What Are Benzodiazepines, and Are They Addictive?

Benzodiazepines make up a class of psychoactive drugs that physicians often prescribe as minor tranquilizers. The drugs’ chemical structure fuses a benzene and diazepine ring, creating a drug that acts on the central nervous system.

The first benzodiazepine, chlordiazepoxide, entered the pharmaceutical market in 1960. By 1977, benzodiazepines were the most prescribed drugs around the world. Currently, there are approximately 15 benzodiazepines with FDA approval for medical use.

People use benzodiazepines to treat a variety of conditions. Doctors prescribe these drugs to patients suffering from anxiety, insomnia, muscle spasms, seizures, or even alcohol withdrawal.

The drugs’ effectiveness as a sedative also makes benzodiazepines a popular choice among recreational drug users. Individuals may use these drugs to achieve a feeling of relaxation or to counteract the negative effects of other drugs.

Dealers sell benzodiazepines on the street as benzos, BZDs, tranx, or sleepers, among other names. Although benzodiazepines have been heavily prescribed for many years, evidence suggests that more and more people are using and abusing these drugs each year.

According to Reuters, benzodiazepine prescriptions have tripled, and benzodiazepine overdoses have quadrupled, over the past two decades. The rise in benzodiazepine abuse and overdose suggests that these drugs may be more addictive than physicians once believed them to be.

How Do Benzodiazepines Work?

Benzodiazepines target gamma-aminobutyric acid (GABA) receptors in the brain. GABA is a neurotransmitter that inhibits excitability in the nervous system. When a person’s GABA receptors bind with a benzodiazepine they have taken, GABA levels in the brain increase, resulting in a sedated, relaxed feeling. The increase in GABA levels also slows a person’s breathing and heartbeat, which can help prevent seizures or panic attacks in some cases.

While the effects of a benzodiazepine can be useful for people with anxiety, insomnia, or other disorders, the drug can be dangerous if someone takes too much or uses it illicitly. According to the Ochsner Journal, benzodiazepine use can contribute to physical problems, including cardiovascular and respiratory depression. Other physical side effects include:

• Drowsiness
• Dizziness
• Blurred vision
• Weakness
• Slurred speech
• Lack of coordination
• Difficulty breathing
• Coma

Benzodiazepine use can also affect a person’s brain in a negative way. The drug is particularly habit-forming; when a person uses a benzo for an extended period, their brain develops a tolerance to the drug, causing them to need more of it to produce the same effects. Not only can this behavior lead to an addiction, it can also be damaging to the body and mind.

The Journal of Clinical Psychiatry reports that long-term benzodiazepine use can cause considerable damage to a person’s cognitive ability. This damage can impair important brain functions, like visuospatial aptitude and the ability to process information.

Types of Benzodiazepines

There are three types of benzodiazepine: short-acting, intermediate-acting, and long-acting. These classifications refer to the drug’s half-life, or the time it takes to leave a person’s system.

‍Short-acting benzodiazepines‍

Short-acting benzodiazepines have a half-life of 1.5-5.5 hours. These drugs are usually used to treat short-term conditions, such as anxiety before surgery or chronic insomnia. However, short-acting benzodiazepines are not suggested for long-term use. A few examples of this benzodiazepine type are:

• Triazolam (Halcion
• Midazolam (Versed)
• Clorazepate (Tranxene)

Intermediate-acting benzodiazepines

Intermediate-acting benzodiazepines last a bit longer in the body, though it can take longer for a person to feel their effects. These drugs have a half-life of around 11 hours, which makes them more effective for a person with chronic insomnia, anxiety, or depression. Although these benzodiazepines also have the potential for tolerance and addiction, some physicians and psychiatrists prescribe these drugs to their patients for extended use. Some of these drugs include:

• Alprazolam (Xanax)
• Lorazepam (Ativan)
• Temazepam (Restoril)
• Oxazepam (Serax)
• Estazolam (ProSom)

Long-acting benzodiazepines

Long-acting benzodiazepines take much longer to affect the body, but their half-lives are incredibly long – approximately 20 hours. Like other benzodiazepines, individuals can use these drugs to treat anxiety, insomnia, and panic disorders. However, because of the potency of the drugs and the duration of their effects, these are more commonly used as muscle relaxants or anticonvulsants.

These drugs can be effective for people with epilepsy, those struggling with tremors from alcohol withdrawal, or those suffering from muscle spasms due to injuries. However, it is important to note that long-acting benzodiazepines still carry the potential for addiction. Some examples of this drug type are:

• Diazepam (Valium)
• Chlordiazepoxide (Librium)
• Flurazepam (Dalmane)
• Quazepam (Doral)
• Clonazepam (Klonopin)

Benzodiazepine Addiction

The United States Drug Enforcement Administration (DEA) has classified benzodiazepines as Schedule IV substances – drugs with acceptable medical purpose and a minimal risk of dependence or addiction.

However, many studies have concluded that benzodiazepines can be very addictive. If you, or someone you care about, are using benzodiazepines, watch for signs of a developing addiction.

According to the New England Journal of Medicine, the most common signs of addiction are frequent dose increases, cravings for the drug, and loss of control surrounding drug use.  

Individuals who decide to stop using benzodiazepine may suffer from a condition known as benzodiazepine withdrawal syndrome. Benzodiazepine withdrawal can include one or more of the following symptoms:

• Anxiety
• Irritability
• Insomnia
• Muscle pain
• Nausea
• Heart palpitations
• High blood pressure
• Tremors

According to the journal Addiction, some of the best ways to manage withdrawal are gradual dosage reduction and psychological support from an addiction specialist. Therefore, it is important to work with a doctor or visit a rehab facility should someone decide to stop their benzodiazepine use.

After going through withdrawal, an individual can begin a long-term treatment program, which will help them discover the driving points behind their addictive behavior and help them learn to cope with cravings and other lingering side effects. The specific of these programs will vary from client to client, but they generally include therapy, medication-assisted treatment (MAT), and 12-Step or peer support groups.

Overcoming Addiction

Although benzodiazepines remain popular drugs in the world of pharmaceuticals, the addictive potential of this drug class is becoming more well known. Thanks to this knowledge, more people who are struggling with physical dependence and addiction are getting help.