Benzodiazepines are an extensive class of prescription medications that are primarily used to treat clinically significant anxiety and seizure disorders. They are available as sedatives or relaxants. The drugs are also useful in the treatment of the withdrawal syndrome associated with alcohol and several other classes of drugs.
All benzodiazepines function by a similar mechanism of action. They all act to suppress the functioning of the neurons in the central nervous system (CNS) by increasing the availability of the major inhibitory neurotransmitter in the brain, gamma-Aminobutyric acid (GABA).
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The release of GABA results in other neurons slowing down their firing rates, accounting for the medical and other effects of benzodiazepines.
Benzodiazepines were initially developed to replace barbiturates in the treatment of anxiety because barbiturates had become significant drugs of abuse. Benzodiazepines were not believed to have a serious potential for abuse, but, as it turns out, they also are significant drugs of abuse and classified as controlled substances by the United States Drug Enforcement Administration (DEA).
Benzodiazepines are most often abused in conjunction with other drugs like opiates, alcohol, and other benzodiazepines. Many familiar drugs like Xanax (alprazolam) and Valium (diazepam) belong to this class of drugs.
Because of their status as controlled substances, only people who have a prescription from a physician are allowed to possess and use these medications legally. They are often used in hospitals and clinics.
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Using Benzodiazepines Can Lead to Physical Dependence
Any extended use of benzodiazepines, whether for medical reasons or as drugs of abuse, may result in the development of physical dependence. Physical dependence on any drug typically occurs as a result of two separate but related factors: tolerance and withdrawal.
Tolerance for benzodiazepines develops very quickly in most people who use them for more than a few days. Tolerance is a complex phenomenon that includes both physical and psychological components, but it is also a very common result of regular use of any type of medication or illicit drug.
The human body responds to the regular use of a drug such that it alters its functioning by adjusting itself to account for the presence of the medication in the system.
When an individual uses a benzodiazepine at regular intervals, the increase in the levels of GABA in the system will be offset by the person’s body naturally producing larger amounts of substances that counteract the effects of the increase in GABA.
This means that other neurotransmitters (mostly excitatory neurotransmitters) and hormones that speed up bodily functioning will be produced in greater amounts.
When a person continues to take benzodiazepines over time, this natural reaction results in the effects of benzodiazepines being diminished, and the person needs more of the drug to achieve the same effects they got at lower doses. If a person is just using the drug for medicinal reasons, the tolerance of the drug is often small, and physicians can adjust dosages if need be.
Abusers of drugs will likely take higher amounts of the drug and take them at more frequent intervals, resulting in a rapid increase in tolerance that eventually may require that the person uses extremely high amounts of the drug to feel its effects.
Over time, these changes lead to a state of imbalance in the system when the levels of the drug drop due to normal metabolic processes. Once the person has stopped using the drug, if the drug is not replenished, they will begin to experience negative effects associated with this state of imbalance. The adverse effects (withdrawal symptoms) associated with this process are typically in contrast to the types of sensations or symptoms that using the drug produces.
Individuals who are in withdrawal from benzodiazepines often experience increases in anxiety, pain, nausea, irritability, and other negative symptoms (see below). Abusers who begin to experience withdrawal effects will be motivated to immediately take the drug to reduce these effects. This leads to a downward spiral of addiction to the drug. Increased tolerance can lead to more severe withdrawal effects, which can lead to increased drug-seeking behaviors.
Whether one develops physical dependence on benzodiazepine use and the severity of the withdrawal symptoms are dependent on numerous factors.
- The type of benzodiazepine
- The amount of the drug the person normally uses
- How often the person uses a drug
- How long the person uses a drug
- The way the person takes the drug
- Individual differences in metabolism
Withdrawal Associated With Benzodiazepine Use
The symptoms associated with withdrawal from a particular class of drugs can vary from individual to individual, depending on the above-listed factors. There is a set of diagnostic criteria for withdrawal from benzodiazepines that is presented by the American Psychiatric Association (APA). These symptoms represent the general types of symptoms that can be used to identify withdrawal from benzodiazepines.
