Benzodiazepines: When the Medicine Becomes Hard to Stop

Physical dependence can develop even when a person follows the prescription. That is not the same as addiction, but both deserve careful treatment.

This is Part 1 of a two-part series. Part 2 covers tapering, treatment, and recovery.

Read this first: Do not stop a benzodiazepine or change the dose on your own. Your body may be physically dependent. A sudden stop or fast reduction can cause a seizure, delirium, or other dangerous withdrawal. A qualified clinician should guide any change. Call 911 for a seizure, severe confusion, hallucinations, inability to wake, slow or stopped breathing, or immediate danger.

“I took it exactly as prescribed. Why do I feel sick when I miss a dose?”

Your nervous system can adapt to a benzodiazepine. This can happen even when you take it as directed. That biological change is called physical dependence. It is not proof of weakness, deception, or addiction. Stopping suddenly may be unsafe. Your next step should be a careful medical review.12

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The medicine may have helped, and dependence may still develop

Benzodiazepines can calm severe anxiety, stop some seizures, ease muscle spasm, support procedures, and help with other selected conditions. Relief can be real.1613

Benefit and risk can also exist at the same time. A person may still get relief. That same person may notice daytime sleepiness, memory trouble, falls, or symptoms between doses. Another person may have few side effects. Yet a late refill may still be a worry.12

Physical dependence is one possible result of repeated exposure. The FDA says it can develop after steady use for days to weeks. This includes use as prescribed. No exact day or dose predicts it for one person. Risk tends to rise with more frequent, higher, or longer exposure. Past withdrawal trouble and some health factors also matter.12

This can be hard to accept. The body can adapt without anyone doing something wrong. Missed-dose symptoms do not prove secret use. What matters now is safe care and an honest review.

A refill delay can become a health risk. Tell the prescriber early if travel, cost, supply, or lost care may break access. Do not wait for severe symptoms.

None of this means every prescription is wrong or every long-term use must end. A seizure disorder, catatonia, current alcohol withdrawal, or palliative need can change the goal. The right question is not, “Is this medicine good or bad?” Ask what benefits and risks exist now. Then ask what plan best fits the condition.1

What benzodiazepines do in the brain

Brain cells use chemical signals to speed activity up or slow it down. GABA is one part of the brain’s braking system. It works at several receptors, including a channel called the GABA-A receptor.

Classical benzodiazepines attach to a site on some GABA-A receptors. This site is separate from the place where GABA binds. They are called positive allosteric modulators. In plain language, they help the receptor respond more strongly when GABA is already there. They do not replace GABA. They also do not simply make the brain produce more of it.3

That added braking can reduce anxiety, relax muscles, and protect against seizures. It can also cause sleepiness, slower reactions, poor balance, and trouble forming new memories. Effects vary. The drug, dose, timing, person, and reason for use all matter.

Here is a limited teaching analogy. Think of GABA as part of a braking system. Think of each benzodiazepine as having its own clock. One clock tracks how fast the drug reaches the brain. Other clocks track its peak, noticeable effect, metabolism, and clearance. With repeated exposure, the nervous system may adjust to the added braking. If the medicine is removed too fast, the system can become temporarily overactive.

This brake-and-clock picture is only an analogy. Brain biology is more complex. Research does not support claims that the brain simply “stops making GABA” or that all GABA receptors are permanently destroyed. For a longer walk through the brain’s braking system, see What Benzodiazepines Actually Do to the Brain’s Brakes.

When benzodiazepines are used properly

Appropriate use begins with a clear target. The medicine may be meant to reduce panic, treat short-term insomnia, stop a seizure cluster, manage acute alcohol withdrawal, relax a severe spasm, or support a procedure. These goals have different time frames. They also have different safety needs.

Some tablets are FDA-approved for anxiety or panic disorder. Some are approved for short-term insomnia. Diazepam, clonazepam, clorazepate, lorazepam injection, and route-specific diazepam or midazolam products have selected seizure roles. Approval depends on the exact product, route, age, and use.45678910111213

Responsible prescribing includes the lowest effective dose and a planned review. It includes an interaction check and a talk about driving or hazardous work. It also includes secure storage and no sharing. There should be a plan for when the medicine is no longer needed. “As needed” use does not erase impairment, interaction, escalation, or dependence risk.12

A review asks whether the target symptom and function improved. It also checks dose changes, falls, memory gaps, daytime sleepiness, other substances, and new health problems. The answers may shift the balance.12

There is no honest class-wide rule that every benzodiazepine must stop after the same number of days. Product labels and clinical goals differ. Still, a prescription should not continue on autopilot. Its reason and benefit need review. So do side effects, other medicines, and current health.

