Website Link apa.org/topics/anxiety An emotion characterized by apprehension and somatic symptoms of tension in which an individual anticipates impending danger, catastrophe, or misfortune. The body often mobilizes itself to meet the perceived threat: Muscles become tense, breathing is faster, and the heart beats more rapidly. Anxiety may be distinguished from fear both conceptually and physiologically, although the two terms are often used interchangeably. Anxiety is considered a future-oriented, long-acting response broadly focused on a diffuse threat, whereas fear is an appropriate, present-oriented, and short-lived response to a clearly identifiable and specific threat. APA is the leading scientific and professional organization representing psychology in the United States, with more than 190,000 researchers, educators, clinicians, consultants, and students as its members.

Website Link nimh.nih.gov/health/education-awareness/shareable-resources-on-anxiety-disorders.shtml Occasional stress and anxiety is a normal part of life. But anxiety disorders involve more than temporary worry or fear. An anxiety disorder is a medical condition that interfere with daily activities such as job performance, schoolwork, and relationships. Download and share these messages to help spread the word about stress and anxiety. You can copy and paste the text and graphic into a tweet, email, or post. We encourage you to use the hashtag #shareNIMH in your social media posts to connect with people and organizations with similar goals. For more ideas on how to use these resources, visit our help page.

Website Link nami.org/About-Mental-Illness/Mental-Health-Conditions/Anxiety-Disorders Most people experience anxiety. For example, speaking in front of a group can make us anxious, but that anxiety also motivates us to prepare and practice. Driving in heavy traffic is another common source of anxiety, but it helps keep us alert and cautious to avoid accidents. However, when feelings of intense fear and distress become overwhelming and prevent us from doing everyday activities, an anxiety disorder may be the cause. Anxiety disorders are the most common type of mental health concern in the United States. More than 1 in 6 U.S. adults (19.1%) have an anxiety disorder and 1 in 9 U.S. youth ages 3-17 (11%) also experience problems with anxiety. Most people develop symptoms before age 21.

Website Link cdc.gov/mental-health/living-with/index.html Everyone experiences stress, which is your body's physical and emotional response to new or challenging situations.1 This can occur when you face problems such as those related to work, school, health, and relationships. Feeling stress can be a normal coping response and can forge a healthy sense of our ability to solve problems. However, when the stress is long term, known as chronic stress, it can lead to worsening health problems. Coping with stress in a healthy way will make you, the people you care about, and your community stronger.

Website Link adaa.org Founded in 1979, the Anxiety and Depression Association of America (ADAA) is an international nonprofit organization dedicated to the prevention, treatment, and cure of anxiety, depression, OCD, PTSD, and co-occurring disorders through education, practice, and research. With more than 1,800 professional mental health members (many of whom contribute blog posts, host webinars, review website content and more) ADAA is a leader in education, training, and research. More than 11 million people from around the world visit the ADAA website annually (and click on more than 19,000,000 pages) to find current treatment and evidence-based research information and to access free resources and support. Together we are changing lives. Welcome!

Website Link anxietyresourcecenter.org The Anxiety Resource Center, Inc. of Grand Rapids, Michigan was founded to educate the public and professional communities about anxiety disorders, including Obsessive-Compulsive Disorder and OCD Spectrum Disorders; to reduce the stigma associated with these illnesses; and to provide a place that offers support, hope and inspiration. The Anxiety Resource Center, Inc. is a non-profit, 501(c)(3) organization. What does the typical person with anxiety look like? Look around. It might be your loved one, your neighbor, your doctor or maybe it’s you. Did you know that one out of every seven people has a diagnosable anxiety disorder? According to the Anxiety Disorders Association of America, there are an estimated 40 million Americans over the age of 18 who suffer with an anxiety disorder. The Anxiety Resource Center Inc. was established in 2005 to create a physical place where people could come together and find SUPPORT, HOPE and INSPIRATION. As a non-profit organization, we exist for YOU. We’re here to offer support, to help you challenge your anxiety, to help you recognize that you’re not alone in this battle. We offer professional presentations by members of our community, we extend invitations for social gatherings and outings, and we encourage you to participate in yoga or meet others in one of our many support group offerings. You’ll even find a lending library to help you expand your understanding. So please take the time to stop by and check out the variety of services we offer.

Website Link nimh.nih.gov/health/topics/anxiety-disorders Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, school work, and relationships. There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and various phobia-related disorders.

