Benzodiazepine Addiction: Causes, Symptoms & Treatment

Benzodiazepines are a class of drugs that have powerful sedative properties. As a result, benzodiazepine users are at high risk for abuse and addiction.

What Are Benzodiazepines? 

Benzodiazepines, often referred to simply as benzos, are classified as depressant drugs. These drugs tend to slow down body systems, inducing feelings of sleepiness and calm. 

Benzodiazepines are most often prescribed in medical settings to treat the following conditions:

• Anxiety disorders
• Insomnia and other sleep disorders
• Seizures
• Spasticity (as the result of CNS pathology)
• Epilepsy

Benzodiazepines are also often prescribed for muscle relaxation.

Quick Facts About Benzos

Here are some quick stats on benzodiazepines:

• Benzodiazepines are useful in a medical setting to help stop seizures. About 1 to 2 percent of emergency room visits each year in the United States are due to seizures.
  
• Benzodiazepines are the most prescribed psychiatric medications in the United States. They are also the third most misused drugs among adults and adolescents.
  
• In a study of 244 patients using benzodiazepines, 154 patients were identified as having benzodiazepine use disorder, which represented 63.1 percent of the sample group. The majority of individuals (64 percent) were females and young adults who fell into the 18–40 age range. The vast majority (88 percent) of these patients had obtained their benzodiazepines legally through a doctor’s prescription.
  
  When surveyed, over half of the individuals studied were less than satisfied with their physicians’ instructions. They reported having a lack of knowledge about the side effects and abuse potential associated with these medications. 

Common Types of Benzodiazepines

These are the most common types of benzodiazepines:

• Alprazolam (Xanax)
• Chlordiazepoxide (Librium)
• Clonazepam (Klonopin)
• Clorazepate (Tranxene)
• Diazepam (Valium)
• Estazolam (Prosom)
• Flurazepam (Dalmane)
• Lorazepam (Ativan)

Xanax

Xanax is most commonly prescribed for the treatment of anxiety disorders. It is a fast-acting benzodiazepine.

Klonopin

Klonopin is most often prescribed for panic disorder and seizures. 

Valium

Valium is often used as a powerful anesthesia, but it is also often prescribed for seizure disorders, anxiety, insomnia, and alcohol withdrawal. 

Ativan

Ativan is often used for anxiety disorders, but it is utilized for anesthesia, sleep disorders, and alcohol withdrawal as well. 

How Does Addiction to Benzodiazepines Happen? 

Benzodiazepines are widely used in medical settings and clinics. Even when used as prescribed, benzodiazepine use can result in dependence. 

Once dependence forms, people may be more likely to misuse their medications to avoid uncomfortable withdrawal symptoms. This can quickly lead to addiction. 

Benzodiazepines are also popularly used recreationally. People may take a Valium or Xanax to relax, or they may combine these medications with other substances, such as alcohol. When substances are abused together, addiction becomes more likely. 

Addictive drugs like benzodiazepines result in an increase in dopamine levels. These drugs also trigger long-lasting synaptic adaptations when it comes to the mesolimbic reward system. As a result, these drugs often induce pathological behavior.

The neural basis for benzodiazepines and their addictive nature is not fully known. We do know that benzodiazepines have the ability to increase the firing of dopamine neurons located in the ventral tegmental area. This is accomplished through the positive modulation of GABA-A receptors in nearby interneurons. 

Benzodiazepines have a lot in common with the pharmacological features of highly addictive drugs through cell type-specific expression.  

What Are the Signs & Symptoms of Benzodiazepine Addiction? 

Signs and symptoms of benzodiazepine addiction can be thought of in terms of physical symptoms as well as mental and behavioral symptoms.

Physical Symptoms 

Physical symptoms of benzodiazepine addiction include the following:

• Slurred speech
• Respiratory infection
• Physical dependence
• Blurred or double vision
• Weakness or lethargy
• Vertigo
• Headaches
• Changes in eating habits
• Changes in sleeping patterns

Cognitive Symptoms 

Mental or cognitive symptoms of benzodiazepine addiction include the following:

• Memory trouble
• Anterograde amnesia
• Confusion
• Slowed mental processing
• Inability to problem-solve
• Slowed reflexes and reaction time

Behavioral Symptoms 

Perhaps the most recognizable symptoms are behavioral symptoms that occur in those who are addicted to benzodiazepines. Behavioral symptoms include the following:

• Engaging in drug-seeking behaviors
• Doctor shopping to get multiple prescriptions for benzodiazepines
• Prescription forgery
• Stealing drugs from medical professionals or loved ones
• Increased tolerance (needing to take higher doses to feel the same effects)
• Inability to meet social and familial obligations
• Poor performance at work or school
• Increasing isolation
• Decreased interest in activities that don’t involve benzodiazepine use
• Using benzodiazepines when it is dangerous to do so, such as before driving or while caring for children
• Combining benzodiazepines with other substances, like alcohol

Generally, the signs of addiction may be subtler in the early stages, but they generally worsen as the addiction grows. Some people describe their loved ones as completely different people once addiction takes hold.

How Is Sedative Use Disorder Diagnosed?

