Why The Ashton Manual/Protocol is so Important & How Ashton’s twelve year Benzodiazepine Withdrawal research clinic began: information for patients whose physicians struggle to find a protocol for benzodiazepine withdrawal
*NOTE: While the Ashton Manual is the most comprehensive text compiled by the most renowned Neuroscientist who studied benzodiazepines and withdrawal, some patients have found that they need to taper even slower than the rates in the Ashton protocol in order to minimize the withdrawal syndrome. The Bristol Tranquiliser Project has confirmed this, here.
The Ashton Manual, a book written by a U.K. Professor who ran a Benzodiazepine Withdrawal Clinic for over a decade, exists to assist many physicians help their patients taper off of benzodiazepines. The book, otherwise known as “Benzodiazepines: How they Work and How to Withdraw” has been an established and frequently updated protocol for the safe and effective protocol for the discontinuation of benzodiazepines. While the Professor/Doctor who wrote the book is now retired from the U.K.’s NHS, the most recent update to the book was as recent as April 2011, and many doctors in other countries are unaware of its existence.
To obtain a copy of this book in nearly any format or language, please scroll down to the bottom of this post.
There must be a problem within the medical community when a doctor can’t help a patient off of a medication that he or she has prescribed. It’s easy to put a patient on a benzodiazepine– it’s not as easy to take them off without potentially severe repercussions. When some populations of people who are prone to the down regulation of their CNS find themselves circling the drain with no support system from their physician and often not even from their own family or friends – they get desperate; they at times get angry. Sufferers of this condition often suffer in silence. They get labeled as drug seekers, doctor shoppers, and addicts. They get encouraged to go to rehab or detox facilities. While rehab and detox may be helpful for some types of drug dependencies or addictions, it is often not appropriate for people coming off of benzodiazepines. Some patients have even resorted to writing to Erin Brockovich.
When you get a diagnosis of Cancer – or, even some “invisible,” but more popular illness, like Epilepsy perhaps – there is a protocol for keeping these people fighting to live their lives. There is access to psychological therapy, validation by their doctor(s) and support from their loved ones for ailments such as those. But when you’re suffering from drug-induced changes to the Central Nervous System on a molecular level (you can’t really “see” the neurotransmitters which can be damaged or “altered” by chronic benzodiazepine use), one which is relatively uncommon, with a vague presentation often mimicking Multiple Sclerosis, and so misunderstood at this point in time by society and western medicine – you don’t typically get any kind of feedback except that maybe you’re an addict, even if you’re not. Many people find benzodiazepines to be very effective at first, and later their body may reject the medication, resulting in a withdrawal syndrome even if they’re not reducing their dose. If you just took this medication as prescribed by your own physician to prevent the torment of withdrawal symptoms (or if you feel like you can’t quit or you must keep increasing the dose to ward off those symptoms) then you still just get slapped with the addict label. While addiction problems can certainly occur with a drug of this class, not everyone on a benzodiazepine craves a high from a benzodiazepine. People feel that, if they put their faith in their prescribing physician that this medication will help them, that same faith can be put into their prescribing physician to help them should they decide to discontinue the medication.
While it is often no fault of the patient to develop a dependency on the medication, it is also at times no fault of the physician, either. (And sometimes, it is – remember, medical negligence and malpractice happens every day). The reality is that many physicians struggle, or outright fail to make the connection between the pharmacological action of the drug in a long-term scenario platform. Sometimes people get a diagnosis of “possible” MS, unable to fully meet the McDonald criteria of diagnosing MS. Sometimes you just have to be a Neuroscientist to figure it out. And even then, it took some time to connect the dots. This is admitted by the most well-known (Internationally known, to be precise) benzodiazepine physician, Professor Chrystal Heather Ashton, DM, FRCP, who is incidentally a Neuroscientist.
Professor Ashton is not the only physician who has recognized benzodiazepine induced illness and the withdrawal syndrome, but she is the only physician who became proactive enough to dedicate several years of clinical research on this issue when she did recognize the problem. She ran a clinic for well over a decade solely for these factions of people who developed such adverse effects from benzodiazepine down-regulation in the brain. This was not as much an addiction detoxification facility as much as it was a long-term clinical research facility that helped patients get off of benzodiazepines as safely and comfortably as possible, and perhaps explore alternative methods for their original ailments; preferably a long-term solution as benzodiazepines are only effective in the short-term.
