Benzodiazepines Addiction: Signs, Risks and Treatments

Benzodiazepine addiction occurs when an individual develops a physical and mental dependence on Benzodiazepines (BZDs), a class of drugs that offer sedative effects and are used to treat anxiety and other mental health and brain-related conditions. While benzodiazepines offer short-term relief for those struggling with mental health issues, their addictive nature poses significant dangers.

According to the 2015-2016 National Survey on Drug Use and Health data, benzodiazepine use was prevalent among U.S. adults, with 12.5% using these medications. Of all adults, 2.1% reported misusing benzodiazepines at least once, while 0.2% developed benzodiazepine use disorders. Looking specifically at benzodiazepine users, 17.1% engaged in misuse, and 1.5% developed use disorders. In numerical terms, this represented approximately 30.5 million U.S. adults using benzodiazepines, with 5.2 million misusing them at least once, and 0.5 million meeting the criteria for benzodiazepine use disorders. Additional data from IMSHealth Total Patient Tracker showed that 25.7 million adults were dispensed benzodiazepines in outpatient retail pharmacies in 2015.

Signs and symptoms of benzodiazepine addiction include intense craving, desire to use the drug despite knowledge of the negative consequences, tolerance and withdrawal symptoms.

Risks of Benzodiazepine Addiction include severe health complications like respiratory depression and impaired coordination, increasing accident risk. Tolerance and withdrawal symptoms lead to cognitive impairments and disrupt social and occupational responsibilities. Overdose risk, especially with other depressants, underscores the need for immediate intervention and treatment.

According to Liu, S.’s 2021 study,’ Trends in Nonfatal and Fatal Overdoses Involving Benzodiazepines – 38 States and the District of Columbia, 2019-2020’, Analysis of benzodiazepine-related incidents from 2019 to 2020 reveals alarming increases in overdose risks. Emergency department visits for benzodiazepine overdoses jumped 23.7%, with a notably higher increase of 34.4% in cases involving opioid co-use. The mortality data is even more concerning: benzodiazepine-related deaths increased by 42.9%, with illicit benzodiazepine deaths surging by 519.6% (from 51 to 316 deaths). Most critically, 92.7% of all benzodiazepine-related deaths involved opioids, with illicitly manufactured fentanyls present in 66.7% of these fatalities, highlighting the extreme danger of combining these substances.

The Treatment for Benzodiazepine Addiction involves medical detoxification, inpatient treatment, and behavioral therapies. Medical detoxification begins with a supervised tapering process, which, when combined with cognitive-behavioral therapy (CBT), significantly increases long-term success rates. Inpatient treatment offers a structured environment for managing withdrawal, while CBT equips individuals with skills to address negative thought patterns and prevent relapse. Supportive counseling further enhances motivation and encourages recovery.

What is Benzodiazepine Addiction?

Benzodiazepine addiction is a chronic neurological and psychological disorder that creates an absolute physical and psychological dependence on benzodiazepine medications (Xanax, Valium, Klonopin, and similar drugs). The addiction specifically alters GABA neurotransmitter systems in the brain, creating permanent changes in brain chemistry that require medical intervention to address. According to Atack J. R.’s 2005 study., ‘The benzodiazepine binding site of GABA(A) receptors as a target for the development of novel anxiolytics’, Benzodiazepines directly affect GABA(A) receptor systems through specific binding sites on alpha1-5 subunits, leading to physical dependence and neuroadaptive changes. These compounds modify GABAergic neurotransmission in ways that create significant receptor alterations, necessitating careful medical management for addiction treatment.

What Are Benzodiazepines?

Benzodiazepines (Benzos or BZDs) are a class of prescription psychoactive medications that function as central nervous system depressants by enhancing the activity of the GABA neurotransmitter in the brain. These controlled substances, including drugs like Xanax (alprazolam), Valium (diazepam), and Klonopin (clonazepam), are specifically designed to produce sedative, hypnotic, anti-anxiety, anticonvulsant, and muscle relaxant effects

According to a National Survey in Drug Use and Health published in 2021, over 25 million people aged 12 and above used benzodiazepines as prescribed.

What are the Signs of Benzodiazepine Addiction?

The signs of Benzodiazepine addiction include a persistent urge to use the drug, and unsuccessful attempts at stopping. These signs also encompass interference with responsibilities and continued usage despite negative impacts.

The American Psychiatric Association in their Diagnostic and Statistical Manual of Mental Disorders (DSM-5) specified that sedative or anxiolytic use disorders, including Benzodiazepine addiction, are characterized by a pattern of use that leads to at least two of these symptoms occurring within a year:

• A persistent urge to use the drug or numerous unsuccessful attempts at stopping.
• Use of the drug in higher doses or longer than intended.
• Spending excessive time in pursuit of the drug.
• Use starts to interfere with responsibilities.
• Use in an environment where bodily harm is possible.
• Continued usage even when aware of the negative impact.
• Tolerance and withdrawal symptoms.

