During the early stages of withdrawal, the person may notice the symptoms of the condition that the drug was treating start to return, or rebound. For example, symptoms of anxiety or insomnia may come back or get worse without the drugs. This dependence may lead to a difficult withdrawal if the person chooses to stop taking the drugs. If you are pregnant or are thinking about becoming pregnant, talk to your OBGYN or psychiatrist about your plans. Your doctor can help you weigh the potential risks and benefits of benzodiazepine use and your pregnancy.

Prescribing

It should not be used in place of the advice of your physician or other qualified Benzodiazepine withdrawal healthcare providers. The onset and duration of withdrawal symptoms depend on the duration of action of the BZD. Withdrawal of short acting BZD’s generally starts within 1-2 days of last use, peak at 7-14 days and gradually subsides. Long acting BZD’s generally have a less severe withdrawal starting at 2-7 days, peaking around 20 days, and abate after a few weeks. It is sometimes very difficult to know whether continuing anxiety is due to withdrawal or whether the original anxiety has resurfaced.

Habits for Proper Mental Health

Patients who are non-verbal (e.g. stupor due to head injury) may not be suited for this regimen as they may not be able to inform the nursing personnel if they were to experience any withdrawal symptoms. The search strategy’s focus on the term ‘harm reduction’ may have excluded studies that employed approaches aimed at reducing harm without explicitly naming this term. Furthermore, the wide variety of terms used to describe novel benzodiazepines made it challenging to create an exhaustive search strategy. Owing to the heterogeneity of the studies included, the evidence provided was of varying quality, and due to the nature of the studies, both risk of bias and meta-analyses were not conducted, and the intended review methodology was changed from systematic to scoping. The inclusion of any studies that used the term ‘harm reduction’ has led to the inclusion of some approaches, such as abstinence-focused treatment, that may not align with most conceptualisations of harm reduction.

Coping strategies

Withdrawal symptoms can occur after as little as one month of use, even on small, therapeutic doses. Among people taking benzodiazepines for longer than six months, about 40% experience moderate to severe withdrawal symptoms when they quit suddenly. Qualitative study participants generally preferred prescribed benzodiazepines over illicit sources due to reduced criminal activity, lower costs, and decreased exposure to contaminated substances 57, 58. Some participants preferred a discontinuation approach to treatment 58, emphasising the importance of choice and individualised treatment.

• Several types of benzodiazepines are sold under popular brand names like Valium (diazepam), Xanax (alprazolam), and Klonopin (clonazepam).
• A recent analysis of 14 drug cryptomarkets (1st February 2024 to 31st January 2025) revealed that benzodiazepines comprised the third-largest percentage (8.1%) of all drug listings 27.
• Benzodiazepines are used to treat anxiety, epilepsy, insomnia, and alcohol withdrawal.
• While there is no FDA-approved medication to treat benzodiazepine withdrawal, your doctor may also prescribe other medications to help you manage withdrawal symptoms.
• We tabulated the major recommendations from each source as regards the management of alcohol withdrawal with respect to severity of withdrawal, doses and regimen used in each study and the outcomes.
• The severity of these symptoms depends on the duration of a person’s drug use, their dosage amounts, and the method of ingestion.

Severe alcohol withdrawal with DT

A rapid review focused on etizolam 77 suggests established harm reduction advice, such as avoiding the combination of benzodiazepines with other sedatives, remains relevant and increasingly important due to the growing prevalence of nonmedical benzodiazepine use. One study examined the gendered impacts of drug supply contamination in British Colombia during the COVID-19 pandemic. In response to increased overdose risk and gendered violence, with particularly attention paid to the risk of sexual assault in the context of benzodiazepine use, women developed informal peer networks to support and check on each other during this time 76. Analyses indicate that novel psychoactive substances (NPS), including benzodiazepines, are widely available for purchase online 5, 25. Drug cryptomarkets, operating on the darknet, are an overlay of the internet accessible only via specialised software and facilitate the anonymous sale of illicit drugs through online marketplaces 26. Since the 2011 launch of the Silk Road, numerous such platforms have emerged, and despite significant law enforcement efforts, cryptomarkets continue to play a persistent role in the global drug trade 25, 26.

It is a common misconception among regular drinkers that stopping alcohol causes more problems than continuing it. This may be partly true in those who have developed dependence as they may experience withdrawal symptoms including autonomic arousal, hallucinations, seizures and delirium tremens (DT). Since many people underplay or minimize their drinking behavior, they tend to develop withdrawal symptoms when hospitalized for other physical problems and not for alcoholism forming a substantial part of consultation-liaison psychiatry. Doctors may use certainmedications to manage drug cravingsand withdrawal symptoms during medical detox. The benzodiazepine withdrawal treatment guidelines at The Recovery Village allow some patients to be treated with medications. Though there are no specific medications designed specifically for treating benzodiazepine withdrawal symptoms, there are several drugs that help relieve the discomfort and/or pain of some withdrawal symptoms and assist in recovery.

