Benzodiazepine Withdrawal And Detox

What Is Benzodiazepine Withdrawal?

Benzodiazepine withdrawal occurs when a person develops a dependency on benzodiazepines and abruptly decreases the dosage or stops using them altogether.

The severity of the withdrawal depends on multiple factors such as the specific benzodiazepine used and the dosage, frequency, and duration of use. Withdrawal symptoms can range from mild to severe. A 2023 study from the Journal of Psychiatric Practice reported that approximately 40% of individuals who have taken a benzodiazepine longer than 6 months will experience moderate to severe withdrawal symptoms.

Dependence is a physiological process in which the brain and body adapt to the presence of a drug. With ongoing benzodiazepine use, the drug alters brain chemistry and changes the way the brain’s reward system functions. Over time, the brain becomes less responsive to natural sources of pleasure (such as food, sex, and exercise) and increasingly reliant on the drug. These changes, known as neuroplasticity, cause the brain and body to depend on benzodiazepines to feel “normal.” When use is abruptly reduced or stopped, withdrawal occurs.

Benzodiazepines act on GABA, the brain’s primary inhibitory neurotransmitter, which slows activity in the central nervous system and produces calming or sedative effects. Sudden discontinuation removes this inhibitory action, creating an overall state of excessive nervous system excitation, which leads to withdrawal symptoms.

Benzodiazepine withdrawal is not only uncomfortable but can be dangerous and even deadly, which is why it’s important to undergo withdrawal or detox from benzodiazepines under medical supervision, as a medically supervised detox can ensure a safe recovery.

What Are The Symptoms Of Benzodiazepine Withdrawal?

​​The withdrawal symptoms of benzodiazepines are physically and psychologically painful. Those with a history of taking higher doses or chronic users of benzodiazepines have a higher risk of uncomfortable and dangerous withdrawal symptoms.

Benzodiazepine withdrawal symptoms are highly variable and often come and go. They may vary in severity and frequency throughout all phases of the withdrawal process.

Withdrawal symptoms typically last up to 10 days and include:

Less common and more severe symptoms can occur as well, especially in cases of severe addiction. These include:

• Hallucinations
• Seizures
• Psychosis or psychotic reactions
• Increased risk of suicidal ideation

Rebound Anxiety And Insomnia

Benzodiazepines are mainly prescribed to treat mental health conditions, including generalized anxiety disorder, panic disorder, and insomnia. Many people with these diagnoses who stop taking benzodiazepines experience increased anxiety or restlessness, referred to as rebound anxiety. Sometimes these anxiety symptoms can be worse than before the person started taking benzodiazepines.

Rebound anxiety usually happens with short-acting or intermediate-acting benzodiazepines because they have a shorter half-life and thus clear the body faster.

Rebound effects from benzo withdrawal, such as anxiety or insomnia, typically begin within the first few hours or days after the last use, depending on the specific benzo, and can last up to two weeks.

The difference between rebound effects and withdrawal is that rebound effects are the return of previous symptoms that were in existence before benzodiazepine use began. In contrast, withdrawal symptoms are caused by the body struggling to adapt to benzodiazepine use.

Benzodiazepine Withdrawal Timeline

The withdrawal timeline for benzos varies from user to user. The following table is just a guideline, as most people have to taper down their benzo use over several weeks.

Seizures, hallucinations, and psychosis can occur anytime during the withdrawal phase, but usually occur during the peak of symptoms, which is usually 2-14 days after the last dose.

Post-Acute Withdrawal Syndrome (PAWS)

Post-acute withdrawal syndrome, also known as prolonged withdrawal syndrome or protracted withdrawal syndrome, are a set of benzodiazepine withdrawal symptoms that can last for months or years after last use.

These symptoms can fluctuate over time and can be hard to diagnose. Since it is not an identifiable medical diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are no clinical guidelines for treating PAWS. However, this is a widely discussed and acknowledged topic in the addiction and recovery community, and there is evidence-based research that supports this syndrome. Many of the associated symptoms fluctuate over time and may go away weeks, months, or years after withdrawal.

Symptoms of PAWS include:

• Persistent anxiety
• Chronic insomnia
• Difficulty performing complex tasks
• Poor concentration
• Distractibility
• Loss of sex drive
• Depression

Duration Of Benzodiazepine Withdrawal

The half-life of specific benzodiazepines determines the withdrawal timeline for each benzodiazepine, as each class has its own half-life; hence, benzos are divided into short-, intermediate-, and long-acting. The half-life is the time it takes for half the active ingredients in a drug to be eliminated from the body through metabolism and excretion by the liver and kidneys.

