Benzodiazepines are a class of prescription drugs marketed to ease anxiety and insomnia, act as muscle relaxers, and manage seizure disorders. Also known by the terms benzos and downers, these drugs depress the body’s stress response by lowering anxiety and tension, enhancing moods, dropping body temperature, and slowing heart rate and blood pressure. Benzodiazepine drugs increase the presence of GABA (gamma-aminobutyric acid) in the brain, which is one of the brain’s chemical messengers that acts like a tranquilizer.
The Drug Enforcement Administration (DEA) publishes that Valium (diazepam), Xanax (alprazolam), Klonopin (clonazepam), Halcion (triazolam), and Ativan (lorazepam) are the most common benzodiazepine drugs in the United States. Benzodiazepines are some of the most frequently prescribed psychotherapeutic drugs, as Reuters publishes that 13.5 million benzodiazepine prescriptions were filled in 2013 in the US.
These drugs may be commonly diverted and abused. The National Survey on Drug Use and Health (NSDUH) reports that in 2013 nearly 2 million Americans who were at least 12 years old reported current abuse of psychotherapeutic tranquilizers or sedative drugs. Benzodiazepines may be abused recreationally to get “high,” as they enhance the level of dopamine, a mood-altering chemical in the brain. They may also be abused as a form of self-medication to ease stress, anxiety, or tension, or to act as sleep aid.
Nonmedical use of a benzodiazepine can be harmful in the long run, however. Long-term use of a benzo can cause addiction, a disease affecting the chemical makeup and circuitry of the brain. In 2008, over 60,000 Americans were being treated for benzodiazepine abuse in an addiction treatment program, per the Treatment Episode Data Set (TEDS). Addiction involving a benzodiazepine drug is optimally treated with a combination of pharmacological and therapeutic methods by highly trained professionals in a specialized facility.
Profile of Benzodiazepine Use and Abuse
In terms of medical use of a benzodiazepine drug, in 2008, over 5 percent of Americans between the ages of 18 and 80 were taking one. Women’s rates of use were double those of men, and use increased with age, the journal JAMA Psychiatry publishes. One in 10 women between the ages of 65 and 80 took a benzodiazepine drug in 2008, and one in every three who took them had long-term prescriptions for these drugs, the National Institute of Mental Health (NIMH) reports.
When someone uses a benzodiazepine drug without a necessary and legitimate prescription, this is considered drug abuse. Nonmedical use of prescription psychotherapeutic drugs was highest among those between the ages of 18 and 25 in 2014, the NSDUH publishes.
It is especially dangerous for older individuals to take benzodiazepines, as these drugs impair mobility, cognition, driving abilities, and can raise the risk of falls and related injuries. Benzodiazepine use by the elderly may increase the risk for developing Alzheimer’s disease, especially in those taking these medications on a long-term basis, the journal BMJ publishes. Benzodiazepine drugs are generally designed for short-term relief of symptoms and not meant to be taken for long periods of time.
Long-term use can cause a person to become tolerant to the drug and require higher doses for it to be effective. Increasing dosage and taking benzos regularly for a length of time can cause drug dependence to form, as brain chemistry is disrupted and some of these changes become more fixed. It can become difficult for a person to feel pleasure, sleep normally, or feel balanced without the drug once physical dependence occurs. Sections of the brain involved in learning, memory, motivation, decision-making, and willpower are impacted, making it difficult to stop taking benzodiazepines. Withdrawal symptoms may occur if drug use is stopped. The US Food and Drug Administration (FDA) warns that taking Xanax for longer than 12 weeks and in amounts greater than 4 mg per day can lead to dependence,.
Signs of Benzo Abuse and Spotting Addiction
Benzodiazepine abuse may start out with legitimate use and then devolve. Someone may try and exaggerate symptoms to get a prescription, or go to more than one doctor to obtain multiple prescriptions, called “doctor shopping.” Forged prescriptions, pharmacy theft, and getting pills from friends and loved ones are further methods of benzo diversion for abuse.
When someone is abusing a benzodiazepine drug, they may take more than the intended dose at one time or alter the tablets or capsules (e.g., crush them) to snort, smoke, or inject the drugs. Empty pill bottles or pills in easy-to-reach locations may be signs of abuse as may financial strife, caused by attempting to purchase more of these drugs through illicit means. Legal troubles may result as well.
Benzodiazepine drugs are often taken in combination with alcohol or other drugs, exacerbating the side effects and leading to more pronounced mood swings, bizarre behavior, a short temper, decreased motor skills and coordination, memory lapses, difficulties thinking straight or making sound decisions, and increased risk-taking behaviors. Someone under the influence of a benzo may appear to be drunk and slur their words, fall down, have sluggish movements and decreased reaction times, and be more social. Inhibitions are lowered due to benzo abuse, potentially leading someone to participate in activities they may not have even considered before. Questionable sexual encounters may be typical while intoxicated.
With regular use, drug dependence, cravings, and difficult withdrawal symptoms may cause someone to lose their ability to control their benzo use. Depression, anxiety, insomnia, tremors, sweats, racing heart rate, high blood pressure, chest pain, nausea, aches and pains, and even seizures may accompany benzo withdrawal. When brain circuitry is altered from chronic drug abuse and an individual can no longer stop taking benzos, addiction may be the result. Addiction is a brain disease, as it impacts the parts of the brain involved in reward processing, willpower, and decision-making abilities.
Further Reading
What Are Benzodiazepines, and Are They Addictive?
What are the Risks of Long-term Use of Benzodiazepines?
