Addiction to benzodiazepine drugs is quite common. Many people who are prescribed these drugs for legitimate medical conditions will unintentionally abuse them and may then go on to develop a crippling addiction. The good news is that treatment is available for benzodiazepine. It is important, however, not to try to quit benzos without medical supervision as doing so could end up being extremely dangerous.
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.
How Do Benzodiazepines Work?
Though each addictive drug may have different effects, all create dependence in roughly the same way – by causing long-lasting changes in the brain’s ‘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 blackouts.
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’.
Benzodiazepine Abuse Causes
Not everyone who is prescribed benzodiazepines will go on to abuse the medication, but those who do tend to have a variety of reasons for doing so. There is absolutely no doubting the fact that some individuals are more predisposed to addiction than others, with a family history of it being a major contributor, but there are other causes too.
The reality is that there is no single cause of benzodiazepine abuse. There are, however, risk factors that increase the likelihood of a person abusing his or her medication. Although family history and genetics tend to play a role, certain environmental factors can also be a cause of benzodiazepine abuse:
It is sometimes difficult to handle a situation where everyone around us uses and stay clean.
When unemployed, we can look into different ways to make ourselves feel better, to feel useful or just take our minds off things through drugs.
Issues in relationships
One of the most serious causes for benzodiazepine abuse is problematic relationships - due to the inability to handle a romantic breakdown, we look into substances to improve our mood.
Poor quality of life
Just as with unemployment, a poor quality of life can bring about depressive moods and anxiety episodes, which we often counter with medications, many of which include benzos.
Although benzodiazepines are prescribed for the treatment of conditions such as panic disorder, anxiety, and insomnia, it is recommended by most medical professionals that they are prescribed for short-term use only due to the high potential for abuse.
Due to the way in which these drugs can affect the brain, there is a tendency for a tolerance to develop. This basically means that you might find that you are not achieving the same level of relief from your medication that you did when you first started to take it as your brain and body has adapted to its presence.
If you increase your consumption of benzodiazepines in order to achieve a specific level of relief, you might also begin experiencing withdrawal symptoms when the effects of the medication wear off. Benzodiazepine abuse tends to intensify once a physical dependence has developed, and this is typically caused by a need to avoid the unpleasant withdrawal symptoms associated with not taking the medication rather than to achieve perceived pleasurable feelings.
What you should be aware of though is that benzodiazepine dependence is not the same as addiction. Addiction causes drug-seeking behaviour and a compulsion to use the drug even when knowing that to do so will cause negative side effects. Physical dependence can occur with long-term benzodiazepine use, even when the drug is taken exactly as prescribed.
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Short-Term Effects of Benzodiazepines
According to WebMD, symptoms caused by high doses of benzodiazepines include:
- Blurred vision
- Slurred speech
- Lack of coordination
- Difficulty breathing
Long-Term Effects of Benzodiazepines
Long-term symptoms of benzodiazepine abuse include:
Anxiety brought 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 also include anxiety, memory impairment, depression and emotional blunting, reduced coping mechanisms.
Due to the potential for abuse with benzodiazepine use, many medical professionals are reluctant to prescribe them, particularly for those patients suffering from conditions such as mood disorders and substance use disorders.
As touched upon above, benzodiazepines are intended for short-term treatment, but there are still many doctors who do prescribe this medication to patients for long-term use. This obviously increases the risk of physical and psychological dependence; the doctor will (or at least, he or she should) weigh up the benefits of doing this with the perceived disadvantages of the aforementioned dependence issues. Those who do go on to develop an addiction to benzodiazepines will almost certainly suffer withdrawal symptoms when they try to quit the medication.
The general consensus is that to overcome a benzodiazepine addiction, complete abstinence is necessary. Nevertheless, most patients with high dose benzodiazepine dependence do not achieve abstinence in the long-term. As a result of this, some doctors and other medical professionals use what is known as benzodiazepine substitution treatment.
When using a benzodiazepine substitution, the drug used must have an antagonist or blocking, effect. It is believed that drugs that have a slow-onset and are long-acting, such as clonazepam, are ideal substitutions for benzodiazepines like lormetazepam. Substituting the one drug for the other by lowering the dose of that which you were tolerant or addicted to while at the same time raising the dose of the other will ensure that you can quit benzodiazepine abuse without suffering the major withdrawal symptoms usually associated with this. It is similar to the way in which methadone is, or should be, used for those who want to withdraw from heroin.
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The Dangers of 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 number 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.
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.
