Benzodiazepine Addiction: Symptoms, Causes, Effects, and Treatment Interventions

Benzodiazepine addiction refers to an intense physical and psychological dependence on benzodiazepines despite the adverse effects it has on its users. Benzodiazepine is a class of drugs used for treating anxiety, insomnia, and other conditions. According to a 2019 research by Maust Donovan T. et al ‘Benzodiazepine Use and Misuse Among Adults in the United States,’ a total of 30.6 million adults (12.6%) reported past-year benzodiazepine use-25.3 million (10.4%) as prescribed, and 5.3 million (2.2%) misuse. Misuse accounted for 17.2% of overall use.

The symptoms of benzodiazepine addiction include increased anxiety, sleep disturbances, irritability, increased tolerance, and intense cravings for the drug. Other signs include slurred speech, coordination problems, drowsiness, memory issues, mood swings, confusion, and difficulty concentrating.

The causes of benzodiazepine addiction involve prolonged use beyond the prescribed duration or dosage, history of substance abuse, underlying mental health disorders, and environmental factors such as stress or peer influence.

The effects of benzodiazepine addiction include cognitive decline, neurological damage, and an increased risk of accidents due to impaired motor skills. Socially, it leads to withdrawal from relationships, reduced occupational productivity, and financial problems. 

Treatment interventions for benzodiazepine addiction include medically supervised detoxification, therapy sessions, support groups, and lifestyle modifications.

What Is Benzodiazepine Addiction?

Benzodiazepine addiction is a type of substance use disorder involving the compulsive use of benzodiazepines, a class of psychoactive drugs primarily used to treat conditions such as anxiety, insomnia, and seizures. Benzodiazepine addiction involves a physical and psychological dependence on the medication, leading to a range of symptoms including cravings, increased tolerance, withdrawal symptoms upon cessation, and continued use that results in negative consequences.

According to Maust, Donovan T. et al.’s 2018 study, ‘Benzodiazepine Use and Misuse Among Adults in the United States,’ 5.3 million adults misused benzodiazepine in the past year.

Benzodiazepines are extremely addictive due to prolonged or inappropriate use, which results in tolerance and withdrawal symptoms. Individuals addicted to benzodiazepines experience increased anxiety, cravings, and severe physical and psychological effects, complicating cessation of use without medical help. This addiction affects personal health and leads to significant social and behavioral problems. Effective treatment involves medical detox and long-term therapeutic support.

What Are The Symptoms Of Benzodiazepine Addiction?

The symptoms of Benzodiazepine addiction include increased tolerance, dependence, cravings, loss of control, continued use regardless of its consequences, and adverse effects upon withdrawal and risky behaviors. 

The symptoms of benzodiazepine addiction are given below:

• Increased tolerance: benzodiazepine addiction causes a need to consume larger doses of benzodiazepines to achieve the same calming or sedative effects that smaller doses once provided.
• Withdrawal Symptoms: People with benzo addiction experience unpleasant physical and psychological effects when not taking benzodiazepine, such as shaking, sweating, increased anxiety, irritability, and sleep disturbances.
• Cravings: Strong and persistent urges to use benzodiazepines, which then dominate the addicted individual’s thoughts and behaviors.
• Loss of Control: Difficulty in controlling the amount and frequency of benzodiazepine use, taking more than intended, or using it for extended periods than planned.
• Neglect of Responsibilities: Failing to meet professional, social, or family obligations due to time spent using or recovering from the effects of benzodiazepines.
• Continued Use Despite Problems: Continuing to use benzodiazepines even when it causes physical or psychological problems, including deteriorating relationships and occupational difficulties.
• Risky Behaviors: Engaging in hazardous activities while under the influence of benzodiazepines, such as driving or operating machinery.
• Dependence: Benzodiazepine dependence occurs when the body adapts to the drug, resulting in a physiological need for it. Individuals with benzodiazepine dependence experience withdrawal symptoms if they reduce or stop intake, indicating a reliance on the substance.

