The Ashton Manual: How and Why it began,

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.htmlIn 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.

24 responses

    • Sorry for the delay in moderating your comment. It was filtered as spam by WordPress.com.

      To answer your question, in short, no. But this post was regarding the most comprehensive, longitudinal clinical study known to me by the most qualified Clinician I’m aware of. The clinic ran and the patients were studied for over a decade.

    • Where did you hear this rumor?

      This post was addressing the reasons why patients are resorting to such measures; I didn’t elaborate on the Brockovich topic because I don’t really know how many people contacted her and to what extent.

  1. i have used valium only intending for short term, i’m about 20 days in of using it at 2.5-5mg doses daily or every other day. i know this isn’t anything like some of the durations spoken about but even i am finding it hard to get off this horrible ‘wonder drug’. i went 4 days without to cease cold turkey and at the 4th day it hit and i was extremely sore in body aches, depressed, more anxious, cold and flu symptoms. i decided to take 2.5mg to see if i was actually sick or having withdrawals and bang i felt fine after about an hour.

    i personally think after this experience, all benzos should be banned. how can something this addictive be so easily prescribed? especially to unsuspecting patients?

    Professor Ashton is doing the only sensible thing with this medication, helping patients who are basically controlled by these drugs; and hopefully leading the way to getting all benzos off the market so no new addictions can begin.

    • Really sorry you had to find this out the hard way. :( Many of us do. I certainly did.

      Some benzodiazepines have life saving properties; I really don’t think they will ever be banned. What we’re hoping for are some stricter prescribing guidelines to prevent people from developing dependency (and these guidelines would ideally apply to people who are not already currently dependent on a benzodiazepine).

      Please do have a look around the blog and feel free to view any of the resources provided. I recommend the Interactive Support Groups page in the Resource menu links to help connect with others going through benzo withdrawal. Thank you for sharing your story. :)

  2. Pingback: The Ashton Manual: How and Why it began, and why patients are resorting to writing to Erin Brockovich | Benzodiazepine Withdrawal Syndrome « KIP Central

  3. In 2001 I was hit by a terrible depression and severe anxiety. The psychiatrist I went to prescribed prozac and clonazapin. I knew what prozac was and I asked what was the clonazapin? He told me it did the same thing as alcohol but without the liver damage. That was it, all that he told me. In 2005, I was taking a different antidepressant but still the clonazapin. I moved to another state, ran out of my meds before I could find another Psychiatrist. I felt terrible. Stomach cramps, unable to concentrate, spinning in the head, unable to sleep. I got the meds, finally and I felt better. In 2012, still taking a few antidepressants and the clonazapin, I moved again. Ran out of meds, again. Had the same symptons, again. When I spoke to my new psychiatrist, I told her that I do not feel depressed, just all the other stuff. She took me off one medication and lowered two others by alf but has kept me on the clonazapin. NOW I KNOW WHY. No one ever told me that this was a highly addictive drug before. It is easy to say in retrospect but in 2001 had I known, I might have decided that after the initial period when I needed this drug to alleviate my immediate symptoms, I would have decided not to take it for a prolonged period. Now I am a drug addict. I do not use increasing doses but my body goes into severe withdrawal if I do not take it. I am angry. I feel as if I have been lied to by omission. I have an appointment to see my psychiatrist in one month. I am going to bring up how I can get off this stuff.

  4. My sister is in benzo hell right now. Her doc told her no problem to stop them. My 83 year old mother and I are going through hell with her and don’t really know what to do. It is criminal that docs prescribe these meds. They don’t have a clue about them. They can’t help you once the patient is hooked and have refused to treat my sister because they say its all in her head. These drugs are for short term use but yet they keep filling the prescriptions because they do know that it is close to impossible to get off of. My sister now does not want to live because the pain and burning is so extreme. We are lost and don’t know how to help her. I would like to line every doc up and pour a bunch of benzos doen their throats to see how they like it!

    Very worried of what the outcome here might be. If you have any advice please write.

    • Hi Judy,

      Have you sought help from the support groups? There is a Resource Menu to the right of this blog post which directs you to resources that might be able to help you– everything from interactive support groups, to self-help tips, crisis help, and to lists of doctors educated on the benzodiazepine withdrawal syndrome.

      In the future there will be content and blog posts designed to help support the carers of benzodiazepine withdrawal syndrome sufferers. Please check back…and keep me updated on your sister’s progress. This is a difficult journey, but it has been embarked upon before and even the most severe of cases have gone on to make a complete recovery.

