Benzodiazepine addiction occurs when a person experiences negative consequences from their benzodiazepine abuse but is unable to stop taking the drug. It is possible for a person with a legitimate benzodiazepine prescription to develop a benzodiazepine addiction.
This often begins with taking it in higher quantities or more frequently than prescribed. This kind of benzodiazepine misuse can be motivated by a desire to reduce negative symptoms of a mental health condition, or sometimes people engage in it because they are physically dependent on benzodiazepines.
In fact, even legitimate benzodiazepine use can very rapidly lead to physical dependence. For this reason, responsible physicians generally only prescribe benzodiazepines for short periods of time to treat acute symptoms. The longer a person remains on benzodiazepines, the higher their likelihood of developing physical dependence.
Some people develop some degree of physical dependence after only a few days, though with increased time and higher doses the severity of physical dependence will only increase. After only a short period of time, many people find that they are unable to function without benzodiazepines. Once physical dependence has occurred, the withdrawal effects that begin as soon as a person stops taking benzodiazepines can be far more severe than the anxiety that led them to taking benzodiazepines in the first place.
Benzodiazepines are also commonly taken for purely recreational reasons. These medications are frequently sold by drug dealers on the street. Given how frequently they are prescribed, many young people obtain them from their friends as well. Recreational benzodiazepine abuse is in fact on the rise for young people. Benzos, as they are often known, provide a “high” that people experience as euphoric, relaxing, and disinhibiting.
The effect of taking benzodiazepines is, in fact, somewhat similar to the effect of drinking alcohol: both drugs increase the effectiveness of the neurotransmitter GABA. Given that fact, many people find that not only do benzodiazepines make them feel “high,” it helps them feel less inhibited in social situations. This can lead to extreme psychological dependence in addition to physical dependence.
What may have started out as a simple desire to get high or to relax can end up being an activity that completely takes over a person’s life. When a person develops a benzodiazepine addiction, they are not only unable to function without benzodiazepines, they experience excruciating, debilitating, and sometimes life threatening withdrawal symptoms when they do not have access to benzodiazepines.
Benzodiazepine addiction leads to a wide range of negative consequences, but those who suffer from this kind of substance use disorder are often helpless to manage their own intake of the drug.
Signs and Symptoms of Benzodiazepine Abuse
Benzodiazepine abuse leads very rapidly to a number of physical, emotional, and behavioral symptoms. Over time, when benzodiazepine abuse turns into benzodiazepine addiction, these consequences can become even more severe. It is important to be able to recognize the signs and symptoms of a sedative use disorder before it becomes life threatening or destroys a person’s livelihood.
Most people who are abusing benzodiazepines, or any other recreational drug, go to great lengths to hide their abuse from friends and family members. Nonetheless, regular benzodiazepine abuse will always be detectable by a keen observer. Substance abuse in general, and benzodiazepines in particular, cause people to engage in uncharacteristic behaviors.
Behaviors that may be signs of a benzodiazepine use disorder include:
- Engaging in uncharacteristic behaviors in order to obtain or pay for benzodiazepines, such as stealing, borrowing money, maxing out credit cards, or draining bank accounts
- Working to ensure that they always have a supply of benzodiazepines on hand, due to fear of benzodiazepine withdrawal
- Disconnecting from obligations and commitments to family and friends in order to get high
- Paying less attention to personal appearance, grooming, or hygiene
- Spending more and more time and energy to obtain drugs, use them, or recover from using them
- Engaging in risky or dangerous activities after using benzodiazepines
- Experiencing extreme shifts in personality or mood
- Being increasingly secretive or lying in order to hide substance abuse patterns
The signs of benzodiazepine abuse generally do not include drug paraphernalia. Since benzodiazepines are a pill, they are generally simply swallowed, which require no equipment aside from the drug itself. However, alternative routes of administration are possible. Some people crush their medications and snort them, and others dissolve benzodiazepines before injecting them directly into their veins. In the latter case, they are likely to be using other substances as well.
One of the most common behaviors engaged in by people addicted to benzodiazepines is a practice known as “doctor shopping.” Doctor shopping involves approaching multiple doctors to obtain prescriptions for benzodiazepines. Since most doctors are reluctant to prescribe benzodiazepines for long periods of time or at high doses, people with addictions often obtain many prescriptions simultaneously so that they can use the drug at their preferred rate and dosage.
