Benzodiazepine Addiction

By Team RehabAid

Last Updated March 22, 2024

Addiction

Millions of Americans struggle with mental health conditions such as anxiety and panic disorders. Therefore, it is no surprise that drugs such as benzodiazepines are widely prescribed, as they are designed to promote calmness, sedation, and relaxation.

However, while benzodiazepines can provide immediate relief for tension and anxiety, the problem with these medications is that they are highly addictive. Due to their strong sedative effects and widespread availability, benzodiazepines are ripe for abuse.

However, treatment is available for individuals who find themselves addicted to benzodiazepines. Before going into the treatment methods that are available for this type of addiction, this article will provide an outline of what benzodiazepines are, as well as their long-term effects.

What Are Benzodiazepines?

Benzodiazepines — known as benzos — are a class of psychoactive medications that primarily treat anxiety and panic disorders through their action on the brain and central nervous system. However, they also serve multiple other purposes, and can be prescribed as muscle relaxants, anti-nauseants, and anti-convulsants. This makes them useful for other symptoms, such as seizures, insomnia, and vomiting.

Other uses for benzos include:

• Anxiety
• Nervousness
• Panic disorders
• Muscle spasms
• Seizures
• Sleeplessness
• Alcohol withdrawal
• Status epilepticus (a life-threatening disorder of the brain)
• Premenstrual syndrome

Benzos work by acting on the gamma-aminobutyric acid (GABA) system in the brain and controlling the neurotransmitters that contribute to anxiety and stress. This results in a general sense of calm and relaxation within the individual taking it.

Benzos are also usually categorized by their rates of action. These are grouped as:

• Ultra-short acting
• Short-acting
• Long-acting

Examples of Benzodiazepines

There are roughly 15 FDA-approved benzodiazepines on the market today. Below are the most common:

Halcion

Halcion is an ultra-short-acting benzodiazepine derivative, and it is primarily used to treat insomnia. Known generically as triazolam, this drug helps a person fall asleep faster and stay asleep longer. Along with its use as a sleeping aid, Halcion also has anticonvulsant, anxiolytic, and muscle relaxant properties.

Xanax

Xanax is the brand name for alprazolam, a powerful and short-acting benzo that is used to treat anxiety disorders, panic attacks, insomnia, and vomiting during chemotherapy. As one of the most prescribed psychiatric drugs in the U.S., Xanax is highly addictive and is considered a Schedule IV Controlled Substance.

Ativan

Ativan is a powerful short-acting benzodiazepine that is used to treat anxiety disorders, panic attacks, seizures, and insomnia. It can also be used as a muscle relaxant, an anesthetic, an anti-nauseant, and as an aid to withdraw from alcohol or other substances. The main active ingredient is lorazepam, but it is sold largely under the brand name, Ativan.

Valium

Valium is the brand name for diazepam, a well-known long-acting benzo that is used to treat anxiety, alcohol withdrawal, and seizures. It can also act as a muscle relaxant for restless leg syndrome and sedation purposes before medical procedures.

Klonopin

Klonopin — generically known as clonazepam — is a long-acting benzo that is used to treat seizures, anxiety, and panic disorders. It is also used to treat a movement disorder known as akathisia. Known as an anti-convulsant and anti-epileptic drug, Klonopin works by calming the nerves and brain. It is also commonly used as a recreational drug.

Librium

Librium is the brand name for chlordiazepoxide, a long-acting hypnotic benzodiazepine that is used to treat insomnia, anxiety, and withdrawal from alcohol or drugs. It is also sometimes used to calm patients who are anxious or fearful before surgery or medical procedures.

Why Are Benzodiazepine Use Rates so High?

While prescriptions of other drugs like opioids have been slowly declining over the years, benzodiazepine prescriptions have continued to rise. In fact, it is estimated that between 1996 and 2013 benzo prescriptions rose by over 67% (from 8.1 million to 13.5 million).

One of the main reasons for this increase is the concurrent rise in sleep issues and anxiety conditions. According to the Anxiety and Depression Association of America (ADAA), 40 million Americans (roughly 18% of the population) suffer from an anxiety-related condition. In addition, the National Institutes of Health reports that 30% of the general U.S. population suffers from insomnia or some form of sleep disorder.

