Benzo addiction, withdrawal and detox

Benzodiazepine Use Disorder:

Benzodiazepine use disorder involves the misuse of benzodiazepines, prescribed or not. It is considered a chronic, relapsing, and potentially fatal condition that is often accompanied by other substance issues [1].

What are Benzos?

Sometimes called “Benzos”, Benzodiazepines are a class of drugs with sedative and hypnotic effects that depress the central nervous system (CNS) [2]. They have a calming (sedative) effect and are often prescribed to relieve acute anxiety. Because they also have a hypnotic effect, they can also be prescribed to treat sleep problems. Benzos are sometimes used during alcohol detoxification because they have an anticonvulsant effect.

Benzodiazepine Effects and Common Uses:

    • Effect: Sedative/Calming
    • Common Use: Anti-Anxiety
    • Effect: Hypnotic/Sleep Inducing
    • Common Use: Insomnia
    • Effect: Anticonvulsant
    • Common Use: Medical Detox for Alcohol

How do Benzodiazepines Work?

It all starts with GABA receptors in the brain. GABA is your major inhibitory neurotransmitter. Benzos allow your GABA receptors to take in more GABA. This slows down the activity in your nervous system by blocking and inhibiting certain brain signals. The more GABA you receive, the more relaxed you will become. That is why benzos have a sedative, anticonvulsant, and hypnotic effect.[3]

 

 

Benzodiazepine Receptors

Benzodiazepine History

Benzodiazepines first arrived on the scene in the 1950s with the introduction of chlordiazepoxide. In 1960 chlordiazepoxide began being marketed to the public as Librium. In 1963 a much more potent benzo called diazepam was introduced and sold by the brand name of Valium. By the end of the 1970s, benzos had mostly replaced the barbiturates. They accounted for 10% of all prescriptions written in the US because of their anxiety-relieving and sleep-inducing properties[3]. In 1981 alprazolam was introduced into the US market by the brand name Xanax.

Are Benzodiazepines Addictive?

Yes. Although benzos are a prescription medication, they can be addictive and abused. And some benzos are more addictive than others due to higher levels of euphoric mood effects. Diazepam, alprazolam, and lorazepam are the benzodiazepines with the highest euphoric effects. Although all benzos are abusable, these three benzos have the highest addiction potential (Abuse Liability) and are the most commonly abused prescription benzos. [4]

List of Most Addictive Benzos:

  • Alprazolam, Brand Name: Xanax
  • Lorazepam, Brand Name: Ativan
  • Diazepam, Brand Name: Valium

List of Commonly Abused Benzos:

  • Alprazolam, Brand Name: Xanax
  • Lorazepam, Brand Name: Ativan
  • Diazepam, Brand Name: Valium
  • Clonazepam, Brand Name: Klonopin
  • Chlordiazepoxide, Brand Name: Librium

Is it dangerous to mix benzos?
polysubstance abuse

Mixing benzos with alcohol and other drugs is the most common way they are abused. When multiple drugs are abused together, it is called polysubstance abuse. Benzos are typically a secondary drug abused in this scenario. Benzos can amplify the euphoric effects of other drugs, and vice versa, having what is called a synergistic effect. They are also abused with other drugs to reduce the unwanted side effects, like insomnia, and withdrawal. [5]

Benzos and Alcohol

Drinking alcohol while taking benzos is a common way benzos are misused. This is dangerous and can result in overdose and even death. According to the CDC, alcohol was involved in 27% of benzo drug-related ER visits and 22% of benzo related deaths. See the graph below. [6]

Benzos and Opioids

Mixing benzodiazepines with drugs like opioids is very dangerous because cross-tolerance can develop, which can lead to overdose and death. In 2004, 18% of opioid deaths involved benzos. In 2011, opioid deaths involving benzos went up to 31% in 2018. [7]

Benzodiazepine-ralated-deaths-graph-statistics

Do Benzos Cause Withdrawal?

Yes, if you suddenly reduce or stop taking benzos, you will likely go into withdrawal. These drugs have a high risk of creating physical and mental dependence. Depending on the dose and how long the benzodiazepines have been used, withdrawal symptoms can range from mild to severe and even be life-threatening. 

Typically, the withdrawal symptoms are the opposite of the effects of the benzos. Anxiety, depression, insomnia are common, and even seizures are sometimes a result of withdrawal. In some cases where benzos have been abused for extended periods, people may experience Post-Acute-Withdrawal-Syndrome or protracted withdrawal. [8] [9] [17]

Common benzo withdrawal symptoms:

    • Seizures (Benzo Withdrawal Seizures Can Be Deadly)
    • Anxiety
    • Depression
    • Panic attacks
    • Psychotic reactions
    • Sleep disturbance
    • Irritability
    • Increased tension
    • Hand tremor 
    • Sweating
    • Difficulty in concentration
    • Dry retching
    • Nausea 
    • Weight loss
    • Heart palpitations
    • Headache
    • Muscular pain 

Addiction Specialist Explains

Is Benzo Withdrawal Deadly?

Benzodiazepines are an anticonvulsant, and when they are suddenly removed from the body, grand mal seizures are a risk. Withdrawal seizures from benzos are very dangerous and can be deadly. [10] If you want to stop taking benzos, you should never attempt it without consulting a doctor or quit benzos cold turkey. The safest way to stop taking benzodiazepines is under the supervision of a doctor with a medical detox.