June 29, 2023 – The third and final paper on the Benzodiazepine Survey of 2018-2019 was published today in the open access journal, PLOS ONE. The publication titled "Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey" formerly introduces the term benzodiazepine-induced neurological dysfunction (BIND) into medical literature. As a member of the research team, I can say that this is our most significant paper yet from this ground-breaking survey. Our analysis uncovered unique trends in symptomatology and adverse life effects revealing a differentiation between acute withdrawal and a separate protracted neurological condition. Previously, all post-discontinuation symptomatology has been lumped together and identified as "withdrawal." This paper suggests that the protracted state (lasting months or years) may be due to neuroadaptation and/or neurotoxicity, and is separate from traditional withdrawal. A nosology team of approximately 23 professionals identified the BIND terminology as it is presented in this paper. Two earlier papers on this survey were published in 2022 and 2023 (listed below). The first paper was highlighted in a 2022 Psychology Today article titled, "Benzodiazepine Withdrawal Tied to Serious Long-Term Harms." Previous publications on the Benzodiazepine Survey of 2018-2019 Experiences with benzodiazepines use, tapering, and discontinuation: an Internet survey Enduring neurological sequelae of benzodiazepine use: an Internet survey BIND Roundtable Video Available! For more information about BIND and the research that lead to its identification, please check out the BIND Research Roundtable. Hosted by the Benzo Free Podcast and Angela Peacock of APeacock Consulting, this video is a lively discussion which unveils the findings behind the paper. Official Press Release Benzodiazepine use associated with brain injury, job loss, and suicide PORTLAND, Oregon, June 29, 2023 (eReleases) – Benzodiazepine use and discontinuation is associated with nervous system injury and negative life effects that continue after discontinuation, according to an article published 06/29/2023 in the open access journal PLOS ONE. “Despite the fact that benzodiazepines have been widely prescribed for decades, this survey presents significant new evidence that a subset of patients experience long-term neurological complications,” stated first author Alexis Ritvo, M.D. “This should change how we think about benzodiazepines and how they are prescribed.” Previous studies had described this injury with various terminologies, perhaps the most well-known being protracted withdrawal. As part of the PLOS ONE study, a scientific review board unified these names under the term benzodiazepine-induced neurological dysfunction (BIND) to more accurately describe the condition. To better characterize BIND, Dr. Ritvo and colleagues analyzed data from a previously published survey of current and former benzodiazepine users that asked about their symptoms and adverse life effects attributed to benzodiazepine use. The survey of 1207 benzodiazepine users from benzodiazepine support groups and health/wellness sites is the largest of its kind. Respondents included those taking benzodiazepines (63.2%), in the process of tapering (24.4%), or fully discontinued (11.3%). Nearly all respondents had a prescription for benzodiazepines (98.6%) and 91% took them definitely or mostly as prescribed. Symptoms were long-lasting, with 76.6% of all affirmative answers to symptom questions reporting symptom duration to be months or over one year. The following ten symptoms (out of a possible 23) persisted over a year in greater than half of respondents: low energy, difficulty focusing, memory loss, anxiety, insomnia, sensitivity to light and sounds, digestive problems, symptoms triggered by food and drink, muscle weakness, and body pain. Particularly alarming, these symptoms were often reported as new and distinct from the symptoms for which benzodiazepines were originally prescribed. In addition, a majority of respondents reported prolonged negative life impacts in all areas, such as significantly damaged relationships, job loss, and increased medical costs. Notably, 54.4% of the respondents reported suicidal thoughts or attempted suicide. BIND is thought to be a result of brain changes resulting from benzodiazepine exposure. A general review of the literature suggests that it occurs in roughly 1 in 5 long-term users. The risk factors for BIND are not known, and more research is needed to further define the condition, along with treatment options. Christy Huff, M.D., one of the co-authors, said, “Patients have been reporting long-term effects from benzodiazepines for over 60 years. I am one of those patients. Even though I took my medication as prescribed, I still experience symptoms on a daily basis at four years off benzodiazepines. Our survey and the new term BIND give a voice to the patient experience and point to the need for further investigations.” The survey was a collaborative effort between CU Anschutz, Vanderbilt University Medical Center, and several patient-led advocacy organizations that educate on benzodiazepine harms. Several members of the research team have lived experience with benzodiazepines, which informed the survey questions. Online Article: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0285584

