Discontinuation of benzodiazepines, even after a relatively short duration of treatment, may result in withdrawal symptoms, which are the main sign of physical dependence. The most frequent symptoms of withdrawal are insomnia, gastric problems, tremors, agitation, fearfulness, and muscle spasms. Less frequent symptoms are irritability, sweating, depersonalization, derealization, hypersensitivity to stimuli, depression, suicidal behavior, psychosis, seizures, and delirium tremens.

Abrupt withdrawal can be dangerous and lead to excitotoxicity, causing damage and even death to nerve cells as a result of excessive levels of the excitatory neurotransmitter glutamate. In excitotoxicity, nerve cells suffer damage or death when the levels of otherwise necessary and safe neurotransmitters become pathologically high. Symptoms may also occur during a gradual dosage reduction, but are typically less severe and may persist as part of a protracted withdrawal syndrome for months after cessation of benzodiazepines

Approximately 10% of patients experience a notable protracted withdrawal syndrome, which can persist for many months or in some cases a year or longer. Protracted symptoms tend to resemble those seen during the first couple of months of withdrawal but usually are of a subacute level of severity. Such symptoms do gradually lessen over time, eventually disappearing altogether.

Benzodiazepines have a reputation for causing a severe and traumatic withdrawal; however, this is due largely to the withdrawal process being poorly managed. A slow and gradual withdrawal is recommended, customized to the individual, with psychological support. The time needed to complete withdrawal ranges from four weeks to several years. Alcohol is also cross tolerant with benzodiazepines and more toxic and caution is advised, in order to avoid replacing one dependence with another.

Withdrawal of benzodiazepines for long-term users leads to improved physical and mental health, particularly in the elderly; although some long term users report continued benefit from taking benzodiazepines, this is likely the result of suppression of withdrawal effects. A number of studies have drawn an association between long-term benzodiazepine use and neuro-degenerative disease, particularly Alzheimer’s disease as well as an increased risk of dementia.


Psychological dependence is a mental disorder that involves emotional symptoms like anxiety and anhedonia after ceasing prolonged drug use. 

It involves a belief that you need the substance to do certain things like sleeping or socializing, and it develops through frequent exposure to a psychoactive substance. While previous definitions of anhedonia emphasized the inability to experience pleasure, anhedonia is now used by researchers to refer to reduced motivation, reduced desire and reduced enjoyment during activity. Psychological dependence doesn’t just result from drug use; it can also happen as a result from a behavior, like exposure to pornography

Environmental enrichment and physical activity can diminish psychological withdrawal symptoms. Environmental enrichment is the stimulation of the brain by its physical and social surroundings. Psychological dependence is not to be confused with physical dependence, though they are not mutually exclusive. Additional symptoms of psychological dependence include panic attack, dysphoria, cravings and stress.

The major difference between psychological dependence and physical dependence is the symptoms they cause. While symptoms of psychological dependence relate to emotional and motivational impairment, physical dependence entails somatic symptoms like increased heart rate, sweating and tremor. Empirical studies have shown that cravings, which are associated with psychological dependence, do involve a physiological element.

In most cases, cognitive behavioral therapy is the best way to address psychological dependence, whether it occurs on its own or alongside physical dependence. In therapy, you’ll explore patterns that trigger your use and create new patterns of thought and behavior.

Definitions surrounding psychological dependence are tricky, and not just because it’s a sensitive subject. There are a lot of terms involved that, though related, mean different things. At the end of the day, psychological dependence refers to the way some people come to emotionally or mentally rely on drugs and alcohol.


If your drug or alcohol use causes significant impairment or distress, you may have a substance use disorder (SUD). Diagnosis usually involves an examination by a psychiatrist, psychologist or a drug counselor, and the most commonly used guidelines can be found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Parameters for the diagnosis of a SUD require impairment or distress from your pattern of abuse, and the appearance of at least two of the symptoms listed below, for over a year; using more of a substance than planned, or using a substance for a longer interval than desired; inability to cut down despite a desire to do so; spending a substantial portion of the day obtaining, using, or recovering from your substance use; cravings or intense urges to use; repeated usage contributing to an inability to meet important obligations. 

Does your usage continue despite your knowledge that it’s causing frequent problems at work, school, or at home? Are you withdrawing from important social, professional, or recreational activities because of your drug use? Are you using in dangerous situations, or is your drug use causing you physical or mental harm? 

SUDs can vary widely in severity, and there are numerous methods to measure the severity of your SUD. If you meet only two or three of the DSM-5’s criteria, you are thought to have mild SUD; if you meet four or five criteria, you may have your SUD described as moderate, and if you meet six or more criteria, your addiction qualifies as severe. In the DSM-5, the term drug “addiction” is synonymous with severe substance use disorder. 

