Benzodiazepines: What You Need to Know
Benzodiazepines are among the top most-prescribed classes of psychotropic drugs for anxiety and sleep issues in developed countries. They are also prescribed for presurgical sedation or to treat muscle spasms, some forms of epilepsy and other illnesses. Benzodiazepines are commonly prescribed alongside an opioid pain medication despite the risk for addiction.
What If My Loved One Is Addicted to Benzodiazepines?
Addiction is not a battle that has to be fought alone. When the moment is right to talk with your loved one about their addiction, it is important to take care and have a compassionate and understanding frame of mind. Remember that addiction is an all-consuming disease that is incredibly difficult to fight off. In fact, overcoming addiction is nearly impossible to accomplish without a strong support system.
As a good starting point, you should try to understand what their mindset is. There are five main things that people addicted to drugs try to convince themselves are true:
“This is in my hands and I can stop any time I want.”
Many addicts incorrectly believe that alcohol and drugs help them control their lives. They convince themselves that they only use by choice and that they can stop anytime. Of course, we know that reality is just the opposite. Addiction controls the lives of the addict. Substances cause them to harm themselves and their loved ones. They can’t stop alone, and so the sooner they receive help from a treatment facility or program, the safer they’ll be.
To convince your loved one of this, you’ll have to prove that previous attempts to quit have been unsuccessful. You can do this by keeping a journal of your loved one’s addiction-related events and dates to show a pattern of abuse. The act of confronting your loved one’s addiction is just the first step of many in a long journey toward their recovery.
“Everything would be fine if everyone would just get off my case.”
Many addicts convince themselves that everyone around them has a problem, not them. They view the attempts of friends and family to get them to quit as the main factor in all problems. This allows them to continue living their destructive lifestyle.
It can be hard to convince someone with an addiction that you have their best interests and well-being at heart, especially if they are feeling paranoid. The best thing you can do is to remind them of how much you care about them and try to gently remind them of the harm they’ve caused others.
“This is my life, and if I’m really going to ruin it, then that’s my choice to make.”
This statement is one of the more difficult ones to argue with, but your main point should focus on the fact that addiction is not just about the addict. Drug and alcohol abuse is often accompanied by dishonesty, legal troubles, financial issues, abusive behavior and more. Addiction has the potential to ruin the lives of everyone involved.
“Going through detox is definitely worse than taking drugs.”
It’s no secret that going through the detox process can be very difficult. The fear of this process, as well as the emotional and behavioral recovery, may cause many people to avoid seeking help. You should let your loved one know that, in general, the longer a person has depended on drugs or alcohol, the more challenging detox can be.
Seeking treatment in a rehabilitation facility and receiving medical intervention can help alleviate the physical symptoms associated with withdrawal, which can include vomiting, insomnia, flu-like symptoms and hallucinations. Through therapy and counseling, the addict can then expect to learn the tools they’ll need to rebuild their lives and move forward.
“Seeking treatment makes me a weak person.”
You need to remind your loved one that it takes strength for a person to admit they have a problem and to seek help. Doing nothing at all is the weak person’s option. The fact is that people who refuse to get help and who continue with their addictive behaviors are not strong enough to accept and confront their necessary lifestyle changes. You just need to remind them that they’re not in it alone.
When It’s Time to Seek Help
One of the biggest hurdles in addressing addiction is the fact that most users are, at least at first, unable or unwilling to recognize that they have a problem. There are a few ways to identify when the time is right to enter a treatment facility for your addiction:
Your addiction is spiraling out of control.
You know your addiction is out of control when you find yourself living your day just looking forward to the next time you can get high. When this occurs, it becomes official that your drug has more control over you than you have over the drug. You ignore pleas from friends and families to stop using, or you may even want to quit and find that you’re just unable to do so.
The effects of your addiction have reached your family.
Family members usually take the brunt of the impact when it comes to addiction. The lying, stealing and general irresponsibility that comes along with addiction could do irreparable damage to your family.
Your ability to hold a job is compromised.
