Benzodiazepines are some of the most commonly prescribed drugs in America, and are also among the most dangerous when misused. Millions of people have become dependent on benzodiazepines like Xanax, Klonopin, Valium, or Ativan, without fully understanding how it happened or how to stop it. And once dependency sets in, stopping cold turkey can be fatal, making professional support absolutely necessary. If you are struggling with benzodiazepine use, knowing what an addiction looks like and what treatment is like could be your next step to a healthier life.
What Are Benzodiazepines?
Benzodiazepines (informally called benzos) are classified as central nervous system depressants, prescribed primarily to treat panic disorder, generalized anxiety disorder, insomnia, seizures, and alcohol withdrawal.[1] Benzodiazepines enhance the activity of GABA, an inhibitory neurotransmitter in the brain, resulting in sedation, muscle relaxation, and reduced anxiety.
The most commonly prescribed benzodiazepines include:
- Alprazolam (Xanax): The most commonly prescribed and misused benzodiazepine. Alprazolam is short-acting and prescribed mainly for anxiety and panic disorder
- Clonazepam (Klonopin): Longer-acting, prescribed mainly for panic disorders and seizure conditions
- Diazepam (Valium): One of the earliest benzodiazepines, prescribed mainly to treat anxiety, muscle spasms, and alcohol withdrawal
- Lorazepam (Ativan): Intermediate-acting, mainly prescribed for use in healthcare facilities and for anxiety
- Temazepam and other sleep-specific benzodiazepines: Prescribed mainly for insomnia, with a high risk of developing physical dependence
While benzodiazepines do have accepted medical purposes, the FDA has mandated that benzodiazepine medications include warnings regarding their potential for abuse, physical dependence, and addiction.[2] Most prescribing guidelines recommend only short-term use. Unfortunately, many people have been taking benzodiazepines for months or even years, raising their risk of developing physical dependence.
Why Are Benzodiazepines So Addictive?
Both neurological and psychological factors contribute to the high potential for addiction to benzodiazepines. From a neurological perspective, as the brain gets used to the presence of the drug, it downregulates its GABA receptors and reduces the level of GABA produced naturally.[3]
With regular use, tolerance develops, and medication stops having the same effects it once did, requiring higher or more frequent doses to achieve the same amount of relief. When usage is reduced or stopped, the underactive GABA system cannot work to stop the activity of the nervous system, causing rebound anxiety, agitation, and possible seizures that are associated with benzo withdrawal.[4]
The psychological component of benzodiazepine addiction has to do with the conditions that benzodiazepines are used to treat. Once benzodiazepine is stopped, the symptoms of anxiety, panic, and insomnia return with increased intensity. This rebound effect makes it extremely difficult for people to distinguish between withdrawal and the return of their original symptoms, creating a strong motivation to keep using.
Physical dependence on benzodiazepines can develop in two to four weeks of daily use, even at therapeutic doses.[5] As a result, a person may be physically dependent on their prescribed Xanax or Klonopin even though they have never misused the medication.
Signs of Benzo Addiction and Abuse
Short-term signs of benzodiazepine use at higher than prescribed doses include:
- Excessive drowsiness and sedation
- Slurred speech and coordination problems
- Memory loss and confusion
- Slowed breathing
- Emotional blunting
- Disinhibition or uncharacteristic behavior
Long-term signs of benzodiazepine addiction and problematic use include:
- Taking higher doses than prescribed or using more frequently than directed
- Obtaining benzodiazepines from multiple providers or non-medical sources
- Continuing to use despite negative consequences to health, relationships, or functioning
- Unsuccessful attempts to cut down or stop
- Spending significant time and energy obtaining or recovering from benzodiazepines
- Experiencing withdrawal symptoms — including severe anxiety, tremors, or muscle spasms — when doses are missed
- Using benzodiazepines alongside opioids or alcohol significantly raising the risk of overdose
The Dangers of Cold Turkey Benzo Withdrawal
Benzodiazepine withdrawal is one of the most medically dangerous withdrawal syndromes there is.[6]
The dangers include:
- Seizures — The most serious risk of abrupt discontinuation. Grand mal seizures can occur 24 to 72 hours after stopping, even in people taking therapeutic doses
- Severe delirium — Confusion, disorientation, and agitation that can arise during acute withdrawal in long-term or heavy users
- Severe rebound anxiety and panic — Typically more intense than the original condition that led to treatment
- Cardiovascular instability — Elevated heart rate and blood pressure during acute withdrawal
- Protracted withdrawal syndrome — Continuing withdrawal lasting weeks or months in long-term users, characterized by ongoing anxiety, insomnia, and cognitive difficulties
The severity of these dangers should make it clear that anyone taking benzodiazepines, including people taking them as prescribed, should never attempt to withdraw without the assistance of a medical professional.
How to Safely Taper Off Benzodiazepines
The recommended method for detoxing from benzodiazepines is a medically supervised taper, which involves reducing the daily dose over a period of weeks to months under the guidance of medical professionals experienced in managing withdrawal. The taper will depend on the specific benzodiazepine being used, the amount, the duration of use, and the characteristics of the person.
In many cases, it is common to start the taper by switching from a short-acting benzodiazepine such as Xanax to a longer-acting one such as diazepam. This is because the longer half-life of diazepam makes for a smoother and less difficult tapering process.[7] Depending on the extent of physical dependence or the stability of the person’s living situation, the taper may take place in a hospital setting or through an outpatient program.There must also be an appropriate level of therapeutic support. During the taper and afterward, continued support from healthcare professionals through individual and group counseling or therapy is strongly recommended. Additionally, the anxiety, insomnia, or other conditions that emerge during withdrawal will also require therapy management, not simply a different medication. If these mental health conditions are not treated along with the addiction, then one tends to make treatment more difficult for the other, making relapse likely and recovery hard to sustain.[8]
