Updated: 31 January 2023 & medically reviewed by Dr. Celeste Small
After prolonged periods of benzodiazepine abuse, the brain develops tolerance to the drug. Tolerance means that users require higher doses to feel the effects of the drug. If they stop taking it, they will often develop withdrawal symptoms.
- The symptoms one may experience when quitting benzos will vary from person to person and may come and go in different levels of severity, including psychological and physical symptoms
- The total time it will take for benzo withdrawal symptoms to wear off and the severity of withdrawal symptoms depends on whether they are short- or long-acting, the dose they have been abused in, how long for, and in what frequency
- Tapering off benzodiazepines may involve either reducing the current dose of the drug being taken gradually or switching to a less potent alternative (valium, Klonopin, etc.)
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Symptoms of Benzodiazepine withdrawal
Like opioid painkillers and other central nervous system depressants, the withdrawal symptoms from benzodiazepines (benzos) can be both physically and emotionally distressing and even life-threatening for those with severe addictions.
The symptoms one may experience when quitting benzos will vary from person to person and may come and go in different levels of severity, including psychological and physical symptoms.
The most common symptoms will begin to present themselves within one to four days of discontinued use and differ depending on the type of benzo abused, in what dose, and for how long. These effects often mirror the conditions that benzodiazepines are prescribed for in the first place but can be far more intense. These include:
- Restless sleep
- Rebound anxiety
- Panic attacks
- Blurred vision
- Broken concentration
- Muscle spasms
- Muscle pain
- Muscular stiffness or discomfort
- Mild to moderate changes in perception
There are more potentially life-threatening benzodiazepine withdrawal symptoms. These often only present themselves in those with severe levels of addiction. These include:
- Suicidal ideation
Duration of withdrawal
The timeline for benzodiazepine withdrawal to take effect varies between extended and short-acting versions of the drug. This timing is due to the half-life of the drug being different between short and long-acting versions.
WIthdrawal from short-acting benzos (Xanax, Dormonoct, Halcion) can start in as little as 6 to 8 hours, whereas long-acting (Valium, Klonopin, Librium) benzo withdrawal will often start between 24 and 48 hrs after the last dose. The withdrawal symptoms from short-acting benzos are often far more severe than those of long-acting ones.
The total time it will take for benzo withdrawal symptoms to wear off and the severity of withdrawal symptoms depends on whether they are short- or long-acting, the dose they have been abused in, how long for, and in what frequency. Those with a mild benzo addiction may get through withdrawal symptoms in as little as a week. Those with severe addictions may experience them for months, especially if they are tapering off the drug to mitigate the more life-threatening symptoms.
- First 6–8 hours: rebound symptoms such as anxiety and insomnia begin to present themselves (short-acting)
- First 72 hours: rebound symptoms peak in the first three to four days.
Intense discomfort from insomnia and anxiety are common, as well as nausea and sweating. Those quitting long-acting benzos will begin to feel withdrawal symptoms at this time.
- First 2 weeks
The effects of short-acting withdrawal can continue for up to 14 days before disappearing altogether. Long-acting benzodiazepine withdrawal may last for four weeks.
- PAWS - Post-acute withdrawal symptoms such as persistent anxiety, loss of concentration, chronic insomnia, and depression can present themselves intermittently for months after stopping use. These often occur in the most extreme cases of addiction and can be prevented by tapering use and continuous therapy.
The physical and psychological effects of benzodiazepine withdrawal, such as seizures and suicidal ideation, are potentially life-threatening and should always be treated by medical professionals in a medically supervised detox.
Medical detox in an inpatient or outpatient treatment center reduces the discomfort from the adverse effects of withdrawal and helps manage more severe symptoms such as the risk of seizures. It also increases the chances of a full recovery by reducing the risk of relapse. As the withdrawal time frame for benzos can be months, detox can be a lengthy process. It may need to be attempted after a period of tapering off the drug.
Tapering benzodiazepine use
Tapering off benzodiazepines may involve either reducing the current dose of the drug being taken gradually or switching to a less potent alternative (valium, Klonopin, etc.). The tapering process helps the body adjust to having less of the drug in its system and allows the brain to produce natural levels of chemicals on its own. It also helps reduce the possibility of experiencing extreme withdrawal symptoms and the amount of time the withdrawal process takes overall.
Medication used to treat benzodiazepine withdrawal
Some medications may be used during the detox process to help manage withdrawal symptoms, such as:
This medication is often used to treat people with co-occurring disorders such as anxiety. The drug doesn’t cause dependence to form and can help ease benzo withdrawal's psychological and emotional effects.
Primarily used to treat benzodiazepine overdose, flumazenil has also shown effectiveness in reducing withdrawal symptoms from long-acting benzodiazepines. Flumazenil attaches to the same pleasure receptors in the brain as benzos. It can relieve withdrawal symptoms and can force the drug out of the system faster.
Benzodiazepine addiction treatment
Benzodiazepine addiction treatment starts with a medically supervised detox but requires long-term treatment to overcome. Those suffering from a severe benzo addiction will often need inpatient rehab treatment to successfully detox and begin therapy and counseling in a safe and temptation-free environment.
Those with milder addictions may find that outpatient treatment centers offer an appropriate level of treatment and can be equally as effective as inpatient centers.
Continuing to nurture recovery is essential for long-term sobriety. One-on-one counseling and support groups are both great ways to effectively monitor and work on healing and develop coping mechanisms to deal with cravings and tempting situations.
To find out what treatment option is right for you, speak to a rehab provider today.