Benzos

Benzodiazepines, often called "benzos," are prescription medications primarily used to treat anxiety, insomnia, seizures, and muscle spasms. These medications work by enhancing the effect of a natural brain chemical called gamma-aminobutyric acid (GABA), which reduces nervous system activity and produces calming effects [1]. Common benzodiazepines include Xanax (alprazolam), Valium (diazepam), Klonopin (clonazepam), and Ativan (lorazepam).

When prescribed by healthcare providers, benzodiazepines can effectively manage certain mental health conditions. However, they also carry significant risks, including dependency, tolerance, and withdrawal symptoms, especially when used for extended periods [2].

Benzodiazepines are classified as Schedule IV controlled substances by the Drug Enforcement Administration, indicating their potential for misuse and dependence despite their medical value. They're typically prescribed for short-term use (2-4 weeks) because the risks of dependence increase substantially with longer use. Despite recommendations for short-term use, many people receive prescriptions for months or even years, which can lead to complications [3].

Common Types of Benzodiazepines

Benzodiazepines vary in how quickly they take effect and how long they remain active in the body.

Short-acting benzodiazepines like Xanax and Ativan take effect quickly (30-60 minutes) and remain active for 2-6 hours. These are often prescribed for acute anxiety or panic attacks.

Long-acting benzodiazepines such as Valium and Klonopin may take longer to feel their full effects but remain active for 20-100 hours. These medications are typically prescribed for chronic anxiety or seizure disorders [3].

Signs and Symptoms of Benzodiazepine Misuse

While benzodiazepines are important medications for many people, they can sometimes be misused. Recognizing the signs early can help prevent serious complications.

Physical Signs

• Drowsiness or excessive sleepiness

• Slurred speech or confusion

• Poor coordination or unsteady walking

• Dizziness or lightheadedness

• Breathing difficulties (in severe cases)

Behavioral Signs

• Doctor shopping (seeking prescriptions from multiple providers)

• Taking higher doses than prescribed

• Using benzodiazepines without a prescription

• Combining benzos with alcohol or other drugs

• Withdrawal from social activities or responsibilities

It's important to note that someone experiencing these symptoms might not recognize them in themselves [4].

Benzodiazepine Dependence and Withdrawal

Benzodiazepines can lead to physical dependence even when taken exactly as prescribed. The body adapts to the presence of these medications over time, and when they're reduced or stopped, withdrawal symptoms can occur.

Common withdrawal symptoms include increased anxiety or panic attacks, insomnia, irritability, muscle tension or pain, tremors, difficulty concentrating, and sensory hypersensitivity. In severe cases, seizures or psychosis may occur.

Withdrawal from benzodiazepines should never be attempted suddenly or without medical supervision. Safe discontinuation typically involves a gradual tapering schedule developed by a healthcare provider [2].

How Benzodiazepine Use Affects Different Populations

Children and Teens

Children and adolescents generally receive benzodiazepine prescriptions less frequently than adults. When prescribed, it's usually for specific conditions like seizure disorders. Young people may be particularly vulnerable to side effects and may experience paradoxical reactions [5].

Older Adults

Older adults process benzodiazepines more slowly, leading to increased sensitivity to effects and side effects, higher risk of falls and fractures, greater cognitive impairment, and increased risk of car accidents. The American Geriatric Society includes benzodiazepines on their Beers List of medications that should be used with caution or avoided in older adults [6].

Differences Between Men and Women

Women may metabolize certain benzodiazepines differently than men, are more likely to be prescribed benzodiazepines, and face special concerns during pregnancy and breastfeeding as benzodiazepines can cross the placenta and be passed through breast milk.

People with Co-occurring Conditions

For individuals with both mental health conditions and substance use issues, benzodiazepine use requires careful consideration. People with depression, bipolar disorder, or personality disorders may experience worsening symptoms with long-term benzodiazepine use. Those with a history of substance use disorders have a higher risk of developing problematic use patterns with benzodiazepines. Patients with chronic pain conditions may be prescribed benzodiazepines alongside opioids, despite warnings about this dangerous combination [5].