The quantity of criteria met offers a rough gauge on the severity of addiction, but a licensed professional will also take into account certain behavioral patterns, frequency of use over time, and assess for substance-specific consequences, such as the incidence of blackouts, or arrests for driving under the influence. 

There are additional qualifiers for stages of remission that are based on the amount of time an individual with a diagnosis of a SUD has not met any of the 11 criteria (except craving).


Drug tolerance describes a user’s reduced reaction to a drug after its repeated use. An increase in dosage may re-amplify the drug’s effect; however, this may also accelerate tolerance, further reducing the drug’s effects. 

One may also develop tolerance to side effects; when this concerns non-addictive, prescribed medications, tolerance may be desirable. A medical intervention that has an objective to increase tolerance (for example, allergen immunotherapy, in which one is exposed to larger and larger amounts of allergen to decrease one’s allergic reactions) is called drug desensitization.

The opposite of drug tolerance is drug sensitization, in which case the user’s reaction increases following repeated use. High tolerance may sometimes lead to drug sensitization. For example, heavy drinkers initially develop a tolerance to alcohol, which requires them to drink larger amounts to achieve a similar effect. However, excessive drinking can then cause liver damage, which puts them at risk of lethal intoxication when drinking even very small amounts of alcohol.

Drug sensitization can also occur in users of stimulants such as cocaine or meth. What had been a recreational dose may become enough to cause psychosis in regular users, or users who previously had a psychotic episode may be more likely to have one in the future and at lower doses once usage continues.

In order for symptoms of withdrawal to occur, one must have first developed a physical or psychological drug dependence, or a combination of both. Dependence develops after consuming one or more substances over a sustained period of time.

Dependence produces withdrawal symptoms that vary with the type of drug in question. For example, withdrawal symptoms from opiates include anxiety, sweating, vomiting, and diarrhea. Alcohol withdrawal symptoms include irritability, fatigue, shaking and nausea. 

There are different stages of withdrawal as well; generally, a person will start to crash, progress to feeling worse, then hit a plateau before the symptoms begin to dissipate. Withdrawal from certain drugs like benzodiazepines can be fatal. While it is seldom fatal to the user, withdrawal from opiates can cause miscarriage, due to fetal withdrawal. 

The term “cold turkey” is used to describe sudden cessation of substance use and the physiologic manifestations that follow. The symptoms from withdrawal may be even more dramatic when the drug has concealed an extended period of malnutrition, disease, or sleep deprivation, common conditions often developed as a secondary consequence of drug addiction. These conditions may resurface when the drug is removed and be confused with withdrawal symptoms.


If you are heading into rehab for the very first time, let me give you some advice, and a sense of where to set your expectations over the next 30-90 days. 

First off, I’d like to congratulate you; not only are you about to embark upon what is essentially an extended vacation, but it’s actually good for you; body, mind and soul! Like an ice cream cake made out of broccolini!

You may think I’m being funny, but I’m actually quite serious; while there are plenty of things about rehab that are challenging, what it is not about is adding to your woes, stress level, or general level of misery. You are there to find a deeper level of happiness. So kick back, put your feet up, and enjoy yourself.

The challenging “work” of rehab will be in the form of talk; specifically, talking about your feelings. If getting mushy isn’t your cup of tea, you have my sympathies. However, I am very, VERY certain it will be good for you (yes, you, in particular) to get comfortable talking about your feelings. 

It is a skill you will find incredibly useful as you re-enter life after rehab, and develop rich social, romantic and familial relationships which will inevitably require conflict resolution through emotional discussions (precisely like those you practice in therapy groups at rehab).

What else about rehab is challenging? Well, you can say goodbye to your privacy. For me, however, this was a plus; the lifestyle in which I’d found myself before I entered rehab was one of abject isolation and I was all too happy to eat, sleep and do pretty much everything else in the company of others. 

If the rehab you are headed to is a good rehab, then you are about to experience a high level of structure. If prior to entering rehab, you were living on your own and were the master of your own fate, this may require a considerable degree of adjustment. There is no easy fix to this, and the only advice I can offer you is to not be a dick about it. 

The temptation to be a dick about it will be great. Don’t succumb to it. As you mature, you will look back on your experiences being a dick about it and cringe. 

Here is my last piece of advice. It is not particularly unique or enlightening, but it is good advice. It is this: listen carefully and think things through. Don’t rush to judgements. 

Over the next 30-90 days, you are going to hear a great many people tell you their opinions and ideas. You will not agree with all of them. Deciding which opinions and ideas you agree with and which you disagree with will form the basis of your spiritual and psychological outlook moving forward. Don’t bail before it’s all had time to settle inside of yourself.

Alright, you’re ready to go to rehab! Have a blast, you rascal!