Benzodiazepine Addiction: Signs, Symptoms & Treatment

Benzodiazepines are prescription medications used to treat anxiety, seizures, muscle spasm, insomnia, and to help manage alcohol withdrawal. However, if misused, a person may be at increased risk of developing an addiction to benzodiazepines.

What are Benzodiazepines?

Benzodiazepines, also referred to as benzos, are sedative medications commonly prescribed for the short-term treatment of anxiety, though they may also be used to manage certain types of seizures, muscle spasticity, insomnia, as well as acute alcohol withdrawal.1 Benzodiazepines are Schedule IV controlled substances with a known potential for abuse and dependence.

Despite having a lower DEA Scheduling than some other known drugs of abuse such as heroin and cocaine, benzodiazepines are not without their risks. Long-term use and misuse can result in dependence, withdrawal, and potentially addiction. Nonmedical misuse (for example, doses that exceed prescribed parameters, concurrent alcohol or other CNS depressant use, etc.) can result in overdose toxicity and death.

The Big Five Benzos

prescription bottle for benzodiazepine lorezapam

Several benzodiazepines are among the most commonly used prescription medications. Five of the most widely prescribed (and widely diverted for illicit misuse) benzos are:2

  • Xanax (alprazolam).
  • Valium (diazepam).
  • Ativan (lorazepam).
  • Klonopin (clonazepam).
  • Restoril (Temazepam).

The first 4 mentioned above are on the list of the top 100 most commonly prescribed medications.3 Another well-known benzodiazepine is Librium (chlordiazepoxide).

Alprazolam may have a relatively higher potential for misuse than some other benzodiazepines, and it may also be more dangerous in overdose situations. This could be because of its high potency relative to its dose/formulation, its relatively short half-life, and its risk of withdrawal phenomena.4

The diversion and misuse of benzodiazepines doesn’t stop with Xanax. Klonopin, despite its wide use for a variety of psychiatric and neurologic conditions, has also been found to be abused as a street drug.3

More About Benzodiazepines

Signs of Benzodiazepine Abuse

Medical and mental health professionals diagnose substance use disorders involving benzodiazepine use with a set of criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). To meet criteria for such a diagnosis, a person must demonstrate at least 2 of the following signs of problematic benzodiazepine use over a year-long period:5

  • Takes a larger amount of benzos over a longer period of time than they meant to.
  • Wants to control use but cannot.
  • Continually tries to get benzodiazepines, use the substance, or is recovering from using the substance.
  • Cravings or strong urges to use benzos.
  • Substance use gets in the way of duties at work, home, or school.
  • Use of benzos even if it continues creating problems with loved ones, friends, or colleagues.
  • Avoids social, occupational, or recreational activities due to benzodiazepine use.
  • Uses benzos in situations where it can be dangerous.
  • Continues taking benzodiazepines even though they know they are abusing the substance.
  • Developing a tolerance to the substance, which leads to taking more to get the desired effect.
  • Experiencing withdrawal symptoms when stopping use.

Side Effects of Benzodiazepines

Like nearly all prescription medications, even therapeutic use may be associated with certain side effects; however, the risk of side effects may be of increasing concern for those who are misusing or abusing these medications.

For example, extreme drowsiness can occur when benzodiazepines are taken in conjunction with other medications such as opioid pain medications. This can lead to severe complications such as overdose that leads to hospitalization, and even death.1

Other benzodiazepine side effects can include:6

  • Drowsiness.
  • Dizziness.
  • Motor issues, including weakness, tremors, or unsteadiness.
  • Slurred speech.
  • Memory loss.
  • Slowed breathing.
  • Drop in blood pressure.
  • Physiological dependence and associated withdrawal.
  • Overdose.
  • Death.

Benzodiazepine withdrawal symptoms are wide-ranging, and can include:4

  • Insomnia.
  • Anxiety, panic attacks.
  • Sweating.
  • Headache.
  • Racing pulse.
  • Palpitations.
  • Nausea.
  • Irritability, restlessness, agitation.
  • Perceptual distortions (e.g., hallucinations).
  • Hand tremor.
  • Seizures.

Elderly patients that are prescribed benzodiazepines or have developed a dependence to them may be at addition risk of experiencing confusion, disorientation, and delirium.4

Benzodiazepine Withdrawal Management

Benzodiazepine use can lead to the development of physiological dependence and a risk of severe and/or complicated withdrawal. Medical supervision and withdrawal management is commonly sought when a patient chooses to stop using benzodiazepines. The agreed upon approach is to taper use of the benzodiazepine down, instead of stopping using the substance abruptly.7

Tapering can take place over several weeks or even months and, in some cases, may be more easily achieved with long-acting benzos rather than short-acting ones (i.e., a longer-acting benzodiazepine may be first substituted for a shorter-acting one prior to initiating a taper). In some cases, outpatient detoxification is an appropriate approach, so long as the patient:7

  • Does not have polysubstance dependence.
  • Is committed to recovery and reliable in adhering to detox protocols.
  • Has supportive loved ones to help monitor their progress.
  • Is willing to check in in-person or over the phone with their doctor.

A gradual tapering is the key to managing benzodiazepine dependence and withdrawal, although combining such a gradual dose reduction with psychological therapy and other behavioral interventions can be additionally beneficial.4

High-risk patients, such as those with underlying medical conditions or a history of seizures, might find more success in their recovery journey by attending an inpatient, medically-managed detox program.4

Benzodiazepine Addiction Treatment

Detox, while important, is no substitute for longer-term rehabilitation efforts, which include therapy, counseling, education, skills training, aftercare planning, among other options.

These approaches to sobriety and recovery can be found at addiction treatment facilities dedicated to quality, evidence-based approaches to treatment. After detox, some may find that inpatient treatment—where they live on the grounds 24/7—is the right approach for their recovery journey. Others can work within the confines of outpatient therapy.

Recovery First Treatment Center offers a full continuum of care for benzodiazepine cessation, as well as for many other substances. Admissions Navigators are available day and night to answer your questions at 954-526-5776.

More About Treatment At Recovery First

Are benzodiazepines addictive?

Benzodiazepines can be addictive, and their potential to lead to compulsive use may increase with longer-than-recommended periods of use or other methods of nonmedical misuse.4

What are benzodiazepines used for?

Benzodiazepines are used for the short-term treatment of anxiety, muscle tension, insomnia, seizures, and to treat symptoms of alcohol withdrawal.1

How long does it take to develop dependence on benzodiazepines?

Although there is no definitive answer to this—as different benzodiazepine drugs have somewhat different pharmacologic properties—there is evidence that should benzodiazepines be used beyond the short-term (i.e., 2-4 weeks) a person may be at increased risk of developing physiological dependence and patterns of problematic use.6

Sources

  1. National Alliance on Mental Illness. (2016). Benzodiazepine-associated risks.
  2. Drug Enforcement Administration. (2019). Benzodiazepines.
  3. Longo, L.P., Johnson, B. (2000). Addiction: part 1. Benzodiazepines—side effects, abuse risk and alternative American Family Physician 1;61(7), 2121-2128.
  4. Brett, J., Murnion, B. (2015). Management of benzodiazepine misuse and dependence. Australian Prescriber 38(5), 152-155.
  5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: APA.
  6. Guina, J., Merrill, B. (2018). Benzodiazepines 1: upping the care on downers: the evidence of risks, benefits and alternatives. Journal of Clinical Medicine 7(2), 17.
  7. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. Rockville, MD: Center for Substance Abuse Treatment.