Benzodiazepine Addiction and Misuse

Benzodiazepine drugs may be prescribed for several different medical reasons. Despite their legal uses, they are also often misused and carry a high addiction potential. This article will discuss the side effects and risks of benzo use, withdrawal symptoms, and benzodiazepine addiction treatment.
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Benzodiazepine Uses, Effects, and Risks

What are Benzodiazepines?

Benzodiazepines are types of prescription sedatives and central nervous system (CNS) depressants that doctors often use to treat conditions such as anxiety, insomnia, convulsions, symptoms of alcohol withdrawal, and more.1,2

Benzos are some of the most commonly prescribed medications, with approximately 120.2 million benzodiazepine prescriptions dispensed in the United States in 2017.2 Reports indicate that benzos are also among the most commonly misused illicit or prescription drugs in the U.S.2,3

Benzodiazepines are often misused:3

  • For their euphoric properties.
  • To enhance the effects of certain drugs (like other CNS depressants or opioids).
  • To alleviate the unwanted effects of certain drugs (like a comedown from stimulants).

Because they have medical uses but still have some misuse and addiction potential, benzodiazepines are classified as a Schedule IV controlled substance by the Drug Enforcement Agency (DEA).4

Common Benzodiazepines

Common benzos include:2

According to the DEA, these are not only the most commonly prescribed but also the most frequently found benzos on the illicit market.2

How Do Benzodiazepines Work?

Benzodiazepines work to calm an otherwise over-excited nervous system.2 Benzos and other sedatives are understood to interact with and influence activity at the gamma-aminobutyric acid (GABA) receptor.1

Through interaction with its corresponding GABA receptors, GABA serves as a signal that increases inhibitory brain signaling and counters excitation.1 This results in the anxiolytic (anti-anxiety) and calming effects that people typically experience when they use benzodiazepines.1,2

Side Effects and Risks of Benzodiazepines

Common benzo side effects can include:5,6

  • Drowsiness.
  • Confusion.
  • Headache.
  • Diarrhea.
  • Tremor.
  • Low blood pressure.
  • Syncope (passing out).
  • Nausea/vomiting.
  • Respiratory depression (slowed breathing).
  • Respiratory arrest (stopped breathing).

While rare, people—especially with psychotic disorders, bipolar disorder, or depression—may also experience paradoxical reactions from benzodiazepines. A paradoxical reaction is when the drug has the opposite of its desired effects.7 With benzodiazepines, paradoxical reactions may include: 7

  • Increased anxiety.
  • Increased hostility.
  • Aggression.
  • Vivid dreams.
  • Hyperactivity.
  • Sexual disinhibition.
  • Rage.

Benzodiazepine-associated risks can increase with long-term use.8 Long-term health effects and risks may include:1,8,9

  • Cognitive impairment.
  • Oversedation.
  • An increased risk of motor vehicle accidents.
  • An increased risk of falls and injuries among elderly people.
Benzodiazepine Addiction, Overdose, and Withdrawal

Are Benzodiazepines Addictive?

Yes, benzos can be addictive.5 The clinical diagnosis for benzo addiction is sedative use disorder.10

Benzos can be addictive for a variety of reasons. For one, benzodiazepines act on dopamine, which is the primary neurotransmitter—or chemical messenger—responsible for reward and pleasure.3 This action is believed to reward or reinforce continued use, which can underlie eventually compulsive misuse patterns.11

Long-term benzo use can also cause someone to develop a tolerance, meaning the body adapts to repeated substance use over time, to the point where a person needs increasing doses to feel the same effects. Tolerance can even occur when someone is taking their medication as intended. However, since the desired effects become blunted, this can lead to escalating patterns of use (i.e., using more of a drug), which can drive compulsive drug use and is a risk factor for addiction.10

Additionally, chronic benzo use—even as prescribed—can lead to physiological dependence, which is an adaptation wherein the body becomes so used to the drug being present in the system that when the individual cuts back on their use or quits, withdrawal symptoms emerge.10 Dependence can develop after just a few weeks of ongoing benzo use.9 intro 2nd par Patients may experience a range of mild to potentially life-threatening benzodiazepine withdrawal symptoms when they stop using the drug.9,10

Since benzodiazepines are often secondary substances of misuse, it is common for people with sedative addictions to also suffer from another form of substance use disorder (e.g., opioid addiction, alcohol addiction, or cocaine addiction). People that misuse other substances also tend to take higher doses of benzodiazepines.12

Studies indicate that people who have struggled with addiction in the past or have a family history of substance use issues are at increased risk for developing a benzodiazepine addiction.13

Signs of Benzodiazepine Misuse and Addiction

Misusing prescription drugs like benzodiazepines can be harmful to one’s health and lead to dangerous consequences, including addiction.10,14

Misuse means using the medication in unintended ways, such as:14

  • Taking someone else’s prescription.
  • Using it for nonmedical purposes (such as to get high).
  • Using other routes of administration (like crushing and snorting pills).11

