Benzos Addiction, Withdrawal & Treatment
Benzodiazepines belong to a class of drugs called Central Nervous System depressants, also known as tranquilizers or sedatives. Some of the street names for benzodiazepines include benzos, downers, and tranks. As they are widely available prescription medications and carry a risk of the development of substance use disorder and overdose, it is highly advisable for anyone who is struggling with benzodiazepine use to seek treatment.
What Are the Types of Benzodiazepines?
Most benzodiazepines are available as prescription pills and some in the form of syrup and injectable liquids.1 These are some of the most common prescription medicines whose active substance is a benzodiazepine:2
- Alprazolam (Xanax)
- Diazepam (Valium)
- Lorazepam (Ativan)
- Triazolam (Halcion)
- Clonazepam (Klonopin)
- Estazolam (ProSom)
- Temazepam (Restoril)
- Flurazepam (Dalmane)
- Midazolam (Versed)
- Chlordiazepoxide (Librium)
There are also benzodiazepine medications that aren’t approved to be used in the United States but can be purchased illegally, such as Rohypnol (flunitrazepam), also known as the date-rape drug.2
How Many People Use Benzos Annually?
In 2019, U.S. pharmacies dispensed 92 million benzodiazepine prescriptions, the most frequent one being alprazolam (38%), clonazepam (24%), and lorazepam (20%).3 According to the American Psychiatric Association, more than 1 in 8 adults in the United States (12.6%) used benzodiazepines in 2018.4 Misuse of prescription benzodiazepines made up 17 percent of the total number, which means they carry a significant risk of abuse.4
Legally, benzo medication can only be obtained through prescription. However, a person struggling with addiction may also buy them illicitly, forge a prescription, or obtain prescriptions from different doctors.2
What Are the Different Benzodiazepines?
Benzodiazepine is approved for a range of medical uses, including anxiety disorder, insomnia, seizures, social phobia, panic disorder as well as premedication prior to certain medical procedures.5 These are some of the ways in which benzodiazepine is used:2
- Long-acting benzodiazepine medications, like alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan) are commonly prescribed to patients who suffer from anxiety and sleep disorders.
- Shorter-acting types of benzodiazepines, such as estazolam (ProSom), flurazepam (Dalmane), temazepam (Restoril), and triazolam (Halcion) are typically taken to treat insomnia.
- Midazolam (Versed) is used for sedation during medical procedures that don’t require general anesthesia, to relieve anxiety in intensive care, and before anesthesia.
- Benzodiazepines such as Clonazepam (Klonopin), clorazepate (Tranxene), and diazepam (Valium) can be utilized as anticonvulsant medication, to treat fits in seizure disorders, like epilepsy.
- Chlordiazepoxide (Librium) is taken for the treatment of alcohol withdrawal.6
- Diazepam (Valium) is also used as a muscle relaxant.6
What Do Benzos Treat?
Benzodiazepine is used for the management of the symptoms of various conditions:
- Generalized anxiety disorder: People who suffer from this condition feel excessively worried and anxious for a prolonged period of time about various areas of their lives.7 This anxiety may interfere with their daily lives and normal activities.
- Panic disorder: People with a panic disorder experience panic attacks. They occur suddenly, causing rapid heartbeat, trembling, sweating, breathlessness, and a feeling of acute fear.7
- Phobias: Phobias are extreme sensations of fear brought about by certain triggers, like flying, heights, insects, or needles.7 People with phobias are afraid of coming across the trigger and actively try to avoid it.
- Insomnia: People with insomnia have difficulty falling asleep and sleeping through the night.8 It may make them feel tired, sleepy during the day, irritable, and frustrated.
- Epilepsy: Epilepsy is a brain disorder that impairs the typical pattern of brain activity, commonly leading to seizures. During the seizure, the sufferer loses consciousness, experiences muscle spasms, and convulsions.9
- Alcohol withdrawal: Alcohol withdrawal is a set of symptoms that occur when someone who has been drinking excessive amounts of alcohol regularly stops consuming alcohol abruptly. It may involve anxiety, depression, irritability, shakiness, nightmares, etc.10
How Do Benzos Treat Anxiety?
