Benzodiazepine Misuse

Though widely prescribed, benzodiazepines can be dangerous. This article will discuss benzodiazepines, signs of benzodiazepine misuse and addiction, and benzodiazepine addiction treatment.
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What are Benzodiazepines?

Classified as prescription sedatives or central nervous system (CNS) depressants, benzodiazepine drugs are often used to treat anxiety, panic disorder, and other conditions.1,2 They are some of the most widely used prescription drugs. In 2017, there were around 120.2 million benzodiazepine prescriptions dispensed in the United States.2

When people use them as directed and for short periods of time, benzodiazepines use can be helpful for their intended purposes. However, benzodiazepines may also be misused:3

  • For their euphoric properties.
  • To enhance the effects of other drugs.
  • To reduce the undesired effects of other drugs.
  • To mitigate benzodiazepine withdrawal symptoms.

Benzo misuse can lead to addiction and other health risks.

Types of Benzodiazepines

Benzodiazepines can be classified as long-acting, intermediate-acting, or short-acting.5 These classifications refer to their half-life (i.e., the amount of time it takes for half the dosage to be eliminated from the body).4

Common long-acting benzodiazepines include:3

  • Valium (diazepam).
  • Librium (chlordiazepoxide).
  • Dalmane (flurazepam).
  • Tranzene (clorazepate).

Intermediate-acting benzos include:3

  • Xanax (alprazolam).
  • Klonopin (clonazepam).
  • Ativan (lorazepam).
  • Serax (oxazepam).
  • Restoril (temazepam).

Short-acting benzos include:3

  • Versed (midazolam).
  • Halcion (triazolam).

Benzodiazepine Uses

In addition to treating anxiety and panic disorders, benzodiazepines may be prescribed for:2

  • Managing seizure disorders.
  • Alcohol withdrawal management.
  • Anesthesia and procedural sedation.
  • Insomnia.

Benzodiazepines are generally prescribed only for short periods of time, as they have the potential to cause physiological dependence quickly, even when used as intended.5

How Do Benzodiazepines Work?

Benzodiazepines and other CNS depressants can calm an otherwise overexcited nervous system, making them effective in treating the conditions discussed above.1

The benzodiazepine mechanism of action involves its interaction and influence on activity at the gamma-aminobutyric acid (GABA) receptor complex.1,2 Through interaction with its corresponding GABA receptors, GABA serves as a signal that increases inhibitory brain signaling and counters excitation.2

Long- and Short-Term Effects and Dangers of Benzo Use

Using and misusing benzodiazepines may produce various short-term side effects and is also associated with some long-term effects and risks.2,6

Short-Term Side Effects of Benzodiazepines

Some of the potential short-term benzodiazepine side effects include:2,6

  • Lack of coordination and delayed reactions.
  • Impaired memory.
  • Slurred speech.
  • Drowsiness.
  • Confusion.
  • Headache.
  • Nausea or vomiting.
  • Diarrhea.
  • Tremor.
  • Depression.
  • Fainting.

In rare cases, people taking benzos may experience paradoxical reactions (i.e., opposite reactions to the desired effects). These reactions are characterized by acute excitement and an altered mental state and may also include:7

  • Increased anxiety.
  • Hyperactivity.
  • Aggression, hostility, and rage.
  • Paranoia.
  • Restlessness.

Long-Term Effects and Risks of Benzodiazepines

Long-term dangers of benzodiazepines use may be more common with chronic and high-dose administration.8 Effects and risks can include:8

  • Oversedation.
  • Long-term cognitive impairments.
  • Impaired psychomotor performance, such as an increased risk of falls and fractures (especially in the elderly), and motor vehicle accidents.

People that chronically use benzodiazepines are at risk for developing physiological dependence and sedative use disorder.2,3

Benzodiazepine Addiction and Overdose

Are Benzodiazepines Addictive?

Yes, the clinical diagnosis for benzo addiction is sedative use disorder. Sedative use disorder is characterized by compulsive misuse despite serious medical, social, or psychological consequences.9

Benzos can cause physiological dependence that may lead to a range of mild to life-threatening withdrawal symptoms.10 In a minority of people, withdrawal symptoms can be severe and look like serious psychiatric and neurological conditions, like schizophrenia and seizure disorders.10

Benzodiazepines also act on dopamine—a brain chemical associated with motivation, reward, and pleasure.10 This action is believed to reward or reinforce continued use.10

Those with a prior history of drug misuse or polysubstance use—using more than one substance at a time—are at heightened risk for benzo misuse and dependence.2

Signs of Benzodiazepine Abuse and Addiction

Prescription benzodiazepine misuse can include:11

  • Using the drug in higher doses or in ways other than prescribed (like crushing and then snorting pills).
  • Taking someone else’s prescription, even if it’s for valid medical conditions.
  • Taking benzodiazepines to feel euphoria or get high.

