Benzodiazepine Treatment Guide

Mood disordersBenzodiazepines can be a lifesaver for some patients. Used to treat disorders like panic attacks, generalized anxiety, and chronic insomnia, drugs like Xanax and Valium have helped millions of patients to manage their mental health symptoms and stay functional and balanced.

Unfortunately, for a percentage of patients, use of benzodiazepines can become an abuse and/or an addiction issue. Though most people who take the pills exactly as prescribed by their physician will not develop more than a normal physical tolerance for the medication, those who abuse the drugs will often develop a full-blown addiction.

Treatment statistics and research

  • A study published in the Journal of Clinical Psychiatry reported that benzodiazepine abuse and addiction were often secondary to another drug or alcohol addiction issue. Many addicts primarily use benzos to augment the effects of other drugs, including alcohol.
  • A study published in The Psychiatric Quarterly found that there was a threefold increase in the prescription of benzodiazepines among those under the age of 18 over a 10-year period. This could lead to an increase in benzodiazepine use and abuse among adults as these patients age.
  • Benzo prescriptions on the rise

  • Similarly, the Monitoring the Future Study of 2013 found that 2.9 percent of 8th graders, 5.8 percent of 10th graders, and 7.4 percent of 12th graders reported use of benzos in their lifetime. About 1.7 percent of 8th graders, 3.9 percent of 10th graders, and 4.7 percent of 12th graders reported past-year use of benzos, and 0.8 percent of 8th graders, 1.6 percent of 10th graders, and 2.1 percent of 12th graders reported past-month use of this type of prescription drugs.
  • Abuse of benzodiazepines may be highest among seniors in the United States, according to a study published in the journal JAMA Psychiatry. Researchers found that use and abuse of benzos tended to increase with age and that seniors very often struggled with high rates of benzodiazepine abuse and addiction as a result of abuse of legitimate prescriptions as well as combining the use of these prescriptions with other substances.
  • Benzo overdose deaths

  • Use and abuse of benzos may be associated with an increased risk for the development of Alzheimer’s disease in some patients, according to BMJ. Risk increases with long-term exposure to these substances.
  • Use and abuse of benzodiazepines contributed to the 22,810 prescription drug overdose deaths that occurred in the US in 2011. It is estimated that about 6,800 of these deaths (or 30 percent of all overdoses caused by prescription drug use) involved the use of benzodiazepines.


Benzodiazepines can be a lifesaver for some patients. Used to treat disorders like panic attacks, generalized anxiety, and chronic insomnia, drugs like Xanax and Valium have helped millions of patients to manage their mental health symptoms and stay functional and balanced.
Though there are many different types of benzodiazepines, only 15 different types are FDA-approved for use in the United States. To be classified as a benzodiazepine, the drug must fit one of the following categories:

  • Behave an as anticonvulsant
  • Act as a muscle relaxant
  • Provide relief from anxiety
  • Act as a hypnotic
  • Work as a memory loss inducer
There are a number of brand name benzodiazepines commonly in use. Some of the most commonly prescribed include:

  • Valium
  • Xanax
  • Halcion
  • Ativan
  • Klonopin

Longer-acting benzodiazepines prescribed to treat patients who experience extreme anxiety include:

  • Xanax (e.g., alprazolam)
  • Librium (e.g., chlordiazepoxide)
  • Tranxene (e.g., clorazepate)
  • Valium (e.g., diazepam)
  • Paxipam (e.g., halazepam)
  • Ativan (e.g., lorazepam)
  • Serax (e.g., oxazepam)
  • Centrax (e.g., prazepam)
  • Doral (e.g., quazepam)
  • Klonopin (e.g., clonazepam)

In addition to treating anxiety, Valium and Tranxene may be prescribed as anticonvulsants.

Some of the shorter-acting benzodiazepines commonly used to treat insomnia or anxiety, sedation, or amnesia in the critical care setting include:

  • ProSom (e.g., estazolam)
  • Dalmane (e.g., flurazepam)
  • Restoril (e.g., temazepam)
  • Halcion (e.g., triazolam)
  • Versed (e.g., midazolam)

These drugs may be available as an injectable or in the form of a syrup in addition to pill form.