These statistics point to the ways that physical and mental health issues are prompting high rates of prescriptions for benzos. The problem with these high rates of prescriptions is that it normalizes the behavior, leading individuals to erroneously assume that they’re safe to use.

How Are Benzodiazepines Abused?

Benzodiazepines are commonly abused medications. Not only are they widely available, but people often take them in excess or for longer periods than prescribed. Some individuals also take them recreationally to get high. Overdoses from benzos are also common, especially if they are taken in high doses and/or mixed with drugs and alcohol. The sedating quality of benzos, their widespread availability, and their addictive qualities make them a prime candidate for abuse.

Benzodiazepines have also been abused as a “date rape” drug because of their sedating effects and because they can greatly impair (or even inhibit) a person’s ability to resist unwanted advances. The drug is often planted into alcoholic drinks in a powder or liquid form that is difficult to taste. Luckily, the detection and conviction of people abusing benzos for these purposes has risen dramatically in recent years.

Are Benzodiazepines Addictive?

Yes, benzos are addictive in a few ways. First, the body can easily develop a tolerance to these drugs, which means that a person needs to take higher doses to achieve the same effect. Second, this increased tolerance leads to intense drug cravings if the benzos are discontinued. It is this cycle of tolerance and cravings that creates an addiction loop that can be difficult to break without proper treatment and intervention.

Also, repetitive drug use can change the reward and motivation pathways in the brain. This can lead to drug-seeking behavior, cravings, and withdrawal symptoms. People who regularly use benzodiazepines can then find themselves spending most of their time thinking about, obtaining, and using these medications.

Benzos are also addictive for emotional and psychological reasons. Many people take these drugs to ease anxiety, panic attacks, and to improve their sleep. The thought of re-experiencing anxiety or panic can cause people to form a psychological attachment to these drugs. This is where therapy can be effective for helping individuals wean off the drug while dealing with the underlying causes of their addiction.

Statistical Overview of Prevalence of Abuse

• Below are some statistics surrounding benzodiazepine abuse in the U.S.:
• According to the National Institute on Drug Abuse (NIDA), over 30.5 million adults (12.5% of the population) used benzos between 2015-2016.
• Between 2014-2016, over 66 million prescriptions were written for benzodiazepine prescriptions.
• In 2018, the Centers for Disease Control and Prevention reported that benzo overdoses were 8 times higher than they were in 1999.
• The American Psychological Association (APA) report on benzodiazepines indicates that 11% to 15% of U.S. adults have taken a benzo one or more times during the preceding year. Of those, 1% to 2% have taken benzos daily for 12 months or more.
• According to the U.S. National Institute on Drug Abuse (NIDA), 73% of heroin users in 1988 were said to have used benzos multiple times a week for more than a year.
• Xanax is the most prescribed psychiatric medication in the U.S., with over 20 million prescriptions written in a given year.

The History of Benzodiazepines

Benzodiazepines first hit the commercial market in 1960, during the emergence of modern psychopharmacology. Originally discovered by a Polish American chemist named Leo Sternbach, benzos were hailed for their relaxing, sedative, and anticonvulsant properties. It wasn’t long before benzos were being prescribed by psychiatrists for a variety of mental health conditions such as anxiety, insomnia, and alcohol withdrawal.

Benzos were considered a miracle drug when they were first introduced in the 1960s. The Rolling Stones even satirized benzos in their 1966 song, “Mother’s Little Helper.” This kind of integration into mainstream culture helped normalize their use.

However, by 1975, doctors acknowledged that benzodiazepines were highly addictive. They were soon classed as a controlled substance by the Food and Drug Administration (FDA), and it was recommended that benzos only be used for two to four weeks to prevent physical dependence and addiction.

Physical and Neurological Effects of Benzodiazepines

Benzodiazepines can be short- or long-acting, which can influence their physical and neurological effects. Some of the most common effects are:

• Slurred speech
• Impaired coordination
• Lightheadedness
• Shallow breathing
• Slow reflexes
• Extreme fatigue
• Pale, cold skin
• Blurred vision
• Slowed heart rate
• Fainting
• Diarrhea
• Vomiting
• Seizures
• Tremors

Benzodiazepine Combinations

Benzodiazepines are commonly abused with other substances, especially alcohol and stimulants. Below are the effects and consequences of these combinations.

