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Benzodiazepine Addiction

As the nation continues to be riveted by the opioid drug crisis, another class of medicines is inflicting its fair share of addiction and overdose deaths at alarming rates. For instance, overdose death rates involving benzodiazepines saw a 10-fold increase from 1999 (1,135) to 2017 (11,537).

Benzodiazepines are especially killing women. Between 1999 and 2017, benzodiazepine-involved deaths for women skyrocketed by 830 percent, according to the U.S. Centers for Disease Control and Prevention (CDC).

Yet, the prescription rates for benzodiazepine medications like Xanax (alprazolam), Valium (diazepam), and Ativan (lorazepam) are “exploding,” according to media reports. There is also evidence to suggest that more people are taking them for longer periods; a use pattern that puts them on a collision course with addiction and the perilous effects of withdrawal and overdose.

Benzodiazepines medications have sedating and tranquilizing effects, when they are abused and taken with other substances such as alcohol, they can be every bit as deadly as opioids.

What are Benzodiazepines? 

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Benzodiazepines or benzos are a class of medications prescribed to address a variety of conditions, including anxiety, insomnia, seizures, and alcohol withdrawal. They are only intended for short-term use. They work by increasing the effects of the neurotransmitter gamma-Aminobutyric acid (GABA), which reduce activity in the brain that governs emotion, memory, logical thought, and breathing, states Medical News Today. What results is a sedative or tranquilizing impact on the body where users feel relaxed, drowsy, and less anxious.

Like opiates, cannabinoids, and gamma-hydroxybutyrate (GHB), benzodiazepines are capable of inducing dopamine spikes in the brain, which endows these medications with addictive qualities. 

The most popularly prescribed benzodiazepines include:  

Xanax (alprazolam): Xanax is one of the most widely-abused benzodiazepines. It is a fast-acting sedative medication that takes effect within 15 to 60 minutes and leaves users feeling drowsy, if not incapacitated, for a few hours.

Valium (diazepam): Valium, another frequently-prescribed benzo, treats anxiety, insomnia, seizures, panic attacks, and muscle spasms.

Ativan (lorazepam): People experiencing seizures are often prescribed Ativan, and it is given to patients who are about to undergo surgery.

Klonopin (clonazepam): This benzodiazepine is prescribed to treat anxiety, seizures, muscle disorders, and epilepsy in children.

Librium (chlordiazepoxide): Librium primarily treats patients who exhibit alcohol withdrawal symptoms. Because Librium is highly addictive, it should be taken as prescribed.

According to MedicineNet, all benzodiazepines are available in tablet forms. Alprazolam is available as an extended-release tablet. Alprazolam, diazepam, lorazepam come as an oral liquid. Alprazolam and clonazepam are available as orally dissolving tablets. Chlordiazepoxide comes as a capsule, and diazepam is available as a rectal gel. Some benzodiazepine medications are made available for injection.

Signs of Benzodiazepine Addiction

Benzos can be very effective in the early stages of use, particularly in its ability to treat insomnia symptoms. When benzodiazepines are taken for longer than prescribed periods or at larger doses, they can become quite addictive.

Before addiction takes hold, a person will start to exhibit tolerance to benzo. This means they begin taking a greater dose than what was originally prescribed to experience the same effect from a smaller amount.

Tolerance can take the form of dependence when someone starts to rely on their benzodiazepine because, without it, they experience physical and psychological disturbances.

These disturbances are often referred to as withdrawal symptoms. The effects of withdrawal are surefire signs that a potential addiction is imminent. Those symptoms include the following: 

  • Seizures and convulsions
  • Profuse sweating
  • Depression
  • Rapid heart rate
  • Hallucinations
  • Paranoia
  • Altered sense of reality
  • Abdominal cramps
  • Nausea and vomiting
  • Nervousness
  • Muscle cramps
  • Tingling, burning, or “skin-crawling” sensations
  • Increased sensitivity to light, pain, and/or sound
  • Tremor
  • Insomnia
  • Irritability
  • Confusion and disorientation

When dependence blooms into an addiction, a user will begin displaying compulsive, drug-seeking behaviors, so much so that the benzodiazepine will become central to their lives. How? Because vital areas of the brain have been so impacted that they associate repeated benzodiazepine use with reward. They will display certain behaviors that are hallmarks of addiction. These behaviors are marked by:

  • Loss of coordination, slow movements, and speech
  • Using benzos to get high
  • Using benzodiazepines stronger doses or higher doses than prescribed
  • Using them in ways inconsistent with their design (for example, crushing pills so they can be snorted, smoked, or injected)
  • Mixing them with other substances (ex: alcohol and opioids) for stronger effects
  • High benzodiazepine tolerance, dependence
  • Strong benzodiazepine cravings
  • Taking benzodiazepines without a prescription
  • Crushing up or dissolving benzos for IV injection
  • Preoccupied with benzo use
  • Increasing benzo doses for the same effects
  • Seeking larger amounts by “doctor shopping”
  • Noticeable changes in appearance, hygiene
  • Lowered inhibitions
  • Loss of interest in daily activities, hobbies, interests
  • Isolation from family, friends, colleagues
  • Shaking
  • Change in eating habits
  • Frequent sleepiness

How Professional Treatment Can Help You

Benzodiazepines, along with alcohol, are one of the few addictive substances that can generate life-threatening withdrawal symptoms in the form of seizures.

