According to Fox News, benzodiazepine medications, including alprazolam derivatives like Xanax, are some of the most prescribed psychiatric medications in America.

Anxiety, stress, panic disorders, insomnia, seizures, and alcohol or opioid withdrawal can be successfully managed with benzodiazepine tranquilizers. Valium, Klonopin, Ativan, and Librium are some of the brand name benzodiazepine medications commonly prescribed for short-term relief.

Benzodiazepines are central nervous system depressants that activate the inhibitory neurotransmitter gamma-aminobutyric acid, or GABA, which has natural hypnotic, calming, and relaxing effects. In short, benzodiazepines, or benzos, can make you feel good and therefore are commonly abused. The National Survey on Drug Use and Health (NSDUH) reported that 1.7 million Americans over the age of 12 abused tranquilizers in the month prior to the 2013 survey.

Any time a medication is used beyond its medical scope or intended purpose, it is considered abuse. Abusing benzodiazepine medications can create a plethora of short-term and long-term side effects. Even when used as directed, benzodiazepines are not without risk factors.

Benzodiazepine Overdose

mental consequencesOne of the most serious potential immediate risks when using or abusing benzodiazepines is the chance of an overdose, which occurs when the drug reaches toxic levels in the bloodstream that the body cannot break down. Since benzos suppress the central nervous system, slowing down respiration, heart rate, body temperature, and blood pressure, an overdose may cause shallow breathing, irregular heart rate and blood pressure, dizziness, muscle weakness, drowsiness, slurred speech, irregular eye movement, and blurred vision as well as a potential loss of consciousness. Emotional symptoms are also present during an overdose, such as anxiety, agitation, hostility, confusion, impaired cognition, short-term memory loss, or hallucinations. A drug overdose is a medical emergency, and if you recognize any of the symptoms of a benzodiazepine overdose, you should seek immediate medical attention.

According to the Centers for Disease Control and Prevention (CDC), drug overdose was the leading cause of injury death in 2012, and approximately 120 people die every day from a drug overdose in America. The CDC further reports that 51.8 percent of the drug overdose fatalities in the United States are related to pharmaceuticals, with 30.6 percent of the pharmaceutical overdoses being linked to benzodiazepines. Injecting benzodiazepines increases the risk for an overdose as it sends the drugs directly across the blood-brain barrier and rapidly into the bloodstream.

The Drug Abuse Warning Network (DAWN) reported that in 2011 approximately 89,310 Americans over the age of 12 sought emergency department (ED) treatment for an adverse reaction to benzodiazepines. Benzos are also commonly mixed with other drugs or alcohol, which increases the potential for a hazardous consequence or overdose. The DAWN report indicated that an additional 50,561 people sought ED treatment for the mixture of opioids and benzodiazepines, another 27,452 for mixing alcohol and benzodiazepines, and 8,229 for combining all three substances.

Alcohol and benzodiazepines are both central nervous system depressants, and the combination of the two can depress vital life functions to dangerously low levels. Mixing benzodiazepines with opioids can also have disastrous results, as Medpage Today published that 30 percent of the narcotic painkiller overdoses in 2010 also involved benzodiazepine drugs. The mixing of benzodiazepine medications and opioids or alcohol resulted in serious medical health issues 50 percent of the time in hospital emergency visits, as published by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Short-Term Side Effects of Benzodiazepine Use and Abuse

The medical use of benzodiazepine medications for the treatment of acute anxiety, panic, stress, or insomnia is considered relatively safe if used for a short period of time and if taken as directed. Most benzodiazepines are short-acting, meaning that they can provide relief rather quickly, within a few minutes even, and last for a few hours. You may experience a sort of hangover effect the next day, resulting in drowsiness and sluggishness if you take these medications to help you sleep. Taking benzodiazepines recreationally, or in larger than intended doses, can result in various potential side effects, including:

  • Fatigue
  • Drowsiness
  • Lethargy
  • Mental confusion
  • Headaches
  • Motor coordination impairment
  • Vertigo
  • Depression
  • Blurred vision
  • Memory issues
  • Nausea and/or vomiting
  • Slurred speech
  • Tremors
  • Constipation or diarrhea
  • Dry mouth
  • Loss of appetite
  • Shallow breathing
  • Mood swings
  • Slowed reflexes

Most of these side effects are the result of over-sedation and will depend on the type of benzodiazepine medication taken, the dosage and method of ingestion, as well as personal physiology. Benzos with shorter half-lives, such as lorazepam or alprazolam, will leave the bloodstream faster, for example, while longer-acting ones, such as diazepam, will have more lasting effects.

Even when used as directed, benzodiazepines can lead to physical dependence. The U.S. Food and Drug Administration, or FDA, publishes warnings that even short-term use of Xanax can lead to the development of a tolerance, for example, stating that dosages greater than 4 mg/day or using Xanax for more than 12 weeks may increase the severity or potential for dependence and withdrawal symptoms when the drug is stopped.

