Benzodiazepine Addiction

Benzodiazepines are often utilised in the fight against common mental health disorders. These disorders include panic attacks, anxiety, and insomnia.

It is estimated that the UK GP’s dispense around 10 million benzodiazepines prescriptions each year. It’s thus not surprising to hear that Benzodiazepine addiction is on the increase.

By far the most common type of benzodiazepines prescribed in the United Kingdom is Diazepam, Alprazolam, and Lorazepam.

Benzodiazepines, commonly referred to as ‘benzos’, are a type of opioid-based drug that acts on the Central Nervous System, changes brain function, and treats a variety of conditions in the process.

There are serious side-effects of taking benzodiazepines, and this kind of strong medication can also be highly addictive when used. Benzodiazepine addiction is a serious health concern and is increasingly common in the UK.

What are Benzodiazepine Drugs?

Benzodiazepines are strong prescription drugs from the sedative class that are used primarily to help patients reduce their anxiety levels or to help improve their ability to sleep. (1,7)

The conditions that medical practitioners usually prescribe benzodiazepines for are insomnia, anxiety, and muscle spasms.

They are also very effective for treating and preventing seizures which also makes them a very effective drug for helping patients diagnosed with an alcohol use disorder withdraw safely from alcohol.

In essence, Benzodiazepines are psychoactive drugs that contain chemicals that impact certain neurotransmitters in the human brain that inhibit the stimulation of brain cells that are responsible for controlling several physiological mechanisms in the human body.

Because its properties inhibit the excitability of brain neurons, it will tend to have a calming effect on the brain and slow down certain physiological functions.  (2)

What are Benzodiazepines Used For?

Benzodiazepines are prescribed by doctors to treat the following conditions:

1. Anxiety: Doctors can prescribe benzodiazepines to help patients cope with severe anxiety. However, they should be taken for short-term relief only
2. Panic disorders: benzodiazepines can also be prescribed to treat panic disorders in patients who don’t respond well to antidepressants
3. Sleeping disorders: benzodiazepines are also commonly used to treat sleeping disorders like insomnia. Individuals with difficulty falling/staying asleep can take benzodiazepines to enjoy normal sleeping patterns. However, as in the case of anxiety, benzodiazepines should be a short-term solution to sleeping problems
4. Alcohol withdrawal: benzodiazepines can also counter the withdrawal effects of alcohol addiction

Benzodiazepines are also used to treat seizures. They also work as muscle relaxants.

Two Categories of Benzodiazepine

Benzodiazepine drugs have hypnotic, anxiolytic, anticonvulsant and muscle-relaxing characteristics. Because many benzodiazepines have muscle-relaxing qualities they are also prescribed to help patients relax and make them calmer before medical treatment/procedures.

All benzodiazepine drugs can be categorised into two areas, one is the hypnotics group and the other is the anxiolytic group. (10,12)

Drugs in the hypnotic category are used for the treatment of sleeping problems such as insomnia and these include nitrazepam, loprazolam and temazepam. (8)

Drugs in the anxiolytic category are prescribed to patients seeking to alleviate their mild to moderate anxious states, drugs in this group include diazepam (Valium), oxazepam, lorazepam and chlordiazepoxide. (11,12 The key differences between Benzodiazepine drugs

The main difference between different types of benzodiazepine drugs is how potent they are as drugs and how quickly they take effect.

Some benzodiazepines are long-acting drugs that take a while to act when taken as they are slowly absorbed by the body such as nitrazepam and diazepam. The drawback with these drugs is that the effects of the drug can linger into the next day making patients feel groggy.

Those with a shorter half-life tend to have high potency and act much quicker such as lorazepam and oxazepam but this means patients are more vulnerable to becoming dependent on the drug as their effects fade away quickly, and there is a danger they can become entrapped in the addictive cycle if they take the drugs for longer than 4 weeks. (10,12)

Types of Benzodiazepines

Benzodiazepines come in many different names. The most common types include:

1. Xanax (or alprazolam): This benzodiazepine is the most popularly prescribed of all benzodiazepines in the U.S. Xanax is FDA approved for treating anxiety and panic disorders

2. Chlordiazepoxide (or Librium): This benzodiazepine is used to treat/manage alcohol withdrawal symptoms

3. Tranxene (or Clorazepate): This benzodiazepine is used to treat severe anxiety and insomnia. Tranxene is a hypnotic sedative