You may have reached the point where you feel you are unable to function as a person without taking the drug. You may be unreliable to your coworkers. This definitely impedes on your ability to pass a drug test.
Money issues start to pop up.
As your addiction becomes more profound, you may be spending most of your finances to fuel it. You begin forgoing basic necessities like food or gas to get to work.
If you’re still unsure whether or not you need help quitting your benzodiazepine of choice, ask yourself:
- Do I suffer from withdrawal symptoms such as intense anxiety when I try to quit using?
- Do I get more than one prescription just in case I run out?
- Do I modify my prescription to get a faster high?
- Do I combine my benzo with another substance to get a stronger high?
- Do I take more than the recommended dose?
- Do I spend more time and more money trying to keep up with my benzo habit?
- Do I feel unable to cope with life if I don’t have drugs?
- Do I try to quit and then go back to using?
Benzo Rehab and Recovery
Entering a drug rehab facility should be a personal and private matter. The process is often accompanied by feelings of shame and embarrassment. For these reasons and others, selecting the right treatment facility is of paramount importance.
At 12 Keys Rehab, we provide full-spectrum addiction recovery services to individuals struggling with substance abuse. Our certified staff members have experience treating the severe withdrawal symptoms associated with benzodiazepine dependence. We have helped many people live sober lifestyles, even when rehab has been tried before.
Benzo rehab begins with medically assisted detox. During detox, you or your loved one will benefit from round-the-clock care. We make it easier to sleep, eat and relax as you prepare for the therapeutic journey ahead. This journey will entail today’s most successful treatments and therapies, as well as the 12 Steps design for living. Because our staff is trained in all aspects of addiction and mental health care, we are well-qualified to address issues related to substance dependency and disorders such as depression, anxiety, post-traumatic stress disorder, bipolar disorder and other problems frequently associated with benzo addiction.
We are very proud of our serene and beautiful facility, which is located on a private stretch of waterfront property in southwest Florida. We keep low enrollment numbers, assuring a family-oriented environment, a high level of individualized care, and less intimidating group therapy sessions. Clients also benefit from our incredible activities that take advantage of the best of the south Florida lifestyle. 12 Keys Rehab is an enjoyable and successful place to recover from addiction, and it’ll be a place for you to start rebuilding a happier, healthier life.
What Are the Benzo Addiction Signs?
One of the greatest dangers of benzodiazepines is that prolonged use worsens the original symptoms of anxiety and stress. This means that taking a benzo can eventually worsen your ability to sleep or simply relax. Taking more and more becomes necessary, and quitting produces severe withdrawal symptoms that provoke most people into abusing benzos again. With the proper withdrawal regimen, however, quitting benzos is possible.
The severity and duration of symptoms for benzodiazepine addiction is dependent on the amount of time the drug was abused and the usual dosage. Benzo addiction symptoms can range from mood and behavioral to physical and psychological. Signs to look for include:
- Bad judgement
- Notable or generally inconsistent mood swings
- Memory issues
- Issues with concentration and attentiveness
- Inappropriate sexual behavior. Benzos have been implicated in some “date rape” cases due to this lack of inhibition.
- A marked increase in sociability. Sometimes, this sociability becomes an excuse to shirk life responsibilities.
- Deterioration of relationships. This is primarily based on the individual’s response to the increased drug abuse.
- Increased risk-taking
- Unexplained financial trouble or legal issues
- “Doctor shopping,” which refers to when someone visits more than one physician in order to get more refills for their benzos. They often fill up these prescriptions at different pharmacies as well.
- Unprovoked anger and aggression.
- Personality changes
- Lack of coordination and unsteadiness on their feet
- Slurred or otherwise indiscernible speech
- Rapid eye movement
- Increased sleep and general lethargy
How Is Benzodiazepine Addiction Treated?
As is true with other health conditions, recovery from benzodiazepine addiction should involve self-management as well as mutual support from a strong network. Treatment usually begins with detox. There are three main stages of detox that you should be prepared to go through:
- Acute stage — During the acute stage, your body withdraws from benzodiazepines and any other drugs you may be using concurrently. This is the stage in which medical supervision is necessary or helpful to make sure your body doesn’t react badly to withdrawal from substances. You may feel nauseous, tired, headachy or achy, similar to flu symptoms. Detox medications can be used to counteract the worst symptoms of acute detox so you don’t have to suffer needlessly.