Someone who continues to chronically misuse benzodiazepines even as it causes serious consequences in their lives likely has a sedative use disorder.9 The American Psychiatric Association (APA) provides the following diagnostic criteria for sedative use disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):9

  1. Using benzos in increasing amounts or for longer periods of time than originally intended
  2. Being unable to cut down on or quit benzo use despite a desire or attempts to do so
  3. Spending a lot of time trying to obtain, use, or recover from the effects of benzodiazepines
  4. Feeling cravings, or strong urges for benzodiazepines
  5. Being unable to fulfill major obligations at work, home, or school because of benzodiazepine use
  6. Continuing to use benzos despite having interpersonal or social problems caused by benzodiazepine use
  7. Giving up important social, work, or recreational activities because of benzodiazepine use
  8. Recurrent benzo use in situations where it is dangerous to do so (such as driving or operating machinery)
  9. Continuing to use benzodiazepines despite the knowledge of having a physical or psychological problem caused or worsened by benzo use
  10. Tolerance, i.e., needing increasing or more frequent doses to experience previous effects (this does not indicate addiction in someone using benzodiazepines as prescribed by a doctor)
  11. Withdrawal symptoms when ceasing or reducing benzo use (this does not indicate addiction in someone using benzodiazepines as prescribed by a doctor)

A medical professional may diagnose someone with sedative use disorder if they exhibit 2 or more of the above criteria in a 12-month period.9

Can You Overdose on Benzos?

Yes, it is possible to overdose on benzodiazepines. The overwhelming majority of benzo-involved overdoses, however, involve polysubstance misuse, typically opioids or alcohol.12,13 Polysubstance misuse is the misuse of multiple drugs at the same time or within a short time of each other.14

Overdose on benzodiazepines typically causes symptoms of CNS depression combined with normal (or almost normal) vital signs.12 Overdose symptoms and signs can vary if a person has also used other substances. If someone is overdosing on benzodiazepines, you may notice specific signs, such as: 15

  • Slurred speech.
  • Confusion and impaired mental status.
  • Respiratory depression.

If someone is overdosing, even if you’re not sure it’s an overdose, it’s best to act as if it is, because you could save their life. You should call 9-1-1 right away and then do the following:14,16

  • Administer naloxone (Narcan, Kloxxado) if you suspect opioid involvement. Naloxone will only have an effect if the person has used opioids, but it will not cause harm if they don’t have opioids in their system.
  • Keep the person awake and breathing.
  • Lay them on their side to prevent choking.
  • Stay with the person until emergency services have arrived.
Withdrawal, Detox and Treatment for Benzo Addiction

Benzodiazepine Detox and Withdrawal

People who have used benzodiazepines for longer than 3–4 weeks are likely to have withdrawal symptoms if they abruptly stop using the drug or significantly reduce their dose.5 Benzodiazepine withdrawal symptoms can be dangerous and it is recommended a person consult with a doctor before discontinuation or that they undergo medical detoxification.1

According to the DSM-5, benzo withdrawal symptoms can include:9,17

  • Increased heart rate.
  • Sweating.
  • Hand tremor.
  • Insomnia.
  • Nausea and vomiting.
  • Auditory and visual hallucinations.
  • Restlessness and uncontrollable movements.
  • Anxiety.
  • Grand mal seizures.

Medical detox for benzodiazepine addiction often involves administering a long-acting benzo in tapering doses to reduce the risk and severity of seizures.17 Addiction specialists may also prescribe anticonvulsants like carbamazepine, gabapentin, or valproate to further mitigate withdrawal symptoms.1,17

The severity of benzodiazepine withdrawal and its timeline can depend on several factors, including the:9,17

  • Half-life of the benzo used.
  • Dosage and frequency the drug or drugs have been used.
  • Length of time someone has been misusing benzos.
  • Presence of other substance dependencies (e.g., alcohol, opioids).

Withdrawal from short-acting benzos (such as lorazepam, oxazepam, or temazepam) can begin within 6-8 hours of your last use, while withdrawal symptoms from long-acting benzos (such as diazepam) may not develop for up to a week.9

Withdrawal symptoms from short-acting benzos can peak in intensity on the second day and noticeably improve by the fourth or fifth day, while withdrawal symptoms from long-acting benzos can peak in intensity during the second week, and decrease markedly during the third or fourth week.9

Patients may develop protracted withdrawal symptoms after quitting benzodiazepines, which typically occurs 4-6 weeks after the initial withdrawal period.18 Symptoms can include:18

  • Anxiety.
  • Depression.
  • Psychotic reactions.
  • Memory impairment.
  • Motor symptoms (muscle jerking, eye twitching, blinking).
  • Paresthesia (burning or prickling sensations).
  • Formication (feeling like insects are crawling under your skin).
  • Tinnitus.
  • Irritable bowel syndrome (IBS).

Symptoms of protracted withdrawal tend to come and go and can persist for 6-12 months, but anxiety can last for up to 2 years.18

How to Quit Misusing Benzodiazepines

Detox is an important step in recovery, but it is often not enough for most people to achieve long-term sobriety. Studies show that detox followed by the appropriate levels of continued treatment is effective in helping people achieve lasting recovery.17

Different types of rehab, such as intensive outpatient, partial hospitalization, or inpatient rehab, offer a combination of treatment approaches. These methods include behavioral therapy, peer support, relapse prevention strategies, and treatment for co-occurring disorders.1,19 Addiction treatment is most effective when it is tailored to the patient’s unique needs.19

If you or someone you care about are struggling with benzodiazepine misuse, call to learn more about our inpatient rehab in Las Vegas or outpatient rehab. Admissions navigators can help you start the admissions process today, explore ways to pay for rehab like using insurance to cover addiction treatment, or go over the different levels of rehab offered at Desert Hope.

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