OVERVIEW: Benzodiazepines are highly addictive. However, addiction is a medical condition and can be treated successfully. Treatment includes a combination of tapering, talk therapy, behavioral therapy, and alternative medications delivered either in impatient or outpatient settings.
Table of Contents
- Types of Benzos
- Understanding Addiction
- Who’s at Risk
- Negative Consequences
- Does Treatment Work?
- Main Options
- Inpatient vs. Outpatient
- What Happens in Rehab
- How to Help Someone
Don’t struggle alone! Are you struggling with benzo addiction alone? Medical treatments can help you get better.
Types of Benzodiazepines
Whether you have been prescribed benzodiazepines for a long period of time or have started upping doses slowly…quitting benzos can be extremely difficult.
Benzodiazepines, also known as prescription tranquilizers include psychoactive medicines such as alprazolam, diazepam, and lorazepam. In fact, these types of drug are some of the most widely prescribed medications in the US. Even though many of are classified as Schedule IV by the Controlled Substances Act and are supposed to be less addictive with mild cases of withdrawal, one study by NIDA-funded researchers has found that benzodiazepines cause addiction in a way similar to that of opioids, cannabinoids, and the club drug gamma-hydroxybutyrate (GHB).
So, if you find yourself struggling with:
- Alprazolam (Xanax)
- Clonazepam (Klonopin)
- Diazepam (Valium)
- Lorazepam (Ativan)
- Temazepam (Restoril)
…don’t continue suffering one day more.
We are here to help you. To find the best treatment option for you, read on. Here, we review common treatments for addiction. We’ll let you know what you can expect. Then, we invite your questions in the section at the end. Please reach out for help. There is no need to do it alone.
Benzos are one of the most commonly abused prescription drugs… and one of the most addictive. Benzodiazepines are often prescribed for insomnia and anxiety. But they aren’t supposed to be used for longer than a week or two at a time. So, why do people become addicted to them?
Anyone who takes a benzodiazepine for longer than 3–4 weeks is likely to have withdrawal symptoms if the drug is ceased abruptly. People continue using the drug to avoid the symptoms. In fact, when these folks stop taking the drug, extreme or serious withdrawal symptoms can emerge. An article published in the medical journal, Addictive Behaviors suggests that more than 40% of chronic benzo users become dependent.
Drug dependence is a sign that your body and brain have gotten accustomed to the presence of benzos – that you have adapted to the chemical cocktail. However, when you try to cut back on doses or to quit altogether, drug dependence kicks up uncomfortable withdrawal symptoms. Withdrawal symptoms can be extremely severe and make people unable to quit, only driving them one step closer to an addictive habit.
Plus, users often develop tolerance to benzodiazepines when they take their medication for a period of time. An analysis in the British Journal of Clinical Pharmacology reported that about a third of people who use benzodiazepines for longer period of time (more than six months) can develop a tolerance, so it is possible to become physically dependent sooner. How does this affect addiction?
As tolerance gets stronger, you feel the need to increase doses in order to get the wanted effects. Because of tolerance and withdrawal symptoms, long-term use of benzodiazepines can lead to dose escalation and worsening of the underlying condition. The higher the amount of benzo you take, the higher your risk of addiction.
But what causes addiction?
Risk of Addiction
Certain people have a tendency toward addiction, which is caused by an interplay of numerous factors, including:
Genetics. People who have a close relative (parents or siblings) who has struggled with some form of addiction are more likely to develop addiction to benzodiazepines compared to those that don’t have a family history of addiction.
Physical factors. Some people’s brain chemistry makes them more susceptible to addiction. Benzodiazepines act on decision making centers of the brain, and with frequent use can alter the structure and function of the brain. After prolonged abuse the brain will no longer be able to properly function without benzos.
Environmental factors. A number of environmental triggers and stressors are related to the development of addiction. They may include, but are not limited to, living under high levels of stress, multiple family tragedies, and growing up around drug abuse.
Cooccurring disorders – It is common for drug abuse to occur at the same time as other mental health disorders. Some of the most commonly seen co-occurring disorders are:
…..Other substance abuse
If you are struggling to understand addiction or want to speak with professionals who can answer questions and support your search for appropriate benzo addiction treatment, please reach out for help. Reputable treatment programs can address the main issues you encounter and help you quit for good.
