Benzodiazepine Addiction and Abuse

Benzodiazepines, also known as benzos, were first developed and marketing in the mid-20th century. For the past 70 years, many different types of benzos have been developed to treat a variety of conditions, including seizures, insomnia, and alcohol withdrawal. The most common use, however, is for the treatment of anxiety and anxiety-related disorders.

Benzos treat anxiety by stimulating gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits the excitability of neurons and produces a calming effect in the brain. Because benzos slow brain activity, they can also cause drowsiness, impaired coordination, dizziness, and more. While the various types of benzos work the same at their core, each different drug formula has its own variations on dosage, half-life, absorption time, and potential for abuse.

There are two primary types of benzos:

• Short-acting – These drugs reach peak effectiveness quickly, and move through a person’s system quickly. Common short-acting benzos include:
  • Xanax (Alprazolam) – Reaches peak level of effectiveness in 1-2 hours; half life of 12 hours
  • Lexotan (Bromazepam) – Reaches peak effectiveness in 1-4 hours; half life of 20 hours
  • Ativan (Lorazepam) – Reaches peak effectiveness in 1-4 hours; half life of 15 hours.
  • Rohypnol (Flunitrazepam) – Reaches peak effectiveness in 1-2 hours; half life between 18 and 26 hours.
  • Klonopin (Clonazepam) – Reaches peak effectiveness in 1-4 hours; half life of 34 hours
• Long-acting – These drugs stay in the system longer, usually a few days, depending on the dosage, and the person’s age, weight, metabolism, overall health and other factors. Common long-acting benzos are:
  • Librium (Chlordiazepoxide) – Reaches peak level of effectiveness in 1-4 hours; half life of 100 hours
  • Valium (Diazepam) – Reaches peak level of effectiveness in 1-2 hours; half life of 100 hours.

Benzos come in pill, tablet, capsule, and, less commonly, intravenous form. Generally, a doctor will prescribe benzodiazepine as a short-term treatment for anxiety. The doctor may have to adjust the dosage or the specific benzo based on effectiveness and the patient’s reaction to side effects. Common side effects of benzos include:

• Confusion
• Drowsiness
• Dizziness
• Headache
• Feelings of depression

When an individual takes benzodiazepine without a prescription, takes more than the prescribed dosage at a time, or continues taking benzos for an extended period of time, this is considered benzodiazepine abuse. The potential for abuse is lower when individuals take benzos only as prescribed. However, because the drugs alter brain chemistry, it is possible that users can form a dependence on them for the calming, pleasurable feelings they cause. Individuals who are not prescribed benzos may seek out the drugs to use recreationally for the same effects.

Because of the potential for abuse, benzos are classified by the Drug Enforcement Administration as Schedule VI controlled substances.

A number of factors can contribute to benzo abuse and addiction:

• Accessibility – The number of prescriptions for benzos doubled from 2003 to 2015, according to a study done by the Journal of the American Medical Association. Doctors are not only prescribing the drugs for anxiety disorders, but also as a treatment for insomnia and chronic pain. This rise in prescriptions means more individuals are exposed to benzos, and there are more pills available, though legitimate and illegitimate sources.
• Habit-forming – Benzos are psychoactive drugs, meaning they alter the brain chemistry. Because they produce a calming, relaxing effective, these alterations may be pleasurable. The longer an individual uses benzos, the more accustomed the brain becomes to the drug’s effects, developing a reliance on them to feel good. When an individual stops taking benzos, they can experience withdrawal symptoms like tremors, difficulty sleeping, irritability, and panic attacks.
• Tolerance – As a dependence on benzos develops, so too will a tolerance for the drug, meaning higher dosages will be necessary to produce the same effects, which can lead to abuse.
• Common uses – Even individuals who do not need prescription benzodiazepines to treat anxiety or another issue may seek out the drugs for one-off purposes like sleeping through a long flight, relieving muscle pain, or dealing with a stressful situation.