  5. Pingback: Progress in the Benzodiazepine Withdrawal Syndrome: Updates on Current Events | Benzodiazepine Withdrawal Syndrome

  6. I am 10 years into Benzo interaction, wish I could find a time machine and go back to 1993 and tell my Doc…….Not at this time. I cannot, all I can do now is warn every person I know, like them or not…….Stay Away from ANY Benzo. They have no clue what that means, I tell them first Clon ( Dr Candy, these days), Xanex and Valium. I am amazed at the response I get. They do not understand what may happen to them, like myself. I explain as much as I can what to watch out for and how these drugs will effect them and their families. I am so frustrated to hear the ignorance these poor unsuspecting folks still have after all these years. These drugs have completely wrecked my past,current and future life until I can finally wave goodbye. I was prescribed 3 mg of Klon for sleep, did that for 8 years while drinking to cover the withdrawal that I never realized was a problem until I took the booze away. Followed the Ashton taper from 2mg of Clon over to 40mg of Diazipam 2 years ago with 3 docs resistance. Down to 10 mg of Diazipam. Thought all was great, went into Detox and they cold turkey me for 2 weeks with Phenobarb……wholly shit, that was a Hell on Earth moment. Do not do that if you are a long time user, trust me. Still trying to find a solution, slow taper seems to be the only answer. This is a bad drug,

    • Hello Tim,

      I am writing this to give you hope. I started taking benzos (clonazipam) in 2001. I was not told that it is an addictive drug. In 2005 I moved to another State and my prescription ran out. I was not prepared for what I was going through. I also ran out of other medications. All of them could cause seizure if suddenly stopped. I knew that so realizing I would run out, I began taking less and less to prepare myself. It did no good. I was in agony. Head aches, stomach cramps, clammy skin and other symptoms. I found a doctor, started taking the drugs again and everything was good. Until I moved again and ran out of meds again in 2012. Same thing happened. By the way, I did not know why this was happening. I figured I was just having symptoms from the original reason I started taking the meds. I was in terrible agony. I found a doctor and she prescribed the meds. She cut some of them down, but not the benzo. I decided to look up benzos on line. I found out the ugly truth. I was a drug addicted individual who was never told. I discussed this with my new doctor and told her that I wanted to get off of this stuff. It only took me 2 months of slowly reducing my intake, but as of this week, I am benzo free. Yes, I had slight discomfort as I reduced, but it only lasted for a day at a time at the most. Completely worth it and not the severe reaction as when I ran out. You need to find a doctor who is knowledgeable and willing to go through this with you and you need to have the determination, not just the desire, to get out of the mess you are in. I did it after 12 years, you can do it too.

      • Hi Jon, I am very encouraged by your post after reading many of the others. It sounds like you made it through withdrawal in-tact. It is good to have some hope to hang on to.

        My concern is that i have some kind of brain damage. I took xanax for 10+ years. I had no idea that it was actually a depressant and was impairing my cognition. Unfortunately I just went through a rapid and unsupervised withdrawal. And, I know that can have long-term effects. Right now, I am furious about what happened. Here’s the story:

        I moved to FL recently and went to a clinic. A careless nurse (not a doctor) decided to get me off the xanax fast – like from 3 to 0 mg. in a month. During this time I was completely alone in a new city. I was trying to find a job, make friends, etc. and she knew it. I quickly did some research, read up on the Ashton manual, and learned of the risks of long-term impairment. I literally begged her not to do it so fast. Her response “this is all because you are psychologically addicted.”

        I had horrible side effects: (from a letter I delivered to the clinic)
        “I am experiencing Almost non-stop heart palpitations, Rapidly worsening depression, Inability to sleep at night & rising at 4 or 5 am, Random muscle spasms and a constant eye twitch, Trembling, Dizziness, Clumsiness, Sweating, Crying spells and Feelings of panic about what is happening to me. I am fearful that I am going to “lose” it, and will not be able to recover. Please help me.”

        Needless to say, that was ignored. Finally I got through to the director of the clinic, this past Monday. They put me back on 1.5 mg, but I wonder if the damage is already done. And, aren’t you not supposed to go “backwards”? But, the symptoms have lessened.

        I m still shaken up and very concerned about going through years of cognitive damage and depression.

        Anyone out there have any ideas for me?? Thanks so much.

        • Hi Dana,

          How long was the length of time between your last Xanax and your reinstatement? If reinstating is necessary, or desired, it is better to reinstate onto a benzo that is gentler on the body to taper. Xanax is very difficult to taper due to its ultra short half life and very high potency/punchy action. But people have tapered it successfully without crossing over to another benzo, so please don’t lose hope.

          I highly suggest scrolling up to the header of the page (below the banner) and click on the “Support Groups” link – many people who are going through this can share with your their experiences with what helped (and what didn’t) for them.

