Benzo Addiction Withdrawal Timeline

In 2016 alone, 4.45 billion prescriptions were written to citizens of the United States. In 2010, that figure just crossed the threshold of 4 billion prescriptions, and since then, there have been six consecutive years of total prescriptions seeing a marked annual increase. Analysts expect this trend to continue, and conservative estimates have America hitting the 5 billion prescription mark in 2023. To put that 4.5 billion number into perspective, if you were to divide that number by the total population of America, including all age groups, that would be roughly 1200 prescriptions per citizen annually. While this may seem like an absurdly large figure, consider the fact that over 70% of Americans take at least one prescription drug weekly.

These sobering numbers clearly illustrate the fact that we as a society overmedicate and deal with the symptoms of many issues, rather than the root causes of those issues. If you have trouble sleeping, if you are in pain, if you have anxiety, depression, or any other issue, there is likely a pill for that. A problem arises however when “Take drugs,” “Take more of those drugs,” or “Try a different drug” is our first response to emotional or physical pain. Now, no one denies these drugs efficacy; they are incredibly efficient at masking or dampening a variety of negative sensations. In fact, most medical experts would agree that they are too good at their job, too good at covering pain. Because of that, many people become dependent upon the drugs to function normally. In such cases, these drugs become an emotional and a physical crutch that strips the user of their ability to cope in healthy, natural ways. An ever-growing group of medical professionals is begging doctors to be cautious with how casually doctors write these prescriptions and warning those people using the prescription not to treat them so cavalierly.

While they are not quite as deadly as opioids, benzodiazepines, have seen similar rate increases in prescription notes, addiction, and overdoses. While they may fly under the radar in most conversations on the prescription drug epidemic, benzodiazepine abuse is quite popular and quite deadly with over 9,000 overdose deaths occurring last year. What this number does not show, however, is the number of times where a benzo played as a catalyst or an enhancer for another drug or substance. While it may not have been the primary drug responsible for the death, it was, however, found in the system of over 33% of all fatal overdoses. Anti-anxiety medications can be quite deadly, especially when combined with alcohol or opioids. On top of that, there are serious long-term side effects that one cannot simply gloss over.

Because of this mounting crisis, if you or a loved one struggle with benzo abuse or addiction, you should speak to a medical professional posthaste for the best way to get diazepam out of your system. While detox may seem like a scary word, it is a necessary step one must take for their long-term health. Perhaps you fear the symptoms of withdrawal that come part and parcel with detox? If that is the case, a significant portion of fear lies in the unknown. Therefore, in order to shed light on this subject, we will discuss the benzo addiction withdrawal timeline and what to expect as you go through inpatient or outpatient rehab.

A Brief on Benzos

In case you were unaware, benzos encompass just about every form of anti-anxiety medication. They are sedatives, and tranquilizers meant to combat phobias, seizures, social anxieties, spasms, insomnia, muscle tension or spasms and panic attacks. The more popular of such pills include Xanax (alprazolam), Ativan ( lorazepam), Klonopin (clonazepam), Valium (diazepam),  and Restoril (temazepam).

Benzos come in pill or bar forms, generally ranging from 2-4 mg doses. The differences between them are relatively minor and generally relate to the duration of effects (half-life of the drug), the drug’s potency and how fast acting the drug is. Benzos directly affect the central nervous system and provide feelings of calm, panic suppression, anxiety relief, and drowsiness that usually last around four to eight hours. While they are commonly used for treating, anxiety and insomnia, panic disorders, and seizures, benzos are also used for general anesthesia, pre-surgery sedation, muscle relaxation, alcohol withdrawal, nausea, and vomiting.

That said, they can generally be categorized into two categories: shorter-acting and longer-acting.

Shorter Acting Benzos

• Xanax – the most popular of all Benzos, Xanax has an intermediate onset of action that lasts up to 20 hours
• Ativan – has slow onset action and lasts up to 20 hours
• Halcion– has a fast onset and lasts 3 to 8 hours
  

Longer Acting Benzos

• Valium – has a fast onset of action, generally 30 to 60 minutes, and lasts anywhere from 1 to 3 days
• Klonopin – has an intermediate onset of action, but has a duration of action of 1 to 3 days

Factors of Benzo Withdrawal

There are a variety of factors that play into how one experiences withdrawal symptoms and the severity of those symptoms. While every individual will have a different withdrawal experience, various generalizations can be made regarding the intensity of withdrawal from benzodiazepines and the withdrawal timeline. Such factors include:

• Dosage –  the more significant the regular dose, the harder the body will feel it suddenly missing from the system. An increasing dose indicates that the body is adapting and growing accustomed to its potency; it depends upon even more copious amounts of the substance to get the same effects or high. When the drugs a clear of the bloodstream, the shock to the system will be much stronger, which means more powerful withdrawal symptoms.
• Family History –  a history of alcohol or substance abuse and dependency play a significant factor in the withdrawal timeline and could also increase the length of withdrawals as well.
• Height and Weight – a person’s physical measurements can alter how strongly a drug effects them or how powerful withdrawal symptoms are. A healthy person who exercises regularly will likely have less severe withdrawals than an indolent person, especially since they have at least some healthy anxiety outlets or coping mechanism.  
• Length and frequency of Benzo Use– benzos are not intended to be used long-term, seeing as even prolonged doctor-recommended usage can lead to adverse health ramifications and increase the potential of addiction. As with the potency, the frequency, and length of use increase in proportion to the feelings of withdrawal. Like in the case of dosage, the longer or more frequently you take a benzo, the harder it will be to get off it.
• Method of ingestion – the way you take a benzo changes how quickly and how hard it hits your system. If you do so regularly by ingesting the pill, the effects and time it will last in your system are more predictable. However, if you snort or inject a benzo, as many addicts do for added effect, the drug goes directly into the bloodstream and skips the whole process of traveling through the digestive tract. As a result, snorting or injecting is nearly instantaneous so the timeline for withdrawals will be sped up.
• Other Drugs – If you have been using other drugs alongside benzos, especially regularly drinking or taking opioids, you will likely have much more severe withdrawal symptoms. This likelihood only increases if you are also addicted to or abusing those other substances since you will suffer the feelings of withdrawal from both simultaneously.
• Type of Drug– The kind of benzo used will have different withdrawal timelines and likely have different strengths of symptoms. We will discuss this further below.
• Underlying mental health or medical issues – While most patients were prescribed benzos to treat social anxiety or panic disorder, during their pre medical detox evaluation, many people uncover that there are additional medical or mental issues that they were unaware of. These issues may very well play a factor in the strength and duration of withdrawal symptoms.