It is also a medication that is often abused with other substances including alcohol, cocaine, heroin, and opioids. This sort of polysubstance abuse is extremely life-threatening.

Thus, professional treatment for benzodiazepine abuse and addiction requires the highest level of clinical intervention. The process often begins with medical detoxification, where the benzo is removed from the body, and ruinous withdrawal symptoms are medically treated. Because a client’s physical and mental health is fragile at the detoxification stage, they are monitored around-the-clock to ensure a safe and comfortable process.

After detox is completed, the next phase of recovery is residential treatment, where comprehensive therapy and care are applied to address the psychological ravages of addiction. It is here that clients have access to an array of evidence-based treatment and alternative therapies that help them uncover the causes behind their addiction. As the name suggests, a residential program allows clients to live onsite where they receive treatment.

When residential treatment is completed, clients enter into an outpatient program, where they continue to receive therapy and care on a part-time basis and live independently.

The modalities offered in treatment include:

  • CBT
  • DBT
  • Motivational Interviewing
  • Group and Individual Therapy
  • Holistic therapies (yoga and meditation)

When clients complete outpatient treatment, they can get connected to a recovery community, which can provide support and serve as a hedge against relapse.  

The Dangers of Benzodiazepine Abuse and Addiction

As with opioids, benzodiazepine overdose, in its most severe form, can result in coma and respiratory depression. Other benzodiazepine overdose symptoms include:

  • Seizures
  • Blurry vision
  • Dizziness
  • Weakness
  • Coordination issues
  • Slurred Speech
  • Confusion
  • Drowsiness

When a benzodiazepine medication is abused with alcohol, opioids, or a stimulant like cocaine, a user is at a higher risk of suffering a fatal overdose. With alcohol and opioids, the result is fatal respiratory depression where a victim forgets to breathe.

Benzodiazepine Addiction Statistics

  • Between 1996 and 2013, the number of adults who filled benzodiazepine prescriptions jumped 67 percent, from 8.1 million to 13.5 million.
  • Between 1999 and 2017, drug overdose deaths involving benzodiazepines spiked from 1,135 to 11,537, according to the National Institute on Drug Abuse (NIDA).
  • Benzodiazepine-related overdose deaths have risen dramatically, from 0.6 per 100,000 in 1999 to 4.4 per 100,000 in 2016, according to this study.
Many people

Sources

Agarwal, S. D. (2019, January 25). Patterns in Outpatient Benzodiazepine Prescribing in the United States. from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2722576

Bachhuber, M. A., Hennessy, S., Cunningham, C. O., & Starrels, J. L. (2016, April). Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996-2013. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816010/

Chatterjee, R. (2019, January 25). Steep Climb In Benzodiazepine Prescribing By Primary Care Doctors. from https://www.npr.org/sections/health-shots/2019/01/25/688287824/steep-climb-in-benzodiazepine-prescribing-by-primary-care-doctors

Drug Overdose Deaths Among Women Aged 30–64 Years – the United States Centers for Disease Control and Prevention 1999–2017 | MMWR. (n.d.). from https://www.cdc.gov/mmwr/volumes/68/wr/mm6801a1.htm?s_cid=mm6801a1_w

Humphreys, K. (2019, January 18). The prescription drug epidemic no one's talking about. from https://www.washingtonpost.com/business/2019/01/18/prescription-drug-epidemic-no-ones-talking-about/?utm_term=.58631534cabb

National Institute on Drug Abuse. (2019, January 29). Overdose Death Rates. from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

Ogbru, O. (n.d.). List of Benzodiazepines: Types, Side Effects, Addiction & Withdrawal. from https://www.medicinenet.com/benzodiazepines_sleep-inducing-oral/article.htm#is_it_safe_to_take_benzodiazepines_if_im_pregnant_or_breastfeeding_my_baby

Sissons, C. (n.d.). Valium vs. Xanax: Differences, similarities, and effects. from https://www.medicalnewstoday.com/articles/323906.php

Well-Known Mechanism Underlies Benzodiazepines' Addictive Properties. (2012, April 19). from https://archives.drugabuse.gov/news-events/nida-notes/2012/04/well-known-mechanism-underlies-benzodiazepines-addictive-properties

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