Coming Off Benzodiazepines: Why Stopping Abruptly Is Dangerous and More

Medication Safety

Coming Off Benzodiazepines: Why Stopping Abruptly Is Dangerous, What the 2025 Tapering Guideline Changed, and How Long It Really Takes

In 2020 the FDA strengthened its warning about dependence and withdrawal. Some prescribers responded by cutting patients off. In 2025, ten medical societies published a guideline that says, in effect: that was the wrong lesson — and here is the right one.

Reviewed by the clinical team at East Coast Telepsychiatry  |  Evidence-based patient education  |  Reading time: 15 minutes

If you take a benzodiazepine — alprazolam, clonazepam, lorazepam, diazepam, or one of their relatives — there's a reasonable chance you've had a version of this conversation recently. Your prescriber brings up the risks, mentions that you've been on it a long time, and suggests coming off. Maybe it was framed as a plan. Maybe it was framed as a decision already made, with a date attached.

What happens next matters enormously, and it is not a minor clinical detail. Benzodiazepine withdrawal is not like stopping most medications. Done gradually, with a prescriber who adjusts to how you respond, it is manageable for most people. Done abruptly, in someone whose body has adapted to the drug, it can cause seizures — and seizures from benzodiazepine withdrawal can be life-threatening.

That gap between the right way and the wrong way is the subject of this article, and it's also the subject of a major guideline published in 2025 by the American Society of Addiction Medicine together with nine other medical organizations. The guideline exists because, in the years after regulators sharpened their warnings about these drugs, a lot of people got stopped the wrong way.

92MBenzodiazepine prescriptions dispensed from U.S. outpatient pharmacies in 2019 ~50%Of patients dispensed them in 2018 received them for two months or longer 5–10%Suggested initial dose reduction every 2–4 weeks in the 2025 guideline Months–yearsHow long a full taper can take after long-term, higher-dose use

What Did the FDA Actually Warn About?

Short answer

On September 23, 2020, the FDA required an updated Boxed Warning — its most prominent warning — across the entire benzodiazepine class, adding the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions. The agency stated that physical dependence can develop when these drugs are taken steadily for several days to weeks, even when taken exactly as prescribed, and that abrupt discontinuation or rapid dose reduction can produce withdrawal reactions including seizures, which can be life-threatening.

The scale behind that decision is worth seeing plainly. The FDA cited roughly 92 million benzodiazepine prescriptions dispensed from U.S. outpatient pharmacies in 2019 — alprazolam 38%, clonazepam 24%, lorazepam 20% — and noted that about half of patients dispensed them in 2018 received them for two months or longer. Benzodiazepine-involved overdose deaths rose from 1,298 in 2010 to 11,537 in 2017, with 55% of those between 2013 and 2017 also involving prescription opioids.

Two things are true at once here, and most writing on this topic only manages one of them. These are genuinely risky medications that were prescribed too freely for too long, particularly in combination with opioids. And the people currently taking them, often for years, on a prescriber's advice, did nothing wrong and are now carrying a physical dependence they didn't choose.

The FDA's own language on how to handle that is unambiguous: a gradual, patient-specific taper, not a standard schedule. That recommendation was in the 2020 communication. It did not always survive contact with practice.

Why Is Stopping Abruptly So Dangerous?

Short answer

Because benzodiazepines act on the brain's primary inhibitory system, and the brain compensates for their presence. Remove them suddenly and that compensation is left unopposed — producing severe anxiety, insomnia, tremor, autonomic instability, and in serious cases delirium and seizures. This is one of only a handful of drug withdrawals that can kill you. Alcohol withdrawal is the other well-known one, and the mechanism is closely related.

If you take a benzodiazepine regularly, do not stop on your own. Not by running out, not by deciding to quit over a weekend, and not by halving your dose because an article suggested it. If you've lost access to a prescription — a prescriber retired, a refill was refused, you moved — treat that as an urgent medical issue and contact a clinician or an urgent care provider the same day. This is the single most important sentence on this page.

It's worth being specific about why this differs from the antidepressant discontinuation that gets discussed alongside it. Stopping an antidepressant abruptly can make you feel genuinely awful for weeks — dizziness, brain zaps, nausea, emotional instability — but it is not typically dangerous. Stopping a benzodiazepine abruptly after sustained use can cause a withdrawal seizure. Those are different categories of risk, and they call for different levels of caution.

The 2025 guideline reflects that: it states that severe or complicated withdrawal should be managed in inpatient or residential medically managed settings, with regular vital signs, structured assessment, and explicit seizure risk assessment. That's not a scare tactic. It's an acknowledgment that some tapers need a level of monitoring that outpatient care can't provide.