No benzodiazepine is FDA-approved to treat PTSD. The 2023 VA/DoD guideline recommends against using the class for PTSD itself. That guidance is not a reason to stop suddenly. A person who is dependent still needs an individual safety plan and effective PTSD care.34

General deprescribing advice does not fit every use. Epilepsy, seizure rescue, status epilepticus, active alcohol withdrawal, and palliative or end-of-life care need specialist review. Catatonia also needs urgent, indication-specific care. In these settings, reducing the medicine may not be the right goal.135

Pregnancy and breastfeeding also require a drug-specific review. Late-pregnancy exposure can cause newborn sedation or withdrawal. Abrupt maternal withdrawal can also be dangerous. The review weighs the medicine and the illness being treated. It also weighs fetal or infant exposure and the risks of change.130

Most dependence and taper research is about adults. Adult findings do not automatically apply to children or adolescents. A younger person needs product-specific and pediatric review, especially when the medicine is used for seizures, rescue care, or a procedure.1

One drug class, different clocks

Two benzodiazepines can feel very different. Onset, peak blood level, noticeable duration, and elimination half-life are separate clocks. Half-life is roughly how long the body takes to clear half of the measured drug. The clocks are related, but not identical.

A fast onset does not always mean a short half-life. The felt effect may wear off while drug remains in the body. Some medicines form active metabolites. These breakdown products can keep working after the original drug changes form.

Shorter or faster-changing drugs may produce sharper rises and falls. In some people, that means earlier rebound. Symptoms may also start before the next dose. Longer-lasting drugs may create smoother levels. They can also build up. Sedation may then last longer. This is especially important for older adults. It also matters when the liver clears medicine slowly. Neither group is always safer.14567891011121314

Common benzodiazepines and their different clocks

Clock categories are approximate and source-dependent. This table contains no dose-equivalence information and cannot be used to switch medicines.

How the nervous system adapts

Repeated benzodiazepine exposure can change how the nervous system responds. Receptors may move or signal in new ways. The brain’s activating systems may also adjust. There is no single “damaged receptor” explanation that fits every person.3

Tolerance means that one effect becomes weaker with repeated exposure. It may develop more clearly for sleepiness than for anxiety relief. A person who no longer feels sedated may still have slowed reaction time or memory effects.13

Physical dependence means the body has adapted enough that a missed dose, sudden stop, or large reduction can produce symptoms. Interdose symptoms can occur when levels fall between scheduled doses. Rebound means the treated symptom returns for a time at greater intensity. Withdrawal is a wider set of new or intensified symptoms after exposure falls.123

These processes can overlap. A person may have tolerance without a use disorder. A person may have physical dependence without ever taking more than prescribed. Another person may have dependence and a harmful pattern of use at the same time.

Adaptation varies. One person may notice mild symptoms after a late dose. Another may become very ill after a fast drop. A calm day does not make a sudden stop safe, and a hard day does not prove lasting injury.

Five terms that are not the same

Dependence is not the same as addiction

People often use the word addiction for any medicine that is hard to stop. Clinicians use a narrower meaning. The formal diagnosis is usually sedative, hypnotic, or anxiolytic use disorder. In this series, we call it benzodiazepine use disorder when benzodiazepines are the main drug involved.

The key issue is a harmful pattern. This may include repeated loss of control, a strong drive to use, or risky use. It may also include continued use despite serious harm to health, safety, work, or relationships. One behavior cannot make the diagnosis. A refill request, fear of withdrawal, or feeling ill after a missed dose may reflect physical dependence and a need for safe continuity, not addiction.12

Prescribed use and a use disorder can coexist. So can nonmedical use without a full use disorder. Assessment looks at the whole pattern over time, the reason for use, other substances, consequences, and attempts to change.12

The assessment should feel curious, not like a test. It asks about control, strong urges, danger, serious harm, and fear of withdrawal. Those facts can point in different directions and need context.12

This distinction changes treatment. Physical dependence calls for safe medication assessment. A use disorder may also require care for craving, triggers, return to use, other substances, and recovery support. It is not a moral verdict.1

What raises the risk

Dependence and harm do not come from one factor. The medicine, the person’s health, and other substances all shape risk.