- Emergent stage — As the substances leave your system, other health problems may begin to present. Not everyone has other health problems masked by substance abuse, but if you do, they will most likely show up during the emergent stage. High blood pressure, hypoglycemia, diabetes and other physical problems may arise, or a co-occurring mental illness such as schizophrenia, depression or anxiety can also emerge. Mentally, you may actually feel a lot better. Many people say they feel relieved because they know they’re on the way back to health again.
- Post-detox — Once the benzodiazepine detox process is complete, you will then undergo an individualized treatment program to heal your mind, body and spirit. You should receive constant treatment and monitoring during the detoxification process, which will then lead to the observation and orientation phase of your rehabilitation. Treatment plans are designed to be as unique as the individuals who need them.
You may still feel a bit uneasy during the month or two following detox. It’s important to remember that you’re recovering from a disease, just like getting over a severe flu or other serious illness. Your post-detox program should include good nutrition, plenty of rest and time for meetings and recovery work can make this stage a little easier. This is the time to adjust to your new, drug-free life.
Former benzodiazepine addicts in recovery should pursue psychological therapy, group therapy and other recovery programs designed to prevent relapse. These programs can provide you with the support network you’ll need and ensure that your path to recovery is sustainable.
What Are the Symptoms of Benzodiazepine Addiction Withdrawal?
With respect to normal doses of benzodiazepines, you should expect to experience a few symptomatic patterns. The most common withdrawal symptom is “rebound” anxiety and insomnia, and it usually occurs within one to four days of discontinuation. After that, full-blown withdrawal syndrome sets in and can last between 10 and 14 days.
Symptoms during this phase of withdrawal can include:
- Increased heart rate
- Gastrointestinal issues
After that, you may experience the return of your anxiety symptoms, which will persist until an alternate form of anxiety management strategy is started. You may also experience major depression or a fear that you cannot function without benzos, which may be considered a form of psychological dependence.
Meanwhile, people who abuse benzodiazepines over a prolonged period of time and who quit using drugs suddenly are at greater risk of developing benzodiazepine withdrawal syndrome. A chronic benzo abuser should never quit unassisted, because benzo withdrawal syndrome can be fatal. In addition to the symptoms described above, other problems include:
- Potentially fatal convulsions and catatonia
- Psychosis, mania and post-traumatic stress disorder
- Suicide and suicidal ideation
- Homicidal ideation, violence and violent behavior
- Delirium tremens
What Causes Benzodiazepine Addiction?
The American Society of Addiction Medicine defines addiction as a primary, chronic disease in which brain reward, motivation, memory and related circuitry are dysfunctional. It is characterized by an inability to consistently abstain from behaviors despite known consequences. There is a marked impairment of one’s behavioral control, cravings and a dysfunctional emotional response to addiction’s effects on interpersonal relationships. Addiction is a complex disease of the brain without any certain cause in particular.
In most cases, there are several factors at play when addiction develops. Some of these factors can include:
Genetics/Family History: Although there has been no conclusive evidence linking genetics to any addiction for any certain class of drugs, the evidence does suggest that addiction tends to run in families. People with a first-degree relative addicted to benzodiazepines are more likely to develop that addiction than others.
Brain Chemistry: The presence of an imbalance relating to reward circuits. This can cause substance abuse or other behaviors to be sought for enhanced reward function. For benzodiazepines in particular, these drugs are thought to serve as stoppers for the neurons in the brain responsible for preventing surges of dopamine.
Environmental: The environment in which people live often influences their ability to develop coping skills. When people perceive their environment as uncontrollable, some may turn to drugs like benzodiazepines to try and quell their feelings of anxiety. The umbrella of environmental factors also includes social anxiety. If benzos help someone suffering from anxiety to feel comfortable in social settings, they may begin to rely heavily on their benzos to help them continue feeling social.
