However, when benzodiazepine addiction is in evidence, it is not possible to treat the issue out of a general practitioner’s office. A comprehensive medical detox and addiction treatment program is recommended. The following steps are involved in the recovery process:
Steps Involved in Benzodiazepine Detox and Addiction Treatment
- Step 1: Stabilize physically. It is not uncommon for clients to enter treatment for benzodiazepine addiction in a state of crisis. Due to a medical emergency, including accident or overdose, or a psychotic episode caused by intensive drug use, it may be first necessary to stabilize the patient and ensure that they are not in danger medically as well as not a threat to self or others.
- Step 2: Evaluate and assess. Once stabilized in treatment, the client can begin the process of evaluation and assessment that will provide the medical and therapeutic history to inform a treatment plan that can be personalized to meet the individual’s needs. This can include a thorough medical exam to assess acute and/or chronic medical issues that may have gone undiagnosed or untreated, mental health diagnoses, and behavioral and learning disorders, if any. In addition, any other significant issues that may impact the client’s ability to thrive in recovery will be noted.
- Step 3: Withdraw from the substances of abuse. Withdrawal symptoms associated with benzodiazepine detox can be intense both physically and psychologically. For most clients, it is necessary to devote the first 1-2 weeks in recovery to the medical process of detox. Though this is the primary focus, the client will also have access to psychological support and treatment. However, the focus initially is on medical monitoring and getting and staying as comfortable as possible until symptoms begin to fade and the person is free of physical dependence.
- Step 4: Address rebound anxiety. It is common for people who take anti-anxiety medications to experience rebound anxiety when they stop taking the drugs, with or without the presence of an addiction. If this occurs for a client in a state of withdrawal, it is important that appropriate medical and mental health treatment be immediately available.
- Step 5: Treat any underlying trauma. Many who struggle with anxiety have the experience of trauma in their history. Whether a single traumatic event occurred in childhood, or the person was victim or witness to ongoing abuse, the experience may have contributed to the development of anxiety as well as the benzodiazepine addiction and therefore must be thoroughly explored and addressed in treatment.
- Step 6: Address co-occurring disorders. Social anxiety, depression, generalized anxiety, mood disorders, panic disorder, and other mental health issues can and should be addressed within the context of treatment for benzodiazepine addiction. The two disorders are often so deeply entwined that it is all but impossible to extricate one from the other and treat it successfully.
- Step 7: Engage with peer support. Learning from the experiences of others, sharing one’s own experience and challenges, getting support during treatment, and offering support in return are just a few of the benefits that can be had by developing a strong peer group in treatment. Support groups, 12-Step meetings, and simply being in treatment with others can provide the connection necessary to build positive relationships with others who are similarly working to stay healthy.
- Step 8: Involve the family. Family members can play a critical role in helping clients in recovery to stay committed to treatment and learn how to navigate the ups and downs that come with transitioning into independent living in recovery. Treatment should offer family members the education they need to better understand the nature of addiction and treatment as well as support to get treatment on their own for issues related to the addiction. Family therapy should be available for all primary relationships. Support groups can help family members to learn more about codependency and how best to maintain boundaries with loved ones in treatment for the best interest of all involved.
- Step 9: Safeguard against relapse. Learning healthy coping mechanisms is essential for people who have formerly turned to benzodiazepines alone or in combination with other substances as a way to manage mood, stress, and boredom. Relapse prevention groups can help clients to explore possible triggers and create an actionable plan for managing those issues in recovery without turning to drugs or alcohol.
- Step 10: Engage an aftercare and support plan. Detox is an important first step in treatment, and therapeutic intervention is critical to helping a client to stabilize in recovery, but aftercare and support that come after treatment is complete is the core that holds everything together. Without ongoing engagement with recovery principles and people who are supportive of a new life without drugs and alcohol, it is far too easy to slip back into old habits. A fresh start in independent living in sobriety is most likely when clients continue to take an active role in their recoveries and stay connected with a positive peer support group.
What Are Benzodiazepines Prescribed to Treat?
Benzodiazepines make up a classification of medication that include drugs commonly prescribed to treat anxiety disorders, including panic disorder, generalized anxiety disorder, and social anxiety. Short-acting benzodiazepines, like lorazepam (e.g., Ativan), may be prescribed for panic and acute episodes of anxiety because their effects are felt more rapidly as compared to antidepressants, and they are then processed out of the system within a few hours. Longer-acting benzodiazepines may be used when short-acting benzodiazepines are not appropriate or effective.