Physical dependence on benzodiazepines can develop within days to weeks of steady use, even at prescribed doses. It is not a sign of misuse.

What Changed With the 2025 Guideline?

Short answer

In June 2025, the American Society of Addiction Medicine published the Joint Clinical Practice Guideline on Benzodiazepine Tapering in the Journal of General Internal Medicine, developed with nine other medical societies including the American Psychiatric Association, the American Academy of Family Physicians, and the American Geriatrics Society. Its central messages: don't stop abruptly in anyone likely to be physically dependent, start with small reductions, adjust to the individual, and make the plan with the patient rather than for them.

The guideline was written partly because clinicians were uncertain how to taper safely — and that uncertainty had consequences in both directions. Some patients stayed on benzodiazepines indefinitely because nobody wanted to open the conversation. Others were tapered far too quickly, or simply discontinued, by prescribers reacting to the risk warnings without a plan for the person in front of them.

As Dr. Aleksandra Zgierska, co-author of the accompanying editorial, put it: "A rushed or poorly managed taper can result in real harm to a patient." And from Dr. Emily Brunner, who chaired the writing committee: "There is no one-size-fits-all tapering schedule."

What the Guideline Says a Well-Run Taper Looks Like

Small initial reductions Generally 5–10% of the total daily dose every 2–4 weeks, and typically not exceeding 25% every 2 weeks. Patients on lower doses for under roughly three months may be able to move faster. Pause and slow, not push through Significant withdrawal symptoms are a signal to hold or slow the taper — not to tough out the schedule. Severe symptoms warrant a slower pace. Switching agents is an option Moving to a comparable dose of a longer-acting benzodiazepine can smooth the decline between doses and make the taper more tolerable. Shared decision-making The plan should be developed with the patient, and with care partners where possible — not handed down with a deadline. A lower dose may be the goal Reaching zero is not the only acceptable outcome. The guideline explicitly notes that maintaining a reduced dose may be sufficient in some cases. Regular reassessment Risk–benefit review at least every three months and at each renewal, with new prescriptions reassessed within a month, plus PDMP review and monitoring for withdrawal at each reduction.

Those percentages are here so you can recognize whether a plan you've been handed is in the range that ten medical societies consider reasonable — not so you can build your own schedule. "We'll have you off in three weeks" is a plan worth questioning. Your actual taper has to be designed and supervised by a prescriber who can adjust it as you respond.

Does Everyone on a Benzodiazepine Need to Come Off?

Short answer

No — and this is the part of the guideline that gets least attention. Tapering is indicated when risks outweigh benefits. The guideline singles out adults 65 and older, who should generally be tapered absent compelling reasons otherwise, and says patients with PTSD should be strongly considered for tapering. But it also identifies situations where long-term use may be appropriate, including severe treatment-resistant generalized anxiety disorder, bipolar spectrum disorders, complex seizure disorders, and catatonia — and recommends specialist consultation in those cases.

That nuance matters because the public conversation has flattened into two camps — benzodiazepines are fine, or benzodiazepines are poison — and neither describes how this decision is actually made.

Situation	What the guideline indicates
Adults 65 and older	Generally should be tapered unless there are compelling reasons to continue. Falls, cognitive effects, and sedation risk all rise with age
PTSD	Tapering should be strongly considered. Benzodiazepines can interfere with the processing that trauma-focused therapy depends on
Risks clearly outweigh benefits	Taper — with a plan, shared decision-making, and adjustment as you go
Severe treatment-resistant GAD, bipolar spectrum disorders, complex seizure disorders, catatonia	Long-term use may be appropriate. Specialist consultation is recommended rather than automatic tapering
Pregnancy	Risks and benefits weighed for the maternal–fetal pair. Not a situation for a default answer in either direction
Unlikely to be physically dependent	May be able to stop without a taper — but should be told what withdrawal or rebound symptoms to report

If you are on a benzodiazepine for one of the conditions in that fourth row, the right response to a prescriber who wants to stop it is not compliance and not refusal. It's asking for the specialist consultation the guideline recommends.

How Long Does Benzodiazepine Withdrawal Last?

Short answer

Acute withdrawal typically begins within days of a reduction and settles over subsequent weeks, with the timing depending heavily on the drug's half-life. The FDA also describes a protracted withdrawal syndrome lasting weeks to as long as 12 months. The 2025 guideline notes that fully tapering off can take months to years after long-term, higher-dose use — which is a statement about the taper itself, not only the symptoms.

