Medication Management

Long-Term Benzodiazepine Use and a Supported Taper

By Dr. Stacey Forbes, DNP, APRN, PMHNP-BC · Updated October 12, 2026

Benzodiazepines such as alprazolam, lorazepam, clonazepam and diazepam can be genuinely helpful in the short term. After months or years of daily use, though, many people find the benefits have faded while the risks have grown, and they want to come off. That is a reasonable goal, and it is achievable — but only with a slow, planned taper. This guide explains why stopping suddenly is dangerous, what the FDA and the 2025 joint tapering guideline say, and what support during a taper looks like.

Why the FDA strengthened its warning

On September 23, 2020, the FDA required the boxed warning — its most prominent label warning — on all benzodiazepine medicines to be updated to address abuse, misuse, addiction, physical dependence and withdrawal reactions. The agency explained that stopping these medicines abruptly or reducing the dose too quickly can cause withdrawal reactions, including seizures, which can be life-threatening, and that some patients experienced withdrawal symptoms lasting many months.

The FDA’s advice to patients was direct: do not stop taking a benzodiazepine suddenly; talk with your health care professional first and make a plan to lower the dose slowly. Its advice to clinicians was to use a gradual taper and create a patient-specific plan, because no single schedule suits everyone.

Physical dependence is not addiction

These two words are often blurred, and the confusion causes needless shame. Physical dependence means the body has adapted to a medicine so that lowering it causes withdrawal symptoms. The 2025 joint guideline notes that it can develop within weeks and varies from person to person. Anyone who takes a benzodiazepine daily for long enough may become physically dependent, even when taking it exactly as prescribed.

Addiction — a substance use disorder — is different. It involves loss of control, craving, and continued use despite harm. Some people develop both, and that changes the plan, but most people tapering a long-term prescription are dealing with dependence alone. Our article on medication dependence versus necessity explores the distinction.

Why stopping abruptly is dangerous

Benzodiazepines enhance the brain’s main calming signal. Over time, the brain turns down its own calming systems to compensate. Remove the medicine suddenly and the brain is left over-excited, which is why withdrawal can include rebound anxiety, insomnia, tremor, and in some cases seizures or delirium.

The joint guideline names seizure and delirium among the more serious withdrawal events and identifies a history of complicated withdrawal — involving seizure or delirium — as a significant predictor of future complications. A history of seizures or severe alcohol withdrawal can also raise the risk. For the broader picture of what happens when any psychiatric medication is stopped suddenly, see what happens if you stop psychiatric medication suddenly.

What the 2025 joint guideline recommends

In June 2025, the Journal of General Internal Medicine published the Joint Clinical Practice Guideline on Benzodiazepine Tapering. It was led by the American Society of Addiction Medicine with nine other organizations, including the American Psychiatric Association, the American Association of Nurse Practitioners, the American Academy of Family Physicians and the American Geriatrics Society. Its main principles:

• Reassess regularly. Clinicians should keep weighing whether the benefits of continuing still outweigh the risks.
• Decide together. The tapering plan should be built through shared decision-making with the patient and, where appropriate, their care partners.
• Do not stop abruptly in anyone likely to be physically dependent.
• Go slowly and individualize. The guideline says the initial pace “should generally include dose reductions of 5 to 10% every 2–4 weeks” and “should typically not exceed 25% every 2 weeks,” with slower reductions for people likely to have strong physical dependence.
• Slow down or pause when needed. If significant symptoms emerge, the taper should be slowed or paused. Some people briefly return to the previous dose until things settle.
• Expect it to take time. According to the guideline, fully tapering off can take months to years, and monitoring should continue for a few weeks after the last dose.

Those figures describe a general framework, not a schedule to follow on your own. Your prescriber will set the actual pace based on your medicine, how long you have taken it, your health, and how you respond to each step. Our guide to psychiatric medication tapering explains the general principles, and why you should never taper alone explains why supervision matters.

Protracted withdrawal

A minority of people have withdrawal symptoms that last well beyond the time the drug takes to leave the body. The joint guideline calls this protracted withdrawal and notes it can persist for months or, in some cases, years. Symptoms can include anxiety, low mood, insomnia, memory problems, tinnitus, dizziness and, less often, more severe neuropsychiatric symptoms.

The guideline’s advice is reassuring in two ways. First, slow, gradual tapers may reduce the risk. Second, symptoms are likely to resolve with time as the brain adjusts. In the meantime, it recommends against restarting the benzodiazepine and suggests that clinicians consider other, non-benzodiazepine medicines for specific symptoms, along with CBT and peer support.

What support during a taper looks like

Lowering the dose is only half the work. The other half is making sure whatever the benzodiazepine was doing — easing anxiety, helping sleep — is handled another way. The joint guideline recommends offering behavioral treatments matched to the underlying condition, naming cognitive behavioral therapy and CBT for insomnia.

• CBT for insomnia (CBT-I). Many long-term prescriptions began as sleep aids. CBT-I addresses the habits and thought patterns that keep insomnia going. See why sleep medication alone often does not fix insomnia.
• Therapy for the underlying anxiety. CBT and related approaches build skills that outlast any medication.
• Non-habit-forming medication where needed. An SSRI, SNRI or other option can treat the underlying condition; see non-habit-forming anxiety medications.
• Lowering other strain. Cutting back on alcohol and caffeine, steadying sleep and meal times, and gentle daily movement all reduce the load on a nervous system that is readjusting.
• Frequent check-ins. Short, regular visits — by telehealth if that is easier — let the pace be adjusted before a rough patch becomes a crisis.

When a taper is not the right step, or not yet

Tapering is not a goal in itself. The joint guideline cautions that clinicians should not assume tapering is the right choice for every patient, and it describes situations in which long-term use may be appropriate, such as treatment-resistant generalized anxiety, some bipolar spectrum conditions, complex seizure disorders and palliative care. For older adults, it generally favors tapering unless there are compelling reasons to continue.

Timing matters too. A major life crisis, an unstable medical condition, or active alcohol or opioid use may mean the taper should wait, happen more slowly, or happen with more support. The guideline suggests considering inpatient care when there is an imminent risk of serious harm, unstable co-occurring conditions, or a history of severe or complicated withdrawal.

If you also take opioids, including medication for opioid use disorder, tell your prescriber; that combination needs coordinated care. See medication-assisted treatment.

How Willow & Stone supports a taper

Willow & Stone builds slow, structured taper plans with the patient setting much of the pace. Dr. Stacey Forbes, a board-certified psychiatric nurse practitioner, reviews your full history, sleep, labs and other medicines, adds therapy and sleep supports, and adjusts the plan as you go. Pauses are part of the process, not a failure. Learn more about integrative medication management, or book a consultation to talk through whether and how to taper.

Common Questions

Sources & Further Reading

• FDA — Boxed Warning updated to improve safe use of benzodiazepine drug class (2020)
• Joint Clinical Practice Guideline on Benzodiazepine Tapering (J Gen Intern Med, 2025)
• ASAM — New benzodiazepine tapering guideline emphasizes patient-centered approach (2025)
• NIMH — Mental Health Medications

This article is general education, not advice for your situation. Do not start, stop, or change a medication or supplement without talking to the clinician who prescribes it.