Benzodiazepine Addiction and Abuse

With anxiety disorders continuing to be diagnosed across the United States, the need for a medication to calm people down is growing. Some people who suffer from anxiety are prescribed benzodiazepines to calm their nerves so they can think clearly and not suffer from regular anxiety. However, benzodiazepines can become addictive if not taken properly, and in some cases, misuse can be more dangerous than the anxiety disorder itself.
Benzodiazepines, also known as benzos, are psychoactive medications that physicians prescribe to people struggling with anxiety and insomnia. There are more than a dozen different kinds of benzos that are all used for their own purpose. Some benzos are able to treat multiple conditions, but the most popular use of benzos is to treat heightened anxiety.

Benzos aren’t used just for psychological symptoms, but they can also be used to help those who are struggling physically as well. Certain benzos work to treat convulsions for people who have cerebral palsy, or to help relax a patient preparing to go into surgery.

When a benzo is taken, it slows down a person’s brain activity. Since benzos increase the effects of gamma-aminobutyric acid (GABA), the medications slow bodily nerve impulses. This results in drowsiness, uncoordinated movements, slowed reaction times, and more. Even though the mechanisms of action are almost all the same across all benzos, there are a few key differences between the variations of the drug. For example, each medication has a unique dosage, half-life, abuse potential and absorption time.

There are two primary types of benzodiazepines: long-acting and short-acting. Each class of benzodiazepines is prescribed for different needs and is classified by the Drug Enforcement Administration based on their potential for addiction. The long-acting kinds, such as Valium and Librium, tend to stay in the body for many more hours. Short-acting benzodiazepines such as Ativan and Xanax do not stay in the body for very long — sometimes just a few hours.

Benzos are usually taken under medical supervision when taken properly. They can be taken in pill, tablet or capsule forms. They can also be administered via injection, but that isn’t as common. In fact, the brand name Versed (which is made from the chemical midazolam) is only administered intravenously. Pharmaceutical companies make multiple types of benzos which can include:

  • Xanax (Alprazolam)Xanax takes 1 – 2 hours to reach its peak level of effectiveness with a half life of 12 hours
  • Lexotan (Bromazepam) – Lexotan takes 1 – 4 hours to reach its peak level of effectiveness with a half life of 20 hours
  • Librium (Chlordiazepoxide)Librium takes 1 – 4 hours to reach its peak level of effectiveness with a half life of 100 hours
  • Klonopin (Clonazepam)Klonopin takes 1 – 4 hours to reach its peak level of effectiveness with a half life of 34 hours
  • Valium (Diazepam)Valium takes 1 – 2 hours to reach its peak level of effectiveness with a half life of 100 hours.
  • Ativan (Lorazepam)Ativan takes 1 – 4 hours to reach its peak level of effectiveness with a half life of 15 hours.
  • Rohypnol (Flunitrazepam)Rohypnol takes 1 – 2 hours to reach its peak level of effectiveness with a half life between 18 and 26 hours.

Like other drugs that are illegally used, benzos go by various nicknames. Some of the most commonly used benzodiazepine street names include:

  • Nerve pills
  • Tranks
  • Downers
  • V’s (Valium)
  • Z bars (Xanax)
Benzo addiction occurs when people misuse the prescribed medication. This could include buying the drug illegally, taking it in larger amounts, and taking it for an extended amount of time. An addiction likely won’t occur if a patient follows a doctor’s instructions, but some people become accustomed to the calm and the high that the drug brings them. United States legislators began to notice this and developed laws to control benzos. Most significantly, the 1970 Controlled Substances Act categorized benzodiazepines as Schedule IV drugs, which means the drugs have a high potential for abuse, addiction and has limited medical uses.

Benzos are habit-forming sedatives, meaning that gaining an addiction to them can be possible if not taken properly. People who take the drug excessively may begin to feel a high and experience an unsafe level of relaxation. From there, their tolerance to the drug’s effects can build as they attempt to emulate that initial high. The fact that the drug has become easily available is also a major contributing factor. In 2016, Reuters Health noted that benzo prescriptions had tripled that year and overdoses involving benzos more than quadrupled since 1996. The risk of death increases if a person uses these drugs alongside other mind-altering substances — especially opioids. With 13.5 million benzo prescriptions written in 2016, the accessibility of benzos is a concern to individuals who manage an addiction to the drug.
Identifying the signs of someone struggling with a benzo addiction can be confusing. However, there are a variety of signs that can reveal that someone is misusing benzos. It’s crucial to take notice of the signs before the symptoms become deadly.
Some physical symptoms that can occur during a benzo addiction include:

