The Effects of Benzodiazepine Use
Are Benzodiazepines Harmful?
Benzodiazepines, or “benzos,” are drugs prescribed to help control anxiety and seizure disorders. They are central nervous depressants, which means that they slow brain activity. Some commonly prescribed benzos include 1:
In small doses over a short period of time, these drugs are helpful for thousands of people. However, chronic use can lead to dependence on the drug, and misuse or abuse can have harmful consequences, such as addiction and physical dangers ranging from excessive drowsiness to tremors 2.
Benzodiazepines’ Short-Term Effects
The increase in dopamine activity that occurs in association with benzo use reinforces continued use of these drugs which, in turn, promotes the development of addiction in some people who take them.
In the short-term, benzodiazepines can cause the following pleasurable effects 2:
- Euphoria, or intense feelings of pleasure.
Benzos influence the activity of a chemical in the brain called gamma-amino butyric acid, or GABA. GABA is an inhibitory neurotransmitter that slows brain activity 2. Benzodiazepines function by intensifying GABA activity, which ultimately results in sedation and anxiety relief 3.
More recent research indicates that benzos also increase dopamine release in the reward centers of the brain. The increase in dopamine activity that occurs in association with benzo use reinforces continued use of these drugs which, in turn, promotes the development of addiction in some people who take them 3. The repeated use of these drugs leads to increased feelings of euphoria—for many, a desirable effect mediated, in part, by dopaminergic activity throughout the reward centers of the brain 4. However, the subsequent development of tolerance leads to an increased need for more and more of the drug to achieve the same levels of response over time 2.
Side effects can occur even when taken at therapeutic dose; however the risk of adverse effects markedly increases at higher doses. Possible side effects include 2:
- Excessive drowsiness.
- Double vision.
- Slurred speech.
- Impaired coordination.
- Increased risk of falls, especially in the elderly 4.
- Memory and cognition problems.
- Mood swings.
Some less common adverse effects include 5:
- Changes in sex drive.
- Menstrual problems in women.
- Jaundice (yellowing of eyes and skin).
- Muscle weakness.
- Severe itching.
A phenomenon known as paradoxical disinhibition can occur with benzodiazepine use 1. This reaction is characterized by a contradictory reaction to the sedative, including hostile, impulsive, aggressive, irritable, or excitable moods, which can lead to antisocial or violent behaviors 1.
The dangers of benzodiazepine abuse increase dramatically when mixed with other central nervous system (CNS) depressants, such as alcohol and opioids 6 because the combination can cause severe respiratory depression.
Long-Term Effects of Abusing Benzodiazepines
Apart from the potential physical health complications, over time, continued use and abuse of benzodiazepines has the potential to cause a number of mental health complications, such as 1,4,7:
- Suicidal ideation.
- Cognitive dysfunction.
Additional consequences of chronic benzodiazepine abuse may include:
- Chronic absenteeism.
- Job loss.
- Academic expulsion.
- Familial problems, such as divorce or child neglect.
- Legal consequences, such as driving under the influence (DUI).
- Financial hardships.
- Physical injuries due to intoxication.
- Criminal offenses, such as assault or burglary.
While these long-term effects do not occur in all users, they are relatively common occurrences in those with chronic substance abuse problems.
Additionally, preliminary research indicates an association between long-term benzodiazepine use and an increased risk of Alzheimer’s disease 8.
People taking benzodiazepines will typically develop tolerance to the drug over time 1. As tolerance grows, it takes greater amounts of the drug to achieve the same effect as a smaller dose previously did. This tolerance can occur quickly in some people and contributes significantly to the development of physical dependence.
Some cases of benzodiazepine dependence have been shown to occur in as little as four weeks 1. In addition to tolerance, certain factors – such as potency of the drug, duration of use, and dose – influence the development of physical and psychological dependence 1.
Dependence does not necessarily equate to addiction; however, as dependence takes hold the risk of addiction increases. You may be developing an addiction if you begin exhibiting the following behaviors 9:
- Taking more of the drug than prescribed by your doctor.
