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Benzodiazepine and z-drug withdrawal - Management
What should I advise people undergoing withdrawal?

  • Advise that drug withdrawal should be gradual to minimize the risk of withdrawal effects.
  • Offer reassurance that the person will be in control of the drug withdrawal and that they can proceed at a rate that suits them. Drug withdrawal may take 3 months to a year or longer if necessary. Some people may be able to withdraw in less time.
  • If the person reaches a difficult point in the drug withdrawal schedule, maintain the current dose for a few weeks if necessary. Try to avoid going backwards and increasing the dosage again if possible.
  • Avoid taking extra tablets in times of stress.
  • Avoid compensating for benzodiazepines or z-drugs by increasing the intake of alcohol or other drugs (prescription, non-prescription, or illicit drugs) or smoking.
  • Stopping the last few milligrams is often seen as being particularly difficult.
    • Reassure the person that this is usually an unfounded fear derived from long-term psychological dependence on benzodiazepines.
    • Warn the person not to be tempted to prolong the drug withdrawal to an extremely slow rate towards the end (such as reducing by 0.25 mg diazepam each month). Advise the person to consider stopping completely when they reach an appropriate low dose (such as diazepam 1 mg daily).
  • Give information on withdrawal symptoms.
    • With slow tapering, many people experience few or no withdrawal symptoms.
      • If withdrawal symptoms are present with slow tapering, some users will have lost all their symptoms by the end of the drug withdrawal schedule. For most people, symptoms will disappear within a few months.
      • Only a very small number of people will suffer from protracted withdrawal symptoms which will gradually improve over a year or longer.
    • Inform the person that nearly all the acute symptoms of withdrawal are those of anxiety.
    • Explain that some of the withdrawal symptoms may be similar to the original complaint and do not indicate a return of this.
    • It is not possible to estimate the severity and duration of withdrawal symptoms as these will depend on a number of factors (such as severity of dependence and speed of withdrawal).
    • For information on managing withdrawal symptoms, see Managing withdrawal symptoms.
  • Reassure the person that they can try again if they did not succeed at their first attempt.
  • Remind the person that reducing benzodiazepine dosage, even if this falls short of complete drug withdrawal, can still be beneficial.

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