What was at one time the most widely used prescription drug is also among the most commonly abused. Benzodiazepines are sedative-hypnotic like alcohol and barbiturates that cause relaxation and euphoria. However, users who take them for more than a few months may become dependent on them, and addiction can lead to abuse, dangerous withdrawals, and a host of adverse side effects.
What Does Benzodiazepine Addiction Treatment Involve?
Benzodiazepine addiction treatment typically will start with the critical first step of medical detoxification (detox). Benzos are one of a few addictive drugs that have the potential to cause life-threatening withdrawal symptoms. If you have developed a dependence on the drug, undergoing and completing detox is the safest way to avoid or prepare for possible delirium tremens and seizures.
Chronic benzo users who want to end their addiction are strongly advised to start the recovery process at a treatment center that offers detox as the first step. Many users will attempt to quit using the medications abruptly as they attempt to go “cold turkey.” This is a dangerous practice, and it’s one we highly discourage.
Medical detox has key benefits. Clients are monitored closely as medical professionals safely remove the benzodiazepine(s) and other addictive or harmful substances from the system. This ensures that uncomfortable and/or life-threatening withdrawal symptoms are effectively managed. Clients can rest knowing that any medical emergencies that arise during their time in detox will be managed. Also, medical treatment for benzodiazepine addiction can be administered. In many cases, it is administered to help clients:
- Gradually reduce the dosage of the benzodiazepine used; and
- Switch to another benzodiazepine to taper off the one at the center of addiction
Detox is just the beginning of one’s recovery from substance abuse. After detox, you may still have cravings that threaten your sobriety. The best relapse prevention strategy is a continuum of care. Continually pursuing recovery can help you ensure lifelong sobriety. Addiction treatment like residential and outpatient treatment can offer behavioral therapies, group therapy, and family therapy to not only show you how to deal with cravings but also to address the deeper issues that may have contributed to your addiction.
Once you’ve completed a treatment program, alumni and aftercare programs can help you safeguard your sobriety. Through 12-step programs, you can connect to a broader community of people in recovery that share your commitment to a drug-free lifestyle and can help encourage you along the way.
Benzo addiction recovery is not a quick process. It can take months or even years. Many users find it can take years to manage the post-acute withdrawal symptoms (PAWS) that remain after benzo addiction has been managed. They include:
- Anxiety
- Problems concentrating
- Energy changes
- Irritability
- Mood swings
- Sleep disturbances
People who are managing benzo-related PAWS are advised to seek help and support from a center that offers aftercare services.
What Are Benzodiazepines?
Benzodiazepines (benzos) are a category of psychoactive drugs that are widely used as medicinal sedatives. Benzodiazepines help people manage: Anxiety disorders, Panic disorders, Insomnia, Muscle relaxation, Seizures, and Severe alcohol withdrawal.
They work by enhancing the gamma-Aminobutyric acid (GABA) neurotransmitter at a particular receptor, which results in sedation and sleep-inducing effects. The neurotransmitter at play also controls muscle tone; when these medications are used, it can encourage the muscles to relax which makes the drug use as an anticonvulsant.
The relaxing and sedating effects work together to create euphoria, which plays on the brain’s reward center and contributes to possible addiction. Benzos are recommended to be used as a short-term remedy because long-term use can cause dependence, in many cases, unknowingly.
Also, these medications are not recommended for use by older adults. Despite this, benzo use seems to increase with age; the largest age demographic that uses the drug are 65 and older.
After the drug was synthesized and tested in the 1950s, benzos quickly became widely used all over the world, primarily for insomnia and other problems with sleep. However, because of the adverse effects and the risk of addiction, nonbenzodiazepine hypnotics recently have been growing in popularity.
Many people, including recreational benzo users, either do not know or understand how powerful these drugs are or what they are getting into when they use them for longer than prescribed or in a manner that is inconsistent with their purpose. Benzo misuse and abuse is an issue in the U.S., as the data show.