- Taking your benzodiazepine in combination with other drugs, especially alcohol, despite dangers.
- Taking the drug in a hazardous situation, such as driving a car.
- Spending a great deal of time thinking about using and acquiring the drug.
- Ignoring family and occupational responsibilities due to your drug use.
- Failing to cut down on or quit using benzodiazepines despite repeated attempts.
- Cravings to use benzodiazepines.
- Continuing to use despite psychological and physical problems exacerbated or caused by the sedative.
- Giving up previously enjoyed hobbies in favor of using.
- Continuing to use regardless of social or interpersonal difficulties.
- Needing to take increasing amounts to get the same pleasurable effects.
- Experiencing withdrawal when not using.
Some users may steal or engage in other criminal behaviors in order to obtain benzos, while others may go to more than one doctor to get multiple prescriptions of the drug.
Benzodiazepine Withdrawal Treatment
The phenomenon of benzodiazepine withdrawal can add to the challenges that addicted individuals face when attempting to quit, no matter how strong the desire to do so. Withdrawing from benzos can be exceedingly difficult for an addicted person to try on their own, due to uncomfortable withdrawal symptoms and cravings. In addition, it can be dangerous to withdraw from these drugs without medical supervision. Symptoms of withdrawal, which are similar to those associated with alcoholism, can include 1,9,10:
- Hand tremors.
- Excessive sweating.
- Increased heart rate, breathing rate, and blood pressure.
- Muscle pain.
- Difficulty concentrating.
- Nausea or vomiting.
- Extreme anxiety.
Not all people in benzo withdrawal experience the full range of these symptoms, but the potential for severe, medically complicating withdrawal effects should always be considered 4. Seizures, severe agitation, and delirium can occur during withdrawal. In the elderly, heart attacks can also occur during this time 4. Medical supervision as part of a professional detox program can ensure safety, increase comfort, and provide the comfort of mind that medical complications will be quickly addressed.
Detoxing from benzodiazepines usually involves a tapering of the dose until the drug is completely removed from the body 4. This may take many weeks or months 4. At times, the withdrawal will involve switching from one benzodiazepine to another – typically a longer-acting one that requires less frequent dosing – to ease this process 4.
Again, all of these methods require close medical supervision to ensure the safety of the person involved, as well as the success of the detox process. It should also be noted that many people who are addicted to benzos also abuse other drugs, including alcohol 9. When someone is addicted to, or abusing, multiple substances, the medical supervision for withdrawal becomes increasingly important for safety.
Finding a Benzodiazepine Recovery Program
A comprehensive treatment plan involving therapy and counseling is effective in treating benzodiazepine addiction. There are many recovery programs available at a wide variety of costs that can assist in the withdrawal and recovery process from benzodiazepine addiction.
- Longo, L.P. (2000). Addiction: Part I. Benzodiazepines—Side Effects, Abuse Risk and Alternatives. American Family Physician, 61(7), 2121-2128.
- Center for Substance Abuse Research. (2013). Benzodiazepines.
- National Institute on Drug Abuse. (2012). Well-Known Mechanism Underlies Benzodiazepines' Addictive Properties.
- Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 45.) 4 Physical Detoxification Services for Withdrawal From Specific Substances.
- Food and Drug Administration. (2011). Xanax.
- Substance Abuse and Mental Health Services Administration. (2014). Benzodiazepines in Combination with Opioid Pain Relievers or Alcohol: Greater Risk of More Serious ED Visit Outcomes
- Stewart, S.A. (2005). The effects of benzodiazepines on cognition. Journal of Clinical Psychiatry, 66(2), 9-13.
- Billioti de Gage, S., Moride, Y., Ducruet, T., Kurth, T., Verdoux, H., Tournier, M… Bégaud, B. (2014). Benzodiazepine use and risk of Alzheimer’s disease: case-control study. British Medical Journal, (349).
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Petursson, H. (1994). The benzodiazepine withdrawal syndrome. Addiction, 89(11), 1455-9.