Benzodiazepine Addiction: Symptoms, Causes, Effects, and Treatment

Benzodiazepines are drugs prescribed to manage anxiety, insomnia, muscle spasms, and seizures. The U.S. Drug Enforcement Administration (DEA) classifies them as depressants, emphasizing their effects on sedation, hypnosis, anxiety relief, and seizure reduction. Benzodiazepine addiction arises due to the drug’s impact on the brain’s chemical and neural pathways, leading to compulsive drug-seeking behaviors and use.

As per a study by Maust, D. T., in 2019, “Benzodiazepine Use and Misuse Among Adults in the United States”, Benzodiazepine misuse accounts for 17.2% of overall use. Age 18-25 had the highest misuse with adults aged 50-64 now using these medications more frequently than those aged 65 and older.

Common symptoms of benzodiazepine addiction include sleep disturbances, irritability, increased tension and anxiety, panic attacks, hand tremors, sweating, difficulty in concentration, dry retching and nausea, weight loss, palpitations, headaches, muscular pain and stiffness, perceptual changes, and more.

The causes of benzodiazepine addiction are multifaceted, stemming from prolonged use of prescribed medications, self-medication for anxiety or stress, underlying mental health disorders, and a history of substance abuse.

Healthcare providers often treat benzodiazepine addiction through a combination of tapering, various therapies, psychological support, and medications. A comprehensive approach, including tailored management strategies, is essential for effective treatment. Benzo treatment centers offer the necessary expertise and support to help individuals overcome addiction and achieve long-term recovery.

What is Benzodiazepine Addiction?

Benzodiazepine addiction is a type of substance use disorder characterized by the compulsive use of benzodiazepines, a class of medications primarily prescribed for anxiety, insomnia, and other related conditions.

This type of addiction can develop due to the drug’s ability to significantly alter the brain’s chemical and neural pathways, leading to compulsive drug-seeking behaviors and use.

According to research published in The National Library Of Medicine on February 11, 2010, by Kelly R. Tan, Matthew Brown, and colleagues, benzodiazepines, like other addictive substances, increase dopamine levels in the brain’s mesolimbic reward pathway. This increase is primarily achieved through the positive modulation of GABA_A receptors on interneurons adjacent to dopamine neurons, which leads to enhanced firing of these neurons in the ventral tegmental area (VTA).

The study highlights how benzodiazepines trigger lasting synaptic changes in the VTA, similar to other drug addictions, reinforcing their addictive potential. The neural mechanisms identified in this study suggest why benzodiazepines are particularly prone to abuse, as they share key pharmacological features with widely recognized addictive drugs

5 Common Types of Benzodiazepines

The top 5 most commonly used benzodiazepines, approved by the United States Food and Drug Administration (FDA) are:

1. Alprazolam (Xanax): Anxiety disorders, panic disorders
2. Diazepam (Valium): Alcohol withdrawal management, febrile seizures
3. Lorazepam (Ativan): Anxiety disorders, convulsive status epilepticus
4. Clonazepam (Klonopin): Panic disorder, agoraphobia, seizures
5. Temazepam (Restoril): Sleep onset and sleep maintenance insomnia

How Common is Benzodiazepine Addiction?

Benzodiazepine addiction is common, representing a significant public health concern. According to the 2021 National Survey on Drug Use and Health (NSDUH), approximately 2.2 million people in the United States ages 12 and older had a tranquilizer or sedative use disorder, which includes benzodiazepines, within the past year. This figure is part of a broader statistic indicating that over 46 million Americans met the criteria for a drug or alcohol use disorder during the same timeframe.

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The rates of tranquilizer and sedative addiction are notably higher among young adults aged 18 to 25, with 0.9% of individuals in this age group affected. The data further reveals that about 127,000 adolescents (ages 12 to 17), 303,000 young adults (ages 18 to 25), and 1.8 million adults (ages 26 and over) experienced this form of addiction in the past year, underscoring the need for targeted prevention and treatment efforts across all age group.

What Are the Signs and Symptoms of Benzodiazepine Addiction?

Signs of Benzodiazepine addiction include sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremors, sweating, and more.

The common benzo withdrawal symptoms or BZDs include:

• Insomnia
• Irritability
• Increased tension and anxiety
• Panic attacks
• Hand tremor
• Sweating
• Difficulty in concentration
• Dry retching and nausea
• Weight loss
• Palpitations
• Headache
• Muscular pain and stiffness
• Perceptual changes

Recognizing the signs of benzo addiction is essential for early intervention and treatment. 

