Benzo Addiction and Treatment
Valium, Ativan, Xanax and Other Benzodiazepines
You're not alone. The help you need to overcome your benzo addiction is one phone call away.
Benzodiazepines—also called benzos—have important medical purposes. But if you're starting to feel like you're developing a dependence on them, then it's important to seek professional help. Many people just like you have worked through their addictions and now enjoy healthy and happy lives.
You can get your own enjoyment of life back by asking for help today. After all, having medical support and supervision is a key component of addiction recovery. It helps ensure that your withdrawal is properly managed.
Learn more about benzo withdrawal and treatment, and discover other facts about addiction below.
Valium, Ativan, Xanax and Other Benzos
Benzodiazepines are tranquilizers or sedatives. They are used primarily to treat severe stress such as anxiety attacks and panic attacks. Benzodiazepines are commonly referred to as "benzos" or "benzoids" and are in the sedative-hypnotic class of drugs. They induce a feeling of calmness, relax muscles, and aid sleep (Miller, 2013). Benzodiazepines are considered mood-altering and addictive (Ries, 1996). They are controlled substances that require a prescription.
How Do Benzodiazepines Work?
Benzodiazepines work by strengthening the brain neurotransmitter called GABA (McGraw, 2004). GABA controls the "calm-down mechanism" of the brain (NYU Langone Medical Center, 2014). It decreases the fight-or-flight reaction related to stress, tension, anxiety, fear, and panic (Davidson & Dreher, NY; NY). In other words, benzodiazepines decrease fear and its natural reactions like pumping adrenalin, agitation, nervousness, tension, and wakefulness.
Benzodiazepines have a rapid effect, producing feelings of relaxation and well-being. They can cause a psychological dependence because of their pleasant effects. This means that people who use them may depend upon them to deal with life's ordinary stresses. If so, they run the risk of having very few real coping skills that are needed to have a drug-free life. Instead, they depend upon the drug to cope for them.
Benzodiazepines are intended to be used for a short time, usually a few weeks, in order to prevent physical dependency (the body's biological need for a drug it is addicted to). Benzodiazepines are safest when used during a brief time such as when having an episode of intense anxiety, panic, or insomnia (Karch, 2007). Physical dependency occurs when the body becomes accustomed to an addictive drug and develops a tolerance for it, needing greater amounts of the drug to achieve the desired effects. Having benzo tolerance also means that if use is abruptly stopped or the usual dose is reduced, a person will have symptoms of withdrawal (Smith & D.Wesson, 2013).
Types of Benzodiazepines
Below is a list of benzodiazepine names. There may be some available on the market that are not included in this list. If you cannot find a drug here that you are concerned about, please consult your physician or pharmacist for information.
This list gives the generic name, and then in parentheses, the brand names it has been marketed under. It also includes forms of benzodiazepines that may not currently be approved for use in the U.S., but may be imported illegally. Please keep in mind that not all brand names are listed as they may have different names in different countries. Also, not all are approved for human use in every country. For example, Brotizolam is approved only for veterinary use in some countries, but for psychiatric treatment in others (Drugs.com, 2014).
- Alprazolam (Xanax, Kalma, Apo-Alpraz, Novo-Aloprazol, Nu-Alprax, Tafil)
- Bromazepam (Lexotan, Lexomil)
- Brotizolam (Lindormin,Brotizolam OD, Cinberamin D)
- Chlordiazepoxide (Librium, Nova-Pam, Apo-chlordiazepoxide, Corax, Medilium, Novo-Poxide, Solium)
- Clonazepam (Klonopin, Rivotril)
- Clorazepate (Tranxene, Apo-Clorazepate, Novo-Clopate)
- Clotiazepam (Clozan)
- Cloxazolam (Sepazon)
- Diazepam (Valium, Ducene, Antenex, D-Pam, Pro-Pam, Apo-Diazepam, Diazemuls, E Pam, Meval, Novo-Dipam, PMS-Diazepam, Vivol)
- Estazolam (ProSom, Tasedan)
- Etizolam (Etilaam)
- Flunitrazepma (Rohypnol, Hypnodorm)
- Flurazepam (Dalmane, Apo-Flurazepam, Novo-Flupam, PMS-Flupam, Somnol, Som Pam)
- Halazepam (Paxipam)
- Ketazolam (Anxon)
- Loprazolam (Dormonoct, Havlane, Sonin, Somnovit)
- Lorazepam (Ativan, Apo-Lorazepam, Novo-Lorazepam, Nu-Loraz, PMS-Lorazepam, Pro-Lorazepam Somnovit)
- Lormetazepam (Noctamid)
- Medazepam (Nobrium)
- Midazolam (Versed, Hypnovel, Dormicum, Dormicum Dormonoct)
- Oxazepam (Seresta, Serax, Serepax, Murelax, Alepam, Serenid, Benzotran, Apo-Oxazepam, Novo-Oxazepam, Oxpam, PMS-Oxazepam, Zape)
- Prazepam (Centrax)
- Quazepam (Doral)
- Temazepam (Restoril, Euhypnos, Normison, Temaze, Euhypnos, Nocturne, Normison, Temaze, Temtabs, Sompam)
- Triazolam (Apo-Triazo, Halcion, Apo-Triazo, Gen-Triazolam, Novo-Triolam, Nu-Triazo, Hypam, Tricam Hypam, Trilam)
Medical Uses of Benzodiazepines
Benzodiazepines are used medically in several ways and are generally considered safe if used with medical supervision. However, people who have an addiction, or who have previously abused drugs or alcohol, are at risk for benzodiazepine misuse, addiction, and overdose (Kranzler, Ciraulo, & Zindel, 2014).