People with these symptoms are advised to seek help from a healthcare professional, to get a proper diagnosis and start treatment.

What are the Risks of Benzodiazepine Addiction?

The risks of Benzodiazepine addiction include respiratory depression, cognitive decline, and severe withdrawal complications. Regular misuse leads to tolerance development, psychological disturbances, and an increased risk of life-threatening overdose, especially when combined with other substances.

Here are the key risks associated with Benzodiazepine addiction:

• Health Complications: Prolonged benzodiazepine use increases health complications, including respiratory depression, dizziness, blurred vision, impaired coordination, and elevated risk of falls and accidents. According to Wang, S. H.’s 2019 study, ‘Benzodiazepines Associated With Acute Respiratory Failure in Patients With Obstructive Sleep Apnea’, benzodiazepine (BZD) users showed a 2.7-fold higher risk of adverse respiratory events compared to non-users. For acute respiratory failure specifically, the risk was markedly elevated – recent users (1-30 days) had a 28.6-fold increased risk, while long-term users (31-365 days) showed a 10.1-fold increased risk. The initial month of BZD use appears to be the period of highest respiratory risk.
• Tolerance Development: Continued benzodiazepine abuse leads to tolerance, requiring higher doses for desired effects.
• Withdrawal Symptoms: Individuals with benzodiazepine dependence experience withdrawal symptoms. Withdrawal symptoms range from mild to severe and include Nervousness, anxiety, difficulty focusing, insomnia, muscle cramps, low energy, and life-threatening complications. According to Huff, C.’s 2023 study, ‘Enduring neurological sequelae of benzodiazepine use: an Internet survey’, 76.6% of all respondents (including those taking full dose, those tapering, and those who discontinued benzodiazepines) who reported withdrawal symptoms experienced them for a long duration (months or years). This finding contrasts with older literature that suggested withdrawal symptoms typically resolved within 28 days. The most commonly reported symptoms were anxiety (90.3%), sleep disturbances (88.7%), and cognitive/focus issues (87.2%), with the majority of these symptoms persisting for months to years rather than resolving in days or weeks.
• Psychological Effects: Benzodiazepine addiction causes profound psychological effects, including cognitive impairment, memory problems, confusion, disorientation, and mood disturbances. According to Huff, C.’s 2023 study, ‘Enduring neurological sequelae of benzodiazepine use: an Internet survey’, Memory problems impact 78.0% of users, predominantly as a long-term issue (85.2% experiencing symptoms for months to years) versus short-term (14.8% experiencing symptoms for days to weeks). Emotional disturbances, manifesting as crying and anger, affect 72.7% of respondents, with 74.6% experiencing these symptoms long-term and 25.4% short-term. Hallucinations, while less common at 35.5% of respondents, show a more balanced distribution between short-term (50.6%) and long-term (49.5%) effects.
• Impaired Responsibilities: Benzodiazepine addiction significantly impairs an individual’s ability to fulfill social and occupational responsibilities.
• Overdose Risk: Benzodiazepine misuse or abuse, especially when combined with other central nervous system depressants like alcohol or opioids, increases overdose risk. According to the National Institute on Drug Abuse, 2021 publication, ‘NIDA. 2024, August 21. Drug Overdose Deaths: Facts and Figures’, Benzodiazepine-related overdose deaths in the U.S. increased tenfold from 1,135 deaths in 1999 to 11,537 in 2017. Following a temporary decline to 9,711 deaths in 2019, fatalities peaked at 12,499 in 2021 before decreasing to 10,964 in 2022.

Benzodiazepine addiction poses serious risks to an individual’s health, well-being, and quality of life. Seeking timely intervention and treatment is essential in addressing addiction and mitigating its harmful effects.

What is The Treatment For Benzodiazepine Addiction?

The treatment for Benzodiazepine addiction includes medical detoxification, inpatient treatment options, and behavioral therapies. Here are the treatment options for Benzo addiction in detail:

• Medical Detoxification: Individuals with severe cases of benzodiazepine dependence usually start treatment with a medical detoxification handled by a medical professional. According to Baillargeon, L.’s 2003 study, ‘Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: a randomized trial’, Benzodiazepine tapering process involved reducing doses by 25% every 1-2 weeks over an 8-week period under medical supervision. When used alone, tapering helped 38% of patients stop their benzodiazepines initially, but only 24% remained drug-free after one year. However, when tapering was combined with cognitive-behavioral therapy, the success rate jumped to 77% initially and 70% remained benzodiazepine-free at one year, making it a significantly more effective approach for long-term benzodiazepine discontinuation.

