Can Small Daily Habits Help With Benzo Withdrawal During a Taper?

Can small daily habits help with benzo withdrawal?

Small daily habits can help, in a modest way. Regular meals, enough water, a steady bedtime, a short daily walk, and a few lines in a notebook give an overexcited nervous system a predictable day to work with. They do not treat benzodiazepine withdrawal, and they do not make it end any sooner.

Most people who search for this kind of help took a benzodiazepine exactly as it was prescribed, often for years. Physical dependence is not addiction. In fact, it is what a healthy nervous system does when it adapts to a medication taken every day, and it is undone the way it was built, slowly.

That slow undoing is the job of a gradual, medically supervised taper over months. So, which habits are worth the effort while the taper does its work, and what should nobody expect from them?

The taper is the treatment, and habits are the support.

In Chapter II of the Ashton Manual, Professor C. Heather Ashton describes slow withdrawal as tapering the dose gradually, “usually over a period of some months.” She calls the precise rate “an individual matter,” and she insists that the person tapering stay in control of the schedule.

Where it helps, the Manual’s crossover taper to diazepam (Valium), a long-acting benzodiazepine, smooths out the swings between doses. The Maudsley Deprescribing Guidelines describe hyperbolic tapering, in which the reductions get smaller as the dose gets lower.

Habits fit around that plan the way a handrail fits a staircase. The stairs bring a person down, and the rail keeps each step steady. While this is not a perfect analogy, it holds one useful rule: gripping the rail harder does not make the staircase shorter, and a good week of habits is not a reason to reduce faster.

Nor does any habit make it safe to stop suddenly. When the United States Food and Drug Administration (FDA) updated the boxed warning on benzodiazepines in 2020, it stated that stopping abruptly or reducing the dose too quickly can result in withdrawal reactions, including seizures, which can be life-threatening. For a seizure or any other medical emergency, call 911.

Regular meals of whole food help to keep blood sugar steady.

Professor Ashton was often asked what to eat during withdrawal. Her answer, in Chapter III of the Manual, was that there is “no need to be over-obsessive about diet.” A normal healthy diet with generous amounts of fruit and vegetables, a source of protein and fats, and not too much pure sugar or junk food “provides all the nutrients a person needs.”

That is ordinary whole food, and the habit is mostly a matter of timing. Breakfast soon after waking and something to eat every few hours help to keep blood sugar from swinging.

A long stretch without food can bring shakiness, a pounding heart, and a short temper, and those feelings are easy to mistake for a wave of withdrawal. Some patients find the day steadier when meals arrive on time. This is clinical experience, and it varies.

What food cannot do is just as plain. The evidence for specific nutrients in benzodiazepine withdrawal is limited, and nutrition during a taper is support, never treatment.

Pages that promise a diet will clear a benzodiazepine from the body faster have the goal backwards. A good diet does not meaningfully speed the medication out, and in a taper the medication is kept on board on purpose while the nervous system readjusts.

Supplements are a separate question. Professor Ashton saw “no general need” for them. Individual response varies, and the decision is made per patient with a prescribing physician who understands the pharmacology.

What about water, coffee, and alcohol?

Water is the simple one. A glass on waking and one with each meal is an easy habit to keep, and Professor Ashton saw “no need to drink extra amounts” in the hope of flushing anything out.

Coffee is more individual. She considered coffee or tea in moderation, about two cups a day, compatible with withdrawal, except for the few people who are very sensitive to caffeine and those with very high anxiety.

Caffeine, then, does not have to go. A person who notices more jitters or worse sleep after coffee has good reason to cut back, gradually, because caffeine has a withdrawal headache of its own.

Alcohol is different. Professor Ashton was lenient here, allowing a glass or two of wine, though she warned against substituting increasing doses of alcohol for decreasing doses of the medication.

Yet, alcohol acts on the same gamma-aminobutyric acid (GABA) receptors as a benzodiazepine. During a taper, when those receptors are readjusting, it is best avoided.

A sleep routine helps, even on the nights when sleep does not come.

Sleep is one of the first things a taper disturbs. Of course, it cannot be forced. What a person can control is the frame around it: the same wake time every morning, daylight early in the day, dim lights in the evening, and the same short wind-down before bed, such as a few minutes of slow breathing.

Professor Ashton’s list of sleep hygiene measures includes avoiding tea, coffee, other stimulants, and alcohol near bedtime, along with relaxation and physical exercise. She says only that these “may be helpful.” That modest claim is the right one.

Does normal sleep come back? Professor Ashton’s answer was yes. In her words, “The need for sleep is so powerful that normal sleep will eventually reassert itself.” Until then, insomnia during a taper is worth reporting to the prescribing physician, especially when it worsens after a reduction.

Gentle movement counts, and a short walk is enough.

“Regular moderate exercise is recommended during withdrawal,” Professor Ashton writes, and she adds that there is no point in slavishly doing exercises a person hates. The word that matters is moderate.

Unfortunately, a nervous system in withdrawal does not always tolerate hard exertion, and some patients find that a strenuous workout brings on symptoms. That is why gentle exercise during a taper starts small, with a walk to the corner, some easy stretching, or ten minutes in the yard.

The test is the next day. If the walk left the person no worse, it can grow a little. If it did not, it shrinks.

A simple journal turns bad days into information.

The journal is not a diary. Each day gets one or two lines: the dose and the times it was taken, the hours of sleep, the two or three symptoms that matter most, and anything out of the ordinary, such as a missed meal, an extra coffee, or a hard conversation.

Why bother? Professor Ashton observed that withdrawal symptoms “characteristically wax and wane” from day to day and week to week. In the middle of a bad stretch, memory insists that it has always been this bad, and the notebook shows that the last bad stretch ended.

It also gives the prescribing physician something better than a general impression. A symptom journal that shows rough weeks after the last reduction is a reason to hold, and one that shows a steady stretch is a reason to talk about the next step.

The same notebook is the place for small goals. One new habit at a time is enough, and a habit small enough to keep on a bad day is the right size. A line that says the walk happened is progress on paper.

On the bad days, pacing and rest are the habit.

Patients call the good stretches windows and the bad ones waves. Professor Ashton described “Windows” of normality that gradually “become more frequent and last longer.”

A common pattern goes like this. The first good week arrives, the person cleans the whole house and catches up on every errand, and the next four days are spent in bed. Pacing means leaving some of a good day’s energy unspent.

On a wave day, the routine shrinks to its smallest version: something to eat, a glass of water, a step outside the door, one line in the notebook. Rest is part of the plan on those days. A wave does not mean the habits have failed, because preventing waves was never their job.

And, when a wave follows a dose reduction and does not settle, that is information about the pace. The usual answer, worked out with the prescribing physician, is a hold and a smaller next step.

Fortunately, the habits are small on purpose.

None of this requires a perfect week. A meal at a regular hour, a fixed time to get up, a walk to the corner, and one line in a notebook are within reach on most days, and the days when they are not will pass. The nervous system does readjust, given time and a taper slow enough to allow it.

Dr. Mark Leeds is an osteopathic physician and deprescribing specialist in Fort Lauderdale, Florida. His practice offers one service, medically supervised benzodiazepine and z-drug tapering for patients in Florida, and the pace of each taper belongs to the patient.

Dr. Leeds’ practice is concierge, not insurance, and he works directly with every patient. Contact Dr. Leeds to talk about a gradual taper that leaves room for ordinary days.

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.