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Benzodiazepine Detox Guide

Benzodiazepines, or “benzos” for short, are prescription CNS (central nervous system) depressants for treating anxiety and insomnia.1 Long-term benzo use or misuse can lead to physical dependence, withdrawal, and addiction.2 This is especially true if you have a previous history of substance abuse.2

According to results from the 2019 National Survey on Drug Use and Health, around 4.8 million Americans aged 12 and older reported misusing benzodiazepines in the past year.3 Fortunately, seeking benzodiazepine withdrawal treatment can help you stop misusing benzos and help you take back control of your life.

Signs and Symptoms of Benzodiazepine Withdrawal

Common signs and symptoms of benzodiazepine withdrawal include:1,4

  • Anxiety
  • Trouble sleeping (insomnia).
  • Depressed mood.
  • Headaches.
  • Concentration or focus issues.
  • Hallucinations (seeing or hearing things that aren’t there).
  • Nausea.
  • Feeling irritable.
  • Tremor (shakiness).
  • Increased heart rate.
  • Seizures (potentially fatal).

You may also have rebound symptoms during withdrawal.4 Rebound symptoms mean the symptoms that you took the medicine for in the first place return.4 For example, if you took benzos to treat insomnia, you may have insomnia again. Rebound symptoms are often more intense than they were before treatment and last for a few days or weeks.4

The withdrawal symptoms you have and how severe they are depends on certain factors, such as which benzo you took, how long you used it, and if you use other substances.

Dangers of Mixing Benzos and Other Substances

According to the DEA, benzodiazepine abuse is common in those who abuse multiple substances (called “polysubstance use”).2 Mixing benzos with other substances can be hazardous to your physical and mental health and increase your risk of injury, overdose, and death.6 A study in the journal Substance Use & Misuse reports that nearly half of those who misused benzodiazepines also misused other substances, with rates of benzo misuse being 4 times greater in people with alcohol use disorder (AUD) when compared to the general population and 39 times greater in people with an opioid use disorder (OUD).5

Mixing alcohol with benzos increases the sedative effects of both substances, which can increase your risk of overdose.7 Chronic alcohol and benzodiazepine abuse also increases the risk of negative health effects on your heart, liver, kidney, brain, and digestive system, as well as worsen existing psychiatric conditions.7

Combining opioids and benzos also increases your risk of overdose. In 2019, roughly 16 in 100 opioid overdose deaths also involved benzodiazepines.8 And out of the 9,711 reported benzodiazepine overdose deaths in 2019, more than half involved the use of synthetic opioids other than methadone.9

Some benzo users may even take opioids without knowing it. Benzos bought on the street may be counterfeit (fake) and could contain the highly potent opioid fentanyl or other dangerous substances.10 In addition to these dangers, combining opioids and benzos may increase mental health distress levels and lead to poor mental functioning.5

How Long Does Benzodiazepine Withdrawal Last?

The benzo withdrawal timeline can vary from person to person, depending on:11–13

  • How much you take.
  • How long you’ve taken it.
  • If you have other physical or mental health issues.
  • If you use other substances, especially other CNS depressants such as alcohol.
  • If you use an extended-release or immediate-release formula.

Benzodiazepine withdrawal symptoms can begin as soon as:11

  • For short-acting benzos (oxazepam, alprazolam, and temazepam): 1 to 2 days after your last dose and last 2 to 4 weeks or more.
  • For long-acting benzos (diazepam and chlordiazepoxide): 2 to 7 days after your last dose and last 2 to 8 weeks or more.

Can You Die from Benzodiazepine Withdrawal?

Benzodiazepine withdrawal can be life-threatening in some cases, especially if you take high doses or use multiple substances.6,13,14 According to a study published in Emergency Medicine News, the most common benzo withdrawal symptom is behavioral change, but seizures can happen in rare cases and may be fatal, especially if a person is left untreated.14

Other severe and possibly dangerous withdrawal symptoms include:1,4,13

  • Hallucinations.
  • Psychosis (not being able to tell what is or isn’t real).
  • Suicidal thoughts.
  • Delirium (sudden, extreme confusion).