Some of the medical uses of benzodiazepines include:
- Alcohol and other drug withdrawal treatment
- Pre-surgery relaxation, and in some cases, anesthesia during minor surgery
- Control of anxiety and panic
- Treatment of insomnia
- Relief of muscular tension and spasms
- Seizure control
- Treatment of restless leg syndrome
- Treatment of dyskinesia (involuntary movements)
- Treatment of dystonia (muscle rigidity)
- Relief from nightmares and night terrors (Smith & Wesson, 2013; World Health Organization, 1996)
People who have an addiction, or who have previously abused drugs or alcohol, are at risk for benzodiazepine misuse, addiction, and overdose.
How Are Benzodiazepines Misused?
Benzodiazepines are misused through self-medicating and recreational use to get "high." Self-medication is common for anxiety and tension as well as to ease withdrawal from other substances. More recreationally, people use benzodiazepines when drinking alcohol to enhance their "buzz," however this combination can be lethal (APA, 1990). Also, opiate users combine benzodiazepines with painkillers or heroin. For example, someone addicted to painkillers or heroin might use benzodiazepines to "stretch" the effects of those drugs. Crack cocaine addicts (and other stimulant users) may also self-medicate the "crash" after a binge (Kouimtsidis, Davis, Reynolds, Drummond, & Tarrier, 2007).
A growing area of concern has been the rising number of benzodiazepine overdoses among children and teenagers. For example, from 2000 to 2015, exposure to these drugs grew 54 percent in the under-18 population. Almost 50 percent of all exposures involved some form of deliberate misuse, including suicide attempts. (Friedrich, J., et al., 2019).
Who Becomes Addicted?
People from all walks of life and of various ages misuse and become addicted to benzos. There are certain commonalities among people who become addicted, however. These include:
- Taking benzodiazepines more than 2-4 weeks.
- Having conditions such as emotional instability, an anxiety disorder, insomnia, depression, and/or chronic pain (Kranzler, Ciraulo, & Zindel, 2014).
- Misusing other substances (Miller, 2013).
Others at risk for misuse and addiction are:
- Those on methadone maintenance.
- Alcoholics who want to prolong the effects of alcohol (Rastegar & Fingerhood, 2005).
Long-term Effects of Use
The long-term effects of benzo abuse include impaired mental functioning. This can continue for some even after withdrawal. It can also be permanent. Such impairment includes a decline in memory, attention, concentration and problem-solving (Barker, Greenwood, Jackson & Crowe, 2004). Long-term use has also been linked to an increased risk for Alzheimer's and depression (APA, 1990; Merz, 2014).
Another long-term effect is a condition called protracted withdrawal (also called protracted withdrawal syndrome or post-acute withdrawal syndrome). In this condition some of the discomfort of withdrawal continues for weeks or months. It can include such symptoms as mood swings, insomnia, fatigue, headaches, anxiety attacks, depression, cravings, and increased sensitivity to stress (UCLA, 2014).
