What Are Benzos and Why Are They Addictive?
Benzodiazepines—benzos for short—are prescription drugs that depress your central nervous system. Benzodiazepines have a calming effect by raising the effectiveness of a neurotransmitter in your brain called GABA, a chemical that slows down nerve impulses. Benzos work quickly to reduce the intensity and symptoms of anxiety and panic, but they also can be prescribed as a sedative to help people sleep, or as a muscle relaxant before a medical procedure. Other names for them are tranquilizers and hypnotics.
Benzodiazepines were first introduced to the public in 1957 when Librium (chlordiazepoxide) came on the market. Benzos have since become the most common psychoactive drugs prescribed worldwide. These medications can help some people regain control of their life or improve their quality of life, but they must be used with caution. They are highly addictive, and responsible for many overdoses, especially when combined with opioids.
Approximately 5% of adults in the United States fill at least one prescription for benzos each year. The use increases with age, from 2.6% of adults ages 18 to 35 years to 8.7% of adults ages 65 to 80 years. Older adults tend to take them for longer periods.
Although there are many types of benzodiazepines, the ones most commonly used in the United States are Xanax (alprazolam), Valium (diazepam), Klonopin (clonazepam), and Ativan (lorazepam). They are very effective drugs with medically appropriate use, but experts recommend only short-term or occasional use. People should not take them every day or over a long period.
Short-acting and long-acting benzodiazepines
Which benzo a doctor or other caregiver prescribes depends on the need and how long your doctor wants the effects to last. Very short-acting benzodiazepines like Versed (midazolam) are useful before surgery. Other short-acting drugs (but not as short as Versed) include Xanax and Ativan. Doctors may prescribe these for anxiety or for help falling asleep. Longer acting benzos include Valium and Librium, which also are effective for anxiety and sleep disorders. Doctors may prescribe them for other conditions, such as a seizure disorder.
Newer, possibly less addictive medications are available to treat anxiety and sleep disorders, but many doctors still turn to benzos for first-line treatment. Buspirone and certain types of antidepressants are two other options for anxiety disorders. Some antidepressants also are effective for sleep problems. Ramelteon (Rozerem) is a non-addictive option for insomnia.
Like all medications, benzodiazepines can have side effects. If you experience unpleasant or potentially dangerous side effects, speak with your pharmacist, who can offer advice on how to reduce them. Another option is to speak with your doctor so you can try another type of medication. Some of the side effects can be quite severe. Benzo side effects include:
- Memory loss or apparent confusion
- Impaired thinking or bad judgement
- Depression, euphoria, or mood swings
- Slurred speech
- Slowed breathing
- Nausea and vomiting
- Abdominal pain or cramping, possibly with diarrhea
- Hostile or erratic behavior
Benzodiazepines should only be used for short periods and only under a doctor’s supervision. A recent survey showed that about 17% of people who use benzos do not have a prescription, or they do but they use the drug more often or for longer than prescribed. Of more than 30 million adults in the United States who take benzos, 25.3 million take them as prescribed. The other 4.7 million don’t have a prescription, obtaining the drug from a friend or relative, or they misuse it.
If you use benzos for more than four weeks, you run the risk of becoming addicted. The same may happen if you abuse it—taking more than your prescribed amount or taking them more often. The drugs affect GABA levels and brain chemistry to the point you need the drug to continue the feeling it creates.
Because benzos seem harmless at first, it’s not uncommon for people to use them with alcohol or other drugs, including opioids. Benzodiazepine abuse and misuse increases the chances of becoming addicted.
Signs of benzodiazepine addiction might not be noticeable in the beginning stages, but eventually as the body depends on them, the person may experience some of these behaviors and feelings:
- Inability to skip a dose or take a lower dose
- Feeling like you can’t function unless you take your pills
- Needing to increase your doses to get the same feeling you used to get at lower doses
- Feeling more anxious or depressed, or unable to sleep if you miss a dose
- Experiencing physical tremors
- Feeling like your sensations are too sharp, having seizures, or wanting to self-harm.
If the addiction worsens, more erratic and destructive changes in behavior occur, such as lying, deceiving or stealing to get the drug.
If you have concerns about benzodiazepine abuse or addiction regarding you or a loved one, it is important to speak with your doctor to safely stop using the drug. Detoxing from a benzo addiction can be dangerous and requires medical supervision. Symptoms of withdrawal include:
Benzodiazepines help people with specific medical needs, but their use must be monitored closely. Do not ever take someone else’s pills, even if you have similar symptoms or you have taken them before. If your doctor prescribes you or your loved one benzodiazepines, ask your doctor how often you should take them and for how long. Do not exceed the recommended dose. If you don’t get symptom relief with the prescribed dose, tell your doctor. There may be other medications or treatments that are more effective.