>Benzodiazepines may be prescribed to treat insomnia, anxiety, anxiety coupled with insomnia, muscle spasms, seizures, or any medical or psychiatric issue that requires sedation.
According to the National Institute on Drug Abuse (NIDA), benzodiazepines work much like cannabis, opiate drugs (including opiate painkillers like OxyContin or Percocet), and club drugs like gamma-hydroxybutyrate (GHB).That is, benzodiazepines cause a surge in dopamine release, a neurotransmitter that can cause a person to feel euphoric or high. This happens because the benzodiazepine blocks the interneurons and neurons that limit the release of dopamine (e.g., GABA), which in turn means that dopamine is not blocked as it usually is. Though benzodiazepines do not directly impact dopamine release, they do impact other neurons that have an effect on how much dopamine is released.Addiction occurs when this process happens repeatedly, and the person begins to crave the feeling created by the lack of dopamine inhibition. Cravings for this high can happen after the first few uses, or it can happen over time – everyone is different. Factors that can impact when or if addiction to benzodiazepines develops include:

  • Dosage: Taking more and more of the drug of choice for a long period of time can contribute to the development of benzodiazepine addiction. Physical tolerance often develops so the body requires larger doses in order to experience the therapeutic response, but this physical tolerance as well as the continued use of the drug can also contribute to the development of addiction.
  • Pill use and abuse: If pills are taken as prescribed (e.g., swallowed in the correct amount on the correct schedule), it is not likely that addiction will develop. But if users of the pills crush them before taking them, take them via another method other than swallowing, combine them with use of other addictive substances (even alcohol), or take them without a prescription, then the development of an addiction may be more likely.
  • Other drugs: Taking benzodiazepines in combination with alcohol, marijuana, or other prescription drugs like opiate painkillers can all contribute to the development of a drug dependence.
  • Genetics: If a parent or sibling struggled with addiction, then the likelihood that someone who abuses their prescription will also develop an addiction is significantly increased as compared to the rest of the population.
  • Environment: Living in a permissive environment that promotes or normalizes unhealthy behaviors including the use of prescription medications non-medically can contribute to the likelihood that someone will abuse benzodiazepines and therefore be more likely to develop a dependence.
A “half-life” of a medication is defined by how long it takes the body to rid itself of half of the dose. Some medications have a half-life of just a few hours, while others take 24 hours or longer to process through the system. Prescribed benzodiazepine dosage amounts and timing are chosen based on the half-life of the medication.
Benzodiazepines can come with a number of side effects. When prescribed at a therapeutic dose, these side effects are usually minimal and fade after a few days of regular use; however, if they become severe, medical attention may be required. Some possible side effects of benzodiazepine use include:

  • Dry mouth
  • Constipation
  • Confusion
  • Drowsiness or fatigue
  • Poor coordination
  • Lost sense of balance
  • Lightheadedness
  • Dizziness
  • Memory loss
  • Sedation
  • Altered eating patterns
  • Weight gain
  • Altered sleep patterns (usually, sleeping more often or harder)
  • Nausea and/or vomiting
  • Lower libido

Additionally, benzodiazepine use may cause negative drug interactions if the person is also taking other drugs to treat other medical or psychiatric conditions. It is important to check with a pharmacist when any new medications are added to ensure that they won’t conflict or cause medical issues.

Also, a physical tolerance may develop to the initial dose over time. That is, the initial dose may be therapeutically effective, but over time, as the body adjusts, the person may no longer experience therapeutic effects and may require a higher dose.

Long-term use of benzodiazepines may also lead to the development of drug dependence in some patients.