Introduction Benzodiazepine Induced Neurological Dysfunction (BIND) is a chronic health condition that some individuals experience after long-term use of the benzodiazepine class (Xanax, Ativan, Klonopin, Valium, etc.) of prescription medications. This article provides a solid introduction to BIND including the scientific literature backing its discovery. Contents Important Disclaimers Benzodiazepines & Z-drugs BIND Terminology BIND Definition BIND Origin Withdrawal vs. BIND The Truth About BIND The Science Behind BIND BIND Symptoms Methods of Tapering BIND In Scientific Literature BIND Research Roundtable Video Benzodiazepine Effects on the Brain and Body Video Important Disclaimers Stopping benzodiazepines abruptly can be very dangerous! For those who wish to reduce or discontinue their medication, PLEASE work with a licensed physician to do so. Most medical literature, including the ASAM Guideline on Deprescribing, recommends a slow taper under doctor supervision. See the "Caution: Taper Slowly" section below for more info. FOR THE NEW PATIENT Fear is common for individuals who believe they may be dependent on benzodiazepines. Please note, thousands have tapered from long-term benzodiazepine use successfully and are living happy, healthy lives. Sites like Uneven Life, Benzodiazepine Information Coalition, and the Alliance for Benzodiazepine Best Practices are loaded with helpful information. ABOUT THE AUTHOR The following information is developed and maintained by D E Foster, host of the Benzo Free and Uneven podcasts, author of the book Benzo Free, co-author of the published study that identified BIND, and panelist on the ASAM Joint Clinical Practice Guidelines on Benzodiazepine Tapering. DISCLAIMER This post is for informational purposes only and should never be considered medical or professional health advice of any kind. D E Foster is NOT a medical professional; he provides peer support only. Any decisions about changes in your medication should be made in consultation with your own qualified healthcare provider. View our disclaimer page for more information. Benzodiazepines & Z-Drugs The term “benzos” is short for benzodiazepines, a class of anti-anxiety medication also known as minor tranquilizers, sedatives, BZDs, BZRAs, and others. These drugs are typically prescribed for anxiety disorders, panic attacks, insomnia, muscle spasms, and seizures. Nonbenzodiazepines (Z-drugs) is another class of sedatives. While this class has a different chemical structure separate from benzodiazepines, their effects can be similar including withdrawal complications and/or long-term neurological complications. That being said, the research referenced in this article was specific only to the benzodiazepine class. To learn more about these drugs, please visit our Basics of Benzos page. To learn more about BIND, please read on. BIND Terminology The standard terms used to define the long-lasting neurological complications associated with benzodiazepine use and/or discontinuation vary greatly depending on the source. Previous Terms for BIND Benzo Dependence / Withdrawal Benzodiazepine Withdrawal Syndrome (BWS) Post-Acute Withdrawal Syndrome (PAWS) Protracted / Persistent / Prolonged Withdrawal Syndrome (PWS) Benzodiazepine Protracted Withdrawal (BPS) Benzodiazepine Injury Syndrome Benzo Brain Injury …and many others. Many of the above terms still exist within benzo literature, including this site. Symptoms that we now relate to BIND, have been considered part of withdrawal, dependence, and even addiction in the past. As we gain knowledge about this condition, terminology changes. BIND Definition BIND (Benzodiazepine-Induced Neurological Dysfunction) defines the lingering neurological effects of sustained benzodiazepine exposure. This term was proposed by our research team in 2022 and was formerly presented in a 2023 research article in the open access journal PLOS ONE titled, "Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey" (Ritvo 2023). BIND is now becoming widely adopted by organizations such as The Alliance for Benzodiazepine Best Practices, Benzodiazepine Information Coalition (BIC), the Benzodiazepine Action Work Group (BAWG), and here at A Calm Voice (uneven). Here is the formal definition of BIND: Benzodiazepine-Induced Neurological Dysfunction (BIND) is a constellation of functionally limiting neurologic symptoms (both physical and psychological) that are the