Benzodiazepines

What are benzodiazepines?

Benzodiazepines (commonly known as sedatives and tranquilizers) are among the most frequently prescribed central nervous system (CNS) depressants in the United States today. There are many different types of benzodiazepine medica­tions. They treat a variety of psychological and physical problems, such as anxiety and sleep disorders. Due to their sedative properties, benzodiazepines have a high potential for abuse. They are especially dangerous when used in combina­tion with other drugs such as alcohol or painkillers (opiates).

Examples of commonly prescribed benzodiazepines include Xanax (alpra­ zolam), Librium (chlordiazepoxide), Valium (diazepam), and Ativan (lorazepam). One benzodiazepine that has received a great deal of media attention is Rohypnol (flunitrazepam). It is also known as “roofies” or the “date rape drug” due to its involvement in sexual assault cases.

Can benzodiazepines be abused?

Benzodiazepines, like many other prescription drugs, are abused when they are taken for nonmedical purposes. The National Institute on Drug Abuse (NIDA) states that the abuse of benzodiazepines and other prescription drugs occurs “when they are used without a prescription, in a way other than as prescribed, or for the experience or feelings the drugs give.”

The American Psychiatric Association (APA) uses the term “sedative, hypnotic, or anxiolytic use disorder” to define a pattern of use that leads to signifi­cant physical, interpersonal, medical, or work problems. Sedative, hypnotic, or anxiolytic use disorder is rated as mild, moderate, or severe based on how many criteria are met. A person diagnosed with this disorder can also be classified as in remission, or what is commonly referred to as “in recovery.” Those with sub­ stance use disorder should receive treatment, and those who identify themselves as addicts often find the skills and support to stay sober through peer support groups like Narcotics Anonymous.

Long­term prescription use of benzodiazepines can build tolerance and even­tual physical dependence, or addiction. When abuse leads to dependence and the drug is suddenly stopped or its dosage dramatically reduced, a dangerous with­drawal can occur, resulting in seizures or other harmful consequences. It is rec­ommended that benzodiazepine users seek medical supervision to help them quit.

Addiction is considered a brain-­based disease characterized by abnormal drug­-seeking behavior that leads to impaired control over one’s drug use. Addic­tion means a person will continue using alcohol or other drugs despite the harm it does to their health, family, work or school, and relationships. An addict may ex­perience withdrawal symptoms (physical pain, fatigue, depression, trouble sleep­ ing, irritability) if they stop using, and may need to keep using just to feel normal. “Curing” addiction is not a matter of willpower or moral strength any more than is curing diabetes or cancer. Like diabetes and cancer, addiction is considered a chronic disease which is beyond one’s control and fatal if left untreated.

How does the abuse of benzodiazepines affect a co-occurring mental health disorder?

Co­occurring disorders, or dual disorders, occur when a mental health disorder, like depression or schizophrenia, is present along with addiction, alcoholism, or other substance use disorders. Screening for co­occurring disorders should be part of any good assessment or treatment plan.

Taking a non­prescribed tranquilizer or sedative to help with sleep or to re­ lieve anxiety can put a person with a co­occurring disorder at risk. For example, a patient receiving a prescribed dosage of Librium for anxiety, and who at the same time is abusing his friend’s benzodiazepines, can endanger his own mental and physical health.

A person with co­occurring disorders should be under the supervision of an addiction specialist who understands the interaction of mood­altering substance use and mental health disorders, especially in the case of any use of benzodiaze­ pines, whether prescribed or not.

Due to their high probability for abuse, benzodiazepines are rarely admin­ istered by treatment centers in the U.S. for any mental health disorder that co­occurs with a patient’s substance use disorder.

How do benzodiazepines affect the brain?

The role of brain chemistry in substance use disorders is a relatively new finding in the treatment field, but a rapidly growing body of evidence supports it.

Like all drugs, benzodiazepines affect a certain neurotransmitter in the brain. The one benzodiazepines affect is called gamma­aminobutyric acid (GABA for short). Because benzodiazepines tend to slow brain activity, the drug produces a drowsy or calming effect. When prescribed medically, a benzodiazepine can be beneficial to people with anxiety or sleep disorders.

In general, there are two categories of benzodiazepines: one is short­acting and the other is long­acting. The length of time the drug remains in the blood­ stream of an individual is what distinguishes them. Long­acting benzodiazepines used for more than six months can produce a phenomenon known as tolerance, where more of the drug is needed just to get the same effect. Tolerance is one of the signs of a substance use disorder.

Is addiction to benzodiazepines treatable?

Yes. Persons addicted to benzodiazepines should not try to stop taking them on their own. Withdrawal symptoms from these drugs can be problematic and—in the case of certain CNS depressants—life­ threatening. Persons addicted to benzodiazepines should undergo medically supervised detoxification. Inpatient or outpatient counseling can also help individuals through this withdrawal pro­ cess. Cognitive ­behavioral therapy—which focuses on modifying the patient’s thinking, expectations, and behaviors while increasing skills for coping with various life stressors—has been used successfully to help individuals adapt to discontinuing benzodiazepine use.

Addiction won’t go away like a cold or the flu. It is a chronic disease, meaning you have it all your life. However, by staying sober and getting ongoing support, recovering people can live normal, healthy, productive lives.

Web resources

There are many resources out there. The websites for the following organizations were chosen for their usefulness and user friendliness.

Center for Substance Abuse Research (CESAR)

An organization affiliated with the University of Maryland, CESAR is dedicated to addressing substance abuse by educating the public and researching preven­ tion and treatment strategies. CESAR’s website includes access to in­depth drug information.

National Institute on Drug Abuse (NIDA)

This government organization is dedicated to addiction research and education. Through its website you can access up­-to­-date publications about many different drugs of abuse as well as emerging trends.