Benzodiazepine Detox

Withdrawal symptoms can include serious physical and mental health complications that can even potentially be life-threatening. Benzo detox is optimally managed under the care and supervision of trained professionals. 

Benzodiazepine Dependence

Benzodiazepine medications include anti-anxiety drugs, sedatives, tranquilizers, and sleep aids. Common benzodiazepines include Xanax (alprazolam) and Valium (diazepam). 

These medications are extremely habit-forming. They can lead to physical dependence even when taken as directed through a doctor’s prescription. 

We’ve long known that benzodiazepines can be dangerous, but in September 2020, the U.S. Food and Drug Administration (FDA) made the risks clearer. The FDA required a black box warning for benzodiazepines, warning of the potential for physical dependence, misuse, and the hazards of stopping these medications suddenly. The warning also describes problems people might experience (such as overdoses) if they use benzodiazepines with substances like opioids.

Benzodiazepine Abuse: How to Tell if You Have a Problem

Benzodiazepines are central nervous system depressant medications that can make you feel relaxed and sleepy as well as ease anxiety and stress. Because of this, they are commonly misused. 

Any use of a benzodiazepine medication without a prescription, or in a way other than it is prescribed, is considered abuse. In 2021, nearly 4 million people in the United States misused prescription benzodiazepines.

Some signs that you have a problem with benzodiazepine abuse can include the following:

• Taking more of the medication at a time than prescribed or intended
• Inability to stop taking benzos even after trying
• Taking the medication in between doses or after a prescription has run out
• Needing to take more of the medication to feel its effects (tolerance)
• Spending a lot of time thinking about taking benzos, taking them, and recovering
• Altering the medication and taking it in a way it was not intended (chewing it, snorting it, smoking it, or injecting it)
• Losing interest in doing things that do not involve using the drug
• Continuing to take benzodiazepines even though doing so is causing social, emotional, and/or physical problems
• Withdrawal symptoms set in when the medication wears off or you stop taking it (dependence)
• Increased risk-taking behaviors while using the drug
• Neglecting responsibilities at home, work, or school

Key Facts About Benzodiazepine Detox

Benzodiazepine detox is the management of withdrawal symptoms after a drug dependence has formed. This can occur in as little as two weeks of taking a benzodiazepine, even with a valid and necessary prescription. 

The more and longer you take a benzodiazepine, the more significant the withdrawal symptoms will be, and the more care and support will be necessary during detox. 

When benzodiazepine dependence is significant — when you have been taking a lot of benzos for a long time, mixing them with other drugs or alcohol, also have a mental health or underlying medical condition, or you abuse benzos — you should not attempt benzodiazepine detox at home on your own. Instead, you should seek out a professional detox center or treatment facility.

Benzodiazepine detox will often include the following:

• Medical supervision and care
• Medications
• Management of withdrawal symptoms
• Supportive care

How Long Does It Take to Detox From Benzodiazepines?

Benzodiazepine detox can vary from person to person for a variety of reasons. This can include personal metabolism, significance of benzodiazepine dependence, presence of underlying medical or mental health conditions, whether or not the drug was taken with other substances, and the type of benzodiazepine used. 

There are both short-acting and long-acting benzodiazepines. Withdrawal symptoms for short-acting benzos are going to start sooner than they will with long-acting benzodiazepines. 

This is due to the half-life of the medication. The shorter the half-life, the quicker the drugs will take effect, but also the faster they will process out of the body and the faster withdrawal symptoms will start. 

These are common short-acting benzodiazepines:

• Xanax (alprazolam)
• Restoril (temazepam)
• Halcion (triazolam)
• Ativan (lorazepam)

These are common long-acting benzodiazepines:

• Valium (diazepam)
• Klonopin (clonazepam)
• Librium (chlordiazepoxide)
• Dalmane (flurazepam)

What Does a Benzodiazepine Taper Look Like?

Quitting benzodiazepines abruptly can lead to serious health problems, including seizures. Tapering doses can help your brain adjust to sobriety slowly, and it can be a safer option.

Every taper schedule is different, as doctors individualize their doses. This example of a lorazepam taper can help you understand how the process might work:

Medical teams will monitor your progress during the taper and ensure you’re feeling safe and comfortable. If discomfort appears, your taper schedule may be too aggressive. Moving slower might be smart. Talk to your doctor about your symptoms, so they can adjust your dosage appropriately.

What Does Benzodiazepine Detox Involve?

It’s critical for anyone with a benzodiazepine abuse problem to get help from qualified professionals. A treatment program can help you get sober safely.

