Benzodiazepine Addiction and Abuse

Benzodiazepines, also referred to as Benzos, are a type of pharmaceutical drug prescribed for a diverse number of mental disorders and ailments. These drugs are used in treating different levels of anxiety, panic attacks, epileptic seizures, and even symptoms that arise from withdrawal from other central nervous system depressants like alcohol. Benzodiazepines are usually prescribed for short-term use due to their addictive nature.

A majority of benzodiazepines are manufactured in pill or tablet form for oral consumption, while brands such as Valium can be injected as a clear, odorless liquid. These drugs are considered legal when they are medically prescribed. However, there is a black market that exists for benzodiazepines. Street names for benzodiazepine drugs may include tranks, downers, bars, sticks, french fries, ladders, or simply benzos.

Benzodiazepines are labeled as Schedule IV drugs under the Controlled Substances Act, which resulted in the drug being highly regulated by the U.S. government.

Given below are some common benzodiazepines:

• Valium
• Ativan
• Klonopin
• Librium
• Halcion

Benzodiazepines attach themselves to neurons called GABA receptors in our brains. It helps slow down the overactive brain function and relieve severe mental stress felt by the individual. Individuals who are struggling with benzodiazepine abuse experience a feeling of euphoria or a “buzz,” followed by a period of extended sedation. The potency of the drug generally depends on the brand of benzodiazepine abused.

The use of benzodiazepines outside of a doctor’s instruction or prescription is considered as abuse. Some individuals who struggle with benzodiazepine abuse generally snort or crush their tablets or pills to increase the impact of the drug; as a result, increasing their chances of overdose exponentially. Some of the severe symptoms of a Benzodiazepine overdose include comas and seizures. Benzodiazepine overdose can also reduce your heart rate and breathing until it completely shuts down, resulting in death.

Benzodiazepines can alter the neurochemistry of the brain over time. This can lead to the development of mental and physical dependencies on the drug. Even under a doctor’s guidance and prescribed dosage, Individuals stand a chance of developing an addiction.

Since Benzodiazepines are distributed through prescription, many are often unaware of the highly abusive and addictive potential these drugs hold. Developing a tolerance to the drugs’ sedative effects or avoiding people and activities to focus solely on abusing the drug are some of the most common symptoms of addiction that are generally overlooked by many.

Due to the heavily prescribed nature of benzodiazepines in America, millions of people face potential adverse effects and even overdose from benzo abuse and addiction every year. Benzodiazepine overdose can result in a decrease in an individual’s heart rate and breathing and eventually lead to death if not treated immediately. When these dangerous drugs are combined with other central nervous systems (CNS) depressants like alcohol, it significantly increases the risk of a lethal overdose.

Behavioral changes around drug abuse are closely associated with how the individual consumes the drug. Generally, benzodiazepines are swallowed. However, some users crush, cook and inject benzodiazepines to amplify the effects of the drug.

These drugs can also be bought on the street. However, purchasing at street level carries certain levels of dangers, such as:

• Drug dealers introduce the addict to other dangerous drugs as an alternative to benzodiazepines, which could lead to polydrug abuse.
• When a drug is purchased on the streets, individuals can never be sure of what they are buying, as these drugs are not tested or verified.

To amplify the effect of the drug, some individuals tend to mix benzodiazepine with other substances such as alcohol and opiate drugs. The chances of a fatal overdose are significantly raised when benzodiazepines are combined with illicit and prescription drugs. It has been reported that 95% of hospital admissions for benzodiazepine overdose have been due to the mixing of other drugs.

Here are a few immediate adverse side effects of benzodiazepine addiction and abuse:

• Mental confusion
• Anxiety
• Blurred vision
• Headaches
• Forgetfulness
• Irritability
• Fatigue

Benzodiazepines are generally not prescribed for long-term use as they tend to change the manner in which the brain functions. After a while, individuals who consume benzodiazepines begin to depend on the drugs to function normally in day-to-day life. This condition is called dependence. However, dependence on the drug does not always result in addiction.

Long-term use of benzodiazepines significantly increases the chances of addiction and lead to harmful and even fatal withdrawal symptoms when an individual stops consuming the substance. Developing a benzodiazepine dependence is only one of many long-term side effects of benzo use.

