Benzodiazepines (benzos) are highly addictive prescription drugs that can lead to physical and psychological dependence. Benzos are prone to abuse, and drug dependency can be swift and serious. While benzodiazepines can be effective when used for legitimate medical reasons on a short-term basis, they are dangerous when abused.
About Benzodiazepines
Doctors may prescribe benzodiazepines for the treatment of anxiety symptoms for a short period. Addiction organizations such as the Substance Abuse and Mental Health Services Administration (SAMHSA) warn against long-term use of benzodiazepines. Concerns about benzodiazepine misuse and dependence are prominent in the medical community because many people develop a tolerance to benzos. This tolerance can build quickly, making it easy to become benzodiazepine dependent. Dependence can lead to addiction with continued abuse.
Brief History of Benzodiazepines
Benzodiazepines were first discovered in 1955 while Chemist Leo Sternbach was working for Hoffmann-LaRoche. The company eventually sold and marketed chlordiazepoxide (Librium), the first benzodiazepine in history.
Diazepam (Valium) was discovered next in 1963. At the time, pharmacists and health care professionals felt that benzodiazepines were safer than barbiturates. Barbiturates were known to slow breathing in patients and be highly addictive. As a result, health care providers began prescribing benzos much more.
Benzodiazepines were the most popularly prescribed medications for mental health issues in the 1970s. By the 1980s, physicians and health care professionals began noticing that patients were becoming dependent on benzos. Some patients were abusing their prescriptions. This is how benzodiazepines came to become a controlled substance designated as a Schedule IV drug by the Drug Enforcement Agency (DEA). Physicians continue to raise concerns about benzos as they record their observations. While benzodiazepines were designed to be a safer alternative to barbiturates, they are also highly prone to abuse.
Commonly Prescribed Benzodiazepines
Some of the most commonly prescribed benzodiazepines include:
Clonazepam (Klonopin)
Used mostly to treat panic or anxiety disorders, Klonopin can also be used to treat epilepsy, Tourette syndrome, and restless legs syndrome. It is effective in preventing convulsions and decreasing anxiety.
Diazepam (Valium)
This drug is most often prescribed for anxiety disorders or relief from anxiety in the short term. It’s sometimes used for seasonal affective disorder (SAD). When prescribed for SAD, users typically start with a low dose and receive an evaluation one week later.
Alprazolam (Xanax)
One of the best known anti-anxiety drugs, Xanax can make you feel calmer right after taking it, but its effects can differ depending on your dosage and it’s commonly abused.
Lorazepam (Ativan)
Lorazepam is prescribed for people with symptoms of anxiety for at least four months or those who have been diagnosed with panic disorder, social anxiety disorder, or generalized anxiety disorder.
Other benzodiazepines include:
- Midazolam (Versed) – sometimes given to children before a surgical procedure
- Temazepam (Restoril) – treats insomnia
- Oxazepam – treats irritable bowel syndrome, insomnia, and symptoms of alcohol withdrawal
There are about a dozen benzodiazepines today that are prescribed for a variety of panic and anxiety-related disorders. They are sometimes used for other purposes, such as:
- Muscle spasms
- Seizures
- Situational anxiety, such as that caused by traveling on airplanes
- Calming patients before surgery
Though each benzo has a different chemical composition, they all work by influencing a chemical in the brain called gamma-aminobutyric acid (GABA). This neurotransmitter produces feelings of calmness by limiting some of your central nervous system activity.
Benzos enhance the GABA receptor, limiting brain activity that is often the culprit of panic or anxiety due to excess neurotransmitter firing in the brain. This is why benzos are sometimes used as “sleeping pills,” helping calm you down and sleep better. There are both long-acting and short-acting benzodiazepines.
Side Effects of Benzodiazepine Prescription Drugs
There are a variety of prescribed benzodiazepines. These medications don’t come without the potential for discomfort though. Using benzodiazepines can lead to the following side effects:
- Sleepiness or drowsiness during the day
- Rebound insomnia (common in short-acting benzodiazepines)
- Constipation
- Appetite changes
- Changes to libido
- Dry mouth
- Lack of coordination
- Short-term memory issues
Rebound Effects of Benzodiazepines
Long-term benzodiazepine use can cause some of the problems they were originally prescribed to address. These symptoms can come in the form of conditions like rebound insomnia or anxiety.
The following are potential rebound symptoms of benzodiazepines:
- Anxiety
- Fear of open spaces (agoraphobia)
- Inability to feel contentment (anhedonia)
- Depression
- Incoherent thoughts
Drinking alcohol when using benzos can worsen some of the adverse effects.
Signs of Benzodiazepine Addiction
Benzo abuse is defined as any use of benzos other than as prescribed by a doctor. This includes taking higher doses of benzodiazepines than instructed or for longer than prescribed. It also includes taking benzos when a doctor hasn’t prescribed them to you.
Benzos are some of the most commonly prescribed medications in the U.S., and as a result, they’re also some of the most abused. Their sedative hypnotic effects can make them attractive to people dealing with everyday stress or undiagnosed mental health disorders like anxiety. Other people may have been prescribed benzos for depression or anxiety disorders and have experienced pleasure, so they’ve taken increasing doses to achieve the same effects. When abusing benzodiazepines, people may deny they have a problem, thinking they can control their use on their own.
Benzodiazepine abuse symptoms include:
- Drug-seeking behavior like buying benzos illegally or doctor shopping for more prescriptions
- Inability to curb or stop benzodiazepine use
- Taking benzos in amounts other than doctor-prescribed therapeutic doses
- Frequent drowsiness
- Dizziness
- Blurred vision
- Combining benzos with alcohol or other drugs
- Dependence and withdrawal symptoms without benzos over a period of time
Taking benzos by themselves as prescribed by a doctor usually isn’t dangerous; however, when abused or combined with alcohol and other drugs, they can be deadly.
