The only safe way to quit benzos is through a carefully structured tapering schedule. If you’re on potent benzodiazepines like alprazolam (Xanax), lorazepam (Ativan), or clonazepam (Klonopin), you may find it extremely difficult to quit benzos due to severe withdrawal symptoms.
A benzo taper schedule typically involves gradually reducing your dosage over time under medical supervision. For example, a common approach is to reduce the dose by 5-10% every 1-2 weeks, depending on your specific situation. This method helps manage withdrawal symptoms and supports a smoother transition off the medication
The Reality of Benzodiazepine Withdrawal
Withdrawal from benzodiazepines isn’t just uncomfortable; it can be debilitating. A survey revealed that 82.9% of respondents experienced work-related issues, while 86.3% faced social interaction difficulties. Alarmingly, 54.4% reported suicidal thoughts or attempts, underscoring the severe emotional toll these medications can take.
The spectrum of withdrawal symptoms is broad, ranging from anxiety and insomnia to more severe manifestations like digestive issues and balance problems.
Many individuals report that these symptoms can persist long after they have stopped taking benzodiazepines, sometimes lasting for years.
Withdrawal from benzodiazepines can often last longer than the initial condition they were intended to treat.
Why You Should Taper Off Benzos ?
Despite the growing evidence linking benzodiazepines to serious issues like treatment-resistant depression, suicide, cognitive impairment, Alzheimer’s disease, and even traffic accidents, doctors continue to prescribe these medications for years—even decades.
Over the past two decades, the number of benzodiazepine prescriptions in the U.S. has tripled. A 2015 study revealed that more than 5% of the U.S. population filled prescriptions for benzodiazepines, with up to a third of those being long-term users, even though the labels typically advise against extended use.
Benzodiazepines are highly addictive, and dependence can develop quickly. You may even experience withdrawal symptoms between doses. Rebound anxiety, which is the return of anxiety symptoms stronger than before, can make quitting extremely challenging.
Tapering off is the safest way to quit benzos.
Stopping suddenly, also known as going cold turkey, can lead to severe withdrawal symptoms that can be life-threatening, including seizures and suicidal thoughts. By tapering off under medical supervision, you can avoid these risks.
Taper Schedule Can Help With Benzodiazepine Withdrawal
Tapering has been shown to significantly reduce the frequency and severity of protracted withdrawal syndrome (PWS), where symptoms can persist for months or even years after stopping benzodiazepines.
It is estimated that 10-15% of individuals using benzodiazepines long-term (beyond the recommended 2-4 week prescribing guidelines) will experience protracted withdrawal.
A slow tapering schedule can help manage anxiety more effectively than abrupt cessation.
Benefits of Tapering off Benzodiazepines
Cognitive Impairments: A gradual taper allows the brain to slowly readjust to functioning without benzodiazepines, reducing the risk of persistent cognitive deficits. Studies show that cognitive function often improves after discontinuation when done through a slow taper.
Anxiety and Panic Attacks: Tapering schedule prevents the sudden rebound of anxiety symptoms that can occur with abrupt discontinuation. By slowly lowering the dose, the brain has time to restore its natural balance and ability to regulate anxiety.
Insomnia and Sleep Disturbances: A gradual taper helps reset the sleep cycle more gently compared to quitting cold turkey. This reduces the likelihood of developing chronic insomnia post-discontinuation.
Mood Swings and Depression: Slowly lowering the benzodiazepine dose helps stabilize mood and emotional regulation. This prevents the severe mood disturbances and depression that can occur with sudden withdrawal.
Physical Symptoms: A slow taper schedule minimizes the intensity of physical withdrawal symptoms like muscle pain, tremors, and nausea. This makes the withdrawal process more comfortable and less likely to interfere with daily functioning.
Sensory Disturbances: Gradual dose reductions help the brain and nervous system adapt to functioning without benzodiazepines, reducing the risk of lasting sensory abnormalities.
How Long Does Benzo Taper Last?
For those who decided to stop using benzodiazepines, the journey can be a long one. About 10.4% of individuals found themselves taking a year or more to taper off completely, highlighting that the process can be both lengthy and challenging for many.
How to Wean Off Benzos?
The Ashton Manual, formally titled “Benzodiazepines: How They Work and How to Withdraw,” is a comprehensive guide developed by Dr. Heather Ashton, a prominent figure in the field of psychopharmacology.
Benzos are not benign and in fact can cause lasting damage. Ashton estimates that 10 to 15 percent of long-term benzo users have lasting symptoms resulting from trying to wean off themselves.
Benzodiazepine Tapering Methods
Strategies for benzodiazepine tapering can differ depending on the type and amount of benzodiazepine taken. The National Center for PTSD has issued guidance with several benzodiazepine tapering methods:
Direct Tapering: Continuing to use the same medication at lower doses over time allows the body to gradually adjust to having less medication, minimizing withdrawal symptoms and decreasing the likelihood of relapse.
Substitute Tapering: Switching from a short-acting benzodiazepine to a long-acting one (such as diazepam) and then gradually reducing the dosage. This method provides a more stable withdrawal process and reduces the risk of interdose withdrawal. The Ashton Manual recommends switching to Valium due to its long half-life and availability in smaller doses, allowing for precise tapering.
Titration Tapering: Involves gradually diluting doses in water over time. However, this method poses several serious health risks and is generally not recommended.
