How Dr. Leeds Uses the Ashton Manual
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What is the Ashton Manual?
In short: The Ashton Manual is Professor C. Heather Ashton’s guide to benzodiazepines and how to withdraw from them, drawn from her years running a benzodiazepine withdrawal clinic in Newcastle, England. Its approach is a crossover to diazepam (Valium) where it helps, small reductions with time to settle after each one, and a pace the patient sets, with no deadline. Dr. Leeds plans every taper with both the Ashton Manual and the Maudsley Deprescribing Guidelines, making each reduction smaller as the dose falls. The patient can slow down, hold, or decline any step.
Dr. Mark Leeds follows the Manual, together with the Maudsley Deprescribing Guidelines, in medically supervised benzodiazepine tapering. He builds his practice on a simple distinction: physical dependence is not addiction. The Manual itself describes several types of benzodiazepine dependence, and the people in its first group became dependent on the ordinary doses their doctors prescribed. A person whose doctor prescribed a benzodiazepine for years has a medical condition caused by the medication, and the treatment is a gradual taper, not a facility stay.
What the Manual recommends for withdrawal
Crossover to diazepam where it helps
For a short-acting benzodiazepine such as Xanax (alprazolam) or Ativan (lorazepam), the Manual describes a crossover taper to diazepam (Valium), a long-acting drug that evens out the level between doses.
Small steps, each with time to settle
The dose comes down in small reductions, with a pause after each one so the nervous system can adjust. The Manual's schedules are examples, and a patient's own steps are worked out with their prescriber.
The patient sets the pace
The person taking the drug decides when the next reduction happens. When symptoms flare, a step can be held for a few extra weeks before the taper goes on.
No deadline
Professor Ashton wrote that there is no need to hurry withdrawal and that many people have taken a year or more to complete it. The Manual sets no end date.
How Dr. Leeds applies and extends the Manual
Dr. Leeds does not follow the Manual alone. He plans every taper with both guides and adapts the plan to the person, not to a printed schedule.
Where the two guides agree
Both guides say go slowly, let the patient set the pace, and hold when needed.
Reductions that get smaller
Following the Maudsley Deprescribing Guidelines, Dr. Leeds makes each reduction smaller as the dose falls, because at low doses each milligram has a larger effect on the brain's receptors. This is called hyperbolic tapering.
Liquid tapers, micro-tapers and z-drugs
When tablets cannot be cut small enough, a compounded liquid formulation allows very small reductions, sometimes called micro-tapering. Z-drugs such as Ambien (zolpidem) are tapered on the same principles.
What a patient can expect from Dr. Leeds
Care starts with a consultation by video, and later visits may be by video or audio, by telemedicine in Florida or at the Fort Lauderdale office. The office takes calls Monday to Friday, 10 AM to 2 PM. Dr. Leeds explains the risks and the alternatives and sets out an exit plan. The patient shapes the taper plan and keeps the right to slow down, hold, or decline any step. The practice is concierge, not insurance-based.
Withdrawal symptoms can still occur during a careful taper. When they do, the plan can slow down or hold, and for some people a steady pace serves better, and Dr. Leeds helps with benzodiazepine withdrawal symptom management, including protracted withdrawal. This page is education, not medical advice, and reading it creates no doctor-patient relationship.
A plan the patient shapes
The plan is written with the patient, not handed to them, and it changes as the taper goes on.
Follow-up with Dr. Leeds himself
Every consultation and follow-up is with Dr. Leeds. The physician who made the plan with the patient is the one who adjusts it. He has practiced medicine since 1997 and serves on the medical advisory board of the Benzodiazepine Information Coalition.
Ready to talk about a taper?
A gradual taper begins with a conversation. Contact the office through the contact form to ask about a consultation.
Questions about the Ashton Manual
Short answers to the questions patients ask most about the Manual, taper length, and follow-up.
What is the Ashton Manual?
The Ashton Manual is Professor Ashton’s guide to benzodiazepines and how to withdraw from them. The Manual’s approach is a crossover to diazepam where it helps, small reductions, and a pace the patient sets.
How does an Ashton Manual taper work?
Where it helps, a short-acting benzodiazepine is crossed over to diazepam. The dose then comes down in small steps with time to settle after each one, and a step can be held for a few extra weeks when symptoms flare.
How long does the tapering process take?
Often a year to 18 months or longer, depending on the drug, the dose, and how long it was taken. Professor Ashton wrote that many people take a year or more and that there is no need to hurry, and Dr. Leeds sets no deadline.
What kind of support will I receive during the tapering process?
Support comes from Dr. Leeds himself. He sees each patient at the consultation and every follow-up and adjusts the plan as the taper goes on. There is no separate counseling service, and Dr. Leeds talks through what is happening as part of each visit.