A concerned family member or parent can generally tell if a person is doctor shopping by examining their prescription bottles. If their prescription bottles have different labels with distinct doctors’ names on them, it is likely they are abusing their medication.
Physical and Psychological Symptoms of Benzodiazepines
Benzodiazepines are powerful drugs that can be life-threatening when abused. Signs that a person has taken a dangerous level of benzodiazepines include a wide range of physical and psychological symptoms. Benzodiazepine overdoses can be fatal, especially when they are combined with other drugs. Symptoms that may emerge include:
- Slurred speech
- Physical weakness
- Reduction in motor coordination
- Blurred vision
- Poor judgment and decision-making abilities
- Difficulty breathing
- Death (especially when combined with another drug, like alcohol)
Regular benzodiazepine abuse can lead to dependence. Over time, additional symptoms emerge. These include:
- Anxiety (often worse than the anxiety disorder that the person had before taking benzodiazepines)
- Memory problems and other cognitive issues
Benzodiazepine withdrawal is not only excruciatingly painful, it can be life threatening. While many infamous recreational drugs, such as opioids, result in painful withdrawal symptoms, few of them lead to results as dangerous as benzodiazepine withdrawal does.
Benzodiazepine dependence develops so quickly that even after a relatively short period of taking the drug, people can experience withdrawal symptoms when they stop taking their medication. People with a low degree of physical dependence may experience what is known as “rebound.” Rebound symptoms occur when the symptoms of their mental health disorder, for which they were taking benzodiazepines in the first place, re-occur.
Rebound symptoms are often more severe than the initial symptoms they had before taking benzodiazepines. However, individuals who have developed a stronger dependence on benzodiazepines are likely to experience a condition far more severe than rebound symptoms: benzodiazepine withdrawal.
Benzodiazepine withdrawal is characterized by a number of different risks. These include:
- Gastrointestinal problems
- Muscle spasms
- Increasing sweating
- Hypersensitivity to stimuli
- Suicidal ideation or behavior
- Delirium tremens
Benzodiazepine withdrawal generally begins within a few hours of a person’s last dosage. Unlike other forms of withdrawal, it does not simply worsen and then get better. Instead, the severe symptoms of benzodiazepine withdrawal often come in waves. During the withdrawal period, there can be days or weeks during which people feel like they are feeling better, followed by periods of more extreme symptoms.
Benzodiazepine withdrawal lasts for a long time, ranging from several weeks to several months. Some people suffer from benzo withdrawal symptoms for far longer than several months. This condition, known as post-acute withdrawal syndrome, or PAWS, affects approximately 10% of people with benzodiazepine dependence.
Given how long, miserable, and dangerous benzodiazepine withdrawal is, it should come as no surprise that people with benzodiazepine addictions go to great lengths to avoid it. However, it is important to understand that benzodiazepine withdrawal can be managed.
With the help of a treatment center, people can engage in a medically supervised tapering program so that they do not experience symptoms at such a high severity. With the support of an outpatient addiction treatment center, not only can physical withdrawal be managed, but a person can begin to develop the skills and coping tools necessary to address their underlying addiction.
Causes of Benzodiazepine Addiction
Benzodiazepines lead to extreme physical dependence. Even after using them once, an individual is likely to be drawn to them again. This is because taking benzodiazepines releases large amounts of dopamine in the brain. Dopamine, a neurotransmitter that plays an important role in the brain’s motivation and decision making centers, is sometimes known as the brain’s “reward chemical.”
It is released whenever an individual engages in a healthy activity or accomplishes a goal. Dopamine makes people feel intense pleasure, and it thereby reinforces behaviors. Benzodiazepines, like other addictive recreational drugs, releases high quantities of dopamine, causing people to seek out more of the drug even when they know it’s a bad idea.
Over time, individual’s brains and bodies acclimate to the effects of the drug. This phenomenon, known as tolerance, means that benzo users need to take increased quantities of the drug in order to achieve the desired effects. As a result, their physical dependence rapidly increases. Once physical dependence truly sets in, people reach a point where the absence of benzodiazepines leads to debilitating benzodiazepine withdrawal symptoms.
