What Is Benzodiazepine Withdrawal?
Users often develop a tolerance to benzodiazepines, or benzos, after taking high doses for a long period of time.
As tolerance gets stronger, the user needs higher doses of benzos to feel their effects.
When someone stops taking the drug, withdrawal symptoms emerge. Withdrawal symptoms affect people who were prescribed benzodiazepines as much as those who were abusing them without a prescription.
Many doctors are hesitant to prescribe benzodiazepines for long-term use because of their addictive nature and intense withdrawal symptoms.
Symptoms of Withdrawal
The withdrawal symptoms of benzodiazepines are physically and emotionally painful and can be life-threatening if the user stops “cold turkey.” Those with a history of taking higher doses or taking the substance for a prolonged time have the worst withdrawal symptoms.
Symptoms of benzo withdrawal may include:
Rebound Anxiety and Insomnia
Benzodiazepines are mainly prescribed to treat generalized anxiety disorder and insomnia. Many people who stop taking these medications experience increased anxiety or restlessness. This is called the rebound effect.
Rebound effects from benzo withdrawal, such as anxiety or insomnia, typically last 2 to 3 days.
After someone numbs their anxiety with benzos for a long time, feelings of nervousness can come back in greater force than before. Even people who had no previous signs of general anxiety often have rebound anxiety as a symptom of withdrawal. The same is true of rebound insomnia.
Duration of Withdrawal
Benzodiazepines’ half-lives (time spent in the body after consumption) vary by brand. Withdrawal symptoms from shorter-acting benzos 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.
The first signs of withdrawal usually start within 6 to 8 hours for shorter-acting benzos and 24 to 48 hours for longer-acting benzos.
Short-acting benzos are notable because of the intense and serious withdrawal symptoms people experience when they quit taking them. Long-acting benzos cause less intense withdrawal symptoms, and it takes longer for symptoms to start.
Taking benzos more frequently, in higher doses, in more potent forms and/or for a prolonged time all increase the duration of withdrawal.
In cases of mild addictions, it may take as little as seven days to overcome withdrawal symptoms. Other cases can take up to three months as the user is slowly weaned off the drug to prevent life-threatening withdrawal symptoms.
Benzodiazepine Withdrawal Timeline
The withdrawal timeline for benzos is different for every user. The following table is just a guideline, as most people have to taper down their benzo use over several weeks.
First 6-8 hrs.The first signs of withdrawal, typically anxiety and insomnia, may emerge within several hours after stopping use. This depends on how long it takes for the substance to leave the system. Withdrawal symptoms usually appear in 6-8 hours for those taking short-acting benzos.
Days 1-4 Rebound anxiety and insomnia peak after a couple of days. During this time, intense discomfort from insomnia and increased anxiety are common. Other symptoms that peak during this time are increased heart and breathing rate, sweating, and nausea. People who used longer-acting benzodiazepines start feeling the first signs of withdrawal during this time.
Days 10-14 The symptoms of withdrawal typically continue for at least 10-14 days before fading away completely. The withdrawal symptoms tied to longer-acting benzos begin to peak during this time, eventually fading within 3-4 weeks from the quit date.
Days 15+ People who are heavily dependent on benzodiazepines may experience protracted withdrawal syndrome (PAWS). These are random periods of sharp withdrawal symptoms months after quitting. Tapering down benzo use with the help of a doctor can prevent PAWS.
The first step in treating a benzodiazepine addiction is removing the drug from the addict’s system. This process is known as detox and can cause dangerous side effects if not done properly.
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 grand mal seizure may occur in perhaps as many as 20-30 percent of individuals undergoing untreated withdrawal from these substances.
- Diagnostic and Statistical Manual of Mental Disorders, 5th Ed.
A medically supervised detox helps people stay safe and healthy while they get clean. Medical detox also reduces the discomfort of withdrawal, which in turn reduces the chances of relapsing into addiction.
Detox can last several months depending on the drug taken and the duration of use.
Tapering Down Benzodiazepine Use
Medical detoxification from benzodiazepines often involves tapering down from the drug. Tapering down can mean reducing the dose or prescribing a less potent benzo. 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 (Valium) or clonazepam (Klonopin). 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.
It takes most people an average of 10 weeks using the tapering down method to fully detox from benzodiazepines.
Benzo Detox Medications
Although most people gradually reduce their dose until it’s safe to stop taking the drug altogether, there are also medications that can help relieve withdrawal symptoms during the detox period. Some of these include:
People with generalized anxiety disorder who have a history of substance abuse are often prescribed buspirone. This drug doesn’t cause physical dependence and can relieve the emotional effects of withdrawal.
The only downside is that buspirone takes 2-3 weeks before it begins to take effect. Patients in detox may begin taking buspirone as they taper down their benzo doses.
This drug is primarily used to treat benzodiazepine overdoses, but has shown some success in reducing withdrawal symptoms of long-acting benzos. Flumazenil is able to block the effects of benzos and relieve withdrawal symptoms because it attaches to the same pleasure centers in the brain as benzodiazepines.
It may also be used for rapid detox as the drug forces benzodiazepines out of the body. This drug should be used with caution as rapid detox can make withdrawal worse.
Treatment for Benzo Addiction
Detox on its own is rarely enough to build long-lasting sobriety. Many people choose an inpatient rehab that offers benzo detox.Inpatient rehab provides a distraction and temptation-free environment in which to recover.
People with mild benzo addictions may choose an outpatient detox instead of an inpatient rehab center. Outpatient care allows people to get treatment without upsetting their daily schedule.
Counseling and support groups are also an important part of recovery. Many former benzo addicts continue therapy and support after rehab to prevent a relapse.