Lorazepam: How Does the Drug Affect the Body?
How Does Diazepam Affect the Body, and What Are the Risks of Use?
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Individuals suffering from an addiction involving a benzodiazepine drug are generally unable to regulate the amount of drugs that they take in a sitting and how often they take them. Thoughts may be dominated by determining where the next dose is coming from, taking the drugs, and then recovering from them. Changes in sleeping and eating patterns, and a decline in physical appearance and personal hygiene may occur. Individuals battling an addiction involving a benzo may be less likely to keep up with schoolwork, production at work, and normal everyday obligations. Family and home life may suffer as a result. Interpersonal relationships may become strained, as addiction often breeds social isolation and withdrawal. Self-esteem may decline, and shame, guilt, and trouble regulating moods and subsequently behaviors may be typical.
Over 350,000 people in the United States received emergency medical treatment in an emergency department (ED) for the misuse of a benzodiazepine drug in 2011, the Drug Abuse Warning Network (DAWN) reports. Benzo abuse can lead to hypertension and an irregular heart rate, and possibly increase the risk for stroke and other cardiovascular complications when used for a long time. Since benzodiazepines act on the central nervous system, slowing down many of its autonomic functions, long-term use can be detrimental to the body. Benzodiazepine use may increase the risk for developing cancer, especially brain, lung, and colorectal cancers, the journal Medicine warns. Certain benzos, like clonazepam, may heighten cancer risk more than others. Long-term benzodiazepine drugs may cause brain damage, leading to memory and cognitive difficulties, Psychology Today publishes.
Long-term benzo use also increases the odds for an overdose, which occurs when levels of the drug reach toxic amounts in the bloodstream. The National Institute on Drug Abuse (NIDA) publishes that in 2014 around 8,000 people died from a benzodiazepine overdose. The journal Drug and Alcohol Dependence reports that between 71 and 98 percent of fatal overdoses involve more than one class of drug. Benzos are commonly mixed with drugs like opioid painkillers, or alcohol, often with disastrous results.
A benzodiazepine overdose causes many life-sustaining functions to slow down or stop altogether. Breathing may become labored, pulse can weaken, and body temperature may decline. Bluish lips, skin, or nails; cold and clammy skin; slow heart rate and low blood pressure; shallow breathing; drowsiness; confusion; blurred vision; dizziness; muscle weakness; and lack of motor control are all signs of a benzodiazepine overdose. An overdose should be considered a medical emergency and may be reversed with quick professional action.
When someone suffers from a chemical dependence on a benzodiazepine drug and when that drug suddenly stops being active in the system, the central nervous system functions, which had been repressed by the drug, rebound. All the emotional symptoms the drug has been regulating may come back with a vengeance. Aggression, hostility, violent outbursts, and suicidal ideations may be common during this time.
Physically, benzodiazepine withdrawal can be hazardous, as seizures may be life-threatening. Benzodiazepine drugs should therefore not be stopped “cold turkey” or without medical help. Medical detox is the optimal course of action. Medical detox is performed in a safe facility with around-the-clock supervision and care.
Benzodiazepines may be slowly tapered off during detox, which means that the dosage slowly is lowered over a safe period of time. Longer-acting benzos like Librium (chlordiazepoxide) may be used to replace shorter-acting ones such as Xanax. Other medications may be introduced during medical detox as well to regulate some of the symptoms of benzo withdrawal. Comprehensive treatment should always follow detox.
Treatment modalities for an addiction involving benzodiazepines typically take one of two main forms: residential treatment or outpatient treatment. With residential treatment, individuals stay onsite in a specialized facility for a period of time, allowing the brain time to heal while attending therapy, counseling, educational, life skills training, and support group sessions and meetings. Outpatient treatment models may include these options as well in a structured and intensive daily program wherein the individual returns home to sleep at night. NIDA recommends no fewer than 90 days in a treatment program for drug addiction care.
Behavioral therapies, such as Cognitive Behavioral Therapy (CBT), instill healthy habits and help to positively modify self-destructive thoughts. Stress management and coping skills are taught in group therapy sessions, which are reinforced during individual sessions. CBT can create new and effective pathways in the brain that may have been damaged by drug abuse.
Anxiety and depression are common during benzo withdrawal, and the Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that nearly 8 million people suffer from concurrent addiction and mental health disorders. When two disorders, such as anxiety and addiction involving a benzodiazepine drug, co-occur, specialized treatment that addresses both disorders in a seamless, simultaneous, and integrated fashion is ideal. In this manner, both medical and mental health professionals, as well as those trained in addiction treatment, can work together to help the individual recover from co-occurring disorders.
he Road to Recovery
Benzodiazepine drugs may be helpful in treating panic and anxiety disorders, insomnia, muscle tension, and seizures when used as directed for a short period of time. When these drugs are abused, or used on a long-term basis, risks and potential health concerns increase. These problems may include:
- Drug tolerance and dependence
- Significant withdrawal symptoms
- Risk for developing dementia
- Short-term memory loss and potential brain damage
- Increased risk for cancer
- Cardiovascular issues
- Overdose and death
- Addiction
Treatment for an addiction involving a benzodiazepine should be comprehensive and individualized. Generally speaking, a combination of medical and therapeutic techniques is ideal. Healthy eating and sleeping habits can also go a long way in keeping stress levels down and helping to promote long-term healing. Supportive care offered by both families and trained professionals is beneficial during recovery. Addiction is a brain disease that can be put into remission with careful care and attention provided in a specialized treatment center.