Benzodiazepine Dependence | Overview, Symptoms, & Treatment

Benzodiazepines are a class of prescription drugs widely used in primary care and psychiatry to treat a variety of different conditions related to anxiety, panic, muscle tension, and insomnia.

However, benzodiazepine dependence forms rapidly and is a serious condition involving a wide range of physical and mental hazards. If dependence does form, discontinuation of the drug can result in severe and potentially dangerous withdrawal symptoms.

For this reason, the Federal Food and Drug Administration (FDA) requires that all benzodiazepines prescribed in the United States carry the strongest warning in regards to the risks of dependency, addiction, and withdrawal if the drug is misused.

Dependence Vs. Addiction

While dependence and addiction are often used interchangeably, they are actually two distinct, but related conditions:

• dependence means that the body has become physical reliant on drug use, in this case benzodiazepines, to function normally
• addiction, also known as substance use disorder, is a disease of the mind where you have strong cravings or compulsions to take a certain substance, regardless of the consequences

These two conditions often go hand in hand, though it is possible to be physically dependent on a substance but not addicted, or to be addicted to a substance that does not cause physical dependence.

In the case of benzodiazepines, physiological dependence and tolerance develop quickly, but are not always joined by benzodiazepine use disorder.

How Benzodiazepine Dependence Works

Common benzodiazepines include:

• alprazolam (Xanax)
• chlordiazepoxide (Librium)
• clonazepam (Klonopin)
• diazepam (Valium)
• lorazepam (Ativan)
• oxazepam (Serax)

These drugs work by binding to GABAA receptors in the synapses of the brain, increasing the body’s sensitivity to the Gamma aminobutyric acid (GABA) neurotransmitter. 

This increased sensitivity to GABA depresses central nervous system (CNS) activity, relaxing tension and calming runaway mental and muscular activity. 

This makes benzodiazepines effective as:

• anxiolytics, or drugs for the treatment of anxiety, anxiety disorders, and panic disorders
• anticonvulsants, or drugs that treat seizures
• hypnotics, drugs that cause drowsiness and sleep
• short-term interventions for a variety of mental disorders, often in combination with antidepressants

However, after between two and four weeks, the body will begin to adjust to the effects of benzodiazepines, developing tolerance to the drugs and dependence on them. This process advances more quickly and is more severe the larger the dose.

At this point, you are likely to experience many of the harmful effects known to result from long-term use of benzodiazepines. This may include potentially severe benzodiazepine withdrawal when you stop taking the drug, or even if you begin tapering your dosage down.

Risks Of Long-Term Or High-Dose Use

Side effects of benzodiazepine abuse, including long-term low dose and high dose recreational use, include:

• dependence/tolerance
• drowsiness
• impaired coordination and balance
• impaired memory and learning
• mood swings
• overdose (usually in combination with opioid/opiate drugs or alcohol, counteracted by flumazenil)

The risk of impairment due to benzodiazepine use is greatest among the elderly even when the drug is used properly, and health care professionals advise prescribing only short-acting benzodiazepines for use by older adults.

Benzodiazepines are also known to cause birth defects if taken by pregnant women.

Benzodiazepine Withdrawal Symptoms

Once you’ve developed a dependence on benzodiazepines, it can be dangerous to stop taking them abruptly. The withdrawal symptoms that often result can be extremely severe and include many of the medical conditions benzodiazepines are prescribed to control. 

The potential symptoms of benzodiazepine withdrawal syndrome may include:

• emotional changes
• headaches
• dizziness
• irritability
• low energy
• insomnia
• memory impairment
• personality changes
• depression
• flu-like symptoms
• hallucinations and psychosis
• suicidal impulses

As a result, benzodiazepine detoxification should be taken slowly, with doses tapering off over time to protect your mental health and give your body and mind the time they need to adjust and recover.

Treating Benzodiazepine Dependence

Whether benzodiazepine drugs have been abused in large doses to get high, or in low doses to manage sleep or anxiety disorders, long-term use can result in physical dependence. 

Qualified inpatient and outpatient treatment programs are designed to help you through benzodiazepine withdrawal safely while providing supportive care and, potentially, treatment for other comorbidities you may live with. 

To learn more about our substance abuse treatment programs, please contact us today.