consequence of neuroadaptation and/or neurotoxicity to benzodiazepine exposure. These symptoms may begin while taking or tapering benzodiazepines, and can persist for weeks, months, or even years after discontinuation. — Benzodiazepine Nosology Workgroup BIND Origin A team of 23 experts with mostly academic, clinical, and/or lived experience formed the Benzodiazepine Nosology Workgroup. This Workgroup defined the rationale for the selection of BIND as the most appropriate terminology for the enduring effects of benzodiazepine exposure. The scientific paper listed above above explains this process and illustrates the need for consensus in nomenclature and convergence on BIND as the single descriptive term (Ritvo 2023). DISCLOSURE: The author of this article, D E Foster, is a member of the Benzodiazepine Nosology Workgroup and the Benzodiazepine Survey Research Team, and a co-author on their published papers. Withdrawal vs. BIND In the past, withdrawal and terms associated with BIND have been somewhat interchangeable. This is no longer the case. Based on recent research, we now understand that these are two distinct effects of benzodiazepine use. Benzodiazepine withdrawal is specific to the removal of the drugs from the body, which typically lasts 7 to 28 days after discontinuation. Symptoms which are common and related to this process can include tremors, hallucinations, and seizures, which can be severe and even life-threatening. Thankfully, these symptoms are usually of short-duration. These are the symptoms that most physicians have been trained to look for when someone is discontinuing benzos. This is one of the key reasons why BIND has been so rarely recognized by the medical community. BIND symptoms are typically longer lasting. There are dozens of neurological symptoms — some claim more than a hundred — that can be attributed to BIND. The most frequently reported of these based on the benzodiazepine survey (2018-2019) are severe anxiety, difficulty focusing and distraction, low energy, and insomnia (Huff 2023). Others like memory loss, sensitivity to light, sound and smell, digestion difficulties, pain, akathisia, trembling, tinnitus, uncontrollable emotions, muscle weakness, pulls, and strains, were also common. These are thought to be attributed to neuroadaptation and/or neurotoxicity, and recovery from these symptoms can take months, even years in some people. The Truth About BIND Some people claim that BIND (formerly known as BWS, PAWS, or withdrawal) is not a real illness, that the patients are making it up or have succumbed to online hysteria and hypochondria. It’s an understandable argument considering the laundry list of seemingly unrelated symptoms which some patients may attribute to this illness. But BIND is real. and the evidence supports it repeatedly. Here are a few quotes regarding the legitimacy of protracted withdrawal (BIND): Physical dependence can occur when benzodiazepines are taken steadily for several days to weeks, even as prescribed. Stopping them abruptly or reducing the dosage too quickly can result in withdrawal reactions, including seizures, which can be life-threatening. — U.S. FDA Black Bow Warning on Benzodiazepines (FDA 2020) Withdrawal from benzos can be more dangerous than withdrawal from heroin. —Dr. Stuart Gitlow, Addiction Psychiatrist and President of the American Society of Addiction Medicine Facts: Benzodiazepine use can result in physical dependence at any dose with prolonged use. —New York City Department of Health and Mental Hygiene (New York City 2016) Benzodiazepines are potentially addictive drugs; physical and psychological dependence can develop within weeks of regular use…Dependence upon prescribed benzodiazepines is now recognized as a major clinical problem. —U.K. National Health Service / NHS Grampian (NHS 2006) I’ve met people who’ve been addicted to benzodiazepines for 20 or 30 years — wrecked their lives, wrecked their jobs, wrecked their families. It’s a silent addiction. We all know about illegal drugs, we all know about alcohol, we don’t know about this group. — Anne Milton, U.K. Public Health Minister Most governments and medical associations agree that benzo dependence is real, it can develop as quickly as two to four weeks, and the neurological effects can be debilitating, drawn out over a long period of time, and even fatal in extreme cases. The Science Behind BIND While somewhat effective treating some conditions, benzos can cause physical dependence when taken continuously for longer than 2-4 weeks. One of the processes that is thought to be affected by benzo use, is that of homeostasis. Homeostasis is the human body’s tendency toward physiological stability. When a new drug is introduced into the body, the body’s physiology changes according to the effects of the drug. Eventually, the body tends to re-balance itself — to find new stability. This process