4. Valium (or Diazepam): Valium is a hypnotic, sedative, anxiety-reducing, and anticonvulsant drug. It has a rapid reaction effective for treating insomnia, panic attacks, restless leg syndrome, seizures, and alcohol withdrawal. Diazepam can treat benzodiazepine addiction because of the drug’s low potency

5. Oxazepam: This benzodiazepine is used to treat insomnia, anxiety, and alcohol withdrawal symptoms

6. Dalmane (or Flurazepam): Dalmane is an anxiety-reducing sedative used to treat insomnia

7. Temazepam (or Restoril): Restoril is prescribed for short-term insomnia treatment

8. Trilam: Trilam or Halcion, Hypam, Triazolam or Apo-Triazo is used for treating severe insomnia

9. Estazolam: This benzodiazepine is used to treat anxiety and insomnia in the short-term

The Effect of Benzodiazepines on the Human Brain

Benzodiazepines have a depressive effect on the human brain and nervous system, this means it acts to reduce the rate of certain biological and chemical mechanisms involved in managing the activities of the central nervous system. (3)

The chemical constituents in benzodiazepines predominantly affect the working of a neurotransmitter called GABA. The role of GABA is to inhibit any transmission between neurons in the brain, reducing neurons’ activation capability.

Benzodiazepines when taken play a key role in enhancing the role of GABA so that the body calms down and is not so easily excitable and the muscles throughout the body will receive electrical messages to relax. (2,13)

Physical Consequences of Abusing Benzodiazepines / Intoxication

As Benzodiazepines are depressant drugs they will have a similar effect on the body to alcohol.

Anyone who has consumed too many benzodiazepines in a short space of time is likely to exhibit certain behavioural and psychological changes,  they may for example say something considered socially inappropriate, become aggressive or display poor judgment.

They will also be vulnerable to dramatic changes in their emotional state. (2,3)

Like all psychoactive drugs taking too many benzodiazepines can result in many unwanted and debilitating physical and psychological consequences, including:

• A decline in physical strength.
• Slurred speech.
• Vision becomes blurry.
• Feeling dizzy.
• Entering a state of confusion.
• A significant decline in cognitive functioning such as attention and memory, decision making and judgmental abilities.
• Difficulty breathing.
• Poor coordination / clumsy.
• A fragile gait.
• Stupor state, or will fall into a coma
• Problems with eye movement.

Long-Term Consequences of Benzodiazepine Use

• Prolonged depression.
• An inability to cope with life.
• Being stuck in an additive cycle due to increased tolerance and withdrawal.
• An increased risk of developing Alzheimer’s and dementia.
• Increased risk of premature death from several other conditions, including stroke, and heart and lung problems.

Benzodiazepines are Highly Effective Drugs

When a person initially takes a benzodiazepine drug for the first time they will find that their anxiety is reduced and/or they will sleep better than before.

However, benzodiazepine drugs just ease the physical symptoms associated with the condition and will not target the route cause.

They do however provide patients with some space to ease their symptoms so that they can find their feet and deal with the underlying psychological and lifestyle factors that may have contributed to their anxiety or insomnia.

It is essential people find long-term solutions to such problems rather than rely on the drug long-term, for example, patients with anxiety should explore counselling as an option and those patients diagnosed with insomnia should analyse and adjust their sleep routine (10,12)

How Quickly Do Benzodiazepines Act?

There is a significant variation in how quickly all the drugs in the benzodiazepine class take effect. Depending on the specific nature of their chemical make up some drugs are processed by the body more quickly than others.

For example, diazepam and chlordiazepoxide are slower-acting drugs with longer half-lives, whereas lorazepam and oxazepam are faster-acting drugs with shorter half-lives.

Half-life refers to the amount of time it takes for half the drug to be removed from the body. (2,10)

It is mainly faster-acting benzodiazepines such as Temazepam (which is used for insomnia) that people become addicted to because they act and wear off quickly, so if a person continues to take the drug they will need to eventually take it in shorter intervals as they have increased their tolerance toward the drug.

