What starts as a legitimate prescription can quickly lead to dependence, even if the medication is used as prescribed, leading to withdrawal if usage stops and may require specialized treatment to resolve. If you or someone you know is addicted to benzodiazepines, learning what to look for and where to go for help can potentially save lives.
What Are Benzodiazepines?
Benzodiazepines are a class of central nervous system (CNS) depressants that work by increasing the effect of gamma-aminobutyric acid (GABA), a neurotransmitter which slows brain activity.[1] This creates a sedative effect, relaxes muscles, reduces anxiety, and at elevated dosages, can induce intense feelings of euphoria. These results do have therapeutic value, but are also the reason why benzodiazepines are so prone to misuse.
Some examples of common benzodiazepines prescribed in the U.S. include:
- Xanax (alprazolam) for anxiety and panic disorders
- Valium (diazepam) for anxiety, seizures, and muscle spasms
- Ativan (lorazepam) for anxiety and insomnia
- Klonopin (clonazepam) for seizure disorders and panic attacks
According to the National Institute on Drug Abuse (NIDA), approximately 12.6% of American adults were prescribed a benzodiazepine in the last year, and approximately 2.2% abused their prescription.[2] Although benzodiazepines are widely prescribed, they are classified as a Schedule IV controlled substance because of their high potential for abuse and dependency.[3] If benzodiazepines are taken with opioids or alcohol, the risk of overdose significantly increases.
Benzodiazepine Addiction and Abuse
Benzodiazepine abuse doesn’t always happen as a result of someone intentionally seeking a high. Many people develop a dependency even though they took their medication exactly as prescribed.
Over time, the body adjusts to having the drug present and develops tolerance, requiring increasingly larger or more frequent doses to achieve the desired effect. Once this happens, discontinuing or reducing usage can result in withdrawal symptoms that range from mild discomfort to potentially life-threatening, making it extremely difficult for a person to overcome their dependency without some form of professional help.
Another way people develop a benzodiazepine dependency is by using them recreationally for their sedating effects, ability to lower inhibitions, or the euphoria they induce, often combining them with other substances such as alcohol or opioids. This habit can greatly increase the potential for overdose and death. Regardless of how a person initially begins using benzodiazepines, developing a dependency is a serious medical condition that can be treated and should not be seen as a moral failing.
Signs and Symptoms of Benzo Addiction
Identifying the warning signs of addiction sooner can save lives. Benzodiazepine use disorder is initially difficult to see, especially for those who started with a legitimate prescription, but with continued use, many behavioral, physiological, and cognitive indicators become apparent.
Below are some of the most common signs:
Behavioral
- Taking higher dosages than prescribed or using the drugs more frequently
- “Doctor shopping” (visiting multiple doctors to get multiple prescriptions) or getting drugs from other sources
- Continuing to use despite negative effects on job, school, or relationships
- Quitting leisure activities, hobbies, or social activities
- Spending significant amounts of time obtaining drugs or recovering from drug use
- Hiding or lying about drug use
Physiological
- Being excessively sedated or drowsy
- Speaking slowly or slurring words
- Impaired coordination or unstable gait
- Dizziness
- Tremors between doses
- Muscle spasms or weakness
Cognitive
- Memory loss and blackouts
- Difficulty concentrating
- Confusion or disorientation
- Irritability or mood swings between doses
If you or a loved one exhibits many of the above signs, we recommend contacting a behavioral health professional to discuss possible treatment options. Discovery Institute understands the complexities of benzodiazepine addiction and can help you get started toward lasting recovery.
Why Are Benzodiazepines So Addictive?
A primary reason benzodiazepines have such a strong potential for addiction is due to how they interact with the brain. When used regularly, the increased GABA receptor activation produces a powerful sense of calm and well-being. Over time, however, the brain will adapt by reducing its own GABA receptors to compensate for the drug’s effects, meaning it is now less capable of producing feelings of relaxation and calm on its own.[4] This is the neurological basis of why benzodiazepine withdrawal feels so debilitating, because the body no longer has the capacity to regulate itself without the drug.
There are several factors that can increase someone’s vulnerability to develop an addiction, including:
- Length of use: Even short-term therapeutic use can lead to physical dependency.
- Taking high doses: Higher doses result in quicker development of tolerance and physical dependence.
- Whether the medication used is short vs. long acting: For example, Xanax is short-acting and can produce a rapid onset of craving after each dose.
- Co-occurring mental health conditions such as anxiety, depression, and PTSD
- Family history of substance use disorders
- History of trauma or adverse childhood experiences
Understanding why benzodiazepines are so addictive helps de-stigmatize struggling with addiction and emphasizes the importance of relying on evidence-based treatment and not just willpower.
Benzodiazepine Withdrawal Symptoms
Benzodiazepine withdrawal is considered one of the most medically serious withdrawal syndromes.[5] While withdrawal from other substances, such as opioids, is painful but not usually fatal, benzodiazepine withdrawal can produce seizures, psychosis, and death if not treated appropriately under a physician’s care.[6] Attempting to quit benzodiazepines abruptly is very dangerous and should never be done without medical supervision.
Common symptoms of benzodiazepine withdrawal include:
- Severe anxiety and panic attacks
- Insomnia and sleep disturbances
- Tremors and muscle spasms
- Lightheadedness
- Nausea
- Irritability and agitation
- Profuse sweating and heart palpitations
- Cognitive impairment affecting memory and concentration.
- In severe cases, seizures
Timeline and severity of benzodiazepine withdrawal symptoms varies depending on the type of medication that was used (for instance, Xanax, Valium, or Klonopin), duration of use, and dosage. Some short-acting formulas, such as Xanax, may produce withdrawal symptoms immediately after the last dose due to shorter half-lives (12 to 24 hours).[7] Long-acting formulas such as Valium and Klonopin may take longer to exhibit full-symptom withdrawal.[8] Professional detox programs provide safe tapering protocols to reduce the risks and discomfort associated with benzo withdrawal.
Benzodiazepine Addiction Treatment Options
Effective benzodiazepine addiction treatment includes addressing not only the physical aspects of dependency, but the emotional and psychological elements too. What works best depends on each individual person.
Detox is usually the first and most important part of treatment to clear the body of substances and prepare for deeper recovery work. Medical staff provide constant supervision during this time, using a gradual taper until the medication can be safely discontinued. The gradual decrease in dosage is done to help minimize withdrawal symptoms, including seizures. Depending on how much you used before admission, this can take anywhere from 1 to 4 weeks. Following detox, most individuals will transition into a residential treatment program or ongoing outpatient treatment.
Benzodiazepine addiction very commonly co-occurs with mental health conditions such as anxiety, depression, and bipolar disorder. To effectively address the addiction, co-occurring disorders need to be treated at the same time. Integrated treatment models offer simultaneous treatment for both the addiction and the co-occurring disorders. If either issue is left untreated, the risk of relapse greatly increases.[9]
