Benzodiazepines, or “benzos,” are a class of sedative drugs administered for the relief of symptoms associated with anxiety and panic disorders, seizures, muscle spasms, insomnia, and alcohol withdrawal.1,2,3 Common prescribed benzodiazepines include:1
Benzodiazepines were first introduced to the medical community as similarly effective substitutes for the more addictive and dangerous barbiturates.2,3 However, with their reinforcing sedative properties, benzos also have a high potential for misuse, and from 1998 to 2008, addiction treatment admissions involving benzo abuse nearly tripled.3,4
Within the benzodiazepine class, various medications are sometimes grouped according to their clearance half-lives as well as their onset and duration of action. Shorter-acting benzos tend to be cleared from the body in a relatively short amount of time, while longer-acting benzos take a longer time to exit the body, and therefore exert their effects over a more sustained duration of time.1,4 A withdrawal reaction from long-acting benzos may not take effect for 1-2 days, if not longer, while shorter-acting benzos may lead to withdrawal in just a few hours.10
Benzodiazepines act primarily on the gamma-aminobutyric acid (GABA) receptors and, through this molecular interaction, increase levels of inhibitory brain signaling—depressing the central nervous system and resulting in sedation and feelings of relaxation.1,3,4 Long-term benzodiazepine use can lead to certain functional changes in the brain that, over time, result in decreased responsiveness to the use of the drug.2 These chronic adaptations serve as the basis for tolerance.
Tolerant individuals will require increasing amounts of benzodiazepine drugs to achieve the desired effect. Over time, the large amounts of drugs taken to overcome tolerance may serve to speed the onset of physiological dependence and, if left unchecked, possibly addiction.2,5
Signs and Symptoms
Signs of benzodiazepine misuse may include the following:1,2,4,
- Pronounced drowsiness.
- Slowed reaction time.
- Double vision.
- Slurred speech.
- Muscle weakness.
- Poor concentration and memory.
- Increased heart rate and blood pressure.
- Excessive sweating.
- Hand tremors.
- Impaired memory, focus, and attention.
- Cognitive deterioration in the elderly.
- Excessive work or school absences.
- Poor occupational or academic performance.
- Familial problems, such as child neglect or divorce.
- Neglect of hobbies and activities that were once enjoyable.
- Loss of close friends due to benzo abuse.
- Increased risk of injury or fatality due to accidents.
- Increased risk of polysubstance abuse (the abuse of more than one substance).
- Increased risk of overdose, especially in a setting of polysubstance abuse.
- Most people who are abusing benzodiazepines have been prescribed these medications for therapeutic reasons.
- Lorazepam (e.g., Ativan), alprazolam (e.g., Xanax), clonazepam (e.g., Klonopin), and diazepam (e.g., Valium) are 4 of the top prescribed medications and also the most frequently seen being sold illicitly.
- Benzodiazepine treatment admissions most commonly include the following demographics: Caucasian (85%) and males (56%), between the ages of 18 and 34 (55%).
- Polysubstance abuse is estimated to be present in 95% of people seeking treatment for benzodiazepines.
- In about 82% of benzo-related treatment admissions, another drug is the primary substance of abuse. Benzodiazepines are often secondary to opioids, alcohol, and marijuana.
- Benzodiazepines accounted for more than 11,000 deaths in 2017 in the United States alone.
Dependence develops as the brain adapts to the effects of a drug and begins to function “normally” only with its continued use. The appearance of withdrawal symptoms upon cessation of use is a clear sign that the user has developed physiological dependence on the drug.6 Benzo withdrawal symptoms may include:1,4
As part of a more protracted withdrawal syndrome, depression, anxiety, and insomnia may persist for extended periods of time following acute withdrawal from benzodiazepines. The existence of such post-acute symptoms can prove to be quite troublesome and could contribute to relapse in recovering individuals.11
Effects of Abuse
Benzodiazepines can be beneficial for short-term management of anxiety, seizure, and muscle spasm, but chronic use or misuse increases the risk of tolerance, escalating patterns of use, and subsequent dependence, as well as associated longer-term side effects. Some of these risks are present even when benzodiazepines are used as prescribed.
Side effects can impact physical and mental health, occupational and social functioning, as well as increase the risk of serious injuries or fatalities.
Side effects can impact physical and mental health, occupational and social functioning, as well as increase the risk of serious injuries or fatalities. Other consequences may include the following:1,4
Mental Health Effects and Other Consequences
Overdose Signs and Symptoms
Abusing benzodiazepines with other central nervous system depressants increases the risk of respiratory depression, coma, and death by accidental overdose.1,3,7 If you suspect an overdose on benzodiazepines or a combination of drugs, call 911 or take the affected individual to an emergency room immediately.
Although benzodiazepines are legally prescribed medications, they have considerable abuse potential and their misuse can have detrimental results, particularly when combined with other substances. The following statistics provide a picture of benzodiazepine abuse and some of the associated risks:2,8,9
- Harvard Health Publishing: Harvard Medical School. (2019). Benzodiazepines (and the alternatives).
- Drug Enforcement Administration. (2019). Benzodiazepines.
- Schmitz, A. (2016). Benzodiazepine use, misuse, and abuse: A review. Ment Health Clin, 6(3), 120-126.
- Center for Substance Abuse Research (CESAR). (2013). Benzodiazepines.
- National Institute on Drug Abuse. (2007). The Neurobiology of Drug Addiction: 6: Definition of Tolerance.
- National Institute on Drug Abuse. (2007). The Neurobiology of Drug Addiction: 8: Definition of Dependence.
- Gresham, C. (2018). Benzodiazepine Toxicity.
- Kroll, D.S., Nieva, H.R., Barsky, A.J., Linder, J.A. (2016). Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care. J Gen Intern Med, 31(9), 1027-1034.
- National Institute on Drug Abuse. (2019). Overdose Death Rates.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal. Substance Abuse Treatment Advisory, 9(1), 1-8.