How can I quit taking benzodiazepines? I'm worried I'm addicted.

Answered by Shivam Patel, PharmD, BSPS, RPh | Posted August 06, 2019

Practicing as a pharmacist, I saw many people clearly abusing benzodiazepines and frequently in denial of the fact that they may have a problem. Abusers will often blame stress in their life in order to downplay the use of benzodiazepines. It is very important to recognize that there may be a problem because that’s really the only way to start solving it! People need to know that 1) they are not alone; and 2) there are options for help. Once people are aware of the signs and symptoms of abuse, it’s easier to seek out support.

Getting help for yourself, friend, or family member is imperative. You can easily reach out to your health care provider for medical recommendations. Another great resource is drug abuse help lines.

The National Drug Helpline provides 24/7 drug and alcohol help to those struggling with addiction. Please call the national hotline for drug abuse today to receive information regarding treatment and recovery at:

1-844-289-0879

What exactly are benzodiazepines?

Benzodiazepines or “benzos” are a class of medication also known as tranquilizers. Common benzodiazepines you may have heard of are Valium (diazepam) and Xanax (alprazolam). These drugs are some of the most commonly-prescribed medications in the United States. According to the National Institute of Health, the number of adults who filled a benzodiazepine prescription increased by 67% (8.1 million to 13.5 million people) between 1996 and 2013.

Doctors and other clinicians usually prescribe a benzodiazepine for legitimate medical conditions such as:

    •    Anxiety
    •    Insomnia
    •    Muscle relaxation
    •    Alcohol withdrawal
    •    Seizure control
    •    Inducing amnesia during uncomfortable procedures
    •    Pre-operation

Benzodiazepines work on the central nervous system by enhancing the effect of the neurotransmitter GABA. GABA provides tranquilizing signals throughout trillions of cells in our body. When benzodiazepines are taken, they chemically add to the calming effect that already occurs naturally, allowing you to feel calm, sedated, relaxed, and less anxious.

Common Benzodiazepines

Generic Name (Brand Name) How quickly the drug starts working in the body Time it takes to eliminate from the body Common Uses
Alprazolam (Xanax) Intermediate Intermediate Anxiety, panic
Chlordiazepoxide (Librium) Intermediate Long Anxiety, alcohol withdrawal
Clonazepam (Klonopin) Intermediate Long Anxiety, insomnia, seizures, panic
Diazepam (Valium) Fast Long Anxiety, seizures, alcohol withdrawal
Flurazepam (Dalmane) Fast Long Insomnia
Lorazepam (Ativan) Intermediate Intermediate Anxiety, insomnia, seizures
Oxazepam (Serax) Slow Short Anxiety, alcohol withdrawal
Temazepam (Restoril) Intermediate Intermediate Insomnia
Triazolam (Halcion) Fast Short Insomnia
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Symptoms of Benzodiazepine Abuse

When people start using benzodiazepines for their sedative effects, it can quickly turn into abuse and lead to addiction of these medications. The chances of abuse are potentially much greater if the user does not have a valid prescription. However, abuse still develops in those patients with a valid prescription if they start taking higher doses than what they were prescribed.

When taking benzodiazepines at prescribed doses, they are usually well tolerated and help alleviate anxiety and insomnia. Problems occur when people start taking high doses of benzodiazepines. The following are signs and symptoms of benzodiazepine overdose or toxicity:

    •    Dizziness
    •    Drowsiness
    •    Confusion
    •    Slurred speech
    •    Blurred vision
    •    Weakness
    •    Lack of coordination
    •    Coma
    •    Difficulty breathing

Chronic abuse of benzodiazepines can lead to symptoms that caused people to use benzodiazepines in the first place, such as:

    •    Headaches
    •    Anxiety
    •    Insomnia
    •    Weakness
    •    Anorexia

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How to Treat Chronic Abuse of Benzodiazepines

Treating chronic abuse of benzodiazepines can be done at home with the monitored help of your health care provider or in drug rehabilitation centers. The initial phase of treatment is a slow reduction of the benzodiazepine dosage to ensure withdrawal and potential seizures do not occur. This is a withdrawal method that most health care providers recommend for weaning people off benzodiazepines. Sometimes, providers may switch people to a longer-acting benzodiazepine, like diazepam or clonazepam, instead of fast-acting ones, like lorazepam, to help make this process easier.

Patients usually begin cutting back about 10% of their dosage per week. This allows the detox to be completed in about 10 weeks. For some people, attempting to gradually wean off their medication may not be successful because withdrawal symptoms are very strong. Symptoms may include severe anxiety, increased insomnia and even panic attacks. Your provider may then recommend a medical detox at a rehabilitation facility to ensure a successful detox can be completed under direct supervision of a health care provider.

With that said, the withdrawal phase is still much easier than the next recovery phase in which people attempt to remain drug-free. Medical care is a great help, but people need social support, including help finding employment. Family and friends play a crucial role in emotionally being there for people during this difficult time.

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How will I feel during a benzodiazepine detox?

Learning what to expect before going into the detox might scare you, but this information will help you know exactly what is going on with your body and the symptoms that are normal during this process.

The start and duration of symptoms vary based on the type of benzodiazepine because of differences in how quickly the drug is eliminated from the body. The severity of the addiction is also a major factor.

Some people experience few to no symptoms of withdrawal. Others will face severe withdrawal effects, requiring placement in a rehabilitation center.

Benzodiazepine Withdrawal Symptoms

Common Anxiety related symptoms:

     •    Anxiety, sleep disturbance, panic attacks
     •    Hyperventilation, tremor, muscle spasms, anorexia, weight loss
     •    Sweating, visual disturbances
     •    change in mood

Perceptual Changes:

     •    Loud noise hypersensitivity
     •    Abnormal body sensations
     •    Feeling disconnected within yourself

Major events:

     •    Generalized seizures
     •    Delirium or other psychotic symptoms

How long does benzodiazepine withdrawal last?

The duration of a benzodiazepine withdrawal depends on how quickly the drug is eliminated from your body.

For example, Xanax is a short-acting drug so it has a short acute withdrawal phase that may last around 7 days.

Valium, a long acting benzodiazepine, can have acute withdrawal symptoms that may last around 90 days.

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Cognitive Behavioral Therapy as an Alternative to Benzodiazepines

Discuss these alternatives with your doctor or other clinician before discontinuing any medication.

According to Harvard University, yoga, breath training, muscle relaxation training, exercise and hypnosis can be used to relieve both insomnia and anxiety. Psychotherapy is helpful for treating insomnia and anxiety long term. For many people, the best alternative to benzodiazepines is cognitive behavioral therapy (CBT).

Treating insomnia with CBT involves recording sleeping habits and optimizing ways to think about sleep. Patients are advised to lie in bed only when actually sleepy, and to avoid eating, watching TV, or working on a laptop while in bed. Patients are also taught to wake up at the same time daily no matter how much sleep they got. Breathing exercises, relaxation techniques, learning how to visualize calming scenery, and playing neutral sounds are methods taught to help fall asleep.

Treating anxiety with CBT involves having patients write and analyze their own thoughts and feelings, with careful attention to ones that aggravate or relieve anxiety. Therapy will help patients become aware of impractical thinking. Patients will learn new ways to respond to situations that cause anxiety and how to apply the techniques of exposure during daily life. Many studies have shown CBT to be as effective as benzodiazepines to address sleeping problems, with a longer lasting impact on patients’ lives.

I encourage you to discuss with your provider how cognitive behavioral therapy may be more effective than prescription drugs.

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Updated November 18, 2019

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