Benzodiazepines

Benzodiazepines are medicines such as alprazolam, clonazepam, diazepam, and lorazepam. They are prescribed for anxiety, panic, seizures, alcohol withdrawal, and sometimes sleep. They work quickly — which is part of why they help, and part of why they can be hard to stop.

In 2020 the U.S. Food and Drug Administration required its strongest warning, a Boxed Warning, on all benzodiazepines, describing risks of misuse, addiction, physical dependence, and withdrawal reactions.¹

Benzodiazepine use disorder is diagnosed within sedative, hypnotic, or anxiolytic use disorders. Physical dependence from prescribed use is common and is not, by itself, a use disorder.

Many people take benzodiazepines exactly as prescribed and become physically dependent, meaning their body has adapted. That is different from a use disorder, which involves loss of control, craving, and continued use despite harm. Both deserve careful, non-judgmental care.

Pills sold outside pharmacies may look like real benzodiazepines but can contain other drugs, including fentanyl or unapproved sedatives.²

• Long-term daily use, even at prescribed doses, can lead to tolerance and dependence.
• Using more than prescribed to manage anxiety or sleep can escalate quickly.
• Combining with alcohol or opioids — sometimes to intensify effects — increases both dependence and danger.
• Untreated anxiety, insomnia, or trauma can keep the underlying need active.

Benzodiazepines enhance GABA, the brain's main calming signal. With regular use, the brain adjusts by reducing its own sensitivity to GABA. When the medicine is stopped quickly, the nervous system is left over-excited — causing anxiety, insomnia, tremor, and in serious cases seizures. This is similar to alcohol withdrawal, and it is why both require medical care.

• Withdrawal symptoms can feel like the original anxiety coming back, making it hard to tell the two apart.
• Rebound insomnia makes nights difficult during a taper.
• Fear of panic or of withdrawal itself can keep people taking the medicine.

• Taking more than prescribed, or more often
• Running out early, or getting prescriptions from more than one doctor
• Buying pills outside a pharmacy
• Drowsiness, slurred speech, memory gaps, or unsteadiness
• Combining with alcohol or opioids
• Anxiety or shakiness that appears between doses

Overdose and breathing

Benzodiazepines combined with opioids, alcohol, or other sedatives can slow breathing to dangerous levels.¹

Falls and accidents

Sedation and poor coordination increase the risk of falls, especially in older adults, and of driving accidents.

Memory and thinking

Memory and concentration problems are common with ongoing use.

Withdrawal

Can be prolonged for some people and should be managed with a clinician.

• You may have done everything right. Many people became dependent following medical advice. That is not a personal failing.
• Tapering can take time. A slow plan may take weeks or months. Going slower than you hoped is often what makes it work.
• Underlying anxiety still needs care. Therapy and other treatments for anxiety and sleep make tapering more sustainable.

• Talk with your prescriber about whether a taper is right for you — and how fast.
• Expect the plan to be gradual and adjustable based on how you feel.
• Pair the taper with support for anxiety and sleep, such as cognitive behavioral therapy.
• Avoid alcohol and other sedatives during the taper.

The core of treatment is a gradual, individualized dose reduction supervised by a clinician, sometimes using a longer-acting benzodiazepine. Cognitive behavioral therapy for anxiety and insomnia can improve outcomes. For people with a use disorder or combined substance use, specialist addiction care — and sometimes inpatient withdrawal management — may be needed.

1. Do not stop suddenly. Keep taking your current prescribed dose until you have spoken with your prescriber.
2. Avoid alcohol, opioids, and other sedatives.
3. Call 911 for a seizure, severe confusion, or if someone cannot be woken.
4. If pills came from outside a pharmacy, they may contain fentanyl: carry naloxone and do not use alone.
5. Write down your questions using Preparing to Seek Treatment.

• Do not take or flush their medicine — sudden stopping can be dangerous.
• Encourage a conversation with their prescriber and offer to go with them.
• Learn the signs of over-sedation and keep naloxone nearby if opioids may be involved.