According to Brett, J., & Murnion, B.’s 2015 study, “Management of benzodiazepine misuse and dependence”, this table outlines the various neurological, psychological, and musculoskeletal symptoms associated with benzodiazepine withdrawal symptoms:

Category	Clinical Features
General	Headache, Palpitations, Sweating
Musculoskeletal	Tremor, fasciculations, Muscle pain, stiffness and aches (limbs, back, neck, jaw)
Neurological	Dizziness, light-headedness, Paraesthesia, shooting pains in neck and spine, Visual disturbances (blurred vision, diplopia, photophobia, vision lags behind eye movements), Tinnitus, Faintness and dizziness, sense of unsteadiness, Confusion, disorientation (may be intermittent), Delirium (in the absence of autonomic hyperactivity), Delusions, paranoia, Hallucinations (visual, auditory), Grand mal seizures (1–12 days after discontinuing benzodiazepines)
Gastrointestinal	Nausea, Anorexia, Diarrhoea (may resemble irritable bowel syndrome)
Psychological	Rebound insomnia, nightmares, Anxiety, panic attacks, Irritability, restlessness, agitation, Poor memory and concentration, Perceptual distortions (sensory hypersensitivity), Metallic taste, Distortions of body image, Feelings of unreality, depersonalisation, derealisation, Depression, dysphoria

What are the Causes of Benzodiazepine addiction?

Common causes of benzodiazepine addiction include prolonged use of prescribed medications, self-medication for anxiety or stress, underlying mental health disorders, and a history of substance abuse.

A combination of physiological, psychological, and social factors may lead to benzo abuse. People become addicted to benzodiazepines due to their potent sedative effects, which can enhance euphoria from other substances or mitigate withdrawal side effects.

Charles P. O’Brien, in his NIH article “Benzodiazepine use, abuse, and dependence,” points out that intentional abusers of benzodiazepines typically struggle with other substance abuse issues and use benzodiazepines as a secondary drug.

And another study by Maust, D. T., in 2019, “Benzodiazepine Use and Misuse Among Adults in the United States”,  mentions, benzodiazepines were the third most misused drug in the U.S., used by about 2.2% of the population. Misuse is also a common cause of benzodiazepine addiction. Key causes of Benzodiazepine addiction include:

• Prescription dependency
• Withdrawal avoidance
• Self-medication
• Recreational use
• Tolerance development
• Physical dependence
• Untreated conditions
• Emotional distress
• Stress

What Are the Effects of Benzodiazepine Abuse?

The effects of benzodiazepine abuse can lead to symptoms such as tremors, headaches, amnesia, dizziness, and other related physical and mental health issues.

According to Bounds, C. G., & Patel, P. (n.d.). 2024 study published in StatPearls, here are all the effects of Benzodiazepine addiction:

Common Side Effects

It’s important to be aware of the common adverse effects associated with certain medications, as they can vary in severity. Here are some frequently reported side effects:

• Drowsiness
• Confusion
• Headache
• Tremors

Cognitive Impairments

Cognitive impairments can significantly affect daily functioning. Here are some common issues associated with them:

• Slowed reaction times
• Motor incoordination
• Anterograde amnesia (impairs the ability to form new memories)
• Profound cognitive impairment
• Significant cognitive decline (persists even months after discontinuing use)

Psychological Side Effects

Psychological adverse effects can have a notable impact on mental health. Here are some common effects to be aware of:

• Euphoria
• Hallucination
• Ataxia
• Dizziness
• Seizure-like activity (during withdrawal)

What Are the Misuses of Benzodiazepines?

The common misuses of Benzodiazepines can involve various behaviors and motivations, such as seeking relief from anxiety or stress, using them to manage sleep disorders, or pursuing euphoria. 

According to Liebrenz, M.,’s 2015 study, four main reasons for continuing Benzo misuse are managing psychological distress, coping with physical discomfort, alleviating substance-related issues, and recreational use. 

Common reasons for misusing Benzodiazepines can be further broken into the following:

1. Anxiety and stress relief
2. Sleep disorders
3. Euphoria
4. Social or peer pressure
5. Lack of awareness
6. Previous substance abuse history
7. Poor coping mechanisms

Common forms of Misuse are:

1. Taking higher doses than prescribed
2. Using without a prescription
3. Using other substances
4. Crushing and snorting or injecting
5. Using for non-medical reasons
6. Longer use than intended

It is a rising concern, with an estimated 2.2% of Americans misusing tranquilizers in the past year, making it the third most commonly misused illicit substance after marijuana and prescription opioids.

