What are Benzodiazepines?

Benzodiazepines—also known as “benzos” or “downers”—are a type of drug that work as a central nervous system (CNS) depressant and sedative.1 Under the Controlled Substances Act, benzodiazepines are a controlled Schedule IV substance—meaning they have medical purposes but also the potential for misuse and risk of dependence.2
Benzo Use and Misuse

What are Benzos Prescribed For?

Benzodiazepines are commonly prescribed to treat:1,3

Through their interaction with the gamma-aminobutyric acid (GABA) receptor in the brain, benzodiazepines can calm an over-excited nervous system.3 In addition, benzos are sometimes administered to treat alcohol withdrawal during medical detox to prevent or mitigate seizures and relax muscle spasms.1

Widely prescribed in the United States, there were over 92 million benzodiazepine prescriptions dispensed in 2019 alone.4

Most benzodiazepine medications are available in the form of a:1

  • Capsule.
  • Tablet.
  • Liquid (injectable or as a syrup).

Benzos are typically meant to be used as a treatment for short periods of time as they can quickly result in physiological dependence, sometimes in as little as a few weeks.3

Most Prescribed Benzos

The top 3 most commonly prescribed benzos in 2019 were:4 (92 million times the percentages)

Benzodiazepines can be classified as short to intermediate-acting and long-acting,5 which refers to the drug’s duration of action in the body (specifically the elimination half-life). Benzo duration of action can range from less than 6 hours to more than 24 hours.1

Short- to intermediate-acting benzodiazepine medications include:5

  • Versed (midazolam).
  • Halcion (triazolam).
  • Klonopin (clonazepam).
  • Serax (oxazepam).
  • Ativan (lorazepam).
  • Xanax (alprazolam).
  • Restoril (temazepam).

Long-acting benzodiazepine medications include:5

  • Valium (diazepam).
  • Dalmane (flurazepam).
  • Librium (chlordiazepoxide).
  • Tranxene (clorazepate).

Benzodiazepine Misuse

While benzodiazepines have several recognized medical purposes, they are also common drugs of misuse. According to the 2021 National Survey on Drug Use and Health, 3.9 million people in the United States 12 years or older misused prescription benzodiazepines.6

Benzodiazepines are sometimes misused:5

  • For their euphoric properties.
  • To enhance the effects of other drugs (such as opioids or alcohol).
  • To mitigate the undesired effects of other drugs (such as insomnia from stimulant use).

Benzodiazepines are often manufactured or diverted from legitimate sources and sold illegally with the intention of being misused. Illicit pills may not be what they appear to be or may contain adulterants, such as deadly doses of fentanyl.7 Common street names for benzodiazepines include:1

  • Nerve pills.
  • Benzos.
  • Downers.
  • Tranks.

Benzodiazepine Side Effects

Benzodiazepine side effects include but are not limited to:8

  • Feeling drowsy.
  • Poor concentration.
  • Slowed breathing.
  • Slurred speech.
  • Confusion.
  • Light-headedness.
  • Dizziness.
  • Headache.
  • Lowered blood pressure.
  • Dry mouth.
  • Problems with memory and coordination (movement).
Benzodiazepines and Polysubstance Use

Dangers of Mixing Benzos with Other Substances

Taking two or more substances at the same time or within a short period of time, also known as polysubstance use, can be very dangerous. In 2019, almost 50% of drug overdose deaths involved more than one substance.9

Polysubstance use involving benzos is especially common and dangerous. People may intentionally take benzos with other substances to enhance the effects of the drug (e.g., opioids or alcohol) or ease undesirable effects of a drug (such as stimulant comedown).5,9 Co-ingesting benzodiazepines with other substances, particularly alcohol and opioids, is associated with an increased risk of overdose.10

Someone may unintentionally engage in benzo polysubstance use if they are unaware of the dangers of drinking alcohol while taking their prescribed medicine or if they take an illicitly manufactured benzo pill that has been laced or cut with other substances (like fentanyl).11

Mixing Benzos with Alcohol

Mixing benzodiazepines with alcohol (also a CNS depressant) can be very harmful. This combination can suppress vital body systems like respiration, potentially causing a fatal overdose.12

Other potential health risks of drinking alcohol and using benzodiazepines at the same time can result from oversedation, symptoms of which include:12,13

  • Drowsiness.
  • Dizziness.
  • Impaired motor control.
  • Issues with memory.
  • Falls and other serious injuries.
  • Slowed or difficulty breathing.

Mixing Benzos with Opioids

Concurrent use of benzos and opioids is highly dangerous, potentially resulting in over-sedation, impaired cognitive function, and suppressed breathing. Fatal overdoses involving benzodiazepines overwhelmingly also involve opioids.14

In 2020, 16% of overdose deaths involving opioids also involved benzos.14

Can you Overdose on Benzos?

Yes, you can overdose on benzos; however, fatal overdoses involving benzodiazepines usually involve multiple substances. Dosage, age, weight, tolerance, and even genetics can also affect someone’s risk of an overdose.15

Signs of an overdose involving benzodiazepines and other depressants or opioids include but are not limited to:11,15

  • Altered mental status or confusion.
  • Involuntary movements or poor muscle control (ataxia).
  • Slowed or stopped breathing.
  • Weak pulse.
  • Passing out or loss of consciousness.

