Benzodiazepine drugs are central nervous system depressants most often prescribed to treat panic disorders and anxiety disorders such as generalized anxiety disorder (GAD). As central nervous system depressants, they slow the nervous system, which gives the user a calm, relaxed feeling and provides effects like sedation and relaxation.
Benzodiazepine addiction can happen to anyone, regardless of whether it is taken as a prescribed medicine or not, and physical dependence can develop in as little as four weeks. After continued use, the body becomes used to the presence of benzos, and people can feel like they can not function without them.
The body builds up a resistance to the drug, meaning a higher dose is needed to acquire the desired effect. Once resistance builds up, people who have been taking the medication often increase the dose without consulting a medical professional, which can lead to benzodiazepine abuse and required addiction treatment.
What Are Benzodiazepines?
Benzodiazepines are a type of sedative, meaning they slow down the body and brain functioning. Benzodiazepine drugs work by increasing the activity of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter that lowers nerve impulses throughout the body. The human body naturally produces GABA and it reduces the activity in the areas of the brain responsible for: reasoning, memory, emotions, and essential functions, such as breathing.
Benzodiazepines are only intended for short- or medium-term use, due to the fact that the body develops a tolerance that causes a reduction in their effectiveness and meaning a progressively larger dose is required to feel the effects.
History of Benzodiazepines as Medications in the US
Benzodiazepines are among the most widely prescribed drugs in the world with benzo drugs prescribed at about 66 million doctors’ appointments a year in the US. The first benzodiazepine to be developed was chlordiazepoxide (Librium) and became available in 1960.
This was following a clampdown on barbiturates that were originally advertised as safe sedatives and became popular during the Great Depression as a way of ‘taking the edge off’, but caused tolerance to build, addiction, and dangerous, difficult withdrawal. Benzodiazepines entered the market as a ‘safer alternative’ with drug makers and distributors assuring the public that the new tranquilizers were a completely safe breakthrough in modern medicine.
However, it became clear in time that Librium carried the same dangers of tolerance and dependence. Following this, subsequent benzodiazepine medications were synthesized and again doctors and pharmacists assured customers that the pills were harmless.
The rebranding of benzos was not as successful in other parts of the world as it was in the US. During the 1980s, many industrialized countries began to strictly regulate benzodiazepines. The United Kingdom saw the largest-ever class-action lawsuit, in which 14,000 patients attempted to sue benzodiazepines producers for downplaying and withholding knowledge of their potential to cause harm.
How Are Benzodiazepines Classified in the United States?
Benzodiazepines, including, Xanax, Valium, and Ativan are considered Schedule IV controlled substances. The substances classified as Schedule IV have a lower abuse potential compared to drugs in other schedules, however, significant risk does remain. Schedule IV drugs have varying medical uses, which in the case of benzodiazepines are mostly anti-anxiety, insomnia, and muscle relaxation.
Drugs listed as Schedule IV are classified this way because “Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in Schedule III.”
Although as Schedule IV substances, benzos have less potential for addiction, research has shown that there are still significant dangers of abusing the drug. Benzodiazepine withdrawal is said to be one of the worst withdrawal processes of any drug, and can be fatal.
What Are Benzodiazepines Prescribed For?
Benzos are prescribed for the alleviation of anxiety, stress, physical pain, and to aid with sleep. They are also on occasion prescribed during alcohol withdrawal.
Clonazepam (Rivotril), alprazolam (Xanax), and lorazepam (Ativan) are prescribed for the short-term relief of severe anxiety. They should never be taken for long-term relief, or for anxiety linked to grief as it may numb the pain and disrupt the grieving process.
Benzodiazepines can be prescribed when a person first starts taking antidepressants, or does not respond to antidepressants. The symptom is known as anhedonia—or loss of pleasure—is often associated with the prescription of benzos in depression treatment. Klonopin, Valium, and Ativan are the benzos most often prescribed to those with a depression diagnosis.
Benzodiazepines approved by the FDA for the treatment of panic disorder include alprazolam (Xanax) and clonazepam (Klonopin). Benzodiazepines are generally used only on a short-term basis because they can be habit-forming, causing mental or physical dependence.
Benzodiazepines can be effective in alleviating insomnia, helping those who find it difficult to fall or stay asleep to get a night of rest. You should only be offered benzodiazepines to treat insomnia if it is severe, disabling, or is causing you a lot of distress. Estazolam, flurazepam (Dalmane), temazepam (Restoril), quazepam (Doral), and triazolam (Halcion) are shown to help with insomnia. However as with anxiety, they should only be prescribed for short-term use.