When someone has a legitimate prescription for benzodiazepines, it’s not always easy to tell whether or not their reaction to the drug is normal or if it is a sign of abuse or addiction. For example, it is possible to experience confusion, a lack of coordination, and other signs of “being high” as a side effect of benzodiazepine use – but all of these can also be signs of taking too much of the drug or otherwise abusing the pills.In this particular example, while it may be normal to have these symptoms in the first days of use, they typically fade quickly. If they continue, it can be a sign that the dose is too high, and it’s time to talk to the doctor about changing the dosage. If these signs continue for months – or begin months later – it can indicate a drug abuse problem.Here are some other signs that benzodiazepine use has turned into benzodiazepine addiction:

  • Using a prescribed benzodiazepine in a way that it is not prescribed: For example, those who are addicted to benzodiazepines may be more likely to crush the pills before snorting them or dissolving the crushed pills in water and injecting the drug. It is never prescribed to be used in this way, and it is certainly abuse of the drugs and often indicates addiction.
  • Using other drugs of abuse in combination: In order to amplify the effect of the prescribed benzodiazepine, many who are struggling with addiction will use other illicit drugs at the same time. Heroin and cocaine are commonly abused drugs by benzo addicts, but teens may be more likely to combine benzodiazepine abuse with abuse of other prescription drugs like painkillers (e.g., Percodan) or stimulants (e.g., Adderall), marijuana, and alcohol.
  • Personality changes: Benzodiazepine addiction has been associated with lost memory, irritability, vivid nightmares, and/or hostile or aggressive behaviors. Additionally, benzodiazepine abuse or addiction may be signified by extreme mood swings, tendency toward isolation, a change in friends or interests, starting to fall behind at school or work, or lying about drug use.
  • Medical issues: Benzodiazepines slow down the respiratory rate and can cause medical emergency including overdose. Overdose can be signified by weak/fast pulse, clammy skin, shallow breathing, and dilated pupils. Additionally, accident under the influence is common; therefore, a multitude of medical issues related to benzo use can indicate an addiction.
  • Fraudulent prescriptions: Maintaining a benzodiazepine addiction is a difficult and expensive proposition. Legislative regulations make it difficult to come by large amounts of these pills. Many people who are struggling with addiction will get the pills they need by seeing multiple doctors and complaining of the same symptoms in order to get multiple prescriptions for the same pills, filling a single prescription at multiple pharmacies, and/or altering a written prescription to increase the pill amount or dosage.
Combining benzodiazepines with the use of other medications can be extremely dangerous. Often, the combination of these sedative pills with other drugs or substances can create a synergistic effect. That is, rather than one plus one equally two, the effect of the benzo dose added to the dose of the other substance is exponentially larger than the sum of their parts.It is never recommended to combine benzodiazepine use with the use of any other substances for any reason. Not only can it render the drug ineffective for its intended purpose, it can also be overwhelming to the body and brain, causing deadly medical emergencies, including overdose.
Withdrawal symptoms caused by physical dependence upon benzodiazepines can be severe. It is not recommended that anyone who experiences withdrawal symptoms when they are without their medication attempt to stop use of the drug without medical supervision. Withdrawal symptoms can include any combination of the following:

  • Altered sleep patterns (usually insomnia)
  • Irritability
  • Panic attacks
  • High anxiety or feelings of paranoia, stress, or tension
  • Tremors, especially hand tremors
  • Heavy sweating
  • Inability to concentrate or focus
  • Nausea and dry heaving
  • Altered eating habits that can result in weight loss
  • Heart palpitations
  • Headache
  • Muscle aches and stiffness
  • Changes in visual and aural perception

At high doses, some patients experience withdrawal symptoms that can include seizures and psychotic reactions.

Patients who struggle solely with physical dependence and are not living with an addiction to the pills (that is, they do not crave the drug or experience a psychological dependence upon benzos) may be able to “step down” their use of the pills, safely lowering the dose incrementally until they are no longer dependent upon the substance. Patients who are living with a benzo addiction will need to enroll in a drug detox program in order to receive round-the-clock care and get the help they need to learn how to remain drug-free after they break away from their physical dependence.

For benzodiazepine-addicted patients who began their addiction due to a prescription for anxiety, the experience of rebound anxiety is common. It is especially important that they receive treatment for anxiety as well as assistance learning how to manage anxiety symptoms on their own healthfully.

