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Long-term benzodiazepine use can take a toll on your brain and body. Studies show that chronic use is linked to memory and thinking problems, even dementia risk in older adults. You may feel constantly foggy or unfocused. Mood can also suffer: benzodiazepines can worsen or cause depression and anxiety over time. Some people notice feeling down or irritable on these medications, especially at higher doses. Paradoxically, although benzos help you sleep at first, they disrupt deep sleep. Most of the extra sleep you get is light (stage 2) rather than restorative REM or slow-wave. This means you may still feel unrefreshed and tired the next day. Finally, chronic use can dysregulate stress hormones (like cortisol) and immune function, increasing inflammation and decreasing energy.

Because of these risks, we will assess whether you need to reduce or stop your benzodiazepines. Every patient is different, which we consider while following evidence-based guides to keep you safe and comfortable as your body adjusts to smaller doses if we move forward.

Our taper plan follows and is informed by the Oregon Benzodiazepine Tapering Guide (a state-recommended protocol), The Ashton Manual, and the ASAM (American Society of Addiction Medicine) Benzodiazepine Tapering Clinical Guidelines to ensure patient safety. The main steps are:

1. Convert to Diazepam (Valium): First, your current benzodiazepines (like alprazolam/Xanax or lorazepam/Ativan) are switched to diazepam over about one month. Diazepam lasts longer in the body, providing a more stable baseline. Typically, one dose (often the bedtime dose) is converted at a time, about one per week. Each dose of your old med is replaced by an equivalent dose of diazepam (using a standard equivalency chart). The aim is to find a diazepam dose that prevents withdrawal but doesn't make you too sleepy. If you were on a high total dose (for example, 6 mg/day alprazolam ≈ , 120 mg diazepam), a small initial cut (25–50%) might be made during this transition to avoid oversedation.

2. Stabilize and Check: After full conversion to diazepam, we will check in a few days (usually 2–4 days later) to make sure the dose is right and to adjust if needed. The CIWA-B assessment will help here.

3. Gradual Reductions: Once stabilized, the total daily diazepam dose is slowly reduced. The general rule is about 5–10% every 2-4 weeks as tolerated, split into smaller decreases taken every few days. For example, if your total diazepam dose is 40 mg/day, we might reduce it by 2–4 mg per two weeks. When your dose falls (say to 20 mg/day), the bi-weekly cut might drop to 1–2 mg. When you’re down to very low doses (like 10 mg/day), reductions might be 0.5–1 mg per every 2-4 weeks.. In each case, these cuts are small enough to minimize withdrawal but still move you forward.

   • After you have reached about half of your starting dose, the taper is often slowed even more.

   • Key point: The process is gradual. Depending on how high your original dose was, you might be on this plan for many weeks or months.

4. Frequent Monitoring: We will check in with you regularly (often weekly or biweekly) to check CIWA-B scores, discuss symptoms, and adjust the plan if necessary. If symptoms are very mild and you’re doing well, the taper continues as planned. If symptoms spike, the speed of tapering can be slowed or paused until you feel stable.

5. No “As Needed” Benzo Doses: It’s important not to take extra (“PRN”) benzodiazepine doses during tapering, as this can disrupt the process. We will focus on learning coping tools for anxiety or insomnia (like relaxation techniques) instead of reaching for “rescue” benzo pills.

Example Taper Schedule (Diazepam):

• Initial high dose: At 40 mg/day, reduce by 2–4 mg every 1-4 weeks.

• Mid-range dose: At 20 mg/day, reduce by 1–2 mg per 1-4 weeks.

• Low dose: At 10 mg/day, reduce by 0.5 to 1 mg every 2-4 weeks.

Throughout the taper, we will emphasize support, including therapy, sleep hygiene, nutrition, and other healthy habits to improve your comfort and mood. The plan is always individualized. If withdrawal feels too severe at any point, we can pause dose reductions or try a very temporary medication to ease a particular symptom.

Benzodiazepine deprescribing is guided by current research and clinical standards. Key resources include:

• Fischer, J. A., Roche, A. M., & Duraisingam, V. (2021). Clinical Institute Withdrawal Assessment – Benzodiazepine (CIWA-B): Description, strengths and knowledge gaps. National Centre for Education and Training on Addiction (NCETA), Flinders University.

• Guina, J., & Merrill, B. (2018). Benzodiazepines I: Upping the care on downers – the evidence of risks, benefits and alternatives. Journal of Clinical Medicine, 7(2), 17.

• Picton, J. D., Marino, A. B., & Nealy, K. L. (2018). Benzodiazepine use and cognitive decline in the elderly. American Journal of Health-System Pharmacy, 75(1), e6–e12.

• Legan, J. A., Gentry, J., Shugoll, J., Zhong, Q., & Ait-Daoud, N. (2025). Pharmacotherapy for alcohol use disorder: A comprehensive review of current treatments and future directions. Medical Research Archives, 13(2).

• Center for Substance Abuse Treatment. (2009). Incorporating Alcohol Pharmacotherapies into Medical Practice (TIP Series No. 49). Substance Abuse and Mental Health Services Administration.

• Oregon Health Authority – Mental Health Clinical Advisory Group. (2022). How to approach a benzodiazepine taper [Guideline]. Oregon Health Authority.

• Oregon Pain Guidance. (2015). Tapering flowchart: Benzodiazepine taper. Retrieved from Oregon Pain Guidance website.

• Ashton, H. (2002). Benzodiazepine withdrawal manual: Chapter 3 – Withdrawal symptoms (Free Ashton Manual). Benzodiazepine Information Coalition.