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Benzodiazepine Abuse

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Benzodiazepines (benzos) are commonly prescribed medications in the United States. In 2017, there were over 120 million benzodiazepine prescriptions dispensed throughout the country.1 Benzos belong to a larger group of medications known as sedative-hypnotics and are commonly used to treat anxiety, panic disorder, muscle spasm, certain seizure disorders, and, in rarer cases, sleep disorders.14 Unfortunately, there is also a significant problem with benzodiazepine abuse in the U.S.

With continued use, both tolerance and physiological dependence on benzodiazepines may develop. As a result, people may feel the need to take more benzos to produce the desired effect and then continue taking them to avoid withdrawal. Though these aren’t the only contributing factors, both of these phenomena can contribute to ongoing, compulsive use, or benzodiazepine abuse.1

In the United States, benzodiazepines are Schedule IV controlled substances, meaning they have known abuse potential and are available only by prescription.1 With the potential for misuse, it’s important to understand what benzodiazepines are, how they work, potential adverse health effects, and signs and symptoms associated with misuse. If you or a loved one feel that you may be struggling with misuse, this article will also help you understand various treatment options available.


What Are Benzodiazepines?

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Benzodiazepines are central nervous system (CNS) depressants. CNS depressants slow certain types of brain activity, potentially resulting in drowsiness and sedation that can be useful for individuals taking them as prescribed by a physician.2 What benzodiazepines are prescribed for is to help treat: 2

  • Anxiety.
  • Panic.
  • Acute stress reactions.
  • Sleep disorders.
  • Muscle spasms.
  • Seizures.

Types of Benzodiazepines

There are a number of different benzodiazepines prescribed in the United States with the five most commonly prescribed in the U.S. being:1

  • Diazepam (Valium).
  • Alprazolam (Xanax).
  • Lorazepam (Ativan).
  • Clonazepam (Klonopin).
  • Temazepam (Restoril).

How Do Benzodiazepines Work?

Benzodiazepines alter brain chemistry by increasing the inhibitory activity of GABA, resulting in a “slowing” of certain neural processes.2 It is the slowing down of brain activity that can lead to the sedative effects of benzos.

Benzos are often grouped according to their duration of action, which can be anywhere from 6 to 24 hours in length.1 A healthcare provider can help determine which type of benzodiazepine is appropriate based on factors such as age, underlying health problems, presenting problems, and other factors.


Benzodiazepine Side Effects

Benzo effects are different for everyone. Common side effects of benzodiazepines can occur even when taken as prescribed and can include:4

  • Blurred vision.
  • Confusion.
  • Dizziness.
  • Drowsiness.
  • Decreased concentration.
  • Lack of coordination.
  • Nightmares.
  • Decreased libido.
  • Hypotension.
  • Respiratory depression.

Benzodiazepine Withdrawal Symptoms

If a person has been taking benzodiazepines for an extended period of time, they can become dependent on them and may experience withdrawal symptoms if they suddenly stop or decrease usage.6 Due to the risk of withdrawal symptoms and the potential for misuse, benzodiazepines are generally prescribed for short-term use of 1 to 2 weeks.6

Withdrawal symptoms can begin to occur within hours for short-acting benzodiazepines with no active metabolites and within several days to a week for longer-acting benzodiazepines.7 Withdrawal symptoms can range from mild to severe and may vary in duration depending on the specific benzos used. Signs of benzodiazepine withdrawal include:6

  • Panic and anxiety.
  • Irritability.
  • Sensory issues (hypersensitive to sight, sound, touch, or taste).
  • Difficulty focusing and concentrating.
  • Memory impairment.
  • Blurred vision.
  • Muscle pain and stiffness.
  • Metallic taste in mouth.
  • Nausea.
  • Paranoia.
  • Delusions.
  • Hallucinations.
  • Depersonalization.
  • Depression.
  • Dizziness.
  • Poor appetite.
  • Diarrhea.
  • Difficulty falling asleep.
  • Nightmares.

