Benzodiazepines make up a class of prescription medications that are used to treat conditions like anxiety, panic disorder, and insomnia.
Sometimes, they are also used in the treatment of seizure disorders and alcohol withdrawal. These drugs are powerful central nervous system (CNS) depressants, which affect a neurotransmitter called gamma-aminobutyric acid (GABA). By enhancing the activity of this neurotransmitter in the brain, benzodiazepines slow down GABA receptor firing and reduce stress reactions in the body.
There are around 15 types of benzodiazepines on the market today, and they can be very effective for short-term use. They help a person stabilize their brain chemistry to stop panic attacks, relax, get sleep, and seek out help from a therapist. However, benzodiazepines can also be very habit-forming, so they are typically not prescribed for longer than one month.
Benzodiazepines are not meant to prevent drug abuse, but they can help manage withdrawal symptoms during detox, so the person can safely and comfortably end their physical dependence on a substance and continue into rehabilitation with reduced potential for relapse.
How Are Benzodiazepines Used in Substance Abuse Treatment?
One of the most consistent off-label uses for benzodiazepines is in the treatment of delirium tremens related to alcohol use disorder. Delirium tremens is a serious, dangerous cluster of withdrawal symptoms that are typically related to heavy and long-term alcohol abuse. If left untreated, symptoms begin within two days after the last drink and peak in 7-10 days.
Symptoms of delirium tremens include:
- Changes in cognition
- Extreme agitation, irritability, or mood swings
- Confusion or disorientation
- Deep sleep for 24 hours or longer
- Excited delirium
- Paranoia or delusions
- Sensitivity to light or sound
- Extreme fatigue
There are many dangerous withdrawal symptoms associated with delirium tremens, but the most dangerous is seizures. Since benzodiazepines can treat seizures, physicians associated with rehabilitation programs may prescribe long-acting benzodiazepines to prevent or reduce the most intense and dangerous of the delirium tremens symptoms until they pass. Once the person has stabilized, and their withdrawal symptoms are beginning to ease, the physician will typically begin a taper to help the person ease off their benzodiazepine prescription. The two most common benzodiazepines used in the treatment of alcohol withdrawal are chlordiazepoxide (Librium) and diazepam (Valium).
Benzodiazepines are also one of many useful tools in the larger treatment of anxiety and panic disorders. These conditions could lead to self-medication and later substance abuse to moderate stress. Instead of abusing illicit CNS depressants, individuals can get medical supervision and use benzodiazepines for immediate, as-needed, or short-term treatment of intense anxiety symptoms, panic attacks, and insomnia. This approach can help individuals avoid addiction to other substances, stabilize their mood, and find the long-term help they need to overcome their anxiety or panic disorder.
People who become addicted to benzodiazepines are more likely to seek out short-acting versions, such as Klonopin, because they can create an almost immediate euphoria, especially at larger doses. They are not designed for slow release into the body. During treatment to overcome this type of substance abuse, a medical practitioner may replace a short-acting benzodiazepine with a long-acting one, such as diazepam, to help the person stop the habit of taking frequent doses of the drug. During this restructuring, the individual will not experience intense cravings or serious withdrawal effects, as they have a benzodiazepine in their body. The drug can be slowly tapered, so the person’s physical dependence on it will end, and their brain chemistry can return to normal. This is considered the best treatment for benzodiazepine addiction.
Due to the risk of serious withdrawal symptoms, benzodiazepines should never be stopped suddenly. Medical detox, with continual medical oversight, is required for benzodiazepine withdrawal.
What Are the Risks of Using Benzodiazepines in Substance Abuse Treatment?
Although benzodiazepines are effective treatments for various issues, they come with risks. Here are the most common risks:
- Potential for abuse: Benzos create similar effects on the brain as alcohol, since both drugs are types of CNS depressants. Some studies have shown that benzodiazepines may “prime” the brain to begin abusing alcohol again; this is why it is important for physicians to closely monitor patients during withdrawal if benzodiazepines are prescribed and ensure that the drugs are only used for a short period of time. Each person should engage in a comprehensive rehab program that includes intensive therapy. Detox alone is not treatment for addiction.
- Enhancement of other drugs: Benzodiazepines can enhance the effects of other CNS depressants, including alcohol and opioids. People in treatment for opioid abuse, especially using buprenorphine or another drug replacement therapy to overcome their narcotic abuse problem, may use benzodiazepines to enhance the euphoric or recreational effects of their medication. This only continues the substance abuse problems, so it is important to monitor all medications when a client is taking any benzodiazepines.
- Rebound effects: Benzodiazepines work to treat seizures by relaxing the body, not through true antispasmodic actions, so they may not be the best option for a long-term seizure disorder, especially if it is due to a drug-induced condition. If benzodiazepines are used in the treatment of any current or potential seizure condition, the treatment drug should be carefully tapered down to prevent rebound seizures. When a person attempts to stop taking benzodiazepines “cold turkey,” they may experience withdrawal symptoms that are like the conditions benzodiazepines are intended to treat, such as anxiety, insomnia, and seizures. Tapering from long-acting benzodiazepines, such as diazepam, which are typically used in the treatment of alcohol withdrawal, may take longer than tapers from short-acting benzodiazepines.
- Protracted withdrawal: Sometimes referred to as benzodiazepine withdrawal syndrome, protracted withdrawal is the extended experience of serious withdrawal symptoms related to benzodiazepine abuse. It is more likely to occur in people who have struggled with addiction to benzodiazepines for a long time, at high doses, and/or with long-acting benzodiazepines. An extended taper off the benzodiazepine is the best option for people who are at risk.
What Are the Benefits of Use?
Despite their potential dangers, benzodiazepines can be very effective for some people in certain medical situations. Those overcoming panic attacks, short-term insomnia with anxiety as the underlying cause, delirium tremens or seizures from alcohol withdrawal, and abuse of short-acting benzodiazepines can all benefit from tightly controlled and monitored doses of benzodiazepine medications. If a person has struggled with substance abuse issues, especially alcohol use disorder, then it is important for the doctor and patient to have an honest conversation about addiction and how that might impact the person’s reaction to benzodiazepines. One may decide to pursue other forms of medical treatment, or they may decide that benzodiazepines can be a useful short-term tool in the larger recovery plan.
Benzodiazepines can be effectively used to treat withdrawal symptoms related to alcohol or drug recovery. Since these medications have a high risk of abuse, they should not constitute the entirely of treatment for substance abuse and any underlying mental health conditions. Most importantly, a doctor should always monitor benzodiazepine consumption and make sure the patient does not exhibit signs of abuse or addiction.