Finding Freedom from Benzodiazepine Dependence in Fort Lauderdale, Florida

Can a person in Fort Lauderdale get off of a prescribed benzodiazepine safely?

Yes, and the way to do it is a gradual, medically supervised taper. Dr. Leeds is an osteopathic physician and deprescribing specialist in Fort Lauderdale, Florida, and helping patients taper off of benzodiazepines and z-drugs is the work of his practice. He sees patients at his Fort Lauderdale office and by telemedicine anywhere in Florida.

Many people find this page by searching for benzodiazepine detox in Fort Lauderdale. The word points them toward the wrong kind of care. Safe discontinuation is a slow taper over months, adapted to the person, not a facility stay with a discharge date.

The first thing a new patient needs to hear is that dependence is not addiction. Addiction is defined by behavior: compulsive use, loss of control, and continued use despite harm. Physical dependence is defined by physiology: the brain has adapted to the drug, and it objects when the drug is reduced or removed.

In fact, nearly every patient who comes to Dr. Leeds for benzodiazepine tapering took the medication exactly as it was prescribed. They have a medical condition caused by a medication, and the treatment for it is medical, not a support-group program. So, how does a medication taken as directed become a medication a person cannot stop?

Dependence develops even when the medication is taken exactly as prescribed.

Benzodiazepines work by amplifying gamma-aminobutyric acid (GABA), the brain’s main calming signal. With steady daily use, the brain adjusts to the extra calming and turns its own signal down, so the drug becomes part of the system’s normal balance.

Tolerance is the first sign of that adjustment: the same dose does less than it did, and the Ashton Manual notes in Chapter I that tolerance to the sleep effect develops rapidly, within a few weeks of regular use. Withdrawal is the same adjustment seen from the other direction. Take the drug away, or reduce it too quickly, and a nervous system that has been leaning on it for months is left without the calming it has come to expect.

On September 23, 2020, the United States Food and Drug Administration (FDA) updated the boxed warning on every benzodiazepine label to say this plainly. Physical dependence can occur when a benzodiazepine is taken steadily for several days to weeks, even as prescribed, and stopping abruptly or reducing the dose too quickly can cause withdrawal reactions, including seizures, which can be life-threatening. A seizure is a medical emergency, so call emergency services for a seizure or any other medical emergency.

The patient did nothing wrong. The drug did what its own label now says it does.

Why do withdrawal symptoms show up between doses?

Interdose withdrawal is withdrawal that arrives before the next dose is due. It is most common with short-acting benzodiazepines such as alprazolam (Xanax) and lorazepam (Ativan), whose blood levels rise and fall several times a day. The Ashton Manual notes in Chapter I that people on short-acting drugs can develop anxiety symptoms between doses, and Chapter II describes the peaks and troughs in blood level that produce a small withdrawal between each dose.

Unfortunately, the symptoms look exactly like the condition the drug was prescribed for. Anxiety, restlessness, a racing heart, and broken sleep return a few hours after each dose, the patient reports worsening anxiety, and the usual answer is a higher dose or a third daily dose. The prescription grows to treat a problem the prescription is causing.

An analogy that may help, while not a perfect one, is a bucket with a small hole in the bottom. A short-acting drug fills the bucket quickly, but by mid-afternoon the level has dropped below the line where the nervous system feels steady, and the next dose has to be poured in to bring it back up. A long-acting drug is more like a large tank with the same small hole, where the level barely moves between fills.

A person who takes alprazolam at 8 in the morning, 2 in the afternoon, and 10 at night may feel the anxiety return late in the morning, late in the afternoon, and before dawn, and that pattern is the drug wearing off, not the illness getting worse. A tank is easier to drain slowly than a bucket, and that is the whole logic of the crossover taper. There is more on this site about interdose withdrawal and why it is so often mistaken for worsening anxiety.

What does the Ashton Manual say about switching to diazepam?

The Ashton Manual was written by Professor C. Heather Ashton and is published free at benzo.org.uk. Its second chapter sets out the approach Dr. Leeds uses for patients on short-acting drugs: switch to diazepam (Valium) first, then reduce the diazepam slowly. Diazepam is chosen because, counting its active metabolite, its half-life runs up to 200 hours, so its blood level falls smoothly rather than in daily swings, and because it comes in small scored tablets that allow very small steps.

The switch itself is done one dose at a time. Professor Ashton’s instruction is to replace the evening or night-time dose first, hold for a few days or a week, then replace the next dose, and so on until the whole day’s medication is diazepam. The Manual’s equivalence table (Chapter I, Table 1) lists 0.5 mg of alprazolam as roughly equal to 10 mg of diazepam, though Dr. Leeds adjusts the conversion for each patient, because people vary in how the two drugs feel.

While some patients notice, at first, that the diazepam seems weaker than the drug it replaced, that impression usually settles as the long half-life builds a steady level. This is the crossover taper, and its purpose is stability before reduction. Nothing is cut until the patient is comfortable on the new medication.

The reduction is slow, dose-based, and shaped to the patient.

Only after a patient is stable on diazepam does the reduction begin. The Manual’s schedules take the diazepam down in small dose-based steps, each followed by a hold, and Professor Ashton is clear that the rate, as long as it is slow enough, is not what matters. Whether the taper takes six months, twelve, or eighteen is of little consequence to someone who has taken the drug for years, and the six-week timetable that many treatment programs use is much too fast for people who have taken the drug for years.

Fortunately, the shape of the taper can be changed as it goes. Dr. Leeds makes the cuts smaller as the dose gets lower, because the last few milligrams carry a larger share of the drug’s effect than the first, and a patient who has a bad week may hold rather than cut. No numeric rate fits everyone, which is why none is published here.

Not every patient needs the crossover. Some people cannot take diazepam, and in that case the taper is done on the medication they already take, and that decision is made with the patient, not for the patient. The Ashton Manual page on this site describes how Dr. Leeds applies the Manual in practice.

What happens after the last dose?

For many patients, the symptoms fade over the weeks after the final dose, and the fading continues long after the drug is gone. Some patients have protracted withdrawal, meaning symptoms that come and go for months after the last dose, and the 2020 FDA label update acknowledges that withdrawal symptoms can last for many months.

Is it permanent? In nearly all cases, it is not, though after months of symptoms that come and go it can feel that way. The nervous system heals on its own schedule, and there is often nothing that can move it along faster than time.

How does Dr. Leeds work with patients in Fort Lauderdale and across Florida?

Dr. Leeds’ practice is a single physician, not a facility. Patients see him in person at his Fort Lauderdale office or by video visit from anywhere in Florida, and every decision about the taper is made between the patient and the doctor. The practice is concierge rather than insurance-based, which is why the taper timetable answers to the patient’s nervous system and not to a benefits limit.

Informed consent comes first. Before anything changes, Dr. Leeds goes through the risks of tapering and the risks of staying on the drug, the alternatives including no change at all, and the plan for getting off the medication, and the patient keeps the right to decline or to stop at any point. The pace is patient-directed: if the taper is too fast, the doctor must slow it, and if it is comfortably slow, patient and doctor may agree to go a bit faster, as tolerated.

There is no group, no meeting attendance, and no fixed timeline. The full description of the service is on the medically supervised benzodiazepine tapering page.

Benzodiazepine dependence that came from a prescription is a medical condition, and it has a medical treatment: a gradual, patient-directed taper with a physician who knows the Ashton Manual. Dr. Leeds’ practice provides that care in Fort Lauderdale and by telemedicine throughout Florida. Contact Dr. Leeds to ask about a first consultation.

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.