Half-life drives much of the experience, exactly as it does with antidepressants. Shorter-acting agents like alprazolam produce sharper peaks and troughs, which is part of why between-dose withdrawal — feeling anxious a few hours before the next dose is due — is so commonly reported with them. Longer-acting agents like diazepam decline more gradually, which is the rationale behind switching before tapering.

The honest answer to "how long" is that nobody can tell you in advance, and a prescriber who gives you a confident number on day one is guessing. What they can tell you is that the pace is adjustable, that holding at a dose is allowed, and that the timeline is a consequence of how you respond rather than a commitment you've made.

What Is "BIND," and How Much Weight Should It Carry?

Short answer

BIND — benzodiazepine-induced neurological dysfunction — is a term describing persistent symptoms some people report long after stopping. It comes from a 2023 survey of 1,207 people in PLOS ONE reporting high rates of long-lasting anxiety, sleep disturbance, low energy, cognitive difficulty, and memory problems. It is worth knowing about and worth treating cautiously: respondents were self-selected from benzodiazepine support groups, there was no control group, several authors hold roles with benzodiazepine advocacy organizations, and in June 2026 the journal's editors added a note flagging concerns about the peer review process while stating they had not assessed the findings themselves.

You will encounter this term if you search for benzodiazepine withdrawal, so it deserves a straight answer rather than either amplification or silence.

What the survey reported: among 1,207 respondents — 136 still taking benzodiazepines, 294 tapering, 763 discontinued — anxiety or fear was reported by 88.1%, sleep disturbance by 86.9%, low energy by 86.2%, and difficulty focusing by 85.3%. Roughly three-quarters of affirmative symptom responses described symptoms lasting months or a year or longer. Over 90% attributed at least one adverse life consequence to benzodiazepine use, with the average respondent reporting 8.1 of 16 listed consequences.

What that design can and cannot tell you: a survey recruited through support groups for people harmed by a drug will, by construction, find people who were harmed by that drug. That isn't a flaw the authors hid — they list it among their own limitations, along with the absence of a control group, no verification against medical records, and no way to establish whether respondents met criteria for a psychiatric disorder. The June 2026 editorial note adds a further caution about how the paper was reviewed.

So where does that leave someone actually trying to decide something? Roughly here: persistent post-withdrawal symptoms are reported often enough, by enough people, across enough clinical settings, that dismissing them is not defensible — the FDA's own description of protracted withdrawal lasting up to twelve months is drawn from adverse event reports, not from advocacy. But a self-selected survey cannot tell you how common these outcomes are among everyone who takes these drugs, and anyone citing its percentages as population rates is misusing it. The uncertainty runs in both directions, and you're entitled to a prescriber who holds it that way rather than collapsing it into whichever answer is more convenient.

Sleep is usually the hardest part of a benzodiazepine taper — and the part most worth building a plan around before the first reduction.

What Actually Helps During a Taper?

Short answer

The things that treat the underlying problem the benzodiazepine was covering. For insomnia, that's CBT-I, which has better long-term evidence than any sleep medication. For anxiety, it's SSRIs or SNRIs plus CBT. The guideline also advises monitoring sleep closely in patients with mood or psychotic disorders, and pausing the taper if significant sleep disturbance develops — because sleep loss destabilizes those conditions fast.

CBT-I for sleep

Cognitive behavioral therapy for insomnia is first-line for chronic insomnia and outperforms sedatives over the long run. Starting it before the taper begins, rather than after sleep falls apart, changes how the whole process goes.

Treating the anxiety properly

If a benzodiazepine has been doing the work of an untreated anxiety disorder, removing it without putting evidence-based treatment in its place is a plan that will fail. SSRIs, SNRIs and CBT take weeks to work, which is an argument for starting them early.

Frequent contact

Tapers go badly when nobody checks in between reductions. More frequent, shorter appointments beat a review every three months — one of the few places telepsychiatry has a structural advantage.

Permission to hold

Knowing in advance that pausing is allowed, and is not failure, is the difference between reporting symptoms honestly and hiding them to avoid disappointing your prescriber.

Someone who knows

A partner or friend who understands what you're doing and can tell you what they're noticing. Irritability and cognitive fog are easier to see from outside than from inside.

Avoiding alcohol

Alcohol acts on the same receptor system and will both mask and worsen withdrawal, while raising seizure risk. This is the one substitution to rule out completely during a taper.

If You've Been Cut Off Rather Than Tapered

This happens, and it is worth naming as its own situation rather than a variant of the above. A prescriber retires, a practice changes policy, a refill is refused after a urine screen, an insurer stops covering the fill, or a clinician reads about the boxed warning and reacts. The patient is left holding a physical dependence with no prescription.

