Substance Use

Benzos Withdrawal

TABLE OF CONTENTSTable of Contents

benzodiazepine definition with needle and glass

Benzos Withdrawal Symptoms, Timeline, and Detox Treatment Options

Benzodiazepines, otherwise known as “benzos,” are a class of central nervous system depressants typically prescribed for anxiety, sleep disorders, and seizures. Legally, these drugs are only available via prescription. However, many users obtain them illegally. They buy them on the streets or steal them from others in their household. Data shows that most misusers got their benzos from friends or family, with only around 20% receiving their prescription from a doctor. Those who develop a benzos addiction may also get prescriptions from multiple doctors or forge prescriptions. 

Two of the most common benzos found on the illicit market are clonazepam and alprazolam. Other commonly abused benzos include lorazepam and diazepam. The type of benzo you take will influence your experience. Other variables to consider are how long you’ve been taking the benzo(s) of your choice, the average daily dosage and if you’ve been combining benzos with other substances, like alcohol. 

Benzos have a risk of abuse, particularly among those with a history of drug use. The way you use benzos is often a telling sign. For example, if you are regularly crushing benzos to snort, this is a major red flag, as you are explicitly using the drug to experience the corresponding high. 

Commonly abused among opioid abusers, benzos can enhance one’s high. Data shows that many patients seeking treatment for opiate withdrawal are also often typically dependent on benzodiazepines. When analyzing patients going through opiate withdrawal only versus those experiencing both opiate and benzos withdrawal symptoms, it’s been found that the latter is more severe. Being dependent on benzos when struggling with opioids will exacerbate benzos withdrawal symptoms, making this combination complex. Using these drugs concurrently is also incredibly dangerous, which is why you should seek professional clinical care as soon as possible. 

Research shows that benzo abuse and addiction are also common among those who have a history of alcoholism. Also, users who do not have a history of abuse, but have a first-degree relative with a history of addiction, face an increased risk. 

What Are the Symptoms of Benzos Withdrawal? 

Benzo use is highly common in the United States. As reported by the National Institute on Drug Abuse, approximately 12.5% of adults in the United States use benzodiazepines. However, the majority use their prescriptions as directed. Only around 2.1% of U.S. adults misuse and only 0.2% meet the criteria of benzodiazepine use disorders.

Some of the most common reasons to misuse benzos are to relax or relieve tension (46.3%) and sleep better (22.4%). Nearly 12% reported using benzos to get high or because they were hooked — which is still a significant number of Americans.

While focusing on dependence and benzos withdrawal, the greatest concerns are among the patients who have been using benzos for over six months. Once benzo addiction develops, you increase your risk of significant consequences — dependence, overdose, and mortality. To develop benzos withdrawal symptoms, you need to develop physical dependence. However, psychological dependence can also be challenging to overcome. 

If you take benzos for longer than three to four weeks, you will likely experience benzo withdrawal symptoms if you suddenly stop. 

Benzo withdrawal symptoms can vary from one person to the next. However, the following clinical features are common. 

  • Headaches
  • Racing heart rate 
  • Sweating 
  • Tremors
  • Muscle pain and aches 
  • Dizziness
  • Shooting pains in neck and spine 
  • Visual disturbances, including blurred vision 
  • Confusion 
  • Delusions and paranoia 
  • Hallucinations 
  • Seizures 
  • Nausea
  • Anxiety and panic attacks 
  • Irritability 
  • Poor memory 
  • Sensory hypersensitivity 
  • Depression 
  • Depersonalization 

Among users first prescribed benzos to treat a severe anxiety disorder, it’s common for benzo withdrawal to be confused with recurrence of the underlying anxiety condition. 

Post-acute withdrawal syndrome (PAWS) is a key reason why ongoing support is so important. Some users can experience symptoms, such as depression, anxiety, and sleep issues, for weeks, months, or years. These symptoms are not necessarily true pharmacological withdrawal symptoms. However, they are related to long-term benzo use. The duration of this syndrome is highly dependent on the individual. Researchers suggest gradual dosage reduction followed by long-term therapeutic psychological support. 

What Causes Benzos Withdrawal?

Benzo withdrawal symptoms develop because of physical dependence and psychological dependence. In many cases, users begin abusing benzos to help ease the symptoms of an underlying mental health condition. You must seek ongoing support to address your mental health if you relate to this scenario.

It is well-understood that people who use high doses of benzos regularly over an extended period may experience benzos withdrawal syndrome when they stop or reduce use. Benzo dependence occurs when there is an adaptation to the drug of choice at the tissue and cellular level. Upon cessation, benzos withdrawal symptoms surface. 

Once patients have taken benzos at higher doses for longer periods than recommended, they should be assessed for dependence or addiction — not just to benzos, but other substances of abuse as well. 

To better understand benzos withdrawal, you must first know how benzos work within your body and mind. Thanks to an increased understanding of physiology and pharmacology, many benzos’ mechanisms of action are now well-understood. 

Although benzos offer immense therapeutic value and are often well-tolerated, the risk of side effects, addiction and toxicity must be considered. Benzos influence GABA receptors to produce a calming effect. GABA is the brain chemical that produces a calming effect, offering anti-seizure and anti-anxiety benefits. 

How benzos interact with GABA receptors is incredibly complex, as several types have been identified. Benzos with high lipid solubility have higher absorption rates and faster onset. Varying effects depend on which receptors are activated and where. For example, the anxiolytic effects of benzos are mediated through receptors located in the limbic system. Not all benzos interact with the same receptors, so when you start mixing benzos (or benzos with other substances of abuse), this process becomes complicated. 

