Ativan Withdrawal and Detox

Pile of white ativan pills on a blue counter

Ativan is a popular brand of the benzodiazepine lorazepam and is frequently prescribed as an anti-anxiety medication. Unfortunately, all benzos, including Ativan, are associated with a relatively high risk of developing dependence or addiction, even when used as directed. Regular Ativan misuse can rapidly result in profound addiction that can result in severe, even dangerous, withdrawal symptoms. 

Like other benzodiazepines, Ativan use disorders pose unique challenges to recovery that should be addressed by a multidisciplinary drug rehabilitation center that can facilitate a medically assisted detox if needed. 

Dangers of Ativan Tolerance

Benzodiazepines, including Ativan, are notorious for their rapid development of tolerance, meaning that ever-increasing doses of the drug are required in order to achieve the same effect. The flip side of tolerance is withdrawal, which occurs when the administration of sufficient quantities of the tolerance-inducing drug is interrupted. Tolerance and withdrawal are fundamentally related by a constant and self-reinforcing need to increase the dose in order to stave off physical and psychological withdrawal symptoms. 

Even if you have a valid prescription that allows for daily doses, Ativan should be used judiciously, only when absolutely needed, and for short time periods, and under the direction of a medical professional. Tolerance and withdrawal symptoms are indicative of physical Ativan dependence, meaning that the body has grown to depend on regular administration of Ativan in order to maintain its new, altered state of equilibrium.

The pharmacological mechanism that underlies Ativan’s anti-anxiety properties involves a chemical in the brain called gamma-aminobutyric acid (GABA). GABA is an inhibitory neurotransmitter that interacts with GABA receptors on neurons to reduce brain activity. Ativan is a “GABA-mimetic,” meaning that its effects on brain function mimic the effects of GABA. Thus, therapeutic doses of Ativan interact with GABA receptors to reduce brain activity and quench anxiety symptoms. 

What Causes Ativan Withdrawal?

Ativan withdrawal is caused when a person reduces or stops taking the drug. The immediate effects of reduced or eliminated Ativan include increased activity in neurons that have GABA receptors. Because GABA dampens neuronal excitability, the net effect of less GABA is more neuronal excitability. Similarly, less Ativan leads to more neuronal excitability, which leads to anxiety, restlessness and insomnia. In extreme cases of Ativan withdrawal, seizures and death can occur.

High doses of Ativan have additional effects on brain activity, specifically in areas that are associated with addiction. Dopamine is a neurotransmitter that is associated with addiction and the “reward pathway.” Under normal circumstances, the reward pathway is an adaptive mechanism that responds to positive stimuli by producing dopamine, leading to a pleasurable physical sensation and a neurochemical reinforcement that the stimulus was good and should be sought out in the future. For example, if you are thirsty and you drink water, dopamine is released in the reward pathway to reinforce that water is good when you are thirsty. 

When abused, drugs like Ativan hijack the reward pathway by forcing huge amounts of dopamine to be released from the reward pathway. This results in a physical rush of euphoria and a powerful, maladaptive reinforcement that the drug that caused the flood of dopamine is great. Because the brain cannot discriminate between adaptive and maladaptive stimuli, the drug is interpreted as something that significantly improves your state of being. Thus, drugs quite literally change your brain by creating a powerful “need” for more drugs.

Ativan Withdrawal Symptoms

How long withdrawal symptoms persist depends on the amount and duration of Ativan misuse. Cases of mild Ativan dependence may be associated with a few symptoms that resolve within a week or two. However, Ativan is a powerfully addictive drug and many people who are in recovery experience withdrawal symptoms for months following cessation.

Ativan withdrawal is generally characterized by two phases: acute and protracted

  • Acute withdrawal symptoms typically resolve in a matter of weeks, during which time a gradual transition into protracted symptoms is made. Post-acute withdrawal syndrome (PAWS) is an extension of acute withdrawal symptoms that persist beyond the time that all traces of Ativan have left the system. Unfortunately, PAWS is common among people in recovery from Ativan addiction and can persist for months, even years. 
  • Protracted withdrawal symptoms can persist for several months, even years. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines protracted withdrawal as, “the presence of substance-specific signs and symptoms common to acute withdrawal but persisting beyond the generally expected acute withdrawal timeframes.’

Because Ativan works by reducing brain excitability, when Ativan is removed, the brain responds by ramping up activity. This is why physical symptoms of Ativan withdrawal include:

  • Rapid heart rate 
  • Tremors 
  • Nausea 
  • Muscle cramps 
  • Dizziness
  • Hypertension 
  • Seizures, in extreme cases

Ativan withdrawal has been linked to suicidal ideation or attempts to self-harm. Psychological withdrawal symptoms are also indicative of brain excitation and include:

  • Anxiety 
  • Panic 
  • Paranoia 
  • Restlessness 
  • Confusion 
  • Anhedonia 
  • Depression

Can Ativan Withdrawal Kill You?

While uncommon, physiological consequences of abrupt Ativan cessation can cause death in extreme cases. The overall effect of Ativan on the brain is to reduce excitability. Chronic, heavy Ativan use can cause substantial changes in brain cell activity levels that cannot be maintained without Ativan. If Ativan is rapidly depleted, these cells may become hyperexcitable, potentially causing hyperthermia, hypertension, seizures and death. For these reasons, it is never recommended that you quit any benzo “cold turkey.”

Ativan withdrawal has been associated with another potentially lethal risk. A 2017 meta-analysis found that benzodiazepines (including Ativan) are associated with an increased risk of suicidal ideation, attempts and completion. 