Signs of Intoxication
If benzodiazepines are used with appropriate medical supervision; there are usually no signs and symptoms of being intoxicated or "high." Intoxication with benzodiazepines is an overdose and state of toxicity requiring medical attention. Below is a list of the signs and symptoms of benzodiazepine overdose:
- Unsteadiness while walking
- Blurred vision
- Poor coordination
- Impaired judgment
- Impaired memory
- Being uninhibited
- Having a decline in the ability to fulfill normal roles and responsibilities
- Weakness (as in muscular weakness, lack of stamina)
- Slurred speech
- Shallow or slowed breathing
- Disturbing dreams
- Coma (Gresham, 2014, Landry, 2004, WebMD, 2014)
If signs of overdose are present, it's imperative to call for an ambulance immediately. Paramedics will transfer the patient to a hospital for benzodiazepine overdose treatment. The patient will have his or her vital signs monitored, and supportive care will be provided as needed. In rare cases, an antidote called Flumazenil (Romazicon) may be administered. Although serious, benzo overdose without co-ingestion of other substances is rarely fatal.
Withdrawal should be planned with a doctor.
Complications of Withdrawal
People show signs of benzo withdrawal if the usual amount taken is suddenly reduced, or if they stop using benzodiazepines abruptly. Withdrawal or detox without a doctor's care can be very uncomfortable and distressful. It also has the potential for serious medical consequences. Withdrawal should be planned with a doctor who will monitor the often slow, very gradual process of weaning or "tapering." A successful withdrawal will help with both the physical and psychological dependence that benzodiazepine addicts have.
Psychological dependence on benzodiazepines involves thoughts, feelings and beliefs about how necessary the drug is in one's life. Psychological dependence causes one to believe that the drugs are necessary in order to cope with life. On the other hand, physical dependence is a serious medical issue for anyone who has used benzodiazepines for more than a few weeks. This is true when the drug is misused as well as when users have been following a doctor's orders.
Dr. Malcolm Lader of the Institute of Psychiatry in London has published over 100 papers on benzodiazepines. He discusses how difficult benzo withdrawal can be:
It is more difficult to withdraw people from benzodiazepines than it is from heroin. It just seems that the dependency is so ingrained and the withdrawal symptoms you get are so intolerable that people have a great deal of problem coming off. The other aspect is that with heroin, usually the withdrawal is over within a week or so. With benzodiazepines, a proportion of patients go on to long term withdrawal and they have very unpleasant symptoms for month after month (M.Lader, 2011).
Symptoms of Withdrawal
Benzo withdrawal symptoms typically begin 12-24 hours after stopping use. The onset of withdrawal depends upon how much has been regularly used and whether the drug is ultra-short acting, short-acting, or long-acting (WebMD, 2014b). Each category of benzodiazepine will have its own timeline for withdrawal, but generally symptoms become intense 24-72 hours after use has stopped or after the dose is significantly decreased. It is always recommended that withdrawal be done with close medical supervision in which symptoms are monitored and the dose of benzodiazepine is gradually tapered (Gabbard, 2007).
Below are symptoms that could occur if benzodiazepines were stopped abruptly or the dose was dropped abruptly without medical supervision:
- Abdominal cramps
- Incoherent thoughts
- Excessive sweating
- Death (Colvin, 2008, Gabbard, 2007)
Benzo Addiction Treatment
Treatment for benzodiazepine addiction begins with withdrawal. Initially, doctors may substitute the benzodiazepine that was abused for another type. They may also stop benzodiazepines altogether and prescribe a barbiturate. Each individual will have a withdrawal treatment plan that is specifically designed for his/her situation.
Hospitalization is recommended for addicts to withdraw and this can be done either in a medical facility or a rehab that provides medical care. Outpatient withdrawal is typically best for those who have not misused their medication, but have a physical dependence that naturally occurred during medical treatment. People who have an outpatient withdrawal also need to have others at home to help monitor the signs and symptoms of any distress. Even in these milder cases, frequent medical appointments are important and there are still risks for delirium and seizures (CSAT, 2006).
Total withdrawal may occur over weeks, or even months, depending on how severe the addiction is. Typically inpatient care is the safest first phase of longer term recovery. In inpatient treatment other significant recovery skills are also learned.
Inpatient treatment services help addicts find ways to cope with living a drug-free life. These services typically provide:
- Supportive counseling through withdrawal
- Education about benzodiazepine addiction and the recovery process
- Identifying what may trigger drug use and coping strategies for avoiding use
- Dealing with emotions, thoughts, and beliefs about drug use
- Dealing with the impact of having been actively addicted and entering the next stage of recovery through education, individual, group, and family counseling
- Becoming acquainted with 12-Step programs for support in the community
- Having any needed psychiatric services
- Referral to outpatient or other community treatment sources such as intensive outpatient services in which people attend several days a week while living at home or in a sober community
What to Do If Someone You Love Is Using Benzodiazepines
Educate yourself about benzodiazepine misuse and addiction. Contact benzo addiction treatment professionals in your area for advice and information about treatment options in order to prepare for discussing the problem with your loved one. Remember that addiction is a condition over which your loved one has no control at this point, and there is a significant need for support and medical care to regain control over his/her life. The medical necessity of supervised withdrawal should be a key element of your discussion with your loved one. Keep your discussion calm and factual while demonstrating concern and support.
