Doctors commonly prescribe benzodiazepines, or benzos, for anxiety, insomnia, seizures and other conditions. Some people use the sedatives recreationally for their relaxing effects.
Unfortunately, continued use of benzos, such as Xanax and Valium, can lead to physical dependence and addiction — and quitting benzos is difficult without help.
How Benzos Hijack the Brain
Benzodiazepines have powerful effects on the body, including sedation, dizziness and weakness. Other benzo side effects range from confusion to depression to memory loss — and with long-term use, dependence.
According to a 2011 study in the journal Addictive Behaviors, up to 44 percent of chronic benzo users end up dependent, and long-term use of benzos causes chemical changes in the brain.
After several weeks of use, these changes in a person’s brain chemistry will cause them to need the drugs to function normally, a condition known as dependency. A person will also require larger doses to achieve the desired effects. This is known as tolerance.
Continued use of benzos also affects the brain’s reward pathways, causing cravings for the drug. A person with a benzodiazepine addiction may be unable to stop using the drugs and feel as if they can’t function without them.
Fear of experiencing withdrawal symptoms also prompts extended benzo use, and the onset of withdrawal symptoms can make a person return to using, even when they want to quit.
Benzo Withdrawal and Detox
Benzo addiction treatment usually starts with a gradual detoxification process. If a person has been taking high levels of benzos for longer than eight weeks, it’s critical to wean them off the drugs slowly to decrease the severity of withdrawal symptoms.
- Anxiety and panic attacks
- Sleep disturbances
- Muscle twitching and tremors
- Nausea and vomiting
- Dizziness and lightheadedness
While rare, benzodiazepine withdrawal can even bring on seizures that lead to death.
In many cases, a person may be able to wean off benzos on an outpatient basis, under a doctor’s care. Their treatment team will formulate a plan to gradually taper their dose or possibly switch them to a longer-acting benzo and then begin tapering that drug.
The safest and most comfortable way to detox from benzos, however, is with medical supervision. Inpatient detox is usually warranted when a person has been taking large doses of benzodiazepines for a long time.
During inpatient detox, you’ll be closely monitored, and you may receive medications to help alleviate symptoms.
Flumazenil, an antidote for a benzo overdose, is sometimes used to alleviate withdrawal symptoms. Some people are given an anti-anxiety drug called Buspirone to help relieve anxiety. Because it is not in the benzodiazepine chemical class, Buspirone is not likely to cause dependence, but it can take time to work.
Other prescription medications, including anti-seizure medications, may also prevent complications.
Doctors may switch patients who have been taking large doses of short-acting benzos to a longer-acting benzo and then slowly taper them off that.
Once physically stable, you can transition to the next phase of treatment. While everyone’s treatment plan is unique to their needs, most people attend a combination of group and individual therapy and counseling.
During rehab you’ll learn more about the roots of addiction and develop tools to help you cope with cravings and avoid relapse.
Rehab is available on both an inpatient and outpatient basis, depending on the severity of your addiction. The length of treatment may also vary, depending on your individual situation, but successful treatment typically requires weeks or months.
Inpatient treatment is often most effective because it allows a person to focus 100 percent on their recovery, without the distractions of their normal routine.
Outpatient therapy provides the same types of therapy and counseling, but enables patients to return home every night. That way, they may be able to keep up with work and other personal responsibilities while receiving treatment.
Individuals do best in outpatient therapy when they have a strong support system to help them in their recovery.
The Importance of Aftercare
While relapse from drug addiction is common, participating in aftercare programs increases your chances of staying sober after you’re done with structured treatment.
Aftercare programs reinforce healthy lifestyle choices and stress coping mechanisms. They can also help you recognize relapse triggers and minimize the damage if you do end up relapsing.
Some people choose to enter sober living after they graduate from rehab. In these drug-free group living environments, they are able to gently ease back into the demands of regular life.
Others may choose individual counseling. Many people in recovery also attend 12-step group meetings for continued support and encouragement.
Meetings are usually free and readily available — and studies have demonstrated one-year abstinence rates of 80 to 90 percent when individuals attend self-help group meetings or other types of weekly continuing care after finishing formal treatment.
DrugRehab.com aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.
