Which factor most increases the risk of severe benzodiazepine withdrawal requiring inpatient management?

• A. Short-term, low-dose use
• B. Long-term, high-dose use
• C. Occasional use only on weekends
• D. Use of nonbenzodiazepine sedatives

Answer: (B)

Physical dependence and withdrawal risk grow with how long and how heavily a person uses benzodiazepines. With prolonged, high-dose use the brain makes neuroadaptive changes in the GABA system to compensate for the drug’s calming effects. When the drug is reduced suddenly or stopped, these adaptations “rebound,” leading to severe withdrawal symptoms such as anxiety, tremors, autonomic instability, and in some cases seizures. Because of this, long-term, high-dose use is the strongest predictor of withdrawal that is severe enough to require inpatient management, where careful tapering and seizure precautions can be provided.

In contrast, short-term, low-dose use is much less likely to produce meaningful dependence or severe withdrawal. Occasional weekend use carries even less risk. Using a nonbenzodiazepine sedative doesn’t cause benzodiazepine withdrawal, though it can lead to its own withdrawal syndrome if stopped abruptly.