That is a medical problem requiring same-day attention, not a reason to ration what's left or source medication elsewhere. Contact another prescriber, an urgent care clinic, or an emergency department and say plainly: I take this medication daily, I no longer have access to it, and I understand abrupt discontinuation carries seizure risk. That framing gets the right response faster than anything else.

The 2025 guideline's existence is itself an acknowledgment that abrupt discontinuation by clinicians has been a real problem. Being in that position reflects a gap in the system, not a failure on your part.

8 Questions Worth Asking Before a Taper Starts

1. Why now, and what specifically are we reducing risk of? A clear answer changes how the whole process feels.
2. What size reduction, and how often? Compare it against the 5–10% every 2–4 weeks the guideline suggests as a starting point.
3. What happens if a reduction goes badly? You want "we hold or go back up a step" — explicitly, in advance.
4. How often will we actually talk during this? Quarterly check-ins are not enough during active tapering.
5. Should I switch to a longer-acting benzodiazepine first? A standard, guideline-recognized strategy worth asking about.
6. What's the plan for my sleep? If the answer isn't CBT-I or something equally concrete, press on it.
7. Is zero the goal, or is a lower dose acceptable? The guideline says a reduced dose may be sufficient. Your prescriber should know that.
8. Who do I call at 2 a.m. if something goes wrong? There should be a real, specific answer before you start.

Where to Find Reliable Information

• FDA Drug Safety Communication on the benzodiazepine Boxed Warning, the primary regulatory document from September 2020.
• Joint Clinical Practice Guideline on Benzodiazepine Tapering in the Journal of General Internal Medicine — the full 2025 guideline, free to read.
• NIMH — Anxiety Disorders, for background on the conditions these drugs are most often prescribed for.
• SAMHSA National Helpline — free, confidential, 24/7 treatment referral at 1-800-662-4357.
• FindTreatment.gov, the federal directory for substance use and medically managed withdrawal services.

Frequently Asked Questions

Am I addicted if I have withdrawal symptoms?

No. Physical dependence and addiction are different things, and conflating them has caused a great deal of unnecessary shame. Dependence means your nervous system has adapted to a drug's presence and needs time to readjust — the FDA notes it can develop within days to weeks of steady use at prescribed doses. Addiction involves craving, loss of control, escalating use, and continued use despite harm. You can have the first without anything resembling the second, and most long-term prescribed patients do.

How fast is too fast for a benzodiazepine taper?

The 2025 guideline suggests initial reductions of roughly 5–10% of the total daily dose every 2–4 weeks, and generally not exceeding 25% every two weeks. Measured against that, plans that aim to finish in a few weeks after years of use are outside what ten medical societies consider reasonable. That said, the right pace is individual, and the figure is a reference point for evaluating a plan rather than a schedule to follow on your own.

Can I just take my benzodiazepine every other day instead?

This is a poor strategy and sometimes a dangerous one, particularly with shorter-acting drugs. Skipping days creates steep swings in blood level — precisely the pattern that provokes withdrawal symptoms, and with benzodiazepines, potentially seizures. Gradual reduction of the daily dose is the approach the guideline describes. If your current doses are hard to divide further, that's a conversation about formulations with your prescriber, not a reason to improvise.

Will I ever sleep normally again?

Rebound insomnia during a taper is common and it is also temporary, though it rarely feels that way at 3 a.m. in week two. The more useful fact is that CBT-I has better long-term outcomes for chronic insomnia than sedative medication does — so the sleep on the other side of a taper is often better than the sleep that prompted the prescription. Starting CBT-I before the first reduction, rather than after sleep collapses, makes a real difference.

My doctor wants me off but I'm scared. What are my options?

Ask for the plan in writing and compare it against the guideline's parameters. Ask explicitly what happens if a step goes badly. Ask whether a lower maintenance dose is an acceptable outcome, because the guideline says it may be. And if your diagnosis falls into one of the categories where long-term use can be appropriate — severe treatment-resistant GAD, bipolar spectrum disorders, complex seizure disorders, catatonia — ask for the specialist consultation the guideline recommends rather than agreeing to a taper by default.

Is benzodiazepine withdrawal really more dangerous than antidepressant withdrawal?

Yes, categorically. Antidepressant discontinuation can be genuinely miserable but is not usually dangerous. Benzodiazepine withdrawal after sustained use can produce delirium and seizures, and can be life-threatening. Both deserve a careful taper; only one of them can require inpatient medical management, which the 2025 guideline recommends for severe or complicated cases.

