Oct. 16, 2019
Overcoming benzodiazepine addiction can be harder than quitting heroin! Everyone knows how terrible heroin withdrawal is but not many know that benzodiazepine withdrawal can be even worse. Benzodiazepines (or benzos) are some of the most prescribed medicines for insomnia and anxiety. You might think that since doctors prescribe benzodiazepines1, they can’t be too bad, right? Sadly, they are among the most abused medications by patients, alongside opioids. Many people who end up addicted to benzos start taking these drugs because their doctors told them to do so2. Problematic use rates are increasing worryingly quickly. So much so, that benzodiazepines are seen by some as the next prescription drug epidemic3. Make sure you stay safe when taking benzos and check our new guide on them (out soon!).
How addictive are benzos really?
We tend to use addiction and dependence interchangeably, but they aren’t quite the same thing. You can be physically dependent on a drug, but not be addicted to it. Addiction is a more complex phenomenon affected by social, psychological, economical and genetic factors. In the case of benzos, your body gets used to the presence of the drug very quickly, much quicker than many other drugs, and thus suffers greatly in the absence of it. Anyone who has taken benzodiazepines for 3–4 weeks or longer is likely to be dependent on the drug and may experience withdrawal symptoms if they stop taking it suddenly4. Avoid taking benzos recreationally on a daily basis (or just too often in general). Benzodiazepines are a large family of drugs, all with varying strengths and durations of action. As a general rule, the stronger and shorter its action is, the more addictive it becomes. For example, alprazolam, also known as Xanax, is more addictive and has worse withdrawal symptoms than diazepam (Valium). The risk of benzo dependence also increases if you are dependent on alcohol or other sedatives5. This is because of the similar way that they work in the body! If you are already using benzos or considering taking some, you might be curious about what to expect when you want to or need to stop taking them.
How bad is benzodiazepine withdrawal?
Withdrawing from benzos is a very long and difficult process once you become dependent (usually several months!). It involves challenging symptoms that you’ll have to manage every single day of that period6. Everyone’s experience is different as many factors affect how your body responds to the absence of the drug. Some of these factors are how long you have used benzos for, the dosage, the type of benzodiazepine, how quickly you reduce the dose and your psychiatric history7. Generally, the risk of having withdrawal symptoms increases if you are using a high dose and taking it for a long time8. The withdrawal symptoms are also more severe for short-acting benzodiazepines5.
Common withdrawal symptoms are anxiety, tension, insomnia, irritability, panic attacks, sweating, poor concentration, headache, muscular pain and stiffness, hand tremor, and nausea. However, this list isn’t exhaustive, and there are many other symptoms as benzodiazepines work everywhere in the nervous system.
There are three main phases of benzo withdrawal5:
- The short-lived “rebound” anxiety and insomnia, which starts within 1-4 days of quitting and is more severe for short-acting drugs.
- The full-blown withdrawal syndrome, which lasts 10-14 days.
- The return of anxiety which lasts until some sort of treatment is received.
You might be using benzos to self-medicate or mask other problems. These problems can resurface in the third phase of withdrawal once you stop taking the drug. They might be related to mental health disorders which won’t go away by themselves until you address the underlying causes. It’s really worth seeking professional medical/mental health help to properly recover from benzo dependence/withdrawal. What if you already feel dependent or addicted to benzodiazepines, and are looking into quitting?
How to quit benzos
Quitting benzos is a daunting and challenging task. Once you stop taking them regularly, you will start feeling the withdrawal effects which can be very uncomfortable. That’s why how you quit really matters. You should be very careful if you’ve been using benzos for more than a month because going cold turkey can cause life-threatening seizures4, and even death9 (although these are extreme cases). Therefore, it’s crucial that you reduce your dose gradually and get psychological support if possible. This doesn’t have to be professional, your support network (e.g. friends and family) are a vital component of this. General encouragement from your friends or family along with learning of non-pharmacological ways of coping with stress and anxiety can make a big difference in relapse9.
The whole process of tapering off benzo use may take weeks to months! There are no standard tapering rules and the rate of tapering depends on how high the starting dose is4. For example, tapering is more rapid at doses higher than 10mg diazepam or equivalent, but much slower at lower doses4. Unfortunately, no drugs have been proven to alleviate withdrawal symptoms7,10, so self-medicating with either licit or illicit drugs is unlikely to be helpful.
Is it worth it?
Benzos have become a fairly common recreational drug, probably in part due to the rise in prescribing, which will have driven black market resale. They’re also often taken in combination with other drugs, most worryingly with alcohol and other depressants, which massively increases the risk of overdose and death. Alcohol and benzos also tend to lead to large blackouts, sometimes whole days or more, with concerning testimonials. Benzos are a very addictive class of drugs and it can be easy to fall into bad patterns of use. When it comes time to try to quit, it can seem an insurmountable task, be careful!
This post was created for informational purposes and is not a substitute for professional medical advice. If you plan on using benzos check out our benzos harm reduction guide to learn about the experience, dosage, legality and more. All drugs pose risks, and the best way to avoid them is not to take any, but we understand that individuals still choose to, so Drugs and Me exists to provide information about drugs to help reduce their harms. Drugs and Me is, and will always be freely accessible, and strives to be objective, unbiased, and base itself on the best evidence available. Our work is fuelled by volunteers and we’ve chosen to not have any ads, so we rely heavily on your support. Why not become a patron today, or if you prefer, make a one-off donation. If you like this post, please share it on social media using the buttons below!
This post was written by Arda, who started as a researcher and analyst for Drugs and Me, working on our first ever survey. She’s now our Director of Strategy at the Alcohol and other Drugs Education Consultancy, helping organisations get their internal drug policies right.
- Steep Climb In Benzodiazepine Prescribing By Primary Care Doctors [Internet]. NPR.org. [cited 2019 Sep 28]. Available from: https://www.npr.org/sections/health-shots/2019/01/25/688287824/steep-climb-in-benzodiazepine-prescribing-by-primary-care-doctors
- Doctors, Patients Struggle with Benzodiazepine Use [Internet]. [cited 2019 Sep 28]. Available from: https://www.webmd.com/mental-health/addiction/news/20190516/doctors-patients-struggle-with-benzodiazepine-use
- Dangers of rising benzo prescriptions raise alarms of next drug crisis [Internet]. [cited 2019 Sep 28] Available from: https://www.nbcnews.com/health/health-news/dangers-rising-benzo-prescriptions-raise-alarms-next-drug-crisis-n895361
- Brett J, Murnion B. Management of benzodiazepine misuse and dependence. Aust Prescr. 2015 Oct;38(5):152–5.
- Pétursson H. The benzodiazepine withdrawal syndrome. Addict Abingdon Engl. 1994 Nov;89(11):1455–9.
- The daily cycling of symptoms [Internet]. [cited 2019 Sep 28] Available from: https://benzowithdrawalhelp.com/recovery/the-daily-cycling-of-symptoms/
- Ashton H. The treatment of benzodiazepine dependence. Addict Abingdon Engl. 1994 Nov;89(11):1535–41.
- MacKinnon GL, Parker WA. Benzodiazepine withdrawal syndrome: a literature review and evaluation. Am J Drug Alcohol Abuse. 1982;9(1):19–33.
- Lann MA, Molina DK. A fatal case of benzodiazepine withdrawal. Am J Forensic Med Pathol. 2009 Jun;30(2):177–9.
- Challenges of the pharmacological management of benzodiazepine withdrawal, dependence, and discontinuation [Internet]. [cited 2019 Sep 28]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896864/