What Is Benzodiazepine Withdrawal?

What Is Benzodiazepine Withdrawal?

The purpose of this article is to review the causes and dangers of benzodiazepine withdrawal, as well as to present you with options for getting help with benzodiazepine dependence or addiction. However, it is also important to understand what benzodiazepines are and the effects that they have on people who take them.

Benzodiazepines Explained

Benzodiazepines, sometimes called “benzos,” are a class of prescription sedative-hypnotic drugs that are prescribed to treat anxiety and panic disorder. Some people also take benzodiazepines for insomnia, and the medication may also be prescribed as a muscle relaxant. While benzodiazepines can treat all of these conditions effectively on a short-term basis, they can also be addictive.1

In 2019, results from the National Survey on Drug Use and Health (NSDUH) indicated that 4.8 million Americans over the age of 12 had used a benzodiazepine for nonmedical purposes in the past year. Further evidence of how addictive benzodiazepines can be is that the survey also estimates that 681,000 people age 12 or older in the United States met the criteria for prescription tranquilizer or sedative use disorder in the past year.2

The following, while not a comprehensive list, are the most commonly prescribed benzodiazepines according to the U.S. Drug Enforcement Administration. They include: Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam), and Restoril (temazepam)3

Effects & Withdrawal Symptoms of Benzodiazepines

Benzodiazepines affect the central nervous system, increasing the effects of the inhibitory neurotransmitter known as GABA. This results in a person experiencing a sensation of calmness and sedation, resulting in feeling more relaxed, less anxious, and increased drowsiness.1

When people use benzodiazepines, even under a doctor’s care, they can develop a tolerance, which means that they will require increasingly larger doses to achieve the desired effects. With escalating use and at higher doses, a person may find that they require the drug to feel and function normally. This indicates the development of dependence which, once established, may result in a person experiencing symptoms of withdrawal should they stop taking the medication.

Long-term, compulsive, or otherwise problematic use of benzodiazepines can lead to significant physical dependence and a higher risk of experiencing severe withdrawal symptoms, which may include seizures and hallucinations.1 Supervised medical treatment is usually recommended for people who are undergoing benzodiazepine withdrawal after a period of consistent use.4

The length of time that you have used benzodiazepines, how high a dose you usually take, your overall health, and the presence of co-occurring mental health conditions are all factors that can impact how serious your symptoms of withdrawal might be.4

Dangers of Benzodiazepine Withdrawals

When a person discontinues using benzodiazepines, they may experience withdrawal symptoms including abnormal involuntary movements, anxiety, blurred vision, memory problems, irritability, insomnia, muscle pain and stiffness, panic attacks, and tremors.

Many people ask if they can die from benzodiazepine withdrawal. Although death from withdrawal is rare, there is the potential for more severe withdrawal symptoms such as seizures, hallucinations, and delirium, which can be problematic.5 Withdrawal severity can be hard to predict, as there are many contributing factors, including the type of benzodiazepine taken, the duration of use, dose amount, other medical or mental health conditions, and polysubstance abuse such as the combined use of benzodiazepines with alcohol and/or opioids.1,4,6,7

Can I Detox from Benzodiazepines Safely at Home?

If you feel that you need a benzodiazepine detox, you should discuss your situation with your doctor rather than attempting to withdraw on your own at home. It’s generally recommended a person have medical oversight when going through benzodiazepine withdrawal to avoid potentially serious complications such as seizures and hallucinations.4,8 It can be hard to predict the severity of withdrawal symptoms.9

Benzodiazepine Withdrawal Treatment

Your options for treatment typically include detox followed by ongoing treatment either inpatient, outpatient, or a combination of both.4

  • Inpatient treatment provides you with 24/7 supervision. After benzo detox, you will typically undergo individual counseling and group therapy which will help to modify thoughts and behavior that fuels addiction, as well as increasing skills to better cope with life’s stressors.4 Detox only gets the benzodiazepines out of your body; detox paves the way for long-term addiction treatment and is generally not considered sufficient to support long-term abstinence.10
  • Outpatient treatment for people who complete a benzo detox may take place in a program where you go for 2 or 3 hours a day, 2 or 3 times a week.4 You receive similar assessments, medical supervision, and individual and group therapy that you would get in an inpatient program.4 The difference is that you would go home at night and on the weekends, allowing you to go about your regular routine. Sometimes people step down to outpatient treatment after making progress with inpatient treatment. For other people, typically those with a mild benzo use disorder, outpatient treatment may be the first step.4

Many factors determine whether inpatient or outpatient benzo detox and treatment is best for you, and a thorough evaluation or assessment from a physician can help with treatment recommendations and decisions.4

Much of the decision depends on how severe your benzodiazepine addiction is. If you have used benzodiazepines at higher doses and for a substantial length of time, you may be at risk for more severe withdrawal symptoms, and your safest option may be to manage your benzo withdrawal in a detox clinic or inpatient treatment program where you can have 24/7 care.4 People who have a more mild or even moderate physical dependence on benzodiazepines may be able to detox on an outpatient basis while being closely monitored by a doctor.4

It is not recommended that a person who has consistently used benzodiazepines detox without the supervision of a physician. There are many factors that can increase a person’s risk of experiencing seizures and other potentially dangerous withdrawal symptoms or complications.4

1. National Institute on Drug Abuse. (2020). What classes of drugs are commonly misused: CNS depressants.
2. Center for Behavioral Health Statistics and Quality. (2020). Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health.
3. Diversion Control Division, U.S. Drug Enforcement Administration. (2019). Benzodiazepines.
4. Substance Abuse and Mental Health Services Administration. (2015). TIP 45:Detoxification and substance abuse treatment..
5. Longo, L. P., & Johnson, B. (2000). Addiction: Part I. Benzodiazepines—Side effects, abuse risk and alternatives. American Family Physician, 61(7), 2121–2128.
6. de Wet, C., Reed, L., Glasper, A., Moran, P., Bearn, J., & Gossop, M. (2004). Benzodiazepine co-dependence exacerbates the opiate withdrawal syndrome. Drug and Alcohol Dependence, 76(1), 31–35.
7. U.S. Food and Drug Administration. (2020). FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class.
8. Gold, J. (2020). Approaches to managing benzodiazepines. Pharmacy Today, 26(3), 41-54.
9. Votaw, V. R., Geyer, R., Rieselbach, M. M., & McHugh, R. K. (2019). The epidemiology of benzodiazepine misuse: A systematic review. Drug and Alcohol Dependence, 200, 95–114.
10. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). Principles of Effective Treatment.