Benzodiazepines are central nervous system depressants that are commonly prescribed to treat anxiety, panic attacks and insomnia. They’re also used to treat symptoms of alcohol withdrawal and to sedate patients before surgery.
They usually come in tablet form, but some are available as liquids. They can be fast-acting or long-acting. Fast-acting benzos can be felt within minutes of consumption, and their full effects can be felt within one hour. Long-acting benzos take longer to work, but they remain in the body for much longer periods of time.
“Benzodiazepines are a class of medications that are referred to as sedative hypnotics,” Dr. Berney Wilkinson, a licensed psychologist, told DrugRehab.com. “They affect the brain by increasing GABA, the primary neuroinhibitor in our brain.”
GABA, or gamma-aminobutyric acid, blocks nerve impulses, resulting in a calming of the nervous system.
For patients with anxiety or panic disorders, Wilkinson said, benzodiazepines “cool down the fire in their brain.”
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Benzodiazepines are usually prescribed for short-term use because the drugs can cause tolerance, dependency and addiction. In most cases, doctors prescribe them to treat anxiety for between two and six weeks. Prescriptions to treat insomnia are usually written for one to two weeks. No evidence supports the use of benzodiazepines to treat any mental health condition for more than six weeks.
When a person takes benzodiazepines for multiple days or weeks, the brain adapts to the presence of the drug. It begins to rely on the prescription drug to function normally, and it starts to require larger doses to produce the same effects.
When tolerance develops, doctors have to prescribe higher doses for patients to achieve the same results. Increasing the dosage makes a person more dependent on the drug, which increases the risk of addiction.
“Benzos increase GABA,” Wilkinson said. “Your brain cannot determine why you have an increase in GABA, so it assumes that it is making too much. So your brain decreases the amount of GABA and GABA receptors in your brain. Now, without the natural GABA your brain was making, you need to take more medication to make up the difference.”
After multiple weeks of continued benzo use, the brain begins to rely on the drug to function normally. When the person stops taking the drug, the brain goes into withdrawal.
“The brain has downregulated its production of GABA and GABA receptors, so when the medication is suddenly discontinued, the brain has, in essence, no GABA,” Wilkinson said. “GABA is the primary neuroinhibitor. No GABA, no inhibitor. When there is nothing to stop neurons from activating, they all can activate, and the person will experience a seizure.”
Other symptoms of benzodiazepine withdrawal include:
Symptoms of benzo withdrawal vary depending on the length of addiction and the dose a person is used to taking. Studies also indicate that symptoms differ between fast-acting and long-acting forms of the drug. Stopping fast-acting benzo use is more likely than ceasing use of long-acting benzos to produce symptoms of anxiety. Severe insomnia is a withdrawal symptom of quitting fast-acting benzos used to treat insomnia.
Many people become addicted to benzos because they want to avoid withdrawal. Addiction is a brain disease characterized by a compulsive desire to use substances despite harmful consequences.
But avoiding withdrawal isn’t the only reason people become addicted to the prescription drug. Like other drugs, benzos cause a dopamine release. Dopamine is a chemical that causes happiness. Repeated use of the drugs can make the brain crave benzos to feel happiness.
Most people who abuse benzodiazepines do so to relax, to relieve anxiety or to help them sleep. Abusing the drugs is dangerous because overdosing can make a person black out or fall into a coma. Overdosing on benzos alone is rarely fatal. However, mixing the drugs with other substances is risky.
“Alcohol and benzos affect the same system,” Wilkinson said. “When taken together, these two substances cause a synergistic effect, meaning the sum of the two together is far greater than expected. Alcohol and benzos increase the effects of each other in an unpredictable and quite exaggerated way.”
It’s risky to combine benzodiazepines with other depressants, such as alcohol or opioids. When combined, the substances can make a person pass out and stop breathing because depressants slow respiration.
In 2015, more than 5 million people 12 or older reported that they misused a benzodiazepine in the past year. Fast-acting benzos, such as Xanax and Klonopin, are abused more often than their slow-acting counterparts because individuals can feel their effects more quickly.
The most commonly abused benzodiazepines in 2015 were:
Benzos are often abused with other depressants, such as alcohol or opioids. Some people who use stimulants take benzos to recover from agitation or insomnia. For example, a person coming off of a cocaine bender may take Xanax to fall asleep.
The drugs are also used in some sexual assault crimes. Slipping a benzodiazepine into a person’s drink can render them unconscious.
When used as prescribed, benzodiazepines usually treat their associated medical conditions with little risk. The most common side effects of most benzodiazepines include drowsiness and feeling hungover. They may also cause confusion, poor concentration, dizziness, slurred speech and low blood pressure.
People under the influence of benzos have an increased risk of being involved in accidents. Someone who doesn’t know how they’ll react to the prescription drugs should avoid driving a car or operating machinery. Elderly individuals sometimes experience breathing difficulties while on benzos, and they may be at a higher risk for falling. Benzos can also cause birth defects in pregnant women.
The drugs are much more dangerous when they’re abused.
Side effects of benzodiazepine abuse include:
Benzodiazepine overdoses are almost never fatal unless the drug is combined with another substance of abuse. Abusing the drugs in combination with alcohol drastically increases a person’s chance of overdose because the combination of substances can slow heart and breathing rates to dangerously low levels.
In some situations, injections of a drug called flumazenil can treat symptoms of benzo overdose. However, flumazenil is not recommended for individuals who are dependent on benzodiazepines or individuals who are under the influence of multiple drugs. Because it’s difficult to assess those factors during a benzodiazepine overdose, the use of flumazenil is rare.
Patients taking benzodiazepines should talk to their doctors about a discontinuation plan before taking the drug and before they quit taking the drug. Quitting benzos abruptly can cause life-threatening side effects. Medical professionals can help patients slowly taper off the prescription drugs to avoid severe side effects.
Individuals who are dependent or addicted to benzodiazepines should seek medically supervised detox. Patients in rehab for benzo addiction slowly taper off the drugs while receiving 24/7 monitoring. Most treatment plans are flexible during detox, allowing for periods of withdrawal and periods of stabilization while the doses are gradually decreased.
Detox from benzos can last weeks or multiple months depending on the severity of the addiction, but detox is often complicated by addictions to other drugs. A 2011 study by the federal government found that 95 percent of people who received treatment for benzo addiction also received treatment for other types of addiction. In more than 80 percent of cases, benzos were the secondary drug of abuse. Opioids were the primary substance of abuse in 54 percent of cases.
Rehabilitation centers are the best resources for individuals with multiple addictions. Rehabs provide safe environments for recovery, teach clients to live without the drugs and provide treatment for co-occurring mental health disorders or other drug addictions.
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