Drug Taper: Definition, Example & Treatment

Drug and alcohol rehab can be a life-changing experience for someone struggling with addiction. However, weaning off medications or substances is sometimes challenging enough to discourage many people from seeking the help they need. While withdrawal symptoms are often uncomfortable, they can sometimes be life-threatening.

Many treatment programs have begun to offer drug tapering to help promote safety and long-term recovery. A drug taper means slowly decreasing the dose of a drug over time to reduce the risk of withdrawal symptoms. By tapering off drugs or alcohol gradually instead of discontinuing use all at once, patients have the opportunity to focus on their treatment and begin the lifelong work of recovery.

What Is Tapering or Weaning off Drugs?

When someone is physically addicted to a substance, their body and brain chemistry can change dramatically. That’s why many people experience withdrawal symptoms when they try to stop taking an addictive substance, especially in cases of long-term or heavy use, because their body and brain can no longer function normally without the presence of the drug. This phenomenon is called physical dependence and leads to withdrawal symptoms when the person stops the substance. While symptoms can be uncomfortable, others may be life-threatening. This is especially true in instances involving alcohol, opioid and benzodiazepine addiction.

What Medications Should Be Tapered?

Many medications and substances cause changes to the body that require the agent to be slowly weaned. Not all of these substances are drugs of abuse. What all of these agents have in common is that the body has adapted to their presence and, therefore, needs time to adjust before the drug is fully stopped. Medications that require a taper include:

• Opioids like OxyContin, Vicodin and Dilaudid
• Benzodiazepines like Ativan, Xanax and Valium
• Barbiturates like phenobarbital
• Antispasmodic medications like baclofen
• Blood pressure medications like clonidine, including beta blockers like metoprolol and propranolol
• Steroids like prednisone
• Stimulants like Adderall, Ritalin and Vyvanse
• Antiepileptic drugs like gabapentin and Lyrica
• Dopamine-stimulating drugs like ropinirole and pramipexole
• Antidepressants like Zoloft and Lexapro
• Alcohol

How to Taper off Drugs

Many rehabilitation centers have begun incorporating drug tapering into their treatment programs to help alleviate severe withdrawal symptoms and promote long-term recovery. Tapering is defined as slowly decreasing the amount of an addictive substance taken over time. When done under the care of experienced medical professionals, tapering can help the body gradually adjust to sobriety and allow patients to find relief from many severe withdrawal symptoms. However, because it’s easy to take too much of a taper medication accidentally, it’s important that people only taper off alcohol or drugs under professional care.

Drug Taper Example

Drug tapers can vary extensively depending on many factors, including the person, the medication they are taking and the dose of the drug. No one-size-fits-all tapering regimen is available. Since the point of a taper is to avoid withdrawal symptoms, tapering regimens may speed up or slow down depending on how a person responds to it.

A sample benzodiazepine tapering regimen for Valium is as follows:

Why Consider Tapering vs. Quitting Cold Turkey?

Tapering is a safe and effective strategy to become sober, particularly if you are under the care of a medical professional. On the other hand, quitting cold turkey can be harmful or even deadly. While it is not common, quitting opioids cold turkey can result in electrolyte disturbances or sudden heart failure that can lead to death. For alcohol and benzos, if you quit cold turkey, you risk having a seizure or dying. Consequences depend on the substance you are quitting, but tapering is generally safer and more effective.

Types of Tapering

Several types of tapers exist, including direct, substitute and titration. However, these tapering methods are not equivalent. While some forms of taper, like direct tapering and substitute tapering, are common and recommended by doctors, titration tapers should be avoided.

Direct Tapering

The most straightforward tapering method, direct tapering, involves gradually reducing the amount of a drug an individual takes. In many cases, the substance consumed is slowly decreased weekly until the individual can stop using completely without experiencing unmanageable withdrawal symptoms.

Substitution Tapering

In cases where people are addicted to illicit, short-acting or low-dose substances, substitution tapering may be an option. Substitution tapering involves replacing the drug of abuse with a similar but more easily tapered substance. By replacing the original substance with controlled amounts of medication with lower abuse potential or longer duration of action, medical professionals can precisely and gradually decrease an individual’s daily dose.

Titration Tapering

Titration tapering involves dissolving a small amount of a low-dose drug in water. Typically, this dilutes a substance further and decreases the amount ingested by small increments daily.

Titration tapering is rarely used in clinical settings and carries significant risk. It should never be attempted without professional supervision. Some drugs are not water-soluble, so their concentration cannot be diluted in water. This may lead an individual to take more of a substance than intended, increasing the risk of overdose. Measuring the dose ingested in each diluted solution is nearly impossible without professional medical equipment, which can further increase the risk of overdose or ineffective tapering.

