Benzodiazepines: Uses, Side-Effects, & Addiction Treatment

Understanding Benzodiazepines

What Are Benzodiazepines?

According to Neurology International, benzodiazepines, commonly known as benzos, are a class of psychoactive drugs that have a depressant effect on the central nervous system (CNS).

What Are Benzodiazepines Used For?

Benzodiazepines are used to treat a variety of mental health and medical conditions, such as anxiety disorders, panic attacks, seizures, muscle spasms, alcohol withdrawal, and sleep disorders like insomnia.

Additionally, benzodiazepines can be used alongside anesthesia during surgery or other medical procedures to reduce anxiety and promote relaxation. 

The diversity of symptoms and conditions that benzos can treat is a product of their depressant effects. 

Are Benzodiazepines Commonly Prescribed?

Yes, benzodiazepines are one of the most commonly prescribed medications in the U.S. 

More than 21 million adults were prescribed benzodiazepines in 2023. Moreover, as the Drug Enforcement Administration (DEA) notes, benzodiazepines are widely prescribed medications with approximately 30.5 million prescriptions for alprazolam, 21.4 million prescriptions for clonazepam, 19.8 million prescriptions for lorazepam, and 8.2 million prescriptions for diazepam in 2024 alone.

Are There Different Types of Benzodiazepines?

Yes, benzos are classified into different types based on their strength and duration of action.

Differences in strength among benzos are based on their chemical structure and the strength of the reaction they cause in the body. The more tightly benzos bind to the gamma-aminobutyric acid (GABA) receptors in your brain, the more potent those benzos are because faster binding leads to a faster sedative effect. 

Benzodiazepines like clonazepam, alprazolam, and lorazepam have high potency due to their stronger binding to GABA receptors. In comparison, benzos like diazepam, flurazepam, oxazepam, and temazepam are considered low-potency, which means you may have to take a higher dose of diazepam to achieve the same effect as a small dose of clonazepam.

There are three main types of benzodiazepines: short-acting, intermediate-acting or medium-acting, and long-acting. 

The duration of action types is based on the half-life of the medication in your system:

• Short-acting benzodiazepines have a short half-life, which means they affect the GABA neurotransmitters in the brain, are processed, and leave your body quickly, making them more effective for sleep disorders. 
• Intermediate-acting benzos gradually release and stay in your system longer than short-acting benzos, which makes them effective for both anxiety disorders and sleep disorders like insomnia. 
• Long-acting benzodiazepines have a longer half-life, which means they take longer to process and leave the body, making them more effective for treating anxiety disorders.

Although potency can vary from person to person, strength is an important factor in prescribing the right dose to effectively treat a condition. 

What Are the Most Commonly Prescribed Benzodiazepines?

The most commonly prescribed benzodiazepines are:

• Valium, the brand name for diazepam
• Xanax, the brand name for alprazolam
• Ativan, the brand name for lorazepam
• Klonopin, the brand name for clonazepam 
• Restoril, the brand name for temazepam

Effects of Benzodiazepine

How Do Benzodiazepines Work in the Brain?

Benzodiazepines work by passing through the blood-brain barrier to mimic and enhance the effects of the naturally occurring GABA neurotransmitter.

GABA is the most common neurotransmitter in your CNS. It is the main inhibitory neurotransmitter that helps block signals, slowing nerve cell activity in the brain. Some of the things GABA helps regulate include movement, balance, sleep, stress, and anxiety, among other functions. 

Naturally occurring GABA is known for producing a calming effect, which can be amplified by benzodiazepines. Specifically, benzos mimic and bind to the already naturally occurring GABA receptors and exert more of that sedative effect to slow down the CNS activity tied to conditions like anxiety disorders, whose symptoms stem from an overactive nervous system.

How Do Benzodiazepines Affect Memory and Cognition?

Some of the common side effects of benzodiazepines can cause memory loss and cognitive impairment, such as:

• Thinking feels slower
• It’s harder to maintain focus 
• Confusion
• Difficulty thinking of words to say 
• Recent memories are blurry and harder to hold onto
• Anterograde amnesia: difficulty forming new memories

What Is the Sedative Effect of Benzodiazepines on the Central Nervous System?

The sedative effect of benzodiazepines on the CNS slows down brain activity, which helps the nervous system settle down and leads to relaxation and calmness.

In addition to the sedative effects of benzodiazepines, they also produce anxiolytic and hypnotic effects that contribute to the sedative effects. The anxiolytic effect helps loosen up the nervous system and leads to a calming effect, while the hypnotic effect produces drowsiness and relaxation to help calm the nervous system.

What Are Other Common Side Effects of Benzodiazepines?