If You Need Help Right Now

If you have run out of a benzodiazepine you take daily, or are having severe withdrawal symptoms — confusion, hallucinations, a seizure, or a racing heart with high blood pressure — seek emergency medical care. Call 911 or go to your nearest emergency department. This is a medical emergency, not something to wait out.

If you're having thoughts of harming yourself, call or text 988 to reach the Suicide & Crisis Lifeline, available 24/7 across the United States, or chat at 988lifeline.org. Withdrawal states can bring on thoughts that are not yours and will pass — telling someone is how you get through to the other side of them.

A Practical First Step

Before a taper starts, it helps to have a documented baseline — so that when you feel worse in week three, you and your prescriber can tell whether that's withdrawal, returning anxiety, or sleep debt. Our free, confidential screening tools include the GAD-7 for anxiety, the PHQ-9 for depression, and the ISI for insomnia — the three measures most worth tracking across a benzodiazepine taper.

A screening isn't a diagnosis. Repeated at each dose reduction, though, it turns "I think I'm doing worse" into a line on a chart.

How We Approach This

Medication management is East Coast Telepsychiatry's core work, and benzodiazepine tapering sits squarely inside it — including the parts that usually get skipped: putting real treatment in place for the underlying anxiety or insomnia before reductions begin, seeing you frequently enough during the taper to catch trouble early rather than at a quarterly review, and treating a pause or a step back up as a normal part of the plan rather than a setback.

Two honest limits. Severe or complicated withdrawal needs inpatient or residential medically managed care, which no telehealth practice can provide — if that's what your situation calls for, we'd tell you and help you find it. And if your diagnosis is one where long-term use may genuinely be appropriate, we'd rather say so than taper you because a guideline headline said to. You can see our providers, the conditions we treat, and what care costs before booking anything.

Related Reading

Conditions We TreatAnxiety, insomnia, depression, PTSD, bipolar disorder and more Free ScreeningsGAD-7, PHQ-9, ISI and other validated self-assessments Our ProvidersBoard-certified psychiatric clinicians across the East Coast Insurance & CostWhat's covered and what care actually costs FAQsHow telepsychiatry works, start to finish More ArticlesEvidence-based mental health education

A Taper Is a Plan, Not a Deadline

Whether you're being asked to come off, want to come off, or were stopped abruptly and are struggling now — this is work that goes better with a prescriber who sees you often and adjusts as you go.

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Sources & Further Reading

1. U.S. Food and Drug Administration. "FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class" — Drug Safety Communication, September 23, 2020.
2. Brunner E, Lindsay D, et al. "Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits." Journal of General Internal Medicine, 2025;40(12):2814–2859. Published online June 17, 2025.
3. American Society of Addiction Medicine. Full guideline document (PDF), developed with AAFP, AAN, AAPA, AANP, AAPP, ACMT, ACOG, AGS and APA.
4. American Society of Addiction Medicine. Press release on the tapering guideline (PDF), June 17, 2025.
5. ASAM Benzodiazepine Tapering Guideline — pocket guide, a condensed clinician-facing summary.
6. Ritvo AD, Foster DE, Huff C, Finlayson AJR, Silvernail B, Martin PR. "Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey." PLOS ONE, 2023;18(6):e0285584. Note: in June 2026 the journal's editors added a note flagging concerns about the peer review process, while stating they did not assess the findings; the survey is also self-selected, has no control group, and several authors hold roles with benzodiazepine advocacy organizations.
7. Indian Health Service National Pharmacy and Therapeutics Committee. "New Boxed Warning for Benzodiazepines" — clinician-facing summary of the FDA action.
8. Vanderbilt University Medical Center Poison Control. "How does the new boxed warning for benzodiazepines affect clinical practice?"
9. "Benzodiazepine Tapering: Key Takeaways From New Guidelines" — Psychopharmacology Institute.
10. National Institute of Mental Health. Anxiety Disorders.
11. FindTreatment.gov — federal directory of substance use and withdrawal management services.
12. SAMHSA. National Helpline — 1-800-662-HELP (4357).

This article is for general educational purposes and does not constitute medical advice, diagnosis, or treatment, and nothing in it is a tapering protocol. Benzodiazepine withdrawal can be medically dangerous, including seizures that can be life-threatening. Never start, change, or stop a benzodiazepine without supervision from a qualified prescriber, and seek emergency care if you have lost access to a medication you take daily. The dose-reduction figures cited are published clinical guidance for clinicians, included so patients can evaluate a plan they have been given — not a schedule to apply independently. Drug names appear for general education and do not indicate that any medication is right or wrong for you. If you are experiencing a mental health emergency, call or text 988 or dial 911.