  7. Hey there,
    I have been on Klonopin since 2001 now. My dosage per day has fluctuated but never exceeds 3 mg. I do not have a schedule. I take them as needed. Usually it’s 1 three times a day as per my doctors request. I have been to several doctors over the years and none of them have ever been helpful in trying to assist me in getting off of the benzos. I do NOT want to substitute with valium. I have had negative experiences with that in the past. My main issue is that I feel I was improperly diagnosed at a young age when my life was very hectic and had gone through some very traumatic situations, probably at too young of an age. Now, I have children and they are twins to boot at almost two years of age. I am extremely fearful that they are going to find them somehow or get into my meds and essentially ruin their and my life. I have other concerns as well. I do not feel like I need medication to be happy or “not depressed”, however, at this point it has been so long that I can’t remember what life was like before the benzos.
    having said all of that, I would really love some advice or support on how I can avoid physical withdraw or anything that will affect my day to day, seeing as i have a job that I need to be present for to support my family and be a fun/good dad and husband. I know I can do this, but again, I don’t really remember life before benzos. I am looking to do this a.s.a.p. I feel like I may be able to do it cold turkey, not sure about all of the side effects though. I have heard and read so much about them, but never experienced it.
    Thanks.

    • Hey there,

      I am all too familiar with hearing stories like yours. (Not that it’s any consolation!) – First of all, please do NOT abruptly discontinue this medication if you are dependent on it. It can be very dangerous to do so.
      I, too, feel I was improperly diagnosed at a young age and I feel that had I not been drugged, I probably would have grown out of the issues I was having (puberty and growing up sucks sometimes). From your history here, it sounds like you’ve been on it for at least 10 years or more. To proceed with a taper – I urge you to be cautious, educate yourself on the withdrawal syndrome, and most long-term users find that they have to taper off very slowly. I cannot make this decision for you. When people do taper off – whether they crossover to Valium or another benzo or not – they typically reduce at the same rate that Ashton recommends, which is one of the main reasons why everyone seems to stress the importance of her book, “Benzodiazepines: How They Work and How to Withdraw.”
      Some people can handle Ashton’s taper rates, but many long term users find that they have to go slower than Ashton’s suggested rate in order to stay functional. It is all very individual.
      I commend you on your bravery and decision to come off the drugs. I would urge you to check out the link to my “Support Groups” Page, (link here: http://benzowithdrawalsyndrome.wordpress.com/support-resources/ ) and talk to other people who are also discontinuing their benzodiazepine for whatever reason. You will find you are not alone, and so often our healthcare professionals invalidate us because many of them are unaware of the benzo withdrawal syndrome. However, that being said, I would advise you to seek the support of a compassionate and trusted healthcare professional while you do this. These can be hard to find. http://www.benzodocs.com is a website with an unofficial list of “benzo wise” doctor recommendations by patients. I wish you luck on your journey, whatever you decide to do.

      • Thank you for the info. I have started to ween today. It helps just to talk about it honestly. There have already been some noticeable differences in the way that my thought process is going through my day, however I have not experienced much of a physical pain yet. A little bit, but it’s to be expected and I think I may just end up feeling like a shell of a man for the next week or three. I took .25 instead of my usual 1mg in the morning. Let’s see what happens and I will try to keep you posted. I know that this message board is not necessarily for that, but it kind of works for me this way. It’s nice to know that there are other people having or have had ht esame issues. It makes me feel less like a drug addict, and that’s important for me since I have had addiction issues in the past.
        My plan is to take three quarters each day instead of three 1mg pills each day. Hopefully after a week of that I can stop. Waiting to hear from a doctor too. We’ll see. I know that I need to replace the benzos with something active and that’s not a problem for me based on where I live. Lends itself nicely to outdoor activities. The thing I am most scared about is my interactions with my wife and kids. I guess it’s better to tackle it all now while my marriage is only 3 years old and my kids almost 2.

        • Hi “dannyboy,” I have not approved your comment dated July 3, 2013 in response to “jvermont” and sent you an email regarding the reasons why, including violation of my posting guidelines. Thank you!

          • So, here I am, clean. No more withdrawal. It is so worth it. I do not need asa much sleep. I wake up more refreshed. I did not realize that it was so hard to get out of bed in the morning because of the benzo. I can think things through more easily. I am happier. It is as if a cloud has been lifted. Think of how good life will be once you are off of it. That is a great motivator.

  8. Bonjour je suis heureuse et j’ai trouvé votre site dans UN site francais car je luute contre un benzo et je veux m’en sortir car Jai beaucoup de volonté

    • Bonjour, je ne parle pas très bien français, donc veuillez pardonner mes fautes d’orthographe. Le Ashton manuel est disponible en langue française, et peut être trouvé sur ce lien: http://www.benzo.org.uk/freman/
      je suggère également trouver un groupe de support en ligne ou message board de soutien pour le benzo retrait si c’est ce que vous allez à travers. Bonne chance pour votre voyage!

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