According to the National Institute on Drug Abuse, CNS depressants, including benzodiazepines, are used as treatment for anxiety, panic, acute stress reactions, and sleep disorders because they inhibit brain activity.11
These drugs affect the brain by enhancing the effects of gamma-aminobutyric acid (GABA), a chemical that naturally occurs in the brain.11 GABA is a neurotransmitter, which functions as a messenger that carries signals between brain cells. GABA works to slow down brain cell activity.12 Since this mechanism causes the feeling of calm and induces sleep, benzodiazepine medications are effective in alleviating anxiety and insomnia. This is also why they produce a sense of euphoria or high, for which some people misuse it.2
What Are the Side Effects of Benzodiazepines?
The side effects of the use and misuse of CNS depressants, including benzodiazepine, can be the following:11
- Having trouble concentrating
- Poor coordination
- Impaired mental functioning
- Memory problems
- Slurred speech
- Mouth dryness
- Decreased blood pressure
- Slow and shallow breathing
When a person begins taking a CNS depressant, they may be uncoordinated or drowsy for the first several days until they become accustomed to the side effects of the drug. The side effects of benzodiazepine use may be exacerbated by combining it with other drugs.3
Benzodiazepine Use and Other Drugs
According to the U.S. Food and Drug Administration, the use of benzodiazepines or other CNS depressant in combination with prescription opioid medication has caused slowed, labored breathing and death.13 They warn healthcare professionals against prescribing opioid cough or pain medicines to patients who take benzo medication or other CNS depressant drugs.
Since alcohol also has CNS depressant properties, mixing benzodiazepine medications and alcohol carries risks for:14
- Increased effects of both substances.
- A higher probability of overdosing.
- Higher chances of harmful and unpredictable side effects.
- Enhanced risk of developing addiction.
- Decreased physical and mental abilities.
- Increased possibility of long-term damage to physical and mental health.
Are Benzos Addictive?
Benzodiazepines can be safe and helpful when they are prescribed by a medical professional and used short-term. Prolonged benzodiazepine use or misuse of benzo medications can develop tolerance and dependence, finally leading to addiction.
Benzodiazepine medications are widely prescribed in the United States, commonly for prolonged periods of time.3 A 2018 study found that 17 percent of the overall number of people who take benzodiazepine misuse the drug, which puts them at risk of developing addiction.4
Misuse is commonly associated with adolescents and young adults who take benzo pills by mouth or crush them up and snort them.2Heroin and cocaine users frequently misuse benzodiazepines to enhance or counteract the effect of the other drug.2
What Is Benzo Addiction Treatment?
People who are dependent on benzo pills can recover by achieving drug detox under medical supervision. Counseling can also provide invaluable psychological support during benzodiazepine drug detox.11
Benzo rehab programs at detox centers help the user to reduce the dose they take safely and gradually. Treatment typically involves slowly tapering the dosage of the drug over a period of several months.12
Additionally, if the person takes short-acting benzodiazepines, like Xanax or Ativan, it may be beneficial for them to switch to a long-acting one, like Valium, under medical supervision, before diminishing their dose. This is because a long-acting benzo medication is better suited to a very gradual tapering of the dosage under the supervision of experienced and qualified professionals.12
The exact rate of withdrawal depends on specific factors, such as the dose and kind of benzodiazepine medications the person uses and the duration of use.12 Withdrawal schedules are adjusted to each person’s individual needs over the course of their benzo addiction treatment helping them achieve full recovery.
Frequently Asked Questions
- When benzodiazepines are taken as prescribed by a healthcare professional, they treat symptoms of existing conditions. They are usually meant to be taken short-term, for weeks or months.3 Deliberate misuse and long-term benzodiazepine use, even when taken as prescribed, can cause tolerance, psychological and physical dependence, and ultimately lead to addiction.2Tolerance means that a person who takes benzodiazepines might require progressively larger doses of the drug to achieve the desired effect. Physical dependence occurs when the body gets used to the presence of the drug, causing withdrawal when the person stops taking the drug or lowers its dose. Psychological dependence refers to drug cravings and drug seeking behavior.2The abuse of prescription benzodiazepines includes:11
- Taking a larger dose of benzodiazepine than prescribed.
- Taking benzodiazepine medications that were prescribed to someone else.
- Taking benzo medication to experience a rush or “high”.