Some of the common side effects of benzodiazepines are:

• Drowsiness and dizziness
• Short-term memory loss and confusion
• Slurred speech and low blood pressure
• Lightheadedness and loss of balance

Developing Dependence

Can Benzodiazepines Be Addictive?

Yes, use of benzodiazepines can be highly addictive, and even with short-term use, physical dependence can develop quickly.

What Are the Signs and Symptoms of Benzodiazepine Addiction?

Some of the signs and symptoms of benzodiazepine addiction include:

• Physical dependence, including needing to use the drug in larger doses to achieve the desired effect
• Cravings and urges to use benzos and an inability to stop your use
• Experiencing withdrawal symptoms or consuming benzos to avoid withdrawal symptoms
• Inability to fulfill your obligations at home, school, or work
• Continuing to use benzos despite their negative impact on your health, life, and relationships

How Does Physical Dependence Develop With Short-Term vs Long-Term Use?

Although the risk of dependence is low, physical dependence during short-term use of benzodiazepines can occur in less than four weeks, while long-term use has an increased risk for physical dependence over a longer period. 

Short-term use can lead to physical dependence because your body quickly adapts to the enhanced effects of benzodiazepines on GABA receptors. Long-term use of benzos can lead to physical dependence as the body gradually adjusts to and needs higher doses to get the same benefits the medication provided when it was started.

How Long Can I Stay on Benzodiazepines?

Typically, you should only be prescribed benzodiazepines for short-term use, which is generally no longer than two to four weeks.

Can Benzodiazepines Cause Withdrawal Symptoms?

Yes, benzodiazepines can cause withdrawal symptoms with both short-term and long-term use.

Health Risks & Overdose

What Are the Side Effects and Complications Possible With Benzodiazepines?

Some of the adverse effects and dangerous side effects that are possible with benzodiazepines include:

• Slurred speech, confusion, poor concentration, memory loss
• Severe drowsiness, slowed heart rate, difficulty breathing
• Low blood pressure, lightheadedness, lack of coordination, falls
• Blurred vision, dry mouth, headache, muscle weakness
• Increased risk of substance use disorder (SUD) and overdose

How Dangerous Are Benzodiazepines When Mixed With Opioids or Alcohol?

Mixing other CNS depressants like opioids or alcohol with benzodiazepines carries an increased risk for adverse and dangerous side effects, including a drug-related visit to the emergency department or admission to the hospital, life-threatening overdose, and overdose death.

Further, mixing depressants poses a serious risk to your health and well-being because they can enhance each other’s effects. For example, mixing benzos and opioids or alcohol can cause severe sedative effects and suppress breathing, which can lead to respiratory failure and death. 

These three CNS depressants also carry an increased risk for physical dependence and addiction, which also increases your risk for overdose and overdose death.

What Are the Reasons I Should Not Take Benzodiazepines?

Some of the reasons why you shouldn’t take benzodiazepines are:

• Behavioral health and non-pharmacological treatment options haven’t been exhausted
• First-line Food and Drug Administration (FDA) approved medications, like antidepressants 
• Increased risk for physical dependence and addiction with short-term and long-term use
• Long-term use cognitive impairment: memory loss, confusion, cognitive decline
• Benzodiazepine withdrawal symptoms

What Is the Risk of Overdose?

The risk of overdose with benzodiazepines increases with higher doses, misuse, and mixing benzos with other substances, especially other depressants like opioids.

According to the National Institute on Drug Abuse (NIDA), in 2023, 10,870 overdose deaths involved benzodiazepines, and almost 70% of the overdose deaths involving benzos also involved illicitly manufactured fentanyl (IMF).

Finding Treatment

When Should I Seek Professional Treatment?

You should seek help from medical professionals if your use of benzodiazepines is disruptive to your daily life, impairing or worsening your mental health, impeding your ability to meet your responsibilities and obligations, or straining your relationships. 

Understanding the signs of benzo addiction can help you recognize when it’s time to seek professional treatment. If you find yourself needing higher doses to achieve the same effects you had on a lower dose, your tolerance and dependence on benzos are increasing. 

Physical dependence doesn’t mean you have benzodiazepine addiction. However, if you’re trying to stop or reduce your use of benzodiazepines, you can experience uncomfortable and potentially severe benzodiazepine withdrawal symptoms that need the support of medical professionals. 

Some of the other reasons to seek professional treatment for benzos include:

• Your prescribed benzodiazepine use has deviated from your provider’s instructions
• Having obsessive thoughts about when you can take your next dose 
• Worrying about running out and seeking out other healthcare providers for a prescription
• You prioritize using benzos over your professional, academic, social, and family life
• You’re experiencing cognitive issues: brain fog, memory loss, poor focus, and judgment
• You find yourself seeking out benzos to cope with minor discomfort, stress, or sadness

Will I Require Detox?