Keep in mind that your loved one cannot simply stop using due to the health hazards involved in doing so. Express the willingness to help them get help and to support them in recovery. Be mindful that their mental functioning may not allow them to problem-solve and make decisions wisely. Present a plan for going to treatment with specific steps that you can assist them with, and if your loved one is willing, act immediately to get them treatment services.
If the addict is not willing to enter treatment consider what you will and will not do for your loved one who continues to use benzodiazepines. It is helpful to seek your own support and counseling to deal with the impact of your loved one's continuing addiction. There are also 12-Step self-help groups for the loved ones of addicts that may be helpful to you as well.
Take Back Control Today
Asking for help is the first and most important step of overcoming a benzo addiction.
Remember that addiction is a condition over which your loved one has no control at this point, and there is a significant need for support and medical care to regain control over his/her life.
APA. (1990). Benzodiazepine Dependence, Toxicity, and Abuse: A Task Force Report of the American Psychiatric Association. Washington, DC: APA (American Pscyhiatric Association).
Barker, M; Greenwood, K; Jackson, M & Crowe, S. (2004). Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis. Archives of Clinical Neuropsychology, 19:3, 437–454.
Friedrich, J., Sun, C., Geng, X., Calello, D., Gillam, M., Medeiros, K., Smith, M., Ruck, B., & Mazer-Amirshahi, M. (2019). Child and adolescent benzodiazepine exposure and overdose in the United States: 16 years of poison center data. Clinical Toxicology, 58:7, 725-731.
Colvin, R. (2008). Overcoming Prescription Drug Addiction: A Guide to Coping and Understanding. Omaha, Nebraska: Addicus Books.
CSAT (Center for Substance Abuse Treatment). (2006). Detoxification and Substance Abuse Treatment: Treatment Improvement Protocol (TIP) Series, No 45. Rockville, MD: SAMHSA.
Drugs.com. (2014, October 21). Brotizolam. Retrieved from Drugs.com.
Gabbard, G. (2007). Gabbard's Treatments of Psychiatric Disorders, 4th Edition. Arlington, VA: American Psychiatric Publishing.
Gresham, C. (2014). Benzodiazepine Toxicity. Retrieved 2014 October 21 from Medscape.
Kouimtsidis, C., Davis, P., Reynolds, M., Drummond, C., & Tarrier, N. (2007). Cognitive-Behavioural Therapy in the Treatment of Addiction: A Treatment Planner for Clinicians. West Sussex, England: John Wiley & Sons.
Kranzler, H., Ciraulo, D., & Zindel, L. (2014). Clinical Manual of Addiction Psychopharmacology, Second Edition. Arlington, VA: American Psychiatric Publishing.
Landry, M. (2004). Understanding Drugs of Abuse: The Processes of Addiction, Treatment, and Recovery. Arlington, VA: American Psychiatric Publishing.
M.Lader. (2011, July 27). BBC Radio 4 Face the Facts: Benzodiazepines. (J. Waite, Interviewer)
McNamee, D. (2014). Increased Alzheimer's risk linked to long-term benzodiazepine use. Retrieved 2020 February 18 from MNT (Medical News Today).
Merz, B. (2014, 10 September). Benzodiazepine use may raise risk of Alzheimer's disease. Retrieved 2014 October 21 from Harvard Health Publications, Harvard Medical School.
Miller, P. (2013). Interventions for Addiction: Comprehensive Addictive Behaviors and Disorders, Volume 3. Academic Press.
Rastegar, D., & Fingerhood, M. (2005). Addiction Medicine: An Evidence-based Handbook. Philadelphia, PA: Lippincott Williams & Wilkins.
Smith, D., & D.Wesson. (2013). The Benzodiazepines: Current Standards for Medical Practice. Hingham, MA: MTP Press.
UCLA. (2014). Post-acute Withdrawal Syndrome (PAWS). Retrieved 2017 July 25 from UCLA Dual Diagnosis Program.
WebMD. (2014). Substance Abuse and Addiction Health Center: Benzodiazepine Abuse. Retrieved 2014 October 21 from WebMD.