The 2016 National Survey on Drug Use and Health reports that an estimated 497,000 people aged 12 or older misused sedatives in 2016; also in that year, an estimated two million people aged 12 or older misused tranquilizers.
Commonly Prescribed Benzodiazepines Include:
Xanax (Alprazolam)
A fast-acting sedative that is reportedly one of the most widely prescribed and widely abused benzodiazepines on the market. Xanax slows down the central nervous system within 15 to 60 minutes and can leave people feeling drowsy and “out of it.” for a few hours.
Valium (Diazepam)
This long-acting sedative is prescribed to treat anxiety, insomnia, panic attacks, muscle spasms, and seizure disorders. It is one of the more widely used benzodiazepine medications and reportedly can lead to heroin abuse if it falls into the hands of drug users whose access to the prescription medication has been cut off.
Librium (Chlordiazepoxide)
The slow-acting benzo is used to treat people experiencing alcohol withdrawal. Its addictive properties mean it should be taken as directed. People who use it incorrectly risk overdose and death. Some people who abused alcohol have abused Librium. Addiction to two substances presents a set of unique challenges that are best handled under the supervision of an addiction specialist or medical professional.
Klonopin (Clonazepam)
This benzodiazepine is prescribed to treat anxiety and seizures. The addictive nature of Klonopin, or K-Pin for short, means it is intended for short-term use. Using it longer than prescribed is not recommended as there is a high risk of developing a dependence on it.
Ativan (Lorazepam)
Ativan users take the sedative to manage their anxiety. It, too, is prescribed for short-term treatments. It calms users by suppressing the central nervous system. Ativan should never be mixed with alcohol or other depressants. Seizure, coma, or death can all result if this practice is followed.
What Are the Signs of Benzodiazepine Addiction?
Benzodiazepines are in a class of drugs called sedative-hypnotics that are known for their high addiction risk. One of the most common signs of benzodiazepine addiction is depending on a sedative to sleep or feeling unable to cope without its effects. If you’ve tried to cut back or discontinue benzo use and had to restart because of withdrawal symptoms such as:
- Sensitivity to touch, sound, and light
- Numbness or pins and needles sensation
- Hallucinations
- Smell sensitivity
- Depression
- Tremors
- Dysphoria or feeling separated from reality
- Appetite loss
- Memory impairment
- Motor impairment
- Muscle twitching
- Nausea
- Muscle pains
- Dizziness
- The apparent movement of still objects
- Lightheadedness
Another common symptom of benzo dependence is a change in the quality of your sleep. The drug is effective in helping people fall asleep, but it’s not proven useful in helping people stay asleep. You may wake up in the middle of the night or toss and turn without falling into a healthy sleep pattern.
When you wake up, you may not feel rested, or it may take you a long time to fully wake up. People who successfully quit benzo use or abuse often report waking up feeling more refreshed than they did while on the drug.
If you use benzos recreationally, you are more likely to become addicted, and you may start experiencing some adverse effects.
The physical, psychological, or mental signs of benzodiazepine addiction include:
- Depression
- Tremors
- Dysphoria or feeling separated from reality
- Appetite loss
- Muscle twitching
- Memory impairment
- Motor impairment
- Nausea
- Muscle pains
- Dizziness
- An apparent movement of still objects
- Lightheadedness
- Sensitivity to touch, sound, and light
- Numbness or pins and needles sensation
- Hallucinations
- Smell sensitivity
There also are other ways to tell if a loved one is struggling with a benzodiazepine use disorder. Those signs include:
- High benzodiazepine tolerance, dependence
- Strong benzodiazepine cravings
- Taking benzodiazepines without a prescription
- Using benzos to get high
- Using benzodiazepines stronger doses or higher doses than prescribed
- Using them in ways inconsistent with their design
- Mixing them with other substances (ex: alcohol and opioids) for stronger effects
- Crushing up or dissolving benzos for IV injection
- Preoccupied with benzo use
- Increasing benzo doses for the same effects
- Seeking larger amounts by “doctor shopping”
- Noticeable changes in appearance, hygiene
- Change in eating habits
- Loss of coordination, slow movements, and speech
- Shaking
- Frequent sleepiness
- Lowered inhibitions
- Loss of interest in daily activities, hobbies, interests
- Isolation from family, friends, colleagues
How Dangerous Are Benzodiazepines?