• Slurred Speech: Difficulty articulating words clearly, leading to communication misunderstandings.
• Coordination Issues: Problems with balance and fine motor skills, increasing fall risk.
• Drowsiness: Excessive sleepiness that interferes with work and social interactions.
• Blurred Vision: Impaired visual clarity, making reading and driving challenging.
• Memory Problems: Difficulty recalling information or forming new memories.
• Mood Swings: Rapid emotional changes causing unpredictability in relationships.
• Irritability: Increased frustration over minor issues, affecting mood stability.
• Symptoms of Depression: Feelings of sadness and hopelessness, impacting quality of life.
• Reduced Motivation: Lack of interest in daily activities and responsibilities.
• Increased Anxiety: Heightened worry or fear, leading to panic attacks or avoidance.

What Are The Causes Of Benzodiazepine Addiction?

The causes of benzodiazepine addiction include extended usage beyond prescribed periods, self-medication for managing stress and anxiety, hereditary susceptibility to substance dependence, underlying mental health conditions, and exposure to high-stress environments. 

The causes of benzodiazepine addiction are detailed below:

• Prolonged Use: Extended use of benzodiazepines, especially beyond the prescribed duration, significantly increases the risk of developing an addiction. These medications should be for short-term use because of their addictive potential.
• Coping Mechanism: Individuals tend to misuse benzodiazepines to cope with stress, anxiety, or sleep problems on their own, without medical guidance, which increases the risk of addiction. According to the 2021 National Survey on Drug Use and Health (NSDUH), 1.4 million individuals aged 12 and older in the US reported using a sedative or tranquilizer, including benzodiazepines, in the previous month.
• Genetic Predisposition: Genetic factors play an essential role in how prone an individual is to addiction. Those with a family history of substance abuse are generally at higher risk.
• Psychological Factors: People with mental health issues are more susceptible to benzodiazepine addiction. This susceptibility results from initially using these drugs for legitimate therapeutic reasons.
• Environmental Influences: Environmental factors such as exposure to high-stress situations, peer pressure, or living in an environment where drug use is prevalent also contribute to the beginning and continuation of drug use and eventual addiction.

What Are The Effects Of Benzodiazepine Addiction?

The negative effects of benzodiazepine addiction include severe physical and psychological complications that are life-threatening. Users commonly experience drowsiness, vision problems, memory loss, heightened anxiety, and dangerous withdrawal symptoms that require medical supervision. Long-term use leads to tolerance build-up, cognitive decline, and increased risk of overdose, especially when combined with other substances. 

A 2023 report by the National Center for Health Statistics reveals that drug overdose deaths involving benzodiazepines increased from 9,711 in 2019 to 12,499 in 2021. The following are some of the critical effects of benzodiazepine addiction:

• Physical Health Issues: Physical health issues of benzodiazepine include drowsiness, dizziness, blurred vision, headaches, and gastrointestinal issues. In more severe cases, it causes respiratory depression, decreased motor coordination, and impaired memory.
• Psychological Effects: Benzodiazepines alter mood and behavior, leading to dependency with long-term use. Users experience increased anxiety, depression, irritability, and mood swings, especially as the drug’s effects diminish. Paradoxical reactions, such as heightened anxiety, aggression, and suicidal thoughts, also occur.
• Cognitive Impairments: Addiction to benzodiazepines is associated with cognitive impairments that affect memory, concentration, and decision-making abilities. These mental effects persist after discontinuation of the drug.
• Tolerance and Dependence: Over time, the body becomes tolerant to benzodiazepines, requiring larger doses to achieve the same effects. This increased dosage heightens the risk of addiction and other adverse effects.
• Withdrawal Symptoms: Withdrawal from benzodiazepines is challenging and dangerous. Benzodiazepine withdrawal symptoms include anxiety, insomnia, restlessness, muscle tension, irritability, and, in severe cases, seizures and psychosis.
• Social and Behavioral Changes: Benzodiazepine addiction leads to behavioral changes like social isolation, neglect of responsibilities, and engagement in risky behaviors. It also leads to legal problems or financial issues due to spending excessive amounts on acquiring the drug.
• Overdose Risk: Benzodiazepines increase overdose risk, especially when taken with other depressants like alcohol or opioids. Overdose affects the central nervous system and requires immediate medical attention.

What Are The Treatment Interventions For Benzodiazepine Addiction? 

The treatment options for benzodiazepine addiction are detoxification, behavioral therapy, counseling, assisted treatment, family therapy, and aftercare planning.