How to Cope with Benzodiazepine Withdrawal

Benzo withdrawal can be challenging. Patients going through benzo withdrawal have described withdrawal symptoms as very stressful, similar to having the flu, and unpredictable.15 But the good news is professional medical detox can help ease these symptoms and keep you as safe and comfortable as possible while you go through the process.12,13

For safety reasons, the Substance Abuse and Mental Health Services Administration (SAMHSA) suggests inpatient detox or some other form of 24-hour medical care for people withdrawing from benzodiazepines.13 A typical benzodiazepine detox process follows these 3 steps:13

Man and female patient discussing what benzodiazepine detox entails

  • An assessment to help decide the right level of care for your recovery needs and to make a treatment plan.
  • Stabilization, where you get medical support to help you withdraw from benzos and become medically stable.
  • Getting ready for additional treatment. You care team will help you prepare for the next step of treatment, as detox is only the first step of the process. Post-detox care will help you learn the skills you’ll need to stay sober and to address the reasons you may have developed an addiction in the first place.

Benzodiazepine Withdrawal Medications

A common benzo detox method is tapering your current benzodiazepine. This means slowly reducing the dose you take over the course of time. Tapering can last a few weeks or even months, depending on the specific benzo you take. This method is typically only effective for long-acting benzos.13 If you take a short-acting benzo, which can have a greater risk of withdrawal symptoms, your care team may switch you to a longer acting benzo.12,13 Other benzodiazepine withdrawal medicines that your care team might prescribe include:13

  • Phenobarbital.
  • Anti-seizure medicines such as carbamazepine.
  • Clonidine to ease withdrawal symptoms.
  • Antidepressants such as trazodone and imipramine.

Can I Stop Benzos Cold Turkey?

Before quitting benzodiazepines on your own, especially if you have been using them for a long time, talk to your doctor. They can help assess your withdrawal risks and suggest the right level of treatment that is best for your needs. They can also help create a tapering schedule to help you stay safe and comfortable during withdrawal so you’re better able to enter recovery in a medically stable state.13

Unpleasant withdrawal symptoms, an increased risk of immediate relapse, and the risk of dangerous withdrawal symptoms such as seizures (which need prompt medical attention) are key reasons to avoid detoxing on your own without medical advice or oversight.13

Finding Treatment for Benzodiazepine Withdrawal

Benzodiazepine withdrawal treatment and medical detox can help manage withdrawal while helping you stay as safe and comfortable as possible during early recovery. American Addiction Centers is a leading provider of detox and addiction treatment, with benzodiazepine detox centers across the nation. Our professional, caring staff and medical experts know how to treat benzodiazepine withdrawal and can help you get started on the path to recovery. Call to talk to one of our admissions navigators any time, day or night. Or get started online by filling out the form below.

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Sources

  1. National Institute on Drug Abuse. (2018, March). DrugFacts: Prescription CNS depressants DrugFacts.
  2. U.S. Drug Enforcement Administration. (2019, December). Benzodiazepines.
  3. Substance Abuse and Mental Health Services Administration. (2020, September). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
  4. Lerner, A., & Klein, M. (2019). Dependence, withdrawal and rebound of CNS drugs: an update and regulatory considerations for new drugs development. Brain Communications, 1(1), fcz025.
  5. Votaw, V. R., McHugh, R. K., Vowles, K. E., & Witkiewitz, K. (2020). Patterns of polysubstance use among adults with tranquilizer misuse. Substance Use & Misuse, 55(6), 861–870.
  6. Ogbu, U. C., Lotfipour, S., & Chakravarthy, B. (2015). Polysubstance abuse: alcohol, opioids and benzodiazepines require coordinated engagement by society, patients, and physicians. The Western Journal of Emergency Medicine, 16(1), 76–79.
  7. Hirschtritt, M. E., Palzes, V. A., Kline-Simon, A. H., Kroenke, K., Campbell, C. I., & Sterling, S. A. (2019). Benzodiazepine and unhealthy alcohol use among adult outpatients. The American Journal of Managed Care, 25(12), e358–e365.
  8. National Institute on Drug Abuse. (2021, February 3). Benzodiazepines and opioids.
  9. National Institute on Drug Abuse. (2021, January 29). Overdose death rates.
  10. U. S. Drug Enforcement Administration. (n.d.). Counterfeit pills.
  11. World Health Organization. (2009). Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings. 4: Withdrawal management. Geneva: World Health Organization.
  12. Brett, J., & Murnion, B. (2015). Management of benzodiazepine misuse and dependence. Australian Prescriber, 38(5), 152–155.
  13. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and substance abuse treatment.
  14. Greenberg, M. (2001). Benzodiazepine withdrawal: Potentially fatal, commonly missed: Following benzodiazepine cessation, withdrawal symptoms may begin within 24 hours or take up to two weeks to develop. Emergency Medicine News, 23 (12),
  15. Liebrenz, M., Gehring, M. T., Buadze, A., & Caflisch, C. (2015). High-dose benzodiazepine dependence: a qualitative study of patients’ perception on cessation and withdrawal. BMC psychiatry, 15, 116.