Benzodiazepines are serious prescription drugs that have a high risk for abuse. People who abuse the drug are more likely to experience dangerous side effects. Like alcohol, overuse of benzos can cause blackouts and memory loss along with several other psychological effects like paranoia and anxiety. Benzos have also been shown to cause paradoxical reactions in some users. A paradoxical reaction refers to a drug effect that seems to contradict its intended use. Benzos are intended to decrease anxiety, remedy panic attacks, and relax the user. However, some users may experience behavioral disturbances, including increased irritability, hostility, and aggression.
Even benzodiazepine withdrawal can be dangerous. If you regularly abuse benzos or if you have used them for a long time (they are not recommended for use longer than a few weeks), quitting cold turkey can have some life-threatening consequences.
Seizures have been known to occur in instances of abrupt cessation of benzo use.
Seizures may not typically be deadly but if they occur when you are alone or driving, they can be.
Quitting benzos abruptly might also cause delirium tremens, a condition characterized by confusion, hallucinations, and shaking.
In a small percentage of cases, Delirium tremens can be fatal. Benzos also carry the risk of fatal overdose. In 2015, more than 9,000 people were killed by benzodiazepine overdose. By themselves, overdose rarely leads to deadly complications. However, benzos are much more likely to lead to a deadly overdose when combined with alcohol.
Chronic Health Issues From Long-Term Benzodiazepine Consumption
If you take benzodiazepines as prescribed, your doctor can help you ease off these drugs if you develop a dependence on them. However, if you take more than prescribed or abuse them for nonmedical reasons, you risk struggling with dependence and other long-term risks.
Dependence
Developing a physical dependence on drugs does not mean that you are addicted, although people who struggle with drug abuse and addiction often develop a dependence on a substance. Dependence simply means your body is used to the presence of the drug to maintain its chemical balance, especially the balance of neurotransmitters.
Compulsive behaviors and seeking a high are characteristics of drug abuse and addiction, while dependence can occur separately. The risk of dependence on benzodiazepines means you should not try to quit these medications suddenly if you have been taking them regularly or abusing them for recreational purposes. Withdrawal symptoms are a risk of physical dependence, and these can be uncomfortable and, in some instances, life-threatening.
Withdrawal
Most withdrawal symptoms from benzodiazepines are rebound symptoms, mimicking the conditions that these sedative drugs are prescribed to treat, with anxiety, panic attacks, and insomnia being the main issues. Depression, mood swings, aggression, and physical discomfort are also associated with peak withdrawal symptoms. High doses may lead to perceptual distortions, sensitivity to light or sound, and depersonalization or derealization.
However, the biggest risk to long-term benzodiazepine abuse, when quitting suddenly, is having a seizure. The structural changes to the GABA system can induce seizure disorders in people who did not have them previously, especially if the drug was abused in large doses for months or years. A survey on decades of data on benzodiazepine side effects and withdrawal reported that nearly all the seizures were grand mal seizures, and sometimes, they have been reported with less than 15 days of consistent use at a therapeutic dose.
Cognitive Decline
Having trouble with thinking and remembering has been associated with long-term benzodiazepine use, even at prescription levels, in elderly adults. There are indications that these problems may begin sooner and can impact anyone who abuses these drugs. A survey of 13 studies over several years found that each measurement consistently showed that people who took benzodiazepine drugs anywhere from one to 34 years displayed lower cognitive aptitude than control groups.