Benzo Withdrawal Symptoms 

As one’s tolerance to benzos grows, the users require a larger dose or a more frequent intake to feel the same effects. When someone stops taking the drugs, withdrawal symptoms begin to spout. These symptoms are emotionally and physically painful and could potentially be fatal if the user goes “cold turkey.” General symptoms of benzo withdrawal include:

• Anxiety
• Depression
• Hallucinations
• Headaches
• Insomnia
• Irritability
• Muscle tension
• Muscle aches
• Nausea
• Numbness in extremities
• Panic Attacks
• Seizures
• Shakes

The Rebound Effect

As mentioned, the vast majority of benzo users initially take it to treat some social anxiety, phobia or anxiety. Because of this, many who suddenly cease taking these medications will undergo increased anxiety or agitation. This rebound effect is only made worse since those who masked their anxiety or phobia with benzos just grew more and more reliant upon the drug to disguise those symptoms. As a result, they are even more unaccustomed to handling those feelings without any medical aid. Typically, extreme rebound effects from benzo withdrawal diminish after two or three days, although, as one might imagine, after months, if not years, of numbing oneself to the world, those feelings of nervousness or anxiety will feel more amplified than ever. In the initial stages, sleeping and handling stress without an anti-anxiety aid will be quite a challenging task.

Duration of Withdrawal

The half-life of a benzo varies from brand to brand. As a result, withdrawal symptoms from short-acting benzos such as Xanax, Halcion, and Ativan begin sooner since the drugs leave the user’s system at a faster rate because it has a short half-life. The initial signs of withdrawal generally start six to eight hours after last taking a short-acting benzo. On the other hand, longer acting benzos such as Valium Librium and Klonopin, stay in the system longer, so withdrawal takes longer to occur. For most longer-acting benzos, withdrawal symptoms begin within 24 to 48 hours of last use. Surprisingly, short-acting benzos such as Xanax have much more severe, and grim withdrawal symptoms and are more addictive than longer-acting benzos.  

Although all benzos are designed to depress the central nervous system, they all have slightly different goals or symptoms they target. As a result, they may work differently within the body or leave the bloodstream at a different rate. Despite the fact that general symptoms of withdrawal will be similar, an individual detoxing from an anti-anxiety benzo may feel higher levels of anxiety while an individual detoxing from a hypnotic benzo may feel higher levels of insomnia or restless sleep.

 Benzo Withdrawal Timeline

As discussed, the withdrawal timeline is unique to the user and depends on a variety of factors. However, the timeline below is a decent measuring stick of what to expect as they taper down their benzo use over a period of time.

• The initial 6-8 hours: The first feelings of withdrawal, generally consisting of anxiety or insomnia will likely arise within hours of stopping use, although it depends on how long it takes for the substance to leave the bloodstream.
• Days 1-4: Rebound insomnia and anxiety take a firm hold of the benzo user, and for those who use longer-acting benzos, the initial signs of withdrawal may begin around this point. Other intense symptoms such as extreme discomfort, shakes, sweating, seizures, aches, and nausea may also crop up, depending on the strength of one’s addiction. This is the hardest stage of detoxification and withdrawal symptoms are the strongest at this point. Because of the chance of shock to the system or seizures (for those with a medical history), it is wise to deal with this stage at a benzo detox center to safely detox through professional treatment.
• Days 10-14: For short-acting benzo users, the symptoms of withdrawal should be fading, if not gone altogether. For longer-acting benzo users, withdrawal symptoms may hit their peak, but again, that depends on the drug, dosage, and frequency.
• Day 15+:  Users who are highly dependent on benzos may deal with PAWS (protracted withdrawal syndrome). Such people may experience seemingly random periods of intense withdrawal symptoms, even months later. By tapering down benzo use for long-term recovery, with medical supervision, rather than quitting cold turkey, one may reduce the odds of getting PAWS.

Sources:

Crane Marisa. “How Long Do Benzo Withdrawal Symptoms Last?” American Addiction Centers. 14 Mar. 2019. https://americanaddictioncenters.org/benzodiazepine/length-of-withdrawal

“7 Things About Benzo Withdrawal You Might Not Know.” Drugabuse.com. 14 Mar. 2019. https://drugabuse.com/7-things-about-benzo-withdrawal-you-might-not-know/

“Benzodiazepine Withdrawal Symptoms, Timeline, and Effects.” Withdrawal.net. 14 Mar. 2019. https://www.withdrawal.net/learn/benzodiazepine-symptoms-timeline-effects/