Medicine factors include regular or near-daily use, longer use, higher exposure, rapid onset, sharp falls between doses, and more than one sedating medicine. A past severe withdrawal episode also matters. There is no exact “safe day” before which dependence cannot occur.12

Health factors include older age, frailty, falls, memory problems, and some mental health conditions. Liver or kidney disease, sleep apnea, COPD, pregnancy, and a seizure history also matter.115 Limited follow-up, unstable housing, an unsafe relationship, or an unreliable supply can make secure storage and timely care harder. The plan needs to fit those facts.1

Combination factors often create the greatest immediate danger. Opioids, alcohol, Z-drugs, gabapentin or pregabalin, sedating antihistamines, and muscle relaxants can add to sleepiness. They can also worsen poor coordination and breathing risk.12152324

This risk needs coordinated care. Benzodiazepine use by itself is not a reason to withhold or abruptly stop buprenorphine or methadone. Those medicines treat opioid use disorder. The disorder and the combined sedation risk should be treated at the same time.133

Risk is not fate. It tells the care team what to ask, watch, and plan for. Several risks can add up, so the same dose may not carry the same risk in a new week.

Risk grows when

These are reasons for assessment, not a score that diagnoses dependence or addiction.

What long-term use may cost

Some harms are direct effects of the drug. Sleepiness, slowed reaction time, poor coordination, and trouble forming new memories are well established. These effects can harm daily tasks. Driving, work, school, parenting, cooking, and medicine use may suffer. A person may feel used to the medicine while reaction time remains impaired.121618

Falls and fractures deserve extra attention in older or frail adults. The 2023 Beers Criteria advises avoiding benzodiazepines in most adults age 65 and older. They are more sensitive to the drugs and face greater risks of cognitive problems, delirium, falls, fractures, and crashes. The guidance still recognizes selected uses. It calls for careful review, not forced withdrawal.1517

Breathing risk depends heavily on context. A prescribed oral benzodiazepine taken alone usually suppresses breathing less than an opioid does. “Less” does not mean harmless. Risk rises with opioids, alcohol, other sedatives, high exposure, frailty, sleep apnea, COPD, and procedural routes. Mixing benzodiazepines with opioids can cause deep sedation, breathing failure, coma, and death. Alcohol also adds sedation, memory, balance, and breathing risk.22324

Sleep medicines can shorten the time it takes to fall asleep or increase sleep time for selected people. Benzodiazepines can also shift time among sleep stages, though the studies are mixed and limited. Feeling asleep does not prove that sleep was fully restorative.31

Long-term thinking and memory effects need careful wording. Current users may have poorer memory, attention, or processing speed. This does not prove that exposure causes ongoing decline or dementia. Dementia studies conflict. Anxiety, insomnia, depression, frailty, other medicines, and early dementia symptoms can affect the results.1819

Mortality findings are mixed outside the clear danger of overdose and combined depressants. Results depend on who was studied and who served as the comparison group. Illness severity and reasons for starting or stopping also matter. These links do not prove that continuing or stopping prevents death.2021

Studies also report a link with suicidal behavior. The evidence is observational and highly varied. Severe anxiety, insomnia, other illness, substance use, and the reason for prescribing can affect the result. This signal calls for monitoring and crisis assessment. It does not prove that benzodiazepines cause suicide or justify a forced stop.32

Some people report symptoms that last in waves for months or longer after the final dose. These reports should not be dismissed. Research cannot yet give a reliable rate, cause, usual length, or best treatment. Lasting symptoms also need a new review. The original condition, another illness, sleep problems, or another substance may be involved. The symptoms do not prove permanent brain damage.122

Daily function can give an early warning. Driving errors, falls, burned food, late work, memory gaps, or trouble with caregiving belong in the review. They may have several causes, but change should not be ignored.

What we know and what remains uncertain

Rebound, recurrence, and withdrawal can look alike

Suppose anxiety surges after a missed dose. That could be withdrawal as the drug level falls. It could be rebound, meaning a temporary return stronger than the symptom treated at first. It could be recurrence of the anxiety disorder. More than one process can occur at the same time.1

Insomnia creates the same puzzle. A sleepless night after a dose change does not prove the medicine is needed forever. It also does not prove that every symptom is withdrawal. Timing matters. So do the earlier symptom pattern, other substances, life events, and repeated follow-up.