She took on patients because she said she was young and “naive” at the time. Obviously, the more seasoned pharmacologists knew that benzo withdrawal can be quite ugly. Ashton described her experience as “unplanned” and “difficult,” because no other pharmacologists “wanted to take on those patients,” as reflected in her quote at the APRIL charity’s November 2008 discussion: third conference “Adverse Psychiatric side effects of medicines: What’s our responsibility?”
“Well, just to put you in the picture, I ran a benzodiazepine withdrawal clinic for twelve years; uh, which was quite unplanned, but, I was to run and work in a general pharmacology clinic and, one day a lady came in who’d been in a traffic accident. [And] she was in plaster, and she had been put on Ativan by the surgeons– the orthopedic surgeons, for muscle relaxation. And she said, ‘You know, I can’t get off this drug. I’m starting to crave every time the next dose is due. I think I’m addicted. Can you help me?’ And well I was young and naive in those days, and I said yes. Uh, but it was difficult. But after her, there was a stream and then a flood, a torrent of patients coming and in and saying ‘These benzos don’t work anymore, they were super at first, but now I’m getting more anxious, and all sorts of other things.’ And so that’s how this clinic started. We had to devote a whole clinic just to benzos. In fact I ended up doing it two sessions a week for years. And no other pharmacologist in that group wanted to take on those patients; because they didn’t like listening to people who said ‘Oh, I’m anxious, and this and that.’ And it sort of, the doctors got defensive. So I got all of those patients. And I just listened, and they told me what to do, and they taught me about withdrawal. And you know, the ways to do it. And we had many trial and errors. But that’s how it all started, so it’s patient power that moves things.” - Professor C. Heather Ashton, DM, FRCP; U.K. (click here to view the video conference where Ashton makes these statements).
You Heard It - we simply must speak up.
“The doctors got defensive,” Ashton mentions as one of the reasons why no one wanted to handle the patients in benzo withdrawal. Perhaps they did not want to assume responsibility for these patients’ illness. One can only speculate in response to a comment like that.
Though physicians often struggle or fail to recognize the syndrome, patients are even more liable to NOT recognize that their drug may be their problem, as with interdose withdrawal phenomenon – rebound withdrawal symptoms are often relieved by dosing or increasing the dose of the drug, making it the “cure.” Patients have questioned what might be physically wrong with them and have questioned their own sanity.
The importance of the Ashton Manual, a by-product of Ashton’s clinical experience with tese patients over a decade, is all because a physician not just recognized the syndrome, but addressed it appropriately. Clinical experience over a long period of time with a focus on the actual problem (benzodiazepine down regulation and dependence) rather than the side effects of the problem (mental illness and/or physical symptoms) is why Ashton’s protocol for benzo withdrawal is the preferred method for most patients who find themselves struggling to get off the benzos. It (the Manual itself) is brief but often updated, and a bit of a one-size fits all application, and many have found her taper schedules to be too fast, while some find them to be too slow. Benzo withdrawal certainly does not warrant a one-size-fits-all approach, however– using Ashton’s long term clinical experience as a guide certainly helps. Many doctors write books; most physicians who write books in the U.K. don’t usually become Internationally sought out. All Professor Ashton wrote up was a short handbook, most well known as “The Ashton Manual,” and people from even non-English speaking countries have developed a need for it, and so obviously sought its invaluable content. This also speaks volumes of how much progress is being made in other countries – it’s not. Hopefully in time, more medical professionals will be able to recognize this vague, but at times extremely debilitating phenomenon.
How to find a copy of The Ashton Manual, a book otherwise known as “Benzodiazepines: How they work and How to Withdraw”:
Official website with content from the book: http://www.benzo.org.uk/manual/
Download the Ashton Manual as *.PDF files from this website: http://lonelylinks.com/ashton.htm
eBook download available here: http://www.theashtonmanual.com/order.html
Soft cover physical book available to order here: http://www.benzobookreview.com/ashton.html — In my experience it is better to order the physical book because it travels easier and professionals who’ve never heard of it, know that it didn’t come from your personal device
The Ashton Manual in other languages:
http://www.benzo.org.uk/ashlangs.htm – The Ashton Manual online in French, German, Japanese, Italian, and more.