Benzodiazepine Addiction and Abuse: a 2023 Comprehensive Review
Updated: 4 days ago
Benzodiazepines, commonly known as benzos, are a class of prescription medications used to treat anxiety, insomnia, seizures, and alcohol withdrawal. The paradox of benzodiazepines is that these anxiolytic molecules can themselves induce anxiety. They also carry serious risks of dependence, addiction, and abuse. In this comprehensive guide of benzodiazepine addiction and abuse, we'll explore what benzos are, their addictive potential, symptoms and signs of benzo abuse, withdrawal effects, and treatment options for overcoming benzodiazepine addiction.
What Are Benzodiazepines and How Do They Work?
Benzodiazepines are central nervous system depressants. They produce sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant effects. Some common benzos include Xanax (alprazolam), Valium (diazepam), Klonopin (clonazepam), and Ativan (lorazepam).
Benzos work by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity. When GABA is stimulated, nerve impulses slow down, resulting in a drowsy, calming effect. For people suffering from anxiety or sleep disorders, benzos can rapidly help. However, persistent use can lead to dependence and addiction.
Are Benzodiazepines Addictive?
Yes, benzodiazepines have a high potential for dependence and addiction. When taken regularly over an extended period, the body and brain become physically dependent to needing benzos. Over time, it takes increasingly higher doses to achieve the same effects, a phenomenon called tolerance.
If the drug is stopped, the person may experience withdrawal symptoms. Withdrawal from benzos can be extremely uncomfortable and even dangerous. Many people continue taking benzos simply to avoid unpleasant withdrawal symptoms of physical dependence, marking the transition to addiction.
Certain factors can increase the risks of benzodiazepine dependence, including:
Taking high doses for long periods of time
Having a history of substance abuse or addiction
Taking benzos in combination with other opioids or alcohol
Having an underlying mental health disorder like depression or anxiety
Even when taken as directed, benzos should only be used short-term because the likelihood of addiction rises steadily after just a few weeks of regular use.
Signs and Symptoms of Benzodiazepine Abuse
For people struggling with addiction, benzos are often taken in larger doses than prescribed or used in combination with other substances to enhance the high. Some common signs and symptoms of benzodiazepine abuse include:
Taking benzos without a prescription or in higher doses than prescribed
Difficulty functioning normally without the drug
Continuing use despite negative consequences
Using benzos along with alcohol or illicit drugs like opioids
Going from doctor to doctor seeking prescriptions (doctor shopping)
Constantly thinking about, craving, or planning to use benzos
Spending large amounts of time using, seeking, or recovering from benzodiazepines
Hiding benzodiazepine use from loved ones
Mood swings, irritability, depression, or agitation when not using
Risk-taking behaviors like driving while impaired
What are the Effects of Benzodiazepine Abuse?
When taken recreationally in high doses, benzos can produce a euphoric high, feelings of well-being, and a dream-like state of sedation. However, benzodiazepine abuse carries serious health risks:
Impaired thinking and coordination: Benzos significantly slow normal brain function, severely impairing memory, judgment, reaction times, and motor control. This can result in accidents, injuries, and erratic behavior.
Respiratory depression: Excessive doses depress respiratory function, which can lead to coma or fatal overdose, especially when combined with alcohol or opioids.
Behavioral symptoms: Benzo abuse is linked to increased agitation, hostility, and aggression as well as suicidal thoughts.
Memory loss: Frequent use can negatively impact memory and cognitive ability, even after quitting the drug.
Sleep issues: While initially helping with sleep, chronic benzo abuse can lead to rebound insomnia.
Mental health problems: Benzo abuse can cause mood swings and worsen anxiety, depression, and psychosis in susceptible individuals.
Legal consequences: Obtaining benzos illegally, doctor-shopping for prescriptions, and driving under the influence carry legal risks. Loss of employment, relationship issues, and financial problems are also common.