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Benzodiazepine Brand Names
- Xanax (alprazolam)
- Valium (diazepam)
- Klonopin (clonazepam)
- Rohypnol (flunitrazepam)
- Ativan (lorazepam)
- Librium (chlordiazepoxide)
- Restoril (Temazepam)
- Halcion (Triazolam)
- Serax (Oxazepam)
Management of Benzodiazepine Misuse and Dependence
As you know by now, benzodiazepines are intended for short-term use only, but they may occasionally be prescribed for a longer period, as discussed in the paragraphs above. But even when taken in low doses, if it is over an extended period a dependency can occur.
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Management of benzodiazepine misuse and dependence typically involves a detox, where the medication is withdrawn, and the symptoms associated with the withdrawal are managed using a substitute drug. This should then be followed by a rehabilitation programme where pharmacotherapies and psychotherapies are used to help address the underlying cause of the addiction.
Abrupt cessation of benzodiazepines is never recommended due to the risk of life-threatening seizures. The recommended detoxification process is as follows:
It is usually recommended that long-acting substitutes are used for both withdrawal and maintenance therapy unless the person with the addiction is elderly.
The new drug is then reduced over a period of weeks with the ultimate aim of achieving complete abstinence.
As benzodiazepines are highly addictive, and a tolerance to the effects of this medication can occur very quickly even in those taking the drugs for medicinal purposes, there is a high potential for abuse when people start taking them for recreational reasons.
But because a tolerance to benzodiazepines occurs quickly, there is an extremely high risk of overdose in those taking the drug in high doses. While fatal benzodiazepine overdose is not common when the substance is used on its own, combining the drugs with another substance can lead to severe complications, possibly even coma and death.
Benzodiazepine overdose occurs then when an excessive amount of medication is taken or when it is combined with other sedative drugs such as opioids or alcohol.
There are certain factors that increase the risk of a benzodiazepine overdose including taking more of the medication than advised to by a medical professional or taking it in ways that are different to how it was prescribed or intended to be taken.
If you are taking benzodiazepines for recreational purposes, for example, you might intentionally (or otherwise) combine it with other substances or use it in a way that it was not intended, such as injecting it. This exponentially increases the risk of overdose.
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Co-Occurring Disorders of Benzodiazepine Abuse
Benzodiazepine addiction can co-occur with a number of mental health problems including anxiety disorder, major depressive disorder, and bipolar disorder. When used in conjunction with other substances such as other drugs or alcohol, depression is a distinct possibility, particularly in those susceptible to such mental health problems.
Although benzodiazepines are commonly used in the treatment of conditions such as anxiety disorder, the risk of addiction to the medication means that a dual diagnosis can often occur. Dual diagnosis is the term used to describe the presence of addiction with a co-occurring mental health problem. When a benzodiazepine addiction occurs at the same time as a mental health problem such as anxiety disorder, the risk for abuse of other substances also increases.
If you are not using benzodiazepines to treat an existing mental health problem, you should be aware that continued use of this medication for whatever reason can increase the risk of you developing a mental health disorder. When treating co-occurring disorders of benzodiazepine abuse, it is necessary to create a plan that treats both conditions at the same time. Treatment of co-occurring disorders typically requires a combined approach of medication with psychotherapy and group support.
Benzodiazepine Abuse Treatment Self-Care at Home
It is important that you do not abruptly stop taking benzodiazepines, particularly if you have been abusing the medication. Doing so can cause you to experience potentially life-threatening withdrawal symptoms such as seizures.
If you have been abusing your medication but are not yet addicted, you may be able to quit without a medical detox. Nevertheless, before you stop taking benzodiazepines you need to speak to your doctor about how to reduce your dosage gradually.
When to Seek Medical Care?
If your use of benzodiazepines is affecting your quality of life, then it is important to seek out help as you may have an addiction. If you are taking your medication even though you know that it is going to have a negative impact on yourself and/or those around you, it is vital that you speak to a medical professional about how to overcome this addiction.
Similarly, if you believe that you or someone you care about might have overdosed on benzodiazepines, it is imperative that you seek medical advice as soon as possible. If you are having trouble breathing and are suffering from blurred vision, tremors, and weakness, seek urgent medical care. Nonetheless, it should be noted that benzodiazepine overdoses are rarely fatal unless another chemical substance is being abused at the same time.
Benzodiazepine Addiction and Possible Treatments
Addiction is classed as any pattern of behaviour that causes negative consequences for the individual. So if your use of benzodiazepines has started to affect your everyday life in a negative way, it is likely that you have an addiction. If this is the case, you will need to get treatment in order to regain control of your life.
Treatment may include a programme of detoxification and rehabilitation and you may or may not be prescribed a substitute drug to help with the withdrawal from the medication. Included may be a combination of the following treatments and therapies:
- cognitive behavioural therapy (CBT)
- motivational interviewing
- contingency management
- group support and counselling
- 12-step work
- relapse prevention strategies.
