December 6, 2018

A Look at a Typical Benzo Withdrawal Timeline

Benzodiazepines, commonly prescribed for anxiety and insomnia, can be highly addictive. Discontinuing these medications requires careful management due to potentially severe withdrawal symptoms. Understanding the benzo withdrawal timeline is crucial for individuals seeking to taper off or quit these drugs.

What Are Benzos?

Benzodiazepines are prescriptions used to help users cope with social anxieties, phobias, panic attacks, muscle spasms, muscle tension, and insomnia. The most prescribed benzos are Xanax (alprazolam), which is the most popular of all benzos, Klonopin (clonazepam), Valium (diazepam), Ativan (lorazepam), and Restoril (temazepam). These come in bar or pill form and typically will be prescribed in a 2mg or 4mg dose.

What differentiates these benzos is their potency, half-life (extent of effects), and how quickly their effects take place. They can be split into two classes: shorter-acting and longer-acting benzos.

Shorter-acting benzodiazepines include:

Ativan—Characterized by slow onset action with effects that last up to 20 hours.
Halcion—Characterized by fast onset with effects that last anywhere from 3 to 8 hours.
Xanax—Characterized by intermediate onset with effects that can last up to 20 hours.

Longer-acting benzodiazepines include:

Klonopin—Characterized by an intermediate onset of action with effects that can last from 1 to 3 days.
Valium—Characterized by a rapid onset of action, generally 30 to 60 minutes, and lasts anywhere from 1 to 3 days.

Although benzos are generally prescribed for panic disorders, social anxiety disorders, and insomnia, they have also historically been used as a muscle relaxant, surgery sedative, and general anesthesia.

Benzos and the Brain

To understand the benzo withdrawal timeline, it is first essential to know how they work in the brain. The brain uses neurotransmitters to send signals that excite or inhibit other brain cells’ impulses. This electrical signaling causes the body to react one way or another. GABA (Gamma Amino Butyric Acid) are inhibitory neurotransmitters that slow the brain’s transmission of messages between brain cells, creating a calming effect.

Benzos operate by enhancing the strength of GABA neurotransmitters and overwhelming other impulses. Once in the central nervous system (CNS), benzos work to sedate the brain, delivering anxiety relief and suppressing panic symptoms. The side effects of these calming measures are drowsiness and lethargy.

Benzo Addiction

Benzodiazepines (benzos) are highly effective in treating anxiety and insomnia, but their potent calming effects can lead to addiction. Even when taken as prescribed, the brain adapts to prolonged benzo use, increasing the risk of physical and psychological dependence.

Tolerance develops as the brain requires higher doses for the same effect and more frequent administration to maintain the desired state. This reliance becomes a physiological dependence, making it difficult to function without the drug.

As benzo use continues, the brain’s natural ability to manage stress and anxiety diminishes, further reinforcing the reliance on the medication. Abruptly stopping benzo use can result in severe withdrawal symptoms as the brain struggles to readjust without the drug.

Signs of Benzo Withdrawal

According to the DSM-5, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, a person who undergoes at least two of these symptoms within hours or days of last use can be considered to be going through benzo withdrawal.

Such post-acute symptoms include:

Anxiety
Depression
Diarrhea
Difficulty falling asleep
Difficulty staying asleep
Hallucinations, including hearing, feeling, or seeing things that are not real
Headaches
Irritability
Muscle aches
Muscle tension
Nausea
Numbness in extremities
Panic Attacks
Psychomotor agitation, inability to stand still
Racing heartbeat
Seizures
Shakes
Tremors
Vomiting

The Benzo Rebound Effect

Since most benzo users are prescribed the drug to help them handle phobias or anxieties, a person who stops using these meds will feel a rebound effect wherein these anxieties return stronger than before. This increased distress and unease is worsened since a person has become accustomed to using the drugs as a crutch to treat the symptoms instead of addressing the underlying issues.

This sudden onset of anxiety can be debilitating and may create extreme confusion and discomfort for regular benzo users. As a result, their psychological cravings are magnified. In most cases, extreme rebound effects will lessen after a few days. Still, echoes of these uncomfortable feelings will likely linger for months after as a person re-learns how to live their everyday life and deal with their stress without the aid of benzos.

Factors That Alter the Benzo Withdrawal Timeline

The benzo withdrawal timeline is different for each person.

