The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the standard tool for clinical professionals and researchers for the classification of mental health and substance use disorders. The DSM-5 includes benzodiazepines in its “Sedative, Hypnotic, or Anxiolytic” category and outlines the dangers of use, abuse, and dependence upon these and other substances in the same class. Review some of the following to see if they apply to you, or someone you love:
There has been an increasing amount of prescriptions written for benzodiazepines. Data from the U.S. Centers for Disease Control and Prevention in 2016 (CDC) reveal Xanax, a popular benzo, was consistently in the top 10 substances involved in overdose deaths.
Unfortunately, the numbers also show how few people actually get the help they need. Overall around less than 10% of the people needing treatment are able to benefit from quality detox followed by a long-term treatment program to address their substance use, as well as the underlying factors.
Benzodiazepine withdrawal can also be dangerous. If you are trying to gain freedom from active addiction, you may need to go through withdrawal before you achieve sobriety. Learn more about benzodiazepine withdrawal and how it can be treated.
Benzodiazepine is a class of drugs that act as a depressant. Most of the popular benzo’s were initially developed for use in the United States, in the 1980s, for the treatment of anxiety and sleep disorders. They were developed to address these issues without the harmful side effects of the traditional barbiturates of the time. Some other commonly prescribed benzodiazepines include diazepam (Valium) and clonazepam (Klonopin).
The brain and the body are constantly seeking harmony to function well. The medical term is homeostasis, and it means that when anything disrupts the CNS, efforts must be made to return to a certain level of stability. For example, when the body becomes hot from exercise or being outside in the sun, we sweat in an effort to cool off or reach the previous level of homeostasis.
Over time, benzodiazepine use will interfere with the CNS’ ability to return to a balanced state.
Everything we do affects our central nervous system. The food we eat, how much sleep we get, the quality of the air and water we inhale and ingest, even things like stress and unseen toxins in cleaning products will have some kind of an effect.
Benzodiazepines function as a central nervous system depressant, similar to alcohol. It acts as a sedative and is typically prescribed to control anxiety symptoms or help promote sleep.
Benzodiazepine use will increase the efficacy of the neurotransmitter GABA, which acts as an inhibitor throughout the CNS to prevent over-excitation or anxiety. The problem develops when the brain stops making GABA once benzos have been introduced.
The brain “understands” that all is well and decides it doesn’t need to produce more of the inhibitory GABA, which leads to someone needing more and more of the drug to maintain the anti-anxiety effects.
Additionally, benzodiazepines have a relatively short half-life, which means it is processed by your body fairly quickly, and slight withdrawal symptoms can occur between doses. This has contributed to the likelihood of it becoming a substance that is abused.
Benzodiazepine withdrawal is dangerous and should not be undergone alone, particularly when other substances are involved like opioids or alcohol. Because opioids and alcohol have similar depressant effects on the CNS, the inclusion of benzos can lead to a potentially fatal withdrawal.
The extent and severity of the withdrawal symptoms will depend on the type, frequency, and amount of benzodiazepines used by the individual. Typically the experience of withdrawal involves the opposite of the effect the drug produced.
For example, we know benzodiazepines act to increase the effectiveness of the inhibitory transmitters, during withdrawal. Those transmitters are not regulated, and an extreme excitatory reaction will occur and potentially lead to seizure activity.
Withdrawal symptoms can be acute or chronic. Acute withdrawal symptoms usually begin within a few hours to a few days after the last use and can include:
In extreme cases, chronic withdrawal symptoms can last longer than 14 days after the last use. When medically managed, most withdrawal symptoms are alleviated within seven to 10 days.
However, it is important to note that treatment following a medically managed detox will result in a better success rate. Safely removing the benzos from the brain and body is only the first step. There are other psychological, emotional, and behavioral issues to address that will set you up for continued sobriety.
It is critical to get the help you need to successfully manage withdrawal symptoms and begin a life without the use of benzodiazepines. Long-term use can negatively affect memory, mood, concentration, as well as the ability to sleep.
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Post-Acute-Withdrawal Syndrome (PAWS) is a condition synonymous with benzo and opioid withdrawal. It refers to a set of impairments that may last for weeks or months after abstaining from benzos. The condition is marked by symptoms you may find in mood disorders and anxiety disorders, which include insomnia, mood swings, and increased levels of anxiety without any stimulus.