These symptoms actually occur because the body has learned to live with benzodiazepines. Benzodiazepines are a central nervous system (CNS) depressant, and when people’s bodies are acclimated to benzodiazepines their central nervous systems are over-stimulated to compensate for the effects of benzos. When the drug is taken away, however, the balance is upset, and the extreme central nervous system stimulation that people experience can be dangerous.
Individuals who are most at risk for benzodiazepine abuse and addiction include:
- People who use benzodiazepines over a long period of time (beyond four weeks)
- People who take high quantities of benzodiazepines
- People who simultaneously abuse other substances, especially alcohol, barbiturates, stimulants, and opioids
- People who suffer from long term anxiety disorders or other mental health conditions
- People with a history of substance use disorders in their families
- People who suffered from traumatic childhoods
- People with weak social support systems
Risks of Benzodiazepine Addiction
People who engage in benzodiazepine abuse for long periods of time are likely to experience a wide range of harmful consequences. In many ways, the consequences of addiction, which are not unique to benzodiazepines, lead to some of the worst consequences. Individuals with substance use disorders tend to restructure their lives around obtaining, using, and recovering from drugs. In prioritizing drug use above all else, most individuals end up letting go of other important aspects of their lives, from their relationships to their career ambitions.
As a result, individuals with benzodiazepine addictions tend to suffer consequences at work, at school, and at home with their families. They are also likely to experience a number of issues with the law, with their personal finances, and with their physical and mental health. Unfortunately, many people respond to these consequences by increasing their benzodiazepine abuse, since the drugs offer a form of extremely temporary relief. The result is a painful and vicious cycle.
Aside from the risks of addiction, benzodiazepines also pose a number of risks that relate specifically to the effects of the drug:
- Cognitive impairment. Benzodiazepines cause drowsiness, slow down people’s reactions, and can make it difficult for people to think clearly.
- Motor vehicle crashes. Not only do benzodiazepines slow reaction time and decrease physical coordination, they also have a disinhibiting effect. While on benzodiazepines, individuals are likely to exercise poor judgment. Those who get behind the wheel of a car have an increased risk of getting into an accident. It is no different from driving while drinking alcohol.
- Interpersonal conflicts. Like alcohol, benzodiazepines cause people to engage in impulsive and regrettable behavior. As a result, conflicts can occur. In some cases, people commit criminal acts, including assault and murder.
- Black outs. High doses of benzodiazepines, and even low doses of benzodiazepines when combined with alcohol, are sufficient to prevent memories from being formed. People who regularly abuse benzodiazepines often have gaps of entire weeks or months that they cannot describe at all.
- Worsened mental illness. Even though benzodiazepines are prescribed to treat symptoms of anxiety and other mental health conditions, benzodiazepine abuse ultimately worsens these symptoms and can lead to the development of new mental health conditions as well.
- Long term brain damage. Some research has shown that the cognitive effects of long term benzodiazepine abuse are semi-permanent. The drugs inflict long term neuronal damage, affecting learning abilities, visual-spatial abilities, processing speed, and verbal skills.
- Overdose. Benzodiazepine abuse can result in overdoses, especially when the drugs are combined with other central nervous system depressants, like alcohol or opioids. Benzodiazepine overdose generally comes in the form of respiratory depression, which can be fatal.
Benzodiazepine Abuse and Polydrug Dependence
Most people who abuse benzodiazepines do not consider benzodiazepines their “substance of choice.” The term “substance of choice” refers to a person’s preferred recreational drug. In fact, the majority of people who abuse benzodiazepines are dependent on one or more additional recreational drugs. This phenomenon, known as polysubstance dependence, can result in more severe consequences and also complicates addiction treatment. There are many reasons why people abuse benzodiazepines alongside other substances.
One common reason is that benzodiazepines are commonly believed to enhance the effects of other drugs. Just as commonly, young people take benzodiazepines to “take the edge off” of other drugs. An example would be someone suffering from cocaine or marijuana-induced anxiety who takes Xanax in order to calm down, or someone who ingests Ativan during an alcohol-induced hangover. While benzodiazepines can indeed offer short term relief for the negative symptoms of substance abuse, it is very likely that anyone using this dubious “solution” is well on their way to developing yet another addiction!