Ativan (Lorazepam) Addiction and Abuse

Written by Jonathan Strum

& Medically Reviewed by Dr. Jessica Pyhtila, PharmD

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Last Updated - 09/08/2023

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Updated 09/08/2023

Ativan (lorazepam) is one of the most commonly prescribed drugs in the United States. In 2019 alone, doctors wrote almost 11 million prescriptions for the medication. However, Ativan is a Schedule IV controlled substance, meaning it carries the risk of abuse, dependence and addiction. If you or a loved one take Ativan, making sure to take the drug only as prescribed can help you prevent the development of an Ativan addiction.

What Is Ativan?

Ativan, the brand name of lorazepam, is a benzodiazepine medication commonly prescribed to treat conditions like anxiety. Ativan is one of the most common benzodiazepines, or “benzos,” and it represented about 21% of all benzos prescribed in the United States in 2019. Similar to other benzos, Ativan works by enhancing the activity of gamma-aminobutyric acid (GABA) in the brain. GABA is the brain’s calming neurotransmitter. By increasing the activity of GABA, Ativan creates calming effects.

Ativan vs. Xanax

Ativan (lorazepam) and Xanax (alprazolam) are very similar drugs that work in similar ways. They both enhance GABA in the central nervous system, calming the brain and body. However, Xanax has a slightly faster onset than Ativan and often wears off more quickly.

While Ativan is normally prescribed to treat anxiety disorders, Xanax is prescribed to treat anxiety as well as panic disorders. This is because Xanax’s quick onset of action can help control panic symptoms quickly. Xanax is the most common benzo in the United States, representing a third of all benzo prescriptions.

Ativan vs. Valium

Ativan (lorazepam) and Valium (diazepam) are benzos that work in nearly identical ways, as they both enhance GABA in the brain and body and lead to a calming sensation. Ativan lasts for a moderate length of time, but Valium has a quick onset and is one of the longest-acting benzos.

Valium’s long duration of action means that it is often prescribed in situations where long-term central nervous system depression is wanted. For example, it can be effective for treating alcohol withdrawal syndrome or seizure disorders. Valium is the fourth most common benzo prescribed in the United States and is responsible for about 11% of benzo prescriptions.

Ativan Uses and Dosage

Ativan is a versatile drug that can be used to treat many different conditions. By slowing down activity in the brain, Ativan can be beneficial for people struggling with anxiety, sleep and even alcohol withdrawal syndrome.

Ativan for Anxiety

Ativan is commonly prescribed to treat anxiety. As a central nervous system depressant, the drug slows activity in the brain and helps to ease anxiety symptoms. A sample starting Ativan dose for anxiety is 2 mg to 3 mg. This can usually be repeated two or three times per day to a max dose of 10 mg daily.

Ativan for Sleep

As a central nervous system depressant with sedative effects, Ativan can sometimes be prescribed for sleep in people who struggle with anxiety. A sample dose in adults under the age of 65 is 0.5 mg to 2 mg at bedtime. However, those over the age of 65 generally need a lower dose that is between 0.5 mg to 1 mg at bedtime.

Ativan for Alcohol Withdrawal

Although Ativan may be used to treat alcohol withdrawal symptoms, doctors typically prescribe longer-acting benzos like diazepam or chlordiazepoxide to help create a smoother alcohol withdrawal experience. However, Ativan may be more appropriate than other benzos in certain alcohol withdrawal cases. For example, it can be helpful for people with severe liver impairment, as other benzos may be too risky.

The Ativan dose needed for a person in alcohol withdrawal can vary greatly depending on their withdrawal symptoms. A sample Ativan dose for alcohol withdrawal is 2 mg to 4 mg per hour as needed.

How Does Ativan Make You Feel?

Ativan is a central nervous system depressant, meaning that it slows activity in the brain. As such, Ativan often makes people feel calmer and sometimes sleepy. It is for this reason that the drug is often prescribed to treat conditions likeanxiety and anxiety-related insomnia. Ativan enhances the effect of the calming neurotransmitter GABA in the brain, which helps relieve these conditions.

Ativan Side Effects

Like all drugs, Ativan has some side effects. When taken at recommended doses, these include:

  • Sedation
  • Dizziness
  • Weakness
  • Unsteadiness

Keep in mind that taking Ativan over the long term can lead to additional side effects that may be irreversible in some cases.

Long-Term Side Effects of Ativan

Ativan is meant to be taken at the lowest possible dose for the shortest possible duration. However, some people may end up taking Ativan over the long term. Unfortunately, this can increase the risk of some long-term side effects, including:

  • Cognitive impairment, which may be long-term
  • Hip fractures
  • Motor vehicle crashes

It is always important to remember that Ativan is a controlled substance. The risk of Ativan addiction does not decrease over time, no matter how long a person has been taking it. Developing an Ativan addiction is always a possibility.

