Benzo Withdrawal Symptoms

Understanding the Withdrawal Time for Benzodiazepines

As a general rule, withdrawal symptoms for benzos will begin within 24 hours and can last for a few days and up to several months, depending on how long the abuse went out and the strength of the drug that was used. Extended withdrawal is not uncommon, though. Roughly 10 percent of individuals who abuse benzodiazepines will continue to feel withdrawal symptoms for years after stopping the drugs.

There isn’t a specific timeline that dictates the length of time a person will experience withdrawal from benzos. While each person will experience the withdrawal differently, it is possible to make certain estimations. Benzo withdrawal intensity and duration depends upon several different factors, including the following:

  • Type of drug used
  • Dosage amount
  • Length of time taking the drug
  • Method used to take the drug
  • Abuse of other drugs/alcohol at the same time
  • Underlying mental health or medical issues

According to the Drug Enforcement Administration (DEA), benzos are considered Schedule IV controlled substances. These drugs are tranquilizers and sedatives that are commonly prescribed to treat symptoms of anxiety, panic attacks, insomnia, muscle tensions/spasms, and seizure disorders. Common benzos include Xanax (generic name: alprazolam), Klonopin (generic name: clonazepam), Restoril (generic name: temazepam), Ativan (generic name: lorazepam), and Valium (generic name: diazepam). Alprazolam (Xanax) was the 13th most popular prescribed medication in the U.S. in 2012, according to one survey.

Benzos are taken regularly recreationally and they are abused for nonmedical purposes. In addition, they are being taken as prescribed medications.

Understanding the Onset of Withdrawal

Please note: It is not intended for benzodiazepines to be taken long-term due to the fact that extended use or abuse can result in the brain becoming both psychologically and physically dependent on the drugs.

Withdrawal symptoms, which can range from anything like physical manifestations like nausea and diarrhea to uncomfortable psychological symptoms, can occur once the drugs have been removed from the person’s bloodstream. A history of drug dependency in the family or any previous issues of substance abuse or dependency could increase the chances of a dependency developing in relation to a benzo and could also possibly add to the timeline duration for withdrawal.

Benzo drugs have a certain half-life that affects the duration it takes for the medication to leave a person’s bloodstream. If a person is dependent on the drug, as soon as it is purged from the body, it is possible for withdrawal to start. For short-acting benzodiazepines such as Xanax, withdrawal can start as soon as 10-12 hours after the last dose is taken. For longer-acting benzos like Valium, it can take symptoms a few days to appear. The withdrawal side effects aren’t usually lethal, but they are better managed under the medical attention and supervision of health care professionals.

Those taking benzodiazepines for numerous months or longer and in higher doses are more likely to experience longer-lasting symptoms than individuals that are taking the drugs for smaller doses for a shorter period of time. For instance, the FDA reports that individuals taking 4 mg per day or more of Xanax for more than three months were more at risk of dependency and more likely to experience more discomfort in terms of withdrawal symptoms than individuals who were taking smaller doses of Xanax for a shorter duration.

Some of the shorter-acting benzos such as Xanax are often considered more potent than some of the longer-acting like Valium. The withdrawal is comparable for both of them, but individuals who use the short-acting benzo medications may undergo more intense symptoms and much sooner since benzodiazepines with longer half-lives remain in the bloodstream longer, thereby slowing down the onset of the withdrawal symptoms.

Regardless of the type, benzos are designed to be depressants of the central nervous system, though each one works slightly differently and targets specific symptoms. For instance, Dalmane, Halcion, and Restoril are considered mainly hypnotic benzo medications that are prescribed for insomnia, whereas Ativan, Librium, Valium, and Xanax are considered anxiolytics and are prescribed primarily for anxiety-related symptoms. Then, Klonopin is considered mainly an anticonvulsant. There are various metabolites of these drugs that cause them to be somewhat different, which can also impact how quickly the drugs leave the body. Withdrawal from different benzos is often thought to cause the same overall symptoms; however, it’s possible that a person that is withdrawing from a hypnotic  will experience sleep patterns that are more disruptive while an individual withdrawing from an anxiolytic will experience much higher anxiety levels.