Only a medical professional can diagnose sedative use disorder, but it can be helpful to be aware of the diagnostic criteria to potentially recognize the benzodiazepine addiction signs early. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the following 11 criteria for sedative use disorder:10

  1. Taking benzodiazepines in larger amounts or over a longer period than was intended.
  2. A persistent desire or repeated unsuccessful efforts to cut down or control benzodiazepine use.
  3. Spending a lot of time in activities that are necessary to obtain, use, or recover from the effects of benzodiazepines.
  4. Cravings, or strong urges for benzos.
  5. Recurrent benzodiazepine use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continuing to use benzos despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of benzodiazepines.
  7. Giving up important social, work, or recreational activities because of benzodiazepine use.
  8. Recurrent benzo use in situations where it is physically hazardous to do so (such as driving or operating machinery).
  9. Continuing to use benzodiazepines despite the knowledge of having a physical or psychological problem that likely to have been caused or exacerbated by benzo use.
  10. Developing a tolerance to benzodiazepines. This criterion does not apply to someone taking their prescribed medication as intended.
  11. Experiencing withdrawal symptoms when ceasing or reducing benzo use. This criterion does not apply to someone taking their prescribed medication as intended.

Individuals that exhibit at least 2 or more of the above criteria within a 12-month period would be diagnosed with sedative use disorder.10

Can You Overdose on Benzos?

Yes; however, overdose involving benzos usually occurs due to polysubstance misuse (i.e., using different substances at the same time or within a short time of each other).15

Classic symptoms of isolated benzodiazepine overdose include: 16

  • Slurred speech.
  • Ataxia (poor muscle control).
  • Altered mental status.

Combining benzos with other CNS depressants or opioids can cause symptoms such as:15

  • Slowed breathing.
  • Weak pulse.
  • Altered mental status or confusion.
  • Passing out.

If you suspect that someone is overdosing, it’s important to seek immediate medical attention and call 9-1-1 right away, then follow these steps:15,17

  1. Administer naloxone if you think the person has also used opioids. Naloxone can save a person’s life if they are overdosing on opioids, but it will not cause harm if they don’t have opioids in their system— it’s better to use it if you’re not sure.
  2. Keep the person awake and breathing.
  3. Lay them on their side to prevent choking.
  4. Stay with the person until medical help arrives.

Benzodiazepine Withdrawal

Benzodiazepine withdrawal can be uncomfortable and, in some cases, potentially life-threatening.10 Medical detox can make the withdrawal process much safer and less unpleasant.

Benzo withdrawal symptoms may include:10

  • Autonomic hyperactivity (sweating or pulse rate greater than 100 bpm).
  • Hand tremor.
  • Insomnia.
  • Nausea or vomiting.
  • Transient visual, tactile, or auditory hallucinations or illusions.
  • Psychomotor agitation (like restlessness or uncontrollable movements.
  • Anxiety.
  • Grand mal seizures.

Seizures can be a serious complication of benzo withdrawal and are believed to occur in around 20%-30% of people who undergo untreated withdrawal from benzos or other sedatives.10

People that use short-acting benzos, (e.g., lorazepam, oxazepam, temazepam) will likely develop withdrawal symptoms within 6-8 hours of their last use, which peak in intensity on the second day and improve by the fourth or fifth day. Those that use long-acting benzos (e.g., diazepam) may not develop withdrawal symptoms for up to a week, with symptoms peaking in intensity during the second week, and decreasing markedly during the third or fourth week.10

Some people may develop a protracted withdrawal syndrome (PAWS), which can include lower-level symptoms that come and go and can persist for months or even up to 2 years.18 Protracted withdrawal symptoms can include: 10,18

  • Anxiety.
  • Depression.
  • Memory impairment.
  • Motor symptoms, such as muscle jerking or eye twitches.
  • Tinnitus (ringing in ears).
  • Burning or prickling sensations.
  • Irritable bowel syndrome (IBS)
  • A feeling of insects crawling under the skin.
  • Psychotic reactions.
Treating Benzodiazepine Addiction

Medically supervised detox is often an important first step in recovery from benzodiazepine addiction. Detox allows patients to safely withdraw from benzos under medical supervision.1 Often, patients will be prescribed a long-acting benzodiazepine in tapering doses during detox to reduce the risk and severity of seizures.19

While detox is crucial for many, most people need continued treatment to remain in long-term recovery.19,20 These patients often transition to various types of rehab, such as the ones offered at River Oaks Treatment Center. The continuum of care at River Oaks includes:

Benzodiazepine addiction treatment in any of the above settings may include various types of behavioral therapy, relapse prevention strategies, and treatment for any co-occurring disorders that may be present, such as depression or anxiety disorders.20

If you’re struggling with sedative use or you know someone who is displaying benzodiazepine addiction signs, please call our free, confidential helpline at to speak to a caring admissions navigator about addiction treatment in Riverview, FL. They can help you through rehab admissions or answer questions about using insurance to pay for rehab and other rehab payment options.

Verify your insurance coverage at River Oaks by using the confidential .

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