Alcohol

Alcohol is commonly mixed with benzos such as Xanax or Ativan. While the combination can intensify a person’s high and increase the sedative properties, it can also be dangerous. Because alcohol and benzos are both nervous system depressants, they can be overly sedating.

Also, if a person drinks alcohol in large quantities, the ability to break down each drug is impaired, resulting in more potent effects. This can lead to dangerously slowed breathing and heart rate, as well as coma and seizures.

Stimulants

Other common combinations are benzos (e.g., Xanax) and stimulants (e.g., Adderall). While it may seem fine to combine them, these drugs are antagonistic, which means they create opposing effects in the body. In other words, the two drugs can cancel each other out and lead to fatal overdoses, especially as it can cause a person to think they are more sober than they actually are.

Another risk of mixing stimulants and benzos is the effect they each have on the respiratory system. Xanax, for example, is known to slow down breathing, while Adderall demands increased oxygen. These conflicting processes can lead to respiratory complications as the individual struggles to meet their oxygen needs.

Opioids

Opioids are also commonly mixed with benzos to increase the high, improve pain relief, or deepen the level of sedation and relaxation. Drugs such as heroin, morphine, or methadone (a painkiller that is used to wean individuals off heroin) are often mixed with benzos. However, like alcohol, mixing two central nervous system depressants is dangerous because it can lead to respiratory failure, coma, and death.

Negative Health Consequences

When taken in excess and for long periods, benzodiazepines can lead to serious health consequences. These include:

• Anorexia
• Insomnia
• Anxiety
• Tremors
• Headaches
• Insomnia
• Memory problems

Overdose

It’s also important to be aware of the signs and symptoms of a benzodiazepine overdose, which include:

• Confusion
• Slowed heart rate
• Extreme drowsiness
• Difficulty breathing
• Fainting
• Loss of balance
• Muscle weakness
• Coma

Signs & Symptoms of Benzodiazepine Abuse

People who are addicted to benzodiazepines can begin to exhibit the following signs of abuse.

Physical Signs of Abuse

• Physical weakness
• Slurred speech
• Confusion
• Poor decision-making and poor judgment
• Blurred vision
• Lack of motor coordination
• Dizziness
• An inability to defend oneself in the case of an attack or threat
• Drowsiness
• Coma
• Difficulty breathing

Behavioral Signs of Abuse

Sudden changes in behavior can be clear indicators of a problem. Some of the behavioral signs of benzodiazepine abuse also apply to other drug dependencies, and may include:

• Running out of prescriptions early
• “Doctor shopping” to acquire multiple prescriptions
• Faking symptoms to get prescriptions
• Hiding or lying about drug use
• Difficulties controlling their drug use
• Continuing to use the drugs, despite any negative side-effects
• Isolation from work, family, and friends
• Loss of interest in activities or hobbies
• Insomnia or over-sleeping
• Worsening performance at school or work
• Suspicious behavior
• Abusing other substances (poly-substance)
• Debts, loss of jobs, or financial problems
• Relationship issues

Benzodiazepines Withdrawal Symptoms

Habitual benzo abuse can lead to tolerance and subsequent withdrawal symptoms. Some of the most common withdrawal symptoms include:

• Headaches
• Blurred vision
• Muscle pain
• Tremors
• Diarrhea
• Numb fingers
• Jaw tension
• Sensitivity to light and sound
• Loss of appetite
• Insomnia
• Heart palpitations
• Sweating
• Anxiety
• Panic
• Paranoia
• Short-term memory loss
• Sore, stiff muscles

Treatment for Benzodiazepine Addiction

If you find yourself struggling with benzo addiction, help is readily available. Below are some of the recommended treatment options for this kind of substance abuse. These therapies are often most effective when combined with other treatments, and are accessible through a doctor or by speaking directly to a rehab facility. You may also want to enroll in a rehab program that offers inpatient or outpatient options, depending on your needs.

Stopping on Your Own

While it can be tempting to try to detox from benzos on your own, it is not recommended. Benzo withdrawal symptoms are very uncomfortable, and medical complications can arise during detox. Recovery from benzo abuse should be done under medical supervision, where doctors and clinicians can keep you safe and comfortable.