Ativan Side Effects in The Elderly

Experts recommend avoiding benzos like Ativan in the elderly whenever possible. This is because seniors are especially sensitive to benzos. Further, their bodies take longer to break down the drugs, which can lead to unexpectedly long durations of action. Benzos increase the risk of certain side effects in the elderly, including:

  • Cognitive impairment
  • Delirium
  • Falls
  • Fractures
  • Motor vehicle crashes

Can You Overdose on Ativan?

It is possible to overdose on Ativan. An overdose of any benzo, including Ativan, is a medical emergency. In addition, Ativan overdoses often occur when someone combines the drug with other substances, which further increases the chances of potentially fatal complications.

Opioids are especially risky to take with Ativan. The overdose risk from mixing benzos and opioids is so high that Ativan carries a Boxed Warning against use with opioids. It is extremely important to call 911 immediately if you think someone has taken too much Ativan and may be having an overdose.

Signs of an Ativan Overdose

If someone takes too much Ativan, they will often start to show symptoms of an Ativan overdose. Fortunately, signs of an Ativan overdose are easy to identify. They include:

  • Slurred speech
  • Coordination problems
  • Changes in mental status
  • Slowed breathing, if taken with substances like opioids or alcohol

If you think someone is overdosing on Ativan, immediately seek emergency medical attention.

Is Ativan Addictive?

Ativan is a Schedule IV controlled substance that carries a risk of abuse, addiction and dependence. This is partly because the brain and body very quickly start to become tolerant to benzodiazepines like Ativan, meaning higher doses are required to achieve the same effects as before. Studies show this tolerance can start as soon as the second day you are on the medication.

To reduce the risk of developing an Ativan addiction, it is important to take Ativan exactly as your doctor prescribes it. Taking Ativan more frequently than prescribed, taking a higher Ativan dose than prescribed or taking someone else’s Ativan can increase the risk of an Ativan addiction.

Signs of Ativan Addiction

When a person begins to develop an Ativan addiction, there are often signs that the person is starting to struggle with the drug. These signs include:

  • Taking more Ativan or using it over a longer period of time than intended
  • Unsuccessful efforts to cut back or stop taking Ativan
  • Spending a lot of time obtaining, using or recovering from Ativan
  • Having Ativan cravings
  • Having problems fulfilling life obligations at work, school or home due to Ativan use
  • Having interpersonal problems caused by Ativan use
  • Missing social or recreational activities due to Ativan use
  • Using Ativan even when it is dangerous to do so
  • Continuing Ativan even though you know it is having a negative effect on your physical or mental health
  • Needing higher Ativan doses to achieve the same effects as before
  • Experiencing withdrawal symptoms when you try to quit or cut back on Ativan

Ativan Withdrawal

Benzos like Ativan can cause withdrawal symptoms if you suddenly stop taking them. This is due to a phenomenon called physical dependence. When you are physically dependent on Ativan, suddenly stopping the drug can cause withdrawal. Withdrawal occurs when your brain and body have become used to the presence of a substance and have adapted accordingly. For this reason, stopping the medication cold turkey can lead to a variety of uncomfortable and potentially dangerous symptoms.

Ativan Withdrawal Symptoms

Ativan withdrawal symptoms are similar to those of other benzos and can include:

  • Sweating
  • Fast pulse
  • Hand tremor
  • Insomnia
  • Nausea and/or vomiting
  • Hallucinations
  • Agitation
  • Anxiety
  • Seizures

Withdrawal symptoms from stopping Ativan can start six to eight hours after the last dose. The symptoms often peak on the second day and improve after four or five days. Risk factors for Ativan withdrawal symptoms include taking the drug over the long term and using high doses.

It is important to note that benzo withdrawal symptoms can be unpredictable, and they may wax and wane during the withdrawal period. This means that symptoms may improve only to worsen again before improving.

Treatment for Ativan Addiction and Withdrawal

Ativan addiction can feel overwhelming and hopeless, but help is available. At The Recovery Village at Palmer Lake, we offer a full continuum of care to help you recover from Ativan abuse and addiction. Our treatment starts with a personalized medical detox program, where we wean you off Ativan so your body can be fully cleansed of the drug.

Treatment continues in our inpatient and outpatient rehab settings, where you participate in therapy to learn the skills to stay Ativan-free. Even after your rehab is complete, we continue to support you through aftercare programs that help you maintain your recovery long-term. If you or someone you love struggles with Ativan, don’t wait – contact us today to see how we can help.


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