Did you know? Benzos mask anxiety and sleeping problems. Treatment for these conditions is non-pharmacological. Talk therapy and behavioral therapies are more effective than medications.
Just how many people are affected?
The article “Benzodiazepine Use in the United States” published in JAMA Psychiatry in 2015 reported that approximately 5.2 % of Americans aged 18-80 used a benzodiazepine in the late 2000’s. However, the numbers are increasing constantly.
The stats speak for themselves.
The 2012 TED report on Admissions Reporting Benzodiazepine and Narcotic Pain Reliever Abuse at Treatment Entry showed that the number of substance abuse treatment admissions reporting both benzodiazepine and narcotic pain reliever abuse increased 569.7% from 5,032 admissions in 2000 to 33,701 admissions in 2010, while the number of all other admissions decreased by 9.6 % during the same period. Also, in the month prior to treatment admission, 45.5% reported daily use of benzodiazepines.
Furthermore, the The Drug and Alcohol Services Information System (DASIS) reported exact of 15,000 addiction treatment admissions for tranquilizers substance abuse disorder in 2015. But the number of people who seek treatment is a very small fraction of those who many need help. In fact, the 2016 National Survey on Drug Use and Health estimates that 2 million people aged 12 and older misused a prescription tranquilizers in the past month. This includes:
- 121,000 adolescents aged 12 to 17.
- 536,000 young adults aged 18 to 25.
- and 1.3 million adults aged 26 or older.
The same report estimates that 618,000 people aged 12 or older had a tranquilizer use disorder in the past year. Moreover, the Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health reported that in 2015, 18.9 million individuals misused benzo drugs:
- Misuse of tranquilizers, such as Xanax, were reported by 6.1 million people.
- Misuse of sedatives, such as Valium, were reported by 1.5 million people.
So, if you think you have a problem with a benzo, you’re not alone.
So, what can happen to you if you delay getting help?
Benzos have long been known to cause three major problems after long-term use:
- Cognitive decline.
- Increased risk of imbalance and falls.
Furthermore, the longer you take a benzo, the more you risk possible problems with overdose or death.
The DAWN Report of 2014 concluded that during the 7 years from 2005 to 2011, almost a million (an estimated 943,032) emergency department visits involved benzodiazepines alone or in combination with opioid pain relievers or alcohol and no other substances. The “benzo-alone” visits happened among all ages, but mainly affected older Americans.
- 174,998 aged 12 to 34
- 88,644 aged 35 to 44
- 150,780 aged 45 to 64
- 72,575 aged 65 and older
Moreover, the CDC Report on Emergency Department Visits Involving Nonmedical Use of Selected Prescription Drugs estimated that the number of visits involving non-medical use of benzodiazepines almost doubled: it increased from 143,500 in 2004 to 271,700 in 2008. The 2016 CDC Report on Drugs Most Frequently Involved in Drug Overdose Deaths showed that about 6,000 overdose deaths involved benzodiazepines alone in 2014:
- Alprazolam (4,217 people died from overdose)
- Diazepam (1,729 people died from overdose)
Further still, studies using the NVSS ICD–10-coded data have shown that benzodiazepines were involved in more than 30% of drug overdose deaths involving opioid analgesics. Check out this chart on Deaths Involving Benzodiazepines
Does Treatment Work?
Yes, benzodiazepine addiction treatment works.
Even if you relapse, it doesn’t mean that you’ve failed. Benzo addiction is often conceptualized as a chronic relapsing disorder. And, although addiction treatment helps you get rid of your need for benzos and become sober, there is more to the process of recovery.
In fact, the personal and societal benefits from living a sober life are numerous:
- A new purpose in life.
- A stable life at home.
- Better relationships with family and friends.
- Improved physical and mental health.
- Professional and educational advancements.
- Your brain and body heal from the effects of benzos.
The great benefit of benzodiazepine rehab programs is building a new life that affords you to live addiction-free…and it all starts when you get the treatment you need to stop benzo use.
Before you begin treatment, you’ll need to be assessed. The initial assessment helps specialists determine:
- The severity of misuse.
- The risk of relapse.
- The risk of harm.
A good assessment will include information about dosing, duration of use, your general health, and any history of psychiatric or medical issues, including drug use. It’s also important to communicate your readiness to change, as your willingness to get better guides the initial management of the condition.
