who took benzos long-term, at high doses, or tapered too quickly. Recovery journeys vary: many people feel relief within weeks, while others experience symptoms for months or even years. It’s estimated that 15% of people prescribed benzos will experience protracted symptoms to some extent (Horowitz & Taylor, 2024).

Why It Occurs

Understanding why BIND happens sheds light on why symptoms may persist long after discontinuing benzo use:

1. Neurological Changes: Benzos act on the GABA neurotransmitter, which calms the nervous system. With prolonged use, the brain adapts by reducing its natural GABA activity, making recovery challenging when benzos are removed (Ashton, 2005).
2. Stress System Overload: The body’s natural stress response, which benzos suppress, may become overly reactive during withdrawal, contributing to heightened anxiety and stress sensitivity.
3. Individual Differences: Genetics, health history, and lifestyle each influence the severity and duration of BIND/PAWS symptoms.

Common Symptoms of BIND/PAWS

The symptoms associated with BIND/PAWS can affect cognitive function, physical health, and psycho-emotional well-being. They vary in intensity and duration, often appearing in waves followed by periods of relief known as “windows.” Here’s an overview of the diverse range of symptoms individuals might experience. Please note, the full list of possible benzo withdrawal-related symptoms encompasses hundreds of complaints and those included here are only a selection of the most commonly identified symptoms.

Cognitive Symptoms

• Memory and Focus: Many people report memory challenges, such as difficulty recalling recent events or conversations. Mental fog, sluggishness, and challenges in executive functioning and following conversations or solving problems are also common.
• Overwhelm and Confusion: Simple tasks can feel overwhelming, and maintaining concentration may require significant effort. This can lead to a sense of being “lost” in one’s own mind.
• Intrusive Thoughts: Unwanted thoughts or memories can surface, often unprovoked, disrupting concentration and mental clarity. This can be especially troubling for individuals with a personal history that includes traumatic experiences.
• Perceptual Distortions: Sensations of depersonalization or derealization (feeling disconnected from oneself or surroundings) can be distressing, accompanied at times by mild hallucinations or sensory distortions.

Physical Symptoms

• Sensory (Eyes, Ears, Nose, Mouth): Blurred or double vision, sensitivity to light or sound, tinnitus, dry mouth, strange tastes, and soreness in the mouth or teeth are frequent complaints.
• Abdominal and Gastrointestinal: Issues like nausea, abdominal pain, and appetite changes are common. Individuals may experience “benzo belly,” marked by bloating, distention, or digestive issues such as constipation and diarrhea.
• Heart and Respiratory: Physical symptoms often include heart palpitations, chest discomfort, difficulty breathing, sweating, and even sensations of overheating or flushing.
• Head and Neck: Dizziness, balance issues, migraines, neck pain, slurred speech, and a sensation of throat tightness are reported by many.
• Muscular and Neuromuscular: Muscle aches, stiffness, tremors, twitches, spasms, weakness, and, in severe cases, seizures or convulsions can occur. Note: If you experience seizures, seek immediate medical assistance.
• Nervous System: Many people describe tingling, itching, numbness, or burning sensations. Heightened sensitivity to touch and altered sensations in the skin (such as feeling like insects are crawling on it) are also common.
• Immune and Endocrine: There may be an increase in infections or immune-related issues, menstrual irregularities, and hormonal symptoms like breast pain or sexual dysfunction.

