The reality of benzodiazepine use and addiction is marked by widespread use and a significant risk of misuse. Benzodiazepines, often prescribed for their anxiolytic and sedative properties, carry a potential for dependence and addiction. Misuse, defined as taking these medications without a prescription or in ways not intended by a healthcare provider, is a growing concern. With millions reporting past-year use and a considerable percentage engaging in misuse, the challenge lies in balancing their therapeutic benefits against the risks of addiction and other adverse effects.
What are benzodiazepines?
Benzodiazepines are a class of prescription drugs known as central nervous system (CNS) depressants, which are commonly prescribed to treat conditions like anxiety, panic disorders, insomnia, and seizures. They work by enhancing the effect of the neurotransmitter GABA (gamma-aminobutyric acid), which results in a calming effect on the brain and nerves. Because of their sedative, muscle-relaxant, anticonvulsant, and anxiolytic properties, benzodiazepines are effective for short-term treatment of these disorders.
However, benzodiazepines carry a risk of dependence and addiction, especially with long-term use or misuse, and withdrawal from them can be severe or even life-threatening. Therefore, their use is typically recommended to be limited to the short-term relief of anxiety or insomnia.
Examples of benzodiazepines include:
- Alprazolam (Xanax): Used to treat anxiety and panic disorders.
- Diazepam (Valium): Prescribed for anxiety, alcohol withdrawal, and muscle spasms.
- Lorazepam (Ativan): Often used for anxiety disorders.
- Clonazepam (Klonopin): Used for seizure disorders and panic disorder.
- Chlordiazepoxide (Librium): Utilised in the management of anxiety and alcohol withdrawal symptoms.
Each benzodiazepine varies in potency, duration of action, and specific therapeutic use, making it important for their prescription and use to be closely monitored by a healthcare professional.
Risk of addiction
Benzodiazepines, prescribed for conditions such as anxiety, insomnia, and seizures, can lead to physical dependence and addiction. This class of medications works by enhancing the effect of the neurotransmitter GABA, leading to sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties.
The risk of addiction increases with the duration of use, higher dosages, and in individuals with a history of substance misuse. Once dependence has developed, discontinuation can result in withdrawal symptoms, which can be severe and include anxiety, insomnia, seizures, and even death. The challenge lies in balancing the therapeutic benefits of benzodiazepines against their potential for abuse and dependence.
Stats of benzo misuse
Research highlights a concerning trend in the misuse of benzodiazepines. For instance, a review of epidemiological studies and articles reveals a dramatic increase in misuse and overdose deaths, particularly when benzodiazepines are combined with opioids. The severity of the issue is underscored by statistics indicating that nearly 14% of opioid-related overdose deaths also involved benzodiazepines.
The rising prescription rates, partly attributed to the COVID-19 pandemic, have further fueled this epidemic. A prospective observational study conducted in Catalonia between March 2020 and December 2021 observed an increase in benzodiazepine prescriptions during the pandemic compared to the previous two years, highlighting the impact of global crises on prescription behaviours.
Physicians often find themselves prescribing benzodiazepines despite acknowledging their risks, driven by the drugs’ efficacy. This dilemma points to the need for interventions aimed at reducing benzodiazepine prescriptions to mitigate their public health impact.
Consequences of long-term benzo use
Long-term benzodiazepine use presents significant health risks and psychological impacts, including a wide range of withdrawal challenges. Users can experience cognitive impairments such as decreased attention, memory, and psychomotor performance. These cognitive issues may persist or only partially improve after cessation of use, particularly in the elderly, where the risk of cognitive decline is amplified.
Withdrawal symptoms, potentially lasting for months, can include:
- Insomnia
- Worsened anxiety
- Vomiting
- Tremors
- Seizures
- Hallucinations
The process can be difficult and, in some cases, dangerous, emphasising the importance of medical supervision during cessation.
Long-term benzodiazepine use is associated with physical health risks, such as an increased risk of hip injuries in older adults and permanent cognitive impairment. It also has a paradoxical effect on conditions it’s often prescribed to treat, like anxiety and sleep disorders, by potentially worsening them over time.
The development of dependence and addiction is another significant risk. Many users may not realise their increased dependency until attempting to stop, facing challenging withdrawal symptoms that can lead them back to usage or seeking the drug beyond medical prescriptions.
Given these risks, alternatives to benzodiazepines for anxiety and insomnia, such as antidepressants, psychotherapy, and other non-addictive medications, are recommended to avoid the long-term consequences of benzodiazepine use.
Seeking help
Recognising the signs of benzodiazepine addiction is important. It often begins with a dependency on the medication for normal functioning, leading to increased tolerance and, eventually, withdrawal symptoms like sweating, panic attacks, tremors, insomnia, and seizures when attempting to quit. Addiction entails a compulsion to use the drug despite knowing its negative consequences, highlighting the need for professional intervention.
There are resources available for those seeking help with benzodiazepine addiction, including those offered by UKAT.
Recovery from benzodiazepine addiction involves a comprehensive approach, including professional treatment, ongoing therapy, participation in support groups like Narcotics Anonymous, stress management, and education on addiction and relapse prevention. It’s a journey that requires patience, support, and access to reliable information and medical care.
If you or someone you know is struggling with benzodiazepine addiction, reaching out for help is a vital first step. Through professional guidance and support networks, recovery is not just a possibility but a pathway to regaining control over one’s life.