Benzodiazepine Addiction: Definition, Symptoms, Causes, Effects and Treatment

Benzodiazepine addiction involves a strong dependence on benzodiazepines, a class of medications commonly used to treat anxiety and sleep disorders. Individuals with this addiction find themselves unable to stop taking these drugs despite experiencing harmful effects on their health and daily functioning. A recent study, “Complex Persistent Benzodiazepine Dependence—When Benzodiazepine Deprescribing Goes Awry” by Peng, Linda, et al. (2022), introduces the term Complex Persistent Benzodiazepine Dependence (CPBD), distinguishing it from addiction and highlighting the unique challenges of long-term benzodiazepine use.

Benzodiazepine addiction symptoms include drug-seeking behaviors, doctor shopping to obtain more prescriptions, taking larger doses or for longer than intended, forging prescriptions, increased desire for solitude; increased respiratory infections, physical dependence, double vision, muscle weakness, vertigo, headaches, changes in eating and sleeping patterns; memory impairment, anterograde amnesia, increased confusion, slowed thinking, slowed reaction time; increased anxiety, irritability and hostility, depression, mood swings.

The causes of benzodiazepine addiction are pre-existing mental health conditions, other substance abuse, long-term use, even at low therapeutic doses, and lack of adherence to prescription guidelines.

The effects of chronic benzodiazepine abuse comprise the inability to maintain employment, homelessness, damaged relationships, legal problems, worsening mental and physical health, increased drug-seeking behaviors, self-harm, and suicidal thoughts.

Treatment of benzodiazepine involves medical detox to manage withdrawal safely, behavioral therapies to address psychological dependence, medications to ease cravings and withdrawal symptoms, and treatment of any co-occurring disorders. Peng et al. (2022) emphasize the importance of careful tapering and individualized treatment plans, acknowledging the severe repercussions some patients face during de-prescribing.

What Is Benzodiazepine Addiction?

Benzodiazepine addiction, also known as benzodiazepine dependence, is a condition characterized by a strong compulsive urge to use benzodiazepine drugs, despite harmful consequences, which is physical and psychological dependence.

Benzodiazepines (also called “benzos”) are a class of depressant drugs that enhance the effects of the neurotransmitter GABA in the brain, resulting in sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant properties. Colloquially known as “benzos,” these drugs are diazepam (Valium), alprazolam (Xanax), and lorazepam (Ativan). Despite their therapeutic benefits, prolonged use encourages tolerance, dependence, and addiction.

As indicated by Baron, Richard, et al. (2020) in the research article, “The rise and fall and rise of benzodiazepines: a return of the stigmatized and repressed,” millions of Americans with anxiety and insomnia are prescribed benzodiazepines that have been widely prescribed since the 1970s.

A new publication in JAMA Psychiatry by physician-scientists at Oregon Health & Science University and the VA Portland Health Care System introduces the term “Complex Persistent Benzodiazepine Dependence” (CPBD). According to Dr. Christopher K. Blazes (2022), M.D., and his co-authors, CPBD describes a condition where long-term benzodiazepine users develop physiological dependence, characterized by tolerance and withdrawal symptoms upon discontinuation. Unlike addiction, CPBD does not result in sacrificing jobs or relationships but covers behaviors similar to addiction during the discontinuation process.

Blazes (2022) emphasizes the dangerous challenge of safely tapering off long-term benzodiazepine use, which sometimes necessitates resuming safe doses if discontinuation attempts fail. The distinction between addiction and dependence is crucial because it dictates different treatment approaches; psychological and behavioral interventions effective for addiction do not work for those with CPBD. Blazes (2022) works with patients to carefully taper off these medications while acknowledging the severe repercussions some face from de-prescribing, given the rising mortality associated with benzodiazepine use.

What Are the Symptoms of Benzodiazepine Addiction?

The symptoms of benzodiazepine addiction are tolerance, withdrawal, drowsiness, coordination issues, digestive problems, craving, anxiety depression, cognitive impairment, emotional instability, doctor shopping, neglecting responsibilities, social isolation, financial problems, and legal issues. The most common symptoms of benzodiazepine addiction are given below as explored by Saarelainen, Laura et al. (2016) in the research “Risk of Hip Fracture in Benzodiazepine Users With and Without Alzheimer Disease”:

• Tolerance: Needing higher doses of benzodiazepines to experience the effects once achieved with smaller amounts, which is a sign of the body’s increasing adaptation and dependency on the drug.
  
• Withdrawal: Facing severe physical and psychological challenges, such as intense anxiety, agitation, and tremors, when cutting or ceasing benzodiazepine use, highlighting the body’s reliance on the substance.
  
• Drowsiness: Experiencing prolonged periods of sleepiness that interrupt quotidian routines and diminishes one’s ability to function effectively throughout the day.
  