This is why symptom lists cannot settle the question. A clinician may need a timeline that includes dose times, missed-dose effects, sleep, panic episodes, alcohol or opioid use, and changes in function. The goal is not to win an argument about the label. It is to identify danger and choose the next safe step.1

A timeline can help. Note the symptom before treatment, when it returned, dose times, missed doses, stress, sleep, and other drugs. Timing may suggest withdrawal, rebound, or recurrence, but the pattern can remain unclear.1

Why “just stop” can be dangerous

When a physically dependent person stops suddenly or reduces too fast, the adapted nervous system can become overactive. Early symptoms may include anxiety, insomnia, tremor, sweating, nausea, sensory sensitivity, or trouble concentrating. Severe withdrawal can include a seizure, delirium, hallucinations, psychosis, or extreme agitation.12

Overdose is a different pathway. It often involves reduced alertness and breathing, especially when opioids, alcohol, or other depressants are present. Slow breathing is not the usual mechanism of benzodiazepine withdrawal. Keeping these pathways separate helps a family give the right information and act without delay.

Emergency 1: possible severe withdrawal after stopping or reducing

Emergency 2: possible overdose or mixed exposure

Give the dispatcher the exact location first. Describe responsiveness and breathing, the pill or substance if known, the possible amount and time, injuries, other medicines or alcohol, and any naloxone already given. If the contents or amount are unknown, say that. Do not delay the call while searching for perfect information.2627

A self-harm crisis

Suicidal intent, an attempt, or immediate danger is a third crisis pathway. Call 911 when harm is happening or danger is immediate. In the United States, call or text 988 for suicide, mental-health, or substance-use crisis support. Intoxication or withdrawal can be present too, but the need for crisis help does not depend on proving the cause.28

For a possible poisoning when the person is awake, breathing normally, and not having the emergency signs above, call Poison Control at 1-800-222-1222. It is free, confidential, and open 24 hours a day in the United States. Do not use online triage for a person who has collapsed, cannot wake, is having a seizure, or has breathing trouble. Call 911.27

Tell the poison specialist the product or container, age and approximate weight, possible amount and time, current symptoms, health conditions, other medicines or substances, and aid already given. If something is unknown, say so rather than guessing.27

When to call the clinician urgently

Call the prescriber or covering clinician soon for worsening symptoms after a dose change when no emergency sign is present. Call for repeated dose errors, new heavy sleepiness, falls, or a mixed exposure while the person is awake and breathing normally. Ask what to do next. Do not make up a dose change while waiting. If the person gets worse, use Poison Control or 911 as the symptoms require.

When a routine appointment is enough

Book a routine review when use is stable but there are questions about benefit, memory, driving, sleep, falls, or drug interactions. A future wish to reduce also belongs here. Bring the full medicine list and the goal for care. A routine visit can become urgent if new confusion, severe symptoms, or unsafe use appears.

Counterfeit pills make the decision harder. A pill sold as alprazolam can contain fentanyl, a different benzodiazepine, or another substance. Its imprint and seller’s description cannot confirm the contents or strength. If exposure is possible and breathing or alertness is impaired, follow the overdose pathway.25

Family job: read the situation correctly

With the person’s permission, learn the medicine name, dose, timing, and purpose. Ask about alcohol, opioids, sleep medicines, and other sedatives without accusation. Notice facts such as missed activities, falls, speech changes, sleep hours, and when symptoms appear. Do not turn those observations into a diagnosis.1

Believe the distress without deciding that it proves addiction. Never hide or confiscate prescribed pills, force a reduction, bargain over doses, or demand sudden stopping. Do not offer another person’s medicine or suggest alcohol, cannabis, or an illicit pill as a substitute.1

Know the emergency signs: slowed breathing, inability to wake, a seizure, hallucinations, or severe confusion. Keep naloxone available when opioid or counterfeit exposure is possible, while remembering that it does not reverse benzodiazepines.26

A useful sentence is: “I am worried about your safety. How can I help you talk with your clinician?”

Your first safe step

Start by writing down what is known. Include every prescription, over-the-counter medicine, supplement, alcohol use, cannabis product, opioid, sleep medicine, and non-prescribed pill. Record the benzodiazepine name, dose, times taken, reason it was started, and who prescribes it.1

Add what happens when a dose is late or missed. Note sleep, anxiety, tremor, sweating, confusion, falls, memory trouble, or other changes. Include past attempts to reduce, any seizure or delirium, and whether a pill may have come from an unregulated source. This is a timeline for assessment, not a self-diagnosis.

