Benzodiazepine Addiction and Possible Treatments

Benzodiazepines – sometimes called ‘Benzos’ – are a class of psychoactive drug often prescribed by doctors for short term treatment of mental health disorders such as anxiety, insomnia and panic disorder. The most common types are Diazepam (Valium), Lorazepam and Alprazolam.

Nonbenzodiazepines – or Z drugs – are psychoactive drugs that have almost entirely the same effects, risks and side effects as Benzodiazepines but contain different ingredients. The most common types of nonbenzodiazepines are Zopiclone and Zaleplon.

– For the sake of this article, Benzos and Z drugs will be referred to collectively as benzodiazepines.

Each year, doctors hand out 12 million prescriptions for benzodiazepines in the UK.

Most commonly, the prescribed drug is Diazepam, or Valium, and it is given for the treatment of anxiety, insomnia or other acute psychological disorders. Invariably, the patient will be told it is for short term use only, somewhere in the region of 2-4 weeks, just to get them through a particularly difficult period of mental anguish.

Many of these patients have little or no idea that the medication they have just been given is one of the most addictive drugs on the market – legal or illegal. And at first, it might help. Anxiety could reduce when they take it, and sleep may come easier when they lie down at night. When their prescription runs out, they may find themselves wondering where they can get more. Maybe the doctor will oblige. Or maybe the patient will start looking elsewhere.

Numbers are vague about the amount of benzodiazepine addicts in the UK, but it could be as high as 1.5 million, making them second only to alcohol on the scale of addictive substances. Over half of these people get their drugs from their GP, and an even higher amount might have been first introduced to the drug by prescription. Others may get them over the internet, from street dealers or through friends and family.

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Types of benzodiazepines in order of popularity

Name Brand name Medical use Half Life (hrs) Colour of Pill
Diazepam Valium/Diastat Anxiety/Insomnia 20-100 Normally White, Yellow, Blue depending on strength
Zopiclone Zimovane/Imovane Insomnia 5-6 Usually white
Lorazepam Ativan Anxiety/Insomnia 10-20 Normally white, sometimes yellow/orange
Alprazolam Xanax/Niravam Anxiety 7-25 Orange/blue/white
Oxazepam Serax Anxiety 4-15 Capsule. Many colours
Zaleplon Sonata, Starnoc, Andante Insomnia 1 Capsule. Usually green

How benzodiazepine addiction works
Though each addictive drug may have different effects, all create dependence in roughly the same way – by causing long lasting changes to the brains ‘reward system’. When a user takes benzodiazepines, they alter the levels of reward producing natural chemicals, such as dopamine and norepinephrine. Over time, the brain physically adapts so that it is unable to produce these chemicals on its own, and becomes reliant on the drugs in order to feel normal.

Benzodiazepines are different from other addictive substances such as heroin or cocaine as they don’t give the user an intense rush or buzz. Instead, the effects generally come on more gradually, giving the user a sensation of calm and sedation that can last for many hours. Like any drug, the more you take, the stronger the sensations are. However, more than other drugs, benzodiazepines can be the basis of low-level, functioning addictions, where the user treats the drug as a pharmaceutical medication, keeping the levels constantly ‘topped up’.

Anyone who has struggled to stop using benzodiazepines will be aware of the serious effects they have on the mind and body. The drugs are designed to have an effect on almost every part of the brain – that is why they are so effective as anti-anxiety medication. But it is also why they can be so difficult to quit.

Benzodiazepines work by literally slowing down the functioning of the brain.

They do this by enhancing the actions of a particular chemical in the brain called GABA, or gamma-amino butyric acid. GABA is a very important part of our brain’s natural sedating mechanism – it sends messages from brain cell to brain cell telling them to slow down or stop firing completely. Normally, it is released in times of high stress and acts as a leveller, allowing us to continue what we are doing without being overcome by anxiety. But when GABA levels are artificially increased by Benzodiazepines, it can lead to a number of effects, from slurring words to total black outs.

One of the effects of GABA is the suppression of important natural ‘reward’ chemicals such as serotonin and norepinephrine. This in turn causes the increased release of a chemical called dopamine, which causes feelings of calm and contentment. However, when benzodiazepines are used for a long period, the brain responds by reducing the amount of these neurotransmitters it naturally produces, leading to a reliance on the drugs just to feel ‘normal’.

