Benzodiazepines are the most commonly prescribed psychotropic medications in the country. In the past year, approximately 12.5% of U.S. adults have taken one.
Medications such as Xanax and Valium can be effective treatments for panic attacks and acute stress reactions. Doctors also prescribe more sedating benzos, such as Halcion, to treat sleep disorders.
These medications are central nervous system (CNS) depressants, which means they slow down overactive brain activity. Benzodiazepines (much like barbiturates) should never be taken on a long-term basis, due to a high risk of developing tolerance, dependence, and addiction. Even short-term use can lead to addiction in some individuals.
Benzo addiction can easily develop because of the way benzodiazepines “take the brakes off” dopamine-producing neurons. Like other addictive drugs, they cause sudden surges of dopamine in the brain’s reward center.
This creates feelings of well-being, and even euphoria at high enough doses. Excessive dopamine in the brain is usually prevented by inhibitory chemicals that restrain dopamine production when necessary; benzos weaken this influence and allow for incredible surges of the neurotransmitter. Dopamine is associated with movement, emotion, and motivation, and is a crucial part of the brain’s reward system.
While the surge of drug-induced dopamine reward is temporary, benzodiazepines can alter the brain’s reward system in lasting ways. For one, they can change the structure of the brain, causing it to function in ways that reduce your ability to experience pleasure. They also promote addiction behaviors by marking them as life-sustaining activities.
These structural changes take time to heal, even after the body has fully detoxed from the addictive chemicals. Not only does the architecture of the brain need to be rebuilt after benzo detox, but the levels of neurotransmitters in the brain also need to rise and achieve the correct balance for good cognitive and emotional functioning.
What Are the Risks of Benzodiazepine Addiction?
Benzodiazepine addiction is a growing problem in the United States, partly due to the dramatic increase in anxiety and sleep disorders seen in recent decades. While usage peaked in the mid-2010s and has been steadily decreasing since 2016, concern over benzo misuse is still high.
Many people who develop a benzo addiction were prescribed the medication to relieve anxiety, panic attacks, or insomnia, and may not even realize that they’ve become physically dependent.
Most benzo prescriptions (56%) are prescribed for anxiety, and the rest for other issues such as muscle spasms, seizures, panic disorders, depression, severe premenstrual syndrome, and insomnia.
When benzo addiction reached its height around 2016, it was because individuals had started taking higher doses of the medication. Taking larger doses of benzodiazepines naturally increases the risk of adverse reactions, addiction, and overdose. People also started mixing benzos with other substances—an extremely dangerous thing to do.
When you mix benzos with other CNS depressants, such as alcohol or opioids, the sedating effects are magnified to a lethal degree. In 2021, almost 14% of opioid-related overdose deaths also involved benzodiazepines. The danger of combining opiates with benzodiazepines is so severe that the FDA issued its strongest warning against it on September 20, 2017.
Types of Benzodiazepines
Ativan
Ativan is a brand name for the drug lorazepam. This is a short-acting benzodiazepine prescribed for insomnia, anxiety, depression-related anxiety, anxiety before surgery, alcohol withdrawal, chemotherapy-induced vomiting and nausea, and epilepsy. It has a faster onset of action than Xanax, with effects starting within 30 to 60 minutes after ingestion, and lasting for about eight hours.
Klonopin
Clonazepam, sold under the brand name Klonopin, is a short-acting benzodiazepine with an intermediate onset of action, like Xanax. It is used to treat seizures, panic disorders, anxiety, and muscle or movement disorders.
It starts working in about an hour, and while the major effects of the medication are only felt for six to eight hours after ingestion, Klonopin has a long elimination half-life. As a result, it will take between 30 to 40 hours for just half of the drug to be eliminated from the body.
Restoril
Temazepam is the generic name for the brand name drug Restoril, a sedative-hypnotic benzodiazepine that is most often prescribed to treat drug withdrawal and insomnia. It starts working in 45 minutes to an hour, and should only be taken for insomnia on nights when you have the time to stay in bed, asleep, for at least seven to eight hours.
Trying to wake up and function with the effects of Restoril still strong in your system can be very dangerous and may lead to unusual behavior and memory problems such as blackouts.
Valium
Valium is a brand name for the benzodiazepine diazepam, which has a fast onset of action, causing it to start working in half an hour to an hour after ingestion. Although most people only feel the effects for four to six hours, its long half-life will keep it in your body for a week or longer. Valium is usually used to treat muscle spasms, anxiety, alcohol withdrawal, insomnia, and seizures.
Xanax
Alprazolam is a short-acting benzodiazepine anxiolytic available under the trade name Xanax, which is primarily used to treat panic disorders and anxiety disorders, and occasionally for premenstrual syndrome, agoraphobia, and depression. Xanax has an intermediate onset of action, meaning that it starts working in about an hour. Once it’s working, a regular dose of Xanax will last for about five hours, while the extended release will last for about 11 hours.
