Benzodiazepine dependence

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 24, 2016
StartDiseasesBenzodiazepine dependence

Benzodiazepines are a form of psychoactive drugs that are regularly prescribed for their sedative and muscle relaxant properties. Though they are very effective at treating muscle spasms, seizures, insomnia, and anxiety, they can be dangerously addictive after longer term usage. Some people who use benzodiazepines become addicted to them and suffer from withdrawal symptoms if they stop using these medications. Benzodiazepine dependence is a mental disorder classified in the Diagnostic and Statistical Manual of Mental Disorders.

Contents

Definition & Facts

Benzodiazepine addiction has become a very prevalent problem in the past 14 years. It is particularly common among seniors because their brains are more sensitive to the effects of these types of medications. Many physicians are beginning to no longer prescribe benzodiazepines due to their addictive qualities.

People who are addicted to these prescription medications have both a psychological dependence and physical dependence on the drug. Not only do they crave the drug's effects, but they may feel like they need to keep using the drug just to not feel sick.

When benzodiazepine use is curtailed, most people with benzodiazepine dependence suffer from painful and potentially dangerous withdrawal symptoms. Many people who are dependent on benzodiazepine do not take it to get high, but instead, they are continuing to take the drug because they want to avoid withdrawal symptoms. 

Symptoms & Complaints

The main symptom of a benzodiazepine addiction is taking higher or more frequent dosages than prescribed by a doctor because people with a dependence on the drug gradually become tolerant to it and desire higher levels. This can lead to many physical issues.

People who are abusing benzodiazepine may often act drowsy, sleepy, or confused. They may start to have blurred vision, difficulty coordinating movements, or slurred speech patterns.

Taking extremely high levels of a benzodiazepine can lead to difficulty breathing or even a coma. In addition to signs of a benzodiazepine overdose, people with a dependence on the drug often exhibit other mental and physical problems even if they are only taking lower doses of the drug.

Patients report that they feel like they cannot function normally without benzodiazepine, and they feel unable to stop using it. If a patient with a benzodiazepine dependence does stop taking the drug, they will have withdrawal symptoms, including insomnia, tremors, aches, twitching muscles, headaches, anxiety, and depression. The depression associated with benzodiazepine withdrawal is so strong that it can result in self-harm or suicide.

Causes

The basic cause of a benzodiazepine dependence is long-term use of a benzodiazepine drug, such as alprazolam (Xanax®) or chlordiazepoxide (Librium®). Typically, people start to develop a dependence after using the drug repeatedly for three to four weeks. More potent benzodiazepines cause people to become dependent faster. A dependence normally happens as the patient realizes that they will face withdrawal symptoms if they stop using the benzodiazepine.

Dependence can also be caused by a patient becoming tolerant to the benzodiazepine. For example, a person might be prescribed a benzodiazepine to help them sleep, but after a few weeks the low dosage is no longer effective. Then the patient may begin taking a higher dose, causing them to develop a dependence even faster.

There are certain risk factors that are associated with causing a benzodiazepine addiction. People who are older are more susceptible to developing an addiction due to chemical changes in their brain.

There may also be a slight genetic tendency towards benzodiazepine dependence since genetics can alter how the brain reacts to benzodiazepine usage. It has also been noted that people who are unemployed, poor, or otherwise at risk for drug abuse are more likely to become addicted to a benzodiazepine.

Diagnosis & Tests

An accurate medical history and a physical examination are often enough to diagnose a benzodiazepine dependence. Patients are often diagnosed with a dependence once they go into a withdrawal state. If a patient comes to a healthcare provider with complaints of tremors, headaches, and other withdrawal symptoms three to four days after stopping benzodiazepine use, it is quite simple for a doctor to tell that they have a dependence issue. However, this can become difficult because chronic drug users have a tendency to lie about their abuse.

A doctor may begin to suspect that a patient is abusing a benzodiazepine if they are constantly needing to refill their prescription. Even if a patient is no longer getting the benzodiazepine through a medical prescription, a doctor will start to consider diagnosing the patient with a dependence if the patient was previously prescribed a benzodiazepine and is now exhibiting classic symptoms of drug abuse. Clinical urine tests can reveal the presence of benzodiazepine, making it a useful way of seeing whether or not a patient is being candid about their drug usage.

Treatment & Therapy

Treatment will first focus on helping a patient to stop using a benzodiazepine without experiencing severe withdrawal symptoms. Slow-acting, low-dose benzodiazepines, such as diazepam (Valium®), may be prescribed to gradually reduce benzodiazepine usage without triggering withdrawal. However, all withdrawal symptoms are not avoidable, and long term usage can cause suicidal ideation that lasts up to a year after benzodiazepine use has ceased.

Patients with a severe addiction may require treatment at an in-patient rehabilitation center where their behavior can be monitored safely. Once the physical issues are treated, it is important for the patient to receive psychiatric treatment for the mental problems associated with addiction. Cognitive behavioral therapy, a form of psychotherapy, gives patients the tools needed to overcome cravings, and it is associated with high success rates for rehabilitation. 

Prevention & Prophylaxis

The only way to truly prevent benzodiazepine dependence is to never take the drug, but this is not always avoidable because it does have some applicable medical functions. However, risks of dependence can be greatly reduced by ensuring that patients only use benzodiazepines for a few weeks.

Medical studies have found that educating patients about benzodiazepine dependence and emphasizing how important it is to avoid long term use greatly reduce dependence rates. Doctors can also reduce addiction risks by only prescribing small doses of slow-acting benzodiazepines.