Causes and Risk Factors for Problematic Benzodiazepine Use

Several factors can contribute to problematic benzodiazepine use, including long-term prescriptions without adequate monitoring, history of other substance use disorders, underlying untreated mental health conditions, history of trauma, high stress levels, and limited access to alternative treatments [3].

The path to problematic use often begins with legitimate medical use. A person experiencing anxiety or insomnia receives a prescription and experiences relief. Over time, the effectiveness may diminish (tolerance), leading to higher doses or more frequent use. The brain adapts to the medication's presence, making it difficult to function without it. This physiological dependence can develop even in people taking their medication exactly as prescribed.

Social and environmental factors also play a role. Easy access to prescriptions, prescribing practices that don't follow guidelines for short-term use, and lack of follow-up monitoring can contribute to problematic patterns. Additionally, personal factors like genetic predisposition to anxiety disorders or substance use problems, history of childhood adversity, and limited coping skills or social support can increase vulnerability [4].

How Benzodiazepine Use Affects Daily Life and Relationships

When benzodiazepines are misused or when dependence develops, the effects can impact many aspects of life:

Ongoing use may lead to persistent drowsiness, memory problems, reduced reaction time, and decreased motivation. This can affect work performance, leading to increased absenteeism, difficulty maintaining focus, and potential workplace accidents.

Relationships often suffer due to communication difficulties, emotional blunting, and conflicts over medication use. Trust issues may develop if medication use is hidden, and family members may experience strain if they take on caregiver roles [4].

Effective Treatment Options for Benzodiazepine Dependence

Recovery from benzodiazepine dependence is possible with proper treatment and support.

Medical Detoxification

involves a carefully planned tapering schedule managed by healthcare professionals who monitor and manage withdrawal symptoms. For safety in severe cases, this is often conducted in inpatient settings.

Therapy and Counseling

approaches include Cognitive Behavioral Therapy (CBT) to address underlying anxiety, Motivational Interviewing to strengthen commitment to change, and family therapy to heal relationships. Group therapy provides peer support and shared experiences.

Medication-Assisted Approaches

may include treatment of underlying conditions with non-benzodiazepine alternatives and adjunctive medications to manage specific withdrawal symptoms.

Treatment may occur at different levels of care depending on individual needs, from intensive inpatient or residential treatment to regular outpatient care [7].

Self-Care Strategies and Coping Skills

Whether you're working toward recovery from benzodiazepine dependence or managing anxiety without medication, self-care strategies can be helpful.

Stress management techniques

include deep breathing exercises, mindfulness meditation, regular physical activity, and creative expression. Lifestyle modifications such as establishing consistent sleep routines, reducing caffeine and alcohol, and maintaining balanced nutrition support recovery and anxiety management.

Building support systems

through support groups, honest communication with trusted friends and family, and working with recovery coaches provides essential connection. Learning about anxiety management, including understanding triggers and developing personalized coping strategies, empowers effective self-management [5].

Many people find that addressing anxiety through non-medication approaches becomes more effective with practice. Progressive muscle relaxation, where you systematically tense and release muscle groups, can reduce physical tension that accompanies anxiety. Guided imagery or visualization exercises help create mental distance from worry thoughts. Establishing a regular mindfulness practice, even just 5-10 minutes daily, can increase awareness of thought patterns and reduce reactivity to anxiety triggers.

Nutrition plays a surprisingly important role in anxiety management. Stabilizing blood sugar through regular, balanced meals helps prevent anxiety spikes. Limiting or eliminating caffeine, alcohol, and nicotine—all of which can worsen anxiety—often leads to significant improvement in symptoms. Creating a sleep hygiene routine that includes consistent bedtimes, a cool dark sleeping environment, and screen-free time before bed supports better sleep quality, which directly impacts anxiety levels [5].

How Family Members Can Provide Support

If someone you love is struggling with benzodiazepine use, your support can make a meaningful difference.