can often reduce the effects of the drug, which leads to the need for stronger doses. This is called tolerance. As one’s body adapts to a benzodiazepine, it down-regulates the gamma-Aminobutyric acid (GABA) receptors, decreasing their sensitivity. So, GABA has less of an effect. And since GABA is an inhibitory neurotransmitter, the calming effect of GABA is less effective. The sensitivity of the glutamate receptors is also affected, but they become more susceptible to stimulation increasing the excitatory effect. The result is a decrease in calming influence and an increase in excitability. When a person discontinues taking benzodiazepines, all the physiological changes are exposed, which results in a rebound effect. The effect is generally the opposite of the initial effects of the drug. The homeostasis process kicks in again, but as before, this process takes time. Sometimes weeks, months, or even years. Eventually, stability is reached again, and the withdrawal symptoms subside. The body returns to normal. The effects of benzo use are not limited to the central nervous system (CNS). There is evidence that the peripheral nervous system and mitochondria are also affected by these drugs. Dopamine, CRF concentrations, and even hyperventilation syndrome might also play a part. The long-lasting neurological effects are thought to be part of neuroadaptation and/or neurotoxicity, causing structural changes in the brain. After discontinuation, there also may exist what Ashton calls a learning deficit. While on benzos, the drug aided in the patient’s psychological and physiological response to stress. The patient didn’t have to develop — or learn — coping mechanisms to handle the anxiety. When the drug is removed, this learning deficit is exposed, and the patient has to create new synaptic pathways to manage the worries and complications of ordinary life. BIND Symptoms If someone had to use just one word to convey the general experience of symptoms during benzo discontinuation and BIND, it would have to be hypersensitivity. People in benzo withdrawal feel more — more pain, more agitation, more restlessness, more emotion, more aches, more spasms, more anxiety, more depression, more hopelessness. Benzodiazepine dependence has caused the central nervous system to become hypersensitive and over-reactive to everyday stimuli. Imagine drinking one cup of coffee but reacting like you drank five. Or even ten. A work party might induce mild anxiety in the average person. Imagine if that same event felt like you were speaking in front of a thousand people. Naked. Imagine being dog tired but inside your body energy is on a rampage and your muscles are spasming as if you just drank a six-pack of Red Bull. Not fun, right? And sensitivity is just the tip of the iceberg. Some individuals also experience depersonalization, memory and cognitive dysfunction, muscle tightness and spasms, heart palpitations, phantom nerve sensations, and chronic gastrointestinal distress, just to name a few. And even though most evidence points to these symptoms being temporary, recovery can be drawn out over a long time. That being said, please remember that these examples are the extremes. Approximately 70% of long-term benzo users will not experience a drawn out, complicated withdrawal. And as for the other 30%, the withdrawal experience can be significantly improved with proper planning, a healthy lifestyle, and a healing-focused mindset. To see a more complete list of possible symptoms, visit our BIND Symptoms page. Methods of Tapering Tapering is the process of reducing one’s dosage of a benzo over a period of time, usually several months. Abrupt cessation of benzos can be dangerous and often leads to a more difficult experience. A slow taper under doctor supervision is recommended by most experts. There are three primary options for tapering from benzos: Direct Taper – The first and most straightforward method of tapering is a direct taper. This means that the patient reduces the dosage of the benzodiazepine they are currently on and they don’t substitute another benzo. Substitution Taper – This method of tapering includes switching, over time, from the patient’s current benzo to another benzo that is better for tapering. The choice for substitution is usually diazepam. Titration Taper – Titration means mixing benzos with milk or water to create a liquid form of the drug, allowing the user to better control her dosage. This allows for very small and accurate doses. The Ashton Manual covers tapering methodology in more detail. Caution: Taper Slowly For those who chose to stop taking their benzos, we understand the urgent desire to become free from this medication. But the most important thing to remember is that quitting cold turkey will most likely make it worse. It can even be fatal in extreme cases. If one decides to stop taking benzos, a slow taper