Meanwhile, another environmental factor that can contribute to the predisposition for addiction is the disruption of healthy social supports. Problems in interpersonal relationships can cause some people to turn to substances for comfort or escape.
Psychological: Benzodiazepines are prescribed to help people manage their mental illnesses, including anxiety disorders. Although they are effective, many people with anxiety disorders usually need some sort of simultaneous behavioral therapy to help them better cope with their condition. A lack of simultaneous therapy can cause people to rely heavily on benzos, which can create a psychological or physical dependence.
For benzodiazepines in particular, the most common causes for addiction are:
- Long-term use, generally defined as four weeks or longer
- Suddenly or steadily increasing the dose
- Concurrent abuse of alcohol or barbiturates
- Long-term anxiety issues that fail to come under control using the prescribed benzodiazepine
What Are the Effects of Benzo Addiction?
Although benzodiazepines themselves can be abused, the drug is more infamously linked to the worsening or exacerbation of other substance abuse issues. An estimated 80% of known benzodiazepine abuse is a part of polydrug abuse. Normally, the other drug is opioids. An addiction to benzodiazepines can come with a host of co-occurring mental health disorders, many of them related to other substances.
- Tobacco use disorder
- Substance addiction, including other sedative, hypnotic and anxiolytics
- Depressive disorders
- Anxiety disorders
- Antisocial personality disorder
- Bipolar disorders
The long-term effects of benzodiazepine addiction can persist even after recovery. These effects can unfortunately damage virtually every aspect of a person’s life. Some of the most common long-term consequences of benzo addiction include:
Drug interactions: There are a host of drugs that can interact dangerously with benzodiazepines, including:
- Pain drugs
- Seizure medications
- Sleeping pills
- Certain antihistamines, including Cimetidine
- Digoxin, which is used to treat mild or moderate heart failure or atrial fibrillation
- Disulfiram, which is used to treat chronic alcoholism
- Levodopa, which treats Parkinson’s disease
Psychomotor retardation: Long-term, chronic use of benzodiazepines can cause a visible slowing of both emotional and physical reactions — including speech. Slow reaction time is common. Psychomotor symptoms can include:
- Poor concentration
- Muscle weakness
- Mental confusion
Psychosocial problems: You can develop neuroticism, introversion or an inability to develop effective coping mechanisms. This can be a barrier to the recovery process.
Interpersonal relationship issues: Your behavior and the decisions you make while addicted to benzodiazepines has the potential to destroy your personal relationships. Love, honesty, trustworthiness and dependability can all come into question. Even after you’ve moved into recovery, some of the people in your life may choose to not forgive you. For intimate relationships, the long-term effects of addiction can take the form of divorce.
Legal issues: Substance abuse can lead to crime, including violent crimes, petty crimes, theft, child abuse and neglect and court costs. In some cases, you may find yourself incarcerated. A survey from 2002 uncovered that 52% of incarcerated women and 44% of incarcerated men were dependent on either alcohol or drugs upon admission.
Anterograde amnesia: Interestingly, benzodiazepines are not typically associated with short-term memory loss, only long-term. Anterograde amnesia refers to memory loss related to events occurring forward in time. Physiologically, benzodiazepines are thought to cause forward memory loss because the drug inhibits the ability for the mind to move events from short-term memory into long-term memory.
Emotional blunting and depression: Emotional blunting refers to the feeling you have when you know you care about something, but you can just can’t feel that caring connection. It hasn’t been determined conclusively, but researchers believe that depression related to benzodiazepine abuse may occur because of a reduction in central monoamine activity. In some cases, this side effect can evolve into suicidal ideation.
Benzos and Your Liver
Though it isn’t very common, abuse of benzodiazepines, not unlike other substances, can wreak havoc on your liver. Xanax (alprazolam), for example, has been linked to acute liver injury. This mild liver damage is rarely life-threatening. Certain factors, including race, gender, age and overall health status, may influence your predisposition to develop liver issues associated with benzodiazepine use.
