Benzodiazepine Addiction and Treatment
What are Benzodiazepines?
According to Harvard Medical School, benzodiazepines belong to the prescription sedative or tranquilizer class of drugs, and doctors most commonly prescribe them to treat insomnia and anxiety. They are considered to be safer and more effective than barbiturate drugs for treating these conditions.1
Benzodiazepines work by increasing the activity of a brain chemical called GABA, which slows down the brain and nervous system, so the person using them feels more relaxed.1 While these drugs can be effective for treating anxiety, they can be abused and lead to addiction.
Because people can illegally abuse benzodiazepines, some users have developed street names to make it easier to hide their use. According to the DEA, common street names for these drugs are as follows:2
Types of Benzodiazepines
There are multiple types of benzodiazepines. According to the DEA, the most commonly prescribed are Xanax, Ativan, Klonopin, Valium, and Restoril.2
As of 2017, Xanax was the most commonly abused benzodiazepine drug, with 42,190 Xanax-positive cases in forensic labs. During the same year, there were 9,863 Klonopin cases, 3,878 Valium cases, and 2,027 Ativan cases.2
Controlled Substances Act Schedule
The Drug Enforcement Administration (DEA) labels benzodiazepines as Schedule IV controlled substances, which indicates that the government has determined these drugs have a low potential for abuse and dependence.3 This classification is likely accurate, as the National Institute on Drug Abuse (NIDA) has reported that research shows few people abuse these medications. In fact, 12.5% of U.S. adults use benzodiazepines, but only 2.1% of the total population misuses them, and 0.2% meet the criteria for a clinical addiction, called a benzodiazepine use disorder. Among people who use benzodiazepines, 17.1% abuse them, and 2% have benzodiazepine use disorders.4
Why People Use Benzodiazepines
While the overall potential for addiction seems relatively low among both the general population and benzodiazepine users, and these medications are generally safe when used as prescribed by a doctor, there is still a potential for some people to abuse these drugs. Among people who abuse benzodiazepines, 46.3% state that their primary reason for doing so is to relax or relieve tension, 22.4% indicate that they misuse the drugs to improve sleep and 11.8% report that they abuse the drugs to “get high” or due to “being hooked” on them. An additional 5.7% state that their main reason for abusing benzodiazepines is to experiment.4
Combining Drugs Can Be Dangerous
Abusing benzodiazepines can be unsafe. For example, people who combine opiate use with benzodiazepine use may be at a higher risk of fatal overdose, because both types of medication suppress breathing. In 2015, 23% of people who suffered a fatal opiate overdose also had benzodiazepines in their systems at the time of death.5 So, while benzodiazepines are generally safe when used under the care of a doctor, the risk of overdose is still present, especially when these drugs are combined with opiates. This risk is especially high among people who are using the drugs illegally without a doctor monitoring their use and providing important safety information.
Effects of Benzodiazepines
In addition to their intended effects of relaxing the body to relieve anxiety and promote sleep, benzodiazepines have various short-term side effects. These include:
Slowed reaction time
There are some negative short-term consequences of benzodiazepine use. Over the long term these drugs can result in dependence or addiction, which means people may experience withdrawal symptoms when they stop using benzodiazepines.
A person who becomes addicted and abruptly stops using may notice unpleasant withdrawal side effects, including:
The severity of withdrawal depends on the dosage and type of benzodiazepine taken. Unfortunately, some people may develop dependence and experience withdrawal even when they take the dose prescribed by a doctor and use the medication appropriately.
In addition, long-term benzodiazepine use can have a lasting negative effect on cognitive functions like memory. In fact, a review of research published in a 2004 edition of the Archives of Clinical Neuropsychology found that people who had a history of using benzodiazepines had worse mental functioning than those who had never used them. Long-term benzodiazepine users have been found to continue to display deficits in mental functioning even 6 months after stopping the use of these drugs.6
Can Benzodiazepines Cause an Overdose?
