Benzodiazepine Addiction: Symptoms & Signs of Dependence

Benzodiazepines belong to the prescription sedative class of drugs. Although benzodiazepines have a calming effect, they are highly addictive, and a person who abuses them faces a host of symptoms. Some of the physical, psychological, and behavioral symptoms of benzodiazepine abuse include:

• Weakness
• Blurred vision
• Drowsiness
• Poor judgment or thinking
• Doctor shopping
• Asking friends, family, colleagues, and/or classmates for their benzodiazepine pills
• Wanting to cut back on the volume of abuse but not being able to do so
• Mood changes
• Risk-taking behaviors, such as driving after abusing benzodiazepines
• Combining benzodiazepines with alcohol or other drugs

Due to the natural process of building a tolerance, over time, a person will require a higher volume of benzodiazepines to reach the familiar high. When the abuse stops or the familiar dose is significantly cut down, withdrawal symptoms will emerge. Benzodiazepine withdrawal can be particularly dangerous and even life-threatening. Undergoing medical detox under the direct care of a doctor is generally advised.

What are Benzodiazepines? Names & Uses

The drug class known as benzodiazepines is made up of prescription tranquilizers, also called sedatives or anxiolytics. They are prescribed for a host of conditions, such as anxiety disorder or panic disorder. Benzodiazepines can be prescribed for the following medical conditions:¹

• Insomnia.
• Seizures.
• Muscle spasms.
• Anxiety.

List of Common Benzos

The following is a list of benzodiazepines, by branded name:^1,2

• Valium®
• Xanax®
• Restoril®
• Ativan®
• Klonopin®

Benzo Addiction Diagnosis

Today, the mental health community uses the term hypnotic, sedative, or anxiolytic use disorder to describe benzodiazepine abuse or addiction. This term comes from a main mental health book for clinicians, the Diagnostic and Statistical Manual of Mental Disorders, 5^th edition.³ In order to be diagnosed with a sedative use disorder, at least two of a possible 11 symptoms must manifest within the same 12- month period. The National Association of Addiction Professionals explains each symptom, five of which are paraphrased here:⁴

• The sedative is taken in a higher volume or over a longer time period than first intended.
• Considerable time is spent getting the drug, using it, and recovering from its effects.
• When the drug is not in a person’s system, the person experiences withdrawal, which can include cravings for the drug.
• Over time, more of the drug is needed to achieve the familiar desired effects (i.e., tolerance).
• The person experiences impaired performance at home, work, or school due to the drug’s effects.

The sedative effect of these drugs, as well as their addiction-forming chemical properties, makes them ripe for abuse. Since these are prescription drugs, it is critical to note that some individuals may initially have a legitimate medical reason to use them, but over time, they develop a use disorder. If a patient who has a prescription for a benzodiazepine follows their doctor’s orders, a use disorder will not likely set in. But if a use disorder does arise, there are different ways people go about getting the volume they need (discussed below). Legitimate doctors will not overprescribe these medications.

Individuals who are concerned that someone they know or love is abusing benzodiazepines should keep in mind that although these drugs are legally manufactured and prescribed by doctors, they are acutely addictive and available for sale on the street.

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Benzodiazepine Overdose & Abuse Symptoms

If you believe that you or a loved one may be overdosing on benzodiazepines or any other drugs, call 911 immediately.

A review of the physical and psychological symptoms associated with benzodiazepine use illuminates the many dangers inherent in abusing this type of prescription drug. Benzodiazepine toxicity may cause the following symptoms:⁵

• Physical weakness
• Slurred speech
• Confusion
• Poor decision-making abilities and poor judgment
• Blurred vision
• Lack of motor coordination
• Dizziness
• Inability to defend oneself in the case of an attack or threat
• Drowsiness
• Coma
• Difficulty breathing
• Death (Rare when abused on its own, fatal overdose may occur when a benzodiazepine is mixed with alcohol.)

If a person chronically abuses benzodiazepines, the following symptoms may emerge:

• Anorexia
• Insomnia
• Anxiety
• Tremors
• Headaches
• Insomnia
• Memory problems

As discussed, the development of tolerance to benzodiazepines is a medical condition, known as physical dependence. Tolerance is the process by which the brain becomes increasingly accustomed to the drug and, for this reason, requires more of it in order for the person to get the familiar high. When the brain does not get its familiar dose, because the person is abstaining or reducing the familiar amount, withdrawal is triggered. Withdrawal from benzodiazepines is considered to be particularly dangerous, and in some instances, it can be fatal. For instance, seizures are a symptom of withdrawal.