According to Votaw, Victoria R. et al.’s 2019 review “The epidemiology of benzodiazepine misuse: A systematic review”, people with substance use disorders (SUDs) in the U.S. have rates of benzodiazepine misuse 3.5 to 24 times higher than the general population.

The review also highlights that while benzodiazepines are often misused for their intended purpose (e.g., sleep, anxiety), misuse is a growing problem for those with psychiatric symptoms and disorders as well.

What Are the Treatment Options for Benzo Addiction?

Common treatment options for benzodiazepine addiction include tapering, various therapies, psychological support, and medications. The treatment of benzodiazepine addiction requires a comprehensive approach that includes various treatment options and tailored management strategies. Benzo treatment centers can provide the necessary expertise and support to help individuals overcome benzodiazepine addiction and achieve long-term recovery.

By addressing both the physical and psychological aspects of addiction, healthcare providers can empower individuals to achieve lasting sobriety and improve their overall quality of life. Individuals can navigate their recovery journey more effectively through therapies, support systems, and proactive prevention measures.

Here are the common treatment options for Benzo Addiction:

Gradual Tapering

The primary treatment for benzodiazepine dependence is gradual tapering, which involves slowly reducing the dosage over time to minimize withdrawal symptoms such as anxiety, irritability, and sleep disturbances. Tapering schedules vary widely, potentially lasting weeks to months depending on the patient’s situation and the specific benzodiazepine used. 

According to Lader M,’s 2009 study, “Withdrawing benzodiazepines in primary care”, patients may be switched to a longer-acting benzodiazepine like diazepam, which offers a more manageable withdrawal profile and is available in liquid form for precise dosing.

Cognitive-Behavioral Therapy (CBT)

Cognitive-behavioral therapy (CBT) is particularly effective in helping patients manage anxiety and prevent relapse. Group therapy can also provide support from peers. As per Chapoutot, M.,’s 2021 study, “Cognitive Behavioral Therapy and Acceptance and Commitment Therapy for the Discontinuation of Long-Term Benzodiazepine Use in Insomnia and Anxiety Disorders”, Cognitive Behavioral Therapy (CBT) achieves 70-80% abstinence rates for benzodiazepine discontinuation. 

CBT includes established techniques and novel approaches. Acceptance and Commitment Therapy is an example of a novel technique.

CBT targets underlying conditions such as insomnia and anxiety. It also addresses benzodiazepine dependence itself.

CBT provides a comprehensive approach to treatment. This approach focuses on root causes and current substance use issues.

CBT’s dual focus enables effective benzodiazepine discontinuation. The article examines these CBT methods for long-term benzodiazepine use cessation.

Psychological Support

According to H Ashton’s 1994 study, “The treatment of benzodiazepine dependence”, psychological support should be provided during and after dosage reduction, including information about benzodiazepines, general encouragement, measures to reduce anxiety, and learning non-pharmacological coping strategies. While most patients require minimal support, some may need counseling or formal therapy.

Pharmacological Aids

Antidepressants can be useful if the patient experiences depression during withdrawal. According to Edinoff, A. N.,’s 2021 study, “Benzodiazepines: Uses, Dangers, and Clinical Considerations”, low-dose flumazenil, a GABA receptor antagonist, may help reduce withdrawal symptoms when used alongside tapering protocols.

What is a Benzodiazepine Overdose?

A benzodiazepine overdose happens when an individual takes more than the prescribed dose or combines benzodiazepines with other substances, which can lead to serious health consequences, including death.

Common Signs and Symptoms of Benzodiazepine Overdose are:

• Confusion
• Drowsiness
• Slurred speech
• Difficulty breathing
• Slow heart rate
• Coma

According to the Centers for Disease Control and Prevention (CDC),  benzodiazepine overdose emergency department visits were more common among females and persons aged 25–34 years, and the highest number of benzodiazepine overdose emergency department visits occurred in Q3 2020. CDC also reported that Illicit benzodiazepines, such as etizolam, flualprazolam, and flubromazolam, were increasingly detected in postmortem and clinical samples in 2020, often with opioids.

Are all Benzodiazepines Addictive?

Not all benzodiazepines are equally addictive, but they all have the potential to be addictive, especially with improper use or prolonged usage. According to Brett, J., & Murnion, B.’s 2015 study.

“Management of benzodiazepine misuse and dependence”, Taking benzodiazepines for over 3-4 weeks can lead to withdrawal if stopped suddenly. Thus factors such as duration of use, dosage, personal history, and specific benzodiazepine type influence their risk for addiction.

Proper medical supervision can help minimize this risk.

