Benzodiazepine Addiction: Symptoms, Causes, Effects, and Treatment

Benzodiazepines are a class of prescription drugs prescribed to manage anxiety, insomnia, muscle spasms, and seizures. They are federally regulated as a controlled substance due to the very real risks of dependence and addiction.

The causes of benzodiazepine addiction are complex, but like most addictions, it usually begins with physical dependence that becomes coupled with a psychological need for the drug as a coping mechanism or escape.

Quitting benzos can be difficult, and even dangerous without medical support. Ohio drug and alcohol treatment centers like White Light Behavioral Health provide benzodiazepine detox and rehab to help people safely stop using drugs like Valium or Xanax and equip them with tools to remain drug-free.

How Benzodiazepine Addiction Begins

The causes of addiction to benzos like Xanax and Klonopin vary from person to person, but there are constants. Many begin with a legal prescription for anxiety and come to rely on the medication when they become physically dependent.

Others may use these medications illegally.

After that, addiction can take root as their relationship with the drug changes. Benzodiazepines become increasingly important, perhaps they discover that taking more than prescribed or combining it with alcohol gives them more pleasurable effects.

People with co-occurring mental health disorders like depression or anxiety are more vulnerable to addiction. Illicit use of benzodiazepines, opioids and many other drugs are often a form of self-medication.

A person trying to soothe their own symptoms or discomfort without medical guidance.

Why Are Benzodiazepines Addictive?

Benzodiazepines are addictive because they boost levels of a neurotransmitter called GABA, which helps us relax. Benzos also influence dopamine, the brain’s reward chemical. Together, they cause euphoria and a sense of well-being. The brain becomes dependent on benzodiazepines to maintain this feeling.

When the drug is removed, we suddenly fact a shortage of GABA. This causes the potentially dangerous rebound effects we know as withdrawal. The threat of benzo withdrawal reinforces the compulsion to use the drug and a person can become caught in the cycle of addiction.

Benzodiazepines are addictive because:

• They create a sense of well-being and euphoria at higher doses.
• Regular use creates physical dependence and withdrawal if the drug is stopped.
• Benzos alter brain chemistry, potentially affecting judgement and lowering inhibition.
• The pleasure people feel coupled with fears of withdrawal reinforce addictive behaviors.
• The drug becomes an obsession and use continues despite consequences as the cycle of addiction sets in.

Examples of Common 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

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

NOTE: Benzodiazepine withdrawal can be very dangerous, and even fatal in extreme cases. You should never attempt to abruptly reduce or stop taking a benzo without a medical detox and appropriate addiction treatment support.

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

Understanding the Causes of Benzodiazepine Addiction

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

A combination of physical, mental and social factors may lead to benzo abuse. People become addicted to benzodiazepines due to their potent effects, which can cause euphoria and a sense of well-being.

These feelings can be especially hard for someone to resist if they were already unhappy, angry or under stress.

How Common is Benzo Misuse?

A 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 noted in the study 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 drowsiness, amnesia, loss of coordination, dizziness, and other related physical and mental health issues.

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

Thought, Memory and Coordination Problems

Benzodiazepine addiction and misuse can significantly affect daily functioning by causing cognitive impairment. Here are some common issues associated with them:

• Slowed reaction times
• Loss of coordination
• Trouble thinking clearly
• Anterograde amnesia (impairs the ability to form new memories)
• 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)

Why and How Do People Misuse 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 simply chasing the euphoric high.

Reasons Why Most People Abuse Benzodiazepines

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

How Most People Abuse Benzodiazepines

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 drug after marijuana and prescription opioids. 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.

How is Benzo Addiction Treated?

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 not only detox, but follow up care at the residential or partial hospitalization level for the best results. Benzo treatment centers can provide the necessary expertise and support to help individuals overcome their 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. 

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. Clinical research has shown that Cognitive Behavioral Therapy (CBT) can achieve 70-80% abstinence rates for benzodiazepine discontinuation. 

CBT includes established techniques to help people identify unhelpful thought patterns and behaviors. Over time, they learn to reframe things and change their perspectives. Increasing awareness of their own thoughts influences behavior positively, weakening the grip of addiction.

Medications for Treating Benzo Addiction

During a a benzodiazepine detox, in addition to a taper with a longer-acting benzo like Valium, other medications are used for safety and comfort. They may include anticonvulsants like gabapentin, beta-blockers like propranolol and non-benzo anxiety meds like Buspar or Vistaril.

Antidepressants can also be useful if the patient experiences depression during withdrawal.

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 room visits were more common among females and persons aged 25–34 years, and the highest number of benzodiazepine overdose ER visits occurred in Q3 2020.

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. Taking benzodiazepines for as little as 3-4 weeks can lead to withdrawal if stopped suddenly.

Factor 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. Short-acting hypnotics like Ativan or Xanax may last a few hours, while the effects of longer acting benzos can last 20 hours or more.

How Long Do Benzos Last?

• Xanax (alprazolam) — short‑acting, lasts 4–6 hours
• Ativan (lorazepam) — intermediate, lasts 6–8 hours
• Klonopin (clonazepam) — long‑acting, lasts 12–24 hour
• Valium (diazepam) — long‑acting, lasts 20–50 hours
• Librium (chlordiazepoxide) — long‑acting, lasts 24–48 hours
• Restoril (temazepam) — intermediate, lasts 6–10 hours
• Halcion (triazolam) — very short‑acting, lasts 2–4 hours

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. Not only does this medication not effectively target withdrawal symptoms, but the combination of benzos and opioids can be very dangerous due to their cumulative sedative effects.

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 Affect Work 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.

Do People Who Misuse Benzos Also Abuse Other Drugs?

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 polysubstance use disorders.

This can make addiction treatment more challenging, and is a reason why it is so important that prospective patients disclose all relevant information about their substance use.

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.