Some of the long-term effects of the benzodiazepines are mentioned below:

• Disinhibition
• Impaired concentration and memory
• Drowsiness
• Increased reaction time
• Ataxia
• Loss of co-ordination
• Amnesia
• Permanent cognitive defects
• Muscle stiffness
• Depression
• Sexual dysfunction
• Dementia
• Hip fracture

Benzodiazepine changes the brain’s neurological pathways used for transferring and processing data resulting in the inability to function normally without the use of the drug. The culmination from dependence and addiction can cause severe reactions when benzodiazepine consumption is suddenly stopped.

Many side effects generally fade away once an individual has detoxed from benzos. However, effects like cognitive decline can persist for several more months. Cognitive abilities that can be affected by benzodiazepine include the ability to recognize visual relationships between objects, the amount of time it takes to process information, and verbal learning skills.

Benzodiazepine dependence is considered to be different from addiction. Dependence affects every individual who consistently consumes benzodiazepine. However, addiction develops only in some.

When an individual consumes benzodiazepines for multiple days or weeks, the brain starts to adapt to the drug. It begins to change the way it generally functions and starts to depend on the drugs to function normally. This condition is known as Benzo dependence.

As dependence on the drug develops, the brain begins to require a larger quantity of the drug to achieve the same effects. This condition is called tolerance. When an individual who is dependent on benzodiazepine stops taking the drug, they will experience withdrawal symptoms.

The prescription status of benzodiazepines can overshadow awareness of the drug’s adverse side effects. Due to its highly addictive nature, Benzodiazepine use disorder can quickly escalate into a serious addiction in just a few months.

Identifying signs and symptoms of misuse is paramount in the fight against addiction.

Mentioned below are some of the signs and symptoms of benzodiazepine addiction:

• Drowsiness
• Blacking out
• Blurred vision
• Weakness
• Passing out
• Poor judgment
• Visiting multiple doctors to obtain multiple prescriptions
• Requesting pills from others
• Withdrawal symptoms
• Mood changes
• Engaging in risky behaviors
• Mixing benzos with other drugs
• Impaired co-ordination
• Unable to stop using
• Behavioral Signs of Abuse

Here are some of the outward signs of benzodiazepine misuse:

• Sweating
• Drowsiness
• Shallow breath
• Slurred speech
• Impaired co-ordination
• Nausea and vomiting
• Dizziness

The mental health community generally uses the term sedative, anxiolytic or hypnotic, use disorder to describe benzodiazepine abuse or addiction. This term originated from the main mental health book for clinicians; Diagnostic and Statistical Manual of Mental Disorders, 5th edition. To be medically diagnosed with a sedative use disorder, at least two of the 11 possible symptoms mentioned must be apparent within the same 12-month period.

Here are a few symptoms stated by professionals at the National Association of Addiction to help diagnose addiction:

• The drug is consumed in a large amount over a longer period than first intended.
• A large portion of time is spent seeking out the drug, using it, and recovering from its impacts.
• When the sedative is not in an individual’s system, the user starts to go through withdrawal, which may involve cravings for the drug.
• After some time, higher consumption of the drug is required to achieve the desired effects.
• The individual may experience a lack of productivity and performance at home, work, or school due to the drug’s impact.

The sedative effect of Benzodiazepines, as well as its addictive chemical properties, significantly raises the chance for abuse. Even though users may initially have a legitimate medical reason to consume this drug, it is important to be aware of its adverse effects.

Addictions to benzodiazepine can be unpredictable, as it may begin at any given moment. It is reported that even when the medication is consumed safely according to the doctor’s prescription, there still remains a chance of developing an addiction. Once the medical prescription has reached its expiration date, or a user starts consuming a higher dosage for more powerful effects, dangerous and unpredictable behaviors or signs may emerge that indicate benzodiazepine addiction.

Sedative use disorder may appear in an individual without him/her being aware. However, over time the signs of addiction will be more apparent to you as well as to those around you. Substance abuse generally has a way of pushing a person into displaying uncharacteristic behavioral traits, making it harder to hide one’s addiction from friends and family.