Symptoms of Benzodiazepine Addiction
Benzodiazepine addiction can cause a range of symptoms, especially over time. Because many benzos have a long half-life, they can accumulate in the fatty tissues, leading to over-sedation.
Over-sedation can cause muscle weakness, poor coordination, slurred speech, confusion, disorientation, and impaired judgment, thinking, and memory. These cognitive impairments are some of the most troubling side effects of long-term benzo addiction.
Although some patients can take benzodiazepines without significant cognitive deficits, most experience some degree of memory issues, brain fog, and decreased productivity. Benzos can also affect your ability to judge visual and spatial relationships between objects, verbal learning, and speed of mental processing.
Although some of these cognitive deficits improve after the benzodiazepines are fully detoxed from the system, many patients do not return to optimum levels of functioning for a very long time, if ever.
Some studies have shown that benzo addiction can raise your risk of developing Alzheimer’s Disease. What is certain is that benzodiazepines slow down cognition and cause confusion, making them especially risky drugs for older patients to take.
The side effects of benzo addiction can quite closely resemble dementia in patients of all ages, but older patients are particularly vulnerable to these effects, as well as to falls and injuries that can result from muscle weakness and impaired coordination.
Signs of Benzodiazepine Withdrawal
If you try to stop using or reduce your dose, it can cause withdrawal symptoms to kick in. This can be a sign of addiction and dependence on the drug. Signs of benzodiazepine withdrawal include:
- Muscular pain and stiffness
- A headache
- Palpitations
- Nausea and dry heaves
- Difficulty concentrating
- Memory problems
- Tremor
- Panic attacks
- Anxiety and tension
- Irritability
- Insomnia and other sleep disturbances
- Psychosis
- Seizures
Is Someone You Love Abusing Benzodiazepines?
Benzodiazepines help countless people cope with anxiety and panic disorders, but they also cause harmful side effects such as fatigue, impaired coordination, cognitive problems like confusion, memory issues, difficulty learning, and confusion; respiratory depression, digestive issues, mood swings, altered vision, and more. They are also highly addictive, even when taken as directed by a doctor.
If someone you care about is regularly abusing Benzodiazepines, you may want to intervene. This is especially pertinent if they have had health problems due to their use, and are still in denial about their addiction.
Try to have an open, and honest conversation about their addiction. Listen, and keep an open mind, as many are afraid to talk about their addiction due to the stigma that surrounds it.
For help in approaching someone about their addiction, speak to a doctor or addiction treatment specialist. They can help you set up an intervention or find a local treatment center.
Treatment Options for Benzodiazepine Addiction
Medical detox in a facility that provides 24/7 monitoring and treatment is advisable for anyone attempting to detox from benzodiazepines, as there is no way to know for certain if a particular patient will experience benzodiazepine withdrawal syndrome.
Withdrawal tends to be most severe for patients who are detoxing from short-acting benzos or high doses of benzos, as well as patients who mixed their pills with other substances such as opiates or alcohol. Both the effects and withdrawal reactions of benzos are extremely variable from person to person.
Benzo Detox Program
No one should ever abruptly stop taking benzodiazepines like Xanax, Valium, or Klonopin, as this will trigger severe withdrawal reactions. Instead, patients should slowly taper their dosage under the guidance of medical professionals, gradually reaching the point where they are taking a tiny, tiny dose of their medication before stopping entirely
While you are following your tapering schedule, you should also make a plan to deal with the side effects of detox and the temptation to relapse. Exercise, meditation, and mindfulness exercises such as deep breathing can help you deal with anxiety, as well as distract from drug cravings.
Counseling—group, family, and individual—will be a great help during detox and beyond. As the medication leaves your system, you will be rewarded by clearer thinking, sharper memory, and an increased ability to engage with what you are doing and to connect with other people. This can help keep you motivated in your recovery.
Inpatient and Outpatient Treatment for Benzo Addiction
Once you have fully detoxed from your benzo addiction, it is time to move on to the next phase of your benzodiazepine addiction treatment. For some people, this will involve a 30 to 90 day stay in an inpatient rehab program, but others will move from detox to an outpatient program, which will allow them to return home to sleep at night.
Patients who shift to an outpatient program in early recovery should make sure they have a stable living arrangement at home, free from negative influences and the presence of addictive substances.
You may suffer some long-term physical and emotional symptoms, such as insomnia, anxiety, depression, mood swings, and increased appetite. These may come and go over the days, weeks, and months of your recovery from benzo addiction, lasting for a year or longer.
Aftercare
After the successful completion of addiction treatment, recovery continues through aftercare services, which may include a continuation of individual counseling and should include peer support groups, such as alumni group therapy or 12-step meetings.
It’s important to connect with other people who are also in recovery, experiencing mutual acceptance and validation, as well as the kind of insightful feedback that can only come from a person who has directly experienced addiction.