You can complete this clinical assessment from the National Institute on Drug Abuse, or look into the CAGE tool. Alternately, you can seek a brief assessment for a drug problem from:
- Your prescribing physician
- An addiction medical doctor specialist
- A psychologist
- A psychiatrist
To get the best treatment possible and to quit drugs for good, you’ll need a tailor made program. Individualized treatment programs are of utmost importance for long-term recovery success. Each person has a unique history, with experiences, personal, and emotional issues that can all influence addiction. A good treatment program needs to answer to these specific needs.
You can choose from a wide variety of options:
- Type of treatment: Inpatient, luxury, outpatient, intensive outpatient, or counseling.
- Duration of treatment: 30 days, 60 days, 90 days, or longer.
- Treatment facility location: Close to your living area or far away.
- Psychotherapy and behavioral therapies: Cognitive Behavioral Therapy (CBT), Motivational Interviewing, Dual Diagnosis treatment, family and couples therapy, educational sessions and career counseling, and more.
- Additional therapies: Mindfulness, yoga, Eye Movement Desensitization and Reprocessing (EMDR), Neurofeedback, art therapy, or animal therapy.
If you have a benzodiazepine addiction problem, it’s important to remember that you don’t have to find all treatment resources on your own. Ask a trusted doctor or your prescribing physician for help. Or, seek a referral from a friend or even your local pharmacist. Whatever you do…take action! Addiction does not get better left on its onw.
Detox, The First Step
The first step in treating a benzodiazepine addiction is removing the drug from your system. This process is known as detox and can cause dangerous side effects if not done properly.
Q: How can I quit benzo addiction safely?
A: By medically supervised detox and tapering doses.
TAPERING: Medical detox often involves tapering benzodiazepine doses down gradually and slowly. Tapering down can also mean taking a long-acting benzodiazepine such as diazepam (Valium) or clonazepam (Klonopin) and tapering those down to shorter acting benzodiazepines, as suggested by your doctor. In general, it takes most people about 10 weeks or more to finally stop taking tapered doses and fully detox from benzodiazepines. You can find guidelines for a safe withdrawal from benzos in the Ashton Manual from Dr. Heather Ashton.
WITHDRAWAL: Benzo withdrawal symptoms typically occur within four hours after the last dose and can persist for days, weeks, or even months. Most of benzo withdrawal symptoms will be present during the acute withdrawal phase and may include:
…..anxiety or depression
…..irregular heart rate
…..muscle pain and stiffness
…..short-term memory loss
Q: Can I quit benzos cold turkey?
A: NO. Quitting cold turkey is very dangerous and can even be fatal. Some serious side effects that may occur during benzo withdrawal, include:
Benzodiazepine withdrawal can be life-threatening due to grand mal seizures that may result in coma or death in heavily dependent individuals that stop taking benzos cold turkey.
At the moment, no medications directly address benzo withdrawal or addiction. What happens more often is swapping one benzo for another…and then withdrawing from the second, longer-acting medication. According to this article written by Dr. Heather Ashton, the foremost authority on benzodiazepine withdrawal in the world, there are a few protocols that can be used when helping someone come off benzos for good. First, you’ll need to decide whether you prefer:
- Benzodiazepine withdrawal with the aim of abstinence.
- Benzodiazepine maintenance therapy.
Prescribing interventions, substitution therapies, psychotherapies, and medicines will then be adjusted according to your goals and your risk of serious complications. Low-risk cases, says Dr. Ashton, may benefit most from attempting withdrawal. High-risk cases are best managed with initial stabilization and maintenance therapy in specialist residential or outpatient addiction services.
Long-acting benzodiazepines are typically used as replacement medications in both withdrawal and maintenance therapy. The dose should be gradually reduced over weeks to lower the risk of seizures.
Other medications may occasionally be required such as antidepressants or propranolol… but no drugs currently help alleviate benzo withdrawal symptoms 100%. Psychological support should be available both during dosage reduction and for some months after cessation of drug use. This can include:
- information about benzodiazepines
- general encouragement,
- measures to reduce anxiety
- non-pharmacological ways of coping with stress
Counseling or formal psychological therapy can also help.
