Medically Reviewed by Dr. Mohammed Saeed, MD.
Benzodiazepines sometimes called benzos or downers, are highly addictive, especially when misused, used long-term, or used concurrently with other sedative drugs. In 2012, researchers at the National Institute on Drug Abuse found that “benzodiazepines cause addiction in a way similar to opioids, cannabinoids, and GHB.”
An article in the New England Journal of Medicine by Dr. Anna Lembke, Medical Director of Addiction Medicine at Stanford University, calls benzodiazepines “our other prescription drug problem,” in reference to the opioid prescription drug crisis in the U.S. She states, “the adverse effect of benzodiazepine overuse, misuse, and addiction continues to go largely unnoticed.” She warns that the use and abuse of benzos is becoming an epidemic, just like the opioid crisis.
Benzodiazepines are especially dangerous when combined with opioids. Both drugs carry the FDA “black box” warning, stressing the danger of using these drugs together. Benzodiazepines and opioids both have a sedative effect and can suppress breathing, which is often the cause of overdose deaths.
A 2016 study published in the Journal of Substance Abuse, concluded that “two in five people seeking detoxification for an opioid use disorder used a benzodiazepine in the prior month.”
To understand what makes benzodiazepines so addictive it’s important to understand what they are, why they’re prescribed, and how they work in the body.
What are benzodiazepines used for?
Benzodiazepines are considered tranquilizers and are often prescribed to treat anxiety disorders, panic disorders, seizures, muscle spasms, insomnia, and alcohol withdrawal. They are also used in patients undergoing medical procedures to provide a sedative, calming effect, or to induce amnesia to prevent the recall of pain or discomfort.
Frequently prescribed benzodiazepines include:
- Lorazepam (Ativan)
- Diazepam (Valium)
- Clonazepam (Klonopin)
- Alprazolam (Xanax)
Benzodiazepines have largely replaced prescription barbiturates, as they are considered to be a safer option. While they may be safer if used short-term and as prescribed, with chronic use or misuse, they are highly addictive. If taken alone, benzodiazepines do not have a high risk of overdose, but when mixed with alcohol, other sedatives, or opioids, they can be extremely dangerous and even life-threatening.
Barbiturates are still commonly abused illegal street drugs. They are often used to temper the hyper excitement caused by drugs like cocaine. The use of these drugs together is extremely dangerous.
How do benzodiazepines affect the body?
Benzodiazepines affect the body’s central nervous system by interacting with receptors in the brain that regulate anxiety, movement, and other functions. The signals sent through neurotransmitters trigger tranquilizing chemicals in the brain, signaling the muscles to relax and the brain to slow down, eliciting a drowsy, calm effect.
Like opioids, benzodiazepines also cause the release of dopamine and endorphins, which are mood-elevating hormones. When these hormone levels rise, positive feelings also increase, and users can come to crave that effect. Seeking to maintain a state of calm and a happy mood may encourage users to exceed the prescribed dosage or frequency so they can keep feeling good. As doses increase, tolerance to the drug increases so more is needed to achieve the desired effect. This cycle can lead to benzo dependence and addiction.
Can you become dependent or addicted to benzodiazepines?
Once a person has been taking benzodiazepines regularly for days, weeks, or longer, receptors in the brain change and adapt to their presence. The center of the brain that controls mood and the ability of a person to feel happy is affected by the constant presence of benzodiazepines and may become unable to elicit those responses without the drug, triggering dependence.
Dependence is different from addiction. People who use a drug, prescribed or not, develop a dependence on the substance to deliver a desired effect. But as the dependence deepens, higher levels of the drug are needed to achieve the feeling of well-being that is craved. The level of dependence a person has developed will affect the severity of withdrawal symptoms when the drug is stopped.
Addiction is defined as a substance abuse disorder and is characterized by continued drug use despite negative consequences to the user. Even if a person is addicted to benzodiazepines, an overdose is rarely fatal unless the drug was used in combination with other drugs or alcohol.
Benzodiazepines to treat alcohol withdrawal
When those with an alcohol dependency abruptly stop drinking alcohol, they experience mild to severe withdrawal symptoms. While all symptoms may be uncomfortable or painful, some can be life-threatening. Comprehensive alcohol recovery treatment plans often include benzodiazepines to help reduce withdrawal symptoms including:
- anxiety
- shakes or tremors
- sleep difficulties
More severe and potentially dangerous symptoms may include hallucinations, seizures, or delirium tremens (DTs). Extensive research has shown benzodiazepines to be the most effective medication for the reduction of withdrawal symptoms.