On occasion, benzodiazepines may be prescribed to treat insomnia, especially if the inability to fall asleep is related to anxiety issues. Additionally, benzodiazepines have sometimes been incorporated into the detox treatment of those who are struggling with severe alcohol withdrawal symptoms or as anticonvulsants for the long-term treatment of seizures caused by epilepsy.
In all cases, the goal is often to make use of benzodiazepines, short-acting or long-acting, for as brief a time as possible. Because they are dangerous drugs and highly addictive, any use of benzos should be monitored by a doctor and any issues should be discussed with the prescribing physician as soon as possible.
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Benzodiazepine Stats and Facts
- Rates of prescription for benzodiazepines are high in the United States. The Centers for Disease Control and Prevention (CDC) reports that 37.6 prescriptions for benzodiazepines were written per 100 persons in the US in 2012. Rates of benzodiazepine prescriptions were highest in the South. According to a study published in the medical journal JAMA Psychiatry in 2015, this amounted to about 5.2 percent of US adults between the ages of 18 and 80 in 2008.
- Rates of drug overdose deaths caused by use of benzodiazepines have increased steadily between 2001 and 2014. The National Institute on Drug Abuse (NIDA) reports that there were fewer than 1,750 deaths due to benzo overdose in 2001, but in 2014, about 8,000 people lost their lives due to benzodiazepine use.
- The use of alcohol in combination with benzodiazepines is an especially risky behavior. The CDC report that about 27.3 percent of emergency room admissions caused by use of benzodiazepines involved the use of alcohol and that 21.4 percent of deaths caused by benzodiazepine overdose also involved the use of alcohol.
- The use of painkillers in combination with benzodiazepines has become an increasingly problem as well. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that the number of people seeking treatment for both benzodiazepine and painkiller abuse or addiction increased 569.7 percent between 2000 and 2010. Of this number, about 45.5 percent of people reported using benzodiazepines daily in the month prior to entering treatment.
How Benzodiazepines Work
The Center for Substance Abuse Research at the University of Maryland (CESAR) reports that benzodiazepines enhance the activity of a neurotransmitter in the brain called gamma-aminobutyric acid (GABA). This has the effect of slowing down the nerve impulses throughout the body, allowing the individual to relax and feel more calm.
Depending on the type of benzodiazepine used and the dosage, this effect may occur more or less rapidly. Short-acting benzos are processed out of the body more rapidly than long-acting benzos, making them somewhat safer for use. Because long-acting benzos remain in the body longer, they can accumulate with regular use and ultimately become overwhelming to the user, especially if the person also drinks alcohol or uses other drugs.
Signs of Benzo Abuse
There are a number of signs that therapeutic use of benzodiazepines has turned into a substance abuse problem. These will vary depending on the person, the type of benzodiazepine they are using, the dose, and the use (or not) of other illicit substances, including alcohol.
In general, however, CESAR reports that the short-term effects of low to moderate doses of benzodiazepines may include:
- Lack of coordination
- Extreme drowsiness or fatigue
- Impaired cognitive ability and/or memory
- Slurred speech
- Respiratory depression
- Change in appetite
- Constipation or diarrhea
- Nausea and/or vomiting
At higher doses, benzodiazepines may cause any of the above issues as well as:
- Mood swings
- Slow reflexes
- Erratic or aggressive behavior
- A high
Additionally, when a benzodiazepine abuse problem, including addiction, is in evidence, the person may exhibit a number of behaviors that can be red flags, including:
- Crushing pills before use
- Snorting crushed pills or dissolving them in water and injecting the solution
- Purposefully combining benzodiazepines with the use of alcohol or other drugs
- Often seeking emergency refills from emergency rooms and doctors’ office due to “loss”
- Going to multiple doctors with the goal of getting multiple prescriptions for benzodiazepines
- Attempting to fill prescriptions at multiple pharmacies
- Lying about drug use
- Experiencing personality changes
- Letting go of interests, relationships, and goals that were once important
- Spending more time in isolation
Health Issues Caused by Benzodiazepine Abuse
There are a number of different adverse effects and potential consequences that may negatively impact someone’s health when taking benzodiazepines.