This will only increase their tolerance further. After several weeks, the drug will be of no use to the patient as its effectiveness has disappeared and their dose level will need to be increased significantly to help their condition. (12)

This is because taking shorter-acting benzodiazepines leads to very sharp increases and declines in the presence of the drug in the blood which leads to them experiencing uncomfortable withdrawal symptoms and cravings to take the drug again.

This is in contrast to longer-acting benzodiazepines which cause their presence in the blood to rise slowly meaning that withdrawal symptoms are not so severe. (12)

However, it is worth mentioning that people can also become addicted to longer-acting benzodiazepines as they produce many desirable effects for the people that take them.

Gender Differences

Research has indicated that there is a higher probability that more women will be prescribed benzodiazepines than men whether this is to reduce symptoms of anxiety or help them sleep.

It has also been suggested that women are more susceptible to using prescription drugs like benzodiazepines to cope with the stress in their lives and, research indicates that the women who took part in their studies had higher levels of anxiety and stronger cravings for the drug, suggesting a strong presence of psychological dependence. (4)

The Addictive Process – Neuroadaptation and How the Brain Responds to Drugs

When a person consumes any psychoactive substance such as benzodiazepines the body automatically responds by activating biological and chemical mechanisms to process it and eliminate it from the body as quickly and as efficiently as possible, as the newly ingested drug is a substance it is not familiar with. (11)

Because the body is programmed to ensure that we carry on functioning as normally as possible it’s important that the body adapts to the presence of the Benzodiazepine drug quickly so that if a person continues to take the drug the effect it has on them will not be so intense.

This is reflected in the fact that benzodiazepines lose their effectiveness very quickly, usually within 1 or 2 weeks of taking it as the body becomes familiar with the drug.

Unfortunately, this means that to continue to experience the same soothing effects that we experienced when we first took the drug we need to take a higher dose, or consume the drug at shorter intervals which can signify the beginning of the addictive process as the patient is building up a tolerance to the drug. (13)

Building Up a Tolerance to Benzodiazepines

As a person continues to take a benzodiazepine they will find they will very quickly build up a tolerance to the drug, particularly if it is a fast-acting benzodiazepine with a short half-life such as temazepam or alprazolam which begins to take effect swiftly.

If a person is at a stage where they need to increase their dose size then they are very vulnerable to developing a physical dependence on benzodiazepine.

This is why benzodiazepines should not be used for longer than a couple of weeks because after this period their effects will weaken as the person’s tolerance has increased. (7,13)

Benzodiazepines – Physical Dependence

As people build up a tolerance to the drug they will find that if they stop taking the drug suddenly or go for 1-2 days without taking the drug they will experience withdrawal symptoms.

This is because their brain and central nervous system have very quickly adapted to the physical presence of the drug in their body and modified certain internal chemical processes so that the person can function effectively whilst taking the drug.

If a person then suddenly stops then their internal biology will become confused and start behaving erratically and withdrawal symptoms will occur.

Just as with all psychoactive drugs the withdrawal symptoms they will experience will be opposite to the main effects of the drug. If a patient has reached the stage when they experience withdrawal symptoms if they stop taking the drug then it is justifiable in claiming they have become physically dependent on the benzodiazepine. (2,11)

Significant Withdrawal Symptoms Associated with Benzodiazepines Addiction

Patients who have been prescribed a benzodiazepine drug and have been taking it for longer than one month are susceptible to experiencing withdrawal symptoms if they suddenly stop taking the drug.

The common withdrawal symptoms patients will experience when they have developed a physical dependence on the drug and stop taking it for 1-2 days include:

• Increased autonomic hyperactivity, such as increased and frequent sweating or pulse rate exceeding 100 beats per minute).
• There is a possibility of experiencing hand tremors.
• Feeling Nauseous or vomiting.
• Transient visual, tactile, or auditory hallucinations or illusions.
• Psychomotor agitation.
• Anxiety and tension.
• Grand mal seizure.

As with all addictive drugs patients who become physically dependent on benzodiazepines will experience intense cravings for the drug alongside their withdrawal symptoms, which can be alleviated by taking a dose of the drug equivalent to, or greater than their regular dose size, which only serves to make it even harder for the patient to function without the drug. (2,6)

Psychological Dependence on Benzodiazepines

The effects of benzodiazepines are very positive and they enable people to feel less anxious and get regular healthy sleep, both of these are significantly rewarding for people who take the drug.