Withdrawal symptoms from shorter-acting benzos (those with a shorter half-life) begin sooner than those from longer-acting ones because it takes a shorter amount of time for the drug to leave the user’s system.

Withdrawal symptoms can manifest as early as 8-12 hours if taking short-acting benzodiazepines, such as Halcion. It usually takes 2-4 days for intermediate and long-acting benzodiazepine withdrawal symptoms to emerge. The timing of withdrawal symptoms depends on the drug used, the amount used, and the frequency of use.

Short-acting benzos are notable because of the intense and serious withdrawal symptoms people experience when they quit taking them. Long-acting benzos generally cause less intense withdrawal symptoms, and it takes longer for withdrawal symptoms to start.

Long-acting benzodiazepines: Withdrawal symptoms start within 2-17 days, peak around 2-3 weeks, and can last several weeks to months.

• Chlordiazepoxide (Librium)
• Diazepam (Valium)
• Clonazepam (Klonopin)

Intermediate-acting benzodiazepines: Withdrawal symptoms start within 24-48 hours, peak around 3-6 days, and last for about 2-3 weeks.

• Alprazolam (Xanax)
• Lorazepam (Ativan)
• Temazepam (Restoril)
• Estazolam (ProSom)
• Oxazepam (Serax)

Short-acting benzodiazepines: Withdrawal symptoms start within 6-24 hours, peak around 2-5 days, and last for about 2 weeks.

• Midazolam (Versed)
• Triazolam (Halcion)

How Should You Detox From Benzodiazepines?

The first step in treating a benzodiazepine withdrawal is safely and slowly tapering off the benzodiazepines until they are eliminated from the person’s body. This process is known as detox and can be dangerous when not done under medical supervision. Quitting “cold turkey” can even be lethal in some circumstances. A supervising physician must be present to monitor for potentially fatal symptoms, including seizures and suicidal behavior.

A medically supervised detox for benzodiazepine withdrawal is centered around a benzodiazepine taper. A taper is administering benzodiazepines in gradually decreasing amounts to minimize withdrawal symptoms. Medical detox also reduces the chances of relapsing after detox is completed. The length of detox can vary and last several days to weeks, depending on the specific benzodiazepine and dosage, and the seriousness of the benzodiazepine dependency.

How Do You Taper Down Benzodiazepine Use?  

Medical detoxification from benzodiazepines often involves tapering down from the drug. Tapering down can mean reducing the dose of the current benzodiazepine or switching to a longer-acting (less potent) benzodiazepine. The strategy used is determined by the severity of addiction and the type of drug that was abused.

Benzos used for detox may include diazepam or clonazepam. These drugs are used for tapering down because they are long-acting and less potent than other benzos. These drugs keep withdrawal symptoms at bay while the user reduces their dose.

Taper schedules should be individualized, and usually a slow taper over a longer duration, at least 8-12 weeks or longer, cannot only minimize withdrawal symptoms but also reduce the risk of rebound anxiety.

Tapering can also be combined with psychotherapy, and psychological support can help the person learn coping skills to help reduce the chance of relapse and future anxiety symptoms.

Which Medications Are Used During Benzodiazepine Detox?

Benzodiazepines are the first line and only FDA-approved medications for treating benzodiazepine withdrawal.

During a benzodiazepine taper, the standard approach for detox, clinicians typically use one of two methods: gradually reducing the dose of the same benzodiazepine or transitioning the patient to a longer-acting benzodiazepine, such as diazepam, and tapering from there.

Featured Centers Offering Treatment for Benzodiazepine Addiction

Treatment For Benzodiazepine Addiction

Detoxification from benzodiazepines addresses the substance dependence but does not address any underlying addiction. An individual can be dependent on benzos but not addicted, and therefore, a successful detox can be sufficient. However, if the person has an addiction to benzos or a co-occurring addiction to another substance, a formalized treatment plan including rehab is highly recommended.

Addiction treatment focuses on underlying triggers and learning healthy ways to cope with triggers and cravings in the future. Many people with a benzodiazepine addiction choose an inpatient rehab that offers benzo detox, as inpatient rehab provides a distraction and temptation free environment in which to recover, especially if the addiction is severe or if there is limited social support.

People with mild benzo addictions may choose an outpatient detox instead of an inpatient rehab center. Outpatient care allows people to get treatment while still maintaining their family and work life.

If you or someone you love is ready to overcome benzodiazepine addiction, contact a treatment provider or visit our rehab directory to learn more about your detox and rehabilitation options today.