A benzodiazepine detox program typically involves the following steps:

1. Enrollment: You’ll talk with an intake professional about your benzodiazepine use, your prior attempts at sobriety, and your insurance coverage. At the end of this call, you’ll be ready to enter the program.
2. Assessment: You’ll meet with a team who will assess your physical and mental health. Together, you’ll create a detox plan that seems right for you.
3. Medication management: Your team will taper your benzodiazepine dose or provide other therapies to help your mind and body adjust to sobriety.
4. Monitoring: Your team will ensure your program is progressing nicely without significant physical or mental health symptoms.
5. Transition: When you’re feeling stronger in sobriety, you’ll move to another phase of care. In treatment, you’ll learn how to build a healthier life and reduce your relapse risks.

Typical Detox Timeline

A typical benzodiazepine detox timeline can look like this:

• 8–48 hours after stopping the medication: With short-acting benzodiazepines, you can start to experience withdrawal symptoms within 8 hours after the last dose. With longer-acting benzos, it can take 24 to 48 hours for withdrawal to start after stopping them.
• 1–4 days: Usually, withdrawal symptoms will peak in the first few days, and this often requires medical management of mental and physical symptoms during detox. This is generally when things are most severe, and it is considered acute withdrawal.
• 1–2 weeks: During this time, withdrawal symptoms will generally begin to wane and start to taper off. Medications and supportive care can be helpful to manage lingering sleep issues, anxiety, and drug cravings during detox. You can often transition from a detox center to a treatment facility after this time.
• 1 month: With long-acting benzodiazepines, some of the withdrawal symptoms can take longer to taper off. They may continue for as long as four weeks, requiring more close monitoring and care during detox.
• 2–6 months: After the initial withdrawal and detox, some people can still experience lingering side effects, including sleep disturbances, anxiety, depression, cravings, and cognitive issues. This can continue for a few months and will benefit from supportive care.

Is Detox From Benzodiazepine Dangerous?

When drug dependence is significant, detox from benzodiazepines can be potentially fatal if the medication is stopped suddenly. While benzodiazepine withdrawal symptoms typically start within 24 hours after the last dose of the medication, they can also take up to two weeks to develop, making detox even more potentially dangerous.

Benzodiazepine withdrawal can cause delirium and seizures. In those with a mood disorder, it can also potentially trigger catatonia. 

For these reasons, benzodiazepine medications are not recommended to be stopped cold turkey. Instead, they are often tapered off slowly to minimize the withdrawal symptoms. 

Benzodiazepines are central nervous system depressants that suppress life-sustaining functions, such as heart rate, blood pressure, and body temperature. When these functions are no longer lowered by these medications after they process out of the body, and the body is used to them doing so, they can rebound strongly, causing serious medical and mental health issues. 

What Are the Symptoms of Benzodiazepine Withdrawal?

Some of the most common symptoms of benzodiazepine withdrawal are rebound anxiety and insomnia. Since these drugs are often taken to manage anxiety or sleep issues, when they are stopped suddenly, these issues can return in full force. 

Severe benzodiazepine withdrawal can be life-threatening, triggering delirium and seizures. 

Additional symptoms of benzodiazepine withdrawal can include the following:

It is usually recommended to detox from benzodiazepines under the supervision and direction of trained professionals.

• Headache
• Sweating
• Tremors
• Rapid heart rate
• Increased blood pressure
• Muscle tension and spasms
• Abdominal cramps
• Vomiting and nausea
• Hypersensitivity
• Difficulty concentrating and focusing
• Anxiety and depression
• Panic attacks
• Insomnia
• Drug cravings

Why Is Detox Necessary for Recovery?

The initial goal of benzodiazepine detox is to achieve physical stability. The brain is changed with regular benzodiazepine use. It can take some time for it to reset and for bodily functions to normalize. 

During this time, mood swings, cognitive issues, mental health issues, and even suicidal ideations are possible. It is important to have support and professional management for benzodiazepine detox.

Detox can allow your brain the time it needs to stabilize and heal, which is necessary for recovery. It can be difficult to stop taking benzodiazepines without professional help due to the intensity of the withdrawal symptoms. Cravings and negative physical and mental health symptoms can encourage relapse. 

Detox can allow benzodiazepines to process safely out of the brain and body in a supportive environment. You can then focus on positive lifestyle changes and building new healthy habits to sustain recovery.

