Benzodiazepine addiction occurs when someone becomes physically dependent on one or more of these depressant medications typically prescribed to treat anxiety disorders. Dependence on benzodiazepines can cause a number of symptoms, but can also be life-threatening if an overdose occurs. Treatment for benzodiazepine addiction includes detox, therapy, residential stays, support, and self-care to manage the addiction and avoid relapses.
What Is Benzodiazepine Addiction?
Benzodiazepine addiction is a physical dependence on any of the prescription drugs in this class of depressants. Benzodiazepines are habit forming, and addiction can occur in someone using the drug as directed, although this is uncommon. More common is addiction in people who misuse benzodiazepines, by using them when not prescribed or taking larger doses and more doses than is recommended.
Dependence on benzodiazepines causes symptoms and general life impairment, but it can also be dangerous and life-threatening. An overdose can be deadly, especially when benzodiazepines are combined with other depressants like alcohol. Addiction can be successfully treated and managed beginning with controlled detox and followed by residential treatment, therapy, support, and ongoing treatment and self-care.
Facts and Statistics
Benzodiazepines are prescription medications that are depressants, meaning they decrease the activity of the central nervous system and cause sedation, sleepiness, and relaxation. They are prescribed to treat anxiety disorders, including panic disorders, as muscle relaxants, and prevent seizures. These drugs are habit-forming, and people may abuse them to get a sense of euphoria, relaxation, and to self-medicate to get relief from anxiety.
- Examples of commonly prescribed benzodiazepines are alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan).
- Benzodiazepines are Schedule IV controlled substances.
- Benzodiazepine use increases with age and is more prevalent in women.
- Combining opioids with benzodiazepines is extremely dangerous. About one-third of opioid overdoses have occurred in people who were also using benzodiazepines.
- In 2016, the Centers for Disease Control and Prevention recommended that doctors do not prescribe patients both opioids and benzodiazepines at the same time.
- Flunitrazepam (Rohypnol) is a benzodiazepine known commonly as “roofies” and that has gained notoriety for being used for sexual assault or as a date rape drug.
- Benzodiazepine addiction statistics show that overdose deaths involving these drugs have been increasing since 2002. Most of these were combinations with opioids.
- From 1996 to 2013, the number of benzodiazepine prescriptions written increased by 30 percent.
- Xanax is the most commonly abused benzodiazepine by teens. In recent years, abuse of these drugs has decreased among eighth graders, but has increased slightly among tenth and twelfth graders.
Symptoms and Diagnosis of Benzodiazepine Addiction
Symptoms of addiction to benzodiazepine include those that are characteristic of other types of addiction. Someone with benzodiazepine dependence will use the drug often and in increasingly larger doses as they develop a tolerance. They may try to stop using or limit use of the drug but without success. They will always be thinking about and trying to get the next dose. This addiction also causes withdrawal when a person tries to stop using it.
There are also noticeable signs of abuse of benzodiazepines, including drowsiness, confusion, impaired thinking, lethargy, poor coordination, and slurred speech. As depressants, these drugs cause effects similar to alcohol. Someone abusing benzodiazepines may seem intoxicated: more outwardly gregarious and cheerful, but then stumbling, slurring their words, and confused with higher doses. Signs of using higher doses of benzodiazepines and long term effects of this abuse include:
- Impaired reflexes
- Slowed breathing
- Nausea and vomiting
- Abdominal pain, diarrhea, or constipation
- Loss of appetite
- Mood swings
- Irrational and angry outbursts
- Difficulty remembering things
- Impaired judgment
Signs of an overdose on benzodiazepines should be taken very seriously. They include extreme drowsiness and confusion, serious loss of coordination or ability to move the body, and loss of consciousness. When combined with other depressants, the risk of overdose is significantly increased. For this reason it is very dangerous to combine benzodiazepines with alcohol, opioids, or any other depressant substance. The combined effects of two or more depressants can cause extreme sedation, slowed or stopped breathing, and even coma and death.
