New Guidelines Recommend Personalized Benzodiazepine Tapering with Psychosocial Support

The Journal of General Internal Medicine recently published a joint clinical practice guideline developed by the American Society of Addiction Medicine (ASAM) in collaboration with nine other medical societies and professional organizations. The guideline offers structured, evidence-informed recommendations for tapering benzodiazepines (BZDs) in adult patients who may be physically dependent and for whom continued use may pose greater harm than benefit.

This multi-society collaboration utilized modified GRADE methodology and clinical consensus to formulate its recommendations. The process included a comprehensive review of existing literature, supplemental searches, and a robust stakeholder feedback system.

Given the limited number of high-quality studies on BZD tapering strategies, most of the recommendations are based on clinical expertise and experience rather than randomized controlled trials. Nonetheless, the guideline provides a much-needed framework for healthcare providers navigating the complex process of benzodiazepine discontinuation, particularly in vulnerable populations.

Key Recommendations for Benzodiazepine Tapering:

• Assess ongoing risks and benefits:
  Providers should continuously evaluate whether the risks of ongoing BZD use outweigh the therapeutic advantages. Tapering should be initiated when the balance shifts toward harm.
• Identify high-risk patients for frequent review:
  Special consideration is needed for individuals taking opioids, those with substance use disorders, co-existing physical or mental health conditions, pregnant patients, and adults over 65.
• Engage in shared decision-making:
  Treatment plans should be made collaboratively with patients and their caregivers to ensure transparency and adherence.
• Avoid abrupt discontinuation:
  Sudden cessation of BZDs in physically dependent patients can lead to serious withdrawal. A gradual taper is essential.
• Outpatient vs inpatient care:
  While most patients can taper in an outpatient setting, those with higher risk should be considered for inpatient or residential care.
• Tapering pace and flexibility:
  Start with dose reductions of 5–10% every 2–4 weeks. For long-term users or those with complications, tapering might need to extend over months or years.
• Tailor the taper to individual response:
  Adjust the taper speed as needed, and consider switching to a longer-acting BZD for smoother reductions.
• Psychosocial support:
  Cognitive behavioral therapies, especially for insomnia, can ease the tapering process and reduce withdrawal symptoms.
• Manage co-occurring disorders:
  Simultaneous treatment for psychiatric or physical conditions that may complicate tapering is recommended.
• Incorporate harm reduction:
  Provide naloxone where needed, educate patients about risks, and connect them with relevant resources.

Despite the lack of robust controlled studies on benzodiazepine tapering, this guideline fills a critical gap by offering a structured, consensus-based approach for clinicians. It also calls for further research to strengthen the evidence base and optimize patient safety and outcomes in BZD management.

Reference:

Brunner, E., Chen, CY.A., Klein, T. et al. Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits. J GEN INTERN MED (2025). https://doi.org/10.1007/s11606-025-09499-2