Bring the bottles or clear label photos when safe. Add the last time each drug was taken. Write “unknown” rather than guessing. A trusted person can help with notes if stress or poor sleep makes the visit hard.

First-conversation checklist

• Identify the clinician responsible for this prescription.
• Describe the benefit the medicine gives now.
• List side effects, missed-dose symptoms, and changes in daily function.
• Report alcohol, opioids, gabapentinoids, sleep medicines, and other sedatives.
• Report any past withdrawal seizure, delirium, overdose, or self-harm crisis.
• Ask whether pregnancy, older age, liver disease, sleep apnea, COPD, epilepsy, bipolar disorder, or another condition changes the plan.
• Agree on what the person and family should do if symptoms worsen before the next visit.

If there is a prescriber, request a risk-benefit review and bring the list. Do not change the current dose before that conversation unless an emergency clinician directs you.

If there is no prescriber, the pills are non-prescribed, the product may be counterfeit, or the dose is uncertain, seek prompt medical or addiction assessment. FindTreatment.gov can help locate U.S. services. SAMHSA’s National Helpline at 1-800-662-HELP (4357) provides treatment information and referral. A listing does not prove that a program can manage benzodiazepine withdrawal, seizures, delirium, or other substance use. Ask about those abilities directly. These resources do not provide real-time medical withdrawal care. Do not buy replacement pills or estimate a taper from an illicit pill’s label.29

For an uncertain dose or possible poisoning without life-threatening signs, call Poison Control at 1-800-222-1222. Use 911 for a seizure, severe confusion, hallucinations, inability to wake, abnormal breathing, collapse, or immediate danger. Call or text 988 for crisis support when suicide, mental health, emotional distress, or substance use is the concern and emergency medical rescue is not already needed.

U.S. emergency and treatment resources

• 911 for life-threatening withdrawal, overdose, breathing trouble, inability to wake, seizure, collapse, or immediate danger. It sends emergency help. Do not delay for an online search.
• Poison Control: 1-800-222-1222 (PoisonHelp.HRSA.gov) for poisoning guidance when there are no current life-threatening signs. It gives expert poisoning advice. It does not replace 911 for abnormal breathing, collapse, seizure, or unconsciousness.27
• 988 Suicide & Crisis Lifeline: call or text 988 (988lifeline.org) for suicide, mental-health, or substance-use crisis support. It is free and confidential. Use 911 for immediate medical or physical danger.28
• Treatment referral and information: FindTreatment.gov and the SAMHSA National Helpline at 1-800-662-HELP (4357). They help locate care. Confirm that a program can assess benzodiazepine withdrawal and other substances. They do not monitor withdrawal or replace emergency assessment.29

The first job is to understand what happened and make the next contact safely. Before the day ends, complete the medicine and substance list and call the clinician or a service whose medical abilities you have confirmed. Part 2 explains how treatment is matched to the person, the withdrawal risk, the original condition, and any use disorder.

Frequently asked questions

I only take it the way my prescriber told me to. Can I really be dependent?

Yes. The FDA says physical dependence can develop after steady use for days to weeks, including use exactly as prescribed. No exact day or dose predicts it for one person.12 Dependence is a change in the body, not a verdict on your character.

Does feeling sick after a missed dose mean I am addicted?

No. A missed-dose reaction points to physical dependence. Addiction, which clinicians call benzodiazepine use disorder, is a harmful pattern such as loss of control, risky use, or continued use despite serious harm. One behavior, a refill request, or fear of withdrawal does not make that diagnosis.12

Is a short-acting benzodiazepine safer than a long-acting one?

Neither is always safer. Shorter or faster-changing drugs can bring sharper rises and falls, earlier rebound, and symptoms between doses. Longer-lasting drugs can build up and prolong sedation, especially in older adults or when the liver clears medicine slowly.14567891011121314

Will long-term use cause dementia?

That is not proven. Current users may have poorer memory, attention, or processing speed, but dementia studies conflict, and anxiety, insomnia, depression, frailty, other medicines, and early dementia symptoms can all affect the results.1819

Does naloxone reverse a benzodiazepine overdose?

No. Naloxone treats the opioid part of a mixed overdose, not benzodiazepine toxicity. Give it if an opioid or counterfeit pill may be involved, but call 911 first and do not wait to see whether it works.26

What should I do first?