Generally speaking, this timeline and the strength of withdrawal symptoms can be altered by a host of factors, such as:

Co-occurring disorders—Benzos are commonly prescribed to treat existing issues such as anxiety or panic disorder. These issues often stem from underlying mental health issues that go untreated.
Family history—Genetics plays a huge role in any potential user. If you have a history of drug use in your parents or grandparents, you will have a natural propensity toward drug addiction.
Frequency of Benzo use—Similar to length and dosage, the frequency with which a person takes benzos will alter the strength of withdrawal symptoms. The more frequent the dose, the more reliant the body is upon the benzos.
Gender—Men and women are biologically different. Their bodies respond differently to substances, and they tend to have varied patterns of drug use. Because of this and their biological variances, men and women will naturally experience slight differences in withdrawal symptoms.
Height and Weight—A person’s size often alters the drug’s effectiveness. A larger person will need more benzos to receive the same effects and may experience stronger withdrawal effects.
Length of Use—The longer a person has been using benzos, the more reliant they become upon the drug and the more difficult it will be to function normally without it.
Medical history—If a benzo user has had previous physical health issues, their body could have a more challenging time fighting withdrawal symptoms. A fit person will typically have an easier time during withdrawal than someone whose body is not functioning optimally.
Mode of Intake—A person can alter the speed of onset and potency of the drug depending upon how they take it. A person who snorts a benzo will feel more substantial effects of withdrawal and have those symptoms hit quicker than a person who simply takes the pill orally as prescribed.
Poly-drug abuse—A person who has had past drug or alcohol abuse issues or used benzos in conjunction with drugs or alcohol will have a more difficult withdrawal period. This is especially true if drugs and alcohol are used in combination with benzos since the user could be dealing with additional symptoms of withdrawal from these other substances.
Strength of dose—The larger the typical dose, the stronger the withdrawal symptoms exhibited, and the greater the shock to the system. A person who takes a much stronger dose demonstrates their body has grown accustomed to the drug’s effect on the brain.
Type of Benzo—Whether you are using a short-acting or long-acting benzo, it will alter the withdrawal symptoms and their timeline.

The 4 Phases of the Benzo Withdrawal Timeline

The four phases of benzo withdrawal vary depending on the specific benzodiazepine and individual factors.However, there’s a general pattern to expect during detoxification:

Phase 1 of Benzo Withdrawal: 6 to 8 Hours

Individuals using short-acting benzodiazepines may begin experiencing withdrawal symptoms within hours of their last dose. Common early symptoms include heightened anxiety, discomfort, and sleep disturbances. Cravings for the drug may also intensify during this phase.

It’s important to note that those using long-acting benzodiazepines typically won’t experience withdrawal symptoms this early in the process.

Phase 2 of Benzo Withdrawal: 24 to 48 Hours

Individuals using short-acting benzos will experience the most intense withdrawal symptoms during this phase. Rebound anxiety and other physical and psychological discomforts are at their peak. This period is particularly dangerous, and relapse is highly likely without professional medical supervision.

For those using long-acting benzos, withdrawal symptoms may begin to emerge, although they often take longer to manifest fully.

Phase 3 of Benzo Withdrawal: 72 to 96 Hours

Those using short-acting benzos may continue to experience withdrawal symptoms, but their severity should gradually decrease. As physical dependence lessens, individuals can begin to address the underlying issues that led to benzodiazepine use.

For those who used long-acting benzos, withdrawal symptoms will be at their peak during this phase. While uncomfortable, they are typically less intense than those experienced by short-acting benzo users.

Phase 4 of Benzo Withdrawal: 10 to 14 Days

The final phase of benzo withdrawal marks the beginning of recovery.

For those who used short-acting benzodiazepines, withdrawal symptoms should have completely subsided. While cravings may persist, the physical dependence on the drug has ended. Individuals can now focus on addressing the underlying issues that led to benzodiazepine use.

For those who use long-acting benzodiazepines, withdrawal symptoms will gradually improve, bringing an end to the physical discomfort associated with detox.

Protracted Acute Withdrawal Syndrome (PAWS)

A small percentage of individuals heavily dependent on benzodiazepines may experience Protracted Acute Withdrawal Syndrome (PAWS).

This condition involves intermittent, intense withdrawal symptoms that can persist for months after initial detox. To reduce the risk of PAWS, many doctors recommend a gradual benzo taper rather than abrupt cessation.

Overcoming Benzo Addiction With Beach House

Quitting benzodiazepines is a challenging journey requiring careful planning and support. Abruptly stopping benzo use can lead to severe withdrawal symptoms and increase the risk of relapse. It’s essential to taper off these medications under medical supervision to manage symptoms effectively.

Remember, recovery is possible. With professional guidance and support, you can overcome benzo addiction and achieve lasting sobriety.

If you or a loved one is struggling with benzodiazepine dependence, please reach out to our addiction specialists for confidential assistance and personalized treatment options.