More commonly, liver damage associated with benzodiazepine use comes as a result of abusing another substance alongside benzos. Excessive alcohol use, for example, can destroy liver cells. Your liver is tasked with processing and ridding your body of harmful substances so they don’t make it into your blood. The three main types of alcohol-related liver disease are: alcoholic cirrhosis, alcoholic hepatitis and alcoholic fatty liver disease.
Meanwhile, opioid-related liver injury is normally caused by a combination of the drug and another pain-relieving ingredient: acetaminophen. Other stresses on your body, including malnutrition, alcoholism or intercurrent illness, can lead to lowered levels of hepatic glutathione and a predisposition for hepatoxicity. At this point, acetaminophen can become toxic when taken in too-high doses.
Benzodiazepine Addiction and Dual-Diagnosis
A person struggling with an addiction while simultaneously dealing with a mental illness is said to have a dual-diagnosis. Dual-diagnosis is not uncommon. The National Institute on Drug Abuse estimates that 40% of people living with a substance abuse disorder of any kind also live with a mental illness. In many cases, the initial reason why a person turns to drugs is to self-medicate symptoms relating to their mental illness. Some researchers believe that dual-diagnosis occurs because the same area of the brain affected by mental illness is also impacted by substance abuse. This is referred to as “shared-vulnerability,” and recovery is possible.
Statistics provided by the Substance Abuse and Mental Health Services Administration about dual-diagnosis show that:
- Around 17.5 million adults in the United States have a serious mental health condition. Of that population, 4 million also have a co-occurring substance abuse issue.
- Over the course of six years, the number people seeking help in a substance abuse treatment facility who also received a diagnosis for a mental health condition jumped from 12% to 16%.
- Just 40% of the 3 million employed adults living with a dual diagnosis receive treatment for either disorder. Less than 5% of these people receive comprehensive treatment for both.
As has been discussed, abuse of benzodiazepines is often related to anxiety. It is important to know the other common dual-diagnoses, because benzo abuse is often accompanied by abuse of another drug. Mental and behavioral health conditions often associated with substance abuse include:
- Comorbid alcohol use and anti-social behavior: It is not uncommon to find out that people who drink alcohol to excess might also struggle with an anti-social personality disorder. Alcohol lowers inhibitions and can blunt the antisocial tendencies. Addiction and dependence on alcohol is often also associated with depression, anxiety and post-traumatic stress disorder.
- Comorbid marijuana use and schizophrenia: The effects of marijuana and the symptoms of schizophrenia are very similar. This tendency makes it difficult to determine which disorder is behind a person’s hallucinations and jumbled thinking patterns. Although it has yet to be determined why, researchers have observed that people with schizophrenia turn to marijuana to ease their symptoms fairly often.
- Comorbid heroin use and depression: The hallmark effect of heroin is immediate feelings of euphoria and pleasure, which some people may use to self-medicate their depression symptoms. On the other hand, use of heroin itself can lead to depression, which creates a greater need for the heroin.
Unfortunately, drugs and alcohol damage important areas of the brain that can exacerbate symptoms of mental illness. In other words, self-medication with substance abuse does not just lead to addiction — it can also cause the original illness to worsen. The only way someone can return to full health, is to go through recovery from their addiction and seek proper treatment for their co-occurring illness.
It’s important to recognize dual-diagnosis, because the treatment plan for those people differs from those of people without a co-occurring disorder. The recovery regimen for someone with a mental illness and drug problem usually includes detox, one-on-one counseling and 12-step recovery meetings.
What Are Benzodiazepines?
Benzodiazepines are a class of legal prescription drugs used to treat anxiety, seizure, insomnia and panic. They are also sometimes used in clinical settings to relax patients before surgical procedures. Benzodiazepines work similarly to painkillers by producing relaxed feelings — but they do not relieve pain. Currently, there are 15 FDA-approved benzodiazepines on the market.
