Benzodiazepine Withdrawal Symptoms, Timeline, and Detox Treatment
Benzodiazepines are widely prescribed central nervous system (CNS) depressants often used to treat anxiety, panic, muscle spasms, and seizures, and to aid in alcohol withdrawal management.1,2 However, benzos are also regularly misused. In 2021, for example, 3.9 million people (1.4 percent of the U.S. population) misused prescription benzodiazepines in the last year.3 Use and misuse of benzodiazepines can also lead to addiction as well as tolerance and withdrawal.4
Read on to discover more about benzodiazepine withdrawal, including symptoms and dangers of benzo withdrawal, potential timelines and stages, and treatment for benzodiazepine addiction.
What Are the Symptoms of Benzodiazepine Withdrawal?
With regular use, benzodiazepines can cause severe, harmful physiological dependence, which can then lead to withdrawal symptoms. Medical complications of withdrawal from benzos are similar to those seen in alcohol withdrawal.5,6 Similar to severe alcohol withdrawal, severe benzo withdrawal can be life-threatening.5
Protracted withdrawal (aka protracted abstinence) can occur. This is when certain symptoms linger following acute withdrawal from benzodiazepines, generally at a much lower level of intensity.2 Lingering symptoms may include anxiety, insomnia, depressed mood, and sensitivity to light, sound, and touch. These symptoms often wax and wane over several weeks or months, and slowly resolve with continued abstinence.8
How Severe Are Benzo Withdrawal Effects?
The duration and severity of withdrawal is largely dependent on the duration of use, daily dose consumed, and the substance’s duration of action, i.e., the length of time the drug is effective.9 However, the use of alcohol and other medications/substances, co-occurring psychiatric disorders, and previous episodes of withdrawal typically generate more severe withdrawal symptoms.6
When short-acting benzos are taken at relatively high doses and/or for long periods of time, more severe withdrawal effects may occur.9 Additionally, the severity of withdrawal symptoms may fluctuate throughout the withdrawal process.5
Benzodiazepine Withdrawal Timeline and Stages
So how long does benzodiazepine withdrawal last? The length and stages of withdrawal are dependent on the daily dose consumed, duration of use, and the substance’s duration of action, which varies among the types of benzodiazepines.5,9 So the start and course of withdrawal symptoms differs based on the substance consumed.5
Short-Acting Benzo Withdrawal Timeline
Alprazolam (e.g., Xanax), oxazepam (e.g., Serex), and temazepam (e.g., Restoril) are examples of short-acting benzos whose effects last approximately 10 hours or fewer. Withdrawal for these substances typically begins within 6 to 8 hours. Peak withdrawal intensity for short-acting benzos occurs on day 2 and improves markedly by days 4 or 5.7
Long-Acting Benzo Withdrawal Timeline
Withdrawal for long-acting benzos such as diazepam (e.g., Valium) may not develop for more than a week. Symptoms typically peak in week 2 and taper off significantly in weeks 3 and 4.7
Protracted Withdrawal Timeline
A prolonged withdrawal period is also possible, where lower-intensity symptoms persist for several weeks or months.7 These symptoms often wax and wane over time, and some sources suggest they can endure for a year or longer.8,10 In terms of prevalence of protracted benzodiazepine withdrawal, an estimated 10 to 25% of people who use benzos long term experience protracted withdrawal symptoms.8
Dangers of Benzodiazepine Withdrawal and Detox
Among the symptoms and medical complications of benzodiazepine withdrawal, seizures and delirium are typically the most severe and can be life-threatening.6
Two groups of people are particularly susceptible to consequences as a direct or indirect result of benzo withdrawal.9
- Elderly. This population is at an increased risk for falls and heart attacks during withdrawal, and marked delirium may also occur.6
- Pregnant women and their unborn fetuses. Since benzos can cross the placenta from the mother to a fetus, symptoms of withdrawal may occur in both pregnant women and their unborn fetuses. Additionally, both the mother and fetus metabolize benzos slowly, so benzo concentrations can build to significant levels, and these populations are at an increased risk for adverse effects during withdrawal.9
Treatment for Benzodiazepine Withdrawal and Addiction
If you or someone you know is having difficulties because of misusing benzodiazepines, treatment is available. And often, the first step toward recovery begins with detox and withdrawal management.
According to recommendations from the Substance Abuse and Mental Health Services Administration (SAMHSA), benzo withdrawal—particularly for those experiencing severe withdrawal symptoms—shouldn’t be attempted without medical supervision to ensure their safety. Inpatient medical management of withdrawal can benefit those who have used high doses of benzos for an extended period by minimizing the risk of severe and potentially life-threatening symptoms.6
Outpatient medically managed detox may be an option, particularly for those who take lower doses, aren’t dependent on any other substances, and have adequate support, such as people in their lives who can aid in monitoring their withdrawal progress.6
While detox and withdrawal management is often an important first step of the recovery process, additional treatment interventions can address the psychological, behavioral, and social issues that are deeply engrained in addiction. Rehab also can equip people with the necessary skills to recognize the stressors and triggers to use substances and avoid a return to unhealthy substance use.11
Treatment options, which typically involve group and individual counseling, include various behavioral therapies, such as cognitive-behavioral therapy (CBT), contingency management (CM), and motivational enhancement therapy (MET).11
Tailored to your unique needs and treatment goals, treatment settings include:6,11,12
- Inpatient. Patients stay at a treatment facility during inpatient treatment, where staff are available 24/7 and patients participate in both group and individual therapy sessions.
- Outpatient. Those in outpatient treatment live in their own residences or a sober living facility but attend scheduled group and individual counseling sessions.
Following inpatient and outpatient programs, an aftercare (aka continuing care) plan will help you maintain your treatment goals and lower the risk of relapse. This can include sober housing, alumni programs, support groups, self-help or mutual-help meetings, medication, and individual therapy sessions.11
Are you or a loved one struggling with benzodiazepine misuse or addiction? American Addiction Centers can help. Our facilities across the United States provide options from inpatient detox and withdrawal management to outpatient treatment and aftercare. Contact our to take your first steps toward recovery.