Common Drug Withdrawal Symptoms

Withdrawal symptoms will differ depending on the type of substance you use, how much, how long you have been using and other factors. In general, symptoms of withdrawal can include:

• Nausea
• Vomiting
• Diarrhea
• Anxiety
• Insomnia

Medication-Assisted Treatment

Medication-assisted treatment (MAT) is a whole-patient plan of treatment where medications that minimize or alleviate withdrawal symptoms are combined with counseling or behavioral therapies that can help sustain recovery. Medications used will depend on the substance you are working to quit. For example, three FDA-approved medications for opioid use disorder (OUD) include:

• Buprenorphine reduces cravings and alleviates withdrawal. Buprenorphine can be used during medical detox and long-term as maintenance therapy.
• Methadone, like buprenorphine, reduces cravings and alleviates withdrawal symptoms. Methadone can also be used to shorten medical detox and long-term as maintenance therapy.
• Naltrexone can cause sudden and severe withdrawal if you take it before medical detox is completed, but it can help reduce cravings afterward, which helps prevent relapse.

Many options exist, so always speak with your pharmacist or healthcare provider if you are considering stopping any medication or other substance.

Drug Withdrawal Timeline

Each medication has a different withdrawal timeline based on the class of substance (e.g., opioid, benzo, etc.), whether it is short- or long-acting, how much you use and how long you have been using. In general, for short-acting medications, you are likely to feel withdrawal symptoms hours after your last dose. For longer-acting medications, it can take up to 12 hours.

Early stages of withdrawal are typically very physical, with symptoms like:

• Nausea
• Vomiting
• Diarrhea
• Sweating
• Heart racing
• Insomnia

Later stages of withdrawal are typically more psychological and include symptoms like:

• Irritability
• Depression
• Anxiety
• Panic attacks

For more specific information, ask your pharmacist or healthcare provider.

Medications Used When Tapering Off

Some ways to taper off might include using your drug at increasingly lower doses over time (direct taper) or stopping your drug and using another to taper off over time (substitution taper) safely. It is critical that you always speak with your pharmacist or healthcare provider before stopping your medication or other substance — stopping on your own can sometimes result in serious consequences or even death.

Frequently Asked Questions on Drug Tapering

If you are planning a drug taper, you may have questions about what to expect. Common questions include:

Can tapering your drug intake reduce withdrawal symptoms?

Tapering your drug intake is much more effective in reducing withdrawal symptoms than quitting cold turkey — which will be uncomfortable and, in the worst case, may result in death. With the help of a trained medical provider, you can create a plan to taper until it is safe to stop. The type of drug you use, how much and other factors will determine how quickly or slowly you should taper.

What are the risks of tapering?

When properly conducted, a taper carries minimal risks. If a substance is tapered too quickly, however, withdrawal symptoms may result.

What happens to your body when you taper?

When you taper a drug, your body has a chance to get used to progressively lower doses of the medication before it is finally stopped. This helps you avoid withdrawal symptoms from stopping the drug too quickly. Instead, a taper eases you off the medication.

How long does it take to taper medication?

In most cases, predicting how long a taper will take is impossible. This is because a taper is highly individualized and should be paused or slowed if withdrawal symptoms emerge. For this reason, even if two people started a taper of the same drug on the same day, one may be able to stop the medication within a few weeks while the other person may require months or longer.

After tapering off one drug, when should you taper off another?

You can taper off a medication when your doctor says it is safe to do so. Sometimes, this may be immediately after completing a different taper, while in other cases, your doctor may prefer that you wait.

How do you cross-taper medication?

A cross-taper means increasing the dose of one medication while decreasing the dose of another. Also known as cross titration, this is typically done when a doctor orders a therapy change from one drug to a different drug to give the body a chance to adjust to both.

How The Recovery Village Uses Tapering

There is no one-size-fits-all approach to recovery. For treatment to be effective, it must be tailored to each individual’s needs. While some people benefit significantly from drug tapering, others do better with more conventional medical detox care. At The Recovery Village, we meet patients where they are by providing comprehensive treatment that works for them.

• In cases deemed medically appropriate, this may involve drug tapering.
• Withdrawal management is only a small part of care at The Recovery Village.
• To help patients address the physical and psychological aspects of addiction, The Recovery Village offers a continuum of treatment with multiple levels of care, including:

• Medical detox
• Inpatient
• Partial hospitalization
• Intensive Outpatient
• Outpatient
• Aftercare and sober living

• During each stage of treatment, patients participate in individual, group and recreational therapies that address co-occurring disorders and identify the underlying drivers of addiction.
• As patients gradually step down to less intensive levels of treatment, they gain the skills and confidence needed to recognize triggers, resist cravings and lead a rewarding life in recovery.

If you or someone you love struggles with addiction, The Recovery Village is here to help. Reach out to a Recovery Advocate today to learn more about our treatment options or get started.