However, a subset of participants, particularly those with a history of hospitalisations and withdrawal attempts, felt that discontinuation was preferable to a maintenance approach, fearing that continued dependence would hinder their treatment decisions. We recommend that clinicians take into account the past history of seizures or DT as well as the current clinical status while deciding upon medications for a patient. Thank you for your suggested approach of prescribing phenobarbital for benzodiazepine withdrawal. In addition, 42% of these patients supplemented their phenobarbital treatment with long-acting benzodiazepines.

By Corinne O’Keefe OsbornCorinne Osborn is an award-winning health and wellness journalist with a background in substance abuse, sexual health, and psychology.

• For example, symptoms of anxiety or insomnia may come back or get worse without the drugs.
• Alcohol facilitates GABA action, causing decreased CNS excitability Figure 1b.
• The authors provided recommendations for healthcare practitioners, including educating adolescents and caregivers about counterfeit pills, securing medication storage, and distributing naloxone and FTS.
• However, it needs to be based upon the severity of withdrawals and time since last drink.
• Long-term treatment after benzodiazepine withdrawal will depend on your reasons for taking them in the first place and your reasons for quitting.

Current treatment approaches for benzodiazepine dependence primarily involve deprescribing through initial stabilisation and/or conversion to prescribed benzodiazepine followed by stepwise dose reduction with the goal of eventual abstinence 14, 37. A reduction plan often includes replacing short-acting, more potent benzodiazepines (e.g., alprazolam) with longer-acting options (e.g., diazepam) guided by standardised dose equivalence protocols 37. However, traditional dose equivalence tools prove challenging for novel and counterfeit benzodiazepines owing to their largely unknown composition and relative potencies, complicating treatment planning. In parallel, regulatory responses, such as medication rescheduling, have been used to address broader issues related to benzodiazepine harm and dependence 38.

The first study involved prescribing long-acting benzodiazepines at 50% of the patient’s usual dose for six residents with high-dose dependence (8% of the sample) 55. The second study outlined the provision of ‘up to 30 mg daily’ to prevent benzodiazepine withdrawal for more than 70 residents; the specific type of benzodiazepine was not specified 56. Both studies reported positive outcomes, with the first study finding low rates of adverse events (intoxication, diversion), no overdoses, and successful isolation completions. The second study revealed improvements in residents’ general health, behaviour, and compliance with public health measures, as reported by staff 56.

A “no benzodiazepine” policy implemented in outpatient mental health settings incorporated individualised treatment plans but enforced cessation as a non-negotiable outcome 62. While some approaches are framed as harm reduction, they may differ from core harm reduction principles commonly described in the literature, such as supporting patient autonomy, incremental progress, and continuity of care without punitive measures 85. This highlights the variability in the operational definition of harm reduction and its application in clinical policies. Some policies may adopt the term “harm reduction” without fully embodying its foundational principles, reflecting a broader lack of consensus.

For Loved Ones: How to Support a Loved One’s Mental Health

This review informs readers about medications to be used for treating alcohol withdrawal, their dosing strategies to be used and managing specific complications arising during alcohol withdrawal such delirum trements (DT) and alcohol withdrawal seizures. We specifically sought articles relating to medications commonly used in India and those that can be recommended based on strong evidence. Protracted symptoms continue to fade over a period of many months or several years. These findings demonstrate the necessity of tailored harm reduction advice, such as cautioning that naloxone may be ineffective for benzodiazepine overdose and exploring other strategies such as avoiding using alone, using a test dose, and keeping naloxone on hand 44.

When measuring success it will be critical to measure patient-centered outcomes (eg, functionality, patient experience) as well as adverse events (eg, protracted withdrawal) instead of using reductions in BZD prescribing as the sole measure of success. From the start of Guideline development, the guideline committee was aware of the potential for unintended consequences. As was seen with the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain, well-intentioned guidelines can be mis-applied and lead to patient harm. Nearly all patients who take BZD regularly for more than a month will develop physical dependence, while only 1.5% will develop a BZD use disorder.

The five included studies suggest some potential benefits, although the evidence is not as robust as that for opioid agonist treatments 33 or as extensively explored as potential methamphetamine agonist treatment options 80. Notably, benzodiazepine agonist treatment during the COVID-19 pandemic has shown positive outcomes, such as successful isolation completion and improved health outcomes, with minimal adverse events 56. These results reflect the broader trend of flexible harm reduction approaches during the pandemic 81. Benzodiazepines with a half-life of less than 24 hours include alprazolam, bromazepam, brotizolam, flunitrazepam, loprazolam, lorazepam, lormetazepam, midazolam, nitrazepam, oxazepam, and temazepam.111 The resultant equivalent dose is then gradually reduced. The STT was proposed by Saitz et al. in 199426 where in chlordiazepoxide was given when CIWA-Ar ratings were eight or more.