A patient with a history of high-dose benzodiazepine use presents after stopping abruptly. Which management plan is most appropriate?

• A. Discharge with a sample prescription forever
• B. Admit for inpatient detox and supervised taper
• C. Recommend self-help groups only
• D. Switch to a higher-dose benzodiazepine and continue outpatient

Answer: (B)

Abruptly stopping benzodiazepines after long-term, high-dose use can trigger a dangerous withdrawal with symptoms like tremors, anxiety, insomnia, autonomic instability, and even seizures. The safest and most effective plan is inpatient detox with a medically supervised, gradual taper. In a hospital or specialized unit, clinicians can monitor vital signs continuously, manage withdrawal symptoms promptly, and slowly reduce the dose—often using a longer-acting benzodiazepine to smooth the taper. This approach also allows evaluation for comorbid issues and connection to further treatment after stabilization, reducing the risk of complications and relapse.

Options that rely on outpatient care alone or simply increasing the benzodiazepine dose fail to address withdrawal safety and dependence, and discharging with a prescription forever does not provide a proper taper or monitoring.