As noted previously, benzodiazepine overdose is possible, and the risk is higher when these drugs are combined with opiates. Mixing benzodiazepines with alcohol can also lead to an overdose. According to experts, older adults are at increased risk of overdose. Taking large doses of benzodiazepines can also lead to overdose symptoms like coma and respiratory depression. Additional signs of overdose include amnesia and excessive sedation.7
Experts report that it is unlikely that a person will experience a fatal overdose from benzodiazepines alone. Often, overdose occurs in combination with alcohol or opiates. Those who do suffer an overdose may require breathing assistance to treat respiratory depression. The medication flumazenil can also be used to undo the effects of a benzodiazepine overdose.7
Misconceptions about Benzodiazepines
Not the Only Treatment for Anxiety
There are some misconceptions surrounding benzodiazepine drugs. One such misconception is the belief that these medications are the only available treatment for anxiety. Benzodiazepines are popular, with about 5.6% of the population filling prescriptions for this type of medication, but there are other options for treating anxiety, including non-pharmacological treatments.8
For instance, some people with anxiety benefit from a specific form of counseling called cognitive-behavioral therapy, which teaches them to overcome anxiety-provoking thoughts and replace them with healthier ways of thinking. In addition, medications other than benzodiazepines can treat anxiety. For example, selective serotonin reuptake inhibitor (SSRI) medications used to treat depression are also useful for some people with anxiety, and a non-benzodiazepine drug called buspirone can treat anxiety symptoms without significant side effects.
Legal Prescriptions Can Still be Abused
There is also a misconception that it is safe to abuse benzodiazepines since they are medications. In reality, it can be dangerous to abuse them. Teens and college students who use benzodiazepines in combination with alcohol may not realize that they are putting themselves at risk of overdose. Unfortunately, overdose rates have increased in recent years. According to an April 2016 report in the American Journal of Public Health, the fatal overdose rate for benzodiazepines was then at about 3 per 100,000 people, up from .58 people per 100,000 in 1996.8
Not Everyone on Benzodiazepines is Abusing Them
Some people believe that everyone who takes benzodiazepines is abusing them, and this is not the case either. There are people who take these drugs under the care of a doctor and use them exactly as prescribed without suffering significant negative side effects or becoming addicted. For some people, benzodiazepines are the most effective medication for treating significant anxiety or sleep issues. Consultation with a doctor can help a patient to weigh the risks and benefits of benzodiazepine use and determine if this is an appropriate treatment option in their particular case.
Treatment Options for Benzodiazepine Addiction
While not all benzodiazepine users become addicted, there is still a possibility that some people will abuse these drugs and develop an addiction. If this happens, treatment is necessary. Since long-term use can cause withdrawal symptoms when people discontinue their use, it may be required to begin treatment with a detox program.
What is the Best Way to Detox?
According to the New England Journal of Medicine, researchers agree that the best way to detox from benzodiazepines is to decrease use over time slowly. Some patients can be treated on an outpatient basis, but those who were taking high doses may need to undergo detox and withdrawal in a hospital setting. During the withdrawal process, people may be treated with antidepressants or mood stabilizers to address sleep issues and underlying psychological problems.9
Counseling After Detox
Once a patient is physically stable after withdrawing, treatment for benzodiazepine addiction involves psychological services, such as cognitive-behavioral therapy. In therapy, people can learn to overcome not only the benzodiazepine addiction but also underlying conditions like anxiety that contributed to the benzodiazepine dependence. A doctor or addiction professional may provide people with education about benzodiazepine abuse and teach them ways to manage anxiety and sleep issues without this medication.9
Recover from Benzodiazepine Addiction
A person who has been taking benzodiazepines and feels dependent upon them and unable to stop using them may have developed an addiction that requires treatment. Other signs of a clinical benzodiazepine addiction include struggling to fulfill duties at work or home because of benzodiazepine use or continuing to use despite health problems arising from using the drug. If someone is struggling with benzodiazepine abuse and would like to stop using, there is treatment available, whether or not they have a prescription for these drugs.