The treatment options for benzodiazepine addiction include: 

• Medical Detoxification: Detoxification under medical supervision represents the first step in treating benzodiazepine addiction. Withdrawal from benzodiazepines poses severe and potentially life-threatening risks, including seizures and psychosis. A controlled environment with medical professionals monitors the patient’s health and manages withdrawal symptoms, ensuring safety during detox.
• Tapering Off: Gradual tapering of benzodiazepines minimizes withdrawal symptoms. The tapering schedule varies based on the duration and intensity of benzodiazepine use. Sometimes, switching to a longer-acting benzodiazepine occurs before gradually reducing the dosage.
• Cognitive Behavioral Therapy (CBT): CBT helps individuals identify and change harmful behaviors and thought patterns associated with benzodiazepine addiction. CBT assists patients in managing withdrawal symptoms, developing coping strategies, and addressing underlying anxiety or depression, which link to physical dependence on the substance.
• Counseling and Support Groups: Individual counseling, group therapy, and support groups provide emotional support and help individuals maintain sobriety from benzodiazepines.
• Medication-Assisted Treatment (MAT): While no FDA-approved medications specifically target benzodiazepine addiction, other drugs reduce withdrawal symptoms and address co-occurring disorders. For instance, antidepressants treat underlying depression or anxiety.
• Family Therapy: Involving family members in the recovery process enhances treatment program outcomes. Family therapy strengthens support systems and addresses family dynamics that contribute to addiction, supporting the treatment program.
• Aftercare Planning: Successful benzodiazepine addiction treatment includes aftercare planning to prevent relapse. This plan incorporates ongoing therapy, support group meetings, and, in some cases, living in a sober environment.

What is Benzodiazepine?

A benzodiazepine is a type of psychoactive drug that belongs to the class of central nervous system depressants. Benzodiazepines are characterized by their ability to enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA-A receptor, resulting in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties. They are commonly prescribed for the treatment of anxiety disorders, insomnia, seizures, muscle spasms, and alcohol withdrawal.

What Are The Types Of Benzodiazepine?

The types of Benzodiazepines include commonly prescribed medications like Xanax for anxiety management, Klonopin for seizure control, Valium for muscle relaxation, and Ativan for acute panic disorders. These medications vary in their duration of action, therapeutic uses, and potency profiles, ranging from short-acting to long-acting formulations.

The 18 types of benzodiazepine are; 

• Alprazolam (Xanax)
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Lorazepam (Ativan)
• Temazepam (Restoril)
• Chlordiazepoxide (Librium)
• Oxazepam (Serax)
• Clorazepate (Tranxene)
• Midazolam (Versed)
• Triazolam (Halcion)
• Flurazepam (Dalmane)
• Estazolam (ProSom)
• Quazepam (Doral)
• Bromazepam (Lexotan)
• Nitrazepam (Mogadon)
• Flunitrazepam (Rohypnol)
• Clobazam (Onfi)
• Lormetazepam (Noctamid)

These medications vary in their onset of action, duration of effect, and potency, allowing for individualized treatment based on the specific condition being treated and the patient’s needs.

Where To Find Treatment For Benzodiazepine Addiction?

To find treatment for benzodiazepine addiction, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website for a national helpline and treatment locator, or the National Institute on Drug Abuse (NIDA) for research-based information and resources.

What Does A Benzodiazepine Look Like?

Benzodiazepines come in various shapes and colors depending on the brand and dosage, including:

• Valium: White (2 mg), Yellow (5 mg), Blue (10 mg), round tablets.
• Klonopin: Orange (0.5 mg), Blue (1 mg), White (2 mg), round tablets.
• Xanax: White (0.25 mg), Orange (0.5 mg), Blue (1 mg), White (2 mg), oval or oblong tablets.
• Halcion: Light blue (0.25 mg), ellipse-shaped tablets.
• Ativan: White (0.25 mg, 1 mg, 2 mg), pentagon-shaped tablets.

What Are The Different Street Names For Benzodiazepine?

Common Benzodiazepines and their street names include:

• Valium (Diazepam): Eggs, Jellies, Vallies, Blues, V, Candy
• Xanax (Alprazolam): Xannies, Bars, Planks, Upjohn, Yellow Boys
• Klonopin (Clonazepam): K, K-pin, Super Valium
• Ativan (Lorazepam): Candy, Downers, Tranks
• Librium (Chlordiazepoxide): Candy, Downers
• Rohypnol (Flunitrazepam): Roofies, Date Rape Drug, Mind Eraser

What Are The Risks Of Combining Benzodiazepines With Other Substances, Such As Alcohol Or Opioids?

