Goodbye Benzos, My Old Friend: Benzodiazepine Tapering Done RightGoodbye Benzos, My Old Friend: Benzodiazepine Tapering Done Right
Addiction Medicine Made Easy
Two addiction medicine doctors break down the ASAM benzodiazepine tapering guideline into practical, real-world strategies for safer benzo reduction. They talk through complex cases, high-risk groups and helpful adjunct treatments while stressing slow tapers, collaboration and persistence.
51:03•4 May 2026
Goodbye Benzos, My Old Friend: How to Taper Benzodiazepines Safely
Episode Overview
- Benzodiazepines should not be stopped abruptly due to the risk of life-threatening withdrawal, including seizures and delirium.
- Most patients do better with slow tapers of around 5–10% dose reduction every 2–4 weeks, and some may need months or years.
- Shared decision-making and regular risk–benefit reassessment are crucial, especially for older adults, pregnant patients and those on multiple substances.
- Keeping patients on the same benzo rather than automatically switching to a long-acting agent can improve both safety and patient confidence.
- Non-addictive medications, CBT and lifestyle measures should be used to treat the original issues—such as anxiety or insomnia—that led to benzo use.
“Remember, benzos don't actually fix anything. They're a downer and just suppress uncomfortable symptoms.”
What are the common struggles and victories in addiction recovery? This conversation between two addiction medicine doctors gets right into the messy reality of getting people off benzodiazepines safely. The episode centres on translating the ASAM benzodiazepine tapering guideline into something real clinicians, patients, and families can actually use.
Dr Casey Grover and returning guest Dr Rizzo swap cases, jokes and hard-earned lessons while breaking down ten key takeaways, starting with the golden rule: never abruptly stop benzos because of the real risk of seizures, delirium and serious withdrawal. You’ll hear a powerful case of a woman on 6 mg of clonazepam daily who was suddenly cut to 3 mg in the Emergency Department, and why that 50% drop was such a problem.
From there, they talk through practical tapering principles: dropping doses by around 5–10% every 2–4 weeks, accepting that some tapers take months or years, and why “there is no one-size-fit-all model in any part of addiction medicine.” The pair highlight the extra challenges for people over 65, pregnant patients, and those using benzos alongside alcohol or opioids.
They also stress shared decision-making and the difference between physical dependence and a full substance use disorder, warning how stigma and over-reliance on urine tests can cause real harm. Things get happily geeky as Dr Rizzo explains how phenobarbital and baclofen can support complex tapers in supervised settings, and why short-acting agents like alprazolam are especially tricky.
Non-addictive medications such as trazodone, propranolol, gabapentin, clonidine and SSRIs, plus CBT and lifestyle changes, are framed as essential tools to treat the original problem—anxiety, insomnia, trauma—rather than just suppress symptoms. Through it all, both doctors keep coming back to one message: persistence matters. Setbacks don’t mean failure, and tapering to a safer dose can still be a meaningful win.
If you’re a clinician, patient, or worried family member, this episode gives you practical ideas and a reminder not to give up—who in your life might need to hear that today?
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