You can see on this benzos list that they are classified into categories based on how long their effects last:
- Ultra-short acting: Midazolam (Versed), triazolam (Halcion)
- Short-acting: Alprazolam (Xanax), lorazepam (Ativan)
- Long-acting: Chlorodiazepoxide (Librium), diazepam (Valium)
The two most well-known benzodiazepine drugs are Valium and Xanax, but there are other commonly used benzos as well. Ativan, Klonopin and generic formulas lorazepam, alprazolam and diazepam are also common. Although they are generally well-tolerated when used precisely as prescribed, the chronic abuse of any benzodiazepine can cause serious problems. Combining a benzo with alcohol — which acts on the same neurotransmitter in the brain, the GABA receptor — is extremely dangerous and potentially fatal. Taking a benzo alongside a prescription painkiller such as Vicodin or oxycodone can be fatal as well.
The human body develops a tolerance to the benzodiazepine class of drugs quickly. This means taking more and more of the drug to achieve the same effects is necessary. People suffering from benzo addiction or abuse often combine it with another substance to get a stronger high, faster. At the same time tolerance develops, the brain begins to rely on the drug to produce relaxed feelings. Stopping the drug suddenly causes the brain to become overexcited. This can end in benzodiazepine withdrawal syndrome, an extremely uncomfortable condition that can last for months, while waxing and waning in intensity.
Despite the addictive potential, there are legitimate indications for benzodiazepines. People are often prescribed benzos for opiate withdrawal, specifically diazepam. If benefits outweigh risks, the most appropriate uses for benzodiazepines include:
- Alcohol withdrawal: Diazepam
- Insomnia or end-of-life anxiety: Diazepam, lorazepam, triazolam or temazepam
- Panic disorder: Alprazolam
- Muscle relaxation: Diazepam
- Seizure: Clonazepam, diazepam
- Perioperative anesthesia: Midazolam
- Status epilepticus: Diazepam
Beyond their addictive potential, benzodiazepines come with a grim set of side effects. Anti-anxiety agent midazolam, for example, is believed to have severe amnesic properties. The risk for memory loss is due to the sedative effect these drugs have on the brain.
According to the Centers for Disease Control and Prevention, prescribers wrote 37.6 prescriptions for benzodiazepines for every 100 people in the United States in 2012 — compared with 82.5 opioid prescriptions per 100 US adults.
Broken down further, the CDC’s analysis of prescribing patterns revealed significant variation between the states. The prescribing rate for benzodiazepines in West Virginia that year was 3.7 times higher than Hawaii. West Virginia, Alabama and Tennessee were the three highest-prescribing states when accounting for both benzos and opioids — all three were more than two standard deviations above the mean.
Addiction to benzos is a growing problem in the US. One study published in the American Journal of Drug and Alcohol Abuse found that 61% of people who used benzodiazepines for non-medical reasons were male, and 74% of those people were under the age of 35. This population also reported that they used other drugs non-medically — 72% said they used marijuana and 49% said they had used cocaine. Other key findings from this study include:
- 11% of drugs implicated in emergency department visits were benzodiazepines.
- 70% of emergency department visits involving benzodiazepines also involved another drug.
- More than 50% of emergency department visits involving benzodiazepines also involved a suicide attempt.
According to the National Institute on Drug Abuse, the number of deaths involving benzodiazepines in the US increased 5-fold between 2001 to 2014 — from around 1,500 deaths to nearly 8,0000 deaths.
In general, benzodiazepines should only be used on a short-term basis, because they are highly addictive, produce intense and long-lasting withdrawal symptoms, and can be fatal when combined with another substance during overdose. A study published in JAMA Psychiatry analyzed benzo prescribing patterns in the US in 2008 and found that long-term benzo prescriptions are common, despite the known risks.
In that year, a little over 5% of adults in the US between the ages of 18 and 80 used benzodiazepines. Broken down by age, researchers observed that this percentage increased with age:
- 18-35 years of age: 2.6%
- 36-50 years of age: 5.4%
- 51-64 years of age: 7.4%
- 65-80 years of age: 8.7%
Just 14.7% of people between the ages of 18 and 35 who received a benzo prescription got it for long-term use. Meanwhile, 31.4% of people between the ages of 65-80 who received a benzo prescription got it for long-term use.
Call 12 Keys Rehab for More Information
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