Common side effects of benzodiazepines
When taken as prescribed, short-term use of benzodiazepines is generally safe. While the drugs have been proven effective for reducing anxiety, inducing relaxation, and promoting sleep, they may still produce uncomfortable, possibly dangerous, side effects. The most common side effects of using benzodiazepines include:
- Dizziness
- Drowsiness
- Grogginess
- Poor coordination
- Depression
- Trembling
- Confusion
- Headache
- Vision problems
If mixed with alcohol or other drugs, side effects will be intensified and could be fatal. Same day, or even next day, side effects like grogginess, drowsiness, and confusion can pose a serious risk of danger if driving or operating machinery.
Because of the symptoms they produce, like grogginess, drowsiness, confusion, and impaired coordination, benzodiazepines like Rohypnol have been used as a “date rape” drug. The drug can even cause amnesia, so the event isn’t recalled.
Although they are widely prescribed for older adults, studies have shown that seniors have an increased sensitivity to benzodiazepines and a harder time metabolizing them. Side effects may be more apparent and longer lasting in the senior population.
When misused and taken at higher doses than prescribed, or taken illegally, severe side effects, including overdose, can occur. Some signs of abuse include the return of symptoms that were being treated in the first place, like anxiety and insomnia. Some signs may be severe, even life-threatening, and may include:
- Weakness
- Anorexia
- Slurred speech
- Lack of coordination
- Difficulty breathing
- Coma
Other changes may include a noticeable deterioration in a user’s physical appearance, in their relationships with family and friends, and in job or school performance.
Once a person has become physically dependent on benzodiazepines, they will experience withdrawal symptoms if they abruptly stop taking them. Withdrawal symptoms may be severe and could include seizures, which is why it’s important to taper off from them gradually, under a doctor’s supervision.
Withdrawal from benzodiazepines
Withdrawal from benzodiazepines can be uncomfortable, frightening, and even dangerous, and should always take place under medical supervision. Symptoms usually start within 24 hours, and typically last a few days to a few months, depending on the severity of the addiction.
The duration of withdrawal and severity of symptoms depends on how long benzos have been taken, the dosage, co-occurring medical or mental health issues, and whether alcohol or other drugs were also used.
Medical and mental health professionals can help make the detoxification process less uncomfortable and safer. Symptoms of benzodiazepine withdrawal can include:
- Rebound insomnia and anxiety
- Panic
- Mood swings
- Blurred vision
- Headache
- Muscle spasms
- Tremors
- Nausea and vomiting
- Sweating/flushing
- Diarrhea
- Seizures
- Cloudy thinking
- Short term memory loss
- Hallucinations
Stopping benzodiazepines “cold turkey” can result in severe withdrawal symptoms and can include life-threatening seizures.
Medical Treatment for Benzodiazepine Abuse
In cases of acute benzodiazepine toxicity, hospitalization may be indicated. Depending on what drugs were taken, doctors may administer activated charcoal to counteract the drug effect, or, in some cases may pump the stomach. Activated charcoal can cause side effects like nausea, vomiting, and abdominal cramps. Unless levels of benzodiazepine have become toxic, evaluation by medical staff may be enough.
If benzodiazepines have built to a toxic level in the body, an extreme sedative effect may result. Those with severe toxicity may appear to be in a stupor, or even comatose, with depressed respiration. Toxic effects can be counteracted by a drug called flumazenil (Romazicon). This drug is used only in very severe cases, as it can result in withdrawal symptoms and seizures. If flumazenil is combined with alcohol, dangerous interactions can occur.
Recovery treatment programs for benzodiazepine abuse.
For those taking benzodiazepines in the dose and manner prescribed, and for a short time period, dependence and withdrawal are not likely to occur. In these cases, patients can often wean themselves from the drug, at home, and under medical direction.
However, those who have misused or otherwise become dependent on the drug need more help in the recovery process. As previously stated, withdrawal symptoms, including seizures, can be severe and should always be overseen by medical professionals.
For safe and long-lasting recovery, treatment at an inpatient or outpatient drug rehabilitation center may be the best option. There, after safely detoxing, patients can participate in a therapeutic treatment plan tailored to their specific needs. Treatment for benzo addiction often incorporates individual and group therapy, 12-step support groups, and family counseling.
Knowing the dangers, should I take the benzodiazepines my doctor prescribed?
Benzodiazepines are highly effective at relieving anxiety, sleep disorders, and other conditions. They are generally safe if used short-term and as prescribed. Benzodiazepines are frequently prescribed in combination with antidepressants to treat anxiety disorders. Because they are fast acting, while antidepressants may take a few weeks to become effective, benzodiazepines can provide initial relief, then be discontinued when the antidepressant starts to work.
Before prescribing this class of drugs, your physician will consider your individual health history, other medications that you are taking, and additional factors to determine if the benefits of this drug outweigh any potential risks. It is very important that you inform your doctor about all prescription, OTC, or illegal drugs you are taking, as well as any herbs you take. Also, be honest about your alcohol use. Interactions with other drugs or alcohol present the most risks associated with the use of benzodiazepines.