Depending upon the reason for the benzodiazepine prescription, there may or may not be a less addictive medication or treatment option. For example, if the drug is needed to manage seizures and other medications do not work, then the patient may need to make some difficult decisions with the assistance of his physician in order to determine what his best options are.If the drug is prescribed to treat anxiety or panic disorder, while there are few non-addictive pharmacological interventions available, there are a number of holistic treatment options that can be helpful in combination. Many patients find that they can at least lower their medication dose significantly if they utilize natural treatment options:

  • Herbal supplements: Some herbs may be helpful in mitigating the experience of stress and/or anxiety. Additionally, if missing nutrients are part of the inability to manage stressors, then identifying that issue and addressing it with supplements may be appropriate. Medical supervision is recommended.
  • Yoga and meditation: Focus on the breath, the ability to clear the mind, and doing slow and focused exercises that connect the mind, spirit, and body can be helpful in managing stress as well. Classes provide a community of support but at-home videos or private practice can make it work for anyone’s schedule.
  • Acupuncture: Long, thin needles are inserted painlessly in the top layers of skin while the patient relaxes, according to ancient Chinese medicinal principles that have been proven effective both for the treatment of addiction and anxiety.
  • Bodywork and massage: Muscle memory has been linked to stress and tension, and regular massage and bodywork sessions can contribute to the patient’s ability to manage stress, sleep better, and function on a day-to-day basis.
  • Dietary changes: Addressing low nutrient levels as well as making sure to not only get enough calories but also the right kind of calories can contribute to a person’s physical and emotional well-being and their ability to manage anxiety and tension. Bulking up on the fruits and vegetables and cutting back on saturated fats, trans fat, salt, and sugar can help to balance mood and moderate impulsive responses to stress.
  • Sleep changes: Not getting enough sleep can contribute to a high stress rate and an inability to manage anxiety. Going to bed at the same time every night and getting up at the same time every morning can make it easier for the body to know when it’s time to sleep and wind down more quickly.
  • Exercise: Gentle exercise is an essential part of mood regulation as well as positive physical health. Walking, swimming, or biking for just 30 minutes a day outside can contribute to positive vitamin D levels from the sun exposure, get the heart rate up, and improve mood.

Detoxification process

Detox processIn most cases, benzodiazepine tapering is not recommended when a benzo addiction is the issue. Though it may be appropriate for patients who only struggle with physical tolerance that results in withdrawal symptoms, it can take months to navigate safely, which is not advised for patients who need to get to a drug-free state more quickly.

For those who attempt to detox “cold turkey” under the care of medical professionals, the expected timeline of withdrawal symptoms will be different related to a number of factors. Depending upon the reason for the individual’s prescription, the dose she was taking at the time of detox, and the half-life of her prescription as well as whether or not the patient is psychologically dependent as well as physically dependent, the detox timeline may vary. Some possibilities include:

Patients who were prescribed their medication for the treatment of anxiety or panic disorder and/or insomnia may experience a “rebound anxiety” as well as insomnia during detox. For those who only have a physical tolerance to their medication, these symptoms usually persist for up to four days, depending upon their dose and the half life of the drug.
For patients who are both physically and psychologically dependent upon benzodiazepines, the timeline may last a bit longer. For up to two weeks, they may experience a host of withdrawal symptoms that are both physical and psychological in nature. Medical supervision at an inpatient program is recommended.
For some patients, after the heaviest withdrawal symptoms have begun to fade, a return of anxiety symptoms may be experienced. Treatment will be necessary to manage these symptoms safely and effectively and avoid relapse; this issue is more likely among patients who originally began using benzodiazepines in an attempt to manage anxiety symptoms.

Use of short-acting benzodiazepines or high doses of benzos may indicate a greater risk of experiencing significant withdrawal symptoms. Dependence upon other substances, including alcohol or other prescription depressants, may make withdrawal symptoms more intense, change or add to the withdrawal symptoms experienced, or alter the detox timeline.