• Inpatient treatment: Inpatient treatment provides a structured, medically supervised environment for safely managing benzodiazepine withdrawal and addiction recovery. This intensive level of care is particularly important for benzodiazepine dependence due to potentially severe withdrawal symptoms. According to Messinger, J. C.’s 2023 study,’The Use of a Single Dose of Phenobarbital for Inpatient Management of Benzodiazepine Withdrawal: A Case Report’, while traditional outpatient tapers have been the standard approach, new protocols using single-dose phenobarbital treatment in inpatient settings show promise for more efficient withdrawal management. In their reported case, a patient using 3-4mg of alprazolam daily achieved successful withdrawal using this protocol with sustained recovery at 60-day follow-up.

• Cognitive-behavioral therapy (CBT): CBT is a structured, goal-oriented therapy that helps individuals identify and change negative thought patterns and behaviors associated with benzodiazepine addiction. By focusing on the relationship between thoughts, feelings, and actions, CBT equips patients with practical skills to manage cravings and prevent relapse. According to Morin, C. M.,’s 2005 study, ‘Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse’, combining CBT with supervised medication tapering creates better outcomes for stopping benzodiazepines, even for long-term users who had taken the medication for an average of 18.9 years. The combined approach resulted in only 33.3% of patients relapsing, similar to the taper-only group at 30.8%. The mean survival time of 12.6 months for the combined approach demonstrates that integrating CBT with medical tapering provides a practical path to breaking free from long-term benzodiazepine use.

• Counseling Support: Supportive counseling and structured interviews play a significant role in encouraging patients to reduce or quit benzodiazepines. Tailored interventions from healthcare providers motivate patients during their recovery process.

What Are The Withdrawal Symptoms Of Benzodiazepines, And How Are They Managed?

Signs and symptoms of benzodiazepine withdrawal include anxiety, insomnia, seizures, and tremors. The severity of these symptoms varies based on the duration of use, dosage, and individual health factors. It’s important to manage these symptoms under medical supervision to ensure safety and comfort during detoxification.

Effective management of benzodiazepine withdrawal involves a gradual tapering of the Benzodiazepine to minimize withdrawal symptoms, along with support from healthcare professionals. According to Vicens, C.’s 2006 study, ‘Withdrawal from long-term benzodiazepine use: randomised trial in family practice’, the structured tapering program successfully helped 45.2% of patients completely stop their benzodiazepines after 12 months, while another 21.9% reduced their dose by at least 50%. The method involved reducing doses by 10-25% every two weeks with regular doctor follow-ups.

Why Are Benzodiazepines Addictive?

Benzodiazepines are addictive because they enhance GABA’s inhibitory effects in the brain, leading to reduced neuronal excitability and alterations in the reward pathway that affect dopamine release.

According to Blum, K., Gold, M.’s 2018 study, ‘Would induction of dopamine homeostasis via coupling genetic addiction risk score (GARS®) and pro-dopamine regulation benefit benzodiazepine use disorder (BUD)?’, Benzodiazepines (BZDs) exert their therapeutic effects through modulation of the GABAergic system in the brain. These medications enhance the inhibitory effects of GABA by binding to GABAA receptors, specifically acting on chloride channels. Through this mechanism, BZDs increase the inhibitory neurotransmitter GABA’s effectiveness, leading to reduced neuronal excitability. In the reward pathway, this action results in decreased VTA glutaminergic drive and subsequent reduction in dopamine release at the nucleus accumbens, producing the characteristic calming and sedating effects associated with benzodiazepine use.

How Does Benzodiazepine Addiction Develop?

Benzodiazepine addiction develops from both prescribed and unprescribed use, leading to physical and psychological benzodiazepine dependence.

• Physical Dependence: Prolonged Benzodiazepine use causes physical dependence. The body adapts to Benzodiazepines and requires them for normal functioning. Abrupt cessation triggers withdrawal symptoms, including insomnia, anxiety, tremors, and seizures. Fear of withdrawal symptoms drives continued Benzodiazepine use.
• Psychological Dependence: Physical dependence on Benzodiazepines increases psychological dependence. Psychological dependence shapes drug use patterns and intensifies over time. Individuals exceed maximum dosages to alleviate anxiety. Eventually, individuals rely on Benzodiazepines to manage stress, anxiety, and emotional issues. Over time, Benzodiazepine intertwines with coping mechanisms, leading to cravings and compulsive drug-seeking behavior.

Key Development Factors:

• Legitimate Medical Use: Individuals are prescribed benzodiazepines for legitimate medical reasons, such as anxiety or insomnia.
• Tolerance Development: Prolonged use results in tolerance, requiring higher doses to achieve the same effects and increasing the risk of misuse and addiction.
• Recreational Use: Some individuals seek benzodiazepines recreationally for their calming effects, leading to compulsive use.