Apart from misusing benzodiazepine on its own to feel a high, people sometimes combine it with other drugs to enhance the drug’s effect or counteract its side effects.2 Certain benzodiazepine pills, particularly alprazolam (Xanax), seem to have higher chances of misuse and cause more serious overdose cases.15
- People who have been taking benzodiazepines for a long time may experience withdrawal if they stop taking the medication or decrease its dose suddenly.11 Withdrawal symptoms may appear within one day of taking the last dose and can last from several days to several months. This depends on several factors, including the type, duration of use, and dosage of benzodiazepine medications.11 Even if a person reduces their dose of benzo medication step by step, they may still experience the following withdrawal symptoms:3
- Involuntary movements
- Blurred vision
- Memory impairment
- Muscle pain
- Panic attacks
While withdrawal from the majority of other drugs is rarely fatal, withdrawal from CNS depressants is potentially lethal. There are serious benzodiazepine withdrawal side effects that warrant urgent medical attention:2
- Catatonia (being unresponsive, unable to move, and agitated)
- Delirium tremens (tremors, sweating, irregular heartbeat)
- Suicidal thoughts
- Mania (euphoria, intense mood swings, hyperactivity)
- Hallucinations (seeing or hearing things that don’t exist outside of one’s mind)
- Psychosis (believing things that aren’t real)
Patients are strongly advised to seek the help of medical professionals who will decrease their dose of benzodiazepines gradually in a safe setting and with ongoing supervision.3
How Long Do Benzodiazepines Stay in Your System?
Benzo medications differ based on their duration of action. There are the following classes of benzo meds according to how long they stay in the body:16
- Long-acting, such as diazepam (Valium) and chlordiazepoxide (Librium), can be in a person’s system for as long as 10 days after use.
- Intermediate-acting, like lorazepam (Ativan), alprazolam (Xanax), and clonazepam (Klonopin) can be detected for up to 5 days.
- Short-acting benzodiazepine triazolam (Halcion) is detectable for 2 days.
- Benzodiazepine overdose happens when a person takes an excessive amount of benzo medications. The possible effects of a benzodiazepine overdose include:2
- Shallow breathing.
- Slurred speech.
- Clammy skin.
- Dilated pupils.
- Weak and rapid pulse.
- In severe cases, coma and death.
Large doses of benzo pills are not often deadly unless a user combines benzodiazepine with alcohol or other drugs.2 The National Institute on Drug Abuse reports that, between 2017 and 2019, there were 9,711 deaths involving benzodiazepine overdose in the U.S.17
What Is Benzo Overdose Treatment?
A benzodiazepine overdose is a medical emergency. If someone is displaying the signs of a possible benzodiazepine overdose, it’s strongly advisable to call 911 without delay.
Healthcare professionals may use a drug called flumazenil (Romazicon) to help a person who has overdosed on benzo medications. It is a short-acting medication, so the person may receive new doses in short intervals until they recover. Flumazenil may not be fully effective in treating slowed breathing and it might cause fits in people who take some antidepressant medications.11
1. U.S. Department of Justice Drug Enforcement Administration. Benzodiazepines.
2. U.S. Department of Justice Drug Enforcement Administration. (2017). Drugs of Abuse: A DEA Resource Guide.
3. U.S. Food and Drug Administration. (2020). FDA Drug Safety Communication.
4. American Psychiatric Association. (2018). Study Finds Increasing Use, and Misuse, of Benzodiazepines.
5. U.S. Food and Drug Administration. Benzodiazepine Drug Information.
6. Drug Enforcement Administration, Diversion Control Division, Drug and Chemical Evaluation Section. (2019). Benzodiazepines.
7. National Institute of Mental Health. (2018). Anxiety Disorders.
8. National Heart, Lung, and Blood Institute. Insomnia.
9. National Institute of Neurological Disorders and Stroke. (2019). Epilepsy Information Page.
10.U.S. National Library of Medicine MedlinePlus. (2021). Alcohol Withdrawal.
11. National Institute on Drug Abuse. (2018). Prescription CNS Depressants Drug Facts.
12. Ashton, H. (2002). Benzodiazepines: How They Work & How to Withdraw. The Ashton Manual.
13. U.S. Food and Drug Administration. (2016). Drug Safety Communications.
14. Preedy, Victor R. (2016). Neuropathology of Drug Addictions and Substance Misuse Volume 3: General Processes and Mechanisms, Prescription Medications, Caffeine and Areca, Polydrug Misuse, Emerging Addictions and Non-Drug Addictions. Elsevier Science.
15 Brett, J., & Murnion, B. (2015). Management of benzodiazepine misuse and dependence. Australian prescriber, 38(5), 152–155.
16. Mayo Clinic Laboratories. Benzodiazepines.
17. National Institute on Drug Abuse. (2021). Overdose Death Rates.