Yes, detox is a critical first step in addiction treatment and provides the necessary care and support needed for a safe and comfortable withdrawal process.

Benzodiazepine withdrawal symptoms can be severe and, in some cases, life-threatening due to symptoms such as seizures. With medical detox, you have access to around-the-clock supervision, medical care, and psychiatric support to ensure safety, effectively manage withdrawal symptoms, and have a smoother transition from detox to treatment.

Can I Get Treatment for My Anxiety Disorder Without Taking Benzos?

Yes, there are several other pharmacological and behavioral healthcare treatment options that can treat anxiety disorders.

There are a variety of first-line treatment choices that should be exhausted before considering prescribing benzos. Prescribing benzos should typically only be done for short-term or emergency use for those in crisis. 

Some of the first-line treatment options available for anxiety disorders include:

• Cognitive-behavioral therapy (CBT) and exposure therapy
• Mindfulness-based practices and relaxation techniques
• Lifestyle changes that support self-care
• FDA-approved selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)

How Can Treatment Help Manage Withdrawal?

Addiction treatment helps manage withdrawal symptoms through integrated healthcare services like medical assistance, structured programming, and a strong support network.

Medical assistance in treatment ensures access to guidance and care from medical professionals, as well as tapering protocols, to address individual medication needs. 

Structured programs provide a safe environment and individualized support to address each client with holistic care. Access to a strong support network provides support and guidance to discover new connections, rebuild your relationship with yourself and loved ones, validate and uplift yourself and your peers, foster accountability, and encourage mutually supportive relationships.

Is Residential Treatment Necessary?

Everyone’s needs for treatment are different, but residential treatment is typically necessary to ensure your safety, support stability, and provide structured care to address your unique experiences and needs for treatment and recovery.

At Legacy Outdoor Adventures, we combine outdoor therapy and evidence-based residential treatment services in our hybrid programs to give each client the tools and support to build a solid foundation for sustained recovery. 

Throughout our program, you’ll build coping, self-care, and life skills, explore self-expression, set goals, and practice integration from treatment to life in recovery.

Long-Term Care and Management

What Are Long-Term Management Strategies for Benzodiazepine Addiction?

Long-term management strategies for benzodiazepine addiction treatment include medical detox, individualized behavioral therapy and other treatment modalities, community services, and lifestyle changes.

Medical detox includes gradually tapering your benzo dosage to reduce the risk of severe withdrawal symptoms and around-the-clock supervision from medical professionals to monitor for complications. A structured treatment program provides personalized, evidence-based support with therapies like individual therapy, group therapy, and CBT. 

Medically supervised care also supports long-term care strategies by prescribing alternative medications for your specific condition and by regularly monitoring for side effects and assessing treatment effectiveness. 

Additionally, community services like peer support groups, family support groups, and psychoeducation support long-term management through education and connection. Learning how to dismantle old habits, practice stress management, foster self-care, and build healthy coping skills for daily life supports long-term management and recovery.

How Do Healthcare Providers Monitor and Prevent Reuse or Relapse?

Through an individualized approach to treatment and relapse prevention planning, healthcare providers can help monitor and reduce the risk of relapse.

With a personalized relapse prevention plan, you’ll learn how to recognize and understand your triggers and build self-care strategies, while continuing to receive counseling and psychiatry support. 

At Legacy Outdoor Adventures, we’re focused on making sure every client has the tools and support needed for long-term healing and growth. Our commitment to your long-term well-being is embedded in our client-centered approach to care, in which every part of your treatment program is personalized to your specific needs, circumstances, goals, and expectations.

What Nonbenzodiazepines and Alternative Treatments Are Available for Anxiety and Sleep Disorders?

Some nonbenzodiazepines and alternative treatment options for treating anxiety disorders and sleep disorders include:

• Anxiety medications: SSRIs, SNRIs, buspirone, beta-blockers
• Therapy approaches: CBT, exposure therapy, dialectical behavior therapy (DBT), mindfulness-based stress reduction (MBSR)
• Lifestyle changes: Regular exercise and sleep schedule, balanced nutrition, mindfulness
• Alternative sleeping pills: Herbal supplements, melatonin
• Other treatments: Relaxation techniques, acupuncture, hypnotherapy
• Lifestyle changes: Regular exercise, mindfulness, meditation, yoga

How Are Co-Occurring Mental Health Conditions Managed Long Term?

Co-occurring mental health conditions are managed long-term through an integrated approach to treatment that simultaneously addresses addiction and mental health conditions to ensure seamless, tailored care. 

Treating co-occurring conditions supports long-term recovery by increasing engagement and adherence to treatment, improving mental health symptoms, and leading to better overall health outcomes.