Psycho-Emotional Symptoms

• Anxiety and Panic: Anxiety is a hallmark symptom, with manifestations ranging from generalized worry and paranoia to full-blown panic attacks and phobias. Hypervigilance toward bodily sensations (health anxiety) is also prevalent.
• Mood and Behavior: Intense mood swings, irritability, feelings of aggression or rage, and sometimes severe depression are commonly reported. Apathy, obsessive thoughts, personality changes, and psychosis are also possible.
• Restlessness and Agitation: Symptoms such as restlessness, jumpiness, and akathisia (an intense need to move) can make sitting still feel intolerable. Note: Akathisia can also be considered a physical symptom, when movements can’t be controlled.
• Sleep Disturbances: Insomnia is a frequent struggle, often coupled with vivid, distressing dreams, “toxic naps” (short naps that result in feeling worse), and jerking movements during sleep.
• Social and Emotional: Many people withdraw from social interactions, often due to fear or feeling emotionally overwhelmed. This can manifest as agoraphobia, fear of people, fear of touch, isolation, or emotional distancing from loved ones.

Each person’s experience with BIND/PAWS is unique, and not everyone will experience all these symptoms. For some, symptoms might be mild and short-lived, while for others, they can be intense and long-lasting, impacting multiple facets of daily life. Recognizing and validating these symptoms as part of the healing process can aid in coping with them and seeking appropriate support. For a better understanding of secondary psychological symptoms, read about the influence of Amy (the withdrawal-hijacked amygdala).

Behavioral Patterns

• Cravings: Thoughts of using benzodiazepines to escape intense symptoms.
• Social Withdrawal: Isolation due to feeling misunderstood or overwhelmed by interactions.
• Stress Sensitivity: Even minor stressors may feel unmanageable, which can further amplify symptoms.
• Avoidant Behavior: Avoidance of situations or activities that could trigger symptoms.

BIND/PAWS Timeline and Duration

Typical Onset Period

BIND/PAWS symptoms generally begin after the acute withdrawal phase, typically appearing within a few weeks to months after stopping benzos.

Duration and Individual Variation

The length of BIND/PAWS varies greatly. While some experience symptom relief after a few months, others report ongoing symptoms for a year or more. Factors that may impact duration include dosage, duration of benzo use, and individual physiology.

Recovery Patterns and Milestones

Recovery typically unfolds in a pattern of “waves” and “windows.” Common milestones include:

• Three to six months: Many people notice a decrease in symptom severity.
• One year: Significant symptom reduction is common for many individuals.
• Beyond one year: Gradual improvement continues, though lingering symptoms may remain for some.

What Causes BIND/PAWS?

Neurological Factors

Benzos enhance GABA activity, but over time, this adaptation down-regulates natural GABA receptors, leaving the brain overstimulated after discontinuation.

Brain Chemistry Changes

During benzo use, the brain creates more excitatory receptors to counterbalance increased GABA activity. These adaptations take time to reverse, which explains the prolonged cycles of “waves” and “windows” in recovery (Ashton, 2005).

Stress System Adaptation

The absence of benzos can cause the body’s stress response to become hyperactive, leading to overreactions to even minor stressors.

Managing BIND/PAWS Symptoms

Medical Support Options

• Therapy: Techniques like Acceptance and Commitment Therapy (ACT, typically stated as the word “act” and not as an acronym), Dialectical Behavior Therapy (DBT)—particularly the concept of radical acceptance—and Cognitive-Behavioral Therapy (CBT) can be beneficial tools for managing anxiety and intrusive thoughts.
• Medication: This is a controversial subject in many benzo recovery communities. However, while it is strongly recommended that use of support medications occurs as a last resort, it is important to discuss the merits of such options since they can prove to be a lifeline for some in recovery. That being said, some may benefit from non-benzo medications like gabapentin, clonidine, hydroxyzine, or cyproheptadine to manage symptoms. Use of support medications should only occur under careful supervision by a healthcare provider and with very thorough research into the secondary risks of their use (such as compounded withdrawals).

Lifestyle Adjustments

• Diet: A nutrient-rich diet supports healing by providing essential nutrients. Reduced consumption of sugar, carbohydrates, and caffeine have also been identified as helpful.
• Exercise: Regular, gentle physical activity (like walking or yoga) helps improve mood, reduce stress, and promote general well-being.
• Sleep Hygiene: Establishing a sleep routine, reducing screen time before bed, and avoiding stimulants can improve sleep quality.