Signs and Symptoms of Benzodiazepine Abuse

If you think you or a loved one may be compulsively misusing benzodiazepines, it is important to speak with a medical professional. They can assess what level of treatment may be needed based on factors such as age, amount of drug use, duration of drug use, types of drugs used, underlying medical and mental health concerns, and any history of addiction.

Long-term use of benzodiazepines, using higher doses than prescribed, and/or mixing with other substances can result in a number of physical and/or psychological signs and symptoms of misuse.5

While it may be hard to identify all the potential signs of compulsive or problematic use in oneself or others, treatment professionals are in the best position to evaluate and diagnose benzodiazepine abuse. The following 11 criteria that professionals use to make a diagnosis of benzodiazepine use disorder:7

  • Benzodiazepines are often taken in larger amounts or over a lon­ger period than was intended.
  • There is a persistent desire or unsuccessful efforts to cut down or control benzodiazepine use.
  • A great deal of time is spent in activities necessary to obtain, use, or recover from the effects of benzodiazepines.
  • Craving, or a strong desire or urge to use benzodiazepines.
  • Recurrent benzodiazepine use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences from work or poor work performance).
  • Continued use of benzodiazepines despite having persistent or re­current social or interpersonal problems caused or exacerbated by their effects.
  • Important social, occupational, or recreational activities are given up or reduced as a result of benzodiazepine use.
  • Recurrent use of benzodiazepines even in situations where it could be physically dangerous, such as driving.
  • Use of benzodiazepines continues despite knowing that one has a persistent physical and/or psychological problem that’s likely to have been caused by the substance.
  • Tolerance, which may include a need for markedly increased amounts of the substance to achieve the desired effect, or less effects from the substance even though a person may be taking the same amount as before.
  • Withdrawal, which may include characteristic withdrawal symptoms (noted above) or use of other types of sedatives, hypnotics, or anxiolytics to relieve or avoid withdrawal symptoms.

Dangers of Mixing Benzodiazepines with Other Substances

Some people use or misuse multiple substances at once, which is known as polysubstance use or misuse. Mixing substances like benzodiazepines with other substances may intensify the euphoric feeling or “high” that would otherwise be experienced with each individual substance.

In some cases, benzos are used to counteract the agitating and stimulating effects associated with cocaine and other stimulants.1 Unfortunately, there can be serious risks associated with mixing substances, particularly when mixing benzodiazepines with alcohol and/or opioids.

One of the biggest risks of mixing benzodiazepines with alcohol and/or opioids is the possibility of overdose and death.4 Because of this risk, in 2016 the Centers for Disease Control and Prevention (CDC) changed the guidelines for the practice of prescribing opioids. These changes encouraged medical professionals to not prescribe opioids and benzodiazepines together.3

Statistics that further highlight the dangers of mixing benzodiazepines with alcohol and opioids include:8

  • In 2011, benzodiazepines were involved in 31% of all opioid-related deaths, which is a substantial increase from the 18% reported in 2004.
  • Approximately 1 of 5 people in the United States who abuse alcohol also abuse benzodiazepines.
  • People who have a prescription for both benzos and opioids are at 15-times greater risk of drug-related death than those not prescribed either drug.
  • In 2016, 16% of opioid-related deaths involved a benzodiazepine.3

Mixing Benzodiazepines and Alcohol

When benzodiazepines are combined with alcohol, a number of potentially adverse health effects can occur, some of which may be temporary and mild, while others can be more severe. These include:9, 15

  • Loss of motor coordination.
  • Poor judgment and decision-making.
  • Falls and accidents.
  • Markedly depressed heart rate and breathing.
  • Liver and kidney injury.
  • Cardiovascular problems.
  • Exacerbation of pre-existing psychiatric conditions.
  • Increased dementia risk.

Mixing Benzodiazepines and Opioids

Simultaneously taking benzodiazepines with opioids can have adverse health effects as well. In addition to the above-mentioned problems, mixing benzos with opioids can potentially lead to:3

  • Impaired cognitive functions.
  • Slowed breathing.
  • Respiratory arrest.
  • Overdose death.