Begin with education about benzodiazepines, dependence, and withdrawal, recognizing that dependence can happen even with prescribed use. Communicate with compassion rather than judgment, using "I" statements and listening actively without interrupting or dismissing experiences.

Provide practical support by helping research treatment options, attending medical appointments if welcomed, and assisting with daily needs during recovery. Setting clear boundaries about behaviors you cannot accept, avoiding enabling, and taking care of your own wellbeing are equally important [4].

It's crucial to understand that recovery from benzodiazepine dependence differs from other substance use disorders. The process typically involves a slow, gradual taper rather than abrupt discontinuation, and withdrawal symptoms may persist for months. This extended timeline can be challenging for both the person in recovery and their support system. Patience and ongoing encouragement become especially valuable during this process.

Family therapy can be particularly beneficial during recovery, as it provides a structured environment to address relationship dynamics, rebuild trust, and improve communication patterns. With professional guidance, families can learn to navigate the emotional challenges that often accompany recovery and develop healthier ways of relating to each other.

Remember that your loved one may experience cognitive difficulties, emotional changes, or sleep disruptions during withdrawal and early recovery. These symptoms are not signs of personal weakness or failure but rather expected physiological responses as the brain adjusts to functioning without the medication. Approaching these challenges with understanding rather than frustration can significantly impact your loved one's recovery experience [4].

Finding Professional Help

If you or someone you love is struggling with benzodiazepine use, professional help is available and effective.

Start with a medical evaluation with a healthcare provider familiar with benzodiazepine dependence. Explore treatment providers including addiction specialists, psychiatrists, and therapists trained in anxiety management and substance use disorders.

Consider insurance coverage for different levels of care and ask about sliding scale fees or payment plans if needed. When evaluating providers, ask about their experience with benzodiazepine dependence specifically, their approach to tapering, and how they address underlying conditions [7].

Taking the Next Step

Living with benzodiazepine dependence or supporting someone who is can be challenging, but recovery is possible with the right support. Remember that seeking help is a sign of strength, not weakness.

Ready to find specialized help for benzodiazepine concerns? Our treatment center directory connects you with qualified providers who understand the complexities of benzodiazepine use and can offer the support you need.

Use our searchable directory to find treatment centers that:

• Specialize in benzodiazepine tapering and recovery

• Offer the level of care that matches your needs

• Accept your insurance

• Provide comprehensive mental health treatment

• Are located near you or in your preferred location

Browse Our Treatment Center Directory Now

Don't wait to get the help you deserve. Take the first step toward recovery today.

Related Conditions

Learn more about other conditions and topics related to benzodiazepine use:

• Anxiety Disorders

• Substance Use Disorders

• PTSD and Trauma

• Depression

References

[1] National Institute on Drug Abuse. (2023). Prescription CNS Depressants DrugFacts. https://nida.nih.gov/publications/drugfacts/prescription-cns-depressants

[2] Guina, J., & Merrill, B. (2018). Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives. Journal of Clinical Medicine, 7(2), 17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852433/

[3] Drug Enforcement Administration. (2023). Benzodiazepines. https://www.dea.gov/factsheets/benzodiazepines

[4] Substance Abuse and Mental Health Services Administration. (2022). Treating Patients With Benzodiazepine Dependence. https://www.samhsa.gov/resource/ebp/treating-patients-benzodiazepine-dependence

[5] Lembke, A., Papac, J., & Humphreys, K. (2018). Our Other Prescription Drug Problem. New England Journal of Medicine, 378(8), 693-695. https://www.nejm.org/doi/full/10.1056/NEJMp1715050

[6] American Geriatrics Society. (2019). American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society, 67(4), 674-694. https://pubmed.ncbi.nlm.nih.gov/30693946/

[7] Soyka, M. (2017). Treatment of Benzodiazepine Dependence. New England Journal of Medicine, 376(12), 1147-1157. https://www.nejm.org/doi/full/10.1056/NEJMra1611832