Accidents and injuries: The sedation, impaired coordination and judgement caused by benzos substantially increase the risks of falls, household accidents, and motor vehicle collisions.
Overdose: High doses of benzodiazepines alone or mixed with opioids and alcohol can result in coma and death from respiratory depression.
Risk Factors for Benzodiazepine Abuse and Addiction
While anyone can develop an addiction to benzodiazepines, certain people face increased risks. Risk factors for benzo abuse include:
Personal or family history of substance use disorder or mental illness
Youth and young adulthood
History of trauma, neglect, or abuse
Chronic stress, anxiety, or sleep problems
High-risk behaviors or impulsivity
Peer pressure and exposure to drug-abusing behaviors
Lack of social or family support
For some vulnerable individuals, simply being prescribed a benzo legally by a doctor can lead to unintended abuse and addiction. This underscores the need for careful screening, monitoring, and follow-up when considering benzos as a treatment option.
Recognizing Benzodiazepine Dependence and Addiction
For people who are prescribed benzodiazepines long-term, recognizing the signs of dependence and addiction can be tricky. Common symptoms of benzodiazepine dependence include:
Experiencing withdrawal symptoms when trying to quit
Needing to take higher doses to achieve the same effect (tolerance)
Being unable to cut down or quit despite trying
Spending excessive time obtaining, using, or recovering from benzodiazepines
Giving up hobbies and social activities because of benzo use
Continuing to use despite physical or psychological problems
Using benzos to avoid or relieve withdrawal symptoms
Full-blown benzo addiction involves an inability to control use regardless of harm or consequences. Signs of benzo addiction include:
Failed attempts to quit or cut back
Constant cravings and urges to use
Using more or longer than intended
Spending excessive time acquiring, using, and recovering from use
Problems at work, school, or home due to use
Social isolation and relationship conflicts
Risky use in hazardous situations (e.g. driving)
Use causing or worsening mood/anxiety problems
Reduced involvement in activities due to use
Recurrent legal issues related to obtaining or using benzos
Getting an objective assessment by a doctor or addiction specialist can help determine if someone meets the diagnostic criteria for benzodiazepine use disorder as outlined in the DSM-5.
Benzodiazepine overdose is scary stuff. It happens when someone takes way too much Xanax, Valium, Klonopin, or similar drugs. The effects can go from zero to fatal very quickly, especially if mixed with other downers like alcohol or opioids. Not good.
Important things to know:
Small amounts of benzos can be toxic if you combine benzodiazepines with alcohol or with other sedatives. Alcohol and benzos is a dangerous game! Best to avoid mixing.
Overdose symptoms include being really drowsy, confused, having slurred speech and lack of coordination. Bad signs.
Things can go downhill fast from mild impairment to coma and suppressed breathing within minutes. You need medical help ASAP if an overdose is possible. Don't wait!
There's an antidote called flumazenil that reverses benzo overdose by blocking its effects in the brain. But it doesn't always work if other drugs are involved too.
If breathing stops, doctors have to step in quickly with ventilation, IV fluids, oxygen etc. Time is everything!
Bottom line: Benzodiazepines may be lethal in overdose, especially mixed with other downers. Staying within prescribed doses is so important. And if you see someone who has possibly overdosed, call 911 - getting prompt medical care can save their life. Be smart and stay safe out there!
Dangers of Benzodiazepine Withdrawal
Because of their short action in the brain and body, benzos must be slowly tapered off under medical supervision. Quitting benzodiazepines abruptly after regular use often causes severe, even life-threatening withdrawal symptoms known as benzodiazepine withdrawal syndrome. These benzo withdrawal symptoms include:
Rebound anxiety and panic attacks
Profuse sweating, heart palpitations, and shakiness
Nausea, vomiting, and stomach pain
Muscle tension, pain, and spasms
Insomnia, nightmares, and disturbed sleep
Heightened senses and sensitivity to light and sound
Depression, suicidal thoughts
Tremors and seizures (particularly with high-dose use)
The time between the last dose and the onset of withdrawal depends on the specific benzo, its potency, half-life, and the person's metabolism. Short-acting benzos like Xanax cause symptoms faster, often within a few hours of the last dose. The peak of withdrawal intensity is usually between 2-4 days after stopping but symptoms can fluctuate and persist for weeks or months.
