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Benzodiazepine Addiction: Symptom, Causes, Effect and Treatment

Benzodiazepines are a class of drugs known primarily for their sedative effects, widely prescribed to manage a range of conditions from anxiety and insomnia to muscle spasms and seizures. The U.S. Drug Enforcement Administration (DEA) categorizes them as depressants, highlighting their role in producing sedation, hypnosis, relieving anxiety and muscle spasms, and reducing seizures. Common benzodiazepines include well-known prescription medications such as Valium®, Xanax®, and Klonopin®, with some forms like Midazolam (Versed®) used critically for sedation and amnesia in medical settings.

Symptoms of benzodiazepine addiction often include increased tolerance, withdrawal symptoms during cessation, and a persistent desire to use the drugs despite adverse consequences.

The effects of benzodiazepine addiction encompass both short-term relief from anxiety and insomnia, and long-term risks including cognitive decline, emotional numbing, and social withdrawal.

Signs of addiction may involve secretive behavior regarding drug use, strained relationships due to usage, and neglect of responsibilities.

Treatment involves a combination of medically supervised detox, counseling, and, often, the use of medications to manage withdrawal symptoms and prevent relapse.

This comprehensive overview lays the foundation for understanding benzodiazepine addiction, highlighting the critical aspects of its impact on individuals and society.

What Is Benzodiazepine Addiction?

Benzodiazepine addiction occurs when individuals develop a physical and psychological dependency on benzodiazepines, often characterized by an inability to stop using the drug despite negative consequences to one’s health and well-being. 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 drugs of abuse, 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

what are benzodiazepines

Is Benzodiazepine Addiction Common?

Benzodiazepine addiction, while not as prevalent as some other substance use disorders, represents 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.

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 groups.

Why Do People Get Addicted To Benzodiazepines?

People often become addicted to benzodiazepines primarily due to their potent sedative effects, which are used to enhance the euphoria from other substances or mitigate the negative side effects associated with withdrawal from other drugs. 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.

In addition to being used as an augmenting agent, there are several other reasons why individuals may develop an addiction to benzodiazepines:

  1. Prescription Dependency: Benzodiazepines are commonly prescribed for legitimate medical reasons, such as treating anxiety, insomnia, or muscle spasms. Over time, patients may develop a tolerance to the medication, requiring higher doses to achieve the same effects, which can lead to physical dependence and, eventually, addiction.
  2. Withdrawal Avoidance: Once dependence has developed, individuals may continue using benzodiazepines to avoid uncomfortable or even severe withdrawal symptoms, such as increased anxiety, insomnia, seizures, and mood swings. This cycle of use can be difficult to break without professional help.
  3. Self-Medication: Some individuals may misuse benzodiazepines to self-medicate for untreated or under-treated conditions like anxiety or depression. This misuse can quickly escalate into addiction as the efficacy of the drug diminishes with regular use and higher doses are required.
  4. Social and Recreational Use: The recreational use of benzodiazepines is also a factor, particularly among younger populations. The drugs are often used to enhance the effects of alcohol or to produce a high when taken in larger doses than prescribed.
  5. Psychological Factors: Emotional distress, trauma, and stress are significant triggers for benzodiazepine abuse. Individuals facing these issues may be more susceptible to the addictive potential of benzodiazepines as they seek immediate relief from their symptoms.

What Are the Symptoms Of Benzodiazepine Addiction?

Key symptoms include taking larger amounts of benzodiazepines than prescribed, running out of prescriptions prematurely, and a preoccupation with obtaining and taking the drug. Those addicted may feel that they cannot function normally without benzodiazepines, which is a clear indicator of dependency.

Physically, individuals might experience withdrawal symptoms, such as anxiety, insomnia, headaches, and even seizures, particularly when they abruptly cease usage. Psychological symptoms often manifest as anxiety, persistent thoughts about the drug, changes in mood, and noticeable declines in social and occupational functioning. In children and adolescents, this might include sudden mood shifts and poor school performance. Long-term effects of chronic benzodiazepine misuse can lead to depression, cognitive impairments, personality changes, and physical health problems like stomach issues and headaches.

According to an article reviewed by Zilpah Sheikh, MD, and written by Sylvia Davis for WebMD on “Benzodiazepine Abuse,” the abuse of these drugs is often linked to their calming and euphoric effects and their widespread availability. The article highlights that about three-quarters of benzodiazepine-related deaths also involve opioids, underscoring the dangers of polydrug use.

effects of benzodiazepine addiction

What Are The Effects Of Benzodiazepine Abuse?

The effects of benzodiazepine abuse include profound cognitive impairment, such as drowsiness, slowed reaction times, motor incoordination, and anterograde amnesia, which impairs the ability to form new memories. Over time, long-term users experience significant cognitive decline that persists even months after discontinuing use.

In the article “Risks Associated with Long-Term Benzodiazepine Use” published by American Family Physician, authors Brian Johnson, MD, from the State University of New York Upstate Medical University, and Jon Streltzer, MD, from the University of Hawaii School of Medicine, detail additional severe health consequences of benzodiazepine abuse. These include an increased risk of motor vehicle crashes and hip fractures, especially in older adults. For example, the use of zolpidem increases the risk of hip fracture by 2.55 times in those older than 65 years.

