Benzodiazepine Addiction, Treatment and Withdrawal

What are Benzos or Benzodiazepines?

All benzodiazepines share a common chemical structure and are central nervous system sedative-hypnotic agents. They inhibit a person’s brain function, decreasing brain stimulation, which induces a calm state and promotes sleep. Benzodiazepines are generally used to treat anxiety, panic disorders, acute stress reactions, anxiety with depression and seizures. They are controlled substances because of their highly-addictive properties. Because they suppress the central nervous system, benzodiazepines are also known as depressants. Examples are:

Valium
Xanax
Ativan
Klonopin
Halcyon
Librium
Serax
Ambien

Throughout the late 1800s and early 1900s drugs with similar uses to benzodiazepines were available. However, they were dangerous, and the effects were not predictable. In the late 1950s, benzodiazepines were discovered. The original formulation had a hypnotic effect. It was also noted for its ability to relax muscle spasms. Librium, the first of this class, was launched commercially for human use in England in 1960, followed by Valium (diazepam) in 1963. Within twenty years the number of drugs in the benzodiazepine class grew to 17, with an additional 12 added during the last 25 years.

According to a benzodiazepine research paper from the University of Maine, benzodiazepines were the most commonly prescribed drug during the 1970s. Because of their highly addictive properties, benzodiazepines have been scheduled as a class IV controlled narcotic by the U.S. Drug Enforcement Agency.

The most common route of administration of benzodiazepines is by oral ingestion. Benzodiazepines can also be injected, but this is typically performed by healthcare professionals. Dosage and absorption times vary widely, depending on the particular benzodiazepine used. It has been reported that those addicted to benzodiazepines may choose to crush and then inject or snort the powder. Alternatively, the addict may choose to simply chew the tablet.

Benzodiazepines are highly addictive medications. They are never intended for recreational use and are made available by prescription only. Physicians prescribe this class of drugs to treat anxiety disorders, panic attacks and to moderate severe stress. Sometimes, benzodiazepines are prescribed off-label to treat depression and pain. However, they are not approved by the U.S. Federal Drug Agency for this use.
Signs and Symptoms of Benzodiazepine Use

Drowsiness
Decrease in balance and fine motor skill coordination
Decreased anxiety
Sedation
Lethargy
Memory lapses
Decreased subjective feeling of pain, due to reduction in anxiety

Depending upon the type of drug taken, the half-life of the drug, and its rate of metabolism, the effects of the drug will wear-off within hours to days. As with other prescription medications, people tend to “chase” the feeling of calm that is produced with benzodiazepines. The user’s thought process responds immediately to the good feelings produced by the initial use.

A person who has been prescribed a benzodiazepine and is prone to addiction may erroneously think, “if one pill produced this feeling of calm, then two pills will produce an even greater feeling of calm.” This thought process is flawed and often leads to benzodiazepine addiction. Eventually tolerance develops to benzodiazepines, requiring an ever increasing amount of the drug to produce the initial sense of calm. Overuse leads to running out of the prescribed amount quicker than should be and the user is placed in a position of finding additional medication quickly.

When additional medication cannot be obtained, either legally, through an authorized prescription, or illegally, by borrowing from friends and neighbors, or buying on the street, the addicted person is likely to begin to experience benzodiazepine withdrawal symptoms. Doctor shopping is when a user seeks multiple prescriptions for the same medication from different prescribers, keeping each prescriber in the dark about the others and the extent of use.

Signs of Benzodiazepine Abuse

Loss of concentration
Slurred speech
Loss of appetite
Development of intermittent agoraphobia
Mood swings
Mental confusion
Missing work
Stealing, lying, or generally unreliable
Not taking care of one’s health or home
Doctor shopping
Buying the drug illegally on the street
Stealing or “borrowing” prescriptions from family members

Health Complications of Benzodiazepine Abuse

Amnesia
Coma
Hypnotic state
Reduced muscle strength
Irritable bowel syndrome
Overdose leading to death
Severe withdrawal causing seizures, heart attack, and/or stroke

Benzodiazepine Withdrawal Symptoms and Withdrawal Treatment

Withdrawal symptoms generally occur with individuals using benzodiazepines for a period of three to six months, or less for those who concurrently use alcohol or other sedatives. Withdrawal symptoms can begin as early as several hours after last use peaking within 24 – 72 hours. However, benzodiazepines with longer half-lives are not as quickly absorbed into, or metabolized out of the body. Withdrawal from those with long half-lives can produce symptoms a week after last use and last for several weeks. Typical signs of benzodiazepine withdrawal are:

Abdominal cramps
Convulsions (seizures)
Muscle cramps
Sweating
Tremor
Vomiting
Hallucinations
Delusions
Severe anxiety
Nightmares
Increased heart rate or blood pressure, that can lead to heart attack or stroke
Perceptual disturbances
Depersonalization
Distorted body image
Formication (sensing insects crawling under or on the skin)
Muscles twitches, restless leg syndrome
Psychosis

Symptoms of benzodiazepine withdrawal vary in severity based on the amount of drug taken, the duration of the drug abuse, and the method of abuse (such as snorting, ingesting by mouth, or injecting the drug I.V.) Remember, withdrawal symptoms should be closely monitored in a medically staffed detox unit.

If the addiction began because of a disorder, the symptoms of the disorder will reappear during detox with greater intensity than before. Without addressing the underlying medical or psychiatric symptoms, it is likely that the addict will return to using drugs and alcohol.

Ironically, benzodiazepines are also prescribed to treat alcohol, barbiturate, and benzodiazepine withdrawal. Withdrawal from sedatives can be life-threatening.
Benzodiazepine Addiction Treatment

It is significant that any one abusing benzodiazepines seek the help of a trained addiction professional before he or she abruptly stops taking the drug. Medically based drug detox is strongly urged to be immediately followed by addiction treatment. Inpatient detox and treatment are recommended as the medical team and psychiatrists can respond to all crises as they occur and determine whether addition medication is needed and at what levels. Relying upon self-reporting and self-medicating, as is done in outpatient programs, is not the best approach.