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Causes and Risk Factors
Benzodiazepine dependence is caused by abuse of one or more of these drugs, although it is possible to become dependent even with prescribed use. The longer the drug is used or abused and the greater the dosage used, the more likely a person is to become addicted. Abusing a benzodiazepine puts a person at a greater risk for addiction than someone who is using it as directed. Short-acting benzodiazepines are more likely to cause dependence, because they trigger more withdrawal, which in turn can lead to greater abuse of the drug to get relief from those symptoms.
While use and abuse of benzodiazepines are the potential causes of addiction, there are also several risk factors for both abusing these drugs and becoming dependent on them. Family history and a genetic propensity for addiction can be a contributing factor, for example. Being a woman is an important risk factor too, as women are by far more likely to be prescribed benzodiazepines. Other risk factors include having other substance abuse problems or addictions, having a mental illness, lower socioeconomic status, being around other people who abuse benzodiazepines, being unemployed, engaging in risky and impulsive behaviors, and experiencing trauma or abuse when younger.
Benzodiazepine Withdrawal and Detox
Dependence on any substance causes withdrawal symptoms when use of the drug is stopped. Benzodiazepine withdrawal syndrome causes characteristic symptoms:
- An increase in anxiety and tension
- Panic attacks
- Tremors in the hands
- Difficulty sleeping
- Difficulty concentrating
- Nausea and dry heaving
- Heart palpitations
- Muscle pain and stiffness
- Weight loss
The most severe addictions to benzodiazepines may cause psychotic symptoms and seizures. Even patients using benzodiazepines under a doctor’s guidance may experience some withdrawal when no longer using the drug. Most commonly this causes mild to moderate anxiety and insomnia. In some cases, a person using these drugs to treat anxiety will experience a long-term return of anxiety after stopping use. They may also experience protracted depression, insomnia, and other symptoms.
Detoxification is an important step in recovering from an addiction, but it will also trigger withdrawal symptoms. These symptoms may be severe and potentially dangerous, so detox should never occur without medical supervision. A medical team can help a patient minimize withdrawal symptoms and the likelihood of relapse.
The most common co-occurring disorders with benzodiazepine addiction are other addictions and mental illness. Studies have found that abuse of benzodiazepines is common in people with severe mental illness. The co-occurrence can be explained in several ways, but exactly why one individual will have this addiction and have other addictions or mental illness is complicated.
One explanation is that mental illnesses and addictions have similar risk factors, such as trauma or family history. Another is that abuse of drugs like benzodiazepines can trigger symptoms of mental illness or make the symptoms worse. It may also be that someone with a mental illness, especially one that has gone undiagnosed and untreated, will abuse a drug like a benzodiazepine to self-medicate. Anxiety disorders are the most common co-occurring disorders, because benzodiazepines are often prescribed to treat them.
Benzodiazepine Treatment and Prognosis
Treatment for benzodiazepine addiction begins with detox, which causes uncomfortable, sometimes dangerous withdrawal symptoms. Detox should always be done in a professional setting with supervision to help prevent relapses and to prevent or minimize the most dangerous symptoms. In rare cases, withdrawal can cause severe anxiety or depression, which can be very harmful to the patient. This can be managed when detox is done in a therapeutic, residential facility.
Once a patient has detoxed from benzodiazepines and is safe and stable, long-term treatment can begin. There are no approved medications for treating this type of addiction, but there are many types of therapies that can help. The main goals of working with a therapist are to help the patient make positive changes, recognize what led to the abuse and addiction, and learn how to stay sober after treatment.
In addition to one-on-one behavioral therapies, patients can benefit from group and family therapy, support groups, and alternative therapies and relaxation techniques, like art therapy, yoga, and meditation. Also important in treatment is learning how to prevent relapses. Relapse is common in addiction, but taking steps to prevent them can minimize the damage.
The outlook is generally good for someone seeking treatment for benzodiazepine addiction. The chances of success can be increased by learning and using good relapse prevention strategies, such as learning and avoiding triggers, avoiding drug-using friends, finding alternative ways to regulate emotions, and finding and relying on a strong social support network. When all of these are put in place along with good residential treatment, a patient addicted to benzodiazepines can make positive changes and learn how to remain sober and happy.