Side Effects of Benzodiazepine Use and Addiction

Benzodiazepines are widely prescribed in the United States.² In fact, Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), and Ativan (lorazepam)—all benzodiazepines—are among the top 100 most commonly prescribed medications.²

While considered to be effective, benzodiazepines carry some notable side effects, including the development of tolerance and dependence, which can occur even when benzodiazepines are taken at therapeutic doses.³

Keep reading to understand how benzodiazepines work, the short- and long-term effects of use, and how to get help if you or a loved one struggle with benzodiazepine misuse and addiction.

How Do Benzodiazepines Work?

Benzodiazepines exert calming effects by manipulating the body’s primary inhibitory neurotransmitter in the CNS, gamma-aminobutyric acid, or GABA.⁴ Benzodiazepines facilitate the binding of GABA at receptors throughout the brain and spinal cord, causing an overly excited central nervous system to calm down; promoting feelings of relaxation.⁴

With repeated use, over time, this neuroadaptive process can build tolerance, which can take two forms: An individual requires more benzodiazepines to achieve the same desired effect or there is a markedly diminished effect with continued use of the same amount of benzos.^1,5 Tolerance can be a contributing factor to developing a physiological dependence to benzodiazepines.¹

Dependence on a drug occurs when a person’s body physically adapts to the drug to the extent that it is needed to function normally. In the absence of the drug, withdrawal symptoms appear.^1,3,6 With significant levels of physiological dependence, a person may continue to compulsively use benzodiazepines to avoid the unwanted withdrawal symptoms, which in the case of benzos, can be uncomfortable but also potentially dangerous and life-threatening.^1,3

Seizures are of particular concern with benzodiazepine withdrawal.¹

Benzodiazepine Misuse

The Drug Enforcement Administration classifies benzodiazepines as Schedule IV substances, which means there is a lower potential for misuse than drugs in Schedules I-III.⁷ However, in 2019, the U.S. Food and Drug Administration (FDA) included a boxed warning—its most prominent warning—on all benzodiazepines, cautioning prescribers and patients about the potential for misuse and addiction, even when benzodiazepines are taken at the recommended therapeutic dose.⁸ And in 2020, 4.8 million people aged 12 and older misused benzodiazepines in the past year.⁹

Misuse of benzodiazepines includes: ^4,10

• Taking more of the benzodiazepine than was prescribed.
• Buying benzodiazepines illicitly after a prescription runs out.
• Taking them in a manner other than was prescribed, such as crushing the pills and snorting them through the nose.
• Taking them with other medications, illicit drugs, or alcohol. For instance, individuals may combine benzodiazepines and opioids to enhance the euphoric effects of each. On the other hand, benzos may be used to self-manage the feelings of irritability and agitation or alleviate sleeplessness induced by cocaine or other stimulant drugs.

Benzodiazepine Side Effects

Benzodiazepines are generally safe when taken as prescribed for short periods of time—no more than a few weeks.^1,3 While all benzos affect the brain similarly (as mentioned above), the side effects may differ, impacted by the type of benzo taken, the dose, and the duration of use.^1,3

Combining benzodiazepines with other substances, including other CNS depressants, such as opioids and alcohol can further slow heart rate and breathing.¹³

Effects of Long-Term Benzodiazepine Use

Benzodiazepines produce almost immediate effects; therefore, they are typically prescribed for short-term or “as-needed” use.³ Individuals who take benzodiazepines may develop tolerance, though the rate depends on the type of benzo taken and duration of use. With long-term, high-dose use, benzodiazepines also become less effective.³

Additionally, there is an increased risk of overdose if individuals use benzodiazepines with other sedative drugs, such as opioids and alcohol.¹⁴

Benzodiazepine Overdose

Deaths resulting from a benzodiazepine overdose alone are rare. Severe overdose and/or fatal overdose is more likely to occur with the concomitant use of benzodiazepines and other substances, particularly, other CNS depressants like alcohol and opioids.¹⁶

According to the Centers for Disease Control and Prevention (CDC), which published a data set on benzodiazepine-involved overdose rates in 38 states and the District of Columbia, of the 41,496 overdose deaths reported by 23 states from January to June 2022, 16.8% involved benzodiazepines, while 91% involved both benzodiazepines and opioids.¹⁶

Benzodiazepine Dependence and Withdrawal

As previously mentioned, dependence can occur even when benzodiazepines are taken as prescribed. Thus, abruptly stopping or trying to cut back use after developing a physiological dependence to the drug can result in unpleasant, potentially dangerous, and even life-threatening withdrawal symptoms, which may include:^1,3,17

• Anxiety.
• Agitation.
• Increased heart rate.
• Elevated blood pressure.
• Hand tremors.
• Insomnia.
• Nausea or vomiting.
• Fleeting visual, auditory, and tactile hallucinations or illusions.
• Seizures.

Several factors impact the severity and duration of withdrawal symptoms.^4,18 For a small portion of individuals, who use benzodiazepines long term, prolonged withdrawal—which can last for weeks, months, even up to a year—can occur after they discontinue use.¹⁸

Benzodiazepine Addiction Treatment

If you or a loved one struggles with benzodiazepine misuse or addiction, help is available. Treatment can aid you in stopping the use of benzodiazepines—and other substances—and allow you to regain control of your life.

Stopping the use of benzodiazepines abruptly (or on your own) is not recommended. If you’re ready to stop, talk to your healthcare provider. You may benefit from medical detox since withdrawal from benzodiazepines can be uncomfortable and, in some cases, life-threatening.^17,20 Medically managed detoxification allows your body to rid itself of the substances safely and as comfortably as possible. However, detox alone is typically not sufficient to help someone maintain lasting recovery; it’s usually the first step in a more comprehensive treatment plan.²¹

The subsequent treatment depends on your individual needs but may include a combination of individual and group counseling, behavioral therapies, psychoeducation, medication, co-occurring disorder treatment, polysubstance addiction treatment, continuing care, and more. It may take place in either an inpatient or outpatient setting.²⁰

To understand your treatment options, you can contact your primary care physician or mental healthcare provider. You can also call American Addiction Centers

AAC is a leading provider in evidence-based treatment. Talk to one of our compassionate Admissions Navigators who can answer your questions, verify your insurance, and explain your treatment options.