Benzodiazepine Dependence Treatment
Benzodiazepine dependence often develops from legitimate medical treatment. We provide careful, medically supervised tapering combined with psychotherapy, because successful discontinuation requires addressing both the physical and psychological dimensions.
If you have come to depend on a sleep or anxiety medication your doctor prescribed, and you want a safe way off it, that is exactly the situation we treat. That includes Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam), and Restoril (temazepam).
Careful, Compassionate Tapering
San Francisco, in-person visits required
Dependence Is Not Addiction
This distinction matters. Research shows that 40-80% of prescribed patients experience withdrawal symptoms when stopping benzodiazepines, yet most never meet criteria for a substance use disorder. These are people who took medication exactly as prescribed and developed physiological dependence, not addiction.
The Benzodiazepine Information Coalition, a patient advocacy group, has documented widespread confusion in medicine about this distinction. Patients are often misdiagnosed as "addicted" and sent to rapid detox programs designed for substance abusers, programs that can cause serious harm to someone with iatrogenic dependence.
We understand the difference. Our approach is designed for patients who developed dependence through legitimate medical treatment, not recreational use.
Source: Ashton, Comprehensive Handbook of Drug & Alcohol Addiction, 2004
The Risks of Long-Term Use
Even when taken as prescribed, benzodiazepines carry significant risks that many patients are not adequately warned about.
Tolerance
The medication becomes less effective over time, often leading to dose escalation.
Cognitive Effects
Memory impairment, difficulty concentrating, and mental "fog" that may persist.
Paradoxical Effects
Some patients experience increased anxiety, depression, or irritability, the opposite of intended effects.
Protracted Withdrawal
10-15% of patients experience symptoms lasting months or even years after stopping.
Why Medical Supervision Matters
Benzodiazepine withdrawal can be medically serious, and, in rare cases, life-threatening. In a 2023 study of more than 350,000 long-term users, 5.5% of those who stopped died within a year, against 3.5% of those who continued. The study could not account for why treatment was stopped or how it was done, so it cannot tell us whether a carefully supervised taper carries that risk. We read it as a reason to go slowly and with support, not a reason to stay on.
Source: Maust et al., JAMA Network Open, 2023
- Seizures with abrupt discontinuation
- Severe rebound anxiety and insomnia
- Neurological symptoms (tinnitus, paresthesia)
- Protracted syndromes lasting months-years
Gradual Tapering
We follow the Ashton Method principles and align with the 2025 joint clinical practice guideline from ASAM and nine partner medical societies, which recommends slow, patient-directed tapering rather than rapid detoxification and distinguishes physical dependence from addiction.
Key principles include:
- Reductions paced by how you are doing rather than a fixed schedule, usually getting smaller as the dose gets lower
- Switching to a longer-acting benzodiazepine (usually diazepam) when appropriate
- Flexibility to pause or slow the taper if symptoms become intolerable
- Supportive medications to manage specific withdrawal symptoms
This Takes Time
A successful taper often takes 6-12 months or longer. Trying to rush typically backfires. We support you through the entire process with regular in-person appointments. That is a real commitment of time and travel, and it is worth weighing honestly before you begin rather than partway through.
Integrated Psychotherapy
Psychotherapy is not optional: it's integral to our taper process. Our therapists help you develop coping strategies for anxiety, process the experience of withdrawal, and address the underlying issues that led to benzodiazepine use.
Supportive Medications
Medication can make the taper more comfortable, and therefore possible. What helps is highly individual, and there is little trial evidence to choose from, so we work symptom by symptom rather than from a fixed list, and we stay with non-addictive options. Some people taper without any. In our experience the two together are often what keep a taper tolerable enough to finish.
Who We Treat
Prescribed Users Wanting Off
Patients who have been taking a benzodiazepine such as alprazolam (Xanax), lorazepam (Ativan), or clonazepam (Klonopin) as prescribed, sometimes for years, and now want to discontinue, either because of side effects, concern about long-term use, or simply feeling ready to manage without them.
