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The opioid epidemic has brought much-needed attention to the overuse of medications in the U.S. The focus on opioids is important, but unfortunately, opioids aren’t the only class of prescribed medication with a high risk of addiction.
Benzodiazepines are another frequently prescribed medication that is often abused. Research published in Psychiatric Services estimates that misuse accounts for nearly 20% of all benzodiazepine use in the U.S.
Benzodiazepine addiction is a serious issue that requires professional intervention and, in some cases, medical care. If you or someone you know have become addicted to benzodiazepines, do not try to quit “cold turkey.” Depending on your level of dependence, suddenly stopping could be life-threatening. In most cases, a tapering-off procedure is required to safeguard the individual’s physical and mental health.
Benzodiazepines, or benzos, are a class of medications that block excess activity in the central nervous system. They have been in use for more than 50 years and are often prescribed for anxiety, depression, seizure disorders, and symptoms of alcohol withdrawal. They might also be used as a muscle relaxant and to induce sleep. Benzodiazepines are included in the DEA list of controlled substances because of their potential for abuse.
The National Institute on Drug Abuse (NIDA) explains that benzodiazepines work by binding to and inhibiting certain gamma amino-butyric acid (GABA) receptors. GABA receptors are neurotransmitters that help inhibit the kind of nerve activity that initiates seizures and anxiety. However, benzos do more than just inhibit neurotransmitters.
NIDA reports that benzos also react with the brain’s reward center, promoting feelings of pleasure and joy. When these changes in brain chemistry are made frequently and regularly — as is usual when taking prescription medication — it can lead to addiction and physical dependence. In time, the brain is no longer able to function normally without the drug.
Benzodiazepine is the name of the class of medication, but there are many types and brand names of benzos available. Some of the most common types of benzos include:
If a person develops both physical and psychological dependence on benzos, a comprehensive addiction treatment program is needed. Benzo addiction requires medically supervised detox to protect a patient’s safety, along with the support of behavioral therapies.
All types of benzodiazepines have the potential to be addictive, but some have a higher risk of addiction than others. The half-life of a medication can affect its potential for abuse. The half-life refers to the amount of time for the concentration of a substance to reduce to half when measured in the bloodstream.
For example, the benzo Ambien has a half-life of two hours. That means the level of Ambien in your system will peak and reduce by half within about two hours. Generally, it takes 5.5 half-lives for a drug to be completely eliminated from the body. That means it would take approximately 11 hours for a dose of Ambien to no longer have any effect.
The half-life of any medication varies from person to person and is affected by:
Due to these variances, a half-life is considered to be a guide. Even with these factors in mind, benzos with the shortest half-lives are considered to have more potential to be addictive because their effects last the shortest time. Whether a person is using the medication for a legitimate health issue or is abusing it for pleasure, the temptation to take more frequent doses will be higher with benzos that are naturally eliminated from the body more quickly.
Benzodiazepines are also classified as low- and high-potency. High-potency benzos carry a greater risk of addiction.
Low-potency benzos include:
High-potency benzos include:
Xanax, Ativan, and Halcion also have short half-lives, so they can be considered some of the most potentially addictive benzos on the market.
Benzos and opiates are considered equally addictive. Some of the similarities between the two drugs include:
One of the main differences between benzodiazepines and opioids is in how they are prescribed. Opioids are primarily prescribed to treat pain, while benzos are primarily prescribed to treat anxiety disorders.
Another difference is in how they affect the brain. While benzos activate inhibitory neurotransmitters to depress nerve activity, opioids block pain receptors and produce feelings of euphoria.
Alcohol and benzodiazepines are both central nervous system depressants, and they both carry a high risk of addiction. Some people may believe that because alcohol does not require a prescription and is not a controlled substance, it must be safer than benzos or other prescribed medication.
Alcohol is one of the most widely abused substances in the U.S. The National Institute on Alcohol Abuse and Alcoholism reports that over 14.5 million Americans age 12 and older have alcohol use disorder.
An even more serious danger comes from mixing alcohol and benzodiazepines. The National Institute on Drug Abuse reports that overdose deaths attributed to combining benzos and alcohol are more likely to occur when people view prescription medications as “safe” because they are prescribed by a doctor.
Tolerance may be the major factor in alcohol-benzo overdose. Alcohol and benzodiazepines both act as central nervous system depressants, and each enhances the effects of the other. When an individual who is addicted to either builds up a tolerance to their preferred substance, they might experiment with an additional substance to achieve the desired results.
According to the CDC, combining the two drugs increases the risk of suppressed breathing and brain function and dangerously low heart rate.
Benzo prescriptions are typically written for short-term use. The longer the drug is used, the greater the risk of addiction. Exactly how long it takes to develop addiction varies by person. Factors that affect addiction rates include:
Whether the medication is being taken as prescribed or being abused also affects the chances of addiction. Some people can become addicted in as little as a month. If you have been taking benzodiazepines for more than six months, you may already have developed an addiction and physical dependence.
Warning signs of a benzo addiction include:
Swallowing benzo pills is a common way to ingest the drug, but some people crush and inject benzodiazepines for a more immediate and intense effect. Any indication of paraphernalia, such as hypodermic needles, is another warning sign to be aware of.
Common signs of benzo intoxication include:
In addition to addiction and physical dependence, long-term use of benzodiazepines is linked to a number of other serious health effects
These effects include:
Some of the side effects of long-term use improve after an individual has completely detoxed from benzos. However, cognitive decline can continue for several months.
If you or someone you know is addicted to benzos, it’s important to seek treatment to start improving quality of life and possibly lessen the effect of benzo withdrawals. Some potential treatments include:
Whatever route taken, it’s also important to be aware of the withdrawal process and prepare yourself adequately.
The withdrawal process differs for each person and depends on several factors, including how long you have been using the drug, what your current dose is, and whether you have other substance use patterns. Benzodiazepine withdrawal symptoms may include:
Symptoms can begin within hours of the last dose. For most people, the physical symptoms of withdrawal last about two to four weeks, depending on the person’s health history and level of addiction. For most people, withdrawal happens in stages, though symptoms can overlap.
Benzodiazepine withdrawal stages begin with the acute stage — symptoms that are experienced anytime after the last dose. Acute symptoms can last as long as 18 months, though they become milder and easier to manage after the first few weeks. Protracted withdrawal, sometimes known as long withdrawal, refers to symptoms that are still experienced after 18 months.
Long withdrawal may be prevented by following a tapering-off protocol. Slowly weaning off benzos is easier on the body and helps reduce the severity of symptoms. The symptoms of long withdrawal are typically the same symptoms that were experienced during acute withdrawal and are considered an ongoing threat to the individual’s ability to remain drug-free.
Detoxing from benzos does not have to be a terrible experience. Treatment programs like the one at Lakeview Health provide the medical care needed to help people manage their withdrawal symptoms.
Treatment options for benzo withdrawal can ease symptoms and prevent serious complications. The sooner rehab clients feel better, the sooner they are able to participate in the therapies that will help them maintain recovery for life.
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