Some behavioral signs of benzodiazepine abuse are explained below:

• To cope with the fear of withdrawal, the individual may take extra measures to make sure he/she has a sufficient supply at home.
• In order to be able to pay for the drugs, the individual may display uncharacteristic and irresponsible behavior such as borrowing money, draining his/her bank accounts, or maxing out credit cards and even stealing.
• The individual may even engage in risky activities after drug consumption, such as driving.
• The individual may spend a large portion of their time and energy on many aspects of drug abuse.
• The individual may display a lack of effort in maintaining personal hygiene or grooming.
• The individual may even get secretive about their daily schedule and lie to protect his/her substance abuse.
• During this phase, shifts in mood or personality are generally experienced.
• The individual begins isolating himself/herself from friends and family while also neglecting responsibilities to consume the drug.
• Purchasing large volumes of this drug by going “doctor shopping.” This includes getting different prescriptions from various doctors.

The consumption of Benzodiazepines over a certain period can cause the development of tolerance towards the drug. The tolerance for the drug gradually results in the consumption of higher and higher dosages to achieve its intended purpose. When the consumption of the drug is paused or stopped, individuals may experience unpleasant withdrawal symptoms. This reaction occurs because of how the benzodiazepines impact our neurotransmitters, particularly our gamma-aminobutyric acid (GABA) receptors. Ideally, these receptors are not meant to react to any artificial GABA stimulants like benzodiazepines. Consequently, this makes the brain believe that it is not required to produce its natural gamma-aminobutyric acid as usual. When an individual stops the consumption of benzodiazepines, the body is suddenly deprived of this necessary acid that it has adapted itself to, causing the brain to overexert itself to try and manage the changes caused by the abrupt stop of the drug’s effect. The effects of this unpleasant reaction are known as withdrawal.

Withdrawal symptoms affect all users alike; users who were prescribed benzodiazepines for medical purposes as well as users who were abusing the drug without a medical prescription.

Many medical professionals are reluctant to prescribe benzodiazepines for long term consumption as these drugs have strong addictive characteristics and severe withdrawal symptoms.

The withdrawal symptoms that arise from benzodiazepine abuse can be physically and emotionally severe, uncomfortable, and painful. These symptoms can even be fatal if the individual suddenly stops his/her usual consumption. Generally, users who are used to consuming high doses of the drug, or consume these drugs for an extended period, suffer from the most severe symptoms of withdrawal. Benzodiazepine withdrawal symptoms are generally highly variable, without any advent fixed pattern. They vary in impact and frequency during all stages of the withdrawal process.

The most general form of benzodiazepine withdrawal symptoms is usually referred to as “rebound symptoms.” These symptoms usually appear within one to four days after the user has decided to stop his/her consumption of the drug. This period also depends on the type of benzo that is consumed, the amount, and the frequency of consumption. These symptoms generally last up to ten days.

Mentioned below are some of these rebound symptoms:

• Sleep disturbances
• Increased tension
• Anxiety
• Panic attacks
• Difficulty concentrating
• Excessive sweating
• Heart palpitations
• Headache
• Muscular stiffness or discomfort
• Mild to moderate changes in perception
• Cravings
• Hand tremors

Less common and more severe symptoms can appear as well. This is more plausible in cases of severe addiction.

Given below are some of these symptoms:

• Hallucinations
• Seizures
• Psychosis or psychotic reactions
• Increased risk of suicidal ideation
• Rebound Anxiety and Insomnia

Benzodiazepines are generally prescribed for the treatment of mental health disorders such as anxiety disorder and insomnia. Most users who stop the consumption of benzodiazepines start experiencing an increase in anxiety and restlessness. This condition is referred to as the “Rebound Effect.“ These effects can last for two to three days. However, there remains a clear distinction between rebound effects and withdrawal symptoms. Rebound effects are the return of the past symptoms that were present before the user started consuming benzodiazepines. Withdrawal symptoms, however, are created by the struggle the body goes through to adapt itself to the change created by the end of benzodiazepines consumption.

The half-life of benzodiazepines varies from brand to brand. Withdrawal symptoms that appear from shorter-acting benzodiazepines are seen earlier than the withdrawal symptoms that arise from longer-acting benzodiazepines.

For shorter-acting benzos, the first signs of withdrawal generally start within six to eight hours, in contrast to longer-acting benzodiazepines, which may take twenty-four to forty-eight hours for the symptoms to appear.

