I’m frequently asked “Where can I find a doctor to help me stop benzodiazepines?” In my opinion, the better question is “How can I be successful coming off benzodiazepines?”
I’ll share some tips that may help one get off benzodiazepines, whether they have an expert doctor or not. While not comprehensive, the list below outlines some information for those wanting to stop benzodiazepines.
Please keep in mind these tips were compiled based on firsthand experience and anecdotes from others, and I am not a medical professional and none of my opinions should be construed as medical advice. Please see our medical disclaimer for more information.
1. Join an Online Support Group.
Relying solely on the medical profession is entirely insufficient— one must truly understand what they are up against. This is best learned in support groups, which contain the most accurate information about benzodiazepine withdrawal (note that there is also a lot of inaccurate information, and that interacting with other benzodiazepine-harmed individuals can provoke anxiety). One must be patient and discerning, but the knowledge is there. Some recommended groups and websites for support can be found in the Resources section of our website.
2. Read the Ashton Manual and our Tapering Strategies and Solutions.
This doesn’t mean one must strictly follow the Ashton Manual, as better options, like micro tapering, exist. However, the Ashton Manual is an expertly written guide answering common questions for laypeople about benzodiazepine withdrawal. A free copy of the Ashton Manual is available on our site. Our own Benzodiazepine Tapering Strategies and Solutions is free on our website. In 2022, we helped author this Benzodiazepine Deprescribing Guidance through the University of Colorado and the Colorado Consortium that may be useful to your prescriber.
3. Accept that there aren’t (m)any benzodiazepine withdrawal experts. Focus on finding a prescriber who is willing to work with you instead.
Many people frantically search for an “expert” to help them with benzodiazepine withdrawal. While some prescribers may claim to be experts, the sad reality is that they usually are not. These searches often waste resources and time that could have been spent tapering correctly and recovering. Also, the more “experts” consulted, the more vulnerable one may be to dangerous prescriber errors. (Some of the most common prescriber errors are discussed here). Most who successfully taper off benzodiazepines do so without an expert. In fact, while ill-advised, many patients report to us that they avoid informing their prescribers that they are tapering due to concerns over the risks of being “cut off,” especially if they have had a poor experience with a past prescriber.
Some prescribers really do know a lot about benzodiazepine cessation, but they are rare and the exception. So, instead of “expert,” search for “benzo-cooperative” prescribers— having one in your corner is the best case scenario.
“Benzo-cooperative” prescribers are willing to:
- taper at your desired/required rate.
- refill the prescription for the duration of the taper.
- accommodate switching to a liquid compound or longer-acting benzodiazepine (should you require one) at the appropriate equivalence.
Unfortunately, some prescribers get skittish when approached about benzodiazepine cessation, leading to risky results. Prescribers may overreact to a patient’s request to come off a benzodiazepine or to their reported withdrawal symptoms and force their patient to “cold turkey,” taper too rapidly, or just drop the patient completely. This is reported frequently, so I want to warn clearly on this:
Have a backup plan, including an appointment set with another prescriber, before having the cessation conversation with your current one.
A list of prescribers given positive feedback by patients and/or who expressed a willingness to be “benzo-cooperative” can be found on our site. That said, many resign from the list, exhausted by the real needs of the tapering, and some are removed due to poor feedback. Please keep this in mind with your expectations.
4. Avoid addiction language when describing your benzodiazepine problem.
Learn the difference between physical dependence and addiction. Inappropriate language undermines your own success. It impairs your ability to get prescriber help, harms other patients, and only serves to broaden the already-large pool of ignorance surrounding benzodiazepines. This topic is explained extensively here, here, here, here, here and here. If you are determined to call yourself an addict, I beg you to read them and consider why you should stop.
5. Don’t go to rehab if you are a compliant patient (with a few exceptions).
As an organization, we warn against compliant patients going to rehab or detox for benzodiazepine cessation. Before considering this approach, find our reasoning fully outlined here.
6. Know the equivalence conversion and how to crossover.
Many patients decide to switch (aka “crossover”) from a shorter half-life drug to a longer one, like Valium. To add further confusion, there are multiple benzodiazepine equivalency charts, many of which may under-dose some patients. Although the Ashton Manual guideline has higher equivalent doses than others, it is the most evidence based in a real clinical setting. You can find a conversion calculator using the Ashton Manual guidance here. That said, these charts are just a guide and true equivalences may vary among individuals.
Switching directly from one benzodiazepine to another without a transition period is also not advised. The crossover charts in the Ashton Manual give specific instructions on how to do a stepwise transition.
7. Recognize some patients will be fine regardless of approach.
Benzodiazepine withdrawal severity is a spectrum. A percentage experience zero to minimal withdrawal symptoms; they will not have problems regardless of the approach. Unfortunately, medicine often regards this as the norm, erroneously attributing the luck of easy withdrawal to the skill of the prescriber or the cessation method. The truth is that there is no way to tell in advance where any patient will fall on the withdrawal spectrum. Asking others what they did and assuming their outcome applies to you will not provide much insight into what your experience will ultimately be.
8. Know that taper rates provided by medical professionals are often arbitrary and overly rapid.
Most prescribers choose an arbitrary taper rate for benzodiazepine cessation based on available doses. Examples include advice to cut a pill in quarters or halves every few days, regardless of the total daily dose, to skip doses, or to reduce by 20-25% (or more) per week. Most patients blindly follow this, as they trust their prescriber, not realizing these tapering suggestions are largely unresearched, and can be damaging or deadly. According to Schweizer et al, reductions implemented by many physicians of 25% per week have a 32-42% failure rate. Even the FDA manufacturer cessation rates have high failure rates. A review by Nassima et al concluded that the FDA’s Xanax tapering recommendations are too fast.
9. Have your own taper rate and method in mind. Start low, go slow.
Many support groups will provide you with a printable taper plan to present to your prescriber (e.g., a liquid microtaper utilizing a 5-10% per month reduction rate). Since everyone is different, going slow at first is the most sensible approach. If no issues are experienced, one can always speed up, while those who struggle can prevent damage and even slow down. It is important to note that some patients report relatively easy tapers and then have problems AFTER being off. This usually takes a few weeks to manifest and can become severe for long periods of time.
10. Polydrugging and supplements don’t solve benzodiazepine withdrawal.
While the desire to lower or avoid suffering is understandable, the evidence for utilizing nearly all medication and supplements to “treat” benzodiazepine withdrawal is very low, unconvincing, or nonexistent. In fact, the British National Formulary and Dr. Ashton specifically warn against polydrugging and supplements. This does not mean you should avoid everything, including things you are medically advised to take. Rather, be your own advocate, being aware medications and/or supplements are often ineffective at reducing withdrawal symptoms, while simultaneously carrying their own dependence and withdrawal potential, and are even sometimes even anecdotally reported to make things worse. We maintain a list of medications and supplements that may cause setbacks on our website.
Hopefully you find these tips useful in your own journey. I wish you well.