Cornerstone

BENZODIAZEPINES
Overview

Information about "benzos", identifying signs of addiction, and recovery.

or

Understanding Benzos as a Drug

Benzodiazepines, or “benzos,” are a class of psychoactive drugs primarily used to treat anxiety disorders, insomnia, and seizures. They work by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA), which reduces brain activity and promotes relaxation. Common benzodiazepines include Xanax (alprazolam), Valium (diazepam), Klonopin (clonazepam), and Ativan (lorazepam). Benzodiazepines were first introduced in the 1960s and quickly gained popularity due to their effectiveness and perceived safety compared to older sedatives like barbiturates. However, long-term use of benzodiazepines can lead to physical dependence, tolerance, and withdrawal symptoms, making them a potential substance of abuse. The misuse of benzodiazepines, often in combination with other substances like opioids or alcohol, has contributed to a growing public health concern, with increased rates of addiction, overdose, and drug-related deaths. While benzodiazepines have legitimate medical uses, their use should be closely monitored and limited to short-term treatment under the guidance of a healthcare provider1.

Understanding Benzodiazepines

Benzodiazepines were first discovered in the 1950s by Leo Sternbach, a chemist working for Hoffman-La Roche. The first benzodiazepine, chlordiazepoxide (Librium), was synthesized in the late 1950s and approved for medical use in 1960. In 1963, diazepam (Valium) was introduced and quickly became one of the most widely prescribed drugs worldwide. Throughout the 1960s and 1970s, several other benzodiazepines were developed, including alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin). These drugs were widely prescribed for various conditions such as anxiety, insomnia, and seizures. However, as reports of abuse and dependence emerged in the 1980s, prescribing guidelines were tightened. Despite this, benzodiazepines remain widely used today, with an estimated 12.5% of U.S. adults reporting use in the past year, although concerns about their potential for abuse and dependence persist, especially when used long-term or with other substances2.

Identifying Benzodiazepines

Identifying benzodiazepines can be challenging, as they come in various forms and may resemble other prescription medications. Legitimate benzodiazepine tablets and capsules typically have imprints indicating the drug name, dosage, and manufacturer. However, the presence of imprints does not guarantee the authenticity or purity of the drug, as counterfeit or adulterated benzodiazepines are increasingly common in the illegal drug market. These counterfeit pills may contain other substances, such as fentanyl or other synthetic opioids, which can greatly increase the risk of overdose and death. The most reliable way to identify a benzodiazepine is through laboratory testing, such as gas chromatography-mass spectrometry (GC-MS) or high-performance liquid chromatography (HPLC). Physicians and pharmacists can also help identify legitimate benzodiazepines based on their appearance, markings, and packaging.

Facts About Benzodiazepines

The misuse of benzodiazepines has become increasingly linked with the opioid epidemic, as they are often combined with opioids to enhance euphoria or manage withdrawal. This dangerous combination can cause severe respiratory depression, overdose, and death, prompting guidelines against their concurrent use. The emergence of illicit benzodiazepines contaminated with synthetic opioids like fentanyl has heightened these risks.

Long-term use of benzodiazepines, even at therapeutic doses, can cause physical dependence and severe, potentially life-threatening withdrawal symptoms such as anxiety, insomnia, tremors, seizures, and delirium tremens. The severity depends on the specific drug, duration, dose, and individual physiology. Gradual dose reduction under medical supervision is recommended to minimize risks. Many individuals may need comprehensive addiction treatment, including behavioral therapies and support groups, for successful discontinuation and long-term recovery 3.

Benzodiazepines effectively treat anxiety and insomnia but are linked to cognitive impairment, especially in older adults. Short-term effects include drowsiness, confusion, and difficulty forming new memories. Long-term use may increase the risk of cognitive decline, dementia, and Alzheimer’s disease, though the causal relationship is unclear. These cognitive side effects can exacerbate age-related issues and increase susceptibility to falls and accidents. Therefore, guidelines recommend cautious prescribing and regular re-evaluation of benzodiazepine use in older adults.