Shorter acting Benzos can be easily identified due to the severe and intense withdrawal symptoms that appear in individuals who stop consuming them.

• Shorter-acting Benzos: Xanax, Dormonct, Halcion

Longer-acting Benzos cause less severe withdrawal symptoms, and it takes a more extended period for these symptoms to appear.

• Longer-acting Benzos: Valium, Klonopin, Librium

Consuming benzodiazepines regularly, in larger quantities, in more potent forms and for a more extended period increases the duration of the withdrawal stage. It may take around seven days for individuals with a mild addiction to overcome withdrawal symptoms. However, those with severe addiction may experience symptoms up to three months as the individual is slowly weaned off benzodiazepine to prevent any fatal, dangerous withdrawal symptoms.

Withdrawal symptoms during a medical detox treatment usually last for a period of 2-3 weeks. However, some individuals may experience prolonged or protracted withdrawal that could last for months. This condition is called post-acute withdrawal syndrome, and it is a condition that affects those diagnosed with a very severe addiction.

Post-acute withdrawal symptoms generally appear for six months or longer after stopping the consumption of benzodiazepines.

Given below are some of the symptoms of PAWS:

• Persistent anxiety
• Chronic insomnia
• Difficulty performing complex tasks
• Poor concentration
• Loss of sex drive
• Depression

The initial step in benzodiazepine addiction treatment is the removal of the drug from the user’s system. This process is known as detox. Detox can cause harmful side effects when not carried out carefully and accurately. Abruptly stopping the consumption of the drug can lead to fatality. Therefore, a medical professional must be present when carrying out this process to monitor any potential fatal symptoms. These symptoms may include seizures and suicidal behavior.

A detox that is monitored and carried out under the supervision of a medical professional helps individuals stay safe and healthy during their recovery process. A medically supervised detox also reduces the chances of severe discomfort during withdrawal. As a result, reduces the risk of relapsing back into addiction. Depending on the drug consumed and the period of consumption, detox can last several months.

Medical detoxification from benzodiazepine generally involves the process of tapering down from the substance. Tapering down involves reducing the general dosage of the drug or prescribing a less effective benzodiazepine. This method of detox is taken into consideration depending on the severity of the addiction and the type of drug consumed.

Benzodiazepines used during the detox process may include Diazepam (Valium) or Clonazepam (Klonopin). Due to their long-acting and less effective nature compared to other Benzos, these drugs are used for medical detoxification. While the individual reduces his/her dosage, these drugs keep withdrawal symptoms at bay.

Most individuals gradually reduce their dosage until it is considered safe to stop the consumption of the drug altogether. However, some medications can help reduce withdrawal symptoms during the detox period.

Mentioned below are some of these drugs:

In order to overcome benzodiazepine addiction, it is vital to start your journey to recovery with the right medical guidance. The first step of treatment for any substance use disorder is detoxification. It is the process of removing or flushing out the addictive substance from your body. Once the individual has gone through the detox process, inpatient or outpatient treatments, and mental health counseling, one can stand a chance to achieve long-term recovery.

There is no definite answer to this question. Each individual differs in their level of consumption as well as the duration of abuse. Making the extent of one‘s treatments vary from addict to addict. Treatment for benzodiazepine addiction generally takes months if individuals are willing to go through all of the most basic and necessary steps required, such as detoxification, inpatient rehab/outpatient rehab, and aftercare. However, some people may need fewer or more stages of treatment and care, depending on the severity of their addiction.

It is important to understand that the recovery process from any drug abuse, including benzodiazepines, is a continuous process. Prolonged treatment for benzodiazepine addiction can last for many months. It is crucial to enroll in a reputable rehabilitation center/program, as it is a vital step in developing a strong base to continue recovery, even after treatment has ended effectively.

Once users have decided to go for treatment, it is recommended to go through an evaluation process to help identify the required degree of care. This evaluation can also uncover any underlying co-occurring disorders that need to be addressed and treated alongside benzodiazepine addiction. The next step after this assessment is medical detox. The gradual removal of benzodiazepines from the user‘s body is considered as an essential step towards sobriety. During the detox process, most individuals gradually reduce their dosage or switch to a less impactful drug such as Klonopin. Medical experts highly advise on the gradual reduction of drug use rather than the abrupt cease of use, as benzodiazepine withdrawal symptoms can be dangerous and even fatal. Gradually reducing the dosage decreases the risks of withdrawal symptoms like anxiety and insomnia. This approach also helps avoid severe complications, such as seizures and hallucinations. It is strongly advised to carry out detoxification with the guidance and supervision of a medical professional.

