Long-term benzo use (≥4–6 weeks) can cause tolerance, dependence, cognitive slowing, mood changes, and functional impairment. Alprazolam (Xanax) has a higher misuse and withdrawal risk. Benzos can be addictive. If stopping, taper slowly under medical supervision and consider professional treatment for therapy, such as Cognitive Behavioral Therapy (CBT). Seek inpatient detox for high doses, polydrug use, or seizure history.
What Counts as Long-Term Benzodiazepine Use?
There’s no single universal cutoff, but many clinical sources consider “long term” to begin around 4–6 weeks of near-daily use, particularly at therapeutic or higher doses. Risk rises as duration extends into months and years, especially with short half-life agents (e.g., alprazolam) and multiple daily dosing [1, 2, 4].
Long-term benzo use is most concerning when the medication is continued beyond the acute indication (panic spikes, procedural anxiety, short-term insomnia) without a clear plan for reassessment or taper.
Common Long-Term Effects (Cognition, Mood, Function)
Chronic exposure is associated with dose- and duration-linked effects on attention, memory (especially anterograde), psychomotor speed, and executive functioning.
Many patients report daytime sedation, emotional blunting, irritability, and reduced motivation that can undermine work, driving safety, and parenting. Older adults face amplified risks such as falls, hip fractures, delirium, and worsening cognitive impairment [1, 2, 4].
Long-Term Effects of Xanax (Alprazolam)
Among benzodiazepines, alprazolam (Xanax) has a short half-life and rapid onset, which may reinforce use and complicate tapering. Long-term effects of Xanax can include interdose withdrawal (rebound anxiety or agitation between doses), memory problems, and escalating reliance on as-needed dosing that gradually becomes scheduled use.
Compared with longer-acting agents, alprazolam has been linked to higher misuse liability and more severe withdrawal syndromes in some studies [6].
These patterns often drive questions like “are benzos addictive?” and contribute to benzo addiction risk when coping relies primarily on pills instead of skills.
Benzo Tolerance: Why Doses Stop Working
Benzodiazepines enhance GABA-A receptor activity. Over time, the brain counterbalances this signal, leading to tolerance—needing more for the same effect—and sometimes paradoxical anxiety or insomnia.
This Benzo tolerance can nudge prescribers and patients toward dose increases, poly-benzo regimens, or add-on sedatives, which compound risks without fixing the underlying drivers of anxiety or sleeplessness.
Withdrawal & Protracted Symptoms (If Stopping)
Stopping benzos suddenly can trigger benzodiazepine withdrawal syndrome (BZD withdrawal), which manifests in many ways and may include the following symptoms:
- Rebound anxiety
- Insomnia/nightmares
- Tremors/shaking
- Sweating
- Heart palpitations
- Loss of appetite
- Weight loss
- Nausea/vomiting
- Seizures
- Confusion/memory problems
- Perceptual changes (suicidal ideation, confusion, depersonalization)
- Burning sensations and pain in the upper spine
- Intense benzodiazepine cravings
- Intrusive memories
- Coma
Symptoms can last days to weeks, and some experience protracted symptoms (e.g., hypersensitivity to stimuli, tinnitus, disequilibrium, cognitive fuzziness) that slowly improve over months [4].
How Do You Stop Benzo Withdrawal Naturally?
Never stop taking benzodiazepines suddenly. A typical outpatient approach is a slow, individualized taper, often 5–10% dose reductions every 2–4 weeks, with pauses as needed.
Some patients benefit from switching short-acting agents (e.g., alprazolam) to longer-acting ones to smooth interdose withdrawal. Medical supervision matters, and severe cases often require higher levels of care.
Gradual tapering: Slowly wean off your dose in a clinically supervised environment.
Psychoeducation: Learn your triggers and coping skills to manage them.
Practicing good sleep hygiene: Resetting and acclimating to a new way of living.
Treatment of co-occurring conditions: Anxiety can sometimes be linked to unresolved trauma or substance use disorder.
Establishing non-benzodiazepine support mechanisms: CBT-I for insomnia, DBT for emotional regulation and anxiety.
Who Is at Higher Risk from Long-Term Use?
Benzodiazepine withdrawal can be dangerous or completely ineffective for certain high-risk groups if done incorrectly. Routine risk–benefit checks and deprescribing conversations are essential in these groups
Higher-risk groups include:
- Adults ≥65 years (falls, fractures, confusion)
- People with COPD, or other breathing disorders
- Those with depression, PTSD, or SUDs (worsening mood, misuse)
- Polysubstance use (opioids, gabapentin, alcohol)
- Pregnancy and postpartum (fetal/neonatal exposure, sedation risks)
When Inpatient Detox or Higher Care Is Appropriate?
Medical stabilization, careful taper protocols, 24/7 monitoring, and integrated therapy tracks (CBT, DBT, relapse-prevention) can lower complication risks and support lasting change. Consider supervised detox or residential treatment when:
- High daily doses or multiple benzos, history of seizures
- Concurrent alcohol/opioid use, medical instability
- Severe psychiatric comorbidity (suicidality, uncontrolled PTSD)
- Failed outpatient tapers or unsafe home environment
Only a clinician can prescribe a taper schedule. Do not try to taper off of xanax or other benzos on your own!
Benzo Detox and Residential Treatment in Michigan
Rushton Recovery understands the complex nature of benzodiazepine addiction. We prioritize your well-being, safety, and comfort during treatment. Our detox and residential treatment center in Michigan offers a healing space to embark on your journey toward sobriety.
We offer evidence-based therapies designed to evolve with your individual needs and address the root of your substance abuse. Let our team help you get clean, repair relationships, and equip you with the skills to achieve long-term recovery.
Reach out to our Admissions team now.
FAQs
Is long-term benzo use ever appropriate?
Sometimes, for clearly defined, refractory conditions with ongoing monitoring and informed consent, though guidelines urge caution and periodic attempts to reduce.
Are benzos addictive?
They carry dependence and addiction risk, especially with prolonged daily use or dose escalation.
What helps with benzo withdrawal symptoms?
Slow, medically supervised tapering, CBT or DBT therapy for managing underlying triggers, and higher levels of care, such as inpatient rehab treatment when needed.
Is “benzo detox” safe?
Yes, if done correctly and in a clinical setting. Benzo detox should be medically supervised, particularly for people who are used to taking high doses, instances of polydrug use, or people with a history of having seizures
Sources
- American Academy of Family Physicians. Risks Associated with Long-Term Benzodiazepine Use. https://www.aafp.org/pubs/afp/issues/2013/0815/p224.html
- Barker MJ, et al. Long-term benzodiazepine use: cognitive & functional impacts. https://pmc.ncbi.nlm.nih.gov/articles/PMC8629021
- American Journal of Psychiatry (2024): Long-term benzodiazepine treatment perspectives. https://psychiatryonline.org/doi/full/10.1176/appi.ajp.20240030
- Wikipedia: Effects of long-term benzodiazepine use. https://en.wikipedia.org/wiki/Effects_of_long-term_benzodiazepine_use
- Vanderbilt University Medical Center news: consequences of chronic use. https://news.vumc.org/2023/07/19/study-highlights-consequences-of-chronic-benzodiazepine-use/
- Journal of Clinical Psychiatry: Toward practice guidelines for long-term treatment. https://www.psychiatrist.com/jcp/toward-practice-guidelines-for-long-term-benzodiazepine-treatment/
- The Lancet (2021): Benzodiazepine prescribing and harms. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00934-X/fulltext
