Basic Benzodiazepine Withdrawal Syndrome Questions

1. Wouldn’t my doctor have told me if my benzodiazepine prescription was dangerous?
Ideally, yes. Each prescription contains a Medication Guide for the patient, which is the basis for what should typically be told to patients. For example, for Xanax®, the Medication guide states, “It is not known if XANAX is safe and effective when used to treat anxiety disorder for longer than 4 months“. But it also states, “Even after relatively short-term use at the doses recommended for the treatment of transient anxiety and anxiety disorder (ie, 0.75 to 4.0 mg per day), there is some risk of dependence.” The “safe and effective” time frame typical of benzodiazepine Medication Guides or Labels is 4 months, although there is ample evidence showing that physiological dependence to benzos can develop in as little as 2 weeks. Depending on the source, prescription guidelines advise the restriction of benzo prescription to 2-6 weeks.  In addition, many patients are prescribed benzos well beyond the 4 month “safe and effective” period, some for years, without being told of the risks.

2. What are my chances of becoming physiologically dependent on benzos?
Various studies have been done on benzodiazepine dependency rates, but they rarely agree with one another. Most of them also include hefty caveats on their numbers and on the type of information presented. These studies almost always focus on long-term use of benzos, which is variously defined, but usually over 6 months. They typically show between 15% and 54% of benzo users becoming physiologically dependent. A report commissioned by the American Psychiatric Association states that 50-65% of long-term benzodiazepine users experience recurrent anxiety, and among panic disorder patients recurrence may be as high as 95%.^[1]

3. How long do I have to take a benzo to become physiologically dependent?
A review of the medical literature on benzos and the various support sites for benzo withdrawal yields a high percentage of withdrawal sufferers who have been prescribed benzos for a period typically longer than two weeks.  A small percentage of patients who have taken their prescription for less than two weeks also become physiologically dependent and go through withdrawal upon removal of the drug. It is also possible to become physically dependent through a process known as “kindling“, where repeated cycles of small doses of benzos followed by abstinence result in increasingly greater dependence and a more difficult withdrawal processes.  Kindling is a well-known phenomena in other sedative-hypnotic drugs like alcohol.

Some people can take benzos for years and have little to no trouble discontinuing them. Theories abound, but it is unknown why there is such variability.

4. How does dosage affect the likelihood of physical dependence?
This is one thing the experts generally agree on: higher dosages and longer usage usually leads to a higher rate of experiencing benzodiazepine withdrawal syndrome. But none of the peer-reviewed literature on benzos puts a numeric value on either the duration or dosage required to become physically dependent.

5. Will my doctor be able to help me?
Most medical providers understand benzodiazepines can result in addiction, but some do not. Many misdiagnose benzo-related problems as addiction when it is not and this can lead to unhelpful treatment decisions. Many doctors who know that benzos are addictive know very little about physiological dependence as a separate problem that can develop even when used “as prescribed”, and its associated withdrawal syndrome. On top of this, some poorly informed medical providers are unaware that benzodiazepine withdrawal syndrome exists. It is very important to engage with a medical provider who understands benzo withdrawal and who can help you, find more info here.

6. If I am dependent, how do I return to normal?
Recovery from benzo dependence is highly variable and depends on many factors. In general, the first step is to learn more about benzodiazepine withdrawal syndrome and how to proceed. The best source for this information is known as the Ashton Manual. The next step is to seek knowledgeable professional help, which is often hard to find. In most cases, the next step is to carefully reduce the amount of benzo you use, usually via a controlled reduction in the dosage, known as a taper. Once the taper is completed, it usually takes your body a period of time to return to normal.

Warning: quitting benzos cold-turkey can cause seizures and even death, so be sure to follow a taper plan.

7. Are there treatment programs to help get me off benzos?
Yes, but be careful. Most prescribers and treatment centers do NOT understand how to properly taper benzodiazepines, nor do they understand the recovery period that follows the tapering process. Many treatment centers, like individual medical providers, misinterpret the problem as addiction which can lead to the kinds of treatment that are not helpful and are even harmful. Treatment for true addiction to other substances, for example, often involves the rapid discontinuation of the involved substance(s), which for benzos can be catastrophic.  See the section on “Treatment Centers for Benzodiazepines” for more on this.

8. Are there support groups to help get me recover from the effects of benzos?
Yes, there are several on-line support groups.  In addition, personal recovery stories appear in several books.