Benzodiazepine Withdrawal and Work: Is It Possible to Keep Working During a Taper?

Is it possible to keep working during benzodiazepine withdrawal?

In most cases, yes, as long as the withdrawal is a slow taper and not an abrupt stop. Many patients on a slow, supervised taper keep working. Some days are harder than others, and the plan has to allow for that.

Professor C. Heather Ashton made the point in Chapter II of the Ashton Manual. Slow withdrawal at home, she wrote, lets a person continue with normal life and fit the withdrawal to their own lifestyle. A job is part of that life.

Dr. Mark Leeds is an osteopathic physician and deprescribing specialist in Fort Lauderdale, Florida, who supervises slow tapers of benzodiazepines and z-drugs such as zolpidem (Ambien). In his practice, the taper is adjusted around the patient’s life, work included. So, what does a taper do to a workday, and what can be changed when it does?

A taper is a medical matter, and that changes the conversation at work.

The word withdrawal makes many people think of addiction. That is the wrong picture for a person who took a medication as prescribed. Physical dependence is not addiction.

It is the nervous system adapting to a medication taken every day. The United States Food and Drug Administration (FDA) recognized as much in its 2020 boxed-warning update, which states that physical dependence can occur when benzodiazepines are taken steadily for several days to weeks, even as prescribed.

A patient who took a medication as prescribed and is now tapering has a medical condition and is under a physician’s care for it. That is not addiction, and there is no reason to describe the taper as addiction treatment to a supervisor or the human resources (HR) office.

Unfortunately, an employee who says “withdrawal” may be pointed toward an addiction program, which is built for a different problem. The accurate description is plainer: a physician is slowly reducing a prescribed medication over months.

What does a taper do to a workday?

The symptoms that matter most at work are the quiet ones. Concentration slips, a name or a word will not come, and a task that took an hour takes two. Anxiety, poor sleep, irritability, and a heavy fatigue are common as well, and Chapter III of the Manual counts poor memory and concentration among the features of withdrawal.

It is often said that withdrawal peaks in the first few days and then fades. That describes stopping abruptly, which no one should do. On a gradual taper, there is no single early peak.

In fact, Professor Ashton wrote that symptoms “characteristically wax and wane,” from day to day, week to week, and even within a single day. Patients call the pattern windows and waves: stretches that feel close to normal, then a return of symptoms, often in the days after a dose reduction.

So, a working patient is not planning for one bad week. The plan covers good days and hard days across months, and sometimes a period after the last dose when symptoms linger, which is called protracted withdrawal. A separate article covers brain fog, memory, and concentration.

The taper is adjusted around the job, and not the other way around.

The most useful tool a working patient has is the pace of the taper itself. A dose can be held steady before a deadline, a trial, a product launch, or tax season. Steps can be made smaller, and after a rough reduction the dose can stay where it is for a short stretch while things settle, with a hold that does not settle within a few weeks taken back to the prescriber rather than extended indefinitely.

Road crews do not close a lane at eight on a Monday morning. They work at night, and the road still gets repaved. While this is not a perfect analogy, a dose reduction can be timed the same way, so that the days after it fall on a quieter stretch.

In Chapter II, Professor Ashton wrote that a person can stand still and take “a vacation from further withdrawal” for a few weeks when circumstances change, and that the patient must be in control of the pace. A hold is not a failure. Professor Ashton advised against raising the dose again, and in Dr. Leeds’ practice a small updose after a cut that proves too large is still a legitimate correction.

The medication matters as well. A short-acting benzodiazepine such as alprazolam (Xanax) wears off between doses, and the low point can land in the middle of the afternoon. Chapter II describes a switch to diazepam (Valium), known as a crossover taper, for a smoother decline.

In this model, the taper itself is the treatment. A hard stretch is answered first with a change of pace, not with another prescription, and a separate article explains who should set the pace of a taper.

Is it better to take time off and stop quickly?

No. The idea is tempting: use two weeks of vacation, stop the medication, and come back finished. Yet, a taper is measured in months, and two weeks is not a taper.

In Chapter II, Professor Ashton answered the claim that going slowly “merely prolongs the agony.” Most patients, she wrote, find slow withdrawal greatly preferable.

The FDA’s 2020 update warns that stopping abruptly or reducing the dose too quickly can cause withdrawal reactions, including seizures, which can be life-threatening. Call emergency services for a seizure or any other medical emergency.

What changes at work actually help?

Small ones, mostly. Short breaks do more than one long push, and the hardest thinking belongs in whatever hours are reliably the best. Grouping similar tasks and writing things down take the load off a memory that is temporarily unreliable.

Sleep deserves protection, which means a fixed wake time and no work email late at night. Alcohol also acts on gamma-aminobutyric acid (GABA) receptors, the same calming system a benzodiazepine works on, so it is best avoided during a taper. Chapter II warns against making up for a falling dose by drinking more.

Coffee or tea in moderation is compatible with withdrawal, according to Chapter III. The trouble starts with the extra cups taken to push through an afternoon of fatigue.

Some jobs involve driving, machinery, or other people’s safety. On a day when concentration is poor, those tasks call for honest judgment, and they are worth raising with the physician before a problem arises.

Does the employer have to be told?

Whether to share health information at work is, for most patients, a personal decision. Some safety-sensitive jobs have their own rules about medications, and a person in one of them should find out which rules apply.

There is a middle ground between silence and a full account. Patients often describe telling a supervisor only that they are being treated for a medical condition and that a physician is adjusting a medication over several months. That description does not name the medication.

A specific request usually goes over better than a diagnosis. A common pattern is a single change, such as moving a standing meeting to after lunch. Of course, what has been said cannot be taken back, so less is a reasonable place to start.

What about medical leave and accommodations at work?

While many patients on a slow taper keep working, some reach a stretch when full-time work is not possible. Leave and workplace accommodations are governed by employment law and by each employer’s policies, so those questions belong with the human resources office or an employment attorney.

For a patient tapering a prescribed medication, the basis for any request is a medical condition under a physician’s care, and not addiction treatment.

How does a person return to work after a leave?

Gradually, where the employer allows it. Shorter days or lighter duties in the first weeks give the nervous system room. Windows and waves will likely continue, and a hard day in the second week back does not mean the leave failed.

The return date should not drive the taper. A patient who speeds up reductions to be “done” before going back is trading a calendar problem for a medical one. Holding the dose steady through the first weeks back is a reasonable choice to discuss with the physician, and a separate article looks at how a person rebuilds work and identity after a taper.

A slow taper and a working life can share the same calendar.

Fortunately, the hard days thin out. In Chapter III, Professor Ashton described windows of normality that “become more frequent and last longer,” and concentration and stamina tend to come back with them. No one can name the date.

Dr. Leeds’ practice provides medically supervised tapering of benzodiazepines and z-drugs for patients in Florida, on a concierge basis. He works directly with each patient. The taper is gradual and patient-directed, with steps that get smaller as the dose falls, as the Maudsley Deprescribing Guidelines describe, and the patient’s work calendar is part of the planning. Contact the office to ask about a taper plan that fits around a job.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.