The Ashton Method
The Ashton Method is a well-known protocol for benzodiazepine tapering that advocates for substitution tapering with diazepam. According to the Ashton Manual, the process involves:
Switching to an Equivalent Dose of Diazepam: The first step is to calculate the equivalent dose of diazepam to replace the current benzodiazepine. This ensures a smooth transition without an abrupt change in blood levels.
Gradual Dose Reduction: Once the switch is made, the diazepam dose is gradually reduced. The rate of reduction depends on the individual’s response and can be adjusted as needed. The typical recommendation is a reduction of 10% every 1-2 weeks.
Monitoring and Support: Regular monitoring by a healthcare provider is crucial to adjust the tapering schedule and manage any withdrawal symptoms. Psychological support, such as cognitive-behavioral therapy (CBT), can also be beneficial during this period.
Studies indicate that a well-structured tapering plan using diazepam can lead to a higher success rate in discontinuing benzodiazepines. The Ashton Method reports around a 90% success rate when using Valium for tapering.
General Tapering Guidelines
Initial Reduction: For high-dose chronic users, a reduction of 25-30% of the current dose is recommended initially. For those on lower doses, a 10-25% reduction can be appropriate.
Subsequent Reductions: After the initial reduction, tapering can continue with further reductions of 5-10% every 1-2 weeks, depending on how well the individual tolerates the decrease.
Long-acting Substitution: If transitioning to a longer-acting benzodiazepine like diazepam (Valium), individuals may switch to an equivalent dose of diazepam before beginning the taper. For example, if someone is taking 10 mg of Xanax, this could be converted to approximately 20 mg of diazepam.
Example of Benzodiazepine Tapering Schedule
Weeks 1-2: Reduce current benzodiazepine dose by 25%.
Weeks 3-4: Further reduce by 10-20% based on tolerance.
Weeks 5-6: Continue tapering by 5-10% every 1-2 weeks.
Weeks 7-8: Assess withdrawal symptoms; adjust taper rate if necessary.
Final Stages: As the dose decreases to lower levels (e.g., below 10 mg of diazepam), consider smaller reductions (e.g., 1 mg or 0.5 mg every 1-2 weeks).
It’s crucial to conduct the taper under medical supervision to monitor for withdrawal symptoms and make adjustments as needed.
Common Mistakes to Avoid When Tapering Off Benzos
Tapering off benzodiazepines like Xanax, Valium, or Ativan can be a challenging process, and many people make critical mistakes that can complicate their recovery. Here are some common pitfalls to avoid:
Unrealistic Expectations: Many individuals underestimate the difficulties of tapering based on how long they’ve been using benzodiazepines. Long-term users often need a slower, more gradual taper to avoid severe withdrawal symptoms.
Lack of an Alternative Plan: It’s essential to have a strategy for managing anxiety and insomnia during the taper. Developing healthy coping mechanisms, such as practicing mindfulness or engaging in therapy, can make a significant difference.
One-Size-Fits-All Approach: Tapering isn’t the same for everyone. Each person’s experience with benzodiazepines varies based on factors like dosage, duration of use, and individual sensitivity. A personalized tapering plan is crucial for success.
Tapering Too Quickly: Rushing the process can lead to intense withdrawal symptoms. A gradual reduction of 5-10% every 1-2 weeks is generally recommended to help the body adjust comfortably.
Increasing the Dose During Stress: When symptoms worsen or life gets overwhelming, some may feel tempted to increase their benzodiazepine dose. This can undermine the tapering process and lead to a cycle of dependence that’s hard to break.
Using “As Needed” Doses: Relying on benzodiazepines for immediate relief during the taper can disrupt progress. It prevents individuals from learning to cope without medication.
Abruptly Stopping: Quitting benzodiazepines cold turkey can trigger severe withdrawal symptoms, including seizures. A gradual taper is vital to avoid these serious complications.
Neglecting Medical Supervision: Trying to taper without professional guidance can lead to mismanagement of withdrawal symptoms. Regular check-ins with a healthcare provider are important for monitoring progress and making necessary adjustments.
Medications That Can Help When Tapering Off Benzodiazepines
Certain medications can provide additional support during the tapering process:
- Buspirone: A non-benzodiazepine anti-anxiety medication that can help alleviate feelings of anxiety and panic during benzodiazepine withdrawal. It is not habit-forming and has a lower risk of dependence.
- Flumazenil: A rescue medication used to reverse the effects of benzodiazepines in emergency situations. However, for regular benzodiazepine users, it can trigger sudden and severe withdrawal symptoms, including seizures. Proper precautions should be taken with flumazenil.
What is the success rate off Benzodiazepine Taper ?
Success rates for tapering off benzodiazepines can vary quite a bit. Research shows that 50-60% of patients who receive support during the tapering process are able to completely stop their benzodiazepine use. Additionally, structured tapering interventions have been found to yield a success rate of about 33%, meaning roughly one in three individuals can successfully navigate the withdrawal process with this method.
Quit Benzos with Medical Detox and Safe Tapering Schedule at Still Detox
If you or a loved one is struggling with benzodiazepine dependence, it is crucial to seek professional help. At Still Detox, we specialize in medical detox and structured tapering programs designed to prevent relapse and support long-term mental health. Our comprehensive approach includes anxiety management, coping strategies without medication, and ongoing support to help you stay off benzos for good. Contact StillDetox today to start your journey towards a healthier, medication-free life.
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