Since the 1960s, benzodiazepine medications – also known as benzos – have been used in mental health treatment for a variety of conditions.
Some of the most commonly prescribed medicines in the US, benzos are used for a range of conditions, including insomnia, anxiety, and seizures. When properly used, these medications can be highly effective at treating these conditions
However, when used incorrectly or abused, benzos come with a high risk of tolerance, abuse, and addiction. Because of this, their use for treating mental health conditions can backfire, resulting in the person’s original condition not improving, while at the same time a second condition develops: a substance use disorder. As a result of this fact – and because benzos are often prescribed in ways that may make abuse and addiction more likely, according to a study in JAMA Psychiatry – benzo use disorders are some of the fastest growing substance abuse problems in the US.
Benzos make up a category of medications that act on the brain to induce a calming effect. As described in a pamphlet by the Royal College of Psychiatrists, this action occurs by increasing the effects of a neurotransmitter called gamma-aminobutyric acid, or GABA, which affects the speed at which the brain can process information. Specifically, GABA slows down the brain’s processing speed, resulting in feelings of relaxation, calmness, and sleepiness.
According to an article in Medical News Today, there is a wide range of benzos available for prescription, depending on the condition that is being treated or the intended use. The different types of benzos vary in the way they act, from low- to high-potency and from short- to long-acting.
Some of the more well-known types include:
- Alpoazolam, known by the popular brand name Xanax
- Clonazepam, known by the popular brand name Klonopin
- Diazepam, known by the popular brand name Valium
- Lorazepam, known by the popular brand name Ativan
Benzos were originally considered to be a safer choice compared to barbiturates, which are highly addictive drugs that have the same basic action on the body. However, over the years they have been used, research has discovered that benzos are also highly addictive substances.
Why Benzos Are Prescribed
A statement from the College of Psychiatry of Ireland describes benzos as being beneficial for treatment of anxiety disorders and agitation. These medicines work quickly to resolve these issues. Similarly, they can be administered to minimize or prevent panic attacks. They also work as sedatives; they can be used to treat insomnia, and they may be given before surgery to decrease anxiety and induce calm. In addition, benzos have anticonvulsive effects and can be given to help prevent seizures.
Benzos have also been used to treat alcohol- and barbiturate-based substance use disorders. Because alcohol withdrawal can be dangerous, benzodiazepines have been used to help in the detox and withdrawal process for people in treatment for alcoholism, as a way to taper off substance use. However, in recent years, treatment professionals have started to resist using benzos for that purpose because of the risk of a complicating and secondary addiction to benzos.
The Shift from Use to Abuse
After long-term use of benzos, many people seem to quickly develop tolerance to the drug, which means that the brain becomes less sensitive to the substance’s action and requires more of the substance in order to experience the same effect that was possible from a lower dose. This development of tolerance is likely due to a complex number of factors, according to an article in Advances in Pharmacological Sciences, including a reduction of GABA receptor sensitivity after long-term use of these medicines.
This tolerance often manifests in a desire to take more of the drug to get the same effect, which can then escalate to abuse of the substance. With continued abuse, the brain may become dependent on the medicine in order for the person to feel good, and addiction can develop.
Because of this risk of long-term use, doctors are advised to limit the use of these drugs to short-term use only. With short-term use, tolerance does not have a chance to build before the medicine is discontinued. However, many doctors do not adhere to this advice, and many people are given long-term prescriptions, increasing the risk of abuse.
As an example, according to a study in the American Journal of Psychiatry, benzos are often prescribed for long-term treatment of depression, with prescriptions of 90-180 days. This is considered to be off-label use; consistently taking benzos for this length of time can lead to the changes in the brain that lead to tolerance, subsequent misuse, and addiction.
Abuse Risk in Mental Health Treatment
Benzo abuse risk is particularly high among people who are being treated for other substance use disorders. For example, as described in an article from Current Psychiatry, 30-50 percent of people in detox from alcohol may also be abusing benzos. Benzos are also commonly abused by people who are using other drugs, such as heroin or other opiates.
However, benzo abuse is not only high in those who abuse other substances. Mental health disorders of many kinds also present a high risk of substance abuse, as presented by the National Institute on Drug Abuse. In combination with the high addiction potential for benzos, this makes it a risk to prescribe these medicines to mental health patients. For this reason, doctors are encouraged to be selective when prescribing these substances, taking care to avoid prescribing them to people who have these and other risk factors for substance abuse.
Signs and Symptoms of Benzo Abuse
Behaviors that may indicate a person is struggling with benzo abuse include:
- Cravings for the substance, or desire to take larger doses than prescribed
- Continued efforts to obtain the drug, to the degree that such efforts interfere with other activities
- Decreased interest in favorite activities in favor of benzo use
- Inability to keep up with responsibilities at work, school, or home
- Problems in personal relationships due to benzo use
- Secretiveness or deception around benzo use
- Inability or unwillingness to stop taking benzos despite the above issues
According to the eMedicineHealth, physical and psychological symptoms of benzo abuse or toxicity include:
- Lethargy, sleepiness, or fatigue
- Slow breathing
- Lack of coordination, slurred speech, or confusion
When to Seek Help for Benzo Abuse
If benzo tolerance, abuse, or addiction is suspected, it is important to get professional help, because benzo withdrawal can be dangerous if the drug is stopped suddenly or tapered incorrectly.
As described in Addiction, symptoms of benzo withdrawal include:
- Increased heart rate
- Muscular pain or aches
- Nausea and stomach upset
Some of these symptoms may lead to death if detox is not managed carefully by a professional. However, it is possible to manage the symptoms of withdrawal and slowly decrease benzo use with the care of a substance abuse treatment program.
At the same time, rehab centers experienced with treating co-occurring disorders can also help with finding safer ways to manage the other mental health condition. Through individualized treatment plans, these programs can address both substance use and other mental health disorders at the same time, helping the person to manage the symptoms of the mental health disorder that might otherwise contribute to continued substance abuse. By treating co-occurring disorders together, the person is more likely to be able to manage both the mental health condition and the substance use disorder.