Benzodiazepines are often prescribed for anxiety disorders like generalized anxiety disorder, panic disorder, and social anxiety disorder, providing rapid symptom relief. They are typically used short-term, especially when starting antidepressants, which take weeks to be effective. Long-term use is discouraged due to risks of dependence, tolerance, and withdrawal. Benzodiazepines don’t address underlying anxiety causes and may hinder the development of coping skills. Guidelines recommend psychotherapy, such as cognitive-behavioral therapy (CBT), and antidepressants as first-line treatments, reserving benzodiazepines for short-term or occasional use.

Benzodiazepines with longer half-lives, such as diazepam and clonazepam, are sometimes prescribed for insomnia, reducing sleep latency and increasing total sleep duration. However, long-term use can lead to tolerance, rebound insomnia, dependence, and abuse. They may also cause daytime drowsiness, cognitive impairment, and respiratory depression, especially with other sedatives. Guidelines recommend benzodiazepines for insomnia only short-term, emphasizing non-pharmacological approaches like cognitive-behavioral therapy for insomnia (CBT-I) and good sleep hygiene practices.

Benzodiazepine overdose can occur with high doses, often combined with other depressants like opioids or alcohol. Symptoms include severe drowsiness, confusion, slurred speech, impaired coordination, and respiratory depression. In severe cases, it can lead to coma and death, especially when combined with other substances. The risk is higher among those with a substance abuse history, taking high doses or multiple benzodiazepines, or using them illicitly. The rise of illicit benzodiazepines, often contaminated with synthetic opioids like fentanyl, has increased overdose risks. Treatment involves supportive care, monitoring, and flumazenil administration in severe cases.4 .

Recovering From Benzodiazepine Addiction

Here’s a condensed version of the text:

Overcoming benzodiazepine addiction can be challenging due to severe withdrawal symptoms and psychological dependence. The first step typically involves a gradual dose reduction (tapering) under medical guidance, sometimes substituting a longer-acting benzodiazepine for a shorter-acting one. Comprehensive addiction treatment often includes behavioral therapies like cognitive-behavioral therapy (CBT) and contingency management, which help individuals identify and change thoughts and behaviors contributing to their addiction, develop coping skills, and maintain recovery. Support groups can provide a sense of community and accountability. Treating co-occurring mental health conditions with alternative medications and psychotherapy is crucial. Overcoming benzodiazepine addiction is a gradual, challenging process requiring professional support, patience, and perseverance, with relapse being common. However, long-term recovery is possible with comprehensive care and support.

effects of benzo

The Stages of Benzodiazepine Addiction

The stages of benzodiazepine addiction typically begin with initial use, which may be prescribed for legitimate medical reasons or obtained illicitly. As tolerance develops, individuals may begin to misuse the drug, taking higher doses or using it more frequently than prescribed. This can lead to physical dependence, where the body adapts to the presence of the drug and experiences withdrawal symptoms when use is reduced or stopped. Psychological dependence may also develop, characterized by a strong desire to use the drug and difficulty controlling use despite negative consequences. As addiction progresses, individuals may prioritize obtaining and using benzodiazepines over other responsibilities and relationships, leading to significant impairment in daily functioning. It’s important to note that benzodiazepine withdrawal can be severe and potentially life-threatening, with symptoms such as seizures, delirium, and rebound anxiety. Benzodiazepine addiction often co-occurs with other substance use disorders, particularly opioid and alcohol use disorders, which can compound the risks and challenges of recovery. Treatment for benzodiazepine addiction typically involves a gradual tapering process, behavioral therapies, and management of co-occurring mental health conditions, and requires close medical supervision and support.

FAQs About Benzodiazepines

What are benzodiazepines?

Benzodiazepines, often referred to as “benzos,” are a class of medications primarily used to treat anxiety, insomnia, and seizures. They work by enhancing the effect of the neurotransmitter GABA in the brain, which has a calming effect.