How Long Do Benzodiazepine Effects Last?

Benzodiazepine effects can last from several hours for short-acting types to several days for long-acting ones. According to Roth, T.,’s 1980 study, Short-acting hypnotics like lorazepam, triazolam, and temazepam have half-lives of up to 10 hours. Long-acting hypnotics such as flurazepam and ketazolam have much longer half-lives, lasting up to 100 hours. A longer half-life correlates with longer-lasting effects.

Can You Use Suboxone for Benzo Addiction?

Suboxone (buprenorphine and naloxone) is primarily used for opioid addiction treatment and is not typically recommended for benzodiazepine addiction. According to Park, T. W.,’s 2020 study, “Associations between prescribed benzodiazepines, overdose death and buprenorphine discontinuation among people receiving buprenorphine”, combining benzodiazepines and buprenorphine greatly increases overdose and death risk, outweighing any potential treatment retention benefits. Extreme caution is necessary when considering concurrent use.

Which Benzodiazepine is the Least Addictive?

The benzodiazepines that are considered the least addictive are oxazepam (Serax), clorazepate (Tranxene), and chlordiazepoxide. According to Longo, L. P.,(2000), study “Addiction: Part I. Benzodiazepines—Side effects, abuse risk and alternatives”, These medications tend to have slower onset of action and less intense effects, which may make them less rewarding for those seeking to abuse them.

How Can Benzodiazepine Addiction Impact Workplace Productivity and Safety?

Benzodiazepine use can significantly impact workplace safety, with a noted increase in accident risks when usage extends beyond recommended durations. Initially, short-term use may reduce these risks, but prolonged usage and the period immediately after discontinuation are associated with higher risks, potentially reducing productivity and increasing safety hazards. This is highlighted in the study “Impact of benzodiazepine use on the risk of occupational accidents” by François-Olivier Baudot, published in PLOS ONE on April 16, 2024.

How does benzodiazepine misuse correlate with the use of other substances?

Benzodiazepine misuse is strongly associated with the abuse or dependence on prescription stimulants or opioids. This finding suggests a complex challenge in managing patients with multi-substance use profiles and underscores the importance of vigilant monitoring by clinicians. This correlation is highlighted in the same study by Donovan T. Maust, Lewei A. Lin, and Frederic C. Blow in Psychiatric Services.

How does the duration of benzodiazepine use influence the difficulty of the withdrawal process?

Prolonged use of benzodiazepines is suggested to complicate the withdrawal process, as indicated by the increased risks associated with extended usage periods. This can necessitate more structured management during discontinuation to avoid heightened risks, including those in the workplace, as discussed in François-Olivier Baudot’s 2024 study in PLOS ONE.

How does benzodiazepine addiction compare to Cocaine Addiction?

While both benzodiazepine and cocaine addictions are serious and can have detrimental effects on an individual’s life, they differ in their symptoms and causes. Benzodiazepine addiction is often driven by the need to cope with anxiety or sleep disorders, while cocaine addiction is more commonly associated with seeking pleasure or escaping reality. 

Additionally, the effects of these addictions on the body differ as benzodiazepines primarily affect the central nervous system while cocaine affects the brain’s pleasure center. Treatment for these addictions may also differ, with benzodiazepine addiction often requiring a gradual tapering off of the medication, while cocaine addiction may involve more intensive therapy and behavioral changes.

What is the prevalence of benzodiazepine misuse among different age groups in the United States?

There are notable age-related differences in the misuse of benzodiazepines. Young adults aged 18–25 report the highest rate of misuse at 5.2%, whereas the elderly aged 65 and older have the lowest at just 0.6%. This data comes from the study “Benzodiazepine Use and Misuse Among Adults in the United States” by Donovan T. Maust, Lewei A. Lin, and Frederic C. Blow, published in Psychiatric Services on February 1, 2019.

Can someone who is addicted to Benzodiazepine also be addicted to Adderall?

Yes, someone can be addicted to both Benzodiazepine and Adderall at the same time. Both drugs are commonly used for anxiety and can have a high potential for addiction. It is important for individuals struggling with addiction to seek comprehensive treatment and support for both substance use disorders.

What are the dangers of quitting benzodiazepines cold turkey without medical supervision?

Quitting benzodiazepines without medical supervision can lead to increased risks, particularly in the workplace, due to potential rebound or catch-up effects after treatment discontinuation. These dangers emphasize the need for medical oversight, especially considering the increased workplace accident risks during the post-discontinuation period as found in the study by François-Olivier Baudot in PLOS ONE, 2024.