Symptoms of Benzodiazepine abuse

According to WebMD, symptoms caused by high doses of benzodiazepines include:

  • Drowsiness
  • Confusion
  • Dizziness
  • Blurred vision
  • Weakness
  • Slurred speech
  • Lack of coordination
  • Difficulty breathing
  • Coma

Long term symptoms of benzodiazepine abuse include:

  • Anxiety
  • Insomnia
  • Anorexia
  • Headaches
  • Weakness

Anxiety bought on by benzodiazepines can manifest itself in different ways, but the most common symptoms are panic attacks and agoraphobia. Addicts may also develop a preoccupation with benzodiazepines and the dose they are taking. This is known as ‘Benzodiazepines Neurosis’.

Long term effects of Benzodiazepine use

Although the immediate effect of benzodiazepines is to induce calm and tranquillity, over time users might find that they become more rather than less anxious. In response, they might up their dose, or turn to other drugs to supplement their habit. But what few realise is that the anxiety is caused by the benzodiazepines themselves, and that over the long term the drugs can only make it worse. Contrary to expectations, when the drugs are stopped anxiety is significantly reduced for over 50% of long term users.

In the long term, benzodiazepines have been shown to cause both memory impairment and amnesia, which gets progressively worse over time. In the short term, the drugs have been known to cause ‘blackouts’, where the user may not remember anything they did while under the influence but not remember anything about it after sobering up.

Long term benzodiazepine users will sometimes develop depression, possibly because of the way the drugs reduce the brains output of the vital ‘fell good’ neurotransmitters norepinephrine and serotonin. These neurotransmitters are part of what activate the brain’s reward system, the mechanism through which we experience positive reactions to events in our lives. Depression will usually resolve within six months of stopping the drug.

People often start taking benzodiazepines to help them cope with life’s difficulties. However, in the long term they often reduce coping skills, leading users to live an increasingly hermetic life. Even seemingly mundane activities such as going to the shops can become overwhelming for long term addicts. In general, coping skills gradually return after withdrawing from the drug.

Benzodiazepines and Brain Damage
In 2010, The Independent newspaper revealed that scientific research proving a link between benzodiazepines and brain damage had been buried by the Medical Research Council for over three decades, in which time hundreds of thousands more people had become addicted to the drugs. The evidence showed that benzos can shrink the brain. Although rare, this causes permanent intellectual and memory impairment.

Withdrawal

Benzodiazepine withdrawal is perhaps the toughest and most dangerous of all drugs. Alongside alcohol, it is the only drug where the withdrawal process can be fatal if not managed effectively. And although the acute stage of benzodiazepine withdrawal generally passes in a few weeks, symptoms can persist for months or years – longer than any other drug. Despite this, once patients are successfully off the drug, relapse rates are relatively in comparison with other drugs, with the majority of users remaining abstinent ten years later.

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Many benzodiazepine addicts may not realise that what they experience when they stop taking the drug is withdrawal. Often, users believe that the flood of anxiety that follows benzodiazepine cessation is not caused by the drug, but is just their natural anxiety problem let loose. After all, anxiety is the reason many people start taking benzos in the first place. In reaction, they may up their dose, believing that they can’t live without it. Though anxiety isn’t the only symptom of benzodiazepine withdrawal, for many people it is the most affecting. In general it is the first symptom to arrive, coming on between one and four days after the last dose, and one of the last to leave, sometimes lingering for months or even years after the drug has been stopped.

But almost any symptom is possible with benzodiazepine withdrawal – the website www.benzo.org lists over 100 known symptoms – and each person going through it will experience something different. However, not everyone attempting to stop using benzos will go through withdrawal; according to the British Journal of Clinical Pharmacology, about a third of people who take benzos for longer than six months will experience withdrawal symptoms.

Treatment

Because of the severity of benzodiazepine withdrawal symptoms, users generally start their recovery by gradually reducing their dosage. For most users, this can be done over the course of a few weeks, though for those on a high dosage the process may take longer. This is designed to wean the patient off the drug as safely and comfortably as possible. Since the effects of the withdrawal can be painful and traumatic even when the dosage is tapered off, the patient me be prescribed anti-anxiety and anticonvulsant medication to help them through the process.

Detox is only the first part of the recovery process; for long term success, treatment must focus on addressing the mental damage caused by benzo abuse, as well as the emotional difficulties that led to drug use in the first place. The British Journal of Clinical Pharmacology suggests that one of the most effective tools for this is Cognitive Behavioural Therapy (CBT), an active talking therapy designed to address difficulties and retrain the brain out of destructive habits.

CBT itself should be assisted by group therapy, in which people in recovery from benzo addiction work through difficulties together. A considerable amount of research shows that group therapy significantly increases the chances of recovery from any addiction.


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