Acute alcohol withdrawal
Long acting benzodiazepines can be used to help with the effects of acute alcohol withdrawal, often during a medically supervised detox in an addiction treatment facility. Valium, Librium and Serax, and Lorazepam are used by rehab facilities across the nation to help patients overcome an AUD.
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How Benzodiazepine Addiction Occurs
Taking benzodiazepines can cause physiologic and psychologic dependence, which is heavily affected by the drug’s dosage, duration of use, and potency. Dependence generally occurs faster for those taking a high dosage of a high-potency benzo such as alprazolam, and this could be as quickly as in one to two months. A patient taking a lower dosage of a long-acting, low-potency benzodiazepine such as chlordiazepoxide will generally take much longer to develop a dependency to the substance. The issue, though, is the temptation of some patients to increase their dose without consultation of a doctor.
There is the chance that a placebo effect when a person starts taking the drug contributes to rapid and thorough alleviation of symptoms, which gradually return. There is also the risk of developing a tolerance to the drug, and instead of consulting a doctor, deciding to increase the dosage and frequency of use. Taking the drug at a higher dose will only work for a short period of time before a person will require a higher dose to feel the same effects as they once did. This often results in a cycle of increased tolerance and dependency where a person becomes so dependent on their use of the drug to get through each day that when they attempt to stop, or leave enough time between doses that the concentration of the drug in their body drops, they will experience withdrawal symptoms.
Does Your Loved One Have an Addiction?
Benzodiazepine addiction can cause a variety of behavioral changes. If you suspect a loved one may be abusing their prescription, it is helpful to be aware of the signs of drug abuse. In addition, if you are worried a loved one may be illicitly acquiring benzos and abusing them, look out for these signs:
- Reduction in energy and increase in apathy or lethargy
- Engaging in uncharacteristic ways in order to obtain more benzos, such as borrowing money, stealing, or maxing out credit cards
- Withdrawal from friends, family, and obligations such as work or study
- Nausea, vomiting, and diarrhea
- Hypersensitivity to light and sound
- Mood changes such as sudden annoyance or irritability (generally caused by the onset of withdrawal symptoms when the drug begins to leave a person’s system)
- Unwillingness to do tasks which require extended attention
- Impaired cognition and memory
- Increased anxiety
- Insomnia or trouble sleeping
- Slurred speech
- Loss of appetite
Knowing the signs of benzodiazepine abuse early can increase the possibility of early substance abuse intervention, lowering the risk of a person becoming physically dependent or addicted to the drug. In 2020, approximately 12,290 people died from an overdose involving benzodiazepines. Early intervention could save a life.
Where to Seek Help for Benzodiazepine Abuse?
Drug abuse is any form of consumption of a drug that is outside of the instructions given by a doctor. This can include taking more of the prescribed medication than has been instructed, taking the drug in another method such as snorting or smoking it, and obtaining a substance illicitly to consume.
Benzodiazepines addiction rehab modalities also vary, depending on a number of factors including the reason you are abusing the drug, whether you have a dual diagnosis, as well as the particular drug that you have been abusing. Every rehab has different specialties so it is important to choose one that aligns with your goals and offers the right treatment modalities to suit you.
Those who struggle with benzo addiction often suffer from underlying mental health conditions and in some cases, other addictions. In this case it is important to seek help from a dual diagnosis center.
Benzodiazepine addiction treatment will begin with detox, where you allow your body to rid itself of all traces of the drug. This process can be challenging and dangerous and should be done under medical supervision. Treatment centers will then offer therapies to help you overcome the addiction. This may include cognitive behavioral therapy, trauma therapy, dialectical therapy, or group therapy in addition to a range of others to treat the root causes of your addiction. Through these therapy sessions, you will learn about your addiction, how to recognise signs of relapse, and ways of coping with difficult emotions or situations.
How Long Will the Admission Take?
If you, your friend, family member or another person you care about is struggling with alcohol or drug addiction, the first and often most challenging step is picking up the phone. The admission process for addiction treatment may seem daunting, but rehab facilities generally have a seamless, confidential, and informative procedure to help you through the stress and fear of entering treatment.
Many private rehabs – such as ours – have staff working 24/7 to answer the phone and admit clients within a day of the initial assessment. You can reach out at any time, day or night, to discuss your situation and what kind of treatment may best suit you. Once you call a treatment center, the admission counselor will conduct a quick, compassionate evaluation over the phone. This will likely include an assessment of the substances you have been abusing, any past treatments or experiences of substance abuse, how long you have been struggling with substance abuse, and whether you have any other medical conditions including mental illnesses.
After the initial phone consultation, you will likely be invited for a physical exam in the treatment center. Some facilities will help organize transport for this. A physical exam often includes tests on blood, heart, and other vital functions. An assessment from a psychiatrist is also common. (CHECK CENTERS POLICY).