Treatment and therapy options

Therapy for addictionWhen a patient struggles with both psychological cravings for benzodiazepines as well as a physical tolerance characterized by withdrawal symptoms, inpatient detox and addiction treatment is recommended. Though some accommodations will be made for different populations (e.g., pregnant women will need to alter their course of treatment in order to protect their own health and that of their unborn child), in general, patients should seek out a treatment program that will provide them with all of the following services:

  • Medical detox: Benzodiazepine withdrawal symptoms can be severe, and few patients are able to undergo the detox process without relapse unless they have the round-the-clock care and supervision of substance abuse treatment professionals. Medical care means that patients will have access to non-addictive medications that can help them to be more comfortable during the detox process as well as other resources that can make detox easier and assist them in stabilizing in recovery more quickly. Additionally, any unexpected medical issue that arises can be treated immediately, ensuring the patient’s safety throughout detox.
  • Individualized treatment: No two patients will benefit from the exact same treatment plan because no two patients have the exact same pre-addiction experience, family situation, co-occurring mental health disorder diagnoses, drug history, or goals for their life after rehab. As a result, every patient should have the benefit of a uniquely designed treatment plan that addresses their personal needs in treatment and ensures that they have all the resources necessary to be strong and confident when it is time to transition into independent living in recovery.
  • Evaluation and diagnosis: In some cases, the symptoms that contributed to their drug use or the issues that arose during active addiction were due in part – or in entirety – to an undiagnosed mental health disorder, behavioral disorder, or other chronic ailment. It can be helpful to take time at the beginning of treatment to consider the possible underlying reasons for the person’s initial drug use and to secure a diagnosis that will help them to get the treatment they need to heal on all fronts.
  • Personal therapy: Meeting regularly with a personal therapist one on one gives the recovering patient a therapeutic “home” in which to address any issues that may be arising or challenges that are becoming obstacles. This regular “check-in” session enables patients to have a voice in their recovery, to request changes as needed, and to create and work toward their own personal treatment goals.
  • Traditional therapeutic support: Group therapy sessions, 12-step meetings, and other traditional therapy options have been proven to be effective in the treatment of addiction over the years. These are often the foundation of patients’ recovery experience and helps them to develop a community of support as they build up time in sobriety.

Therapy options

  • Alternative treatment options: A range of treatment options may be helpful in treating different aspects of a patient’s experience and give him or her the coping tools necessary to grow in recovery. Some examples include outdoor and adventure therapy, animal-assisted therapy, dance therapy, and other therapeutic interventions that can go beyond words and provide the patient with different methods of growing mentally and emotionally.
  • Holistic treatment services: Life coaching, acupuncture, acupressure, massage and bodywork, yoga, meditation, nutritional counseling, herbal supplements, and hypnotherapy – there is almost no end to the possible holistic treatment services that may prove beneficial to the patient hoping to heal on all fronts. These methods help to improve a patient’s ability to lower his experience of stress and improve his quality of life in sobriety.
  • Treatment plan adjustment: As treatment goals are reached, it may be appropriate to adjust the plan to include or exclude different therapy options. Patients should play a role in this process and have a voice in their treatment experience.
  • Family support: Family members should have the option of attending family therapy sessions with their addicted loved one as well as getting support on their own. Support groups for family and friends of addicted people, educational workshops, and personal therapy sessions can all be effective in helping loved ones to better understand the nature of addiction and its treatment, and to learn how they can best be supportive of the recovering person when they return home.
  • Aftercare: Detox is a crucial first step in recovery, intensive therapeutic care is essential to stabilization in sobriety, and aftercare is needed to ensure that this new way of life becomes a permanent change. Before leaving treatment, it is recommended that the recovering person work together with his or her therapeutic team to create an aftercare plan that includes continued therapeutic growth, 12-step meetings, treatment for co-occurring mental health issues, medication if necessary, and a connection to the alternative and holistic treatment services that proved useful in treatment. Additionally, family members should be included in order to ensure that everyone at home is on the same page with what the recovering person needs in the months and years following treatment.

If you are concerned that your loved one is struggling with benzodiazepine abuse or addiction, connecting that person with the treatment services that will help her change her life is the first step. Here at The Recovery Village, we can assist you. Contact us today at the phone number listed above to learn more about your loved one’s options in benzo detox and addiction treatment services, and to begin the process of enrollment that can help to start the healing process today. We are standing by to assist you. Call now.

Benzodiazepine Treatment Guide was last modified: November 22nd, 2016 by The Recovery Village