Benzodiazepines are commonly known as “Benzos”. They are a type of depressant drug that slows the nervous system down, relaxes muscles, and lowers anxiety levels. They are prescribed to treat conditions such as:
- Anxiety disorders
- Insomnia
- Seizures
- Alcohol withdrawal
- Premedication for medical procedures
Read on to learn more about how they work, the effects they can have, addiction, and treatment.
How Benzos Work
Benzodiazepines enhance the effect of the neurotransmitter GABA, at the GABA-A receptor. They have several distinct properties:
- Sedative
- Hypnotic
- Anti-anxiety
- Anti-convulsant
They work by blocking excessive nerve activity in the brain and other areas of the nervous system.
Common Benzodiazepines
There are many forms of benzos. Some commonly prescribed ones include: Xanax, Diazepam, Valium, Lorazepam, and Klonopin.
How Does Addiction to Benzos Happen?
Addiction to benzos develops through a complex interplay of activity in the brain. The process typically involves the following [1]:
Brain Mechanisms
- Changes to GABA Receptors: Benzos enhance the effect of the neurotransmitter GABA at one of its receptors. This leads to sedative and anti-anxiety effects.
- Activation of Dopamine System: Benzos increase the firing of dopamine. Through a series of connections, this triggers long-lasting adaptations in one of the brain’s reward systems. This may induce addictive behavior.
- Development of Tolerance: With prolonged use, tolerance to the therapeutic effects of benzos develops rapidly. This occurs due to:
- Reduction in the sensitivity of GABA receptors
- Increased sensitivity of excitatory neurotransmitters such as certain glutamate receptors
- Decrease in the number of GABA receptors
- Potential long-term changes in genetic coding of brain cells
- Physical Dependence: As tolerance develops, physical dependence can occur, with withdrawal symptoms upon dose reduction or stopping use of Benzos.
Clinical Progression of Addiction
- Initial Therapeutic Use: Benzos are often prescribed for legitimate medical reasons, such as anxiety disorders or insomnia.
- Escalation of Use: As tolerance develops, with the need to take more of the drug to have the same effect, patients may increase their dose to achieve the same therapeutic effects, often without medical supervision.
- Withdrawal Avoidance: Continued use becomes tied to avoiding unpleasant withdrawal symptoms rather than seeking pleasurable effects.
- Compulsive Use: Despite negative consequences, individuals may continue to use benzodiazepines, showing drug-seeking behaviors and an inability to cut down or stop use.
- Cross-Addiction: Benzos addiction often co-occurs with other avoidance disorders, particularly alcohol or opioids, which can accelerate the addiction process.
Risk Factors
There are a number of factors that are risky or promote risk, including:
- History of substance abuse
- Prolonged use (even at therapeutic doses)
- Genetic predisposition
- Co-occurring mental health disorders
- Environmental and social factors
While dependence can occur in most patients undergoing therapeutic benzodiazepine treatment, the transition to addiction occurs in less than 10% of users.
Benzos Addiction Treatment
Benzos addiction can develop due to their potential for dependence, especially when used long-term or at high doses.
For many people, the degree of support required during withdrawal is minimal. Psychological support should be available both during dosage reduction and for some months after stopping benzos.
This support should include information about benzos, encouragement, and measures to reduce anxiety and promote non-medication ways of coping with stress. A minority may need counseling or formal therapy. Unwilling individuals should not be forced to withdraw [2].
Treatment typically involves a comprehensive approach.
- Medical Detox: Detox should be done under medical supervision, due to the risk of severe withdrawal symptoms. To safely wean the individual off the medication, controlled tapering of the drug is usually performed.
- Therapy: Cognitive Behavioral Therapy (CBT) is often used. It helps individuals understand the thoughts and behaviors that led to their addiction and teaches new coping mechanisms for handling stress and anxiety.
- Withdrawal Management: The withdrawal process can last several weeks to months. Symptoms may include anxiety, insomnia, irritability, and muscle stiffness. Medical professionals can help manage these symptoms during the detox process.
- Long-term Support: Ongoing support and counseling are key to maintaining recovery and preventing relapse.
Withdrawal Symptoms
Withdrawal can be dangerous if not properly managed. Abruptly stopping the drug can lead to severe symptoms. Therefore, treatment should be overseen by medical professionals in a controlled environment. Here are some common symptoms [3] [4]:
| Anxiety | Sensitivity to light, sound, and smells | Confusion or memory loss |
| Depression | Nausea and vomiting | Hallucinations |
| Dizziness or unsteadiness | Sleep problems or nightmares | Delusions |
| Stomach cramps | Loss of appetite | A burning feeling on your skin |
| Head, face, neck, eye, or tongue pain | Loss of sex drive | Seizures |
| A bad taste in your mouth | Fast heartbeat, high blood pressure, sweating & shaking | More serious withdrawal symptoms include seizures and psychotic reactions |
Trauma-Informed Therapies at Maple Mountain Mental Health and Wellness
Addiction and Trauma can feel isolating and overwhelming, but healing is possible with the right support. Whether through therapy, medication, or holistic practices, recovery is within reach. Seeking help is a sign of strength and you don’t have to navigate this journey alone.
Maple Mountain Mental Health & Wellness Center has a compassionate team of trauma-informed therapists who are here to provide comprehensive support.
We understand the complex nature of trauma and offer individualized treatment options. Healing starts with taking the first step. Reach out to our Admissions team today.
Sources
[1] Tan KR, Brown M, Labouèbe G, Yvon C, Creton C, Fritschy JM, Rudolph U, Lüscher C. 2010. Neural bases for addictive properties of benzodiazepines. Nature. 2010 Feb 11;463(7282):769-74.
[2] Ashton H. 1994. The treatment of benzodiazepine dependence. Addiction. 1994 Nov;89(11):1535-41.
[3] Pétursson H. 1994. The benzodiazepine withdrawal syndrome. Addiction. 1994 Nov;89(11):1455-9.
[4] Davis S. 2024. Benzodiazepine Abuse. WebMD.