Very soon they will build up an expectation in their minds that the drug can alleviate unpleasant experiences that have a severely detrimental effect on their lives, so it very quickly becomes a drug they will rely on

However, people who come to rely on benzodiazepines alone as a solution to their anxiety or sleep problems will become psychologically dependent on the drug if they see it as anything other than a short-term solution to their medical issue. (12)

It is vitally important for people to find social and psychologically based solutions for their problems in the long term rather than rely on the drug.

For example stress management techniques or an in-depth analysis of their sleeping patterns. If the drug becomes an easy way out for people and they fail to accept it is only a short-term measure then they are highly vulnerable to becoming addicted to the drug. (5,7)

Diagnosing Benzodiazepine Addiction

Since the advent of DSM5 in 2013 benzodiazepine addiction now falls into the category of sedative, hypnotic or anxiolytic use disorder.

This category of addictive disorder includes prescription medication to help with insomnia or trouble sleeping and all anti-anxiety prescription medications. (1)

The implications of developing a benzodiazepine addiction are similar to that of alcohol and include a loss of inhibitions, an increase in the potential for accidents, relationship difficulties and a decline in educational and academic performance and aspects of cognitive functioning.

Criteria for Diagnosing Sedative, Hypnotic or Anxiolytic Use Disorder

If over one year a person taking a benzodiazepine drug has 2 or 3 of the following criteria then they will be assessed as having a mild addiction, if they have 4/5 of the criteria then they will be diagnosed with a moderate addiction, whilst those who meet 6 or more of the criteria will be diagnosed with a severe addiction. (1)

• Benzodiazepines are consumed in ever-increasing amounts, or for over a longer period than was intended or recommended by medical professionals.
• The person has tried several times to cut down their use of benzodiazepines but has been unsuccessful, so it is apparent that they are unable to stop or reduce their use of the drug.
• A disproportionate amount of time is spent thinking about the drug, obtaining the drug and recovering from its negative effects.
• Are unable to meet work, family and social commitments because of their excessive benzodiazepine use.
• Anyone addicted to benzodiazepines will experience strong cravings for the drug.
• Continued use of benzodiazepines despite the fact it is causing them professional, social and interpersonal difficulties.
• The user will miss out on meaningful activities and social events because of their benzodiazepine use.
• They will continue to take benzodiazepines, even in situations where it causes potential harm and danger to themselves and others, including driving a car.
• The person continues to take benzodiazepines even though they realise it is causing them psychological and physical problems,s or making pre-existing problems worse.
• The person will develop an increased tolerance to benzodiazepines.
• Withdrawal symptoms are experienced when they stop taking the drug for 12 hours or more.
• Behaviours Associated with Benzodiazepine Addiction

Even though people who become addicted to benzodiazepines originally sought the drug for therapeutic uses which, has gradually gotten out of hand they will begin to behave like other substance users as they become physically and psychologically dependent on the drug which has changed their internal psychological processes and behaviour. (1)

The behaviours they may exhibit include:

• Isolate themselves from friends and family.
• Secretive about their lives and daily activities to hide their drug dependence.
• There will be a recognisable change in their mood.
• They will do anything to obtain the drug, such as borrow money from friends and family, take out loans and get into debt or even steal from family members and work colleagues.
• They may ask friends and family to give them benzodiazepines if they are aware they take them or persuade them to visit the doctor to try and get a prescription for the drug.
• They may change doctors if they are unable to obtain a prescription for benzodiazepines from their current GP.
• There will be a noticeable decline in their appearance and standards of personal hygiene. (6,10)

Benzodiazepines Should Be a Short-Term Solution

Because benzodiazepine drugs are generally fast-acting they should only ever be a short-term solution because patients can easily build up a tolerance to the drug and become physically dependent and psychologically reliant on the drug. (11)

Benzodiazepines should not be taken for longer than one month as it is a powerful drug that is designed to reduce anxiety and improve the quality of sleep over a period of 2-4 weeks.

Patients should be seeking alternative ways of dealing with their anxiety and sleep problems whilst the benzodiazepines see them through a difficult time. (12)

Because benzodiazepines are effective drugs for anxiety and sleep problems patients can easily build up a tolerance to the drug which means after 3-4 weeks they will require stronger doses to help them as the strength of the initial dose they received is not as effective as it initially was anymore.