The Physical, Mental and Emotional Dangers of Benzo Abuse:

Physical Effects:

List of short and long term physical effects of Benzodiazepine Abuse: [15] [16] [17]

  • Weight Gain.
  • Difficulty speaking
  • Drowsiness.
  • Clumsiness.
  • Car accidents
  • Slower reactions.
  • Impaired balance.
  • Loss of coordination.
  • Anorexia 
  • Headaches

Mental Effects:

Short and long term mental effects of benzodiazepine abuse: [15] [16] [17]

  • Showing little to no emotion.
  • Decreased brain function
  • Higher risk of Alzheimer’s
  • Loss of memory
  • Anxiety
  • Insomnia

Social Effects:

The short and long term social consequences of abusing benzodiazepines include: [15] [16] [17]

  • Isolation
  • Less interest in social activities or hobbies
  • Decreased performance in school or work
  • Unemployment
  • Blunted emotions

Who is at Risk?

Because forming a physical dependency with benzodiazepines happens so quickly, anyone who takes a prescription regularly for longer than three weeks is at risk of developing a future addiction.

However, certain factors seem to be more common for those who misuse benzodiazepines.

    1. Non-hispanic white populations [4]
    2. Young adults (age 18-35) [4]
    3. Those with a family history of addiction [4]
    4. People with psychiatric disorders [4]
    5. Women receive more benzo prescriptions, but men are more likely to misuse prescriptions [18]. 
    6. People who abuse other drugs (polysubstance abuse). Especially opiates or alcohol [4].

Why do people abuse benzos?

Like all addictive drugs, benzodiazepines increase the amount of dopamine (a neurotransmitter that creates happiness). Individuals who are vulnerable to crave the surge of euphoria caused by the drug quickly begin abusing it to recreate this feeling as much as possible [19]. 

But people become dependent on benzodiazepines, even if they are not trying to abuse them. Physical dependence for these drugs form very quickly, meaning that if a person stops taking the drug they will feel withdrawal symptoms that often begin with a magnified version of the symptoms that prompted them to use benzos. [8]

To avoid the pain of withdrawal, people will begin drug seeking behaviors if they run out (e.g. lying to doctors, family, or friends to get pills, buying pills online or from dealers, stealing pills or money). [17]

Treatment for Benzo Use Disorder:

Treatment for benzodiazepine use disorder often begins with a loved one intervening to discuss the habit. This is followed by physical detox and attending a rehabilitation program. This section outlines these steps. 

1. Intervention:

If someone is struggling with benzodiazepines and hasn’t considered treatment, then it might be necessary to intervene and help them decide to accept help. Confronting a loved one about suspected substance use is stressful, but it may be the difference between them getting help or not. Maybe even life or death. 

2. Detox:

Detox occurs while all chemical traces of substance leave the body. For benzodiazepines, detox can cause fatal seizures and must be done in a medically supervised setting.  

Things that put someone at risk for fatal seizures are: [10]

    • You have taken benzodiazepines for more than 6 months.
    • Quitting all at once or “going cold turkey.”
    • You take high doses of benzos (above prescribed amounts).
    • You are also a heavy drinker or user of opiates

In a medically supervised detox, medical professionals will prescribe a taper where patients are given smaller and smaller doses of a drug to help wean them off the drug. In addition to reducing the risk of seizures and other alarming symptoms like hallucinations, a taper also makes detox less painful. [21]

3. Rehab:

Inpatient care:

Provides a sober living residence within the facility, 24-hour care, and a variety of treatment programs such as counseling, group therapy, coping skills, and relapse prevention. Programs often confiscate cell phones for the duration of the stay and require semi-frequent drug tests. For those with severe or long term, addictions inpatient care is always recommended. [20]

Outpatient care:

Provides the same treatment as inpatient programs, but requires less time in recovery. Participants also live off the premises at home instead of at the center. Short term drug users or those who don’t use heavy narcotics can make a full recovery in outpatient care. [20]

Once in treatment, several things can help bring benzo addiction into remission:  

  • Eating healthy to nourish the body and brain properly. 
  • Engaging in physical activity to promote self-esteem as well as help normalize brain function. 
  • Forming a support group for use throughout the individual’s life. 
  • Identifying and make peace with any past traumatic events. 
  • Unmasking the source of their anxiety that drives them towards sedatives like benzos.
  • Practicing coping tools for stress, anxiety, or panic until they become second nature.

Aftercare:

Sobriety is a lifelong process, and finishing rehab is only the beginning. For you to avoid relapse, you need to use what you’ve learned in treatment and maintain healthy habits. This includes:

  • Recognizing and trying to avoid things that trigger the urge to use.
  • Using coping skills to recognize and deal with stress or anxiety.  
  • Eating healthy foods that boosts mood.
  • Exercising to improve mood and self-esteem.  
  • Finding support networks such as Alcoholics Anonymous or Narcotics Anonymous. 

 

Take the next steps today

At Tree House Recovery, we are proud of the program we’ve built to create sustainable sobriety. Our method works. We use eight connected treatments to help our patients understand the cause of their addiction, the pathology of the disease, how to cope, deal with stress, and reset their brain chemistry. Our graduates become someone they’ve never met before — a person who’s deeply confident, strong, at peace with themselves, and most important: happy.

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Important info when getting sober:

ANHEDONIA | The Feeling of Blahhhh
Do you feel a lack of joy when you do things that should give you pleasure? Lean About Anhedonia in Early Recovery

POST ACUTE WITHDRAWAL | PAWS
Got sober and now you feel depressed, irritable and some anxiety? It could be PAWS; a common and temporary condition as your brain and body heal.

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