There are 11 primary symptoms of sedative use disorder. If an individual has two of these symptoms in a one-year window, they may have sedative use disorder:

• Trouble fulfilling work and social obligations due to sedative use
• Spending an increasing amount of time trying to acquire the drug, using it, or recovering from the effects of use 
• Being in compromising and hazardous situations due to drug use
• Repeated desire to quit using sedatives but being unable to do so
• Continuing to use sedatives despite interpersonal or social problems, such as problems with family members, friends, or partners
• Increased tolerance over time — taking more sedatives to achieve the same or similar effects
• Using sedatives in larger amounts and being on the drug for longer than initially intended
• Withdrawal symptoms after stopping use or significantly lowering one’s regular dosage
• Continuing to use sedatives despite undesirable or negative effects 
• Strong cravings for sedatives
• Increasing isolation

Tolerance & Dependence 

Individuals build tolerance to benzodiazepines with repeated and prolonged use. This means the same dosage doesn’t bring the same effects it once did as the body and brain become accustomed to the presence of the drug. The person may then need to take a higher dose to experience the same effects.

Tolerance is usually a precursor to physical dependence. The body and brain begin to rely on the constant presence of the drug. When it is not present, it throws the body into disarray, and withdrawal symptoms begin.

Benzodiazepines result in physical dependence very quickly. In some cases, dependence can occur after just two weeks of regular use. Because of this, many benzodiazepines are only intended for short-term use. 

If dependence has formed, it’s important to never stop taking benzodiazepines suddenly. Withdrawal can trigger life-threatening withdrawal symptoms, including seizures, so a tapered approach to withdrawal under medical supervision is needed.

Can You Overdose on Benzodiazepines?

It is possible to overdose on benzodiazepines, though it is not common to overdose on benzodiazepines alone.

Overdose is much more common when benzodiazepines are being used in conjunction with other drugs. The most common substances used with benzos include opioids, alcohol, and other kinds of illicit or prescription drugs.

According to the CDC, about 7,000 overdose deaths in 23 states involved benzodiazepines in 2020, which marked a sharp increase in overdose cases since 2019. This represented 17 percent of all drug overdose deaths in those states.

The CDC also asserts that over 90 percent of illicit benzodiazepine-involved overdose deaths were in cases where individuals also used either prescription or illicitly manufactured opioids. This highlights the dangers of combining drugs, particularly benzodiazepines and opioids.

Overdose Symptoms

Using two or more drugs together, whether it is intentional or unintentional, is considered polydrug use. Mixing drugs amplify the effects and risks of each drug while also putting a tremendous amount of stress on the body. Overdose can result in coma or death. 

Benzodiazepine overdose symptoms include the following:

• Respiratory issues, including respiratory failure
• Vomiting or nausea
• Slurred speech
• Confusion and disorientation
• Poor motor skills and lack of coordination
• Loss of consciousness

Risk factors that increase an individual’s likelihood of overdose include the following:

• Taking high doses of the drug
• Using other substances, particularly alcohol and opioids, with benzodiazepines 

In cases of benzodiazepine poisoning, flumazenil may be administered. The general treatment is supportive care, such as administration of IV fluids. In some cases, intubation may be needed if the patient is unable to breathe on their own.

Treatment Options for Benzodiazepine Addiction 

Benzodiazepine addiction can be treated with both inpatient and outpatient treatment, depending on an individual’s situation and the severity of the addiction. Inpatient treatment is generally recommended for severe and long-standing addictions or in cases of polysubstance abuse. It’s also the ideal solution for people with co-occurring disorders, such as when someone has both an addiction and another mental health disorder.

Outpatient treatment works well for people who have a supportive home environment. They attend therapy sessions and other addiction treatments during the day but return home to sleep at night. Oftentimes, people begin in a more intensive level of treatment and transition to a less intensive form of care once they begin to find their footing in recovery. 

Treatment may begin with a supervised taper, as the person slowly weans on benzodiazepines. If they have been abusing a short-acting benzodiazepine, they may be transitioned to a long-acting one for the tapering process.

Therapy will generally occur on both an individual and group basis. People begin to build healthy habits in therapy that support their long-term recovery. Support groups are often part of the recovery process as well. 

References

Benzodiazepines. (November 2022). StatPearls. 

Benzodiazepine Use Disorder: A Cross-Sectional Study at a Tertiary Care Center in Lebanon. (September 2022). Medicine. 

Experiences With Benzodiazepine Use, Tapering, and Discontinuation: An Internet Survey. (April 2022). Therapeutic Advances in Psychopharmacology. 

Diazepam. (September 2022). StatPearls. 

A Nationwide Cohort Study of the Association of Benzodiazepines With SARS-CoV-2 Infection and Clinical Outcomes. (September 2022). Scientific Reports. 

Mechanisms Underlying Tolerance after Long-Term Benzodiazepine Use: A Future for Subtype-Selective GABAA Receptor Modulators? (March 2012). Advances in Pharmacological Studies. 

A Day to Remember. (August 2021). Centers for Disease Control and Prevention. 

Cognitive Functioning in Long-Term Benzodiazepine Users. (September 2022). European Addiction Research. 

Addiction: Part I. Benzodiazepines—Side Effects, Abuse Risk and Alternatives. (April 2000). American Family Physician.

Neural Bases for Addictive Properties of Benzodiazepines. (February 2010). Nature.

Benzodiazepine Toxicity. (June 2022). StatPearls.

Flumazenil: An Antidote for Benzodiazepine Toxicity. (March 1993). American Family Physician.

Tapering Patients Off of Benzodiazepines. (November 2017). American Family Physician.

Co-Occurring Disorders and Other Health Conditions. Substance Abuse and Mental Health Services Administration.