Tapering Process

Benzos require a tapering-off process, as sudden discontinuation is not only uncomfortable, but it is also dangerous. Medically assisted detox facilities or doctor-led withdrawal programs will aim to slowly wean an individual off their original dosage of benzos. This is done by either gradually decreasing the dosage or by replacing the drug with a different type of benzo that is easier to withdraw from. For example, if a person is addicted to a short-acting benzo, they will often switch them to a longer-acting one so that the need to take them is less frequent.

Dual Diagnosis

Because benzos are mostly used to treat anxiety and panic disorders, finding a treatment program that deals with both addiction and mental health conditions can be highly beneficial. Rehab facilities that offer dual diagnosis are often staffed with psychiatrists or clinical therapists that are qualified to diagnose and treat concurrent mental health conditions. This type of program is especially useful for people who have underlying issues like depression, anxiety, and post-traumatic stress disorder (PTSD). This allows clinicians to safely address these conditions alongside withdrawal from the drug itself.

Cognitive-Behavioral Therapy (CBT)

Cognitive-behavioral therapy (CBT) is one of the most highly recommended and widely used therapies for substance abuse and mental health conditions like anxiety. CBT helps individuals identify automatic and negative thinking patterns and change them into more positive ones. Another benefit of this type of therapy is that it can teach clients how to deal with stress, cope with cravings, identify triggers, and deal with situations that encourage inhalant use.

Dialectical-Behavior Therapy (DBT)

Dialectical-behavior therapy is a type of cognitive-behavioral therapy that focuses on mindfulness, how to live in the moment, cope with stress, and improve relationships. DBT also helps clients identify negative influences in their lives and learn how to develop healthy coping skills. This kind of therapy is useful for people who have been addicted to Xanax, especially those who have anxiety or depression. DBT is also effective for PTSD and for people who exhibit self-destructive behaviors.

Motivational Interventions

Motivational interventions such as contingency management are useful counseling techniques for addiction. These approaches are based on a reward system, and they use motivational techniques to help individuals commit to change and remain abstinent. Individuals who receive motivational interventions learn that it is possible to achieve sobriety using self-control and they are often given rewards or incentives as a guide.

Support Groups

Support groups such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and 12-Step programs can also be beneficial. These groups are well established and recognized for their ability to provide ongoing support and help individuals reduce the risk of relapses.

Medications

There are a few medications used for treating benzo addiction. Some of these can prevent relapse and minimize withdrawal symptoms:

Anticonvulsants

These drugs, such as Gabapentin, can sometimes be used for people who experience seizures during withdrawal or who have a history of seizures.

Beta-Blockers

Beta-blockers, like propranolol, can be useful during withdrawal to ease physical symptoms such as tremors.

Blood Pressure Medications

Medications such as clonidine can sometimes be used to maintain normal blood pressure during the detoxing process.

Anti-Depressants

Anti-depressants like Paxil or Prozac can be useful to help with anxiety while a person detoxes from benzos.

Melatonin

Melatonin is a natural hormone that is produced in the brain and is responsible for setting the body’s sleep-wake cycle. As benzo withdrawal can cause sleep disruption, melatonin can help clients obtain adequate and sustained sleep.

Wellness & Holistic Activity Programs

Programs that encourage healthy activities such as yoga, social outings, outdoor adventures, etc. can be highly beneficial for individuals who are recovering from substance abuse and mental health conditions. These types of programs are great for encouraging calmness, emotional expression, improving physical health, and teaching valuable skills.

Resources

If you or a loved one are struggling with benzodiazepine abuse or addiction, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.

You can also find a list of treatment centers near you on our website to help get you on the path to recovery.

Key Sources

Ogbru, O. (2018). Benzodiazepines: Types, Side Effects, and Addiction. MedicineNet. https://www.medicinenet.com/benzodiazepines_sleep-inducing-oral/article.htm#what_are_benzodiazepines_and_how_do_they_work_mechanism_of_action.

National Institute on Drug Abuse. (2021). Overdose Death Rates. Drugabuse.gov. https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates.

National Institute on Drug Abuse. (2018). Research suggests benzodiazepine use is high while use disorder rates are low. Drugabuse.gov. https://www.drugabuse.gov/news-events/science-highlight/research-suggests-benzodiazepine-use-high-while-use-disorder-rates-are-low.

Torgeson, T. (2017). My Addiction to Benzos Was Harder to Overcome Than Heroin. Healthline. https://www.healthline.com/health/addiction-drug-problem-benzos.

Medical Disclaimer

At RehabAid.com, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.

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