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Ativan (lorazepam) is widely used in medical settings, including hospitals, where it may be given for pre-surgical procedures or in the intensive care unit for sedation. It is also commonly prescribed to treat anxiety disorders. While effective when used as directed, repeated or prolonged exposure, particularly in a medical setting, can lead to Ativan addiction, even in individuals who have never used the drug recreationally.
Key Points
- Ativan (lorazepam) is an intermediate-acting benzodiazepine used for anxiety, insomnia and hospital sedation.
- Dependence can develop through legitimate medical use, including hospital stays.
- Older adults are at particularly high risk for Ativan dependence and adverse effects.
- Withdrawal is moderate in onset and intensity compared to Xanax.
- Treatment follows the standard benzo taper model.
What Is Ativan (Lorazepam)?
Ativan is the brand name of the medication, lorazepam and is considered an intermediate-acting benzodiazepine (benzo) with a half-life of 10-20 hours.1 Benzos are a classification of drugs that produce sedation and depress the central nervous system.
It is typically given in divided doses and is effective for approximately 6 to 8 hours. Ativan is widely used in medical settings as a pre-surgical sedative to relieve anxiety and sedation for procedures in the intensive care unit.2
Many people who start taking Ativan in the hospital and ICU may develop a dependence on the drug. In fact, that is the most common pathway to dependence.
Outside of medical settings, Ativan is used to treat anxiety disorders, insomnia and in certain cases, epilepsy.
Ativan use can lead to side effects, including:
- Dizziness
- Drowsiness
- Muscle weakness
- Fatigue
- Sedation
- Unsteadiness
- Confusion
- Slurred speech
How Ativan Dependence Develops
Drug dependence develops as the brain adapts to regular use, building tolerance and beginning to rely on the substance to function normally. With Ativan, the drug enhances GABA activity. GABA is a chemical that calms the nervous system. Over time, the brain may reduce its own production, leading to dependence.
This can occur within just a few weeks of regular use, even at prescribed doses. For many, exposure begins in medical settings like the ICU or post-surgery, although Ativan is also commonly prescribed in outpatient care, particularly for anxiety in older adults.
Although Ativan is listed as a medication potentially inappropriate for use in adults 65, according to the 2023 American Geriatrics Society (AGS) Beers Criteria, Benzos like Ativan are still among the most widely prescribed drugs in the elderly population. Approximately 13% to 25% of individuals aged 65 and over report current or recent use.3
The geriatric community faces age-related risks when taking Ativan, including:
- Slower metabolism: Metabolism is slower in older adults, which causes the drug to build up in the system and can increase its negative side effects.
- Increased side effects: Side effects of Ativan often include confusion, delirium, dizziness, loss of balance/coordination and severe drowsiness, which can be worse in older adults who already struggle with some of these conditions.
- Dementia complications: It can exacerbate agitation, confusion and mood swings in patients with dementia.
- Drug interactions: Since elderly patients are often on multiple medications, combining Ativan with other psychoactive drugs increases the risk of falls or severe cognitive impairment.
Signs of Ativan Addiction
Ativan addiction can happen to anyone. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic criteria for addiction include:
- Using the substance in larger amounts or for longer than intended.
- Persistent desire or unsuccessful attempts to cut down or control use.
- Spending significant time obtaining, using or recovering from the substance.
- Craving, or a strong desire/urge to use the substance.
- Recurrent use that results in a failure to fulfill major obligations at work, school or home.
- Continued use despite persistent social or interpersonal problems caused or worsened by the substance.
- Giving up or reducing important social, occupational or recreational activities.
Some of the specific key warning signs of Ativan addiction include:
- Drowsiness or fatigue
- Sedation
- Slurred speech
- Slowed reflexes
- Withdrawing from people
- Losing interest in activities
- Forgetfulness
Signs of addiction may present differently in older adults. Some of the symptoms, such as confusion, can be mistaken for dementia in older patients. As well, falls in elderly individuals who take Ativan may be increased.
Ativan Withdrawal Symptoms and Timeline
A person who is dependent on Ativan and stops using it will likely experience symptoms of withdrawal.
Withdrawal is a set of physical and psychological symptoms that occur when you stop or reduce a substance your body has become dependent on. Over time, the brain adapts to the drug’s presence and when it is suddenly removed, the body must readjust.
The exact timeline of Ativan withdrawal will vary from person to person. Typically, withdrawal symptoms start to appear 1-3 days after your last dose. The intermediate half-life of the drug places it between other benzodiazepines like Xanax and Valium in onset and intensity of withdrawal symptoms.
Common Ativan withdrawal symptoms include:
- Sleep disturbance
- Irritability
- Increased tension
- Anxiety
- Panic attacks
- Hand tremor
- Sweating
- Difficulty in concentration
- Dry retching and nausea
- Weight loss
- Palpitations
- Headache
- Muscular pain and stiffness
- Seizures
- Psychotic reactions
Ativan Addiction Treatment
There are several treatment options available to people who are facing an addiction to Ativan. Most treatment plans involve a supervised taper along with ongoing therapy to help you avoid relapse.