Some people may experience other symptoms that are more idiosyncratic in nature, but nearly everyone who is experiencing a withdrawal syndrome associated with benzodiazepine use will express at least two of the following:
- An increase in anxiety
- Changes in body temperature, blood pressure, heartbeat
- Tremors, most often in the hands
- Significant restlessness, irritability, nervousness
- Gastrointestinal effects like nausea/vomiting
- Psychotic behaviors
- Seizures, which can lead to brain damage or death
People will express these symptoms after they discontinue their use of the benzodiazepine. For a formal diagnosis of withdrawal from benzodiazepines, they need to express at least two of the above symptom categories; they can and often do display more than two.
Research on withdrawal from benzodiazepines has suggested that there are several stages people go through when they are experiencing withdrawal symptoms from benzodiazepines.
There is an acute period where a person begins to experience symptoms within one to four days after they have stopped using the drug. The symptoms are typically mild at first but increase in severity.
The acute symptoms generally will peak within several days and then begin to decline in their intensity. The person will experience a more extended period of decreasing symptoms.
Some individuals may experience longer periods with mild or intermittent symptoms after the withdrawal process has completed (usually within one to two weeks). Often, individuals may experience problems with motivation, periodic mood swings, and intermittent cravings to use benzodiazepines weeks, months, and even years after they have stopped using their drug of choice.
Other symptoms that individuals may experience during withdrawal include insomnia, headaches or other pains, depression, confusion, problems with thinking (attention and memory), emotional distress, and significant cravings to use benzodiazepines.
How to Handle Withdrawal From Benzodiazepines
It cannot be stressed strongly enough that individuals who are experiencing withdrawal from benzodiazepines are at risk of developing seizures. Seizures result from potentially dangerous and uncontrollable activity in the brain that leads to an individual being unable to control their movements. They will often experience convulsions, changes in heart rate, and changes in breathing rate that can be dangerous.
The potential to experience brain damage associated with experiencing a seizure is significant. Moreover, seizures can be fatal if they are not controlled.
Therefore, no reputable source will ever advise an individual who has developed physical dependence on benzodiazepines to attempt to get through the withdrawal process without being under the supervision of a physician. There is no safe way for anyone to withdraw from benzodiazepines without professional supervision. Although not everyone will experience seizures as a result of withdrawing from benzodiazepines, the risk is high enough that medical supervision is required.
Anyone who has been using benzodiazepines on a regular basis should not abruptly discontinue their use (stop them altogether) unless they are told to do so by their physician. Instead, the appropriate method to address withdrawal from benzodiazepines is to become involved in a physician-assisted medical detox program. Such a program is standardized. Addiction medicine physicians have a general protocol they will follow when attempting to help someone discontinue benzodiazepine use safely. The general protocol is adjusted to fit the specific needs of the person who is being treated.
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The general protocol is to have the physician administer a long-acting benzodiazepine like Valium or Librium to the person in a dose that results in the person not experiencing any significant symptoms of withdrawal. Over time, the physician will be able to slowly lower the dose at specific points in the treatment process to allow the person to slowly be weaned off the benzodiazepine and not experience any significant or dangerous withdrawal effects.
Physicians will closely monitor the person’s recovery, and some individuals may need to be involved in inpatient detox programs. Physicians will also administer other medications if they are needed to control symptoms like cravings, insomnia, and headaches. The process will often take a longer time than attempting to withdraw from benzodiazepines without using a formal medical detox program, but it is significantly safer and far less uncomfortable.
Moreover, the process reduces the potential that a person will relapse early in recovery. Relapses can be dangerous because as a person’s tolerance level drops, they become vulnerable to overdose.
While in medical detox, people can practice behaviors that can assist them in getting through withdrawal safely and comfortably.
- Follow a healthy diet and engage in light exercise
- Remain hydrated
- Try mindfulness meditation
- Participate in therapy and other treatments
Call (844) 432-0416 to hear more about the therapy options that might be available to you. Even though addiction is difficult to overcome, you don’t have to go through it on your own. Start your road to recovery today.
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(January 2009). Withdrawing Benzodiazepines in Primary Care. CNS Drugs. from https://pdfs.semanticscholar.org/60c4/e76aac21cdf16b8a14c6b93f54c1c67e0ee3.pdf