Benzodiazepines are highly addictive. They are prone to abuse, and dependency can form quickly with continued use. As a result, benzodiazepines are generally only prescribed for short-term use.

While benzodiazepines can be effective when used for a legitimate medical reason on a short-term basis, they are very dangerous when abused.

Benzodiazepine Overview

Anxiety is one of the most discussed mental health issues in the United States today. In May 2018, TIME magazine reported that up to 18 percent of Americans have an anxiety disorder. This adds up to about 40 million people.

For those who deal with a diagnosis of anxiety, benzodiazepines (BZDs) can be very helpful if used as recommended. The Substance Abuse and Mental Health Services Administration (SAMHSA) says that these medications should only be used in the short term as a stabilizing mechanism for anxiety and related disorders.

Concerns about addiction have been brought up over the years because most people develop a tolerance to benzodiazepines. This tolerance can build quickly, making it easy to become dependent on them. Dependence can then progress to addiction with continued abuse.

Benzodiazepines are scheduled drugs, which means you cannot take them unless you have received a prescription.

Commonly Prescribed Benzodiazepines

Below is a list of the most commonly prescribed benzodiazepines and what they are used for.

• 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 is sometimes used for seasonal affective disorder (SAD). When used for this purpose, it is recommended that users start with a low dose and receive an evaluation one week later.
• Alprazolam (Xanax): This is one of the best known anti-anxiety medications today. Xanax can make you feel calmer right after taking it, but its effects can differ depending on your dosage.
• Lorazepam (Ativan): This medication is prescribed to people who have been feeling 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), which is often given to children before a surgical procedure.
• Temazepam (Restoril), which treats insomnia.
• Oxazepam, which is effective in treating irritable bowel syndrome, insomnia, and symptoms of alcohol withdrawal.

Harvard Medical School reports that about a dozen benzodiazepines exist today that can be prescribed for a variety of panic and anxiety-related disorders. They are sometimes used for other purposes, such as to address muscle spasms, seizures, or anxiety, such as that caused by traveling on airplanes. They are also used to calm patients before surgery.

Though their formulations are different, benzodiazepines work by influencing a chemical in the brain called gamma-aminobutyric acid (GABA). Some benzodiazepines stay in the body longer than others.

Overall, benzos enhance GABA’s effects, limiting brain activity that is often the culprit of panic or anxiety due to excess neurotransmitter firing in the brain. This is how benzodiazepines calm you down and promote better sleep.

History of Benzodiazepines in Treatment

In a 2013 paper, the Consultant Pharmacist explained that benzodiazepines were first discovered in 1955. Chemist Leo Sternbach was working for Hoffmann-LaRoche and the company eventually sold and marketed chlordiazepoxide (Librium), the first benzodiazepine in history.

Valium was discovered next in 1963. Pharmacists and health care professionals felt that benzodiazepines were safer than barbiturates. Barbiturates were known to slow breathing in patients and be highly addictive. Health care providers began prescribing benzos much more as a result.

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 scheduled drugs. Physicians continue to raise concerns about them as they record their observations.

While benzodiazepines were designed to be a safer alternative to barbiturates, they are also highly prone to abuse.

Side Effects

There are a variety of benzodiazepines available. They all can lead to the following side effects:

• Sleepiness or drowsiness during the day
• Rebound insomnia (common in short-acting medications)
• Constipation
• Changes in appetite
• Changes to libido
• Dry mouth
• Lack of coordination
• Short-term memory issues

In the long term or at higher doses, benzodiazepines are known to cause some of the problems they were prescribed to address. The following are potential rebound symptoms:

• Anxiety
• Fear of open spaces (agoraphobia)
• Inability to feel contentment (anhedonia)
• Depression
• Incoherent thoughts

You should not drink alcohol when using benzos, as it can worsen some of these side effects. SAMHSA says that benzodiazepines can cause dependency with six weeks of continued use.

Who Misuses Benzodiazepines?

The American Psychiatric Association (APA) defines misuse of benzodiazepines as any use of the medication in a way a doctor did not direct. This includes taking the medication in higher doses than instructed or for longer than prescribed.

Per APA, in 2018, young adults between the ages of 18 and 25 were most likely to misuse benzodiazepines. APA also says that 12.6 percent of adults, or one out of every eight people, took benzos in 2018. Misuse of these medications adds up to 17 percent of total use.

• Women are more likely than men to have a prescription for a benzodiazepine.
• Men are more likely than women to report misusing benzos.

The following are common reasons for misuse of these medications:

• To assist with sleep
• To relax
• To relieve tension

People who reported misuse stated that their source of the drug was a friend or family member with a legitimate prescription.

The National Institute on Drug Abuse (NIDA) reports these findings:

• Between 1996 and 2013, the number of adults who received a prescription for benzodiazepines went from 8.1 million to 13.5 million, increasing 67 percent.
• In 2015, nearly a quarter of fatalities due to opioid overdoses also implicated a benzodiazepine in toxicity screenings.

Is Treatment Available for Benzodiazepine Misuse?

UCLA’s Semel Institute for Neuroscience and Human Behavior says that physicians use criteria from the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) to assess addiction to benzodiazepines and other drugs. Some signs they look for are:

• Tolerance to the medications.
• Inability to stop use even with their best efforts.
• Withdrawal symptoms when not taking benzodiazepines.

If you have been misusing benzodiazepines, your treatment will most likely include these components:

• Intake: 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 medical or mental health conditions that need to be addressed.
• Detox and withdrawal management: Detox is not equivalent to treatment, but it is an important first step when addressing benzodiazepine addiction.Dependence on benzodiazepines forms quickly, and it is dangerous to stop taking these drugs suddenly. Doing so can result in life-threatening withdrawal symptoms, such as seizures.Generally, a tapered approach is used for benzo withdrawal. You will most likely slowly decrease the amount of benzos you are taking while under medical supervision. This can take many months if you have been taking benzodiazepines for a long time.
• Therapy: This is where you address the core issues that led to your abuse of benzodiazepines. Therapy comes in many forms, such as individual therapy, group therapy, and family therapy. Alternative therapies, such as art therapy or equine-assisted therapy, may also be used.
• Aftercare: Once you have completed a formal addiction treatment program, your team will work with you to develop a comprehensive aftercare plan. This plan forms the basis of your life as you continue in recovery. Most often, it includes ongoing therapy sessions and support group meetings.

The Bottom Line

Addiction is a major concern with abuse of benzodiazepines.

These drugs should only be used according to prescription instructions by the person who is prescribed them. Anyone not prescribed them cannot take them legally. Any abuse can rapidly lead to dependence.