This is the start of the addictive cycle as they will then find it difficult to come off the drug due to the strong cravings they will experience.

Research has indicated that after taking a benzodiazepine for 2 weeks doctors should recommend that patients start tapering down the dose, and rarely increase the strength of the patient’s starting dose. (6,12)

Risk Factors for Benzodiazepine Addiction

There have been significant concerns for nearly 40 years about the risk of physical dependence in those patients who use benzodiazepine drugs over the long term, which for benzodiazepines is over 4 weeks. (1a)

Most cases of benzodiazepine addiction are because patients currently taking a drug from this category carry on taking the drug beyond the short-term period their doctor initially advised and do not seek other means of alleviating their sleep or anxiety problems. (10)

Common Risk factors for developing a benzodiazepine addiction:

• Using the drug over a longer period (anything over four weeks).
• Patients who increase their dose size over time.
• People who tend end to drink alcohol excessively while taking benzodiazepines.
• People who tend to use other drugs at the same time they are taking a benzodiazepine drug.
• Patients who take highly potent, fast-acting benzodiazepines are at risk of experiencing symptoms of anxiety between their doses which may lead to them needing to take the drug more often.
• People who take benzodiazepines but who fail to investigate other approaches to treating their conditions and begin to rely on the drug. (7,10)

Individuals Diagnosed with Certain Medical and Psychiatric Conditions are Vulnerable:

People who have been diagnosed with a mood disorder, anxiety disorder or sleep disorder by a GP or psychiatrist are susceptible to developing an addiction to benzodiazepine drugs.

Benzodiazepines will help their condition in the short term but as some patients have a long-term condition as opposed to needing a short-term solution to their anxiety, mood or sleep problems they are vulnerable to needing higher doses of the drug to help them deal with the symptoms related to their condition.

Benzodiazepines are only really for people who are struggling in the short term while they find other solutions to their temporary situation rather than people who require a long-term solution.

Anyone on a benzodiazepine drug for longer than 4 weeks who increases their dose will find it very challenging to come off the drug which could be a lengthy process.

What is the Treatment Process?

1. Detoxification

The first phase of Benzodiazepines addiction treatment is detoxification. This means eliminating all traces of opioids from the body.

When one becomes dependent on Benzodiazepines, the body’s tolerance for also increases. This means a greater dose is needed and a larger quantity to satisfy your craving and addiction.

Long-term Benzodiazepine abuse means that it’s probable that your only chance of recovery is undergoing a treatment option – namely, a tapered detox.

Tapering the amount of Benzodiazepine you consume slowly allows the body to withdraw from the drug, and can be a way to avoid unpleasant withdrawal symptoms.

Due to the intensity of the drug and its heroin-like qualities, the detoxification process can be unpleasant. This is not the time to be put off or delay seeking treatment, as Benzodiazepine addiction can, and does, result in fatalities.

The team of experts at our rehab facilities will accommodate your physical needs during the detox process, and we also offer treatment that focuses on mental problems like brain damage caused by prolonged Benzodiazepine abuse.

The best addiction rehabs offer cognitive behavioural therapy to deal with Benzodiazepines addiction.

2. Rehabilitation

Rehabilitation works in a variety of ways. Perhaps the most important component of rehabilitation is the therapies you will benefit from.

These therapies include:

• Relapse prevention strategies
• Motivational interviewing
• Group support and counselling
• Contingency management
• Cognitive behavioural therapy (CBT)
• 12-step work

Therapy in the rehabilitation stage is effective since it addresses the negative effects of Benzodiazepines abuse while retraining the brain to avoid destructive habits going forward.

CBT should be complemented by group therapy where Benzodiazepine addicts work through their difficulties together.

There is evidence linking a combined approach to increased chances of recovery from all kinds of addiction, let alone addiction to Benzodiazepines.

While regular rehabs can offer treatment, outpatient rehab treatment may not be recommendable for the kind of specialised care needed for Benzodiazepine addicts.

3. Aftercare

Private residential rehab treatment is a better bet for all cases due to the aftercare provided – you aren’t alone when you exit our facility once you have made a full recovery.

At Rehab 4 Addiction, we offer a year of aftercare for all of our patients, which includes round the clock help and advice, motivational resources to fall back on, as well as a community and support that will stay with you as you continue on your road to a Benzodiazepine-free life.