How to Stop Benzodiazepines
Doctors and other healthcare professionals primarily prescribe benzodiazepines—commonly referred to as benzos—to treat anxiety disorders, insomnia, and seizures.1 While benzodiazepines serve several medical purposes, they also carry the potential for dependence and misuse.2
Benzodiazepines can be misused even by individuals with a legitimate prescription in various ways, including:1,3
- Taking a higher dose of benzodiazepines than was prescribed.
- Taking them for a longer period by purchasing them on the street after a prescription runs out.
- Taking them in a manner other than was intended, such as crushing the pills and snorting them.
- Taking them with other medications, illicit drugs, or alcohol to intensify effects or counteract unwanted side effects of others.
In 2020, about 4.8 million individuals aged 12 or older reported misusing benzodiazepines in the past year.4
That being said, stopping benzodiazepines abruptly—and without medical supervision—can result in dangerous, even life-threatening consequences.5
If you or a loved one struggle with benzodiazepine misuse, there is help. Continue reading to better understand benzodiazepines, their addictive potential, the symptoms of withdrawal, the dangers associated with quitting on your own, and the available treatment that can put you on the path to lasting recovery.
What are Benzodiazepines?
Benzodiazepines are drugs that depress the central nervous system (CNS) and exert sedative, hypnotic, and anxiolytic effects.1,6 In 2019, more than 92 million benzodiazepine prescriptions were filled in the United States to treat a variety of conditions, including generalized anxiety disorder, insomnia, seizures, panic disorder, and social phobias.7
Some common benzodiazepines that are prescribed include:1
- Xanax (alprazolam).
- Ativan (lorazepam).
- Klonopin (clonazepam).
- Valium (diazepam).
- Restoril (lemazepam).
How Addictive are Benzos?
Benzodiazepines have the potential to be very addictive. In 2020, the U.S, Food and Drug Administration (FDA) added a boxed warning, the FDA’s most prominent warning, to all benzodiazepine medication labels to caution healthcare professionals and individuals of the serious risks of misuse, physical dependence, withdrawal, and addiction potential associated with benzos.8 In fact, even when taken at the recommended dosage, benzodiazepine use can lead to the development of physical dependence and addiction.8
Physical dependence can also occur when benzodiazepines are misused, especially when they are taken at high doses.1 When an individual becomes physically dependent on benzodiazepines, it means that their body has adapted to having the benzos present in the system. Stopping benzos or significantly reducing the dose causes withdrawal symptoms to surface. Individuals may then continue to take benzodiazepines to avoid these withdrawal symptoms.1
Additionally, misuse of benzodiazepines is often associated with the misuse of other substances—such as prescription opioid pain relievers, cocaine, and alcohol.1 This polysubstance use (taking 2 or more substances at the same time) increases the risk of overdose and death, especially when mixing benzodiazepines with other respiratory depressing substances like opioids or alcohol.8,9
Signs of Benzodiazepine Addiction
Healthcare professionals use the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) to guide the diagnosis of a benzodiazepine addiction, which is classified as a sedative, hypnotic, or anxiolytic use disorder. The diagnostic criteria includes:10
- Taking sedatives in larger quantities or for a longer duration than intended.
- Having a desire to stop taking sedatives or reduce use but being unsuccessful in those efforts.
- Spending a lot of time obtaining, using, or recovering from sedative use.
- Craving sedatives.
- Failing to meet obligations and responsibilities at home, work, or school due to sedative use.
- Continuing to use sedatives even though doing so causes interpersonal or social problems.
- Using sedatives in dangerous situations, such as while driving a vehicle.
- Giving up social, recreational, or occupational activities due to sedative use.
- Continuing to use sedatives even though they cause or worsen recurrent physical or psychological problems.
- Developing a tolerance to sedatives, meaning it takes higher doses to achieve the same effects or the effects are diminished when the same dose is taken.
- Experiencing withdrawal symptoms when sedative use is abruptly stopped or the dosage is drastically reduced.
Exhibiting 2 or more of the above symptoms means the individual meets the diagnostic criteria for a sedative, hypnotic, or anxiolytic use disorder.10
Benzodiazepine Withdrawal Symptoms
As previously mentioned, withdrawal symptoms occur after an individual develops a physical dependency on benzodiazepines.1 Several factors impact the severity and duration of the withdrawal symptoms, including:1,5
- The benzodiazepine dose taken.
- The type of benzodiazepine used.
- How long benzodiazepines were taken.
- Concurrent substance use.
- An individual’s health.
