Benzodiazepines such as Xanax, Ativan and Valium are commonly prescribed to treat anxiety, panic disorders and insomnia. The prescription sedatives are also used to treat seizures and muscle spasms, and they are often used in combination with anesthesia to calm anxiety prior to surgery.
People also use benzodiazepines recreationally to get high.
Unfortunately, a person can become physically dependent on benzodiazepines in as little as three to four weeks of regular use. When that happens, their brain and body will require the drug to function normally, and attempting to cut back or stop using the medication can bring on agonizing withdrawal symptoms.
In fact, studies have shown that avoidance of withdrawal symptoms is one of the key factors contributing to benzodiazepine addiction.
Benzodiazepines — or benzos, as they’re often called — work to calm a person by increasing levels of a chemical called GABA (gamma-aminobutyric acid) in the brain. Because GABA is an inhibitory neurotransmitter, it reduces messaging between brain cells and quiets the mind.
With repeated exposure to benzodiazepines, your brain becomes accustomed to this lowered level of activity. This adaptation, known as “down-regulation,” is the brain’s way of counteracting the drug’s sedative effects and attempting to restore the body’s equilibrium.
But these complex chemical changes can trigger a cascade of ill effects if a person suddenly stops taking a benzodiazepine or lowers their dose.
Between 20 and 50 percent of individuals taking benzodiazepines will experience withdrawal symptoms when they cease using the drug, according to a 2015 study in the peer-reviewed journal BMC Psychiatry.
The most common benzodiazepine withdrawal reactions are rebound insomnia, anxiety and mild behavioral changes. These effects typically occur within one to four days of discontinuing use of the drug and are often short-lived.
However, withdrawal symptoms may vary widely and can last for a few weeks to several months.
Symptoms of benzodiazepine withdrawal include:
A small percentage of people withdrawing from benzodiazepines develop psychotic behavior. Symptoms can include hallucinations, paranoia, delirium, confusion and disorientation. Depersonalization, a sense of detachment from one’s self, is another psychiatric manifestation of withdrawal.
While these symptoms are more common among people taking high doses of benzodiazepines, they can occur at any dose.
Taking too large a dose of a benzodiazepine can result in a deadly benzo overdose — but quitting the drug cold turkey is also dangerous.
In severe cases, benzodiazepine withdrawal can cause severe seizures and death.
A 2009 report in The American Journal of Forensic Medicine and Pathology describes the case of a woman was admitted to a Colorado hospital with a fever, high blood pressure, bizarre behavior and irregular body movements.
Fifteen hours after she was admitted, the woman developed seizures and died.
While the woman was originally believed to have died from a sleeping pill overdose, no zolpidem was found in her system. An autopsy later concluded she had stopped taking alprazolam four days prior to her hospitalization and died from benzodiazepine withdrawal.
Suicide is also a rare but potential complication of benzodiazepine withdrawal.
Generally speaking, benzodiazepine withdrawal usually begins within one to four days of abruptly stopping the drug. The first symptoms to occur are usually rebound anxiety and insomnia, along with nausea and sweating.
But the onset and duration of benzo withdrawal can vary significantly depending on the half-life of the drug. Short-acting drugs have shorter half-lives. As such, they are eliminated from the body more quickly and withdrawal comes on sooner. Longer-acting drugs are metabolized more slowly, so withdrawal symptoms may develop more gradually.
With short-acting benzos, such as such as lorazepam (Ativan) and alprazolam (Xanax), withdrawal symptoms usually set in one to two day after the last dose. Symptoms typically resolve within two to four weeks, but may continue longer.
Withdrawal from longer-acting benzodiazepines, such as diazepam (Valium), usually begins within two days to one week after the last dose. Symptoms may continue for two to eight weeks or longer.
People who’ve used high doses of benzos for month or years can experience recurrent symptomatic episodes for months after quitting. This condition is known as post-acute withdrawal syndrome, or PAWS.
By gradually tapering their dose, a person can usually avoid severe withdrawal. But withdrawing from benzodiazepines on your own can be difficult and is best handled with the help of medical professionals.
A medically managed detox can provide you with the support and medical care to safely stop using benzodiazepines. Benzo detox can be handled on either an inpatient or outpatient basis depending upon the severity of your dependence.
Your physician will likely devise a detox schedule to gradually reduce your doses over several weeks or several months.
Alternatively, your doctor may decide to switch you to a longer-acting benzodiazepine, such as diazepam, and then gradually wean you off that. This will minimize symptoms and prevent withdrawal complications while your body and brain readjust.
Both of these methods of benzodiazepine withdrawal treatment are endorsed in the Ashton Manual, a guide written by Dr. Heather Ashton, former emeritus professor of clinical psychopharmacology at the University of Newcastle upon Tyne, England.
The Ashton method takes into account the various factors — including the type of benzo, the duration of use, and the dose taken — that affect patterns of withdrawal among benzo-dependent people and offers several withdrawal schedules that can be adapted as needed.
Individuals with severe withdrawal symptoms or a high risk of complications may require hospitalization. With inpatient treatment, you’ll receive round-the-clock monitoring and therapeutic support. You’ll also receive medications to help combat nausea, insomnia, anxiety and withdrawal-related symptoms.
After completing detox, you’ll be ready to begin the next steps of benzo treatment.
Quitting benzodiazepines can be grueling, but a successful detox is your best hope for beating benzodiazepine dependence. According to a 2018 review in the Journal of Clinical Medicine, recovery success rates can approach 70 to 80 percent when benzodiazepine withdrawal is properly managed.
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