It is common to develop an increased tolerance to the effects of benzodiazepines that can then lead to a physical dependence. The risk of dependence increases the longer you are taking the drug. Whether you are taking benzodiazepines on the advice of a medical professional or are abusing them for recreational purposes, the risk of dependence is the same if you take them over a long period of time.
To overcome an addiction to benzodiazepines, a detox will likely be necessary; this could potentially lead to a range of unpleasant withdrawal symptoms. We mentioned this above, but it is important, so we’ll mention it again: it is not recommended that you stop taking your medication abruptly as this can lead to severe symptoms.
During a detox, experienced staff will ensure you are comfortable and safe at all times and will monitor your progress while administering appropriate treatment should you experience unpleasant symptoms. You may be advised to reduce your benzodiazepine consumption over the course of a few days until you are able to quit completely. You might be provided with a substitute drug to help prevent the worst symptoms from occurring.
What you should be aware of though is that if you have been taking benzodiazepines for the treatment of an anxiety disorder, you could experience an increase in feelings of anxiety when you stop taking your medication. This is known in the medical world as rebound anxiety.
The length of your detox will typically be between one and two weeks. However, if you have a severe addiction, it may be advisable to wean you off your medication over a much longer period of time, meaning you may not be completely clean for a number of months.
What about 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 low in comparison with other drugs, with the majority of users remaining abstinent ten years later.
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.
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Do You Need to Go into Rehab?
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.
Benzodiazepine Addiction Statistics
- According to the Medicines and Healthcare Regulatory Agency (MHRA), prescriptions of benzodiazepines in England remained stable between the period 2008 to 2012.
The number of prescriptions during this period ranged from 10.9 million to 11.1 million prescriptions each year.
- The Royal College of Psychiatrists states that forty per cent of people who take benzodiazepines for longer than six weeks will go on to develop an addiction. It also recommends that benzodiazepines should be taken for no longer than four weeks.
- The British Medical Association (BMA) states that 12 million benzodiazepine prescriptions were issued in 2015, at a cost of more than £50 million.
- The BMA also said that a recent survey registered in Bradford showed that there are between 265,000 and 295,000 patients aged between 16 and 80 in the UK taking benzodiazepines and Z-drugs for longer than a year.
- The report also found that 35% of all patients taking benzodiazepines have been taking them for at least twelve times longer than the recommended 2-4 weeks as per the British National Formulary (BNF).
- In England and Wales, the number of deaths attributed to benzodiazepine use was at an all-time high of 406 in 2016; records began in 1993.
Where else can I find help?
If you are struggling with a benzodiazepine addiction and need help to get your life back on track, you can call us here at UKAT. Alternatively, you can speak to your doctor about the treatments that are available to you via the NHS.
How does benzodiazepine addiction start?
Benzodiazepines are highly addictive, and addiction starts with an increased tolerance to the effects of the drug. Whatever way you are taking benzodiazepines, either medicinal or recreational, you may find that you need to take more of the drug in order to achieve the level of satisfaction that you desire.
If you increase the amount of benzodiazepines that you are taking then you run the risk of developing a physical dependency on your medication (although this can also happen when benzodiazepines are taken over a long period of time). If your use of benzodiazepines progresses after physical dependence and you are taking them even when it causes negative consequences for you and your loved ones, you likely have an addiction.
Who gets addicted to benzodiazepines?
It is easy to assume that a specific type of person gets addicted to benzodiazepines, but this is not the way that addiction works. In fact, addiction is an illness that does not discriminate and anyone who uses these drugs can go on to develop an addiction. It does not matter what age you are, where you come from, or how much money you have, if you allow your use of benzodiazepines to get out of control, you could go on to develop an addiction.
What should I do about benzodiazepine addiction?
if you believe you have an addiction to benzodiazepines, it is important to get help as soon as possible. It might be easier to do nothing, but your addiction will not go away if you ignore it. In fact, failure to address the issue now could mean that it gets worse as your need for benzodiazepines increases.
If you would like help for your addiction, you can speak to your own doctor or you can contact us here at UKAT for confidential advice about what the next steps should be.
How to help someone who is addicted to benzodiazepine?
If someone you love or care about is addicted to benzodiazepines, you will want to do all you can to help. However, you may find that this person is reluctant to admit the problems exists. Most of those struggling with addiction are not ready to accept they have a problem.
If you want to help this individual, it would be a good idea to have a calm and frank discussion about your concerns. Do not be surprised if you are met with angry denials; this is common. But that does not mean that you have to give up. Try to broach the subject again and if the person refuses to accept help, you may need to arrange an intervention with other family members and/or friends.