under doctor supervision is the recommended course of action. Abrupt cessation of benzodiazepines may be very dangerous. — Prof. C. Heather Ashton, The Ashton Manual For those who have already stopped taking benzos cold turkey (CT), don’t panic. Thousands of people have CT’d and recovered fully — many under doctor’s orders. While all evidence points to a better outcome for those who taper slowly, it also points to success even for those who stop more rapidly. For more information about discontinuing (tapering) from benzodiazepines, please check out the Deprescribing Guidelines from the Benzodiazepine Action Work Group. No one should reduce their dosage of benzos or any other prescription medication unless under the direct supervision of a licensed physician. BIND in Scientific Literature Our research article formally introducing the term BIND was published on June 29, 2023 in the open access journal PLOS ONE, titled "Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey." This story has been picked up by dozens of publications including Psychology Today, the New York Post, and WebMD among others. BIND Research Roundtable Video Join the Benzodiazepine Survey Research Team for a lively roundtable discussion about their research, the findings from the survey, and their latest paper which formally introduces the term benzodiazepine-induced neurological dysfunction, or BIND. This video was recorded on June 9th, 2023 and is available on the Uneven Life YouTube Channel, among many other videos and podcast episodes. VIDEO POST: https://www.easinganxiety.com/post/the-bind-roundtable-benzodiazepine-survey-research-team Benzodiazepine Effects on the Brain and Body This 8-minute animated video was created by the Benzodiazepine Action Work Group for the "Recovering from Benzodiazepines for Peer Support" training course. It demonstrates the effects that benzodiazepines have on the nervous system, the role glutamate, GABA, and GABA receptors play, how homeostasis affects healing, and why this process may take months or years. References The Alliance for Benzodiazepine Best Practices. “Benzodiazepine-induced neurological dysfunction (BIND).” May 2022. https://benzoreform.org/bind. Ashton, C. Heather. Benzodiazepines: How They Work and How to Withdraw (aka The Ashton Manual). 2002. Accessed April 13, 2016. http://www.benzo.org.uk/manual/. Ashton, C. Heather. “Protracted Withdrawal from Benzodiazepines: The Post-Withdrawal Syndrome.” Psychiatric Annals 25(3)(1995):174-179. Accessed April 14, 2018. doi:10.3928/0048-5713-19950301-11. Bleyer, Jennifer, “Popping Xanax Is More Harmful Than You Think,” Self, February 20, 2014, accessed January 30, 2017, https://www.self.com/story/xanax-more-harmful-than-you-think. Finlayson AJR, Macoubrie J, Huff C, Foster DE, Martin PR. Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey. Therapeutic Advances in Psychopharmacology. 2022;12. https://journals.sagepub.com/doi/full/10.1177/20451253221082386. Foster, D E. Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal. Erie, Colorado: Denim Mountain Press, 2018. https://unevenlife.com/book. Huff C, Finlayson AJR, Foster DE, Martin PR. Enduring neurological sequelae of benzodiazepine use: an Internet survey. Therapeutic Advances in Psychopharmacology. 2023;13. https://journals.sagepub.com/doi/10.1177/20451253221145561. New York City Department of Health and Mental Hygiene (NYC DOHMH). City Health Information: Judicious Prescribing of Benzodiazepines 35(2)(2016). https://docs.wixstatic.com/ugd/990dad_167113513c9445f8bc77a77370ce649f.pdf. Ritvo AD, Foster DE, Huff C, Finlayson AJR, Silvernail B, et al. (2023) Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey. PLOS ONE 18(6): e0285584. https://doi.org/10.1371/journal.pone.0285584. Trickett, Shirley. Withdrawal from Benzodiazepines. Journal of the Royal College of General Practitioners 33(254)(September 1983):608. Accessed April 17, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1973010/. U.K. National Health Service (NHS). “Guidance for Prescribing and Withdrawal of Benzodiazepines & Hypnotics in General Practice.” NHS Grampian. October 2006. Reviewed October 2008. https://www.benzo.org.uk/amisc/bzgrampian.pdf. U.S. Food & Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. September 23, 2020. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class. For Informational Purposes Only – Not Medical Advice All information presented here is for informational purposes only, and should never be considered medical or health advice. Withdrawal, tapering, or any change in dosage of benzodiazepines or any other prescription drugs should only be done under the direct supervision of a licensed physician. Please read our site disclaimer for more information.