Detox
For many people with addiction, the first step in recovery is detox. This process allows the body to adjust to functioning without the substance it has come to rely on. With Ativan, a gradual taper is recommended rather than stopping suddenly, as withdrawal can be risky.
In some cases, longer-acting benzodiazepines, such as diazepam, are used during the taper to ease symptoms and help to prevent complications such as seizures.
Therapeutic Interventions
Once you are stable, ongoing treatment typically involves therapy to help you develop coping skills for managing cravings and maintaining long-term recovery.
Cognitive behavioral therapy (CBT) is a common therapeutic approach that helps you identify unhealthy patterns of thinking and behaviors that have contributed to your addiction. With awareness, you can begin to develop healthier ways of thinking that support a future in sobriety.
Motivational interviewing is another approach that focuses on asking probing questions to help you uncover thoughts and feelings that may be behind your substance use. By asking thoughtful questions, you can gain insight into your unconscious mind and learn to strengthen your decision-making processes.
Contingency management is also a common practice in addiction treatment. This method uses incentives or cash prizes to reward you when you accomplish specific therapy goals, such as staying sober for a period of time.
Treatment Settings
Depending on your specific needs and the severity of your Ativan addiction, there are varying levels of care available.
The highest level of care is found in inpatient and residential programs. These programs provide 24-hour care, with medical and mental health professionals available to address your needs. Services typically include medically assisted detox, individual counseling, group therapy, holistic care such as yoga, meditation and mindfulness practices and relapse prevention planning.
In contrast to an inpatient program, outpatient rehab does not include overnight stays. In outpatient rehab, you will attend sessions throughout the week but return to your home for the night. There are varying levels of care, including:
- Partial hospitalization program (PHP): Offers more intensity than a standard outpatient program. For many, it serves as a bridge between inpatient and traditional outpatient treatment. It is similar to inpatient treatment, because participants typically attend daily programming that includes individual counseling, group therapy, medical monitoring when indicated, medication management and family therapy while allowing you to return to your home at the end of the day.
- Intensive outpatient (IOP) treatment: Offers care that is more intensive than standard outpatient care but less intensive than partial hospitalization. Typically, IOP involves between 9 and 15 hours of treatment per week. This type of program allows for more flexibility with sessions offered throughout the day and evening. This flexibility in programming allows you to maintain your family, work or school responsibilities while still getting the comprehensive care you need. IOP includes individual counseling, group therapy, psychoeducation, family therapy and relapse prevention planning.
Geriatric-Specific Considerations
A geriatric-specific program for Ativan addiction is especially important. Because the elderly respond differently to benzodiazepines than younger individuals, they face greater medical risks with withdrawal.
Therefore, their treatment should include closely monitored detox followed by comprehensive care that addresses the unique factors that contribute to their addiction, including isolation, chronic illness and long-term prescription drug use.
Aftercare
Addiction treatment does not end when an individual leaves detox or rehab. Aftercare is an important component of an individualized treatment plan. Aftercare plans are an important part of recovery because relapse is a common occurrence with addiction disorders.
An aftercare plan may include:
- Ongoing therapy appointments
- Regular check-ins with your doctor
- Continuing medication-assisted treatment
- Attending support groups or 12-step meetings
Explore the Rehab.com treatment provider directory to find a program near you that fits your treatment needs.
FAQs
Yes, it is possible to become dependent on Ativan after a hospital stay. This is common because benzodiazepine use can lead to dependence in as little as a few weeks with regular use.
You can experience dependence and addiction after just a few weeks of use, even if you are following your prescribed dosage.
Ativan is generally not considered safe for older adults. It is actually listed on the American Geriatrics Society Beers Criteria as a medication to avoid. Due to the slower metabolism of older adults, the drug increases their risk of falls, fractures, delirium and cognitive impairment. If you are an older adult, ask for other medication options that do not pose the same health risks as Ativan.
Ativan dependence refers to the biological need the brain and body experience after regular use of the drug. As the body adjusts to the substance and begins to rely on it to function normally, when the substance is stopped or reduced, withdrawal symptoms occur.
Addiction is both biological and psychological in nature. It involves compulsive use despite the negative consequences it may have on your health, relationships and daily life.
A person can have Ativan dependence without addiction; however, addiction usually involves both dependence and a pattern of compulsive use that leads to personal harm.
Yes, many non-addictive anxiety medications exist to help you manage symptoms. SSRIs such as Lexapro, Zoloft, Prozac and Paxil are medications that can help with anxiety, but do not cause addiction. Ask your doctor about options that may be right for you.
Sources
- U.S. Drug Enforcement Administration. (n.d.) Benzodiazepines.
- National Library of Medicine. (2024). Lorazepam. National Institute of Health.
- National Library of Medicine. (2014). Adverse performance effects of acute lorazepam administration in elderly long-term users: pharmacokinetic and clinical predictors. National Institute of Health.
- National Library of Medicine. (2025). Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits. National Institute of Health.
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