Physical Tolerance, Dependency and Addiction

When the body requires more or higher doses of a drug in order to produce its effects, the user is considered tolerant. The regular use or abuse of a benzodiazepine medication can quickly lead to tolerance, which may then continue on to dependence. A physical dependence occurs when the brain depends on the chemical’s interaction with it. The natural balance and reward pathways are disrupted, and in order to feel what it now perceives as normal, the brain will expect and rely on the drug’s effects. When the drug is removed, or even between doses, the brain will struggle to restore balance, creating uncomfortable and even dangerous withdrawal symptoms. The severity and duration of these symptoms will depend on the level of dependency and duration of use or abuse as well as the dosage amount and method of ingestion. Injecting benzodiazepines may increase the potential for developing a dependency or addiction, for example.

Addiction is defined as compulsive drug-seeking behavior wherein the addict spends most of his or her time obtaining the drug, using the drug, and recovering from its effects. Both tolerance and the presence of withdrawal are symptoms of physical dependence but may not always signify addiction. In order to be classified with addiction at least two of the following criteria must additionally be present in a 12-month period, according to the most current Diagnostic and Statistical Manual of Mental Disorders (DSM-V), as published by the National Institute on Drug Abuse (NIDA):

  • Use of the substance for longer than intended or in greater amounts than intended
  • Drug cravings
  • Numerous unsuccessful attempts to stop using substance
  • Using the substance regardless of negative physical or interpersonal consequences or in physically hazardous conditions
  • Withdrawal from previously enjoyed activities
  • Loss of production at work or school and failure to fulfill familial obligations

Physical dependency may be best treated by a gradual decrease, or controlled tapering, of benzodiazepine medications, closely monitored by medical professionals and consulting physicians through a detox protocol. Adjunct medications may also be used to combat drug cravings and withdrawal symptoms, resulting in a rebound effect as the brain tries to regain its natural balance. This can cause the individual to experience symptoms that he may have been taking benzodiazepines to suppress, such as in insomnia, anxiety, tremors, or panic. Additional withdrawal symptoms may include dizziness, nightmares, sweating, irregular heart rate, muscle fatigue, altered perceptions and sensory functions, confusion and cognitive impairment, agitation, difficulties concentrating, hallucinations, or even seizures.

Successful Treatment

Addiction and withdrawal can, however, be successfully treated in a specialty facility that attends to both the physical and emotional symptoms through detox and psychotherapy.

Lasting Effects of Benzodiazepine Use or Abuse

In addition to the risks for developing a physical and psychological dependency or addiction, using benzodiazepine medications long-term can have lasting effects on the brain and body. Most benzodiazepines are not meant to be taken for a long period of time due to these increased risks. While the exact science or persistence of cognitive impairment down the line is unclear, medical professionals do indicate that long-term benzodiazepine use may potentially negatively affect memory, sensory perceptions, processing speed, and learning abilities.

The journal BMJ published a study showing a link between benzodiazepine use and an increased risk for the dementia form of Alzheimer’s. The risks increase with the length of time taking a benzodiazepine medication. Those taking benzos for fewer than three months showed no increase in risks for developing dementia while those taking them for three to six months showed a 32 percent increased risk. Those using benzodiazepines for longer than six months showed an 84 percent increased risk for developing the incurable disease, as published by Harvard Health.

Specific Risks for the Elderly

Approximately 30 percent of all medications are prescribed to the elderly, and one of the most prescribed classes of drugs is benzodiazepines, as reported by Psychiatry Online. The elderly population may be at an increased risk for adverse side effects of benzodiazepines, not only for the heightened potential of developing Alzheimer’s disease. In the elderly, these drugs may also increase the odds for impaired motor coordination, causing motor vehicle accidents or other injuries related to a loss of balance, as published by the Psychiatric Times. Elderly patients may have increased sensitivities to central nervous system depressant medications, including benzodiazepines. As you age, your metabolism also slows down, which can lead to a dangerous buildup of medications in your system, leading to hazardous long-term consequences.

Benzodiazepine medications are generally prescribed for the treatment of mental illness symptoms and sleep issues, as muscle relaxers, or to manage acute short-term stress. When used as directed, these medications can be very effective; however, when they are used in higher-than-intended doses, or for an extended period of time, the risk factors increase. Co-occurring disorders, such as substance abuse and mental illness, need to be treated with simultaneous and integrated care by teams of highly trained professionals.

Black Bear Lodge offers a peaceful respite where you can recover from a benzodiazepine dependency or addiction in privacy. Highly trained professionals use evidence-based methods to address the entire individual. Withdrawal symptoms can be managed with adjunct medications and behavioral therapies during detox and recovery. Addiction is a treatable brain disease, and with the proper care, recovery can help you or your loved one start a new healthy life. Call us to learn more.