Do not change the dose on your own. Write down every medicine, supplement, and substance, note what happens when a dose is late, and bring that list to the prescriber for a risk-benefit review. If there is no prescriber or the pills may be counterfeit, seek prompt medical or addiction assessment.129

Related reading on NP FADY

• Reducing Benzodiazepines: Tapering, Treatment, and Recovery (Part 2)
• What Benzodiazepines Actually Do to the Brain’s Brakes
• Anxiety vs. Panic Attacks: Know the Signs & Find Relief
• Buspirone (BuSpar) for Anxiety: How It Works, Side Effects, and How It Compares With Benzodiazepines and SSRIs
• Sleep Medications Demystified: When They Help and When They Don’t
• Drug Interactions to Know: Antidepressants, Alcohol, CBD, and More
• Treating Kratom Dependence and Addiction: What Recovery Looks Like

References

1. Brunner E, Chen C-YA, Klein T, et al. Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Benzodiazepine Risks Outweigh Benefits. Journal of General Internal Medicine. 2025. DOI 10.1007/s11606-025-09499-2; official ASAM PDF.

2. U.S. Food and Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. September 23, 2020. FDA Drug Safety Communication.

3. Engin E. GABA-A receptor subtypes and benzodiazepine use, misuse, and abuse. Frontiers in Psychiatry. 2023;13:1060949. PMID 36713896; full text.

4. DailyMed. Alprazolam immediate-release tablets, current U.S. labeling. Current label.

5. DailyMed. Clonazepam tablets, current U.S. labeling. Current label.

6. DailyMed. Diazepam tablets and route-specific rescue products, current U.S. labeling. Oral label; Valtoco nasal label.

7. DailyMed. Lorazepam oral and injection products, current U.S. labeling. Oral label; injection label.

8. DailyMed. Oxazepam capsules, current U.S. labeling. Current label.

9. DailyMed. Temazepam capsules, current U.S. labeling. Current label.

10. DailyMed. Triazolam tablets, current U.S. labeling. Current label.

11. DailyMed. Chlordiazepoxide capsules, current U.S. labeling. Current label.

12. DailyMed. Clorazepate tablets, current U.S. labeling. Current label.

13. DailyMed. Midazolam products, current U.S. labeling. Procedural injection label; Nayzilam nasal label.

14. DailyMed. Flurazepam capsules, current U.S. labeling. Current label.

15. 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society. 2023;71(7):2052-2081. DOI 10.1111/jgs.18372.

16. Rapoport MJ, Lanctot KL, Streiner DL, et al. Benzodiazepine use and driving: a meta-analysis. Journal of Clinical Psychiatry. 2009;70(5):663-673. PMID 19389334.

17. Donnelly K, Bracchi R, Hewitt J, et al. Benzodiazepines, Z-drugs and the risk of hip fracture: a systematic review and meta-analysis. PLOS One. 2017;12(4):e0174730. DOI 10.1371/journal.pone.0174730.

18. Crowe SF, Stranks EK. The residual medium and long-term cognitive effects of benzodiazepine use: an updated meta-analysis. Archives of Clinical Neuropsychology. 2018;33(7):901-911. DOI 10.1093/arclin/acx120.

19. Wu CC, Liao MH, Su CH, et al. Benzodiazepine use and the risk of dementia in the elderly population: an umbrella review of meta-analyses. Journal of Personalized Medicine. 2023;13(10):1485. PMID 37888096.

20. Patorno E, Glynn RJ, Levin R, et al. Benzodiazepines and risk of all-cause mortality in adults: cohort study. BMJ. 2017;358:j2941. PMID 28684397.

21. Maust DT, Petzold K, Strominger J, et al. Benzodiazepine discontinuation and mortality among patients receiving long-term benzodiazepine therapy. JAMA Network Open. 2023;6(12):e2348557. PMID 38117495.

22. Shade KN, Ritvo AD, Huff C, et al. Long-term neurological consequences following benzodiazepine exposure: a scoping review. PLOS One. 2025;20:e0330277. DOI 10.1371/journal.pone.0330277.

23. National Institute on Alcohol Abuse and Alcoholism. Alcohol-Medication Interactions: Potentially Dangerous Mixes. Updated May 8, 2025. Official resource.

24. National Institute on Drug Abuse. Benzodiazepines and Opioids. Updated November 7, 2022. Official resource.

25. O’Donnell J, Tanz LJ, Miller KD, et al. Drug overdose deaths with evidence of counterfeit pill use, United States, July 2019 to December 2021. MMWR. 2023;72:949-956. CDC report.