Failed Taper Attempts
Patients who have tried to taper on their own or with a provider who moved too quickly. We can restart the process with a more gradual approach and proper medical support.
Combination Dependence
Patients who are dependent on benzodiazepines along with alcohol or opioids. These complex cases require integrated treatment addressing all substances simultaneously.
Underlying Anxiety Disorders
Patients whose original anxiety never resolved despite benzodiazepines. We can help taper the benzodiazepine while treating the underlying condition with other approaches.
Z-Drugs and Sleep Medications
Ambien (zolpidem), Lunesta (eszopiclone), and Sonata (zaleplon) are not benzodiazepines, but they act in the same way and can produce the same dependence and withdrawal. Ashton's clinic tapered them alongside benzodiazepines, and the same principles apply.
Benzodiazepines Bought Online
Some people end up on benzodiazepines that were never prescribed and are not approved in the United States, such as etizolam, often after a prescriber stopped refills or because they did not want to depend on a prescriber. Pill presses now turn out tablets the DEA describes as nearly indistinguishable from genuine ones, separable only by chemical testing, and some carry fentanyl. So the dose you have been taking may not be the dose you think it is, and establishing that comes first. Stabilization may have to come before any taper can safely begin.
Treatment Inside a Medical Practice
Benzodiazepine dependence rarely occurs in isolation. The reason the medication was originally prescribed may still be there: anxiety, insomnia, trauma. But underneath the benzodiazepines we may find entirely different or unexpected symptoms, and our patients frequently have other coexisting medical conditions. Long-term users are reported to have a higher prevalence of heart, kidney, and other chronic disease than people who do not take benzodiazepines, so a new symptom during a taper is not automatically the taper. Even a slow taper can produce symptoms that confuse the picture, so part of our job is to get you through this safely without missing anything important. Because we are a medical practice first, we can help evaluate what is withdrawal and what is not, manage your overall health picture, and bring in the right specialists when they are needed.
The ambiguity runs the other way too. Ashton recorded that withdrawal can produce abdominal symptoms distressing enough that patients undergo hospital gastrointestinal investigations, which usually find nothing. She also recorded palpitations that do not signify heart disease. Knowing what does not need investigating is part of the same judgment.
There are two ways to work with us. If you already have active primary care in place, you can join the taper program as a separate process, and we coordinate with the physician managing the rest of your care. But if you would rather have us coordinate everything in one place, you can join the concierge practice with the treatment program built in, so that the taper happens inside comprehensive medical care rather than separate from it. Therapy follows the same logic. Most people who already have a therapist pause that work, taper with our integrated team, and return to them afterward. Whether an outside therapist can instead carry you through the taper is our clinical judgment, not a given, because they have to be willing to coordinate with the medical team and equipped for this particular kind of work.
We ask about primary care because a taper often runs 6-12 months or longer, and someone has to be managing the rest of your health while it does.
Your Treatment Team
Paul Abramson, MD
Medical Director & Founder
Dr. Abramson comes from a multi-generational lineage of physicians.
Kelly Yi, PhD
Psychotherapist
Dr. Kelly Yi completed his doctoral training from the clinical psychology program at Sofia University in Palo Alto, CA.
Orion Harris, LMFT
Psychotherapist
Orion Harris completed his masters degree in Counseling Psychology at California Institute of Integral Studies.
Talk to Us First
If you've been on benzodiazepines and want to get off, or have tried and struggled, contact us for a confidential consultation. What you tell us stays private, and nobody here will judge you for asking. We can help you create a realistic plan.
Note: We require in-person visits at our San Francisco office. We do not offer telemedicine-only treatment for benzodiazepine tapering.
Our physicians and our therapists are all out of network, and the taper program carries a monthly fee on top of visits. A PPO plan often reimburses part of the physician and therapist visits, though not the program fee. We are opted out of Medicare, and HMO plans do not reimburse private practice care like ours. For some people, the cost or the travel to San Francisco makes this the wrong place, and that is worth knowing before you call. A slow, supervised taper can be run by any physician willing to go at your pace, and we would rather you begin one near home than wait for one here.