- An older study from 2005 found that long-term treatment, at therapeutic doses, with benzodiazepines led to trouble with:
- Visuospatial ability
- Mental processing speed
- Verbal learning
These issues begin quickly after benzodiazepines are administered, but they can be attributed to sedation on a short-term basis. Long-term, though, the study found that detoxing from benzodiazepines somewhat improved cognition, but brain function did not match benzodiazepine-free control groups.
A more recent study examined the association between dementia-like symptoms, especially cognitive decline, and benzodiazepine use. While the study did not find a causal link between the two, researchers noted that depression, anxiety, and insomnia are all reasons that benzodiazepines are prescribed, and in older adults, the onset of these issues may actually be early symptoms of dementia. Benzodiazepine prescriptions in older people may be treating early dementia issues, but they are not causing the problem. Still, this study was on older adults, and it did not examine the cognitive impairment associated with other age groups.
Falling
Like cognitive problems, gait issues and muscle weakness are short-term issues associated with intoxication and sedation from benzodiazepines.
Long-term, though, they have different underlying issues, including brain structure changes.
One case study of a 60-year-old woman admitted to the emergency room due to a suicide attempt reported that when benzodiazepines were metabolized out of her body and a different psychiatric medication was applied to treat her condition, suicidal ideation resolved, and her gait trouble and muscle weakness improved; however, they did not disappear.
Other studies suggest that muscle atrophy or weakness can become increasingly present and may develop into a chronic issue.
Falling may also be associated with early-stage dementia.
Why Is Quitting Cold Turkey Dangerous?
Quitting benzodiazepines cold turkey can cause your nervous system to go into overdrive. At first, this will cause something called rebound symptoms, or the return of symptoms that benzos are designed to remedy. Typically, this means you will experience anxiety, irritability, and insomnia.
Other Withdrawal Symptoms Can Include:
- Blurred Vision
- Chest pain
- Dizziness
- Dry mouth
- High blood pressure
- Fatigue
- Mood swings
- Paranoia
- Tachycardia
- Tremors
CNS depressants, like benzodiazepines, also cause a phenomenon known as kindling. Kindling is a neurological condition in which withdrawal symptoms are worsened after going through several withdrawal periods. In other words, the more you go through CNS withdrawal symptoms after relapsing, the worse your symptoms may become. Someone who has relapsed multiple time may be more likely to experience life-threatening symptoms.
The most dangerous symptom of benzodiazepine withdrawal is Delirium tremens, a severe condition characterized by sudden changes in the nervous system and your mental state. Delirium tremens can cause panic, agitation, seizures, hallucinations, and catatonia. In some cases Delirium tremens is life-threatening. Seizures and mental confusion can cause injuries to yourself or others and the changes in heart rate can cause a heart attack.
Benzodiazepine Tapering Strategies
Tapering off of a drug is the process of slowly taking less and less of the substance before you stop using completely. Doing this gives your brain time to adjust to new chemical levels, balancing out your brain chemistry as it returns to normal. However, this might be difficult to do on your own for several reasons.
It may be difficult to know the exact dose you should take or how long to wait before your next dose when tapering off. In some cases, just taking less of a drug is enough to trigger potentially dangerous withdrawal symptoms. The process is safest under medical supervision, where risks can be avoided and you can be given the proper doses by a professional. The process may also be unpleasant to go through by yourself just because of the rebounding symptoms you might feel.
While you taper off, you may feel irritable, aggressive, and you might start to suffer from anxiety and insomnia. In a medical setting, those symptoms can be treated or at least mitigated.
Finally, if your dependence on benzos has become an addiction, you may find it difficult to taper off on your own. Dependence affects your brain’s communication system but addiction affects your reward and learning centers and its effects are much deeper. According to the National Institute on Drug Abuse (NIDA), “Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.”
Addiction is usually identified by a person seeking drugs even after you’ve experienced medical, social, or psychological issues as a result. If you have become addicted to benzos, your use of the drug might be out of control and you may find it difficult to resist cravings and triggers to use.