Combining benzodiazepines with other substances, particularly alcohol or opioids, significantly increases the risk of severe side effects and potentially fatal outcomes.

Both benzodiazepines and alcohol are central nervous system depressants, and their combined use leads to enhanced sedation, respiratory depression, and even death.

Similarly, mixing benzodiazepines with opioids like morphine results in dangerous respiratory depression and overdose. It is crucial for individuals to be aware of these risks and for healthcare providers to monitor and manage poly-substance use carefully. Treatment plans include education on the dangers of mixing substances and strategies to prevent these high-risk behaviors.

How Long Does It Take To Develop Benzo Dependence?

Benzo dependence takes long-term use to develop, even at low therapeutic doses. Tolerance to the anticonvulsant, hypnotic, and muscle relaxant effects develops within days or weeks, and after four months, there is little evidence that benzodiazepines retain their anxiolytic properties.

Why Do People Abuse Benzos?

People abuse benzos because they seek the euphoric or intoxicating effects of the drug. Benzodiazepines enhance GABA inhibition in the brain, leading to feelings of relaxation and pleasure. Over time, users develop tolerance, requiring higher doses to achieve the same effects, which leads to misuse. Additionally, some individuals abuse benzodiazepines to self-medicate for anxiety or insomnia, despite the risks of dependence and withdrawal symptoms.

Can Benzodiazepines Cause Hallucinations?

Yes, benzodiazepines cause hallucinations, particularly during withdrawal. Withdrawal symptoms include perceptual disturbances, such as hallucinations, along with anxiety, tremors, and sleep disturbances. According to Huff, C., Finlayson, A.’s 2023 study, ‘Enduring neurological sequelae of benzodiazepine use: an Internet survey’, Hallucinations occur due to neurological changes when benzodiazepines are discontinued, triggering a chain reaction: increased NMDA receptor activity and heightened calcium channel activity lead to more calcium ions entering cells. This increases nitric oxide production, resulting in high peroxynitrite levels. This creates a feedback loop that reduces GABA function in the brain, though the exact mechanism is still being researched.

Hallucinations affected 35.5% of people who stopped taking benzodiazepines, with most experiencing them for days (28.8%) or weeks (21.8%), while only 19.6% reported them lasting a year or more.

How Does Benzodiazepine Addiction Increase The Risk Of Developing A Tobacco Addiction?

Benzodiazepine addiction increases the risk of developing a tobacco addiction due to the intertwined nature of substance use behaviors and the pursuit of relief from withdrawal symptoms. Individuals addicted to benzodiazepines may turn to tobacco as an alternative or additional coping mechanism for managing anxiety and stress during withdrawal. Both substances create a reinforcing cycle of dependency, complicating treatment and recovery.

How Do The Effects Of Benzodiazepine Addiction Differ From Those Of Heroin Addiction?

The effects of benzodiazepine addiction differ from heroin addiction in terms of their impact on the body and mind. Benzodiazepine addiction affects the central nervous system, causing sedation, memory impairment, reduced motor coordination, and heightened anxiety during withdrawal. 

Heroin addiction exhibits intense euphoria, rapid physical dependence, and severe withdrawal symptoms like muscle aches, vomiting, diarrhea, and cravings. 

Benzodiazepines risk respiratory depression, especially when mixed with alcohol or opioids. Heroin risks include overdose, respiratory failure, and increased infectious diseases from needle use. Both addictions are life-threatening, but their mechanisms, withdrawal profiles, and health risks differ significantly.

According to Han B.’s 2020 study named, ‘Reported Heroin Use, Use Disorder, and Injection Among Adults in the United States, 2002-2018.’, published in JAMA, Heroin prevalence in the USA showed an upward trend from 2002-2018, with usage doubling from 0.17% to 0.32%, while use disorder increased from 0.10% to 0.21%. 

In contrast, benzodiazepine usage presents a significantly higher prevalence at 12.6% of adults (30.6 million), with 2.2% reporting misuse. While benzodiazepines have higher overall usage due to legitimate medical prescriptions, heroin, despite the lower prevalence, represents a more severe public health concern given its illegal status and risk profile.