Addiction | 6 min read

How Long Do Benzo Withdrawal Symptoms Last?

Medically Reviewed

Medically Reviewed By

Dr. Po-Chang Hsu

Dr. Po-Chang Hsu

On September 3, 2022

Written By

Amanda Stevens

Amanda Stevens, B.S.

On February 27, 2019

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Benzodiazepines, or “benzos,” are one of the most highly abused substances in America. According to the National Institute on Drug Abuse, “16 percent of overdose deaths involving Opioids also involved benzodiazepines” in 2020.

Many who develop an addiction or dependency on this substance have done so due to exposure to prescription medication. Anxiety-related issues are the leading cause of mental health problems in America. Benzodiazepines are routinely prescribed for conditions ranging from mild anxiety and related insomnia to treatment for the experience of full-fledged panic attacks. Some concerned medical healthcare providers are even placing the risk of prescription Benzodiazepine addiction on par with the opiate crisis. Substance users may be unaware of the risks of such a widely-prescribed medication.

Within the last decade, there have been several accounts of celebrity deaths associated with the presence of benzodiazepines, which highlights the cultural prevalence of the use of this substance. In many documented drug overdose cases, Opioids are present along with benzos, highlighting the danger of mixing benzodiazepines with other depressants.

Benzo withdrawal can be an excruciating experience that makes it difficult to stay off these drugs. The good news is benzo withdrawal does come to an end. However, your comfort level will depend on whether you have certain supports in place.

Progression of Dependence

Benzodiazepines, such as Xanax, Ativan, Valium, Librium, and Klonopin, have a wide range of uses. Their ability to slow activities in the central nervous system, coupled with how benzos go about doing this, makes them effective at treating various conditions, including anxiety, insomnia, seizures, panic attacks, and muscle spasms. While highly effective, benzos should only be used short-term, or a substance use disorder may form.

Benzodiazepines work by stimulating the cells in the brain that secrete GABA. GABA, the brain’s primary inhibitory neurotransmitter, plays a central role in keeping chemical and electrical activities balanced throughout the central nervous system. GABA slows brain activity and works with glutamate (the brain’s primary excitatory neurotransmitter) to keep things running smoothly. These interactions directly affect your mood state, energy levels, thinking, and even your coordination, which are most affected when you go through benzo withdrawal.

The ease of developing a dependence on benzos lies in the way that this substance affects the brain. Upon ingestion, receptors within the brain are signaled to bind with the chemicals, which induce a feeling of relaxation and drowsiness. The result is a sense of calm and well-being for the user. However, because an outside substance induces the process, the brain can learn, over time, that it does not need to react to stress by producing its relaxation chemical response. This leads the user to feel it is impossible to function properly without continued exposure to benzodiazepines, as they find that anxiety levels have stopped decreasing naturally. This level of biological dependency can be experienced within just a matter of weeks after the first dosage.

Benzo Withdrawal Symptoms

Benzo withdrawal symptoms can take many forms depending on how your body responds and why you are taking the drug. If you take Xanax or Ativan to relieve anxiety, not only will anxiety be a withdrawal symptom, but it may be more severe than it was before. This is known as the rebound effect, where symptoms experienced during withdrawal become more intense or severe than before starting the drug. The same goes for benzos that treat insomnia, seizures, panic attacks, and muscle spasms.

Initial withdrawal symptoms from benzodiazepines can include the inability to sleep and a general sense of anxiety. As withdrawal progresses, the dependent user can experience severe symptoms, such as nausea, dry heaves, muscle aches and spasms, inability to concentrate, memory lapse, irritation, heart palpitations, excessive sweating, and tremors.

Severe cases of Benzodiazepine withdrawal can result in the need for emergency hospitalization. In addition, the experience of grand mal seizures can accompany withdrawal and lead to coma or even death. Multiple reports of death as a result of Benzodiazepine withdrawal are emerging from recent studies.

Common symptoms of benzo withdrawal include:

  • Profuse sweating
  • Memory problems
  • Loss of coordination and balance
  • Insomnia
  • Nausea and vomiting
  • Aches and pains
  • Blurred vision
  • Muscle spasms
  • Feeling nervous
  • Moderate to severe drug cravings

The overall degree of discomfort experienced, coupled with rebound symptoms, makes it extremely difficult to stay off benzos once you stop taking them. For these reasons, it’s best to undergo a medical detox rather than trying to stop on your own. With medical detox, medication treatments relieve uncomfortable symptoms, which greatly increases your chances of making it through the benzo withdrawal period and staying off benzos for good.

Timeline of Withdrawal

It has been found that certain types of benzodiazepines may be more likely to induce these withdrawal symptoms, as well as to contribute to the severity and length of the experience. In general, withdrawal symptoms from shorter-acting benzodiazepines –  such as Xanax and Ativan – will begin within a few hours. However, withdrawal symptoms from longer-acting benzos – such as Valium and Diazepam – can take several days to begin.

