How To Safely Taper Off Of Benzodiazepines

Getting off benzodiazepines after taking them regularly for a long time can be a very difficult thing to do, especially if you’ve become dependent on them through substance use disorder.

Benzodiazepines can be addictive and habit-forming. Getting off them completely may take some time and may require what’s known as a tapering process.

Tapering off benzos can be safely accomplished with a primary care doctor or through an addiction treatment center.

What Does Tapering Off Benzodiazepines Mean?

Tapering is a process that involves gradually reducing how much of a drug you take over a period of time. For instance, over the course of several weeks, or potentially several months.

This is different from a rapid discontinuation, where you stop taking a drug all at once. Abruptly stopping benzodiazepines after physical dependence has developed can cause life-threatening withdrawal, including grand mal seizures. Never stop taking benzodiazepines abruptly without medical guidance.

Tapering off a benzodiazepine dose may be recommended if you:

• have taken a benzodiazepine regularly for at least several weeks
• have benzodiazepine dependence from long-term use
• have a history of substance use disorder
• have previously attempted detox
• have co-occurring medical or mental health conditions
• have other risk factors for severe benzodiazepine withdrawal

Which Benzodiazepine Drugs Require Tapering?

Benzodiazepines are a class of central nervous system (CNS) depressants. They are sometimes prescribed by primary care providers for anxiety disorders, panic disorder, or insomnia.

Common benzodiazepine drugs you may need to taper off of include:

• alprazolam (Xanax)
• lorazepam (Ativan)
• clonazepam (Klonopin)
• diazepam (Valium)
• temazepam (Restoril)
• chlordiazepoxide (Librium)
• triazolam (Halcion)

These drugs are prescription-only for the treatment of certain mental health and medical conditions. They are not available over-the-counter but can be bought and sold illicitly.

Pharmacists, clinical prescribers, and other healthcare providers — such as a mental health counselor or psychiatrist — may be involved in the legal prescription and dispensing process.

How Does Tapering Off Benzodiazepines Work In Addiction Treatment?

Although they are legally prescribed for certain health conditions, benzodiazepines can become addictive through a pattern of chronic drug misuse.

If you do develop physical dependence through long-term use of benzodiazepines, a doctor will likely create a tapering schedule as part of your treatment plan.

The Ashton Manual, a widely referenced clinical guide developed by Professor C. Heather Ashton, provides detailed protocols for benzodiazepine tapering and is available free online.

Here’s how the process of tapering off benzodiazepines in addiction treatment may work:

Assessing Your Physical And Mental Health Needs

First, a clinician will ask you questions about your drug use history. They will also perform both a physical and mental health assessment to determine a suitable tapering plan.

A doctor will likely ask you questions about:

• your initial dose and current drug dosage
• how frequently you take benzos
• use of other drugs (e.g. opioids, other sedative-hypnotics)
• your medical history
• current/previous mental health diagnoses
• if you’ve tried detoxing from benzos before
• how long you’ve been taking benzos

Creating A Tapering Schedule

Once a doctor has gathered the information they need, they will go about creating a personalized tapering schedule and addiction treatment plan that’s informed by your specific healthcare needs.

A slow taper, taking place over the course of several weeks or months, may be required if you’ve been taking benzodiazepines for a long time and/or have been taking high doses.

This is to increase safety and help prevent the development of severe withdrawal symptoms, such as seizures, abnormal changes in heart rhythm, or psychosis.

Medical Treatment For Benzo Withdrawal

The early days of benzodiazepine detox and withdrawal can be highly uncomfortable, even with a taper. You may experience greater anxiety, depression, or a relapse of other symptoms.

To help ease the physical and/or psychological distress that can occur from discontinuing benzodiazepine use, certain adjunctive agents, or medications, may be provided.

Common treatments for symptoms of benzodiazepine withdrawal include:

• trazodone (for anxiety, insomnia, or depression)
• buspirone (a non-benzo medication for anxiety)
• hydroxyzine (a non-benzo medication for insomnia)
• clonidine (can help with diarrhea, nausea, anxiety, insomnia, and other symptoms)
• carbamazepine (an anticonvulsant that can treat seizures)
• other antidepressants or neuroleptics

In addition, if you’re dependent on a benzodiazepine with a short half-life, like triazolam, a doctor may switch you to a benzo with a long half-life, such as diazepam, during your taper.

This can help reduce discomfort and may help prevent the development of severe withdrawal symptoms.

Emotional And Behavioral Support During The Tapering Process

An effective treatment plan for benzodiazepine addiction will typically include both medical and behavioral health treatments.

This can help address the root causes of your mental health and/or substance use issues.

Treatment interventions for benzodiazepine addiction may include:

• cognitive behavioral therapy
• individual and group therapy
• psychiatry services
• skills development (including relapse prevention)
• aftercare planning (including follow-up)

How Long Does Benzodiazepine Withdrawal Last?

The timeline for a benzo taper can depend on a range of factors, including personal factors related to your substance use and overall health status.

A rapid taper can take place over the course of several days to several weeks. However, a slow taper, for chronic drug dependence, may involve gradual dose reductions over several months.

Some people experience protracted withdrawal symptoms, including anxiety, insomnia, and cognitive difficulties, that persist for months after completing a taper. This is sometimes called post-acute withdrawal syndrome (PAWS). Symptoms typically improve gradually over time with continued support.

What Are The Risks And Dangers Of Benzo Withdrawal?

Benzodiazepine withdrawal, like alcohol withdrawal, can be potentially life-threatening if certain precautions aren’t taken during the early stages of withdrawal.

Without a taper, severe benzo withdrawal can cause life-threatening grand mal seizures.

Other possible complications of benzodiazepine withdrawal may include:

• delirium (loss of touch with reality)
• hallucinations
• panic attacks
• thoughts of suicide

What Is The Best Way To Get Off Benzos?

The safest way to get off benzodiazepines once dependent is to find a benzodiazepine detox program or an inpatient treatment center that offers detox services.

You can also taper off benzodiazepines while attending an outpatient drug rehab program. An acute inpatient stay may be recommended if you have severe drug dependence.

Inpatient medical detox can offer:

• increased safety
• 24/7 medical monitoring
• medication for the short-term effects of benzo withdrawal

A detox program, or treatment facility that offers detox, can also help create a tapering schedule, based on your substance use history, overall health status, and other relevant factors.

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Written by the Addiction Resource Editorial Staff