How Long Does Benzos Withdrawal Take? 

A key consideration is a benzo’s half-life, which is the estimated time needed to reduce the concentration of that benzodiazepine in the plasma by half. It takes approximately five half-lives for a drug to be eliminated from your body. So, if you take a dose within this period, drug accumulation is likely. In some cases, active metabolites are produced. For example, diazepam, a long-acting benzodiazepine, produces a range of metabolites that increase the drug’s duration of action. 

  • Short-acting benzos have an average half-life of one to 12 hours
  • Intermediate-acting benzos have an average elimination half-life of 12-40 hours 
  • Long-acting benzos have an average half-life of 40-250 hours

The onset and duration of benzos withdrawal syndrome will depend on the specific benzo you’re taking. For example, short-acting benzos (alprazolam, oxazepam, nitrazepam) typically cause withdrawal symptoms within one to two days of last use. Symptoms peak at seven to 14 days and gradually subside. However, if you’re taking long-acting benzos (diazepam, clonazepam), withdrawal symptoms are less severe between two to seven days, peaking around day 20 and then subside after a few weeks. Again, it can sometimes be challenging to differentiate between withdrawal symptoms and the original anxiety. 

Understanding a rough benzos withdrawal timeline will help you develop a better plan as you work alongside a professional care team. It’s important to have realistic expectations. When you have a clear idea of what to expect, you can continue to set goals and achieve them. Remember, this process is a marathon, not a sprint. Think of a professional care team as your coach, guiding and encouraging you every step of the way. 

If the benzos withdrawal process is hindering you from getting the help you need, know that this step will allow you to work toward a healthier, more fulfilling future. Recovery is an ongoing process, but with the right support, you can succeed. The benzos withdrawal period is a small window of time. Once you overcome the physical symptoms of withdrawal, you will benefit from greater clarity, allowing you to focus on your psychological well-being. 

The price of not seeking treatment could be dangerous, even fatal. If you’re someone that often mixes benzos with alcohol, this increases your risk of overdose. If this is the case for you, please do not go through the benzos withdrawal period unsupervised. Complications can quickly arise, threatening not just your recovery process but your life. 

How To Safely Manage A Benzos Detox 

To best address your symptoms, you will need to be assessed. Upon your assessment, a customized plan will be required. An individualized approach helps ensure a comfortable, safe benzo withdrawal process. 

A tapering plan is typically the first line of defense. Under no circumstances should a patient abruptly stop taking benzodiazepines. The overall strategy will depend on several factors, including:

  • The detoxification setting
  • The severity of dependence and tolerance
  • The total drug combinations used
  • The user’s mental health history

Gradually reducing benzodiazepine dosage is particularly useful when dependence has developed among those who:

  • Take only benzos
  • Became dependent after taking doses within the therapeutic range
  • Are being treated in a medical setting

This strategy will vary. However, a dosage reduction of 10 to 15 percent each week is common. A tapering period of six to twelve weeks is ideal for outpatient detoxification. Faster reductions are possible but require more intensive clinical contact and support. 

If you have an uncomplicated benzodiazepine dependence and tolerance, you may be able to detox on an outpatient basis. However, those who can relate to the below criteria benefit from a multidisciplinary team approach. This holistic approach often requires psychological, psychiatric, counseling, nursing, and ongoing educational support. 

Although anyone withdrawing from benzos can benefit from ongoing clinical support, it is particularly critical that you seek professional help if you:

  • Are on very high doses (e.g., over 50 milligrams of diazepam per day)
  • Are abusing multiple substances of abuse 
  • Suffer from neurological disorders and seizures 

An ongoing treatment plan will be required to achieve long-term changes. For example, someone with an anxiety disorder may begin to experience overwhelming symptoms that feel as though they’ll be permanent. At this time, a support team can provide the guidance and reassurance needed to continue making lasting changes. 

When a medication-assisted approach is taken, several options are available depending on the user’s needs and history. For example, for those addicted to short-acting benzos, such as alprazolam or those using benzos with alcohol, chlordiazepoxide may be prescribed. Clonazepam is another commonly suggested benzo that can help protect against withdrawal seizures. 

Once you have eliminated all substances, you can focus on your psychological dependence or any underlying mental health symptoms. Research shows that treatment for the discontinuation of benzos is most successful when a gradual dose reduction to combined with psychological treatment, compared to a tapering plan alone. Ongoing therapy may be necessary to maintain sobriety. 

Seeking the support of an accredited, professional facility is imperative. A compassionate medical team that understands the value of holistic healing can make all the difference. Partner with a facility and team that focuses on evidence-based treatment strategies and offers a range of therapy options. For example, in addition to individual and group therapy, many patients benefit from art therapy, adventure therapy, or equine-assisted psychotherapy.

Take the Next Step

Whether you began taking benzos to address a sleep disorder and developed a dependence or have been abusing benzos illegally for years, you deserve a life free from the chains of addiction. You no longer need to accept the current cycle you’re living. If benzos withdrawal continuously drives you to use, even though you want to stop, it’s time to take the next step. 

Unlike withdrawing at home, when you seek the support of a professional substance abuse and mental health facility, you will receive the clinical care required to make it through this initial period. You will gain peace of mind knowing you’re safe and well-monitored. You’ll then benefit from an individual treatment plan that is tailored to your unique needs and goals. That is a powerful thing. 

Help is available. Now is the time to say yes to the future you seek.