***** Please visit D's UPDATED BIO at: https://defoster.com ***** Summary Founder of the support community Uneven Life, D E Foster has spent over a decade as a peer support advocate helping individuals manage severe anxiety and navigate the complications of anxiety medication dependence and withdrawal (BIND). D has struggled with anxiety most of his life. In 2002, he was prescribed clonazepam (Klonopin) by his primary care physician and he took the medication for 12 years without warning. His withdrawal experience was extreme and became the foundation for his 2018 book, Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal. In 2019, he launched the Benzo Free Podcast and followed that up with the Uneven Podcast in 2024. As co-founder and former co-chair of the Benzodiazepine Action Work Group. D was involved in several projects supporting the benzo community including development lead and pilot instructor for the Recovering from Benzodiazepines for Peer Support training course. He is also a member of multiple research teams where he co-authored a variety of papers including the 2023 study which introduced benzodiazepine-induced neurological dysfunction (BIND). In 2023, D was invited to join the lived-experience panel for the American Society of Addiction Medicine (ASAM) which published The Joint Clinical Practice Guidelines on Benzodiazepine Tapering on March 3, 2025. D has been benzo-free since 2014, but he still deals with the lingering effects of BIND to this day. He now lives in northern Colorado with his wife, Shana, and dog, Murphy. *** D E Foster provides peer support only; he is NOT a medical nor mental health professional of any kind. He encourages you to seek care directly from a licensed physician and/or certified therapist as needed for your situation. Research Teams / Publications Scoping Review of Benzodiazepine Protracted Symptomatology Co-Author (Published August 2025) BZD RESEARCH TEAM (The Alliance for Benzodiazepine Best Practices) Shade KN, Ritvo AD, Silvernail B, Finlayson AJR, Bressi JE, Foster DE, Martin IJ, Piper C, Martin PR. (2025) Long-term neurological consequences following benzodiazepine exposure: A scoping review. PLOS ONE 20(8): e0330277. https://doi.org/10.1371/journal.pone.0330277 Joint Clinical Practice Guideline on Benzodiazepine Tapering Panelist / Development (Published March 2025) AMERICAN SOCIETY OF ADDICTION MEDICINE (ASAM) American Society of Addiction Medicine (ASAM). "Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations when Benzodiazepine Risks Outweigh Benefits." March 3, 2025. https://www.asam.org/quality-care/clinical-guidelines/benzodiazepine-tapering Evidence-Based Guidelines Are Needed (Letter to the Editor) Co-Author (Published May 2024) BZD RESEARCH TEAM (The Alliance for Benzodiazepine Best Practices) Breanna Sigler, BS; Bernard Silvernail, MS; Alexis D. Ritvo, MD, MPH; Christy Huff, MD; D. E. Foster, BS; Reid Finlayson, MD; Jolene Bressi, PharmD, PMP; Peter R. Martin, MD. "Evidence-Based Benzodiazepine Practice Guidelines Are Needed." J Clin Psychiatry . 2024;85(2):24lr15306. https://doi.org/10.4088/JCP.24lr15306. Benzodiazepine Discontinuation Questionnaire Co-Author (Published February 2024) ROYAL COLLEGE OF SURGEONS, IRELAND (RCSI) Lynch T, Ryan C, Presseau J, Foster DE, Huff C, Bennett K, Cadogan C. "Development and validation of a theory-based questionnaire examining barriers and facilitators to discontinuing long-term benzodiazepine receptor agonist use." Res Social Adm Pharm. 2024 Feb;20(2):163-171. doi: 10.1016/j.sapharm.2023.10.015. Epub 2023 Oct 29. PMID: 37919219. https://pubmed.ncbi.nlm.nih.gov/37919219/. Content Analysis of Benzodiazepine Discontinuation Questionnaire Co-Author (Published January 2024) ROYAL COLLEGE OF SURGEONS, IRELAND (RCSI) Lynch T, Ryan C, Huff C, Foster DE, Cadogan C. '"We need more support and doctors that understand the process of tapering …' A content analysis of free-text responses to a questionnaire on discontinuing long-term benzodiazepine receptor agonist use." Health Expect. 2024 Feb;27(1):e13962. doi: 10.1111/hex.13962. PMID: 39102711; PMCID: PMC10771803. https://pmc.ncbi.nlm.nih.gov/articles/PMC10771803/. Benzodiazepine Induced Neurological Dysfunction (BIND) — Benzo Survey Co-Author (Published June 2023) BZD RESEARCH TEAM (The Alliance for Benzodiazepine Best Practices) Ritvo AD, Foster DE, Huff C, Finlayson AJR, Silvernail B, et al. (2023) "Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey." PLOS ONE 18(6): e0285584. https://doi.org/10.1371/journal.pone.0285584. Enduring Neurological Sequelae — Benzo Survey Co-Author (Published February 2023) BZD RESEARCH TEAM (The Alliance for Benzodiazepine Best Practices) Huff C, Finlayson AJR, Foster DE, Martin PR. "Enduring neurological sequelae of benzodiazepine use: an Internet survey." Therapeutic Advances in Psychopharmacology. 