6 Things About Benzo Withdrawal You Might Not Know

Don't let benzo withdrawal symptoms take you by surprise.
Benzodiazepines (benzos) are an anxiolytic class of drugs that belong to a larger group of substances that can be categorized as central nervous system (CNS) depressants.1 Benzodiazepines work by increasing inhibitory neurotransmission throughout the brain. Various benzodiazepine agents are prescribed for a wide range of conditions including anxiety, panic disorder, muscle spasms, tremors, seizures, and insomnia; certain benzodiazepines are also used to manage acute alcohol withdrawal .1,2 Some of the more commonly prescribed benzos include Valium, Xanax, Ativan, and Klonopin.1,2,3

What You Need to Know

Most benzos are intended for oral use yet some people misuse the drugs by crushing up the oral tablets prior to snorting them.1 While fatal overdose with benzos alone may be relatively uncommon, misuse of these drugs is often in the setting of polysubstance abuse; severe respiratory depression and lethal overdose becomes much more likely when combined with opioids or other CNS depressant drugs, including alcohol.4

Withdrawal from benzos may be extremely unpleasant and potentially dangerous. Benzo withdrawal may include symptoms of severe anxiety, insomnia, dysphoria, tremors, and seizures.4 While challenging to endure, there are certain things that can be done to help manage symptoms and minimize severe risks of withdrawal.

Here are 6 things you’ll need to know about benzo withdrawal:

1. A Long Withdrawal Process

For most people, benzo withdrawal isn’t a matter of days but months or even years. Withdrawal for relatively short-acting drugs may begin 1-2 after the last dose and persist for 2-4 week, if not longer.5 For a longer-acting benzodiazepine, withdrawal might start 2-7 days after the last dose and can continue for 2-8 weeks or longer.5  For some people, protracted benzodiazepine withdrawal symptoms may last for months or even years.6

2. The Symptoms are Painful

Some of the most common benzo withdrawal symptoms include1,4-6

  • Dysphoria.
  • Poor concentration and memory.
  • Anxiety.
  • Irritability and agitation.
  • Insomnia.
  • Restlessness.
  • Blurred vision.
  • Racing heart.
  • Muscle tension and aches.
  • Tremors.

3. Cold Turkey is Never Recommended

It might seem logical to immediately stop using a drug to minimize its continued negative health impact, but symptoms like agitation, anxiety ,and panic can become overwhelming when you try stopping cold turkey.2 Hallucinations have been reported in some cases of abrupt withdrawal from short-acting benzos; withdrawal seizures may be possible with short, medium, and long half-life benzodiazepines, if discontinued abruptly. 2,7 With that in mind, professional help for benzo withdrawal may be necessary and could be life-saving.

4. Consider a Slow-Taper Detox

Once the body has grown dependent on a consistent supply of benzos, treatment professionals and rehab facilities may utilize a slow-taper detox program. This allows a person to detox slowly and avoid severe withdrawal symptoms.8

Tapering off of a benzo generally involves a doctor prescribing increasingly smaller amounts of the drug over time or changing prescriptions to a longer-acting sedative. For example, if someone is dependent on a very short-acting benzodiazepine like alprazolam (Xanax), a doctor may administer an equivalent dosage of a long-acting benzodiazepine like diazepam (Valium). Longer-acting benzodiazepines like diazepam allow for less frequent dosing and a more consistent, slower decline in concentration throughout the tapering schedule.8

5. Don’t Drink

Other CNS depressant substances, though they might temporarily resolve some symptoms, would only serve to postpone the eventual onset of the withdrawal symptoms in question, and could introduce additional complications at the point that withdrawal resumes.3

6. Getting Clean is Possible

You can! Although benzo withdrawal can be uncomfortable at best and painful at worst, many others have successfully done it and gone on to live healthy, sober lives.

Sources

  1. United States Drug Enforcement Administration. (2017). Drugs of Abuse: A DEA Resource Guide, 2017 Edition.
  2. Harvard Health Publishing. (2019). Benzodiazepines (and the alternatives).
  3. Center for Substance Abuse Research. (2013). Benzodiazepines.
  4. Drug Enforcement Administration. (2013). Benzodiazepines.
  5. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings: 4 Withdrawal Management.
  6. SAMHSA-HRSA Center for Integrated Health Solutions. (2017). Safe & Effective Use of Benzodiazepines in Clinical Practice.
  7. Hu, X. (2011). Benzodiazepine withdrawal seizures and management. J Okla State Med Assoc, 104(2), 62-65.
  8. Thirtala, T., Kaur, K., Karlapati, S.K., Lippmann, S. (2013). Consider this slow-taper program for benzodiazepines. Current Psychiatry, 12(9), 55-56.