Benzodiazepine withdrawal symptoms can be severe. Supervised medical detox may be necessary to keep an individual safe and limit the risks of withdrawal complications like seizures.8
Sedative, hypnotic, or anxiolytic withdrawal symptoms may include:10
- Increased heart rate.
- Elevated blood pressure.
- Hand tremors.
- Nausea or vomiting.
- Sensory hypersensitivity.
- Grand mal seizures.
Can Withdrawal from Benzos Be Deadly?
Benzodiazepine withdrawal can be fatal in severe cases, especially when left untreated.11,12
Individuals who may be at a greater risk of experiencing more severe withdrawal symptoms when they stop taking benzodiazepines include:5,11,13
- Individuals over 65 years old.
- People who also misuse alcohol.
- Individuals who concurrently take other sedatives or sleep aids.
- People who also use opioids.
- Individuals with a history of seizures.
- Individuals with co-occurring substance use and mental health disorders.
- People with physical health problems.
Benzodiazepine withdrawal can carry serious risks. Medical detox means the body rids itself of benzodiazepines (and other substances) and experiences withdrawal symptoms in a supervised environment, which ensures the individual remains safe and as comfortable as possible.11
Detoxing from Benzodiazepines Safely
Before stopping benzodiazepine use, talk to your healthcare provider. As previously mentioned, medically managed detoxification—done in an inpatient or outpatient setting—helps manage the acute intoxication and withdrawal symptoms from various substances, including benzodiazepines.11 During detox, the toxins associated with the substance are cleared from the body in a safe manner under medical supervision.11
Detoxing from benzodiazepines includes tapering from the drug and may also include medications to help reduce the potential severity of withdrawal symptoms.11
Detox alone is rarely sufficient to help addicted individuals achieve long-term abstinence. Detox is typically the first step in a more comprehensive treatment plan that helps an individual address the emotions, thoughts, and behaviors that contribute to their substance use disorder.11,14
How Long Do Benzodiazepine Symptoms Last?
The duration of withdrawal symptoms depends on several factors.
With short-acting benzodiazepines—such as Xanax, Ativan, and Restoril—withdrawal symptoms may begin within hours after the last use but significantly improve within 4-5 days.10,15
For long-acting benzodiazepines—like Klonopin, Valium, and Librium—symptoms may start 1-2 days after last use and may continue for 3-4 weeks.10,15
In some instances, individuals may experience symptoms for weeks or even months after the acute withdrawal symptoms subside. Some individuals experience the reemergence of symptoms (rebound symptoms), such as anxiety or insomnia, for which the benzodiazepines were initially prescribed. Sometimes these reemerging symptoms occur with greater intensity.13
A small portion of individuals who take benzodiazepines long term may experience prolonged withdrawal (for weeks, months, and up to a year) after they discontinue use. These symptoms can be difficult, unpredictable, and come with complications.16 Symptoms may include:16
- Nausea, vomiting, and diarrhea.
- Muscle aches and headaches.
- Rapid heart rate.
- Vision disorders.
- Nervousness and restlessness.
- Complete loss of appetite.
Benzodiazepine Addiction Treatment
As previously mentioned, medical detox and continued treatment can help if you or a loved one struggle with benzodiazepine addiction. There are various treatment options that can help you safely quit benzodiazepines and remain in recovery.11,13 The most effective treatment is tailored to your specific situation and needs and may include:17,18
Inpatient or residential rehab. Inpatient requires you to move into a hospital or residential treatment center for the duration of treatment, which may last for weeks or months, depending on your needs. Typically, inpatient and residential programs include individual and group counseling, education, behavioral therapies, and medication if needed.
Outpatient rehab. Outpatient programs require you to attend onsite (or virtual) counseling sessions and therapies, which look similar or identical to inpatient services. However, you return home or to a sober living environment after treatment each day. Additionally, outpatient programs differ depending on your needs—some may require your attendance at counseling and therapy sessions for several hours each day; others may only have you meet a couple of times each week.
Behavioral therapy. Behavioral therapies are used in both inpatient and outpatient programs to help individuals change the thoughts, emotions, and behaviors behind their benzodiazepine use and also teach them strategies to identify triggers, manage stressors, and prevent relapse.
Aftercare. Aftercare, also called continuing care, sets you up for lasting recovery with community support and accountability after completing a formal treatment program and may include mutual-help groups, counseling, and/or sober living environments.
If you or a loved one struggle with benzodiazepine addiction or misuse, you are not alone. American Addiction Centers (AAC) has treatment options to help support you on your road to recovery. We have facilities nationwide. If you’re ready to start treatment—or have questions—contact one of our compassionate Admissions Navigators today. Call .