- Physical dependence: Physical dependence on benzodiazepines can occur with any long-term use of the medications even with a doctor’s supervision and great care given to following the prescription exactly. This means building a tolerance, or requiring more and more of the drug in order to achieve the original effect. This issue can trigger withdrawal symptoms even at low doses and should be monitored by a doctor.
- Impaired cognitive ability: Benzodiazepines serve to slow down all functions of the brain and body, including how the brain processes information and responds to stimuli. This occurs both while under the influence of the drug and in the time after it wears off. For those who take the substance regularly, it can strike hard at the ability to function well at work, manage commitments at home, or make positive decisions in general.
- Impaired driving ability: A significant issue that occurs when using benzodiazepines is a marked decline in the ability to drive safely. Drugged driving occurs when a driver is under the influence of a mind-altering drug whether or not that drug was prescribed by a doctor. Drugged driving can be fatal to the driver, passengers, and others on the road.
- Risk to safety among seniors: In a study published in the journal Expert Opinion on Drug Safety, researchers reported that use of benzodiazepines, though common among older adults, may not be advisable due to the increased risk of falls, sedation, cognitive impairment, impaired driving ability, and negative interactions with other medications and substances, including alcohol.
- Medical emergency, including overdose: Benzodiazepines cause respiratory depression, or a slowing of the breathing and heart rate. Too high of a dose can cause these functions to shut down entirely, and the risk of this or associated medical emergencies occurring increases significantly when someone takes other depressant drugs – like alcohol or painkillers – in combination with benzodiazepines.
- Addiction: Addiction to benzodiazepines occurs when someone experiences both a physical dependence as described above and a psychological dependence on the medication. This can manifest as cravings and compulsive use of benzodiazepines at all costs without consideration for the negative consequences that develop; every day, those who are living with benzodiazepine addiction are at risk of overdose or accident under the influence. A person who is addicted to benzodiazepines is unable to stop using the drug, and should not attempt detox without professional medical and therapeutic treatment.
Most Commonly Abused Benzodiazepines
According to NIDA, benzodiazepines are one of the most commonly abused drugs. The most commonly abused benzodiazepines include:
- Alprazolam (e.g., Xanax): Xanax is the most frequently prescribed benzodiazepine in the United States, usually used in the treatment of generalized anxiety disorder and panic disorder.
- Diazepam (e.g., Valium): Valium is a rapid onset, hypnotic, anticonvulsant, sedative drug that is often prescribed for the treatment of insomnia, panic attacks, seizures, alcohol withdrawal symptoms, and restless leg syndrome. It is a low-potency benzodiazepine compared to others, but because it is so commonly prescribed, it is often abused.
- Lorazepam (e.g., Ativan): A sedative muscle relaxant, Ativan is often prescribed for the treatment of anxiety and insomnia.
- Clonazepam (e.g., Klonopin): Klonopin is a hypnotic, anticonvulsant, sedative drug that is extremely potent, due in part to the fact that it is a long-acting benzodiazepine with a half-life of 20-50 hours. It is often prescribed to treat anxiety and seizures related to epilepsy.
- Triazolam (e.g., Halcion): Halcion is a sedative used to treat severe insomnia, and it is often abused due to its high potency.
- Chlordiazepoxide (e.g., Limbitrol): Limbitrol or Librium is prescribed for the treatment of alcohol withdrawal syndrome and may be abused by patients who are not closely monitored during alcohol detox.
Co-occurring Mental Health Disorders
SAMHSA reports that about 45.7 percent of people seeking treatment for both benzodiazepine addiction and painkiller addiction also reported a diagnosis for a co-occurring mental health disorder, significantly higher than the 27.8 percent of people who also had a mental health diagnosis but cited other drugs of choice as their reason for admission. This means that, very often, it is necessary for people seeking treatment for benzodiazepine addiction to choose a treatment program that can treat both the addiction disorder and the mental health disorder at the same time, as it is likely that symptoms of the mental health issue will be a trigger for relapse if untreated.
Because benzodiazepines are so frequently prescribed for the treatment of anxiety, it is very common for people to be diagnosed with both a benzodiazepine addiction and an anxiety disorder. However, benzodiazepines are also often prescribed for the treatment of insomnia, an issue that can be related to depression as well; thus, both anxiety and depression are common disorders faced by people living with a benzodiazepine addiction. It is critical for people to learn how to manage symptoms of anxiety or depression healthfully and without the use of medication in order to keep cravings in check and minimize the recurrence of episodes related to the mental health condition.