Inpatient vs. Outpatient
Benzodiazepine addiction can be treated at either an inpatient or outpatient rehabilitation program.
- Inpatient care is recommended for individuals whose addiction is too severe for them to detox and recover by themselves. Living at the facility and focusing on recovery only, without life distractions can help long-term sufferers of acute addiction to get and stay sober. The round-the-clock monitoring and support they need is provided by qualified healthcare professionals.
2.Outpatient care works well for patients who have not been on benzodiazepines for a long period of time and who don’t have an addiction to the medications. These are usually people who can follow a tapering schedule, treat symptoms of withdrawal with short-term prescription or over-the-counter medications, and don’t require constant monitoring as part of their treatment process.
What happens in rehab?
Here is what you can expect during the addiction treatment process from benzos:
STEP #1. Intake and evaluation. Intake consists of an initial meeting with doctors and addiction therapists. They will assess the severity of your benzo abuse as well as diagnose any co-occurring mental health conditions.
STEP #2. Medical detox. Benzodiazepine detox is the safest way to cleanse your body of the drug. At the detox clinic, you will receive around-the-clock care in order to ensure that you’re as comfortable as possible and do not relapse due to withdrawal effects.
STEP #3. Therapy. Therapy is an integral part of treatment. It assesses the root problems that influenced your abuse, while helping you to build healthy coping skills for stressful situations in life. Some of the common therapies used to treat the psychological and behavioral aspects of an addiction to benzos include:
…..Dual diagnosis treatment.
…..Life skills classes.
STEP #4. Aftercare. The final step in the rehab process is aftercare planning. You will require guidance and continued support to ease the transition back into the real world once you are done with initial treatment. In case you attended a program away from home or a smaller program, you should be provided with recommendations to local resources.
How to Help Someone With a Benzodiazepine Addiction
It can be extremely difficult for benzo addicts to quit on their own. Family and friends can help positively influence them into treatment. But, approaching a loved one suffering from addiction is never easy.
So what can you do?
Stage an intervention. During an intervention, family members and close friends come together with the individual in need and talk to them about their addiction and urge them to get into a treatment program. The approach should be loving and supportive in nature. Yelling, threatening, or expressing anger in order to get someone addicted to benzos into treatment is not helpful and may drive the addicted person further away from seeking treatment.
Use Community Reinforcement Approach and Family Training (CRAFT). CRAFT is designed to help family members intervene in such a way that they keep open communication and continue to care for their addicted loved one, while avoiding unhealthy behaviors like enabling and sacrificing their own self-care. The CRAFT approach can help motivate a loved one to seek treatment. In fact, there is a multitude of empirical evidence that support the CRAFT-based strategy for staging a successful intervention as successful and effective for getting loved ones into treatment.
What happens after rehab?
Ongoing care is often essential in facilitating lasting recovery from an addiction. Why? For a few reasons. First, the long-term effects of benzo abuse include protracted withdrawal symptoms (PAWS). Impaired brain function may take a long time to heal. Next, aftercare helps prevent relapse. And finally, aftercare helps people transition back into every day life. Aftercare services often include counseling and support group meeting.
1. Counseling interventions/Group therapy. These include Cognitive Behavioral Therapy (CBT), relaxation training, motivational interviewing, self-monitoring of consumption, goal setting, management of withdrawal and coping with anxiety.
2. 12-step Groups. These self-help programs are based on a set of guiding principles outlining the course of action for tackling addiction. The 12-steps teach that recovery is sought in physical, mental, emotional, and spiritual domains.
3. Follow-up medical care. Supervised medical management is recommended for those with a history of benzodiazepine abuse due to various physical and psychological complications that may arise as a result of long term benzodiazepine use.
4. Sober living communities. Sober living facilities offer a prolonged stay for recovering individuals who have quit using and look forward to a drug free life, but are just not ready to step into the real world yet.
5. Contingency Management (CM) – This behavioral therapy is aimed at preventing or reducing benzodiazepine use by making positive reinforcement contingent on drug free behavior. CM has been has been found to improve retention in treatment and allow long-term abstinence from benzos.
To learn more about the aftercare can be incorporated into your benzodiazepine addiction treatment, reach out for help. Talk with your doctor, a psychologist, or even a licensed clinical social worker.
You do not need to suffer alone.
Help is available!