As a former journalist and a registered nurse, Amy draws on her clinical experience, compassion and storytelling skills to provide insight into the disease of addiction and treatment options. Amy has completed the American Psychiatric Nurses Association’s course on Effective Treatments for Opioid Use Disorder and continuing education on Screening, Brief Intervention and Referral to Treatment (SBIRT). Amy is an advocate for patient- and family-centered care. She previously participated in Moffitt Cancer Center’s patient and family advisory program and was a speaker at the Institute of Patient-and Family-Centered Care’s 2015 national conference.
- Ashton, H. (2005, May). The diagnosis and management of benzodiazepine dependence. Retrieved from https://www.benzo.org.uk/amisc/ashdiag.pdf
- Brett, J. & Murnion, B. (2015, October 1). Management of benzodiazepine misuse and dependence. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657308/
- Drug Enforcement Administration. (2013, January). Benzodiazepines. Retrieved from https://www.deadiversion.usdoj.gov/drug_chem_info/benzo.pdf
- Government of South Australia. (n.d.). Benzodiazepine withdrawal management. Retrieved from http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/substance+misuse+and+dependence/substance+withdrawal+management/benzodiazepine+withdrawal+management
- Griffin, C.E. et al. (2013). Benzodiazepine Pharmacology and Central Nervous System-Mediated Effects. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684331/
- Greenberg, M. (2001, December). Benzodiazepine Withdrawal: Potentially Fatal, Commonly Missed. Following benzodiazepine cessation, withdrawal symptoms may begin within 24 hours or take up to two weeks to develop. Retrieved from https://journals.lww.com/em-news/Fulltext/2001/12000/Benzodiazepine_Withdrawal__Potentially_Fatal,.13.aspx
- Guina, J. & Merrill, B. (2018, January 30). Benzodiazepines II: Waking Up on Sedatives: Providing Optimal Care When Inheriting Benzodiazepine Prescriptions in Transfer Patients. Retrieved from http://www.mdpi.com:8080/2077-0383/7/2/20/pdf
- Hanson, G.R., Venturelli, P.J. & Fleckenstein, A.E. (2017, January 26). Drugs and Society. Retrieved from https://books.google.com/books?id=7NLGDQAAQBAJ&dq=timeline+for+benzodiazepine+withdrawal&source=gbs_navlinks_s
- Hood, S. et al. (2014, February). Benzodiazepine dependence and its treatment with low dose flumazenil. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4014019/
- Jahnsen, K., Roser, P. & Hoffmann, K. (2015, January 5). The Problems of Long-Term Treatment With Benzodiazepines and Related Substances: Prescribing Practice, Epidemiology, and the Treatment of Withdrawal. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318457/
- Miller, N. & Gold, M. (1998, July 1). Management of Withdrawal Syndromes and Relapse Prevntion in Drug and Alcohol Dependence. Retrieved from https://www.aafp.org/afp/1998/0701/p139.html
- Minaya, O. et al. (2011, August). The Benzodiazepine Dependence Questionnaire (BDEPQ): validity and reliability in Mexican psychiatric patients. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21481543?dopt=Abstract
- Morton, S. & Lader, M. (1995, July 1). Buspirone treatment as an aid to benzodiazepine withdrawal. Retrieved from http://journals.sagepub.com/doi/abs/10.1177/026988119500900407
- National Center for PTSD. (2015). Benzodiazepines and PTSD. Retrieved from https://www.ptsd.va.gov/about/print-materials/Helping_Patients_Taper_Patients.pdf
- National Institute on Drug Abuse. (2018, March). Benzodiazepines and Opioids. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids
- National Institute on Drug Abuse. (2012, April 19). Well-Known Mechanism Underlies Benzodiazepines’ Addictive Properties. Retrieved from https://www.drugabuse.gov/news-events/nida-notes/2012/04/well-known-mechanism-underlies-benzodiazepines-addictive-properties
- Pétursson, H. (1994, November). The benzodiazepine withdrawal syndrome. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/7841856
- Semel Institute for Neuroscience and Human Behavior. (2018). Benzodiazepine Addiction. Retrieved from https://www.semel.ucla.edu/dual-diagnosis-program/Conditions_Treated/Benzodiazepine_Addictions
- Tan, K.R., Rudolph, U. & Lüscher, C. (2011, April). Hooked on benzodiazepines: GABAA receptor subtypes and addiction. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4020178/
- Vinkers, C.H. & Olivier, B. (2012, March 29). Mechanisms Underlying Tolerance after Long-Term Benzodiazepine Use: A Future for Subtype-Selective GABAA Receptor Modulators? Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321276/
- World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK310652/