Both opioids and benzodiazepines can depress vital physiological functions. When they are used together, or when opioids are used with other types of CNS depressants (e.g., barbiturates, non-benzodiazepine sedative-hypnotics, etc.), the functions of the central nervous system can be significantly depressed which can lead to the effects listed above.10 If you or someone you know is struggling with polysubstance misuse, seek medical assistance immediately to understand the risks and identify treatment options.


Benzodiazepine Addiction Treatment

If you or a loved one are struggling with benzodiazepine use, you are not alone—help is available. Treatment for benzodiazepines and other substances occurs on a continuum and can involve different types of services with varying degrees of intensity.

Treatment should be tailored to meet a person’s unique needs and can include the following:11

  • Outpatient: A person receives treatment, which may include detox, therapy, support groups, and more, but does not stay overnight in the facility.
  • Intensive Outpatient (IOP) and Partial Hospitalization Programs (PHPs): With IOP and PHP programs, a person does not live in the facility, but may be required to spend more time at the treatment facility to engage in therapy, support groups, and other services to support recovery.
  • Residential/Inpatient: People receiving treatment stay overnight in the facility. Services can include therapy, support groups, detox, and treatment for co-occurring disorders.
  • Medically managed intensive inpatient: When more critical care is needed, a person may need to spend some time in a hospital setting. Services include 24/7 medical monitoring by a nurse as well as regular physician care. Counseling is available, but the goal is to stabilize a person’s physical health before addressing behavioral, psychological, social and other factors related to addiction.

Level of care is determined by many individual factors, which may include underlying medical and mental health issues, length of addiction, and types of drug used. Your treatment plan and levels of care are determined by you and your treatment provider based on your unique needs.

Creating a treatment plan that addresses your unique needs is key to successful treatment outcomes. The goal of substance abuse treatment is to not only help a person stop using drugs and alcohol, but also to help return people to productive functioning in all areas of their lives including at work/school, with their family, and in the community.12

Effective treatment addresses the “whole” person including underlying mental health issues, physical issues, family, and other social factors. Treating mental illness in conjunction with a substance use disorder has been proven to lead to better treatment outcomes than addressing each issue separately.13

Treating co-occurring disorders often involves collaboration among clinical providers and addresses things such as legal problems, homelessness, vocational skills, physical health.13


Benzodiazepine Detox

Detox is typically the first order of treatment when addressing benzodiazepine abuse. Due to the propensity for withdrawal symptoms, medical supervision is highly recommended during detoxification. Tapering off of benzodiazepines is also recommended rather than abruptly discontinuing use, regardless of how long a person has been taking them.16

Medically supervised detox creates a safe, monitored environment for medical staff to manage withdrawal medications. This may include slowly tapering off by using the same benzodiazepine the person is already taking, which can take several weeks or even months. This is typically more effective when a person has been using long-acting benzos.16

In some cases, it may be helpful to use a different type of benzodiazepine to manage withdrawal, particularly in cases where a person has significant loss of control and/or abuse problems with the benzo they primarily misused.16


Does Insurance Cover Benzodiazepine Addiction Treatment?

Treatment for substance use disorders depends on the level of care and treatment facility a person chooses. Some treatment facilities may offer scholarships, payment plans, financing, and accept insurance to help pay for the cost of treatment. If you have health insurance, be sure to check with your provider about the types of addiction treatment they cover as a part of your plan.

If you or a loved one are ready to get help for a substance use disorder, American Addiction Centers is here to help. Our compassionate admissions navigators understand the challenges related to addiction and substance misuse, and can discuss the various treatment options available. Call 1-877-740-4716 to verify insurance and get valuable information about addiction treatment today.

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Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating him to seek a clinical psychiatry preceptorship at the San Diego VA Hospital’s Inpatient Alcohol and Drug Treatment Program. In his post-graduate clinical work, Dr. Thomas later applied the tenets he learned to help guide his therapeutic approach with many patients in need of substance treatment. In his current capacity as Senior Medical Editor for American Addiction Centers, Dr. Thomas, works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.
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