26. Centers for Disease Control and Prevention. What to Do If You Think Someone Is Overdosing; Lifesaving Naloxone. Overdose response; naloxone guidance. Checked 2026-08-31.

27. Health Resources and Services Administration. Poison Help: What You Can Do. Official Poison Help guidance. Checked 2026-08-31.

28. 988 Suicide & Crisis Lifeline. Official 988 site. Checked 2026-08-31.

29. Substance Abuse and Mental Health Services Administration. FindTreatment.gov; National Helpline. Checked 2026-08-31.

30. American College of Obstetricians and Gynecologists. Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum. Clinical Practice Guideline No. 5. 2023. Official guideline page.

31. Martins-da-Silva AS, de Mendonça FMR, de Mendonça GPR, et al. Benzodiazepines and sleep architecture: a systematic review. CNS & Neurological Disorders Drug Targets. 2023;22(2):172-179. PMID 34145997; DOI 10.2174/1871527320666210618103344.

32. Hamadieh Z, Goldfarb DG, Ellendon N. Prescribed benzodiazepines and suicidal behaviors: a systematic review, meta-analysis, and clinical implications. BMC Psychiatry. 2026;26:303. PMID 41787415; DOI 10.1186/s12888-026-07931-3.

33. U.S. Food and Drug Administration. Timeline of Selected FDA Activities and Significant Events Addressing Substance Use and Overdose Prevention. The September 20, 2017 entry records the warning not to withhold buprenorphine or methadone solely because of benzodiazepine or other CNS-depressant use. Current FDA timeline. Checked 2026-08-31.

34. U.S. Department of Veterans Affairs, National Center for PTSD. Use of Benzodiazepines for PTSD in Veterans Affairs. Current page summarizing the 2023 VA/DoD PTSD guideline. Official VA resource. Checked 2026-08-31.

35. Rogers JP, Oldham MA, Fricchione G, et al. Evidence-based consensus guidelines for the management of catatonia: recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology. 2023;37:327-369. PMID 37039129; full text; DOI 10.1177/02698811231158232.

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This article provides general education, not personal medical advice, diagnosis, or a taper plan. Reading it does not create a clinician-patient relationship. Do not start, stop, switch, or change a benzodiazepine dose without a qualified clinician. No doses are given here, and nothing on this page can be used to switch medicines or build a taper. Emergency symptoms require emergency care. Evidence and U.S. guidance were checked on August 31, 2026.

If you or someone you know is in crisis

• Call 911 or go to your nearest emergency room for any life-threatening emergency.
• 988 Suicide & Crisis Lifeline — call or text 988, available 24/7. En español: marque 988 y oprima 2. Veterans: 988 and press 1, or text 838255.
• Crisis Text Line — text HOME to 741741.
• The Trevor Project (crisis support for LGBTQ+ young people) — call 1-866-488-7386, or text START to 678-678.
• National Sexual Assault Hotline (RAINN) — call 1-800-656-HOPE (4673) or text HOPE to 64673; free, confidential, 24/7. Online chat at RAINN.org/hotline.
• National Domestic Violence Hotline — call 1-800-799-SAFE (7233) or text START to 88788; 24/7, help in 200+ languages. Online chat at TheHotline.org. If your phone or computer may be monitored, calling from a safer device is an option.
• Riverside County — Inland SoCal Crisis Helpline 951-686-HELP (4357), 24/7 (Inland SoCal United Way / 211+, in partnership with RUHS-BH); Community Access, Referral, Evaluation and Support (CARES) Line 800-499-3008, 24/7.
• San Bernardino County — Access Unit (Behavioral Health Helpline) 888-743-1478, 24/7; Mobile Crisis/CCRT 800-398-0018 (24/7, all ages) or text 909-420-0560. Arrowhead Regional Medical Center (ARMC) has a dedicated walk-in adolescent psychiatric ER (ages 13–17).
• Children under 13 — call 911 for immediate danger, contact your county's mobile crisis team (they respond to all ages), or go to the nearest pediatric emergency room.
• California Peer-Run Warm Line (non-crisis — someone to talk to) — call or text 1-855-600-WARM (9276); daytime and evening hours, not a 24/7 line.
• NP Fady (non-emergency) — for routine scheduling or questions, call (909) 707-6261. This line is not monitored for emergencies.