Individuals struggling with benzodiazepine addiction are strongly advised to seek professional medical treatment. However, this can sometimes be difficult and challenging as most people are unclear about what to look for when choosing a treatment program. Not every rehab center is alike, and not every treatment plan provided is identical. The treatment center that the patient chooses should offer complete care and provide users with a wide range of effective treatment programs.

Below are some such treatment options:

• One-on-one or group and family therapy sessions
• Detox and withdrawal
• Evaluation and diagnosis
• Building an individualized treatment plan
• Inpatient or outpatient rehab
• Aftercare or sober living
• Alternative therapy methods

Inpatient and outpatient rehab centers play a crucial role in providing necessary help and resources to recovering addicts. These rehab centers also provide targeted recovery techniques, including counseling and medication, to help individuals manage withdrawal symptoms effectively.

Inpatient rehab centers create a peaceful environment void of any distractions. This setting helps individuals keep their focus on achieving sobriety without any added form of temptations. Inpatient care increases the chances of long-lasting recovery, and it is an ideal setting for those suffering from severe addiction.

Inpatient treatment for benzodiazepine users generally lasts between 28 to 90 days. This schedule is determined by the individual’s degree of addiction to the drug. Specialized inpatient treatment centers also provide behavioral therapy to help patients find their way back into their daily lives without the use of any benzodiazepine.

Inpatient rehab is not meant for everyone. In such cases, intensive outpatient rehab is a sound choice. Outpatient treatment centers are an ideal option for individuals with a mild addiction to benzodiazepine. These centers allow individuals to continue and maintain their daily personal/work responsibilities during treatment.

The benzodiazepine abuse treatment programs provided in these centers often require the individual to live near a center in order to help facilitate regular, sometimes daily, mental, and physical monitoring/treatment. An intensive outpatient rehabilitation program is more effective when the individual has an active and supportive social network that is continuously helping him/her on their journey to recovery.

Long-term dedication and well-detailed treatments are essential to overcome benzodiazepine addiction. Continuous encouragement and support from community support groups and specialized counseling can assist former users to ease back into their daily routine without the use of benzodiazepines. For example, Support groups that follow the 12-step model provide beneficial and long-lasting reinforcement for individuals who are working towards recovery.

Since benzodiazepines have strong addictive characteristics that can result in intense psychological withdrawal symptoms, support groups are considered essential tools to avoid relapses. Friends, family, and religious organizations can also assist in helping individuals maintain sobriety.

In recent times, many individuals are identifying and seeking out help and treatment for benzodiazepine addictions than ever before. There are many clinics in the U.S that specializes in the treatment of benzodiazepine addiction as well as providing treatment for co-occurring disorders. Treatment specialists at addiction centers can design a precise treatment program and provide guidance to help cater to each individual’s particular needs.

The cost of rehab is another factor to consider when looking for the right treatment option for you. The cost generally depends on the needs of the individual. Insurance may be able to cover some costs, while the remaining costs may be out-of-pocket expenses.

Although the cost of rehab plays a crucial factor, it is important to seek treatment at a proper facility to help increase your chances of a long-lasting recovery. Participating in detoxification that is quick, done at home, or conducted without the supervision/guidance of a medical professional can be very hazardous and can even lead to death. There are many options and programs available to help individuals off-set any potential out of pocket expenditures or for those who are unable to afford treatment due to financial circumstances. Some of these options include loans, payment plans, grants, and scholarships.

Health insurance plans usually cover addiction treatment, but the types and periods of coverage can differ widely. Rehab insurance can help individuals cover expenses related to detoxification, treatment, and medication.

Several options are available for individuals who attend rehab without insurance coverage. State-funded rehab centers use government funds to provide treatment options and programs for individuals with low incomes or for those without any insurance coverage. Rehab centers operated by faith-based groups are mostly free. Other non-profit organizations can also assist individuals in obtaining financial support or grants to enroll in rehab. Some treatment centers may provide additional financial support options, such as sliding scale payments, loans, and financing options.