As dependence develops, withdrawal symptoms emerge when attempting to stop, reinforcing the cycle of addiction. This interplay of tolerance, psychological reliance, and withdrawal creates significant challenges for recovery, necessitating comprehensive treatment to address both the physical and mental health aspects of addiction.

According to de las Cuevas, C.’s 2003 study, ‘Benzodiazepines: more “behavioural” addiction than dependence’, Benzodiazepine dependence affected 47% of patients who used these medications for longer than one month, according to a study of 1,048 patients across 20 primary-care centers. The research revealed that dependence was more common among middle-aged women who were separated, had limited education, and were either unemployed or housewives. While factors like higher doses, longer use, and short half-life benzodiazepines showed a correlation with dependence, multivariate analysis identified just three key factors: dose level, duration of use, and concurrent antidepressant use.

How Do Benzodiazepines Interact with Other Medications and Substances?

Benzodiazepines interact with alcohol, opioids, and certain antidepressants, increasing the risk of adverse effects and overdose. According to Malone, D.’s 2023 study, ‘Phenobarbital versus benzodiazepines in alcohol withdrawal syndrome’, benzodiazepine treatment for alcohol withdrawal syndrome showed concerning outcomes in 71 patients, with 51% requiring intubation, 47% developing pneumonia, and 39% needing high-flow oxygen support (≥6 liters). Patients treated with benzodiazepines had extended hospital stays (median 10 days) and prolonged ICU stays (median 4 days), indicating significant respiratory risks associated with benzodiazepine-based protocols.

Do Benzos Get You High?

Yes, some benzodiazepines get you high. According to El Balkhi, S.’s 2020 study, ‘Designer benzodiazepines’ pharmacological effects and potencies: How to find the information.’, shows etizolam produces the strongest euphoric effects among designer benzos. In contrast, benzodiazepines like diazepam and pyrazolam do not create euphoria at all. The euphoric effects feel similar to prescription benzodiazepines.

Are There Alternative Treatments For Anxiety And Sleep Disorders Besides Benzodiazepines?

Yes, there are alternative treatments for anxiety and sleep disorders besides benzodiazepines. Non-pharmacological treatments such as cognitive-behavioral therapy (CBT), relaxation techniques, and lifestyle modifications effectively manage anxiety and improve sleep quality. Some antidepressants and anticonvulsants serve as alternatives to benzodiazepines.

How Can I Support A Loved One Struggling With Benzodiazepine Addiction?

You can support a loved one struggling with benzodiazepine addiction by offering emotional support, encouraging them to seek professional help, and avoiding enabling behaviors such as providing access to benzodiazepines. Promote healthy coping mechanisms and connect them with support resources.

How Does Benzodiazepine Addiction Impact Cognitive Function?

Benzodiazepine addiction significantly impairs cognitive function over time. Prolonged use is associated with memory impairment, decreased attention span, and difficulties in processing complex information. These cognitive deficits affect daily functioning, impacting both personal and professional life. 

According to Nader, D. ‘s 2020 study, ‘Long-Term Benzodiazepine Use a Risk Factor for Cognitive Decline? Results of a Systematic Review’, long-term benzodiazepine use, cognitive domains affected included global cognitive functioning, verbal memory, intelligence, psychomotor speed, and speed of processing. While acute cognitive effects of benzodiazepines are well-established, little evidence supports a significant association between long-term benzodiazepine use and cognitive decline in the general adult population.

Recovery and improvement in cognitive functions are possible with appropriate treatment.

Transitioning into a treatment program that includes a dual diagnosis approach proves beneficial, especially for individuals experiencing concurrent mental health issues alongside substance use disorder. This comprehensive treatment strategy addresses both the addiction and underlying cognitive or psychological issues, offering a path toward recovery and cognitive restoration.

Is Benzodiazepine Withdrawal Life Threatening?

Yes, benzodiazepine withdrawal can be life-threatening based on research evidence showing increased mortality rates among patients who discontinue these medications compared to those who continue them.

According to Maust, D. T’s 2023 research, ‘Benzodiazepine discontinuation and mortality among patients receiving long-term benzodiazepine therapy.’, research published in JAMA Network Open (2023), the study of 353,576 patients demonstrated significant mortality risks associated with benzodiazepine discontinuation. Among patients not taking opioids, those who discontinued benzodiazepines had a 5.5% death rate (2.1 percentage points higher than continuers) and 1.6 times higher mortality risk. The risks were even higher for patients also taking opioids, with discontinuation leading to a 6.3% death rate (2.4 percentage points higher than continuers) and similarly 1.6 times higher mortality risk. Secondary adverse outcomes were also more frequent among those who discontinued, highlighting that benzodiazepine withdrawal carries serious risks that require careful medical management.