Detox and acute withdrawal from Ativan misuse can be dangerous, even lethal. For these reasons, detox and withdrawal are best done under the care of medical professionals who are equipped to provide medical intervention in the case of physical or psychological complications.

Ativan Withdrawal Timeline

Light to moderate Ativan use will likely have relatively mild acute symptoms that resolve in a matter of days to about one week, with prolonged symptoms possibly persisting for another week or two. Conversely, people who used large amounts of Ativan chronically may endure a month or more of acute withdrawal symptoms and PAWS that can stretch out for months, even years. 

The half-life of Ativan is relatively short (~12 hours), so it will be completely metabolized within a matter of days. The prolonged Ativan withdrawal timeline is a consequence of significant changes in brain chemistry. These changes cannot be reversed overnight.

Ativan Detox

Ativan detox and acute withdrawal are at best uncomfortable and can be associated with debilitating physical and mental symptoms. Tapering Ativan doses has been empirically shown to reduce acute symptoms. In extreme cases, tapering is required in order to give the brain time to safely adapt to its new, more excitable state.

Medical Detox

Ativan detox should be done under the supervision of medical professionals who can prescribe a tapering dose and intervene in the case of unexpected complications. In cases of extremely uncomfortable or debilitating withdrawal, medically assisted detox, including pharmacological intervention with benzos that have longer half-lives than Ativan, can help mitigate the severity of symptoms. Tapering the prescribed dose under the guidance of a medical professional is the most effective way to safely quit Ativan. Working with a medical professional or rehab center ensures that a customized plan and an appropriate tapering schedule are in place before detox begins.

Outpatient Detox

In cases of mild Ativan use disorder, outpatient detox may be appropriate. Prior to detox, it is important to consult with a medical professional who can provide an appropriate tapering schedule. Many people find it helpful to discuss what to expect during detox and withdrawal and to identify goals for immediate and long-term recovery. It is important that the person undergoing detox feel confident that they can contact the rehab facility at any time during the process should they have questions or encounter unexpected complications.

At Home Detox

While possible, at home Ativan detox is not recommended. Ativan detox and withdrawal can be associated with dangerous medical complications. Physical and psychological symptoms are often overwhelming, and relapses are common during the early days of recovery. If you do decide to detox at home, it is imperative that you consult with your doctor or a rehab center before you start. Medical professionals strenuously advise against quitting cold turkey, particularly for people with chronic Ativan use disorder. Abrupt cessation of benzodiazepines, including Ativan, can have dangerous, even lethal, consequences.

Finding an Ativan Detox Center in Washington or Oregon

When choosing an Ativan detox center, there are several key things to consider:

  • Location: Avoiding triggers is incredibly important in the first days of recovery. Sometimes facilities that are farther away can minimize temptation.
  • Cost: Rehab can be expensive, but many insurance programs (including Medicaid) can help to offset some or all of the cost.
  • Accreditation: Accreditation through The Joint Commission or CARF International guarantees a certain standard of care. The Recovery Village Ridgefield is proudly accredited by the Joint Commission.
  • Dual diagnosis: An underappreciated component of many substance use disorders is the potential for an underlying mental health issue. In cases where a dual diagnosis is appropriate, multidisciplinary facilities that can address both the substance use and the mental health components of recovery will often provide the best outcome.

If you or a loved one is struggling with Ativan use disorder, the Recovery Village offers a detox center convenient to Washington state and Oregon. Our medical detox program offers safe and supportive supervision for individuals detoxing from Ativan. 

  • The Recovery Village Ridgefield Detox Center
    The Recovery Village Ridgefield Detox Center

    5114 NE 94th Ave
    Vancouver, WA 98662
    (360) 719-1480

Key Points: Understanding Ativan Withdrawal

Ativan withdrawal is challenging. Keeping these key points in mind can help you make informed choices about treatment:

  • Acute symptoms of Ativan withdrawal can be lethal. Detox and withdrawal should only be completed after a medical consultation that delivers a detailed plan for recovery
  • Despite its short half-life, Ativan withdrawal symptoms can last for months, even years
  • Like other benzodiazepines, quitting Ativan cold turkey can be dangerous, especially without the assistance of a medical professional 

If you or a loved one is struggling with Ativan use disorder, help is available. Call The Recovery Village Ridgefield to speak with a representative about how comprehensive programs can be tailored to address your needs. You deserve a healthier future. Start your recovery journey today.

Tan, Kelly; Rudolph, Uwe; Luscher, C. “Hooked on benzodiazepines: GABAA receptor subtypes and addiction.” Trends in Neuroscience, April 2011. Accessed July 27, 2019.

University of Colorado Boulder. “Neuroanatomy and Physiology of the “Brain Reward System” in Substance Abuse.” The Institute for Behavioral Genetics. Accessed August 14, 2019.

Ashton, Heather. “Protracted Withdrawal Symptoms from Benzodiazepines.” Comprehensive Handbook of Drug & Alcohol Addiction, 2004. Accessed July 27, 2019.

Dodds, Tyler J. “Prescribed Benzodiazepines and Suicide Risk: A Review of the Literature.” The Primary Care Companion for CNS Disorders, 2017. Accessed July 27, 2019.

Substance Abuse and Mental Health Services Administration. “Protracted Withdrawal: Substance Abuse Treatment Advisory.” July 2010. Accessed July 27, 2019.

Lann, Meredith; Molina, D.K. “A Fatal Case of Benzodiazepine Withdrawal.” The American Journal of Forensic Medicine and Pathology, June 2009. Accessed July 27, 2019.