  • Extreme fatigue
  • Slurred speech
  • Impaired coordination
  • Slowed heart rate
  • Shallow breathing
  • Slower reflexes
  • Pale, cold skin
  • Dilated pupils
  • Lightheadedness
  • Blurred vision
  • Fainting
  • Diarrhea
  • Vomiting
  • Tremors
  • Seizures
When taken for a longer amount of time, psychological symptoms can begin to appear. These can include:

  • Depression
  • Suicidal thoughts
  • Irritability
  • Mood swings
  • Cognitive dysfunction
Those who struggle with a benzo addiction may suffer in different aspects of their life. They may cut themselves off from their friends and family in order to take benzos to avoid judgement. Along with their relationships being affected, they also may struggle financially as they either miss work to consume the drug, or spend all of their money on obtaining more of the substance.

Common Questions About Benzo Use

According to a guide provided by Drugs and Alcohol Information and Support, they indicate some average times for benzodiazepines to exit the system. These are rough estimates and as such the factors mentioned in this article will affect these timeframes.

  • Urine: 3 to 6 weeks
  • Hair: Up to 90 days
  • Blood: 2-3 days

These are rough estimates and factors, like age, wieght, half-life and others mentioned in this article will affect these timeframes. Peak levels and drug half-life of benzodiazepines depend on several factors such as the specific drug that has been prescribed or ingested, dosage amount, time between doses, and method of administration. In general, benzos can be divided into these three categories:

  • Ultra short acting benzos – The half-life of ultra short acting benzodiazepines is 5 hours or less.
  • Short acting and intermediate benzos – This class of benzodiazepines have a half-life that ranges from 5-24 hours.
  • Long acting benzos – Long acting benzodiazepines have half-life values of 24 hours or longer. Benzos in this group have long acting pharmacologically active metabolites, which create significant stores inside the body with multiple doses.
“Benzo belly” is a term used to describe the stomach discomfort that happens when people withdraw from a benzodiazepine medication. “Benzo belly” itself usually begins in the protracted withdrawal phase. It may continue for several weeks after the last dose of a benzodiazepine. Symptoms usually get better with time, but may last a year or more for some people.
Yes, such an overdose can occur — but it is extremely unlikely. By itself, Valium has a low threshold for overdoses. This is lowered even further for fatal overdoses. It would take a considerable amount of the drug to overdose on Valium alone, let alone succumb to the effects and pass away. So, in this way, any mention of lethal Valium overdoses has to come with an asterisk of sorts.
Klonopin can say in your system for up to 14 days, and it is detectable on a drug test during this time.
The average half-life for Ativan is approximately 12 hours. This means that after taking your last dose, it may take around 2.75 days for the drug to be fully eliminated from your system. The active metabolite of lorazepam glucuronide has a longer half life of 18 hours.

To fully eliminate this metabolite from your system will take longer than Ativan itself. Lorazepam glucuronide will stay in your system and can be detected in your urine for up to 4 days after you ingest the Ativan. An estimated 13.5 percent of lorazepam is eliminated as various minor metabolites. Within 5 days of taking the drug, nearly 95 percent of a lorazepam dose will have been fully eliminated.

The best way to treat a benzo addiction is by seeking help through an accredited facility. Doing this allows medical professionals and clinical therapists to determine the severity of the addiction, and find any underlying co-occurring disorders that have to be treated. The Recovery Village has various facilities throughout the country that can help with this process.

A reputable facility will first evaluate a person to learn about their addiction and find out key information, such as the amount of time the drug has been used and the doses that have been consumed. Once a treatment team determines the severity of the addiction, the detox process begins.  Detox can include uncomfortable symptoms depending on which benzo is being withdrawn from, but a medical professional has the ability to prescribe medication to ease the discomfort. After the withdrawal symptoms subside is when an individual learns the tools needed to manage their addictions. This learning process can occur during inpatient, outpatient, partial hospitalization, intensive inpatient or intensive outpatient programs. Once completed, aftercare begins and the skills learned in treatment can be used outside of the facility. Aftercare can include regularly scheduled therapy sessions or reside in a sober-living home.

The amount of benzo prescriptions given out regularly can be seen as a factor pertaining the amount of Americans struggling with addiction. However, benzos aren’t only an American issue. They’ve become an issue across the globe.

  • In 2015, Xanax was called the world’s most popular pill, with tens of millions of prescriptions being dispensed globally
  • American doctors are writing 12% more Xanax prescriptions every year
  • In 2011, 49 million alprazolam prescriptions were written worldwide
  • During the mid-19th century, benzodiazepines were called “the devil’s capsules” in some American circles

If you or a loved one struggle with an addiction to benzodiazepines, call our representatives for more information on our facilities and programs. Start your journey to an addiction-free life today.

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Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.