Coping Strategies

• Mindfulness and Meditation: Practices like yoga nidra and body scanning reduce stress and cultivate calm.
• Breathing Exercises: Techniques like deep breathing calm the nervous system during intense anxiety episodes.
• Distraction Techniques: Engaging in healthy hobbies or light activities provides a mental break from symptoms.

Support Systems

• Support Groups: Online or local groups provide a sense of community, understanding, and encouragement. Note: many people recovering from benzos find that benzo-specific support groups meet their needs more effectively than more general groups like Narcotics Anonymous or Alcoholics Anonymous—though these groups can be important recovery resources.
• Family and Friends: Educating loved ones about BIND/PAWS fosters empathy and provides support.
• Professional Guidance: Working with an experienced therapist or benzo recovery coach can provide effective coping strategies and emotional support.

Self-Care Practices

• Routine: Having a daily schedule creates stability and a sense of normalcy.
• Journaling: Writing about symptoms and emotions helps track progress and offers perspective.
• Gentle Exercise: Light physical activity, like stretching or walking, supports physical health without overtaxing the nervous system.

Recovery and Healing

Progress Indicators

Signs of progress include a reduction in symptom intensity, longer “windows” of relief, and greater resilience to stress.

Setback Management

Setbacks, or “waves,” are common and not indicative of failure. Adjusting self-care routines, seeking additional support, and focusing on personal progress can help manage setbacks more effectively.

Long-Term Outlook

Most people experience gradual improvement and eventual relief over time. While recovery isn’t always linear, maintaining connections with supportive networks, practicing self-care, and moving at your own pace can lead to positive outcomes. For the vast majority, symptoms do subside, allowing for a return to a more stable and fulfilling life.

Success Factors and Building Resilience

Building resilience and a successful recovery journey often includes these key factors:

• Self-centered Recovery: Rather than suggesting selfishness, this approach means taking ownership of your journey and prioritizing your healing—it isn’t free license to be a jerk though, since that’s a different kind of self-centeredness.
• Support from Loved Ones or Professionals: Having a solid support system provides emotional strength and encouragement.
• Consistency with Coping Strategies: Practicing techniques like mindfulness, breathing exercises, and grounding helps manage stress and symptoms effectively.
• Self-Compassion and Patience: Recovery is unique for everyone, so embracing a patient, self-compassionate approach can make the process less overwhelming.
• Radical Acceptance: Embracing the reality of a given situation or symptom without judgement or resistance can be a powerful method for de-escalating distress—but it doesn’t mean you have to approve of the experience or enjoy it.

When to Seek Help

Warning Signs

If symptoms worsen significantly or lead to self-destructive thoughts or behaviors, it’s essential to seek help. Indicators like increased isolation, severe depression, or intrusive thoughts of inflicting harm to self or others should be addressed by a mental health professional.

Professional Support Options

• Therapists: Look for specialists in addiction or anxiety-related therapy who understand the complexities of benzo withdrawal or appropriately credentialed recovery coaches.
• Support Groups: Joining groups like the Benzo Recovery community on Reddit (r/benzorecovery), the Benzo Warrior Community on Facebook, Benzo Buddies, or other groups specific to BIND/PAWS can provide shared experiences, validation, and normalization of symptoms in a community that understands the challenges and realities of benzo withdrawal and recovery.
• Medical Consultation: For severe physical or psychological symptoms, consult a physician experienced in benzo withdrawal who can provide appropriate care or testing.

Emergency Situations

If you experience thoughts of self-harm or suicide, seek immediate help by contacting a crisis line or visiting an emergency room.

FAQ About BIND/PAWS

Common Concerns

Can I do anything to speed up recovery?

Recovery is a gradual process unique to each person. While there isn’t a quick fix, maintaining a healthy lifestyle—like balanced eating, exercise, and stress management—supports your body’s healing. Staying connected with support groups and practicing coping strategies can also foster improvement.