2023;13. doi:10.1177/20451253221145561. https://journals.sagepub.com/doi/10.1177/20451253221145561. Experiences with Benzodiazepines — Benzo Survey Co-Author (Published April 2022) BZD RESEARCH TEAM (The Alliance for Benzodiazepine Best Practices) Reid Finlayson AJ, Macoubrie J, Huff C, Foster DE, Martin PR. "Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey." Therapeutic Advances in Psychopharmacology. 2022;12. doi:10.1177/20451253221082386. https://journals.sagepub.com/doi/full/10.1177/20451253221082386. Safeguarding BZRAs — Benzo Survey Co-Author (Published April 2022) ROYAL COLLEGE OF SURGEONS, IRELAND (RCSI) T Lynch, CRyan, C Bradley, D Foster, C Huff, S Hutchinson, N Lamberson, L Lynch, and C Cadogan, "Supporting sAFE and GradUAl ReDuctIon of loNG-term BenzodiaZepine Receptor Agonist uSe: development of the SAFEGUARDING-BZRAs toolkit using a co-design approach," International Journal of Pharmacy Practice, Volume 30, Issue Supplement_1, April 2022, Pages i2–i3, https://doi.org/10.1093/ijpp/riac021.003. PUBLIISHED BOOK "Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal" Author (Published August 2018) Foster, D E. "Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal." Denim Mountain Press, Erie, Colorado, 2018. https://www.easinganxiety.com/post/benzo-free-the-world-of-anti-anxiety-drugs-and-the-reality-of-withdrawal. Key Speaking Events / Trainings COLORADO CONSORTIUM FOR PRESCRIPTION DRUG ABUSE PREVENTION CME Lunch 'n Learn: "Benzodiazepine Induced Neurological Dysfunction (BIND)" Co-Presenter (February 12, 2025) Co-Presenter (March 29, 2023) Co-Presenter (May 8, 2022) UNIVERSITY OF COLORADO, DENVER / Addiction Counseling Masters Program "Benzodiazepines: Research, Reality, and Recovery" Guest Lecturer (November 18, 2024) BENZO WARRIOR COMMUNITY "Living with BIND" Presenter (November 11, 2024) Presenter (July 26, 2022) COLORADO CONSORTIUM FOR PRESCRIPTION DRUG ABUSE PREVENTION "Caring for the Benzo Affected Individual" Presenter (October 18, 2024) RX AND ILLICIT DRUG SUMMIT Faculty (April 10-13, 2023, Atlanta, GA) TRAINING COURSE DEVELOPMENT "Recovering from Benzodiazepine Use for Peer Specialists" (12-Hour Course) Development Lead / Pilot Instructor (2022-2024) COLORADO DEPARTMENT OF PUBLIC HEALTH AND EDUCATION (CDPHE) Benzo Wise Colorado (BWC) Presentation to CDPHE (Director and Staff) Co-Founder of BWC / Co-Presenter (December 12, 2019)

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. Listen here on YouTube... Or on these other carriers too: Apple / Spotify / Amazon / Blubrry / Pandora / Podbean 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 Recording Info — RECORDED: Friday, April 18, 2025 — LOCATION: Colorado The Podcast 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).

Been pissed off lately? Stressed Out? Tired? Using my podcast as therapy, I explore my own anger and overwhelm, and the progress I've made during my healing journey. It's a summer Sunday afternoon and Murphy is by my side. Join us. Listen here on our primary podcast carriers: Podbean and YouTube... Or on these other carriers too: Apple / Spotify / Amazon / iHeart / Podchaser Chapters 0:00:00 i got pissed off 0:01:23 intro 0:02:01 overwhelmed, tired, and irritated 0:03:42 my podcast is my therapist 0:04:59 back to being overwhelmed 0:06:15 small audience / catching up 0:07:51 back to getting pissed off 0:08:20 the art of letting go 0:10:05 ruminating on the anger 0:10:52 allowing it to pass 0:12:05 pema chodron / the angry people 0:16:15 avoidance vs. processing 0:19:14 ai & imperfections 0:23:30 that anxiety off switch 0:24:16 a bit more on ai (sorry) 0:26:11 we're not perfect @ uneven 0:31:57 tying it all into overwhelm 0:34:26 count your blessings 0:35:49 balancing priorities 0:38:55 we all have crazy days 0:41:02 in search of an awesome closing 0:42:25 step back and watch the circus 0:46:43 signing off References "Don't Bit the Hook" by Pema Chodron — https://a.co/d/8TkerHk — Finding Freedom from Anger, Resentment, and Other Destructive Emotions ARTICLE: Mental Health in the Age of AI — https://www.easinganxiety.com/post/mental-health-in-the-age-of-ai Recording Info — RECORDED: Sunday, July 27, 2025 — LOCATION: Colorado The Podcast PODCAST SITELINKS — UNEVEN WEBSITE: https://theUnevenLife.com — YOUTUBE: https://youtube.com/@theUnevenLife — X (TWITTER): https://twitter.com/@theUnevenLife PODCAST SUMMARY Welcome to “uneven,” a podcast about life, anxiety, and being human. In such a chaotic world, how do we better our lives and the lives of those around us? Maybe, just maybe, we might find a few solutions together. Join veteran podcaster D E Foster as he explores the intimate struggles so many of us experience — often in silence. I hope you’ll join us. PODCAST DISCLAIMER The uneven 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) Uneven theme music — TITLE: From the Earth — ARTIST: Humans Win — PUBLISHER: Lance Conrad (BMI) PODCAST PRODUCTION The Uneven Podcast is part of the Uneven (https://theUnevenLife.com) and is a production of Denim Mountain Press (https://denimmountainpress.com).