Self-Assessment: Am I Addicted?
Alternatives to Benzodiazepines
In response to widespread prescription drug abuse and addiction, many medical professionals look for alternatives to drugs like benzos when clinically appropriate. For instance, some studies show the following approaches to be effective alternatives to benzodiazepines, especially for long-term treatment in people with substance abuse issues:
What Is Benzodiazepine Withdrawal Like?
Benzo addiction can come with various withdrawal symptoms when you stop taking them. This is known as benzodiazepine withdrawal syndrome and may include:
- Insomnia
- Seizures
- Nausea
- Panic attacks
- Depression
- Distorted perceptions
When people addicted to benzos want to quit, they may try detoxing on their own. However, they are putting themselves at great risk since their withdrawal symptoms might be too difficult for them to handle. Withdrawal from benzodiazepines should always take place under the care of medical professionals at a detox center. They are trained to safely treat withdrawal effects due to psychological and physical dependence.
How Do You Treat Benzodiazepine Addiction?
The first step of benzodiazepine addiction treatment is detoxing. Benzo detox may involve a gradual dose reduction, also known as a taper schedule. If you have been misusing benzodiazepines, your treatment will most likely include the following:
Drug and Alcohol Dependence Assessment
A doctor or addiction specialist will document your medical history and ask questions about your use of benzos. They will assess and potentially diagnose co-occurring disorders like depression, anxiety, or post-traumatic stress disorder.
Detox and Withdrawal Management
Detox is an important first step in benzodiazepine discontinuation. Dependence on benzodiazepines forms quickly. Abrupt withdrawal from the drug is dangerous. Doing so can result in life-threatening withdrawal symptoms, such as seizures. During medical detox, a physician will gradually reduce the amount of benzos you’re taking. This can take several weeks if you have been taking benzodiazepines for a long time.
Behavioral Therapy
After detox, you’ll begin addressing the core issues that led to benzo abuse. You’ll do this through many outlets such as individual therapy, group therapy, and family therapy. You may also participate in alternative approaches like art therapy, music therapy, EMDR, or yoga.
Aftercare
Once you’ve completed a formal substance abuse treatment program, your team will work with you to develop a comprehensive aftercare plan. This plan forms the foundation of your life as you continue in recovery. Most often, it includes ongoing therapy sessions and support group meetings.
Addiction treatment has various levels of care. The one that’s right for you will depend on the severity of your addiction and what is most supportive for your life situation.
Residential Treatment
Inpatient treatment provides the most structure in addiction treatment. You live at the treatment facility with peers and attend programming during the day. Evenings typically include recovery activities like 12-step meetings, support groups, or opportunities to practice socializing in sobriety.
Partial Hospitalization Program
Partial hospitalization programs offer structured programming five days a week for six hours a day. You live at home while going to treatment. A PHP offers the life skills taught in outpatient treatment while also providing the clinical benefits of residential treatment.
Intensive Outpatient Program (IOP)
Intensive outpatient programs (IOP) are a step above basic outpatient treatment. IOP gives you the opportunity to focus on responsibilities like school or work while also attending individual or group therapy. IOP is usually offered three to five days a week for three hours a day, in both the day and evening.
Outpatient Treatment
Basic outpatient treatment is different from IOP in that it’s less frequent and there are fewer sessions. Basic outpatient offers the most freedom with programming one to three hours a week typically.
Recovery Homes
Recovery homes or sober living houses provide a safe, drug-free environment for people in addiction recovery. These settings offer you real-world opportunities to use your relapse prevention skills and strengthen your sobriety.
What Happens After Benzo Treatment?
The length of benzodiazepine treatment will depend on the severity of your addiction, co-occurring disorders, and if you’re abusing other substances. Sometimes the physical process of getting off benzos can include several weeks of tapering as well as alternative approaches to help discontinue benzodiazepines.
It’s important to have a strong relapse-prevention plan in place after treatment. This includes healthy self-care practices like exercise, eating right, and getting enough sleep, as well as recovery support like:
- 12-step groups
- Individual therapy
- Physician and psychiatrist appointments
- Your treatment center’s alumni program
- Family or couples therapy with loved ones
Does Insurance Pay for Benzodiazepine Treatment?
Most insurances are required to pay for treatment in the same way as they would cover medical care. You may need to meet a deductible or pay co-insurance or other out-of-pocket costs. The specifics will depend on your individual insurance plan. If you’re curious about what drug rehab costs your insurance will cover, call us for a free consultation. We’ll work directly with your provider to determine your benefits.
Get Help for Benzo Addiction
If you think you have a problem with benzodiazepines or you see signs your loved one has a problem, it’s important to get professional help. Our compassionate addiction medicine and behavioral health experts have helped thousands of clients get better. We can help you too. Contact Footprints today.
- https://www.samhsa.gov/data/sites/default/files/DAWN-SR192-BenzoCombos-2014/DAWN-SR192-BenzoCombos-2014.pdf
- https://pubmed.ncbi.nlm.nih.gov/24007886/
- https://www.dea.gov/sites/default/files/2020-06/Benzodiazepenes-2020_1.pdf
- https://www.health.harvard.edu/mind-and-mood/benzodiazepines_and_the_alternatives
- https://pubmed.ncbi.nlm.nih.gov/31030902/
- https://pubmed.ncbi.nlm.nih.gov/27479478/
- https://www.aafp.org/afp/2000/0401/p2121.html
- https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment/
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