It is not always easy to identify someone who is abusing or addicted to benzos, but the following symptoms can be an indication of a problem:

Physical Abuse Symptoms

• Nausea and vomiting
• Extreme fatigue
• Insomnia
• Drowsiness
• Tremors
• Impaired coordination
• Shallow breathing
• Cold, pale skin
• Dizziness or vertigo
• Forgetfulness
• Slurred speech

Psychological Abuse Symptoms

Long-term benzo abuse can also lead to the following psychological symptoms:

• Mood swings
• Irritability
• Cloudy mental state
• Depression
• Suicidal thoughts

Behavioral Abuse Symptoms 

Addiction to benzos can also manifest in changes to the individual’s behavior and lifestyle. Common behavioral symptoms include:

• Cutting themselves off from family and friends to avoid judgement
• Financial problems related to missing work, or spending too much money on benzos
• Borrowing or stealing money to pay for drugs
• Struggling with work, school, or family responsibilities
• Visiting multiple doctors to obtain prescriptions
• Engaging in erratic or risky behavior

Long-term abuse of benzos can lead to a number of serious physical and psychological consequences, including:

• Withdrawal – When an addicted individual stops taking benzos suddenly, they can experience severe withdrawal symptoms including seizures, tremors, and muscle cramps.
• Death – Although it is rare for an individual to overdose on benzos alone, death can result from mixing benzos with alcohol or other recreational drugs. Additionally, long-term use can lead to depression and suicidal ideation.
• Damage to personal and professional life – For addicts, finding and consuming drugs becomes a full-time job, to the detriment of relationships, jobs, and other obligations. Individuals may find their personalities changing due to their drug use. Benzo abuse can also lead to decreased mental function and brain damage, which can have a negative impact on work or school.
• Legal problems – Individuals who abuse benzos can find themselves in legal trouble, whether from driving while intoxicated, stealing or committing other illegal acts to obtain drugs or money for drugs, or possessing controlled substances.
• Increased risk of dementia and Alzheimer’s disease – Some studies have shown that long-term benzo use can lead to an increased risk of dementia in the elderly population.

Generally, addiction to benzodiazepine is diagnosed by a physician, based on the patient’s habits and history. Doctor’s may use a diagnostic tool like Severity of Dependence Scale, but diagnosis still relies heavily on the patient’s honesty and transparency. In situations of overdose, you or others with you may be able to tell the doctor what you ingested. The assessment should also evaluate the severity of the abuse, and the potential for relapse.

The first step in the recovery process is usually detoxification, or detox, when the drugs begin to work their way out of the patient’s system. This can be a difficult and even dangerous process if not monitored carefully. Because benzos stimulate neurotransmitters in the brain, the brain may stop producing essential neurotransmitters, like gamma aminobutyric acid, on its own. If an individual quits benzos cold turkey, the body suddenly does not have this important acid, and can react with severe, uncomfortable symptoms. The duration of an individual’s drug use, and the amount of drugs used will also impact the severity and length of their withdrawal symptoms.

Physical withdrawal symptoms may include:

• Seizures
• Heart palpitations
• Diarrhea
• Nausea and vomiting
• Abdominal pain
• Tremors
• Impaired vision
• Difficulty sleeping
• Flu-like symptoms (sweating, full body aches, headaches)
• Dizziness or vertigo

Psychological and emotional withdrawal symptoms may include:

• Anxiety
• Depression
• Confusion
• Irritability
• Psychosis
• Memory Loss

Because of the intensity of the benzo detoxification process, it is common for patients to wean themselves off of the drug a little at a time in a detoxification center or under the care of a physician. This method involves slowly lowering the dosage of benzos, giving the patient’s body time to readjust to the absence of drugs. In some cases, a physician may prescribe other medication to assist in alleviating withdrawal symptoms, or help the brain transition off of benzos. These medications can include Buspirone, Flumazenil, and Acamprosate, but should not be taken without a doctor’s consultation.

Once the patient has detoxed and withdrawal symptoms have subsided, they can begin the addiction treatment and recovery process. There are a number of options available for treatment, including:

• Inpatient or residential rehabilitation centers
• Outpatient rehabilitation programs
• Individual mental health and addictions counseling
• Group therapy programs

Individuals should consult with their physician, counselor, and other trusted parties when deciding what type of treatment plan and facility is right for them. Often, people were prescribed benzos initially as a treatment for another disorder; there may also be other underlying issues that contributed to their addiction. These concurrent issues must be addressed to reduce the chances of relapse. The road to recovery from benzodiazepine addiction can be difficult, but individuals should not give up as they work towards a healthy, drug-free life.

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