A person who is concerned with a loved one’s benzodiazepine abuse may not be able to pinpoint whether the signs they are seeing are symptoms that are emerging as a result of drug use or because of withdrawal. People who want to help may feel unsure and not know whether what they are seeing is a dangerous symptom or a common one. Ideally, the person who used the benzodiazepine would disclose important facts, such as the amount recently taken. If any serious symptoms emerge such as signs of benzodiazepine overdose the best practice is to seek immediate help, which can include going to a local emergency room or contacting a doctor.

How Quickly Does Tolerance for Benzos Develop?

Tolerance tends to develop when someone chronically takes benzos for long periods of time.⁴ Most people who are prescribed benzodiazepines for anxiety prefer these medications for the treatment of their condition because they can take them on an as-needed basis.⁴ Most patients can use benzos judiciously.⁴ But when someone uses benzos for a long period time, uses benzos in excess (or uses more benzos than they prescribed), this can lead to the development of benzodiazepine dependence and tolerance.⁴

Every person’s body chemistry is different, and the time it takes for someone to develop a tolerance for benzos will vary from person to person. The amount of benzos someone uses and other factors can also influence how quickly they develop a tolerance to benzos.

Behavioral Signs of Benzo Abuse

The development of a sedative use disorder may creep up on a person, but when it exists, it is likely going to be observable. Substance abuse has a way of shifting a person into exhibiting uncharacteristic traits. In short, the person stops being in service of the life they used to lead, and now spends an increasing amount of time in service to the drug abuse. People who develop a substance use disorder may exhibit some or all of the following (partial) list of behavioral symptoms of substance abuse:³

• The person withdraws from friends, family, and obligations in order to use the drug.
• From a place of fear of being without the drug, the person ensures that an adequate supply is maintained at home.
• The person does uncharacteristic things to be able to pay for the drug, such as borrowing money, stealing, draining bank accounts, or maxing out credit cards.
• The person engages in risky activities, such as driving, after using the drug.
• The person spends an increasing amount of time and energy on different facets of drug abuse.
• The person exhibits a reduction in effort to maintain hygiene or grooming (i.e., the person may begin to look disheveled).
• The person is uncharacteristically secretive about daily schedule and/or tells lies to protect the substance abuse.
• Shifts in mood or personality are experienced.

Behaviors around drug abuse relate to different facets of drug use, including how the person administers the drug. Typically, benzodiazepines are swallowed. According to feedback from individuals who tried to crush, cook, and inject benzodiazepines, they do not appear to be injectable drugs. There may be very little paraphernalia associated with benzodiazepine abuse.

Since benzodiazepines are prescription drugs, some individuals who have a sedative use disorder will get a high volume of this drug by “doctor shopping.” Getting a few prescriptions from different doctors can occur, and individuals will have to fill these prescriptions at different pharmacies. Prescription bottles and their labels will reveal if an individual has different prescriptions from different doctors, filled by different pharmacies within the same timeframe.

Benzodiazepines can also be obtained from people who are not drug dealers – friends, a friend of a friend, coworkers, or family members may share or sell their pills. Benzodiazepines can also be purchased on the street. Purchase at the street level carries specific dangers. For instance, when drug sellers do not have benzodiazepines available, they may offer other dangerous drugs to the person, which can lead to polydrug abuse. Also, whenever a substance is purchased on the street, users never truly know what they are buying, as substances are not tested or verified.

As mentioned earlier, benzodiazepine abuse alone does not typically result in death (though withdrawal can be life-threatening). However, it appears that many people take benzodiazepines with alcohol, and this combination can be deadly. Addiction professionals agree that the best practice for individuals seeking to stop using benzodiazepines is to be weaned off these drugs during a medically supervised detox process.

Tips for Preventing Benzo Addiction

Addiction can’t always be prevented, but there are certain measures you may be able to take to remain aware of how you use benzos.

1. Only take your prescribed dose of benzodiazepines.
2. Only take benzos if you are prescribed them for a condition of yours.
3. Educate yourself on the early warning signs of benzo addiction.
4. Familiarize yourself with the symptoms of a substance use disorder.
5. Reach out for help if you begin to spot signs of benzo addiction or dependence in yourself or your loved one.

Sources

1. United States Drug Enforcement Administration. (N.A.). Benzodiazepines.
2. United States Drug Enforcement Administration. (2020). Drug Fact Sheet: Benzodiazepines.
3. American Psychological Association. (2015). Diagnostic and statistical manual of mental disorders, Fifth Edition.
4. American Academy of Family Physicians. (2000). Addiction: Part I. Benzodiazepines—Side Effects, Abuse Risk and Alternatives
5. Kang M, Galuska MA, Ghassemzadeh S. (2022). Statspearls. Benzodiazepine Toxicity.