Tips to Help Detox From Benzodiazepines

How to detox from benzodiazepines depends on the level of dependency and the severity of withdrawal. Moderate to significant dependence to a benzodiazepine will require medical management, monitoring, and intervention. 

For mild dependence, consider these tips during detox:

• Talk to your doctor about lowering your dose of a benzodiazepine. Do not just stop taking them cold turkey. Taper off them slowly in a controlled fashion as directed by your doctor.
• Consider switching to a long-acting benzodiazepine medication for the taper period. 
• Discuss all withdrawal symptoms with your doctor and use adjunctive medications when necessary.
• Ensure that you have enough support in your home environment and that your support team understands the symptoms of withdrawal and when intervention is necessary.

How to Detox Safely

It is usually recommended to detox from benzodiazepines under the supervision and direction of trained professionals. Detoxing at home on your own is not generally a good idea. 

Benzodiazepine detox can be difficult and even dangerous without professional help and intervention. There are two main options for detox: a treatment facility or a detox center. 

Treatment Facility

A treatment facility, or rehab center, will offer a continuum of care that can include detox. 

Usually, the detox program is housed separately from the rehab center, and you will spend the first week or two in the detox facility to stabilize during benzodiazepine withdrawal. There, you will receive medical interventions and management for withdrawal symptoms. You will also be monitored around the clock to ensure your safety. 

The goal of detox in this environment is to help you become physically and mentally stable enough to continue treatment. You will also often receive supportive care and can begin some therapeutic interventions before transitioning into the main treatment facility where you will work on making positive behavioral and lifestyle changes to manage stress, triggers, and cravings. You’ll begin to develop new coping mechanisms without drugs. 

This program can last for several weeks, allowing you the chance to solidify healthy habits to sustain a long-term recovery.

Medical Detox

A detox center is often the first place you’ll stay in an addiction treatment program. The professionals at this facility can help to medically manage benzodiazepine withdrawal. 

Similar to the detox component of a treatment facility, a detox center will be set up to provide 24/7 medical monitoring and necessary interventions during acute withdrawal to help keep you safe and manage the side effects of withdrawal. 

Medications, supportive care, and therapeutic interventions are all involved through a professional care team that will include both medical and mental health professionals. Typically, after spending some time in a detox center, you will transition to an inpatient or outpatient rehab facility.

Comfort Medications for Benzodiazepines

Benzodiazepine detox is best managed with professional help. During acute withdrawal, this can include medical monitoring and pharmaceutical management of withdrawal symptoms. 

Generally, in these programs, a tapered approach is employed where doses are gradually lowered over a period of weeks or months. Short-acting benzodiazepines may be replaced with longer-acting medications, so they stay active in the body longer with fewer doses.

Medications used during detox for benzos are typically aimed at minimizing specific withdrawal symptoms. These medications may be used:

• Anticonvulsants to reduce seizures
• SSRI antidepressants for mood stabilization
• Beta blockers for physical symptoms like tremors
• Anti-nausea medication for stomach upset
• Clonidine to help regulate the central nervous system

Additionally, other medications are being studied for their effectiveness and safety, including gabapentin as an anxiolytic medication to be used off-label to calm the central nervous system.

What to Look for in a Detox Center for Benzodiazepines

A detox center should feel safe and comfortable, as it provides you with a supportive and medically monitored environment. It is important that it is staffed with trained medical and mental health professionals that will be able to optimally manage benzodiazepine withdrawal symptoms and potential complications. 

If you also have mental health or medical concerns, it is vital that dual diagnosis treatment is offered as well. If you need medications for any co-occurring disorders, this can also be managed in a comprehensive detox center. 

Look for a detox center that will work with you financially. These facilities often accept insurance. Many will set up a payment plan to make the out-of-pocket costs more manageable.

It can be helpful to choose a detox center that will help you transition seamlessly into a residential treatment center when the time is right. Drug detox alone is not considered a treatment for drug dependence and addiction. The National Institute on Drug Abuse (NIDA) recommends a comprehensive treatment program, including the use of medications during detox to minimize relapse. 

The Importance of Supported Detox

Detox is an important aspect of addiction treatment and recovery, offering a high level of professional care that can ensure your safety and well-being. While it isn’t enough on its own, detox will help you to stabilize physically and mentally, so you can proceed into the deep work of recovery in ongoing therapy.  

Benzodiazepine detox can be hazardous and even fatal when attempted at home. Because of the risks, it should be managed through a specialized detox center or facility that can provide you with encouragement, medical monitoring, therapeutic interventions, and supportive care.

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More