Benzodiazepines (benzos) are a group of drugs often prescribed for the short-term treatment of anxiety and panic disorders. Doctors also prescribe them to relieve muscle pain and spasms and sometimes to treat seizures.
Though considered safe when used as directed, benzos can also be highly addictive. They can be even more dangerous when combined with other prescription medications or illicit drugs or when misused in other ways.
Benzos are classified as central nervous system (CNS) depressants. According to the National Institute on Drug Abuse, CNS depressants slow brain activity. This is what makes them effective for treating anxiety and other conditions. Slowing brain activity also creates a sense of euphoria. The euphoric effect is part of what drives people to abuse benzos.
Misuse or abuse of any prescribed medicine means:
- Taking the medication in higher doses or more frequently than directed
- Taking benzos that are prescribed to someone else
- Using medication for its pleasurable effects
- Buying benzos illegally
People who abuse benzos may choose to crush the pills in order to snort or smoke the substance for a more intense and immediate effect. No matter the method of ingestion, misusing benzodiazepines poses a risk to your physical and mental health.
The most recent data from the National Institutes on Drug Abuse (NIDA) found that approximately 30.5 million adults in the U.S. use benzos. Approximately 2% of those who have used the drug admit to misusing it, and about 0.2% meet the standards for benzodiazepine use disorder (BUD).
Other statistics on benzos include:
- Close to 25% of people who misuse benzos do so to reduce stress and improve sleep
- Nearly 6% of those who have abused benzos did so out of curiosity
- Only 20% of people who admit to abusing benzos got them from their doctor
- Around 12% of people who abuse benzos do so to get high
Combining benzos with other illegal or prescribed medications makes them even more dangerous. Tragically, approximately 115 people in the U.S. die every day from an opioid overdose. NIDA reports that around one-third of those overdoses also involved benzos.
The high number of benzo-related fatal overdoses is linked to the increased number of benzo prescriptions being issued in the United States and the increase in opioid use.
Many individual drugs are classified as benzodiazepines. Both brand-name and generic versions are available and widely prescribed. Some of the most commonly used benzos include:
- Byfavo (generic name: remimazolam)
- Doral (generic name: quazepam)
- Halcion (generic name: triazolam)
- Klonopin (generic name: clonazepam)
- Librium (generic name: chlordiazepoxide)
- Niravam (generic name: alprazolam)
- Prosom (generic name: estazolam)
- Restoril (generic name: temazepam)
- Seizalam (generic name: midazolam)
- Serax (generic name: oxazepam)
- Tranxexe SD and Tranxene T-Tab (generic name: clorazepate)
- Valium (generic name: diazepam)
- Xanax (generic name: alprazolam)
Doctors prescribe benzodiazepines to adult men and women as well as some children. A study published by the National Library of Medicine found that women were more likely to use benzos than men.
It also indicated that the generic drug lormetazepam (often sold under the brand name Noctamid) is most likely to be abused by women, and lorazepam is most likely to be abused by men. However, all generic and brand-name versions of benzodiazepines are dangerous and addictive.
Benzos react in the body in ways similar to alcohol. It binds to gamma-aminobutyric acid (GABA) receptors. The job of the neurotransmitter GABA is to block certain signals to the nervous system (the brain and spinal cord) in order to reduce anxiety. When balanced, GABA helps us fight negative emotions and stay calm in stressful situations.
The introduction of benzodiazepine removes the brain’s ability to control how many signals GABA can block. This results in an overload of pleasure-producing chemicals like dopamine. Though it may feel good in the moment, the imbalance created by benzos can lead to addiction and worsen mental health conditions in the long run.
Some of the most common general signs of drug addiction include:
- Wanting to quit but not being able to
- Continuing to use the substance despite experiencing consequences
- Experiencing withdrawal symptoms when you stop using
- Avoiding friends and family in preference to drug use
- Intense cravings for the substance
- Doctor shopping to get more of the drug
- Accusing others of stealing medications or saying they are lost
- Spending a great portion of time getting benzos or recovering from them
- Behaving recklessly, such as driving while under the influence of benzos
Some of the physical signs that are specific to benzo use include:
- Slurred speech
- Inability to focus
- Lack of inhibition
- Loss of coordination
- Falls, accidents, and unexplained injuries
- Problems with memory
- Involuntary eye movements
- Muscle weakness
- Worsening depression
To fully evaluate an individual’s level of dependence and addiction, a mental health professional will consider these symptoms as well as other measures. Before receiving treatments like benzo detox or addiction therapies, potential patients must undergo a thorough mental and physical assessment.
Detox is the process that happens when your body cleanses itself of a substance you have stopped taking. Benzo detox is the first step in healing from benzo addiction. In order to recover from the effects that physical, psychological, and social damage addiction can cause, you must first stop using.