• Coordination Issues: Struggling with basic motor skills, making tasks that require precision and control, such as writing or walking steadily, increasingly difficult and unsafe.
  
• Digestive Problems: Enduring frequent nausea and vomiting, which interfere with the body’s ability to maintain a healthy digestive process and disrupt normal eating habits.
  
• Craving: Feeling an overbearing, persistent desire for benzodiazepines that consumes thoughts and drives compulsive behavior, spawning the continued use despite negative consequences.
  
• Anxiety and Depression: Suffering from heightened levels of worry and sadness, which are exacerbated by ongoing substance dependency and worsen with the absence of benzodiazepines.
  
• Cognitive Impairment: Noticing a decline in mental processes like memory and concentration, severely impacting one’s ability to think clearly and solve problems over time.
  
• Emotional Instability: Experiencing frequent and intense mood swings with unpredictable emotional reactions that strain personal relationships and hinder emotional well-being.
  
• Doctor Shopping: Engaging in the risky practice of visiting multiple healthcare providers to obtain more benzodiazepine prescriptions than one doctor prescribes, indicating a deeper level of addiction.
  
• Neglecting Responsibilities: Failing to meet essential duties at work, school, or home due to the overpowering need to use benzodiazepines, precipitating negative consequences in daily life.
  
• Social Isolation: Withdrawing from social activities and distancing oneself from friends and family to avoid judgment or conceal the extent of benzodiazepine addiction.
  
• Financial Problems: Struggling with money management due to the high costs associated with sustaining a benzodiazepine addiction, generating massive financial strain and potential debt.
  
• Legal Issues: Involvement in illegal activities, such as forging prescriptions or purchasing benzodiazepines through illicit means, often results in legal consequences and further complicates the addiction.

What Are Causes of Benzodiazepine Addiction?

The causes of benzodiazepine addiction are prescription use, self-medication, genetic predisposition, and environmental factors. The most common causes of benzodiazepine addiction are given below as spotlighted by Dortmuth, Colin R. et al. in the research “Effect of a centralized prescription network on inappropriate prescriptions for opioid analgesics and benzodiazepines”:

• Prescription Use: The administration of benzodiazepines under medical guidance for managing conditions like anxiety, insomnia, muscle spasms, and seizures. Over time, prolonged use, especially with increasing doses, breeds physical dependency and a heightened risk of addiction as the body adapts to the medication.
  
• Self-medication: The unsupervised use of benzodiazepines by individuals attempting to alleviate chronic stress, anxiety, or other mental health conditions. This misuse often leads to escalating doses, fostering tolerance, dependence, and eventually, addiction, as individuals deviate from medically prescribed guidelines.
  
• Genetic Predisposition: The heightened probability of developing a benzodiazepine addiction due to inherited traits from a family history of substance use disorders. Genetic makeup can affect how a person metabolizes drugs, increasing their vulnerability to dependence and addiction.
  
• Environmental Factors: The influence of external circumstances, such as traumatic experiences, high-stress situations, or environments where drug use is prevalent. These elements, coupled with social pressures and peer influences, contribute significantly to the initiation and continuation of benzodiazepine use, ultimately leading to addiction.

What Are the Effects of Benzodiazepine Addiction?

The effects of benzodiazepine addiction are respiratory issues, neurological impairments, digestive problems, mood disorders, cognitive decline, relationship strain, social isolation, and financial and legal problems. The most severe effects of benzodiazepine addiction are listed below as highlighted by Peng, Linda et al. (2022) in their research “Complex Persistent Benzodiazepine Dependence—When Benzodiazepine Deprescribing Goes Awry”:

• Respiratory Issues: Persistent impairments in lung function and breathing arise from chronic benzodiazepine use, leading to conditions like bronchitis and pneumonitis that damage lung tissues over time.
  
• Neurological Impairments: Ongoing issues with memory and cognitive function emerge from benzodiazepine abuse, resulting in enduring problems even after cessation of the drug.
  
• Digestive Problems: Ongoing disruptions in the digestive system manifest through symptoms such as nausea and vomiting, with prolonged benzodiazepine use affecting normal digestive processes.
  
• Mood Disorders: Persistent mood swings and emotional instability are common, with benzodiazepine use contributing to heightened anxiety and depressive symptoms impacting overall mental health.
  
• Cognitive Decline: A decline in mental functions such as memory and concentration is a consequence of long-term benzodiazepine use, marked by significant memory loss and confusion.
  
• Relationship Strain: Increased tension and conflict within personal relationships occur, with addiction leading to mistrust, emotional stress, and withdrawal from responsibilities.
  
• Social Isolation: Withdrawal from social interactions and activities becomes evident, with individuals opting for solitude to avoid judgment and hide their addiction.
  
• Financial and Legal Problems: Financial strain and legal issues arise, driven by the cost of obtaining the drug and involvement in illegal activities to secure it.

What Is the Diagnosis of Benzodiazepine Addiction?