Common benzodiazepines include diazepam (Valium), alprazolam (Xanax), and lorazepam (Ativan). While they are effective for short-term use, they can be addictive and are generally not recommended for long-term use due to the risk of dependence and other side effects.

What does using benzodiazepines feel like?

Using benzodiazepines typically results in a sense of calm and relaxation. Users may experience reduced anxiety, muscle relaxation, and sedation. These effects can help individuals feel more at ease and aid in sleep for those with insomnia.

However, benzodiazepines can also cause side effects such as drowsiness, dizziness, and impaired coordination. High doses or long-term use can lead to memory impairment and cognitive dulling.

What are the side effects of benzodiazepines?

Common side effects of benzodiazepines include drowsiness, dizziness, impaired coordination, confusion, and memory problems. Some people may also experience slurred speech, blurred vision, or gastrointestinal symptoms like nausea or constipation. Long-term use of benzodiazepines can lead to tolerance, dependence, and withdrawal symptoms upon discontinuation.

What are the dangers of using benzodiazepines?

The dangers of using benzodiazepines include:

  1. Addiction and Dependency: Regular use can lead to physical and psychological dependence.
  2. Overdose: Taking high doses, especially in combination with other depressants like alcohol, can be fatal.
  3. Withdrawal Symptoms: Sudden cessation can lead to severe withdrawal symptoms, including anxiety, seizures, and psychosis.
  4. Cognitive Impairment: Long-term use can result in memory problems and decreased mental function.
  5. Motor Vehicle Accidents: Impaired coordination and drowsiness can increase the risk of accidents.
  6. Interaction with Other Medications: Benzodiazepines can interact dangerously with other medications, especially other central nervous system depressants.

How long does it take to become physically addicted to benzodiazepines?

The time it takes to become physically addicted to benzodiazepines can vary depending on several factors, including the specific medication, dosage, frequency of use, and individual differences. Generally, physical dependence can develop within a few weeks of regular use, especially at higher doses. For some individuals, dependency can occur even more quickly if they are taking benzodiazepines multiple times a day or if they have a history of substance abuse.

Signs of physical addiction include tolerance (needing higher doses to achieve the same effect) and withdrawal symptoms (such as anxiety, insomnia, and seizures) when not taking the drug. It’s essential to use benzodiazepines only as prescribed by a healthcare provider and to discuss any concerns about dependency with a medical professional.

What are the signs of benzodiazepine addiction?

Signs of benzodiazepine addiction may include:

  • Taking benzodiazepines in higher doses or for longer than prescribed
  • Experiencing cravings or strong urges to use benzodiazepines
  • Continuing to use benzodiazepines despite negative consequences
  • Neglecting responsibilities or activities in favor of benzodiazepine use
  • Developing tolerance and requiring higher doses to achieve the desired effects
  • Experiencing withdrawal symptoms when attempting to reduce or stop use

How can I safely stop taking benzodiazepines?

If you have been taking benzodiazepines regularly and wish to stop, it is important to do so under the guidance of a healthcare provider. Abrupt discontinuation of benzodiazepines can lead to severe and potentially life-threatening withdrawal symptoms, such as seizures and delirium tremens.

Your healthcare provider can help you develop a gradual tapering plan to safely reduce your dose over several weeks or months, minimizing the risk of withdrawal complications. They may also recommend additional support, such as therapy or participation in a support group, to address the psychological aspects of benzodiazepine dependence and maintain long-term recovery.

CLINICALLY REVIEWED

Dr Yar Khan, MD

Faz Yar Khan, MD FACP

Medical Director

Dr. Faz Yar Kahn, our Medical Director, is an American Board of Internal Medicine-certified physician. He graduated from the Medical University of the Americas and completed his residency at Mercy Hospital in Chicago. With expertise in primary care, hospitalist medicine, critical care, and addiction medicine, along with ACLS certification, Dr. Kahn leads our team in providing exceptional substance abuse treatment.

Get Started
Now

Call and speak with one of our caring team members about help for you or a loved one.

Get informed

Visit Cornerstone's
Recovery Knowledge Base