Many people find it helpful to look for a treatment facility that maintains both a women’s detox center and a men’s detox center. Gender-responsive therapy can address social concerns specific to men and women and allow patients to feel safe during treatment.
Benzo detox is physically and emotionally uncomfortable. Depending on your level of addiction, withdrawal symptoms can be severe and even life-threatening. In order to keep you safe, we may recommend a tapering-off protocol in which you reduce your dosage gradually as part of a medically supervised detox program.
The exact timeline of benzo detox varies according to several factors, including:
- The type of benzo you are taking
- Your general health
- Your addiction history (past detox or relapse experiences)
- Whether you are using other substances
Some benzos have a shorter half-life than others, meaning they take less time to leave your bloodstream. With shorter-acting benzos, such as Xanax, detox symptoms typically begin within 10 – 12 hours after the last dose. Stopping the use of longer-acting benzos like Valium may take several days to cause withdrawal symptoms.
In general, benzo detox occurs in two phases.
Phase one is called the acute stage. It begins within a few hours or a few days after the last dose and can last several days. Most of the physical symptoms arise during phase one.
Phase two is called protracted withdrawal or post-acute withdrawal syndrome (PAWS). Cognitive and psychological symptoms are most likely to occur during this stage. Symptoms of PAWS can last six to 12 months.
Withdrawal symptoms occur after the body has become physically dependent on benzos to maintain homeostasis (balance). Without the drug, it can take several days or even weeks for the body to begin producing the right amount of chemicals again and for the central nervous system to correct itself.
Acute benzo detox symptoms may include:
- Nausea and other flu-like symptoms
- Rapid heartbeat
- Vision problems
- Mood swings and irritability
- Muscle spasms
- Suicidal behavior
Long-term or PAWS symptoms can include:
- Low energy
- Balance problems
- Trouble staying focused
- Digestive problems
- Sensory sensitivity
- Suicidal thoughts
Some people might also experience rebound insomnia or anxiety. Rebound symptoms refer to the reoccurrence of the symptoms benzodiazepines were originally prescribed to treat.
Medications can help alleviate the discomfort of benzo detox and reduce the risk of severe symptoms. Your medical team will evaluate your individual needs for pharmaceutical interventions. Four of the most commonly prescribed medications to help with benzo detox include:
Phenobarbital is an anti-seizure medication that is often prescribed to people diagnosed with seizure disorders such as epilepsy. It is effective for treating anxiety during benzo withdrawal and may help detox patients with improved sleep.
Flumazenil is used to treat benzo overdose and may help reduce withdrawal symptoms of benzos with a long half-life.
Buspirone helps to relieve the emotional withdrawal symptoms associated with benzo withdrawal. It may be prescribed for people who take benzos for anxiety because it does not come with a risk of physical dependence.
Clonidine is a medication for treating high blood pressure. It may help treat benzo addiction by blocking the chemicals that trigger sympathetic nervous system activity.
Other medications that doctors commonly prescribe during benzo detox include:
- Non-addictive pain medication
Nutritional therapy and mindfulness practices, such as breathing techniques and meditation, can also help manage detox symptoms.
Poly-drug use disorder refers to abusing or being addicted to more than one drug simultaneously. Opioids, which are also depressants, are one of the types of substances that people commonly use with benzos. When used together, the effects of both substances are enhanced, including the dangerous effects.
Some of the negative effects of benzo poly-drug abuse include:
- Liver damage and liver failure
- Brain damage
- Suppressed breathing
- Heart problems
- Bleeding in the stomach
- Respiratory failure
Combining benzos with other non-prescription or abused prescription drugs increases the threat to your health and may increase your risk of long-term problems. Recovering from poly-drug use disorders can be more difficult for some people because of the physical and psychological damage caused by heavy drug use.
It is dangerous to attempt benzo detox at home without medical care.
Seizure is one of the most serious benzo withdrawal symptoms. Seizures may occur with all types of benzodiazepines if use is stopped abruptly or “cold turkey.” People who have been using benzos at high doses or for extended periods have a higher risk of seizures.
In addition to the potentially life-threatening, severe withdrawal symptoms you may experience, accidental overdose is a major concern. Overdose can happen when a person accidentally takes a larger dose than their body can process. Even in the acute stages of benzo detox, your body may not be able to metabolize the same dosage it used to tolerate.
Once a patient is stable, they can begin participating in the treatments that will help them maintain recovery. Treatment centers typically provide science-backed therapy services, such as:
- Individual counseling
- Group therapy
- Trauma-informed therapy
- Cognitive-behavioral therapy
- Dialectical behavior therapy
Aftercare programs, including sober living opportunities, help patients transition back into daily life while maintaining a strong support network.
Learn more about benzodiazepine addiction treatment.
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