Benzodiazepine Addiction, Withdrawal and Treatment
- Benzodiazepine Addiction
- Signs & Symptoms of Abusing Benzodiazepine
- Benzodiazepine Withdrawal & Detox
- Treatment for Benzodiazepine Dependence
Benzodiazepines are a class of prescription drugs known as central nervous system (CNS) depressants. Referred to by the street names benzos or downers, the drug is considered a mild tranquilizer. Due to its sedative qualities, doctors commonly prescribe benzodiazepines to treat anxiety disorders, insomnia, muscle spasms, and seizures. Benzodiazepines are typically in tablet or capsule form, and can be taken orally or crushed up and snorted.
Benzodiazepines work by enhancing the activity of a key neurotransmitter in the brain: gamma-amino butyric acid (GABA). GABA inhibits motor neurons by slowing or stopping them. This slows nerve impulses throughout the body, and either causes an anti-anxiety or sedative effect. Short-acting benzodiazepines work quickly and leave the body quickly, but research shows dependence develops sooner than in patients who are taking a long-acting, low-potency version of the drug. With prolonged use or abuse, the changes benzodiazepines make to the neural processes can be permanent.
The most common benzodiazepines are Valium, Xanax, Halcion, Ativan, and Klonopin. Generic versions of these drugs are also available: diazepam, alprazolam, triazolam, lorazepam, and clonazepam, respectively. Another well-known drug in the benzodiazepine family is Rohypnol, or the date rape drug.
Categorized as a Schedule IV controlled substance, benzodiazepines are defined as having a low potential for abuse and low risk of dependence. However, abuse or long-term use can lead to addiction. And, because these drugs change the way the brain works, dependency can be difficult to reverse.
Like with other controlled substances, a dependence on benzodiazepines (obtained legally or illegally) can lead to drug-seeking behaviors such as obtaining prescriptions from multiple doctors, forging prescriptions, or buying them from illegal sources. In addition to physical consequences, this type of behavior can have a negative impact on a user’s personal relationships and professional endeavors.
Signs & Symptoms of Abusing Benzodiazepine
Primary effects of benzodiazepines include relaxation, calmness, and anxiety relief. Side effects of low to moderate doses, like those prescribed by a doctor, are as follows:
- Impaired motor coordination
- Memory impairment
- Vision changes
- Speech impairment
- Slowed breathing
- Nausea, vomiting, and/or digestive discomfort
In higher doses, benzodiazepines typically have more pronounced side effects:
- Slower reflexes
- Mood changes
- Hostile, erratic behavior
- A state of euphoria
People taking benzodiazepines recreationally or without a prescription will likely exhibit one or more of the above side effects. People abusing the drug by taking a higher dose than prescribed will likely exhibit some of the side effects associated with higher dosage rates. People who are addicted to the drug may exhibit additional symptoms:
- Nightmares or vivid dreams
- Sleeping problems
- Uncontrolled leg movements
- Pain in bones and muscles
It is possible for a person to take too much benzodiazepine, leading to a drug overdose. During an overdose incident, the user may exhibit shallow breathing, clammy skin, dilated pupils, and/or a weak, rapid pulse. If left untreated, an overdose may result in a coma or, rarely, death. Though an antidote is available, it is rarely used due to the low likelihood of death and the high likelihood of adverse side effects.
Benzodiazepine Withdrawal & Detox
Withdrawal from benzodiazepines is considered severe and, in some cases, can even be deadly. For this reason, it is not recommended a user stop taking the drug abruptly. Instead, the amount of medication ingested should be reduced gradually until the dose is low enough to prevent discomfort. Even with tapered dosage, users may experience withdrawal symptoms:
- Increased anxiety and/or panic attacks
- Difficulty concentrating
- Vomiting or dry heaving
- Heart palpitations
- Muscle pain
- Cognitive impairment
In cases of prolonged use or addiction, users may experience protracted abstinence syndrome, a condition in which withdrawal symptoms can last for months. Long-term users may choose to detox in a residential or outpatient facility under the supervision of medical professionals.
Treatment for Benzodiazepine Dependency
Benzodiazepine addiction is difficult to treat, as many benzodiazepine addicts also abuse other drugs like alcohol and opioids. Furthermore, benzodiazepines cause long-lasting changes in the way the brain’s dopamine receptors work, which can be difficult to reverse. In the event the drug has been prescribed as a treatment for a medical condition, that issue must also be addressed.
There are two approaches to reducing a user’s physical dependency on benzodiazepines, depending on the risk of harm and/or relapse. Low-risk patients, defined as users who are taking a lower dose of the drug or who have significantly lowered their own dosage prior to seeking treatment, are eligible for withdrawal with the aim of abstinence. This process begins by tapering the dosages of the drug until the patient is ready to quit using it entirely.
Higher-risk patients are considered to be those who have previous withdrawal attempts, concurrent medical or psychiatric conditions, or those who abuse other drugs. These patients are candidates for benzodiazepine maintenance therapy. The goal of this process is to simply reduce the dosage rates of the drug to stable levels.
Patients in both of these treatment approaches should be monitored by a physician in either an inpatient or outpatient setting. Both treatment options also share common practices:
- Prescribing interventions – The process of staged dispensing, in which medication is incrementally handed out in small quantities, allows a physician or pharmacist to assess the patient through the withdrawal and/or maintenance process.
- Benzodiazepine substitution – Because some benzodiazepines are more dangerous and more likely to be misused, it may be helpful to substitute a less potent form of the drug with a longer half-life.
In some cases, medication therapy can be used to help a patient through the withdrawal process. Anticonvulsants can be used in patients with no other drug dependency. Flumazenil, a drug that blocks the effects of benzodiazepines, has been used to help patients rapidly withdraw with minimal symptoms. Additionally, psychotherapy may improve results in some patients.
- Misuse of Prescription Drugs – National Institute on Drug Abuse (NIDA)
- Benzodiazepines – Center for Substance Abuse Research (CESAR)
- Drug Scheduling – United States Drug Enforcement Administration (DEA)
- Benzodiazepines – MedicineNet.com
- Benzodiazepines Drug Fact Sheet – United States Drug Enforcement Administration (DEA)
- Benzodiazepine Toxicity – Medscape
- Well-Known Mechanism Underlies Benzodiazepines’ Addictive Properties – National Institute on Drug Abuse (NIDA)
- Management of Benzodiazepine Misuse and Dependence – National Institutes of Health (NIH)