This long, drawn-out withdrawal syndrome is why most experts recommend gradual tapering under medical supervision instead of abruptly stopping benzodiazepines. Getting through benzo withdrawal often requires a high degree of medical monitoring, emotional support, and an unwavering commitment to seeing the process through to completion.
Treatment for Benzodiazepine Addiction and Abuse
Overcoming benzodiazepine addiction involves two phases - safely detoxing off the drug under medical supervision, followed by comprehensive addiction treatment programs and services.
Because the symptoms of benzodiazepine withdrawal can be long, difficult, and potentially dangerous, attempting rapid detox at home by yourself is extremely risky. Medically-managed detox provides 24/7 monitoring, medications to ease symptoms, and IV fluids and nutrition. Most patients are tapered off benzos slowly using diazepam or similar longer-acting benzos to help avoid significant withdrawal symptoms. Often, patients need treatment for other commonly abused drugs; substances like opioids or alcohol that can make detox challenging.
Following detox, intensive inpatient or outpatient addiction programs help clients learn to live sober. Treatment options available may include behavioral therapies, counseling, 12-step programs, and peer support. Treatment focuses on identifying triggers, changing addictive thinking patterns, developing healthy coping skills, and actively working a program of recovery. Medications may also be used to treat co-occurring problems like anxiety, depression, and insomnia during this recovery period.
Because of the high rates of relapse, ongoing follow-up care and social support are crucial for maintaining sobriety. Peer support groups, 12-step programs, counseling, recovery coaching, and sober living homes provide a community of support during the first year of recovery and beyond. Long-term participation in recovery programs and services has been shown to drastically improve addiction recovery outcomes.
Hope for Recovering from Benzo Addiction
Benzodiazepine addiction is treatable, even when dependency has lasted for many years. With thorough detox, comprehensive treatment, and ongoing recovery support, many people are able to achieve lasting sobriety. The road to recovery often starts with having the courage to admit there’s a problem and seeking help.
If you or a loved one is struggling with benzo abuse, reach out to an addiction specialist or treatment program to start the recovery process today. There are many compassionate professionals and volunteers within the recovery community who understand exactly what you’re going through. With their guidance and support, long-term recovery is possible.
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I lead a team with decades of experience, and a commitment to providing you with comfort, care, and respect as you navigate this challenging time in your life. We are located in a private secluded area in Tulsa, Oklahoma. We also make treatment super convenient with hours of operation that extend from 0800 AM to 0900 PM, 7 days a week through scheduled appointments, accept most insurances, making addiction treatment accessible to practically all who call 918-518-1636. I am waiting for your call.
Key Takeaways: Overcoming Benzo Addiction
Benzodiazepines are commonly prescribed to treat anxiety disorders.
They have a high potential for abuse and dependence.
Addiction can develop even when taken as directed.
Risk increases with higher doses and longer use.
Look out for signs of abuse like requiring higher dose, combining benzos with other drugs, and continuing despite consequences.
Symptoms of benzodiazepine overdose include drowsiness, slurred speech, confusion, and difficulty walking.
Medically-supervised detox is crucial to safely taper off benzodiazepines and minimize dangerous withdrawal symptoms.
A comprehensive treatment program provides the tools and support needed to establish long-term sobriety.
Recovery is a lifelong process requiring ongoing professional treatment, abstinence, lifestyle changes, and community support.
Don’t lose hope - many people fully recover from benzodiazepine addiction by making sobriety their number one priority.
About the author:
Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.
This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.