How To Get Off Benzodiazepines

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

March 12, 2019

Understanding Benzodiazepines

Benzodiazepines are central nervous system (CNS) depressants commonly prescribed to treat anxiety and sleep disorders, which slow brain activity to allow a relaxing and calming effect. Although benzodiazepines are highly effective when taken as directed, they are prescribed with caution because of their addictive properties.

Some of the most prescribed, and commonly abused, benzodiazepines include:

• Ativan (lorazepam)
• Halcion (triazolam)
• Klonopin (clonazepam)
• Restoril (temazepam)
• Valium (diazepam)
• Xanax (alprazolam)

It’s hard to say when using benzodiazepines becomes a problem, as everyone responds to these drugs differently. But, when people take benzodiazepines for too long, in ways other than directed, or in larger amounts than prescribed, they run the risk of developing dependence and addiction.

Long-Acting Or Short-Acting?

When trying to get off benzodiazepines, it can be important to know if it’s a short-acting or long-acting medication. Short-acting and long-acting benzodiazepines differ in the time it takes for the effects to kick in, as well as how long the effects last. Here are some examples of short-acting and long-acting benzodiazepines:

Short-acting

• Halcion (triazolam)
• Restoril (temazepam)
• Xanax (alprazolam)

Long-acting

• Klonopin (clonazepam)
• Valium (diazepam)
• Serax (oxazepam)

Knowing whether the benzodiazepine in question is long-acting or short-acting can help a person anticipate the onset of withdrawal. The duration of effects can also influence how quickly a person develops dependence. After becoming dependent, it can be very difficult to stop use because of uncomfortable, and potentially life-threatening, symptoms of withdrawal.

Benzodiazepine Withdrawal

Depending on the benzodiazepine, symptoms of withdrawal are likely to occur soon after the last dose. For short-acting benzodiazepines, withdrawal can onset as soon as one to two days later. Withdrawal symptoms for longer-acting benzodiazepines, like Valium, typically occur between two to seven days after the last dose.

There is no guarantee for how long it takes for withdrawal to onset or how long the symptoms will last. Symptoms can be gone in two weeks but may persist for as long as eight weeks.

Symptoms of benzodiazepine withdrawal can include:

• agitation and irritability
• anxiety
• insomnia
• muscle pain and weakness
• nausea
• panic attacks
• poor concentration and memory
• psychotic reactions
• restlessness
• seizures

The severity of symptoms can change very quickly. Withdrawal may begin with anxiety and insomnia but fluctuate to more severe symptoms, like panic attacks or seizures. There is no gradual increase in the severity of symptoms, which makes stopping without help extremely difficult. To avoid the dangers of withdrawal, it’s often recommended for a person with a benzodiazepine addiction or dependence to enter a medically supervised detox program.

Medically Supervised Detox Programs

Medically supervised detox programs generally take place in addiction treatment centers or hospitals. It’s advised that someone going through benzodiazepine withdrawal be monitored every three to four hours, and detox programs allow close observation by trained staff. Staff may also ask questions about the patient’s physical or psychological symptoms, provide assurance, and give explanations when applicable.

For benzodiazepine dependence, detox programs are an effective way to ensure safety and comfort during the worst of withdrawal. These programs also allow staff to administer medications, if necessary, to help alleviate unpleasant symptoms. While detox programs don’t treat addiction, they can help lessen dependence and prepare a person for further addiction treatment.

Gradually Reduce Dose

Another way to safely get off benzodiazepines is a process called tapering. Tapering means the dose of a benzodiazepine, or similar medication is given to a patient and gradually reduced over time to avoid withdrawal. This should only be attempted in a medical or professional setting with the approval and guidance of a physician or counselor.

How long doses are reduced depends on the person and the severity of their withdrawal symptoms. In general, the longer the time between decreasing each dose, the safer and more comfortable the withdrawal symptoms. Physicians and nurses, at a treatment center or hospital, will determine the effective rate of dosage reduction and adjust dosage as necessary.

Continuing Support

Finding networks of support is crucial for getting off benzodiazepines. Just managing withdrawal symptoms likely isn’t enough for a person to effectively stop use of the drugs. Many people suffering from benzodiazepine addiction also struggle with anxiety or other psychological disorders. Following up with therapy, mutual support groups, and other methods of addiction treatment can benefit the person and promote long-lasting recovery.

Therapy is useful for identifying what led to substance abuse issues in the first place. Many behavioral therapies can help prevent relapse by teaching people to manage potential life stressors and triggers that lead to drug use. Behavioral therapies also promote healthy lifestyles, like exercising, eating well, and mindfulness, which all contribute to staying off benzodiazepines long-term.

Treatment For Benzodiazepine Abuse And Addiction

Inpatient addiction treatment is an effective option for treating benzodiazepine abuse because many programs begin treatment with medical detox, and then help transition the person into a rehab program. These programs range in length and depend on individual needs. For benzodiazepine addiction, a short-term (28-day) program can be useful because they tend to be more intensive, focus on withdrawal and lessening dependence, and help prepare a person for a return to the community.

Within inpatient rehab programs, a patient will have access to both medications and behavioral therapy. An individual treatment plan can help determine if tapering is necessary, how long tapering will last, and which therapies will be most effective alongside dosage reduction. What’s more, inpatient rehab programs offer around-the-clock care and supervision, which provides ongoing support, safety and comfort, and the skills needed to prevent relapse.