Benzo Withdrawal: Symptoms, Timeline, & Treatment
When a person develops a dependence on benzodiazepines (benzos), they may develop benzo withdrawal symptoms if they cut back or stop using the benzodiazepine.1 Withdrawal symptoms can range from mild to severe and the withdrawal timeline may involve immediate to lingering symptoms that may last for many weeks or months.2
If you or your loved one is struggling with your use of benzos, you should know that professional detox can ease withdrawal symptoms from benzodiazepines.
What Are Benzodiazepines?
Benzodiazepines are a class of prescription drugs that include such medications as:1
- Ativan (lorazepam)
- Valium (diazepam)
- Klonopin (clonazepam)
- Xanax (alprazolam)
Benzos are widely prescribed for many purposes, including treating insomnia and anxiety, as well as preventing and treating seizures.1
All benzos have the potential for misuse and addiction, even when taken as prescribed.1 Benzos produce feelings of euphoria and relaxation and are often misused in combination with other drugs.1 For example, people often take benzos along with alcohol to enhance the effects of alcohol. People may use Valium or Xanax in combination with methadone, an opioid, to increase its euphoric effects.1
As recently as 2017, there were over 120 million prescriptions written for alprazolam, lorazepam, clonazepam, diazepam, and temazepam.1 An estimated 4.8 million people in the US misused prescription benzos in 2020.4 In addition, around 1.2 million were diagnosed with a benzo addiction.4
What Happens During Withdrawal from Benzodiazepines?
Dependence is a physiological adaptation of the body to a substance, wherein the body becomes so used to the drug being present in the system that when the individual cuts back on their use or quits, withdrawal symptoms emerge. With significant levels of physiological dependence, a person may continue to compulsively drink or use drugs to avoid unwanted withdrawal symptoms.2
Benzo dependence may develop after repeated use, meaning that individuals may feel that they are unable to function normally without the presence of the drug, and may experience certain uncomfortable withdrawal symptoms when not using the drug.2
Over time, benzo dependence may develop as the brain adapts to exposure to the drug.13 When people who are dependent on benzos stop consuming the drug, they may experience withdrawal symptoms.
There is no set amount of time for someone to become dependent on benzos, but it has been recognized that physical dependence that would result in a significant withdrawal syndrome may occur withing 6 weeks of starting benzo usage. When someone uses benzos for a long period of time or uses benzos in excess (using more benzos than prescribed) this can lead to the development of benzodiazepine dependence.12 A study found that those who used alprazolam could experience withdrawal symptoms within 7 days of starting use.2 A study has found that anyone who takes a benzo for more than 3-4 weeks will probably experience withdrawal symptoms if they stop taking it.7
Benzo Withdrawal Symptoms
The symptoms of benzodiazepine withdrawal vary from one person to another. They can be physical and psychological and range from mild to severe.8 It has been estimated that anywhere from 20-30% of people who had an unsupervised withdrawal from benzos and other sedatives experienced a seizure.8
When someone withdraws from a benzo, the severity and number of symptoms they may experience do vary a great deal and can depend on several factors that can include: 6,7
- Severity of physical dependence on benzos.
- Use of other drugs and alcohol.
- Co-occurring medical or mental health disorders.
- Current dosage of benzos.
- Number of previous benzo detox and withdrawal episodes.
- Whether benzos were injected or taken by mouth.
