Signs of Benzo Addiction and Treatment Options

What Are Benzodiazepines?

Benzodiazepines, or benzos, are prescription medications that act on the central nervous system by enhancing the effects of GABA, the primary inhibitory neurotransmitter found in the brain, resulting in sedation, anxiety reduction, and muscle relaxation.[1]

The most frequently prescribed benzodiazepines include:

• Valium (diazepam)
• Xanax (alprazolam)
• Klonopin (clonazepam)
• Ativan (lorazepam)

Benzodiazepines are among the most widely prescribed medications in the United States, typically used as short-term treatment for anxiety disorders, including panic attacks, insomnia, and seizures.[2] They work well in the short term; however, medical literature states that the usage of a benzodiazepine should be measured in weeks rather than months or years. This is because prolonged use can produce many negative medical consequences, such as risk of physical dependence, cognitive impairment, and, in some cases, can worsen anxiety over time.[3]

What Is Benzodiazepine Dependence?

Benzodiazepine dependence develops as the brain adapts to the ongoing presence of the medication, altering GABA activity as a result of this constant exposure and the artificially elevated inhibition it causes.[4] Over time and with continued use, the brain begins to rely on the medication for baseline functioning. Once this has happened, stopping use or decreasing the amount used will result in withdrawal that can range from mild symptoms like anxiety and insomnia to more serious ones like tremors, seizures, and, in the worst cases, life-threatening complications.[5]

Benzodiazepines are a very challenging addiction to treat because withdrawal is not just uncomfortable, it is medically dangerous. Similar to alcohol, benzodiazepine withdrawal can be fatal if not clinically supervised.[6] This is why tapering under a doctor’s care is essential and why those who are a severe benzodiazepine addiction must go through a detox program before any further treatment can be delivered.

It is important to understand that benzodiazepine addiction doesn’t only happen to those who misuse their prescriptions; someone can become dependent even if the medication is used as prescribed.[7] It is not a failure of character, merely a physiological adaptation. Many people develop significant physical dependence following months of therapeutic use at standard doses.

Signs of Benzodiazepine Addiction

There are well-defined signs that may indicate someone is addicted to or abusing benzodiazepines. Signs of benzo addiction include:

• Taking more benzodiazepines than were prescribed, or taking them more often than intended
• Getting benzodiazepines without a prescription or from multiple providers (doctor shopping)
• Believing it is impossible to manage anxiety, sleep, or functioning without benzodiazepines
• Significant withdrawal symptoms such as rebound anxiety, insomnia, tremors, or sweating if doses are missed or reduced
• Continuing to take benzodiazepines even though they are having a negative effect on memory, cognition, relationships, or functioning
• Hiding usage from doctors, family members, or friends
• Combining benzodiazepines with opioids or alcohol, greatly increasing potential risks
• Gradually increasing use as tolerance develops
• Having cravings or an obsession about getting or timing doses

The majority of people who have a dependency on benzodiazepines may not recognize their use as a problem right away, primarily because they began using them with a prescription. This makes gradual dependence difficult to recognize.

Benzodiazepines and Mental Health

The relationship between benzodiazepines and mental health is the reason why most people start taking them in the first place — and why dependence develops. 

The problem lies in the fact that while benzodiazepines are effective in treating anxiety and panic disorders in the short-term, chronic use doesn’t lead to better results. It may suppress symptoms, but does not address the underlying disorder, which typically worsens. When the medication is tapered or stopped, the anxiety it was suppressing returns with even more intensity than before, which is known as rebound anxiety. This happens because the underlying condition was never truly addressed, and the brain’s anxiety regulation ability has been altered due to long-term benzodiazepine usage.

The result is a vicious cycle: untreated anxiety leads to prescribed benzodiazepine use, which creates dependency, which makes it difficult to stop. Meanwhile, the underlying anxiety disorder continues to go untreated. Breaking out of this cycle must first begin by treating the anxiety disorder, or whatever mental health condition is the primary cause for the initial benzodiazepine prescription. 

Like many substance use disorders, benzodiazepine addiction frequently co-occurs with other psychiatric disorders such as depression and post-traumatic stress syndrome (PTSD), each with its own underlying causes that require its own treatment approach within a dual diagnosis integrated treatment plan.[8]

When the Real Problem Isn’t the Benzos

Many patients at Helios West Palm with a history of benzodiazepine dependency have had previous treatment for their benzodiazepine use, including tapering, withdrawal management, and detoxification. And while it may have helped in the short-term, none of these addressed the underlying reasons for needing the medications in the first place, such as anxiety disorder or past trauma. As soon as patients complete treatment, the anxiety returns with full force, and the path back to benzodiazepines, or to another substance that provides relief, is usually relatively short.

Helios West Palm was built to address this very issue. We are not a detox facility or a primary treatment facility for substance abuse. Instead, we offer integrated psychiatric treatment to resolve the issues causing the benzodiazepine dependency.

 

What To Expect from Benzodiazepine Addiction Treatment

Helios West Palm has established a dual diagnosis program for clients who have a history of benzodiazepine addiction. Prior to beginning the program, clients complete a thorough psychiatric evaluation that looks not only at the history of substance use but also at the underlying psychiatric disorders that may have been driving it. After completing the evaluation, each client is given an individualized treatment plan that includes treatment for both co-occurring conditions. 

Helios has a fully trained and supervised on-site psychiatric team that manages and monitors all medication. Clients with anxiety disorder diagnoses will be considered for all evidence-based non-benzodiazepine treatment options, such as antidepressants and other anti-anxiety medications, as part of their treatment plan.

Patients who require medical detox — including supervised tapering — prior to admission are referred to appropriate medical providers. Benzodiazepine withdrawal can be life-threatening and requires clinical supervision; our admissions team can assist with coordinating safe medical management as part of the intake process.