An overdose is a medical emergency requiring immediate emergency services. If you suspect someone is overdosing, call 911 immediately.11

If opioid use is suspected to be involved in an overdose, naloxone (Narcan) can be administered to reverse the overdose while awaiting the arrival of emergency services.11 If you do not know if opioids were involved but have access to naloxone, it should still be given, as it may help yet will not harm the person; naloxone only affects a person who has taken an opioid.16

Benzodiazepine Addiction and Withdrawal

Benzodiazepine Addiction

Addiction is characterized as the compulsion to seek and use a drug despite serious negative effects on one’s life.14 Benzodiazepines, in particular, are addictive for several reasons:

  • Benzos can cause physiological dependency quickly. Even people that are using benzodiazepines as prescribed may experience withdrawal symptoms when they cease or reduce their use. People sometimes continue using benzodiazepines simply to avoid withdrawal.3
  • Benzodiazepines are associated with an increase in dopamine activity (a brain chemical associated with motivation and reward that serves to reinforce use).3
  • As discussed above, benzodiazepines are frequently misused with other substances. People that engage in polysubstance use involving benzos tend to take higher doses of benzos than those who only use benzodiazepines.18 High dose use of benzos can speed up the development of dependence more quickly, and polysubstance use can further complicate the withdrawal process.19

Signs of Benzo Addiction

The criteria for diagnosing a sedative use disorder—the clinical term for benzodiazepine addiction—outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) are as follows:17

  1. The sedative is often taken in larger amounts or over longer periods of time than was intended.
  2. There are unsuccessful efforts or a persistent desire to control or cut down sedative use.
  3. A large amount of time is spent in obtaining, using, or recovering from the effects of the sedative.
  4. There is a strong desire or urge to use the sedative, also known as craving.
  5. Failure to fulfill major role obligations at home, school, or work due to recurrent sedative use.
  6. Continued sedative use despite persistent interpersonal or social problems exacerbated or cause by the effects of the sedative.
  7. Important occupational, recreational, or social activities are reduced or given up because of sedative use.
  8. Repeated sedative use in physically hazardous situations (e.g., while driving).
  9. Continued sedative use despite knowledge of a persistent psychological or physical problem.
  10. Markedly larger amounts of the sedative are needed to achieve the desired effect, also known as tolerance. This criterion is not considered to be met if someone is taking a sedative as prescribed.
  11. Symptoms of withdrawal occur if sedative use is decreased or abruptly stopped. This criterion is not considered to be met in someone taking a sedative as prescribed.

Experiencing 2 or more of the above symptoms within 12 months indicates sedative use disorder. However, please note that sedative use disorder is a medical condition that requires a diagnosis from a professional.17 If you suspect that you or your loved one may have a benzodiazepine addiction, reach out to a medical professional for an evaluation.

Benzo Withdrawal Symptoms

Anyone that has consistently used benzodiazepines for 3-4 weeks is likely to experience withdrawal when they stop or significantly reduce their use.20 Withdrawal symptoms can occur even when someone has been taking benzos as directed by their healthcare provider for a medical condition.14

Symptoms of benzodiazepine withdrawal may include:17

  • Insomnia.
  • Anxiety.
  • Nausea or vomiting.
  • Sweating.
  • Pulse rate greater than 100 beats per minute.
  • Hand tremor.
  • Repetitive or unintentional movements (psychomotor agitation).
  • Seizures.

Individuals with severe withdrawal symptoms may experience auditory, visual, or tactile hallucinations or illusions.17 Some people may also show symptoms that resemble serious neurological and psychiatric conditions including seizure disorders and schizophrenia. Additionally, people experiencing benzo withdrawal are at a heightened risk of suicide.3

One of the most dangerous potential symptoms of benzo withdrawal are seizures.19 A grand mal seizure can occur in as many 20-30% of people experiencing withdrawal without medical treatment.17 Medical detox greatly reduces the risk and severity of seizures during benzo withdrawal.19

The timeline of benzo withdrawal heavily depends on the type of benzodiazepine used. With short- to intermediate-acting benzos, withdrawal symptoms may develop within several hours after the last dose, peak on the 2nd day and ease by the 4th or 5th day. With long-acting benzos, symptoms typically peak the 2nd week after cessation and decrease by the 3rd or 4th week.17

In some cases, protracted withdrawal may occur, and certain symptoms may continue for several months after quitting. Symptoms of protracted withdrawal may include:21,22

  • Anxiety.
  • Depression.
  • Insomnia.
  • Memory and cognitive impairment.
  • Paresthesia (burning or prickling sensations).
  • Formication (feeling like insects are crawling under your skin).
  • Tinnitus.
  • Weakness, tremors, or muscle twitches.

Protracted withdrawal can last several weeks to more than 12 months after quitting.

Treatment for Benzo Addiction

Benzo Addiction Treatment Options

Evidence-based treatment can help people struggling with benzodiazepine addiction achieve lasting recovery.17,23

Medical detox is often a necessary first step in treating benzo addiction.16 It is common for people in medical detox for benzodiazepine addiction to be given tapering doses of a long-acting benzodiazepine to ease withdrawal and reduce the risk of seizures. Sometimes, phenobarbital is administered additionally or in lieu of a benzodiazepine.19

Patients in the medical detox program at Sunrise House Treatment Center in Lafayette, New Jersey receive around-the-clock care from a team of nurses and doctors that are ready to respond to any potential emergencies.

After patients have safely withdrawn from benzos in medical detox, most require continued treatment to address the psychological and social factors that contribute to the thoughts and behaviors that support their addiction.19,23 Addiction treatment typically involves a combination of behavioral therapy, peer support, psychoeducation, medication (if needed), and treatment for any present co-occurring disorders. These interventions may be performed in various settings, such as an inpatient drug rehab, outpatient rehab program, or 12-step program.23

The levels of addiction treatment offered at Sunrise House include:

For more information on benzodiazepine addiction treatment, rehab admissions, rehab payment options, and using your insurance to cover rehab, reach out to Sunrise House’s confidential admissions navigators available 24/7 at .

Verify your insurance coverage at Sunrise House using the confidential .

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