Furthermore, benzodiazepines lead to dependence and severe withdrawal symptoms that require medical supervision and a carefully managed tapering schedule to resolve. The risk of overdose increases significantly when benzodiazepines are combined with other sedatives like opioids or alcohol, creating a dangerous and often fatal mix.

The authors emphasize the necessity of alternative treatments for anxiety and insomnia to avoid these risks. Psychotherapy, antidepressants, or other non-addictive medications are preferred for treating these conditions without the potential for rebound insomnia or other severe side effects associated with benzodiazepines.

What Are The Signs That Someone Is Addicted To Benzodiazepines?

Individuals addicted to benzodiazepines often demonstrate an increased tolerance, requiring progressively higher doses to achieve the same effects, as noted by Charles P. O’Brien in his 2005 study published in the Journal of Clinical Psychiatry. This pattern signifies a deepening dependency on the drug.

Compulsive drug-seeking behavior is another critical sign of addiction. Affected persons may resort to doctor shopping, purchasing drugs from illicit sources, or forging prescriptions. This loss of control over drug use emphasizes the drug’s priority over personal, familial, or occupational responsibilities.

Physical symptoms are also indicative of addiction, particularly apparent when access to benzodiazepines is restricted. Withdrawal symptoms such as anxiety, insomnia, tremors, and, in severe cases, seizures and psychosis, compel ongoing use of the drug to alleviate discomfort, perpetuating the cycle of addiction.

Early recognition of these signs is crucial for healthcare providers to differentiate between therapeutic use and problematic abuse, allowing for effective interventions and support for recovery.

What Are The Symptoms Of Benzodiazepine Withdrawal?

Benzodiazepine withdrawal is characterized by a range of symptoms that typically emerge when a dependent individual reduces or stops benzodiazepine intake. According to Charles P. O’Brien’s 2005 study in the Journal of Clinical Psychiatry, these symptoms reflect the body’s physiological adaptation to the absence of the drug previously used regularly.

Common symptoms of benzodiazepine withdrawal include increased anxiety and insomnia, which are often the initial signs. These can be accompanied by physical symptoms such as tremors, sweating, muscle stiffness, and hypersensitivity to stimuli like light and sound. Psychological symptoms may also manifest, including irritability, confusion, and in severe cases, hallucinations and delirium.

Withdrawal can also induce seizures, particularly in individuals who have been using high doses or taking benzodiazepines for an extended period. The severity and duration of withdrawal symptoms can vary significantly based on the benzodiazepine’s half-life, dosage, and the duration of use.

Managing these symptoms often requires medical supervision to safely taper the drug’s use and mitigate withdrawal effects, ensuring a safer and more comfortable recovery process.

treatment for benzodiazepine addiction

How Is Benzodiazepine Addiction Treated?

Treating benzodiazepine addiction involves a combination of medical management, counseling, and support services. The process often starts with a medically supervised detoxification to safely manage withdrawal symptoms, which can be severe and include anxiety, insomnia, seizures, and, in extreme cases, psychosis.

According to the article reviewed by Zilpah Sheikh, MD, and written by Sylvia Davis for WebMD on “Benzodiazepine Abuse,” a crucial aspect of treatment is addressing the physical dependency through gradual dose reduction or tapering. This method minimizes the withdrawal symptoms and helps manage the risk of seizures. In some cases, doctors may switch the patient from a short-acting benzodiazepine to a longer-acting one to stabilize drug levels in the bloodstream and facilitate a smoother withdrawal process.

Counseling and behavioral therapies are vital components of the treatment regimen. These interventions help patients understand the nature of addiction, alter their attitudes towards drug use, and increase healthy life skills. Therapies can include cognitive-behavioral therapy (CBT), which helps patients identify and manage triggers for drug use, and motivational interviewing, which builds motivation to change behavior.

Support groups and aftercare programs provide ongoing support and are essential for long-term recovery, helping to prevent relapse. These might include structured programs like 12-step groups or other peer support options facilitated by community health centers.

Overall, the treatment of benzodiazepine addiction is comprehensive and tailored to the individual’s specific needs, considering factors like the duration of addiction, dosage of the drug being abused, and the presence of any co-occurring mental health disorders.

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 a 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 that is addicted to Benzodiazepine also be addicted to Adderall?

Yes, it is possible for someone to 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.

Ryan Wakim MD
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Dr. Wakim is a board-certified psychiatrist with a passion for and expertise in addiction, mood disorders, trauma-related disorders and the subspecialty of interventional psychiatry. He obtained his medical degree from West Virginia University where he also completed his residency training, finishing as chief resident. Dr. Wakim co-founded and served as the CEO of Transformations leading to a successful merger with Shore Capital in May 2021. He is purpose driven towards improving the standard of and removing stigma related to behavioral healthcare. Dr. Wakim enjoys golf, traveling and time spent with his two dogs, Lulu and Rayna.

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