The onset of withdrawal is also related to the way that the drug is ingested. For example, when the drug is injected or snorted, the drug is sent straight into the bloodstream, causing the drug to take a near instantaneous effect. If the drug is ingested orally like a pill, then it must be digested through the digestive tract, creating a less intense high and a slower start of the withdrawal symptoms.

Poly-Drug Abuse

Benzos are often abused regularly in conjunction with alcohol and/or other drugs. When this occurs, it is known as poly-drug abuse, and it can influence with severity and timeline of the withdrawal process. The Treatment Episode Data Set (TEDS) report from 2011 reported that 95 percent of individuals who were admitted into a drug treatment facility for dependency or abuse of benzodiazepines also abused alcohol or another drug at the same time. When other illicit substances are abused, it can increase the number and type of withdrawal symptoms that an individual experiences.

It is not recommended for an individual to stop taking benzodiazepines abruptly “cold turkey” without being under the supervision of a medical professional. Instead, it is recommended to undergo medical detox. Medical detox typically involves tapering off of the benzos with professional medical assistance and support. Apart from making certain that patients are safe throughout the entire process of detoxification, health care professionals can also assist in the alleviation of uncomfortable withdrawal symptoms. In many cases, medical detox can consist of substituting a long-acting benzo with a short-acting on during the weaning process to reduce the withdrawal symptoms and make the process a bit smoother for the patient. There are other medications that can also be prescribed during the detoxification process to treat certain symptoms, such as flumazenil. Research is ongoing and looking for new ways to ease the withdrawal process for benzodiazepines.

Phases of Withdrawal

There are three primary phases of benzodiazepine withdrawal: early, acute, and protracted withdrawal.

The phase of early withdrawal typically begins within just a few hours to a few days of halting the medications, and the phase can last several days. During this phase, a person may experience insomnia and anxiety symptoms since the brain will begin rebounding without the benzos in the system. Any symptoms that the drugs once suppressed will likely come back in a flooding fashion. The tapering process that is often used during the medical detox can help to diminish the rebound effect.

Several days after stopping a benzo medication, the acute withdrawal phase can start. This second phase makes up the majority of the withdrawal. The symptoms that may be experienced include panic, anxiety, muscle tension or spasms, diarrhea, nausea and/or vomiting, short-term memory impairment, clouded thinking, trouble concentrating, agitation, mood swings, twitching, hallucinations, blurred vision, seizures, and weight loss as a result of a decreased appetite. It’s during this second phase that certain medications can prove to be most beneficial at helping with withdrawal symptoms. During the acute withdrawal phase, suicidal thoughts and subsequent actions may occur, and therapy and support groups may assist in eliminating these emotions. This phase can last anywhere between two weeks to several months.

According to a study that ABC News published, around 10 percent of people can experience the third phase—which is known as protracted withdrawal—that can extend numerous months, possibly even years, after the use of a benzo medication has been stopped.

Individuals could experience prolonged insomnia and anxiety, tingling in their extremities, muscle twitches, and cognitive deficits as well as mood swings and depression that could be hard to manage. These symptoms can randomly appear without any warning at all. Mental health services/support outside of medical detoxification tend to include counseling and therapy to assist in the management of protracted withdrawal symptoms. If there is a mental health disorder present as well, which is known as co-occurring disorders, there is dedicated treatment that is tailored to these types of dual diagnoses that can effective during the recovery process.

Though there isn’t a specific timeline for the withdrawal period from benzos, mental health and medical professionals can assist in significantly reducing the duration and intensity of the symptoms that may be experienced during the medical detox process. As previously mentioned, withdrawal from benzodiazepines should never be attempted on your own and should only be done under the supervision of medical personnel. Medical detox can assist in the safe removal of benzos from the brain and body, and a smooth recovery can be achieved by following up with family and therapy support services.

If you or someone you know has an addiction to benzodiazepines, reach out to us Shadow Mountain Recovery for help.