Will the symptoms ever completely go away?

The vast majority of people experience significant symptom reduction over time, and most reach complete recovery. As the brain’s GABA system restores balance, symptoms often lessen in frequency and intensity. However, minor symptoms may persist for some, although they generally become manageable.

Is it normal for symptoms to come and go?

Yes, it’s common to have periods of relief (“windows”) followed by symptom flares (“waves”). This cycle can be challenging, but it typically indicates that the brain is healing and adapting.

Misconceptions

Does everyone experience BIND/PAWS after benzo withdrawal?

No, not everyone will experience these symptoms. Factors like dosage, duration of use, and individual brain chemistry affect the likelihood and severity of BIND/PAWS symptoms.

Are BIND and PAWS specific to benzos?

While PAWS can occur with other substances, BIND is specific to benzodiazepines and their impact on the brain’s GABA system. Understanding these nuances can help tailor your support and recovery approach.

Treatment Questions

Are there medications that can help?

Although best left only as a last resort, some medications might help manage certain symptoms. These should be carefully monitored by a healthcare provider and warrant careful research of secondary risk factors for compounded withdrawal—avoid medications that could interfere with brain healing or increase dependence.

Should I consider therapy?

Therapy—especially Acceptance and Commitment Therapy (“ACT”), dialectical behavior therapy (DBT), and cognitive-behavioral therapy (CBT)—can provide valuable tools for managing anxiety, intrusive thoughts, and other symptoms associated with BIND/PAWS. Note: arguably everyone should consider therapy, even if life is all rainbows and sunshine.

Recovery Expectations

How can I set realistic expectations for recovery?

Recovery isn’t linear, so it’s natural to have ups and downs. Focus on small, measurable improvements—like longer windows of relief, reduced symptom intensity, or improved stress management. Celebrating minor milestones can help maintain motivation and morale.

Final Thoughts

Navigating through BIND/PAWS can be really challenging, but understanding the process can empower you to manage symptoms and make informed choices. Each person’s journey is unique, and what works for one may not work for another. Focusing on building a supportive environment, treating yourself with kindness, and celebrating small steps toward recovery can all contribute to a positive outcome.

Next Steps: If you or someone you know is struggling with BIND/PAWS, consider reaching out to a benzo recovery coach or qualified therapist, joining a support group, or consulting resources like the Ashton Manual. Healing is possible, and there’s support available every step of the way.

References

Alliance for Benzodiazepine Best Practices. (n.d.). BIND facts. https://benzoreform.org/bind-facts/

Ashton H. (2005). The diagnosis and management of benzodiazepine dependence. Current Opinion in Psychiatry, 18(3), 249–255. https://doi.org/10.1097/01.yco.0000165594.60434.84

Horowitz, M., & Taylor, D. M. (2024). The Maudsley deprescribing guidelines: Antidepressants, benzodiazepines, gabapentinoids, and z-drugs. Wiley.

Lader, M. (2011). Benzodiazepines revisited—Will we ever learn? Addiction, 106(12), 2086–2109. https://doi.org/10.1111/j.1360-0443.2011.03563.x

Olfson, M., Blanco, C., Wang, S., Laje, G., & Correll, C. U. (2015). Benzodiazepine use in the United States. JAMA Psychiatry, 72(2), 136–142. https://doi.org/10.1001/jamapsychiatry.2014.1763

Peiris, D., Simon, J., & Hayden, J. (2018). Neurological consequences of benzodiazepine exposure: Evidence and mechanisms. Current Opinion in Neurology, 31(5), 606–612. https://doi.org/10.1097/WCO.0000000000000612

Substance Abuse and Mental Health Services Administration (SAMHSA). (2020). Post-acute withdrawal syndrome (PAWS). SAMHSA Publication No. PEP20-02-01-010. Rockville, MD: National Institutes of Health. https://www.samhsa.gov/