The initial symptoms of benzo withdrawal, such as insomnia and nausea, tend to last from one to four days. Following this period, the more distressing symptoms – which can include seizures and psychosis – tend to last anywhere from one to two weeks. The final stages of physical withdrawal occur after this intense period and resemble the initial symptoms. This tapering off of physical dependence can last from a few weeks to a few months.

Recovery from the psychological and emotional symptoms of Benzodiazepine withdrawal can last much longer than the physical symptoms. Former benzo users can suffer from bouts of unpredictable and uncharacteristic behavior, will report experiences of depression, and tend to provide an overall lower quality of life rating. These psychological withdrawal symptoms have persisted for several months after discontinuing the drug, and the experience of discomfort sometimes prompts patients to resume their habit of using benzodiazepines.

A smaller percentage of former Benzodiazepine users will experience what is known as Post-acute Withdrawal Syndrome (PAWS.) With PAWS, the symptoms of withdrawal can last for several years. In these cases, multiple factors are believed to contribute to long-term symptoms. The former user may lack the tools necessary to handle stress – depending on the substance for stress maintenance –  which prolongs the experience of anxiety. The effects on the user’s ability to store and access memories may be negatively impacted by the benzos’ long-term use, resulting in an inability to institute learned coping methods. And in some cases, benzodiazepines may refuse to leave the nervous system promptly.

Factors That Affect the Benzo Withdrawal Timeline     

A range of factors can affect how long benzo withdrawal will last, one of which is whether you’re coming off a short-acting or long-acting benzo. Short-acting benzos can stay in your body for up to two days, whereas long-acting forms can take as long as 10 days to leave the body.

Other factors that affect the benzo withdrawal timeline include:

  • How large a dose you take regularly
  • How long you were on benzos
  • If you developed a physical dependence on the drug
  • If you became addicted
  • If you abused other substances, such as alcohol or opiates, along with benzos

Stages of Benzo Withdrawal

Early or Immediate Withdrawal

Early withdrawal typically starts within a few hours or a few days after stopping the drug, depending on whether you were taking a short-acting or long-acting benzo. It’s at this initial stage where rebound symptoms tend to develop. In effect, if you were taking benzos to relieve anxiety, insomnia, or any other known treatment purpose, the initial symptoms will come back in full force, if not stronger.

Acute Withdrawal

Acute benzo withdrawal symptoms typically develop within three to five days after your last dose, lasting anywhere from five to 28 days. Acute withdrawal is when the most severe of symptoms occur. This symptom severity reflects the state of imbalance present in the brain and body. The brain, especially, has to re-learn how to regulate GABA secretions without the help of benzos, which accounts for why symptoms can be so severe at this stage.

Protracted Withdrawal

Protracted withdrawal, also known as post-acute withdrawal symptoms or PAWS, doesn’t affect everyone coming off benzos. You’re more likely to experience PAWS if you used benzos for longer than prescribed, abused them, or developed an addiction. In effect, the longer you take benzos, the more your brain and body come to depend on them. When you stop taking the drug, it takes longer for your body to return to normal. For these reasons, protracted withdrawal symptoms can last up to 12 months or longer.

Symptoms to expect during protracted withdrawal include:

  • Depression
  • Anxiety
  • Mood swings
  • Problems concentrating
  • Decrease in sex drive
  • Problems sleeping

Reducing the Severity of Withdrawal Symptoms

Substance abuse treatment programs are available to assist a recovering person in reducing the physical discomfort experienced while detoxing from benzodiazepines. Several medical treatment options are available, including Benzodiazepine reduction and substitution methods. Treatment medications can be delivered orally and intravenously, including antidepressants and anticonvulsants.

Robust detox treatment programs will also include components that address the psychological and emotional concerns which tend to arise during the process. Treatment programs that combine psychotherapy with medication assistance are the most effective in reducing relapse in Benzodiazepine abuse cases. This makes sense in light of the many psychological factors associated with withdrawal from this drug.

In addition to providing immediate support for withdrawal issues, a detox treatment provider can assist the recovering person in developing a plan for ongoing support and coordinating mental health services. Using local resources, the choice of abstaining from benzodiazepines can be solidified with the convenience of outpatient services. Due to the potential for long-lasting, negative effects of withdrawal from benzodiazepines, a cohesive plan for extended maintenance of sobriety provides the recovering user with the best chance of success.

If you or a loved one are struggling with addiction to benzos or other substances, reach out to Ascendant today. Our NYC addiction treatment programs can provide the support you need to begin your recovery journey.

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Amanda Stevens

MEDICAL CONTENT WRITER

Amanda Stevens, B.S.

Amanda is a prolific medical content writer specializing in eating disorders and addiction treatment. She graduated Magna Cum Laude from Purdue University with a B.S. in Social Work. Read more

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