Benzodiazepine withdrawal symptoms are both psychological and physical and can include:8
- Nausea and/or vomiting
- Rapid pulse rate
- Fleeting visual or auditory hallucinations
These unpleasant symptoms of benzo withdrawal are one of the reasons that people find it hard to stop. Individuals who have experienced previous benzodiazepine withdrawals are reluctant to stop taking benzodiazepines due to the unpleasant withdrawal symptoms.9
For most people, withdrawal symptoms of benzos begin around 1-2 hours after the last use of short-acting benzos and around 2-7 days after the last use of long-acting benzos.2 In addition to the common symptoms noted above, some people do develop other symptoms, such as:7
- Ringing in the ear (tinnitus)
- Muscle pain
The most severe, potential outcomes of withdrawal from benzodiazepines include:2
- Suicidal thoughts or actions
It is possible for a person to die during benzo withdrawal, typically if the benzos are suddenly stopped.5
Benzo Withdrawal and Sleep
One of the symptoms that may result during benzo withdrawal is sleep disturbances. These may include sleeplessness and sleep difficulties such as insomnia or strange and disturbing dreams. These sleep disturbances may last longer than 2-3 weeks, when many of the other possible symptoms peak and resolve. With protracted withdrawal, sleep disturbances could last for weeks or even months.2 Though there aren’t enough studies to prove that rebound insomnia occurs with the cessation of benzos, there is a potential that rebound insomnia, a sleep disturbance, may occur with the discontinuation of benzos.
Benzo Withdrawal Timeline
The course of benzo withdrawal is often unpredictable and therefore the benzodiazepine withdrawal timeline can vary from person to person.8,9 Generally, when looking at how long benzo withdrawal lasts, the duration of the benzodiazepine withdrawal timeline, and its severity of symptoms, is influenced by such factors as:8
- Whether short-acting or long-acting benzos were being used.
- The dosage.
- The duration of use.
While everyone is different, in general, the benzo withdrawal timeline can last around 2-4 weeks for people withdrawing from short-acting benzos and 2-8 weeks for those who have been using long-acting benzos.2
First Symptoms of Benzodiazepine Withdrawal
Generally, most people going through a benzodiazepine withdrawal will start to show the first signs of withdrawal approximately 2 days after the last use for short-acting benzos, such as Xanax and Ativan, but it can take as long as 7 days after the last use with long-acting benzos like Valium and Klonopin.2
Protracted Benzodiazepine Withdrawal
Some people experience protracted withdrawal symptoms from benzodiazepines, which can appear around 4-6 weeks after their last use and typically continue for 6-12 months. In some cases, symptoms such as insomnia, anxiety, cravings for benzos, and fatigue can continue up to 2 years after their last use.11 Some studies indicate that around 10-25% of people who used benzodiazepines long-term had symptoms of protracted withdrawal for years.11
Preventing & Treating Benzo Withdrawal
There are various things that people may try to deal with benzo withdrawal on their own, but this may not be recommended. Going through detox and withdrawal with medical support and supervision can make the experience as safe and comfortable as possible. Tips for managing withdrawal on your own may include various recommendations but seeking care and support from a medical provider will provide a greater chance at completing detox and working toward recovery.
Preventing benzo withdrawal symptoms can best be done in a medically monitored detox program where the risk of serious outcomes can be minimized. The symptoms can be managed and treated to keep you comfortable.10 There are some common approaches to how to treat benzo withdrawal that include methods such as tapering. With tapering, a person is given subsequently lower doses of benzos until they are completely weaned off. This typically only works with long-acting benzo.10
Sometimes, if a person is using short-acting benzo, they can be given a substitute of longer-acting benzodiazepine and can be subsequently tapered off.10
Full detox means the substance is completely out of a person’s system. This can take weeks, but the average stay in a detox program is about 7 days.10,12 Detox is the initial stage for treatment and is defined as clearing the body of any misused substances, often under medical supervision to minimize any withdrawal side effects. 10
Ideally, after a person completes detox, they will go on to complete further benzodiazepine addiction treatment. Ongoing treatment can occur in inpatient or outpatient settings, can help prevent relapse, and can help people manage the symptoms of protracted withdrawal.10 Treatment for protracted withdrawal can involve behavioral therapies, as well as self-help groups, to help a person cope with withdrawal and avoid relapse.10
Find Out if Your Insurance Plan Covers Benzodiazepine Addiction Treatment
American Addiction Centers can help people recover from benzodiazepine misuse and substance use disorders (SUDs). To find out if your insurance covers treatment at an American Addiction Centers facility, click here, or fill out the form below. Your information is kept 100% confidential. You can also click here to find a rehab near me. If you or a loved one are struggling with benzodiazepine misuse, We are available 24/7.
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