PAWS most commonly occurs after using benzos for extended periods. It is estimated that 75 percent of psychotropic users will experience the condition. There is still not a precise reason as to why the phenomenon occurs, but scientists believe it has something to do with the physical changes that occur in the brain during substance abuse. Increased tolerance to a substance is responsible for recurring symptoms.
Symptoms will fluctuate in severity but may disappear altogether only to reappear weeks later. It is challenging to contend with as someone entering into recovery. The most common symptoms of PAWS include:
The withdrawal from benzodiazepines is dangerous. Individuals may suffer severe seizure activity, and it can be potentially fatal if opioids or alcohol are involved, so it is critical to seek appropriate treatment. When seeking treatment, it’s important to understand the difference between the various levels of care so you can get the most out of your treatment experience.
Medical detoxification, or simply detox, is a medically managed detoxification from benzodiazepines. Following a thorough history and physical examination, the medical staff will determine the best medication protocol to manage your withdrawal symptoms safely.
A detox from benzos can take up to 10 days or more, depending on the severity and extent of drug use and is up to the discretion of the medical providers. Medical complications, using more than one substance, or a history of mental health diagnoses are all examples of when detox may take longer than usual.
Treatment centers will require you to successfully complete detox to safely and fully participate in their programs.
Detox can take place in a hospital setting if you have severe or unmanageable medical complications, or it can take place in a standalone detox facility. These standalone, privately run facilities must be staffed 24 hours a day with medical personnel, as well as support staff, to monitor your symptoms and ensure the safest, most comfortable experience possible. Specially trained staff will know how to observe your progress throughout the detox process and will be able to respond to any potentially life-threatening situations.
Residential treatment typically follows a successful detox and involves living on-site and participating in a variety of therapy. Individual sessions with a trained therapist, as well as group and family therapy sessions, are some of what is required at each residential facility. It’s during this time; you will be examining patterns of thoughts, emotions, and behaviors that may have contributed to your substance use. Residential treatment length of stay will vary depending on your needs, but can typically last from 30 – 90 days following the detox.
Outpatient treatment is intended for those individuals who are in a more stable position medically, physically, and emotionally. After the support from detox and residential care, the activities of daily living on your own are more manageable, and you will remain involved with outpatient treatment to continue your journey of recovery.
You will continue to participate in therapy on a less frequent basis and maintain connections with your support system and therapist. This is an important part of your recovery, as it will allow you to transition to the next phase of your life with the support that played such a beneficial role.
In a recovery treatment program, you will be able to address the physical, psychological, medical, and social aspects of benzodiazepine addiction, learning through various therapeutic tools how to manage your addictive behaviors effectively and maintain long-term sobriety.
This is done through an individualized treatment plan, which you will customize with your therapist, and may include some of the following common treatment modalities:
Though benzodiazepines can cause chemical dependence and addiction, it’s sometimes used in addiction treatment. People that are seeking medical detox for alcohol withdrawal may experience severe and even dangerous symptoms. To help avoid life-threatening complications like seizures or delirium tremens, benzodiazepines can be used to help wean you off of alcohol.
Benzos and alcohol work in very similar ways in the brain. However, mild benzos may be more easy to manage in a medical setting than alcohol. The benzodiazepine binds to GABA receptors just like alcohol. As you go through a weaning period, you will take smaller and smaller doses of the drug until you are free from chemical dependence.
Not everyone who goes through alcohol detoxification needs benzodiazepine medication. However, it can help avoid some serious medical complications in some people. Still, weaning with a benzo may prolong your detox period.
Whether you want to stop using alcohol or benzos, it’s important to speak to a doctor or medical professional before quitting cold turkey. Though withdrawal can be deadly if you go through it on your own, it’s much safer with treatment. Medical detox can help you avoid dangerous symptoms, and it can help manage discomfort.
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National Institute on Drug Abuse. (2016, February). 8: Medical detoxification. Retrieved from https://www.drugabuse.gov/publications/teaching-packets/understanding-drug-abuse-addiction/section-iii/7-medical-detoxification
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