Benzodiazepines are a class of psychiatric medications used in the short-term treatment of anxiety, panic disorders, and insomnia. They can also be used to treat seizure disorders, including epilepsy. For the most part, benzodiazepines are prescribed for use “as needed,” or for no more than one month of regular use; this is because benzodiazepines are very habit-forming. They affect the neurotransmitter, gamma-aminobutyric acid (GABA), helping people who are struggling with anxiety to relax. However, they can also lead to a relaxed, euphoric high, which can be addictive for some people.
This group of medications is important in psychiatric settings. When their use is supervised by a psychiatrist or therapist, benzodiazepines can be a useful tool to overcome some addictions.
How Benzodiazepines Are Used in Detox
When used as part of a detox and/or rehabilitation program to overcome addiction, benzodiazepines should be monitored closely by the medical professional who prescribes them. Since these substances have a potential to become addictive, it is important for the clinician to monitor any signs of potential addiction.
There are three uses for benzodiazepines in a detox or rehabilitation setting.
Alcohol withdrawal: When a person has struggled with problem drinking, leading to an alcohol use disorder and physical dependence on the substance, medical professionals should supervise detox to keep the individual safe. Alcohol withdrawal syndrome, or delirium tremens, can cause dangerous symptoms, including seizures, delusions, and intense anxiety. To avoid physical danger from seizures, and the potential for relapse caused by mood disorders, a psychiatrist or physician may prescribe a benzodiazepine to ease or stop withdrawal symptoms during alcohol detox. Diazepam (Valium) and chlordiazepoxide (Librium) are two long-acting benzodiazepines that are most often prescribed for alcohol withdrawal, although medium-acting benzodiazepines lorazepam (Ativan) and oxazepam (Serax) have been used successfully as well.
Benzodiazepine replacement: People who have struggled with benzodiazepine addiction typically develop their addiction when they are prescribed a short-acting benzodiazepine, like alprazolam (Xanax) or triazolam (Halcion). Since these medications act almost immediately on the brain after they are ingested, it is easy for a person to take more to get high, or to mix the fast-acting drugs with other intoxicating substances like alcohol or opioids to intensify their intoxication. To taper the drug successfully, a medical professional will likely replace the short-acting benzodiazepine with a long-acting one, like diazepam, so the habit of frequently taking the drug can be stopped; then, the doctor will work with their patient to gradually reduce the long-acting benzodiazepine dose until the individual has successfully detoxed.
Anxiety leading to addiction: Mood disorders like depression and anxiety are correlated to substance abuse problems. If a person struggles with anxiety disorder, they are more likely to self-medicate with central nervous system depressants like alcohol, marijuana, or opioid drugs. When a mental health issue and a substance abuse issue are linked, this is a co-occurring disorder. People who struggle with substance abuse may need additional psychiatric help once they detox, and this could mean a closely monitored dose of benzodiazepines to ease anxiety and panic attacks.
Once a person enters detox and rehabilitation, especially for alcohol or benzodiazepine addiction, they will begin the process of tapering these medications until their withdrawal symptoms have passed.
Side Effects of Benzodiazepines
Benzodiazepine use, even when the medication is taken as prescribed, can lead to some side effects. These include:
Drowsiness or fatigue
Trembling or shaking
Loss of coordination
Grogginess or feeling “drugged”
People who are concerned about benzodiazepines and physical dependence, further substance abuse, or relapse should speak with their doctor. While this medication is often the best option to treat intense short-term anxiety and alcohol withdrawal symptoms, it is still very habit-forming. Though benzodiazepines may be helpful during the detox process, they should only be used under medical supervision.
Benzodiazepines are most commonly tapered when they are part of replacement therapy to overcome benzodiazepine addiction or to ease alcohol withdrawal symptoms. Tapering can depend greatly on how intense the withdrawal symptoms are, and they may be adjusted as the clinician works closely with the individual who is detoxing. A few general guidelines on dosage and tapering for alcohol withdrawal are:
Diazepam: 5-10 mg orally as needed
Lorazepam: 1-2 mg orally every 4-6 hours for the first three days
Moderate withdrawal: diazepam
Day 1: 15-20 mg four times per day
Day 2: 10-20 mg four times per day
Day 3: 5-15 mg four times per day
Day 4: 10 mg four times per day
Day 5: 5 mg four times per day
Moderate withdrawal: lorazepam
Day 1-2: 2-4 mg four times per day
Day 3-4: 1-2 mg four times per day
Day 5: 1 mg twice daily
10 to 25 mg diazepam every hour as needed, until sedation occurs, and seizures are avoided, or
1 to 2 mg of lorazepam intravenously as needed every conscious hour, for three to five days
However, this taper can be adjusted based on the individual’s needs and if they are overcoming polydrug abuse, benzodiazepine addiction, or struggling with substances because of an underlying anxiety condition. Ideally, the person should not take benzodiazepines for more than 1-2 weeks in a detox or rehabilitation setting, specifically to avoid potential addiction.