The diagnosis of benzodiazepine addiction is clinical interviews, physical examinations, and psychological assessments. The most common methods for the diagnosis of benzodiazepine addiction are noted below as elaborated by Tapiainen, V. et al. (2018) in the research “The risk of Alzheimer’s disease associated with benzodiazepines and related drugs: a nested case-control study”:

• Clinical interviews: are conducted by healthcare providers to understand the history and patterns of benzodiazepine use, helping to identify the presence and severity of addiction.
  
• Physical examinations: evaluate the user’s overall health and identify any complications arising from prolonged benzodiazepine use, which is crucial in formulating a treatment plan.
  
• Psychological assessments: gauge the severity of addiction and assess co-occurring mental health conditions, aiding in addressing both addiction and underlying psychological issues simultaneously.

What Is the Treatment of Benzodiazepine Addiction?

The treatment of benzodiazepine addiction involves detoxification, medication-assisted treatment (MAT), behavioral therapy, motivational interviewing (MI), contingency management (CM), support groups, group therapy, and aftercare.

The most common treatments for benzodiazepine addiction are explained below as mentioned by Donroe, Joseph H. and Tetrault, Jeanette M. (2018) in the research “Narrowing the treatment gap in managing opioid use disorder”:

• Detoxification: Detoxification is a process of medically supervised withdrawal from a substance to safely remove it from the body. It is a process of gradually tapering off benzodiazepines to minimize withdrawal symptoms and health risks.
  
• Medication-Assisted Treatment (MAT): Medication-assisted treatment is the use of medications to ease withdrawal symptoms of benzodiazepine addiction and reduce cravings during recovery.
  
• Cognitive Behavioral Therapy (CBT): CBT is a therapeutic approach that addresses and alters negative behaviors and thought patterns associated with benzodiazepine addiction.
  
• Motivational Interviewing (MI): Motivational interviewing is a counseling technique that aims to empower an individual’s motivation to engage in benzodiazepine addiction treatment and make positive changes, addressing ambivalence and building commitment to the recovery process.
  
• Contingency Management (CM): Contingency management is a behavioral intervention that offers rewards for maintaining sobriety from benzodiazepine addiction and participating in treatment to reinforce positive behaviors and encourage adherence to treatment protocols.
  
• 12-Step Programs: 12-step programs are structured recovery programs, such as Narcotics Anonymous (NA), that provide peer support and accountability during the benzodiazepine addiction treatment, giving a framework for recovery and fostering a sense of community and belonging.
  
• Group Therapy: Group therapy is a therapy format conducted in a group setting where individuals share their benzodiazepine addiction experiences and support one another to facilitate mutual encouragement and aid in lessening feelings of isolation.
  
• Aftercare: Aftercare is ongoing support and therapy following initial treatment of benzodiazepine addiction to prevent relapse and sustain long-term sobriety. Aftercare includes continued counseling, lifestyle adjustments, and holistic wellness approaches.

What role do benzodiazepines play in co-occurring disorders? 

The role of benzodiazepines in co-occurring disorders is to manage anxiety disorders and address the symptoms of other covalent conditions. Spotlighted by Cleveland Clinic’s (2022) article “Substance Use Disorder” (SUD), their use complicates treatment for individuals with co-occurring mental health conditions because they interact with medications used to treat other disorders like depression or bipolar disorder, requiring careful management and monitoring by healthcare providers. Jessell, Lauren, et al. (2019) state in the research “Factors Associated with Benzodiazepine Prescribing in Community Mental Health Settings” that 19.9% of patients in community mental health settings were prescribed at least one benzodiazepine, 35.1% had a co-occurring SUD.

Are there alternatives to benzodiazepines for managing anxiety and insomnia? 

Yes, there are non-benzodiazepine medications and alternative therapies that are effective in managing anxiety and insomnia.  Published research in The Lancet by Crescenzo, Franco De. et al. (2022) “Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis,” lists choice varieties such as antidepressants, antihistamines, cognitive-behavioral therapy (CBT), relaxation techniques, and lifestyle changes.

SSRIs like escitalopram and sertraline are commonly prescribed for anxiety disorders. A study by Saker, Fatema‐Tun‐Naher, et al. (2019), “Benzodiazepine usage and patient preference for alternative therapies: A descriptive study” found that SSRIs are effective in treating generalized anxiety disorder (GAD), with response rates around 60-70% in clinical trials.

What Are The Common Signs Of Benzodiazepine Addiction And Valium Addiction?

Common Signs Of Benzodiazepine Addiction and Valium Addiction include physical symptoms like dizziness, slurred speech, impaired coordination, and psychological indicators such as increased anxiety and compulsive drug-seeking behavior. Key indicators are needing higher doses, experiencing withdrawal symptoms, and continuing use despite negative consequences. Valium’s longer half-life can make its addiction particularly challenging, requiring careful medical supervision for safe recovery.